Unmet need, a central concept in family planning research and a key indicator for programmatic interventions, is a composite measure based on apparent contradictions between women’s reproductive intentions and non-use of family planning. Demographic and Health Surveys, the largest source of data on contraceptive patterns in developing countries, compute unmet need based on responses to 18 questions asked at different points during the women’s interview. This study reports the results of a mixed-methods follow-up study nested within the 2014 Ghana Demographic and Health Survey (GDHS). Women in 13 clusters who were identified as having unmet need, along with a reference group of women who reported using family planning, were approached to be reinterviewed (RR=92.3%) within an average of three weeks from their GDHS interview. Among fecund women identified by the 2014 GDHS as having unmet need, follow-up interviews revealed substantial underreporting of method use, particularly traditional methods. Complete postpartum abstinence was sometimes the intended method of family planning but was overlooked during questions about method use. Other respondents classified as having unmet need had ambivalent fertility intentions. In several cases, respondents expressed revised fertility intentions upon follow-up that would have made them ineligible for inclusion in the unmet need category. The reference group of family planning users also expressed unstable fertility intentions. Interviews with women who had consistent fertility intentions and perceived themselves at risk of an unintended pregnancy but who were not using family planning revealed multiple reasons for aversion to modern method use, particularly the risk of side effects, personal or partner opposition to family planning, and religious views. The most common side effect women were concerned about was menstrual irregularities. Partners have an important influence on fertility intentions and family planning use. In some cases women’s desire to avoid pregnancy is weaker than their desire to please their husbands. While unmet need is typically used as a proxy for latent demand for family planning, among those studied, potential demand for family planning appears to account for a relatively small proportion of unmet need. The study reveals some data quality concerns, largely in the area of traditional method measurement. In addition to these substantive findings, study results produce lessons learned for nested qualitative studies and for population-based surveys that measure family planning.