MEASUREMENT

INDICATOR 9 : MODERN CONTRACEPTIVE METHOD MIX

INDICATOR NO.9
Percentage of women using each modern method of contraception

The percentage of total family planning users using each modern method of contraception

Core Indicator 9, modern contraceptive method mix, presents the distribution of modern contraceptive users by the method they use, based on the most recent survey data available.

Contraceptive method mix is a complex indicator, as the choice of a contraceptive method reflects individual preferences, societal and cultural norms, and local and regional issues affecting contraceptive availability and accessibility, including policies, cost, infrastructure, and provider training. This indicator provides insight into and context for Core Indicator 2, MCPR, detailing the composition of contraceptive use in each of the 69 FP2020 countries. Contraceptive method mix highlights which methods are driving contraceptive use as well as which methods are potentially underutilized, indicating where there may be issues of acceptability or accessibility of particular methods, or opportunities to expand access to a wider range of methods.

While there is no “right” method mix or “ideal” method, there is broad consensus that providing access to a wide variety of methods is essential to providing quality of care and ensuring full choice in family planning from a rights-based framework 9. A diverse mix of methods on offer provides women with greater choice as well as access to longer acting and more effective methods of contraception, reducing the risk of unintended pregnancy and subsequent negative outcomes. Availability of a range of options makes it more likely that women can choose a contraceptive method that best suits their needs and preferences, increasing consistent use and reducing discontinuation.1011

Modern contraceptive method mix varies greatly across the 69 FP2020 focus countries. Figure 13 shows the most commonly used modern method in each country (defined as the single method that makes up the largest proportion of the method mix). Injectables are the most common method in use in 28 countries, followed by pills in 16 countries, condoms in 9 countries, and IUDs in 8 countries. Female sterilization is the most common method in use is 6 countries (Honduras, India, Nepal, Nicaragua, Solomon Islands, and Sri Lanka) ranging from 32% of modern contraceptive use in Sri Lanka up to 75% in India. This kind of method skew (where one method dominates, making up 60% or more of the method) seen in India with female sterilization and in Ethiopia, where 63% of modern contraceptive users rely on injectables, can be indicative of individual preferences and socio-cultural norms promoting or discouraging particular methods. Skew toward a particular method may also be strongly driven by the healthcare system, contraceptive availability, and how and where women access contraceptives. Limited health infrastructure or a shortage of healthcare providers may prompt women to obtain methods from shops and pharmacies, where they are generally limited to pills and condoms, while public sector implementation of task-sharing may dramatically expand access and use of methods like implants and injectables.

More important than the most common method in use is an examination of the number of methods available and in use in each country. Analysis in developing countries has shown that when more contraceptive methods are offered, a larger proportion of women choose to use a modern method 12 and contraceptive discontinuation rates are lower, both contributing to national growth in MCPR.13 Based on method mix data for the 69 FP2020 countries, 39% (or 27 countries) have 5 or more modern methods in use, measured as at least 5% of users using each method.i Among these, three countries have 6 methods in use: Bhutan, Cambodia, and Kenya. In these countries, female sterilization, IUDs, injections, pills, and condoms (listed in order of effectiveness) all contribute at least 5% of the method mix. In Cambodia and Kenya, implants contribute at least 5% of the method mix. Of note, Bhutan is one of only two countries (the other being Nepal) where male sterilization comprises more than 5% of the method mix, making up nearly 20% of use in Bhutan and 10% in Nepal. Pills and injectables are among the methods in use among all countries with 5 or more methods in use, while male condoms are in use in all but one country (Timor-Leste). Female sterilization is in use in nearly all those with 5 or more methods in use (except Benin, Ghana, and Senegal). Among those countries with 5 or more methods in use, implants make up at least 5% of modern use in all the African countries while IUDs make up at least 5% of modern use in all Asian and LAC countries, with some overlap. At the other end, two countries are categorized as having only one method in use: Uzebekistan and DPR Korea, where more than 80% of modern users are using IUDs.Four countries—Niger, CAR, Sudan, and Djibouti— are categorized as just having two methods in use, with the majority of modern users relying on short-term methods (pills, injectables, or condoms) for contraception.

While data on method mix alone cannot be used to assess availability of methods, it can be used in conjunction with other indicators, such as Indicator 11 (measuring the proportion of facilities offering at least 3 or 5 modern methods) and Indicator 10 (measuring method-specific stock-out levels), to help understand method use and potential barriers limiting women from accessing a full range of modern methods.

Shifts in method mix and method prevalence over time can provide evidence of changing norms and preferences, improvements or declines in the healthcare system, shifts in policy, and changes in access to various contraceptive methods. Analysis of changes in method prevalence and method mix since the inception of FP2020 j suggests that previously observed growth trends in the prevalence of implants and injectables have continued. The prevalence of injectables and implants each grew in 17 of 25 countries with sufficient data for analysis. The fastest growth in implants was seen in Malawi, where implant prevalence grew 7.9 percentage points among all women between 2010 and 2015, contributing to a large increase in MCPR. While increases in injectables generally continued to support their dominance in the method mix—or method skew in some countries—the growth in implants is increasing the diversity of the method mix in many countries.

COUNTRY DATA USE

India is using data on their contraceptive method mix and changing demographics to identify strategies for expanding method choice through the public sector. For several decades, women in India have primarily relied on female sterilization after having their desired number of children. The Government of India is in the process of introducing a range of new methods through the public sector to increase the contraceptive options available to women and couples. Recent data from the NFHS-4 survey reveal an increase in the age at marriage and may indicate changing social norms around marriage and early childbearing. The rapidly changing social norms suggest an opportunity for the government’s expansion of method choice to reach the next generation of women in India.

  • i.

    5% of users was used as a cutoff, rather than any users (>0%), so as to indicate wider uptake of a method. Lactational Amenorrhea Method (LAM) is excluded from this analysis to focus on methods that require a service or commodity. The following methods were included: female sterilization, male sterilization, IUDs, implants, injectables, pills, male condoms, female condoms, diaphragm, foam or jelly, standard days method, and emergency contraception.

  • j.

    Countries with sufficient data for analysis included: Bangladesh, Burundi, Cambodia, Cameroon, Chad, Egypt, Ethiopia, Ghana, Guinea-Bissau, India, Kenya, Kyrgyzstan, Lesotho, Malawi, Mauritania, Rwanda, Sao Tome & Principe, Senegal, South Africa, State of Palestine, Sudan, Tanzania, Timor-Leste, Uganda, and Zimbabwe.

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