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      Use of modern contraception increases when more methods become available: analysis of evidence from 1982–2009

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      Global Health, Science and Practice

      Global Health: Science and Practice

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          Abstract

          International data over 27 years show that as each additional contraceptive method became available to most of the population, overall modern contraceptive use rose. But in 2009 only 3.5 methods, on average, were available to at least half the population in surveyed countries. Family planning programs should strive to provide widespread access to a range of methods.

          Abstract

          International data over 27 years show that as each additional contraceptive method became available to most of the population, overall modern contraceptive use rose. But in 2009 only 3.5 methods, on average, were available to at least half the population in surveyed countries. Family planning programs should strive to provide widespread access to a range of methods.

          ABSTRACT

          Objective:

          To examine how much contraceptive use increases as additional methods are made available to populations.

          Methods:

          We used data estimating contraceptive use from representative national surveys and data estimating method availability from special surveys to make comparisons for 6 modern contraceptive methods, in each of 6 years: 1982, 1989, 1994, 1999, 2004, and 2009. To estimate method availability, we used various method accessibility rules governing different proportions of the total population (ranging from 20% to 80%) that must have access to a method in order for it to qualify as “available.”

          Results:

          Contraceptive use is greater when more methods are available to a large portion of the population, both cross-sectionally and over time. The addition of 1 method available to at least half the population correlates with an increase of 4–8 percentage points in total use of the 6 modern methods, for example, from 40% to 44% or 48%. A consistent pattern emerges for the relationship of contraceptive use and choice among multiple methods.

          Conclusions:

          Use of contraception may be increased by extending the availability of current methods, by improving features of current methods, or by introducing new methods. A wider choice of methods also improves the ability to meet the individual needs of women and couples. Although the method mix has been improving over time, current availability is far from ideal; in 2009, only about 3.5 methods, on average, were available to at least half of the population in the 113 countries included in our analysis.

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          Most cited references 5

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          Contraceptive Method Choice in Developing Countries

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            Fertility differences among developing countries: are they still related to family planning program efforts and social settings?

            In many developing countries, fertility has declined steadily in recent decades, while the average strength of family planning programs has increased and social conditions have improved. However, it is unclear whether the synergistic effect of family planning programs and social settings on fertility, first identified in the 1970s, still holds. Data from 40 developing countries in which Demographic and Health Surveys were conducted in 2003-2010 were used to examine associations among socioeconomic conditions, family planning program effort strength and fertility. Cross-tabulations and multiple regression analyses were conducted. Variation among countries in scores on the Family Planning Program Effort Index, but not on the Human Development Index, has diminished since the 1970s. On average, fertility levels were lower among countries with better social settings or stronger family planning programs than among those with poorer settings or weaker programs; they were lowest in the presence of both good social settings and strong programs. In addition, fertility was positively associated with infant mortality and negatively associated with female education, but not associated with poverty. About half of the 2.3-birth difference in fertility between countries in Sub-Saharan Africa and those elsewhere can be attributed to differences in program efforts and social settings. Policies focused on improving levels of female education, reducing infant mortality and improving family planning services can be expected to have mutually reinforcing effects on fertility decline.
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              Trends in national family planning programs, 1999, 2004 and 2009.

              National family planning programs in the developing world vary greatly in strength and coverage, and in the nature of their outreach. Periodic measures of their types and levels of effort have been conducted since 1972. In 2009, expert observers in 81 developing countries completed a questionnaire that assessed 31 features of family planning program effort, as well as other program measures. Data were compared with those from similar surveys fielded in 1999 and 2004 to examine trends over the decade. On average, national family planning programs improved their effort levels slightly from 1999 to 2004, and again from 2004 to 2009. The average effort in 2009, however, was only about half of maximum; component scores for service measures and for measures of access to contraception did not reach 50% of maximum in 2009. Differences by region and by effort quartile emerged in subgroup analyses. Overall, improvement of women's health and avoidance of unwanted births were the most important program justifications, ranking higher than fertility reduction, economic development or reduction of childbearing among unmarried adolescents. The subgroups given the most emphasis were poor and rural populations, while unmarried youth and postabortion women received the least. Among external influences, changes in donor and domestic funding were seen as more unfavorable than the merging of family planning programs into broader health services. Average program effort levels have been sustained, although deficiencies remain. Countries have not yet ensured universal access to a variety of contraceptive choices, through various channels, for both short- and long-term methods.
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                Author and article information

                Journal
                Glob Health Sci Pract
                Glob Health Sci Pract
                ghsp
                ghsp
                Global Health, Science and Practice
                Global Health: Science and Practice
                2169-575X
                August 2013
                26 July 2013
                : 1
                : 2
                : 203-212
                Affiliations
                [a ]Futures Group International , Washington, DC, USA
                [b ]Futures Institute , Glastonbury, CT, USA
                Author notes
                Correspondence to John Ross ( jross@ 123456futuresgroup.com ).
                Article
                GHSP-D-13-00010
                10.9745/GHSP-D-13-00010
                4168565
                © Ross et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of this license, visit http://creativecommons.org/licenses/by/3.0/

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