INDICATORS 1-2 : ADDITIONAL USERS AND MCPR
ADDITIONAL USERS AND MCPR
Core Indicator 1, the number of additional users of modern methods of contraception, is the most direct measure of progress toward achieving the goal of adding 120 million additional users by the year 2020. Additional users are calculated by comparing the total number of users of modern contraception across the 69 FP2020 focus countries in any given year with the number of users there were in 2012, at the outset of FP2020. The total number of users of modern contraception is calculated using Core Indicator 2, the prevalence of use of modern methods of contraception among all women, and the total women of reproductive age in each country, estimates of which are available from the United Nations Population Division.
At the 2017 Family Planning Summit, policymakers, countries, donors, civil society, and private sector partners renewed their commitment to reaching more women and girls, and data show that there are many signs of progress even in the face of challenges and uncertainty. As of July 2017, the total number of women and girls using a modern method of contraception in the world’s 69 poorest countries had grown to more than 309 million, 38.8 million more than were using contraception in 2012 (see figure on next page).
The population of women of reproductive age in the 69 FP2020 countries is growing by 15 million each year, and today there are an estimated 909 million women age 15–49 in FP2020 countries. This is 74 million more than there were in 2012. The growth in additional users of modern methods of contraception to 38.8 million is approximately 30% greater than the historic trend, and is a sign that health systems are stepping up to the task of meeting the contraceptive needs of an ever-growing number of women and girls.
Closer examination of Core Indicator 1 shows that more than half of the 38.8 million additional users of contraception are in Asia (21.9 million). Asia includes four of the five most populous FP2020 countries: India, Indonesia, Pakistan, and Bangladesh. Because of their size, progress in Asian countries has a large influence on progress toward the FP2020 goal of 120 million additional users. Yet despite the large increase in the number of women using contraception in Asia (today there are 246 million users of modern contraception in the FP2020 countries of Asia), the modern contraceptive prevalence rate (MCPR) across regions of Asia is growing between 0.2 to 0.4 percentage points per year (see Figure 10). In 2017, 38% of all women of reproductive age in Asia were using a modern method.
In contrast, the pace of MCPR growth in Africa over the last several years has been much faster. As of July 2017, there were 16 million additional women using a modern method of contraception in the FP2020 countries of Africa as compared to 2012. Since 2012, MCPR among all women has grown from 19.5% to 23.4% in the region, with the fastest growth occurring in Eastern and Southern Africa (1.2 percentage point increase per year), followed by Western Africa (0.8 percentage point increase per year).
The S-Curve pattern of MCPR growth, described in depth in last year’s report, remains an important tool that helps countries assess their trends and opportunities for growth both at national and subnational levels (see Figure 8). Countries are increasingly using data to assess and adjust their family planning programs, and there are now 12 countries within reach of achieving the goals for MCPR growth they established as part of their FP2020 commitments.
High prevalence countries, such as several in Asia, are exploring opportunities to expand method choice, increase postpartum family planning, reduce inequity, and ensure sustainability through domestic financing options for their family planning programs. These options include engaging the private sector, ensuring national health insurance coverage of contraceptives, and securing financing for domestic procurement of contraceptives.
Countries with moderate prevalence are attempting to capitalize on the opportunity for rapid MCPR growth and are focusing their FP2020 efforts on service delivery and supply chain improvements. They are also striving to reach underserved and marginalized populations through mobile outreach services and ensure that existing contraceptive services reach adolescents and youth. Across all FP2020 countries, analysis of MCPR by wealth quintile suggest that these efforts are having an impact. Among the 19 countries with two comparable surveys with wealth quintile data since the launch of FP2020, 17 have seen an increase in MCPR among the lowest wealth quintile—and in 14 countries that increase has been faster than the national average.
Low prevalence countries, principally in Western and Central Africa, face different challenges in expanding the availability and use of contraceptives. Efforts in these countries can be most effectively focused on building political support for family planning, promoting supportive social norms around family planning and stimulating demand for services, and establishing the basic infrastructure and providers to deliver quality services.
Many countries struggle to achieve the right balance of investments between expanding family planning services and undertaking social and behavior change (SBC) activities. If countries allocate too few resources to SBC, then investments to improve family planning services may fall short of their potential impact. If there is not enough support for expanded services, then countries may not be able to meet demand.
Track20 has developed the Maximum Contraceptive Prevalence “Demand Curve” and associated analyses to help countries assess this balance. The “demand curve” (purple line) represents the likely maximum MCPR that could be reached given fertility intentions and related norms and constructs that influence contraceptive use. The curve is based on a historic relationship between MCPR and the mean ideal number of children, an indicator that represents a broad range of social and cultural norms that influence the motivation to use, or not use, contraception. The gap between where a country sits on the graph and the curve is called the “potential use gap,” and can be interpreted as follows:
- In countries such as Tanzania and Chad, where the gap is small or modest (indicated by a red or orange dot on the graphic), investments in SBC likely need to be prioritized, and there is limited potential for growth in MCPR from a narrow focus on investments in expanded service delivery.
- Countries where this gap is large, such as Benin and Mozambique (indicated by a green dot on the graphic), are more likely to see substantial increases in MCPR from investments to improve and expand family planning service delivery. Demand in these countries is less likely to be a constraint.
- Finally, this concept is not considered applicable in countries such as Bangladesh where the mean ideal number of children is low (indicated by a grey dot on the graphic).
Regardless of a country’s position in the graphic, additional analysis is likely to be helpful in understanding barriers to uptake. While this graphic shows the national picture in each country, there is often very large subnational variation across states or regions.
Subnational demand curves are available for most FP2020 countries under the “Additional Analysis” tab on each country page of the FP2020 and Track20 websites: familyplanning2020.org/countries and track20.org/pages/countries
