Contraceptive Method Mix: Updates and Implications

Abstract

Context: Improving contraceptive method choice is a goal of international family planning. Method mix-the percentage distribution of total contraceptive use across various methods-reflects both supply (availability of affordable methods) and demand (client preferences). We analyze changes in method mix, regional contrasts, and the relationship of the mix to contraceptive prevalence.

Methods: We use 789 national surveys from the 1960s through 2019, from 113 developing countries with at least 1 million people and with data on use of 8 contraceptive methods. Two measures assess the "evenness" of the mix: method skew (more than 50% use is by 1 method), and the average deviation (AD) of the 8 methods' shares from their mean value. Population weighted and unweighted results are compared because they can differ substantially.

Results: Use of traditional methods has declined but still represents 11% of all use (population weighted) or 17% (unweighted country average). Vasectomy's share was historically low with the exception of a few countries but is now even lower. The previous trend toward greater overall evenness in the mix has slowed recently. Sub-Saharan Africa shows a hormonal method progression from oral contraceptives to injectables to implants in a substantial number of countries. In some countries with high HIV prevalence, the condom share has increased. The leading method's share differs by region: female sterilization in Asia (39%) and in Latin America (31%), the pill in the Middle East/North Africa (32%), and the injectable in sub-Saharan Africa (36%). Method skew persists in 30% of countries. "Evenness" of mix is not related to contraceptive prevalence.

Conclusion: The marked diversity in predominant methods underscores the conclusion that no single method mix is ideal or appropriate everywhere. But that diversity across countries, coupled with the persisting high degree of extreme skewness in many of them, argues for continued concerted efforts for programs to increase method choice.

FIGURE 1.

Changes in the Method Mix Between Earliest and Latest Surveys, by Method and Region, Change per Year, Weighted by Population Abbreviation: IUD, intrauterine device.

FIGURE 2.

Rwanda: Changes in Method Mix Between 1983 and 2014^a Abbreviation: IUD, intrauterine device.^a In the middle of Figure 2, the share due to traditional methods increased and the shares for modern methods fell. The timing corresponds to the Rwanda genocide in mid-1994; overall contraceptive use fell from about 20% to about 13% between the surveys of 1992 and 1996 but proportionately less for traditional methods than for resupply methods dependent upon logistics systems.

FIGURE 3.

Ghana: Changes in Method Mix Between 1979 and 2017 Abbreviation: IUD, intrauterine device.

FIGURE 4.

Contraceptive Method Mix in Each Region and All Countries, Population Weighted Abbreviation: IUD, intrauterine device.

FIGURE 5.

Relationship Between the Measure of Average Deviation and Contraceptive Prevalence Rate, 113 Latest Surveys