Number of people of reproductive age currently using a modern family planning method

Background

Contraceptive use is a measure of coverage of family planning and reproductive health programs used to determine the extent of access and demand for contraceptive products and services. This indicator measures the total number of men and women of reproductive age (15–49) who are using a modern contraceptive method. Community workers are an essential component of the family planning workforce responsible for the delivery of family planning services. Certain community workers work directly with specific health facilities to care for reproductive, maternal, newborn, and child health in the community and bring clients to care. Others are involved in outreach activities on health and primarily focus on information, education, and communication. Community workers and community-based distributors of contraceptives primarily create awareness of contraceptive methods; distribute Cyclebeads, condoms, and oral contraceptive pills; and refer individuals to health facilities for clinical methods and counseling. This indicator can be used by community workers to track whether individuals in their communities have adopted a modern method based on contraceptive demand and unmet need.

This information is of particular importance for those living with HIV, because condom use is an essential practice to prevent transmission between serodiscordant couples if antiretrovirals or pre-exposure prophylaxis are not being used. Condom use is also essential practice for HIV concordant couples, especially if either partner has engaged in sexual risk taking or has been subjected to forced sex. Condoms are the only form of modern contraception that simultaneously reduce the risk of HIV and other sexually transmitted infections and prevent unintended pregnancy. Modern contraceptive methods allow couples to decide the number and size of their families and prevent pregnancies that are mistimed or unwanted and protect themselves from sexually transmitted infections and HIV. Contraceptive use is particularly important for women living with HIV, because family planning reduces the risk of unintended pregnancy and, as a result, the number of babies who are living with HIV, especially in areas with low access to antiretrovirals.

Numerator

Number of women and men of reproductive age (15–49) who were using a modern contraceptive method during the past visit with a community worker within the reporting period

Unit of measure

Number

Calculation

Sum results across reporting period

Method of measurement

This indicator should not be confused with modern contraceptive prevalence, because additional information on the population at risk for pregnancy would be required. This information should be used by HIV programs to determine pregnancy intentions and support modern contraceptive use based on need among beneficiaries of reproductive age. Community workers should not track this information by counting the number of individuals in their communities that they distributed a contraceptive method to during the reporting period. To determine current use, community workers must ask each beneficiary directly if they are currently using a modern contraceptive method, and the list the methods they could be using. If the beneficiary indicates that he or she is using any of the modern methods below, and the last time this question was asked was during the reporting period, the beneficiary can be counted towards this indicator. If the beneficiary is using more than one modern method at the time of the visit, this information should be recorded. The community worker should define current use as the last time that they visited the beneficiary and they responded affirmatively to the question posed.

The following are modern methods:

• Oral contraceptive pill
• Intrauterine device (IUD)
• Injectables
• Implant
• Condoms (male or female)
• Diaphragm
• Foam/jelly
• Sterilization (male or female)
• Patch
• Vaginal ring
• Sponge
• Lactational amenorrhea method (LAM)
• Standard Days Method (SDM)

Community programs can provide counseling and support to ensure that family planning needs are met, and that beneficiaries are provided with alternatives if their current method does not suffice. Under no circumstances should any person be forced to use any method against the person’s will or without his or her consent. The concept of informed choice is extremely important, and training for community workers should ensure patient rights are protected. (Learn more about informed choice here.)

Data source

HIV programs obtain this information through community family folders detailing the health status of mothers and their children. Most community programs ask that their community workers report whether family planning counseling services or referral were provided during any interaction. They also ask that beneficiaries report barriers to family planning use.

Disaggregation

• Age
• Key population type (sex workers, men who have sex with men, people who inject drugs, transgender people)
• Type of method (specific type from the above list, modern, traditional, any)
• Sex

Data quality considerations

Although this indicator can provide detail on method mix, or the number of current users or acceptors by method, community workers should not be asked to calculate or aggregate this information. Community programs could calculate and analyze this information if data collection forms included fields allowing community workers to report which modern method is currently being used. Method mix provides insight into access to contraceptive methods, because limited variability can suggest a lack of access to certain methods (see MEASURE Evaluation’s definition for this indicator here for more detail). It is important for community workers to not double count beneficiaries for this indicator. This indicator does not track discontinuation rates or any difficulties with current method use.

The overall number reported for this indicator should equal the sum of the numbers of people in each disaggregation type. Only one type of age disaggregation should be used throughout, and overlap should be avoided.

Reporting frequency

Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a quarterly basis.

Data element

Modern contraceptive use

Category

HIV Prevention, Key Populations, Vulnerable Children

References

Contraceptive prevalence rate (CPR). (2017). Retrieved from https://www.measureevaluation.org/prh/rh_indicators/family-planning/fp/cpr

Workforce. (n.d.). Retrieved from http://www.familyplanning-drc.net/workforce.php

Guidance on oral pre-exposure prophylaxis (PrEP) for serodiscordant couples, men and transgender women who have sex with men at high risk of HIV. (2015). Retrieved from http://www.who.int/hiv/pub/guidance_prep/en/

HIV prevention based on ARV drugs. (2013). Retrieved from http://www.who.int/hiv/pub/guidelines/arv2013/clinical/prevention/en/

Family planning/Contraception. (n.d.). Retrieved from http://www.who.int/mediacentre/factsheets/fs351/en/