Skewed Method Mix: A Measure of Quality in Family Planning Programs

Author(s): Bertrand J T, Rice J, Sullivan T M, Shelton J

Year: 2000

Abstract:
While contraceptive prevalence has been a central to family planning research over the past few decades, there has been surprisingly little consideration of method mix, an important aspect of quality of care. There is no "ideal" method mix recognized by the international community; however, there is reason for concern when one or two methods predominate in a given country resulting in "method skew." In this article method skew is measured using a modified index of dissimilarity. Of the 25 countries with the highest method skew three groups emerge: (1) a first group comprised of half of the high skew countries, all of which (except Turkey) are Sub-Saharan nations where traditional methods predominate; (2) a second group consists of four countries in which female sterilization predominates (China, India, Dominican Republic, and El Salvador); and (3) a third group is made up of nations that rely on a single reversible method (the pill in Algeria, Kuwait, Morocco, and Zimbabwe and the IUD in Cuba, Egypt, Jordan, and Vietnam). Possible explanations for these patterns of method skew are explored through a review of the literature. Of the five variables tested using linear regression (access, physicians per inhabitant, religion, GNP, and region) two correlates of method skew emerge: access and region. Method skew is lower in high access areas and in Latin America as compared to Asia or Africa. This article demonstrates the utility of the index of dissimilarity as a macro-level measure that may be used to monitor method skew in family planning programs worldwide.