Core Indicators 9, 10, and 11
Core Indicator 9, modern contraceptive method mix, shows the percentage distribution of contraceptive users by type of method used. Method mix varies greatly across countries, reflecting the different contexts in which women live. A more diverse method mix helps meet the varied family planning needs of women, girls, and couples. Countries offering more types of modern methods in their programs also have higher percentages of contraceptive use (mCPR).23 88% of the FP2020 focus countries have six or more types of modern methods in use by women of reproductive age in the country.
In February 2015, the FP2020 Reference Group formally adopted two new indicators that will help gauge whether investments in family planning are translating into increased commodity availability and choice of methods at the facility level. Core Indicator 10 measures stock-outs of contraceptive supplies and Core Indicator 11 measures the number of modern methods available by type of facility.
The most useful way to understand contraceptive stock availability is by method. For 2014, this data was available for 14 of the 29 FP2020 focus countries where surveys were conducted on contraceptive security.24 Overall, for the 14 countries, stock-outs of female condoms and emergency contraception are most common. On average, 40% of facilities in the 14 countries were stocked out of female condoms and 31% of facilities were stocked out of emergency pills. For male condoms, pills, and injectables, stock-outs were on average lower, with 10 of the 14 countries reporting less than 20% of facilities stocked out.
When using the more restrictive definition of being stocked out of any modern method, stock-outs appear to be pervasive across the 28 surveyed countries. On average over 60% of facilities were stocked out of at least one modern method on the day of survey in the 28 countries where this data was available.
As we look back at this year’s accomplishments, FP2020 is also looking to the future, guided by the resolve to empower women and girls to make healthy reproductive choices and link our progress to achieving the Sustainable Development Goals. Our country partners in government and civil society are the soul of these efforts and the drivers of the change essential for success. We will go forward together—with the countries that have pledged to FP2020, created country implementation plans, or are actively and ambitiously preparing for increased engagement.
Dr. Ariel Pablos-Méndez
Assistant Administrator for Global Health Child and Maternal Survival Coordinator, US Agency for International Development
Core Indicator 12
Core Indicator 12 is government domestic expenditures on family planning. Over the past three years, the global community has laid the foundation for producing estimates in the future. However, at the current time, very limited data is available for public reporting. Estimates for 2013 were available for just three countries: Burkina Faso, DR Congo, and India.
Core Indicator 13
Core Indicator 13, Couple-years of Protection (CYPs), is the estimated number of years of protection provided by family planning services during a one-year period. It is our only Core Indicator to come directly from routine data systems. Countries collect information on the number of services and products provided to clients because this information is vital for monitoring performance, forecasting stocks to ensure adequate supplies are available, and tracking progress over time.
Since countries need to have robust data systems to report on this indicator, it can also serve as a proxy for the importance of investing in data systems and using routine data in countries. In the previous FP2020 Progress Report, we presented CYP estimates for the five countries that provided us with estimates; this year, the total increased to 14 countries.
Core Indicator 14
Core Indicator 14, the Method Information Index, speaks directly to key dimensions of rights and empowerment: informed consent, method choice, and the quality of consultation offered by family planning providers. It uses existing survey questions to construct a proxy estimate that measures what type of information is being made available when women obtain a method of contraception. A low score may indicate a lack of provision of basic information on a routine basis, and argues for the need for further investigation into the quality of services and choice of methods offered. This year, we report Method Information Index estimates for the 24 FP2020 focus countries with sufficient data collected at or since the time of the London Summit.
Core Indicator 15
Core Indicator 15 shows what proportion of women received family planning information in the last year, either during a visit with a community health worker, or at a health facility. This question is asked of all women of reproductive age, regardless of whether they are currently users of contraception. Of the 23 countries with sufficient data for this analysis, on average around one-quarter of women reported receiving family planning information during the last year. The values range from 6.6% in Guinea to 52.4% in Pakistan.
Core Indicator 16
Core Indicator 16 shows the percentage of women who make family planning decisions alone or jointly with their husband or partner. Across the 25 countries with data available since the London Summit, the average value of this indicator is fairly high at 87.7%, ranging from 71% in Comoros to 98% in Egypt. Despite the high scores, in 14 of the 25 countries, more than 10% of women using contraception report that they were not involved in making these decisions.
Core Indicator 17
Core Indicator 17, the adolescent birth rate, is expressed as the number of births to adolescent girls (age 15 to 19) per 1,000 adolescent girls. Among the 25 countries with sufficient recent data to produce estimates, the adolescent birth rate ranged from 44 per 1,000 in Pakistan and Kyrgyzstan, to 206 per 1,000 in Niger. In general, the highest rates are seen in francophone Africa, a reflection of the proliferation of child marriage and low levels of contraceptive use among all women in that region. High adolescent birth rates may also be attributed to policies that limit young people’s access to contraceptives as well as social stigma and provider bias.
23. Ross J, Stover J. Use of modern contraception increases when more methods become available: analysis of evidence from 1982–2009. Glob Health Sci Pract. 2013;1(2):203-212. http://dx.doi. org/10.9745/GHSP-D-13-00010.
24. PMA2020 R1 surveys were used for Ethiopia (since the UNFPA survey measured only combined method availability) and Malawi (since the Service Provision Assessment Survey was based on the data consensus workshop). Four countries had no UNFPA surveys, and for these countries alternative sources were used: PMA2020 survey data were used for Ghana, Kenya, and Burkina Faso, and logistics report data were used for Côte d’Ivoire.
