A new research approach provides evidence that can be used to hold governments accountable for the success of public programs in satisfying demand for family planning, according to "The Role of Public-Sector Family Planning Programs in Meeting the Demand for Contraception in Sub-Saharan Africa," by John Bongaarts and Karen Hardee of the Population Council. The article, which examines data from national surveys in 26 countries in Sub-Saharan Africa, proposes a new measure called the public-sector family planning program impact score (PFPI) and demonstrates its use to show why it is a valuable addition to existing indicators designed to understand trends in contraceptive behavior.
While measures currently used by researchers who study these trends center on the demand for contraception and its use within studied populations, the new indicator specifically focuses on the role of public-sector family planning programs. Because it reveals unique information not directly captured by other measures—such as modern contraceptive prevalence, unmet need for modern contraception, demand for contraception and proportion of demand satisfied—PFPI can be used to hold governments accountable for fulfilling their commitments to ensuring universal access to sexual and reproductive health care, and for meeting family planning needs.
To shed light on the relationship between current indicators and the proposed PFPI, the researchers examined trends in those measures between 1990 and 2014 in 26 countries in Sub-Saharan Africa. Overall, they found that on average, 30% of contraceptive demand was met by public programs in these countries (the average PFPI), 14% was met by the private sector and 55% remained unmet. PFPI varied widely by country, ranging from 5% to 69%.
A closer analysis of public-sector family planning programs between 1990 and 2014 in four countries—Nigeria, where family planning efforts remained limited; Ethiopia and Rwanda, where contraceptive use rose sharply; and Kenya, where contraceptive prevalence remained high throughout—offers a practical demonstration of how PFPI can be used to understand a government’s role in meeting its population’s need for family planning. In Ethiopia and Rwanda, in particular, the PFPI suggests that substantial investments in public family planning programs yielded a significant increase in contraceptive use.
The researchers propose PFPI as a valuable tool that can be applied at national and subnational levels to identify underserved areas or population groups, to measure program effectiveness and better target resources. At the same time, they underscore that PFPI does not reflect the degree to which government efforts often indirectly benefit private-sector family planning programs (e.g., by facilitating the importation and distribution of contraceptives), and should therefore be considered an approximate indicator of the impact of public family planning programs. With that caveat in mind, PFPI provides valuable information not captured by other current indicators, and is an important contribution to the study of contraceptive behavior. PFPI produces evidence that can be used to hold governments accountable for their obligations to meet family planning needs.
"The Role of Public-Sector Family Planning Programs in Meeting the Demand for Contraception in Sub-Saharan Africa," by John Bongaarts and Karen Hardee, appears in International Perspectives on Sexual and Reproductive Health and is currently available online.