[CYP (couple years of protection): an excellent programmatic indicator that needs refinement]. / El A.P.P.: un excelente indicador programatico que se puede refinar.

PIP: This work assesses proposed changes in conversion factors for the family planning program indicator "couple years of protection", with a discussion of the proposed changes and citation of references for each method. Unlike most service statistics, couple years of protection allows the total family planning contribution of different contraceptive methods to be totalled and compared. Recently, the US Agency for International Development and the International Planned Parenthood Federation have proposed new conversion factors for calculating couple years of protection for most methods based on careful scrutiny of the average fecundity of method users, rates of continuation and failure, and waste. The fertility of users is not the same for all methods; most candidates for sterilization for example are older than users of oral contraceptives (OCs) or IUDs, and consequently their average fertility has declined. Neither are all methods equally effective, and the couple years of protection indicator should reflect these differences. The proposed conversion factor for OCs has been increased from 13 cycles per couple year of protection to 15 cycles to take into account the 6-20% of users who have been found to use the method incorrectly. 15 cycles was arrived at by assuming that 13% of users employ the method incorrectly. The proposed conversion factor for IUD is 3.5 years of protection per IUD instead of 2.5, on the assumption that of each 100 users, 10 would use the device for an average of 6 months, 45 for an average of 42 months, and 45 for an average of 76 months. The resulting total of 5370 months of use divided by 100 would yield 53.7 months. Subtracting 7% for the expected accidental pregnancies still yields 4 years and 11 months. The old measure of 2.5 years per IUD is apparently outdated. The proposed conversion factor for sterilization has been lowered from 12.5 couple years of protection to 10 per operation to reflect the higher average age and lower fecundity of sterilization acceptors. The revised conversion factor should help combat the excessive enthusiasm for sterilization of some family planning programs that neglect reversible methods appropriate for younger and more fecund women in favor of sterilization, which accumulates many couple years of protection without the same demographic impact. The proposed conversion factor for the condom has been changed from 1 couple year per 100 condoms to 1 per 150 condoms, to reflect the well documented failure rate of 10% per year, plus wastage due to poor storage and the difficult to evaluate but significant use of condoms for purely prophylactic rather than contraceptive purposes. The proposed conversion factor for vaginal creams, foams, and other spermicidal methods was also increased from 100 to 150, largely because of their higher failure rate. The proposed factor for Norplant implants is 3.5 per implant.^ieng

An evaluation of Profamilia's female sterilization program in Colombia.

The findings of three surveys and three studies used by Profamilia to evaluate and improve their voluntary female sterilization program are presented. The surveys measured sociodemographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost-effectiveness analysis. Results of the projects were used by Profamilia management to identify areas of program strengths and weaknesses and to implement operational changes.

PIP: Profamilia is a nonprofit, private family planning organization based in Bogota, Colombia. To improve program performance, the findings of 3 surveys and 3 studies were used by Profamilia to evaluate and improve their female sterilization (FS) program. The surveys measured socio- demographic characteristics of users, factors behind the sterilization decision, and user satisfaction with the operation in the short run and over time. The studies explored methodologies for more accurate cost- effectiveness analysis. Results of the projects were used by the Profamilia movement to identify areas of program strengths and weaknesses and to implement operational changes. In 1970, Profamilia offered vasectomy; FS was offered in 1972. The vasectomy program was ineffective; however, FS was very successful. Approximately 72% of all procedures performed in Colombia are done by Profamilia. In 1972, 2 Colombian gynecologists, (1 from Colombia) were trained in Colombia to do FSs by doctors from Johns Hopkins Hospital. At present, Profamilia uses about 40 doctors directly, and contracts with others. Program evaluation is done by using cost-effectiveness evaluation to measure financial efficiency, survey analysis to measure general program efficiency and client satisfaction, and collection of service statistics to measure program output. The 1st survey was done in 1976 and 1977 to learn about user characteristics. The 2nd project was a 2-phase (retrospective-prospective) survey carried out in 1978-83. In 1985, Profamilia decided to do a follow-up survey in conjunction with Association for Voluntary Surgical Conception (AVSC). It emphasized factors influencing the decision to be sterilized. Sterilization acceptors were interviewed in 8 clinics in a nonrandom sample. 3 cost- effectiveness studies have been done on Profamilia's FS program. A departmental study determined the cost per couple year of protection offered by the 5 service departments of Profamilia; an accounting study determined the full unit cost per sterilization; and an organization-wide cost study determined how to assign indirect and shared costs of support divisions to service departments like sterilization.

SMF focus: a comparison of vital statistics.

PIP: Prices for socially marketed condoms and oral contraceptives (OCs) in selected countries--Bangladesh, Costa Rica, El Salvador, Ghana, Honduras, India, Indonesia, Jamaica, Nepal, Zimbabwe, and Mexico--are set forth and compared with cost of living data such as per capita income and food prices. Also presented for each country is a couple-years of protection cost factor, representing the hypothetical number of days of income per capita needed to purchase a 1 year supply of condoms. The lowest such cost factor exists in India (0.9 day), followed by Jamaica (1.4 days) and Ghana (1.6 days). Countries with particularly high couple-years of protection cost factors include Honduras (10.3 days) and Zimbabwe (11.6 days). Contraceptive prices relative to a kilogram of rice are highest in Mexico, Zimbabwe, and Honduras and lowest in Bangladesh and India. Condom prices are more than twice the comparable couple-years of protection rate for OCs in Honduras and El Salvador, while there is a price equivalency in the contraceptive costs of these 2 methods in social marketing programs in Bangladesh, Jamaica, and Nepal.^ieng

Social marketing program sales.

PIP: A table presents the latest available statistics on social marketing program sales and status in the countries of Bangladesh, the Caribbean, Ecuador, Egypt, El Salvador, Guatemala, Honduras, India, Jamaica, Mexico, and Nepal. The Bangladesh Family Planning Social Marketing Program was implemented in 1975 and is active at this time. Over the June 1983 to May 1984 period, 87,034,000 Raja condoms, 4,242,000 Panther condoms, 1.157,000, Maya pills, 846,000 Ovacon low-dose pills, and 4,332,000 Joy foaming tablets were sold for 1,109,000 couple years of protection (CYP). Over the March 1984 to May 1984 period, the Caribbean Social Marketing Project, implemented in 1983, sold 16,000 Panther condoms, 1000 Perle pills, and 1000 Perle low-dose pills. Sales are expected to begin in Ecaudor's program in August 1984. Egypt's program is active. Data for July 1983 to June 1984 show that 6,722,000 condoms, 1,988,000 Amman foaming tablets, 114,600 Cu-T IUDs, 66,600 Cu-7 IUDs, and 578,000 Norminest low-dose pills were sold for a total of 515,000 years of protection. Over the March 1983 to February 1984 period, El Salvador's program sold 537,000 Condor condoms, 125,000 Perla pills, and 61,000 Suave foaming tablets for 16,000 CYP. There have been no sales as yet in Guatemala's program. Sales for the Honduras program began in March 1984, but no data are available as yet. India's Nirodh Marketing program was implemented in 1968. For the January 1983 to September 1983 period, 83,140,000 Nirodh condoms were sold for 1,109,000 CYP. Over the May 1983 to April 1984 period, Jamaica's program sold 1,031,000 Panther condoms and 330,000 Perle oral contraceptives for 35,000 CYP. Mexico's Profam, implemented in 1978, sold 6,602,000 condoms, 18,000 pills, and 9000 injectables for 35,000 CYP for the May 1983 to June 1984 period. Nepal's Contraceptive Retail Sales Corporation was implemented in 1976. For the May 1983 to April 1984 period, 2,833,000 condoms, 82,000 Gulaf pills, 15,000 Nilocon low-dose pills, and 167,000 Kamal foaming tablets were sold for a total of 37,000 CYP.^ieng

Summary of sales and CYP in seven social marketing programs.

PIP: During 1983 contraceptive social marketing programs selling products in 7 countries -- Bangladesh, Egypt, El Salvador, Jamaica, Mexico, Nepal, and Sri Lanka -- provided complete monthly sales reports to the International Contraceptive Social Marketing Project. Together, these countries provided a total of 1,694,177 couple years of protection (CYP) among an estimated 54.98 million women of reproductive age. Tables compare 1982 and 1983 CYP for each contry. Also provided are sales data and CYP for individual products in each country. In Bangladesh the CYP was 816,072 in 1982 and 1,066,434 in 1983. For Egypt the CYP was 288,103 in 1982 and 377,632 in 1983. In El Salvador the CYP was 21,557 in 1982 and 16,630 in 1983. Jamaica's CYP was 34,016 in 1982 and 44,145 in 1983. In Mexico the CYP was 77,286 in 1982 and 63,832 in 1983. Nepal's CYP was 27,229 in 1982 and 35,942 in 1983. The CYP in Sri Lanka was 95,264 in 1982 and 89,562 in 1983.^ieng