Is the Decision Not to Use Contraception an Indicator of Reproductive Agency?

Women's engagement in the decision to use contraception, an indicator captured in the Demographic and Health Surveys (DHS), is frequently used to assess women's reproductive agency. In 2014, DHS added a corollary question to the women's questionnaire on decision-making not to use contraception. Study authors hypothesize that women's engagement in decision-making not to use contraception is also indicative of reproductive agency. Analyzing DHS microdata from 30 countries collected between 2015 and 2020 (n = 292,141), this country-level study examines data quality in terms of missingness of data (t-tests), indicator utility in terms of response pattern variability (descriptive statistics), and construct validity in terms of associations between engagement in the decision not to use contraception and engagement in household decision-making (multivariable linear regression). Findings indicate the measure is of good quality, provides nuanced insight, and has construct validity. Importantly, the new measure deepens our understanding of women's reproductive agency.

Standardizing Measurement of Contraceptive Use Among Unmarried Women.

Historically, the family planning practices and needs of married women have been monitored and reported uniformly. However, the same uniformity does not hold for unmarried women. Because key data and information platforms employ different measurement approaches-namely, different definitions of sexual recency-reports of contraceptive prevalence and unmet need among unmarried women are inconsistent. We examine how the measurement approaches employed by 3 large organizations yield such divergent estimates. We find that contraceptive prevalence and unmet need estimates among married women do not vary much by sexual recency. For unmarried women, contraceptive prevalence is systematically lower and unmet need is systematically higher as the sexual recency window widens. In the short term, we recommend using the 1-month cutoff as analyses reveal it yields the most precise estimates for better recognizing the needs of this important demographic group.

Measuring contraceptive prevalence among women who are at risk of pregnancy.

OBJECTIVES: The contraceptive prevalence rate (CPR) is generally reported among in-union women ages 15-49. Here, union status and age serve as proxies for exposure to the risk of pregnancy. As a result of changing dynamics, age and union status proxies may be insufficient for determining the rate of contraceptive use among women at risk of pregnancy. Our objectives are to define a measure of contraceptive use among women at risk, to measure contraceptive use among such women and to compare this rate with conventional CPR. STUDY DESIGN: Using data from the United States 2011-2013 National Survey of Family Growth (NSFG), we explore self-reported data on contraceptive use, sexual recency, pregnancy status and fecundity to develop an alternative CPR (ACPR) measure, contraceptive prevalence among women at risk of pregnancy. After defining and measuring ACPR, we compare ACPR and conventional CPR estimates using NSFG and Demographic and Health Survey data from 48 surveys completed from 2000 to 2015 in low- and middle-income countries. RESULTS: For measuring ACPR, it is best to limit sexual activity recency component to "four weeks" to minimize underreport of coital-specific methods. It is best to limit the contraceptive use component to "current use" rather than "use at last sex" to minimize underreport of permanent methods. In the United States, 86% of women at risk of pregnancy are currently using contraception. CONCLUSION: Women at risk of pregnancy report higher levels of contraceptive use than the conventional CPR indicates. IMPLICATIONS STATEMENT: Development of ACPR exposed some potential family planning measurement weaknesses. Specifically, because CPR is based on report of "current use," our analyses show that CPR may underreport coital-specific methods. As a result, CPR estimates may be somewhat deflated, and unmet need estimates may be somewhat inflated.

Measuring Access to Family Planning: Conceptual Frameworks and DHS Data.

Expanding access to family planning (FP) is a driving aim of global and national FP efforts. The definition and measurement of access, however, remain nebulous, largely due to complexity. This article aims to bring clarity to the measurement of FP access. First, we synthesize key access elements for measurement by reviewing three well-known frameworks. We then assess the extent to which the Demographic and Health Surveys (DHS)-a widely used data source for FP programs and research-has information to measure these elements. We finally examine barriers to access by element, using the latest DHS data from four countries in sub-Saharan Africa. We discuss opportunities and limitations in the measurement of access, the importance of careful interpretation of data from population-based surveys, and recommendations for collecting and using data to better measure access.

Meeting demand for family planning within a generation: prospects and implications at country level.

BACKGROUND: In order to track progress towards the target of universal access to sexual and reproductive health care services of the post-2015 Sustainable Development Goals (SDGs), a measure (demand for family planning satisfied with modern contraceptive methods) and a benchmark (at least 75% by 2030 in all countries) have been recommended. OBJECTIVES: The goal of this study was to assess the prospects of reaching the benchmark at the country level. Such information can facilitate strategic planning, including resource allocation at global and country levels. DESIGN: We selected 63 countries based on their status as least developed according to the United Nations or as a priority country in global family planning initiatives. Using United Nations estimates and projections of family planning indicators between 1970 and 2030, we calculated percent demand for family planning satisfied with modern contraceptive methods for each year and country. We then calculated the annual percentage point changes between 2014 and 2030 required to meet the benchmark. The required rates of change were compared to current projections as well as estimates between 1970 and 2010. RESULTS: To reach the benchmark on average across the 63 countries, demand satisfied with modern methods must increase by 2.2 percentage points per year between 2014 and 2030 - more than double current projections. Between 1970 and 2010, such rapid progress was observed in 24 study countries but typically spanning 5-10 years. At currently projected rates, only 9 of the 63 study countries will reach the benchmark. Meanwhile, the gap between projected and required changes is largest in the Central and West African regions, 0.9 and 3.0 percentage points per year, respectively. If the benchmark is achieved, 334 million women across the study countries will use a modern contraceptive method in 2030, compared to 226 million women in 2014. CONCLUSIONS: In order to achieve the component of the SDGs calling for universal access to sexual and reproductive health services, substantial effort is needed to accelerate rates of progress by a factor of 2 in most study countries and by a factor of 3 in Central and West African countries.

Improving data concerning women's empowerment in sub-Saharan Africa.

This study assesses the utility of Demographic and Health Survey (DHS) questions regarding women's empowerment in the context of sub-Saharan Africa. We examine the use of, and need for improvements to, women's empowerment data in Ghana, Mozambique, Senegal, and Uganda. Drawing on interviews conducted among gender and health experts and on context-specific literature, our findings reveal that although DHS data are widely used, data needs remain in five areas: economic empowerment, knowledge of legal rights and recourse, participation in decisionmaking, attitudes and social norms, and adolescent girls. We recommend that Demographic and Health Surveys be modified-for example, through adding specific survey items-to fulfill some but not all of these emerging women's empowerment data needs. We also suggest that other surveys fill known gaps and that data users carefully consider the meaning and relative weight of the women's empowerment items according to the cultural context in which the data are collected.

Assessing the quality of data regarding use of the lactational amenorrhea method.

This study assesses the quality of Demographic and Health Survey (DHS) data regarding self-reported current use of the lactational amenorrhea method (LAM). LAM is an important modern contraceptive method that, when practiced correctly, has a 98 percent effectiveness rate six-months postpartum. The objectives of this study are to examine the accuracy of self-reported LAM use, compared with the constructed correct-practice variable, and to explore differentials in accuracy measures by characteristics at the individual and survey level by analyzing data from 73 DHSs conducted in 45 countries between 1998 and 2011. Findings reveal that only 26 percent of reported LAM users meet the criteria for correct LAM practice. We discuss the implications for future DHS data collection and for family planning and maternal and child health programming.