Trends in the Contraceptive Method Mix in Low- and Middle-Income Countries: Analysis Using a New “Average Deviation” Measure

Below:  Number of Countries With Method Mix Skew According to the 50% Rule,a by Dominant Method (N = 35 Countries). Abbreviation: IUD, intrauterine device.

a Each method comprises over 50% of total contraceptive use in the country. Missing regions in the bars had no country with over 50% use of that method among contraceptive users; male sterilization, the implant, and the condom had no countries at all with over 50% use of those methods among contraceptive users.

Below:  Method Mix Among Contraceptive Users Based on Latest Surveys for 123 Countries. Abbreviation: CPR, contraceptive prevalence rate; IUD, intrauterine device.

Below:   Method Mix Among Contraceptive Users by Age

Below:   Declining Trends in Method Mix Skew Based on Average Deviation Values in 15 Selected Countries

Below:   Changes in the Method Mix Over Time, 4 Illustrative Countries.  Abbreviation: CPR, contraceptive prevalence rate; IUD, intrauterine device.

The method mix of contraceptive use is severely unbalanced in many countries, with over half of all use provided by just 1 or 2 methods. That tends to limit the range of user options and constrains the total prevalence of use, leading to unplanned pregnancies and births or abortions. Previous analyses of method mix distortions focused on countries where a single method accounted for more than half of all use (the 50% rule). We introduce a new measure that uses the average deviation (AD) of method shares around their own mean and apply that to a secondary analysis of method mix data for 8 contraceptive methods from 666 national surveys in 123 countries. A high AD value indicates a skewed method mix while a low AD value indicates a more uniform pattern across methods; the values can range from 0 to 21.9. Most AD values ranged from 6 to 19, with an interquartile range of 8.6 to 12.2. Using the AD measure, we identified 15 countries where the method mix has evolved from a distorted one to a better balanced one, with AD values declining, on average, by 35% over time. Countries show disparate paths in method gains and losses toward a balanced mix, but 4 patterns are suggested: (1) rise of one method partially offset by changes in other methods, (2) replacement of traditional with modern methods, (3) continued but declining domination by a single method, and (4) declines in dominant methods with increases in other methods toward a balanced mix. Regions differ markedly in their method mix profiles and preferences, raising the question of whether programmatic resources are best devoted to better provision of the well-accepted methods or to deploying neglected or new ones, or to a combination of both approaches.

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