Contraceptive method choice in developing countries

CONTEXT: For all persons to enjoy a choice among contraceptive options, a range of methods must be readily available. Yet measures of access show serious deficits that depress use of each method Countries differ both in the number of methods offered and the extent to which each is made available. Information is needed on how these factors have changed over time and how they have affected contraceptive use overall and use of individual methods. METHODS: Patterns of contraceptive use are derived from data from national surveys, and Weis of access to four methods (female sterilization, the IUD, the pill and the condom) are measured by estimates from cycles of a program effort study of the proportion of couples for whom each method is available, as of 1982, 1989, 1994 and 1999. The analysis focuses on the relationship between access to contraceptives and patterns of use. RESULTS: In all four cycles of the program effort study,the mean prevalence of the four methods rises with mean access. For example mean prevalence in 1994 and 1999 was close to 12% in countries with very low access, compared with 44% in those with high access. Prevalence is highest in countries where access to all methods is uniformly high In 1994, for example, mean prevalence was 12% in countries where mean availability was high and diversity in the availability of individual methods was low, compared with 9% in countries where mean availability was high and access to individual methods varied considerably. Between 1982 and 1994, the number of countries with uniformly high access rose from nine to 23, while the number with uniformly low access declined from 23 to nine. At the lowest level of mean availability, the condom and the pill contribute most to availability (40% and 36%, respectively), but at the highest level, the contributions of the four methods equalize at 22-27% each. The situation for prevalence is similar. The pills share at the lowest level of availability, is 6796, compared with 3 1 % at the highest level, where it is surpassed by female sterilization (36%). CONCLUSIONS: Full choice among a variety of contraceptive offerings is yet to be attained in many countries. Its absence restricts personal access to each method as well as the use of all methods in the population. To the extent that the ability to choose satisfactory contraceptive protection depends on ready access to multiple methods, a clear mandate exists for greater progrommatic attention to the provision of a full range of methods.