Contraceptive Method Mix: Updates and Implications

Jane T. Bertrand; John Ross; Tara M. Sullivan; Karen Hardee; James D. Shelton

doi:10.9745/GHSP-D-20-00229

Key Messages

Contraceptive method mix reflects both supply and demand.
Recent trends include a progression in hormonal methods toward implants in sub-Saharan Africa, and where HIV is common, more condom use in some countries.
However, dominance of 1 method in the mix remains very common, though countries and regions throughout the world are diverse as to which method is dominant.
Our analysis argues for continued concerted efforts of programs to increase contraceptive method choice.
There is no ideal method mix; client preferences are key.

ABSTRACT

Context:

Improving contraceptive method choice is a goal of international family planning. Method mix—the percentage distribution of total contraceptive use across various methods—reflects both supply (availability of affordable methods) and demand (client preferences). We analyze changes in method mix, regional contrasts, and the relationship of the mix to contraceptive prevalence.

Methods:

We use 789 national surveys from the 1960s through 2019, from 113 developing countries with at least 1 million people and with data on use of 8 contraceptive methods. Two measures assess the “evenness” of the mix: method skew (more than 50% use is by 1 method), and the average deviation (AD) of the 8 methods’ shares from their mean value. Population weighted and unweighted results are compared because they can differ substantially.

Results:

Use of traditional methods has declined but still represents 11% of all use (population weighted) or 17% (unweighted country average). Vasectomy’s share was historically low with the exception of a few countries but is now even lower. The previous trend toward greater overall evenness in the mix has slowed recently. Sub-Saharan Africa shows a hormonal method progression from oral contraceptives to injectables to implants in a substantial number of countries. In some countries with high HIV prevalence, the condom share has increased. The leading method’s share differs by region: female sterilization in Asia (39%) and in Latin America (31%), the pill in the Middle East/North Africa (32%), and the injectable in sub-Saharan Africa (36%). Method skew persists in 30% of countries. “Evenness” of mix is not related to contraceptive prevalence.

Conclusion:

The marked diversity in predominant methods underscores the conclusion that no single method mix is ideal or appropriate everywhere. But that diversity across countries, coupled with the persisting high degree of extreme skewness in many of them, argues for continued concerted efforts for programs to increase method choice.

Footnotes

Received: May 20, 2020.
Accepted: September 22, 2020.
Published: December 23, 2020.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-20-00229

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