Contraceptive Method Skew and Shifts in Method Mix in Low- and Middle-Income Countries

Over the 20-year period following the 1994 International Conference on Population and Development (ICPD) in Cairo, family planning has waned as a priority on the global health agenda, 1,2 although some signs of renewed interest and investment have occurred in recent years. In 2005, "universal access to reproductive health" was added to Millennium Goal 5, albeit as an afterthought. In addition, three international family planning conferences have taken place, in 2009 (Uganda), 2011 (Senegal) and 2013 (Ethiopia). The high-profile Family Planning Summit 2020-held in London in July 2012 and sponsored by the Bill and Melinda Gates Foundation, the United Kingdom Department for International Development and the United Nations (UN) Population Fund, among othersconcluded in 11 donor countries and 22 developing countries pledging funding, commodities and political support to reach the ambitious goal of making affordable lifesaving contraceptive information, services and supplies available to an additional 120 million women in the world's poorest countries by 2020. However, human rights and women's groups, among others, have expressed concern that in the rush to meet the 2020 goal, issues of voluntary use, reproductive choice, quality of care and client-centered service delivery may be compromised. lthough studies specifically focused on voluntary use and reproductive choice, 5 quality of care in family planning services 6-8 and discontinuation rates exist, 9 there is no standard indicator from readily available data sources to measure these concepts. One relevant framework that is well-recognized and widely cited in family planning circles is the Bruce-Jain framework for quality of care. 10 One of the framework's six elements is "choice of methods," which refers to the number of contraceptive methods available to clients on a consistent basis. Various questions have been used to capture this concept in surveys, such as "Did you receive the method you wished on the day of service?"; however, no standard question is used across existing data sources.