Global trends in contraceptive method mix and implications for meeting
the demand for family planning
Ann Biddlecom and Vladimira Kantorova
United Nations, Department of Economic and Social Affairs, Population Division
19 August 2013
PRELIMINARY DRAFT
Corresponding author: Ann Biddlecom, United Nations, Department of Economic and
Social Affairs, Population Division, New York, NY 10044 (email: biddlecom@un.org).
Paper to be presented in Session #013 “Sexuality and reproductive health”, XXVII
IUSSP International Population Conference (Busan, Republic of Korea). The views
expressed herein are those of the authors and do not necessarily reflect the views of the
United Nations.
Abstract
Measuring progress in meeting the demand for family planning requires not only
attention to levels and trends in contraceptive prevalence and unmet need for family
planning but also assessment of the diversity of contraceptive methods used. We examine
changes in contraceptive method mix from 1990 to 2011 for 188 countries and if trends
in contraceptive prevalence are associated with the average effectiveness and
concentration of methods used. We use annual Bayesian hierarchical model-based
estimates of contraceptive prevalence and unmet need for family planning among married
or in-union women aged 15-49 and apply the distribution of contraceptive users by
method used from surveys at two time points (around 1990 and 2011). Female
sterilization and the IUD were the two most common methods used worldwide and
geographical differences in method mix profiles were large. Shifts were gradual over the
past two decades in the distribution of users by method and average effectiveness. The
evidence does not suggest an association between increases in contraceptive prevalence
and improvements towards a more balanced or effective method mix. We propose a
measure of the effectiveness of contraceptive demand—one that incorporates unmet need
for family planning—as a useful summary measure to describe improvements in meeting
the demand for family planning.
2
Introduction
The past twenty years have witnessed significant progress in meeting the demand for
family planning. Worldwide contraceptive prevalence has risen among women of
reproductive age who are married or in a cohabiting union from 54.8 per cent (95 per cent
uncertainty interval 52.3–57.1) in 1990 to 63.3 per cent (60.4–66.0) in 2010, or 8.5
percentage points (4.7–12.1) (Alkema et al. 2013). Most of the increase in contraceptive
prevalence at the global, regional and country level that occurred between 1990 and 2010
was attributable to increases in the use of modern methods. Worldwide, 57.0 per cent
(54.1–59.7) of married women of reproductive-age were using a modern method in 2010.
The largest absolute increases from 1990 to 2010 in the use of modern methods (more
than 15 percentage points) were in Central America, Eastern Europe, and three
subregions of Africa (Eastern Africa, Northern Africa, and Southern Africa). In a similar
manner, the percentage of women of reproductive age, either married or in a union, with
an unmet need for family planning (i.e., women who want to stop or delay childbearing
but are not using any method of contraception) decreased worldwide from 15.4 per cent
(14·1–16·9) in 1990 to 12.3 per cent (10·9–13·9) in 2010, which was driven by decreases
in developing countries.
Yet measuring improvements in meeting the demand for family planning requires not
only assessment of overall levels and trends in contraceptive prevalence and unmet need
for family planning but also an assessment of the effectiveness and range of contraceptive
methods used. A key objective of family planning programmes, emphasized in the
Programme of Action of the 1994 International Conference on Population and
Development, is to ensure that “…women and men have information and access to the
widest possible range of safe and effective family-planning methods in order to enable
them to exercise free and informed choice” (United Nations 1996). Of course, use of
specific methods does not approximate access, but they are indeed related. Prior research
has shown that as access to a range of modern contraceptive methods improves, modern
contraceptive prevalence increases (Ross et al. 2001) and a high concentration of
contraceptive use on one or two methods may be a sign of a limited range of available
methods (Sullivan et al. 2006).
3
We provide updated estimates of the distribution of contraceptive users by method at two
time points (1990 and 2011) for 188 countries or areas—one of the most comprehensive
assessments to date—and examine the degree to which a rise in contraceptive prevalence
over time is associated with increases in the average use-effectiveness and decreases in
the concentration of methods used. We draw on different measures of the effectiveness
and concentration of method mix to characterize global, regional and country level
changes over time.
Data and measures
Analysis of family planning levels and trends is challenging because the number of
survey-based observations per country is limited or often not timely. In a 2012
compilation of data on family planning indicators for 194 countries and areas, 60 per cent
of countries and areas with data on contraceptive prevalence had less than five
observations (United Nations 2012). Furthermore, differences in the survey design and
implementation, as well as differences in the way survey questionnaires are formulated
and administered can affect the comparability of data over time and between countries.
To strengthen the comparability of our analysis of family planning levels and trends, we
draw on Bayesian hierarchical model-based estimates of contraceptive prevalence (total,
modern and traditional) and unmet need for family planning for 1990 and 2011 among
women of reproductive age (15-49 years old) who are married or in a cohabiting union
(see Alkema et al. 2013 for model details).
To produce estimates of prevalence of specific methods, we used data on the distribution
of contraceptive users by method from surveys covering nationally representative
samples of married or in-union women of reproductive age. Methods were classified into
10 categories: female sterilization, male sterilization, the pill, injectables, implants, IUD,
male condom, vaginal barrier methods, other modern methods and any traditional method
(e.g., rhythm or withdrawal). Categorization is mutually exclusive with more effective
methods receiving priority. Detailed data, including information on data sources and
model-based country, regional and global estimates, are publicly available in a recent
4
United Nations Population Division data set on family planning indicators (United
Nations 2012) and a 2013 update for monitoring progress on the target under Millennium
Development Goal 5 to achieve universal access to reproductive health by 2015 (United
Nations 2013).
We applied survey-based observations on the distribution of contraceptive users by
method at two time points, around 1990 (1983-1999) and around 2011 (2000-2012), to
the model-based estimates of modern contraceptive prevalence in 1990 and 2011. We
used the model-based estimates of traditional method prevalence and did not examine the
distribution of specific traditional methods as emphasis in most family planning
programmes and governmental health system initiatives is to expand access to effective
methods of contraception rather than to promote less effective traditional methods.
Moreover, the typical use-effectiveness of traditional methods is similar across the main
traditional methods used.
Data on the distribution of contraceptive users by method for the two time points were
not available for 33 of 188 countries or areas (or 18 per cent): 17 are countries or areas in
the Caribbean and Oceania with small population sizes, 9 are countries in Europe (or 26
per cent of the 35 countries in Europe with any data) and the remaining 7 countries
(Equatorial Guinea, Israel, Libya, New Zealand, South Sudan, Turkmenistan and the
United Arab Emirates) are spread across other regions (see appendix table 1). While the
distribution of specific modern methods was held constant in these 33 cases, the
percentages were applied to the model-based estimates of modern contraceptive
prevalence in 1990 and 2011, which changes over time. Thus, the proportion of users by
specific method will be the same over time in these cases but the percentage of married or
in-union women using the methods changes over time (as the percentage of modern
method use changes over time).
Overall, for the 1990 reference year, survey data were from the 1983-1999 time period
except for 25 countries (or 13 per cent of all countries with data) that had method mix
data from 2000 or later. For the 2011 reference year, survey data were from the 20005
2012 time period except for 31 countries (or 16 per cent of all countries) that had data
prior to 2000.
We used several measures of the effectiveness and concentration of methods used among
all contraceptive users from prior studies. The first measure is the average method
effectiveness of the methods used. It is constructed by multiplying the proportion of all
users according to the method they use by the complement of the proportion of users who
become pregnant during the first 12 months of typical use of the specific method
(pregnancy rates from typical use are defined as the percentage of couples who
experience an accidental pregnancy during the first year if they do not stop use of the
method for any other reason). We used pregnancy rates from typical use of a method
based on the experience of women in the United States and corrected for under-reporting
of abortion (Hatcher et al. 2011). The method-specific pregnancy rates used are: Female
sterilization (0.5 per cent), male sterilization (0.15 per cent), pill (9 per cent), injectable
(6 per cent), implant (0.05 percent), IUD (0.5 per cent (the average from two common
types of IUD)), male condom (18 per cent), vaginal barrier methods (12 per cent, we used
the lower failure rate of the diaphragm compared with other barrier methods), other
modern methods (21 per cent, we used the lower failure rate of female condoms
compared with other methods) and traditional methods (23 per cent, we used an average
from rhythm and withdrawal).
Alternative pregnancy rates due to method failure are also available based on
Demographic and Health Survey data from 19 countries (Ali et al. 2012). The methodspecific median values of failure rates for the first 12 months of use are lower than those
from the United States with the exception of the IUD (1.1 per cent versus 0.5 per cent).
The failure rates become more similar once the 24-month duration of use is taken into
account, except for IUD (a higher failure rate) and the injectable and condom (lower
failure rates). We opted to use the higher failure rates (and thus lower method
effectiveness) from the United States in our calculations of the effectiveness of the
method mix since the rates were adjusted for the under-reporting of abortion. Higher
values of average method mix effectiveness (with a maximum value of 0.995) signify a
6
more effective method mix profile and, by implication, fewer unintended pregnancies
among women who use contraception.
The second measure is an exploratory measure of the effectiveness of total demand for
contraception. Total demand is the sum of contraceptive prevalence and unmet need for
family planning. Similar to the average effectiveness of the method mix, we multiplied
the proportion of all women with a demand for family planning according to the method
they used by the complement of the proportion of users who become pregnant during the
first year of typical use of the specific method. For the proportion of women with an
unmet need for family planning, we used the same assumption in other research of
unintended pregnancy (see Darroch and Singh 2011) that 40 per cent of women who want
to avoid pregnancy but are not using a method will become pregnant over a 12-month
period. The figure from the United States is much higher—an 85 per cent pregnancy rate
for women who are not using any contraceptive method—though this is based on couples
where contraception is not used and from women who cease using contraception in order
to become pregnant. The lower pregnancy rate assumption reflects the fact that not all
women are exposed to the risk of pregnancy (e.g., some are not fecund, some are not
having sex regularly). We applied the complement of the proportion of women who
become pregnant in the first year of not using contraception (or 1 - 0.40= 0.60). This
summary measure of the effectiveness of total demand indicates the degree to which
women’s preferences to prevent pregnancy are being met effectively, and takes into
account not only shifts in the distribution of users by method used but also changes in the
percentage of women who are not using contraception but who express a preference to
delay or stop childbearing.
We assess the concentration of method mix distributions with two measures. The first is a
dichotomous indicator of whether 50 per cent or more of contraceptive use is accounted
for by a single contraceptive method (Sullivan et al. 2006). The second measure captures
the breadth of modern methods used and is computed as the difference in prevalence rates
between the most prevalent modern method (of the nine method categories examined)
and the third-most prevalent method, divided by total modern method prevalence
7
(USAID 2012). The higher the value, the more concentrated modern method use is
among just a few methods.
Results
Trends in the distribution of contraceptive users by method
In 2011, female sterilization and IUDs were the two most common methods used by
women worldwide who were aged 15-49 and married or in a union (figure 1 panel A and
appendix table 2). About 19 per cent of the world’s married women of reproductive age
opted for female sterilization and 14 per cent used the IUD. Temporary methods were
less common: 9 per cent of women used the pill, 8 per cent relied on male condoms and 4
per cent used injectables. Only 6 per cent of married or in-union women worldwide used
traditional methods as of 2011.
The distributions of contraceptive users by methods used are quite distinct across regions
and countries. Short-term and reversible methods, such as the pill, injectable and condom,
were more commonly used than other methods in Africa and Europe whereas longer-term
and permanent methods, such as sterilization, implants and the IUD, were more common
in Asia and Northern America. Latin America and the Caribbean and Oceania were more
balanced in the prevalence of short-term versus long-term methods. For example, the
IUD was most commonly used in Asia (18 per cent) and levels were over 25 per cent in
China, Democratic People's Republic of Korea, Viet Nam and four countries in Central
Asia. Female sterilization was most prevalent (more than 20 per cent) in Asia, Latin
America and the Caribbean and Northern America in 2011 and levels were over 25 per
cent in several populous countries (i.e., Brazil, China, India and Mexico). Use of the
contraceptive pill has the widest geographic distribution of any method. Other modern
contraceptive methods are also popular in certain regions. In Africa, for instance,
injectables as well as the pill are the most common methods used (8 per cent each).
Between 1990 and 2011, all modern contraceptive methods increased in prevalence
worldwide except for vasectomy and vaginal barrier methods, the former due principally
to declining prevalence of vasectomy in several Asian countries, especially the two
8
largest, China (from an estimated 8.6 per cent in 1990 to 4.5 per cent in 2011) and India
(from an estimated 3.5 per cent in 1990 to 1.2 per cent in 2011).
Nine out of every 10 married or in-union women using contraception in the world in
2011 relied on modern methods of contraception, and more than half of users relied on
either female sterilization or the IUD (figure 1 panel B and appendix table 3). Modern
methods requiring male participation are not common: only 17 per cent of married or inunion women worldwide who used contraception relied on male sterilization or male
condoms. The regions with the highest proportion of use of traditional methods in 2011
were Africa (18 per cent of use) and Europe (16 per cent of use).
Change over the past 20 years in the distribution of contraceptive users by methods used
has occurred slowly at both the global and regional levels. Permanent or long-lasting
methods have declined slightly and short-term and reversible methods have increased.
Sterilization declined from 38 per cent of all use in 1990 to 34 per cent in 2011 and the
IUD declined from 24 per cent to 22 percent. For the world as a whole, the pill’s share of
total contraceptive use remained stable over the past 20 years (14 per cent), while the
share due to injectables has risen (from 2 to 6 per cent) as they became more widely
available in Africa (rising from 9 per cent of all use in 1990 to 27 per cent of all use in
2011). Since 1990, the share of total contraceptive use accounted for by traditional
methods declined sharply the regions where their use had been common: in Africa (from
27 per cent to 18 per cent of all use) and Europe (from 30 per cent to 16 per cent of all
use).
9
Figure 1. Prevalence of method-specific use and the distribution of contraceptive
users by method used, by major area and development region, 1990 and 2011
A. Percentage of women using specific methods among those aged 15- 49 who are married or in a
union
8 0 .0
Traditional
7 0 .0
O ther modern methods
6 0 .0
Vag inal barrier method
Male c ondom
5 0 .0
IUD
4 0 .0
Implant
Injectable
3 0 .0
P ill
Male s ter .
2 0 .0
Female s ter.
1 0 .0
0 .0
rl
Wo
d-
1
1
1
11
11
0 01 1
0 01 1
2 01
99 0 2 01
99 02 01
99 0 2 0
02 0
19 9 2
1 99 2
-1
-1
-1
9 90
19 9
ia
a-1
pe
ca
i
s
i
o
n
a
r
A
r
n
c
ea
Af
Eu
eri
bea
Oc
ri b
Am
Ca
rn
e
&
h
rt
er
No
Am
t in
a
L
B. Percentage of share of overall method use
100%
90%
Traditional
80%
O ther modern methods
70%
Vag inal barrier method
60%
Male condom
50%
IUD
Implant
40%
Injectable
30%
P ill
20%
Male s ter.
Female s ter.
10%
0%
W
d
o rl
1
1
1
11
11
0 01 1
01 1
2 01
99 02 01
99 0 2 01
99 0 2 0
9 90 2 0
1 99 2
9 02
-1
-1
-1
-1
9 90
9
1
e
a
1
a
i
a
i
ri c
As
r op
nca
e an
Af
Eu
eri
be a
Oc
ri b
Am
a
n
C
er
r&
r th
me
No
A
t in
La
10
Average method mix effectiveness
Given the slow change in the distribution of contraceptive users by method used at the
global level, it is not surprising that the average effectiveness score of method use across
10 methods changed little from 1990 to 2011, remaining steady at 0.93-0.94 (table 1).
Across major regions and subregions, the range of method mix effectiveness scores in
2011 was from 0.81 in Middle Africa to 0.97 in Eastern Asia (table 1) and across
countries the range in 2011 was from 0.78 in Somalia and South Sudan to 0.97 in China
(the red data points in figure 2). The largest changes over time were in Eastern Africa
(from 0.87 in 1990 to 0.91 in 2011) and Western Africa (from 0.84 in 1990 to 0.87 in
2011). Across all other subregions method mix effectiveness changed little over the past
twenty years and, where it declined slightly, average scores were already relatively high
in 1990 (0.91 or higher).
The summary measure of the average effectiveness of total demand shows much more
variability over time as it incorporates changes (usually declines over time) in the
proportion of total demand comprised by unmet need for family planning. In 2011, the
average effectiveness of total demand for contraception was 0.88 worldwide (table 1).
Across subregions, average effectiveness of total demand was below 0.80 in three
subregions
of
Africa
(Eastern,
Middle
and
Western
Africa)
and
in
Melanesia/Micronesia/Polynesia. Among countries, the range in this score in 2011 was
from 0.63 in South Sudan to 0.96 in China (figure 2), and all 19 countries with an average
effectiveness score below .70 in 2011 were in sub-Saharan Africa (with relatively low
contraceptive prevalence and high unmet need).
11
Figure 2. Average effectiveness of method mix and total demand among countries
by contraceptive prevalence level, 2011
1 .0 0
0 .9 5
0 .9 0
Avg.
e ffe c tiv e ne s s
to tal de m and
(2 0 1 1 )
0 .8 5
0 .8 0
0 .7 5
Avg.
e ffe c tiv e ne s s
1 0 m e tho ds
(2 0 1 1 )
0 .7 0
0 .6 5
0 .6 0
0 .5 5
0 .5 0
0 .0
1 0 .0
2 0 .0
3 0 .0
4 0 .0
5 0 .0
6 0 .0
7 0 .0
8 0 .0
9 0 .0
C o ntrace ptiv e pre v ale nc e (2 0 1 1 )
The average effectiveness of total demand increased globally and in all subregions except
in Western Europe, Northern America and Oceania. Generally, the larger the increase is
in contraceptive prevalence between 1990 and 2011, the larger the improvement in the
average effectiveness of total demand. Thus, while the method mix effectiveness of
contraceptive users may have changed little over time for subregions where most women
were already using highly-effective methods, the degree to which all women were able to
prevent pregnancy effectively increased over time once women who wanted to prevent
pregnancy but were not using any methods were included in the picture.
12
Table 1. Change in contraceptive prevalence and measures of effectiveness and concentration of method mix distributions by
development group and region, 1990 and 2011
C o n t ra ce p ti ve
p r ev a len ce
1 9 90
2011
A ve ra g e e ff ec ti ve n e ss A v e ra g e ef f ec tiv e n es s o f
o f 1 0 m et h o d s
to t al d em an d
A n y o n e m et h o d > 5 0 %
o f c o n tr a cep tiv e
p re va le n ce
C o n c en t ra t ed m o d er n
m et h o d u s e
A b s o lu te
ch a ng e
P r o b ab ility
o f c h an g e
19 9 0
2 0 11
A b s o lu te
ch a n ge
1990
2 01 1
A b s o lu te
ch an g e
1 9 90
2 0 11
A b s o lu te
c h an g e
1 99 0
2011
A b s o lu te
ch an g e
W o r ld
5 5 .0
6 3 .2
8 .2
1.0 0 0
0 .9 4
0 .9 3
-0 .0 0 4
0 .8 6
0 .88
0 .01
0
0
0
0 .19
0 .1 7
-0 .0 2
A f ric a
Ea s ter n A f ric a
M i dd le A f ri ca
N o r th er n A fr ic a
S o u th er n A fr ic a
W es te rn A fr ica
1 7 .8
1 2 .0
1 1 .3
3 7 .8
4 6 .6
8 .2
3 1 .3
3 3 .7
2 0 .9
5 3 .6
6 2 .6
1 5 .1
1 3 .5
2 1 .8
9 .5
1 5 .9
1 5 .8
6 .9
1.0 0 0
1.0 0 0
1.0 0 0
1.0 0 0
0.9 7 2
1.0 0 0
0 .8 9
0 .8 7
0 .8 0
0 .9 2
0 .9 4
0 .8 4
0 .9 1
0 .9 1
0 .8 1
0 .9 3
0 .9 3
0 .8 7
0 .0 1 4
0 .0 3 9
0 .0 1 4
0 .0 0 9
-0 .0 0 9
0 .0 3 6
0 .7 2
0 .6 8
0 .6 6
0 .8 0
0 .8 3
0 .6 6
0 .78
0 .78
0 .70
0 .86
0 .87
0 .70
0 .06
0 .10
0 .04
0 .06
0 .04
0 .04
0
0
1
0
0
1
0
0
1
0
0
0
0
0
0
0
0
-1
0 .35
0 .39
0 .12
0 .47
0 .24
0 .25
0 .1 5
0 .4 6
0 .2 9
0 .3 7
0 .2 7
0 .2 2
-0 .2 1
0 .08
0 .17
-0 .1 0
0 .03
-0 .0 3
A s ia
C en tr al A s ia
Ea s ter n A s ia
S o u th er n A s ia
S o u th -E as te rn A s i a
W es te rn A s ia
5 6 .7
5 1 .3
7 6 .7
3 9 .0
4 8 .3
4 4 .0
6 7 .0
5 9 .4
8 2 .3
5 6 .2
6 2 .9
5 7 .9
1 0 .3
7 .9
5 .5
1 7 .1
1 4 .6
1 3 .9
1.0 0 0
0.9 0 1
0.8 8 3
0.9 9 9
1.0 0 0
1.0 0 0
0 .9 6
0 .9 4
0 .9 7
0 .9 4
0 .9 3
0 .8 6
0 .9 4
0 .9 5
0 .9 7
0 .9 3
0 .9 2
0 .8 8
-0 .0 1 3
0 .0 1 3
-0 .0 0 7
-0 .0 1 5
-0 .0 0 7
0 .0 1 8
0 .8 8
0 .8 5
0 .9 4
0 .8 2
0 .8 4
0 .7 8
0 .89
0 .89
0 .95
0 .86
0 .87
0 .82
0 .01
0 .03
0 .00
0 .04
0 .03
0 .04
0
1
0
1
0
0
0
1
0
1
0
0
0
0
0
0
0
0
0 .33
0 .84
0 .29
0 .59
0 .13
0 .25
0 .2 6
0 .7 2
0 .3 3
0 .4 9
0 .1 9
0 .1 8
-0 .0 6
-0 .1 2
0 .04
-0 .1 0
0 .06
-0 .0 7
E u ro p e
Ea s ter n Eu r o pe
N o r th er n E u ro p e
S o u th er n E u ro p e
W es te rn E u ro p e
6 8 .4
6 5 .5
7 3 .5
6 4 .7
7 4 .0
7 0 .0
7 0 .1
7 7 .6
6 5 .8
6 9 .9
1 .6
4 .5
4 .0
1 .1
-4 .0
0.7 6 3
0.8 6 1
0.9 1 4
0.5 9 6
0.1 3 1
0 .8 8
0 .8 6
0 .9 1
0 .8 4
0 .9 1
0 .8 9
0 .8 6
0 .9 1
0 .8 6
0 .9 1
0 .0 0 7
0 .0 0 6
-0 .0 0 1
0 .0 2 4
0 .0 0 0
0 .8 4
0 .8 2
0 .8 8
0 .8 0
0 .8 8
0 .85
0 .83
0 .88
0 .82
0 .88
0 .01
0 .01
0 .01
0 .02
-0 .0 1
0
0
0
0
1
0
0
0
0
1
0
0
0
0
0
0 .16
0 .44
0 .17
0 .23
0 .54
0 .1 5
0 .2 1
0 .1 4
0 .2 6
0 .4 5
-0 .0 1
-0 .2 3
-0 .0 3
0 .03
-0 .0 9
L a tin A m e ric a an d th e
C a ri b b ea n
C ar ib b ean
C en tr al A m er ica
S o u th A m er ica
6 1 .0
5 4 .0
5 5 .6
6 4 .0
7 2 .8
6 0 .7
6 9 .6
7 5 .6
1 1 .8
6 .7
1 3 .9
1 1 .5
1.0 0 0
0.9 9 1
0.9 9 5
0.9 9 8
0 .9 2
0 .9 5
0 .9 3
0 .9 2
0 .9 3
0 .9 4
0 .9 4
0 .9 2
0 .0 0 4
-0 .0 1 5
0 .0 1 2
0 .0 0 1
0 .8 5
0 .8 6
0 .8 4
0 .8 6
0 .89
0 .86
0 .89
0 .89
0 .03
0 .00
0 .05
0 .03
0
0
0
0
0
0
0
0
0
0
0
0
0 .26
0 .26
0 .23
0 .30
0 .2 4
0 .2 5
0 .4 2
0 .1 6
-0 .0 1
-0 .0 1
0 .19
-0 .1 4
N o rt h e rn A m e ric a
7 2 .0
7 5 .4
3 .4
0.7 9 1
0 .9 3
0 .9 2
-0 .0 1 1
0 .9 0
0 .89
-0 .0 1
0
0
0
0 .16
0 .1 3
-0 .0 4
O cea n ia
A u s tr alia /N ew Z ea lan d
6 1 .9
7 1 .3
5 9 .4
6 9 .0
-2 .4
-2 .2
0.3 2 0
0.3 6 7
0 .9 2
0 .9 2
0 .9 2
0 .9 2
0 .0 0 0
0 .0 0 1
0 .8 6
0 .8 8
0 .85
0 .88
-0 .0 1
0 .00
0
0
0
0
0
0
0 .22
0 .22
0 .0 6
0 .0 4
-0 .1 6
-0 .1 8
M e lan e s ia/M ic ro n e s ia/
P o ly ne s ia
2 8 .3
3 6 .9
8 .4
0.9 0 0
0 .9 0
0 .9 1
0 .0 0 2
0 .7 5
0 .78
0 .03
0
0
0
0 .14
0 .1 7
0 .02
So ur c e s : M od e l -ba s e d e s t i m a te s ba s e d o n A l ke m a e t a l. (20 13 ) us i ng m e t ho d-m i x c om pu ta ti o ns ba s e d o n U ni t e d N a tio ns (2 01 2, 20 13 ).
Among the 188 countries examined, the average method mix effectiveness score
increased in 103 countries (or 55 per cent of all countries) from 1990 to 2011 and the
range of change varied widely across countries, from -0.05 in Botswana to 0.13 in
Burkina Faso and Djibouti. Figure 3 shows the 188 countries by absolute change between
1990 and 2011 in method mix effectiveness scores and the percentage point change in
contraceptive prevalence according to a country’s average method mix effectiveness
score in 1990 (with 0.90 used as a cut-point to distinguish high from low effectiveness).
Increases in contraceptive prevalence were not generally associated with increased
method mix effectiveness. Increases in contraceptive prevalence since 1990 were not
associated with improvements in method mix effectiveness, even among countries with
less effective method mix profiles in 1990 (R2 of 0.004).
Figure 3. Absolute change from 1990-2011 in average method mix effectiveness and
contraceptive prevalence for 188 countries, by method mix effectiveness in 1990
0 .1 4
A bso lute c ha ng e in a v era g e m etho d m ix effectiv e ness
0 .1 2
0 .1 0
Effectivenes s les s
than 0 .9 0 (1 9 9 0 )
0 .0 8
Effectivenes s 0 .9 0
or hig her (1 9 9 0 )
0 .0 6
0 .0 4
2
R = 0 .0 0 4
Linear
(Effective nes s les s
than 0 .9 0 (1 9 9 0 ))
0 .0 2
0 .0 0
-1 0 .0
-0 .0 2
-0 .0 4
-0 .0 6
0 .0
1 0 .0
2 0 .0
3 0 .0
4 0 .0
5 0 .0
6 0 .0
The exploratory measure of effectiveness of total demand over time provided a broad
sense of change in effectiveness in pregnancy prevention over time. However, the
measure is highly correlated with change in contraceptive prevalence (R2 = 0.75 among
188 countries) and thus is best used as a summary measure that includes both coverage of
family planning among women who want to delay or stop childbearing and the
effectiveness of methods used.
Method mix concentration
The dominance of a single method among married or in-union women who use
contraception occurred in only four subregions (table 1) and the specific methods that
dominated varied. In 2011, one method accounted for 50 per cent or more of use in
Central Asia (IUD is 72 per cent of total use), Middle Africa (traditional methods are 57
per cent of total use), Southern Asia (female sterilization is 52 per cent of total use) and
Western Europe (pill is 54 per cent of use). The same methods also dominated use in
these subregions in 1990 as well. Only Western Africa moved from the dominance of
traditional methods in 1990 (56 per cent of total use) to no dominant method in 2011.
Among the 188 countries in 2011, a single method accounted for at least half of all
contraceptive use in 52 countries (or 28 per cent of all countries), 13 of which moved into
a skewed method distribution over time while the remaining 39 countries had a skewed
distribution in 1990 (table 2). The most common dominant methods in 2011 were the pill
and traditional methods. Countries with a dominant single method spanned geographic
regions and contraceptive prevalence levels. For example, Ethiopia had a 28 per cent
contraceptive prevalence rate in 2011 and 73 per cent of users relied on injectables while
Mexico had a 72 per cent contraceptive prevalence rate in 2011 and 53 per cent of users
relied on female sterilization). An additional 30 countries moved from a disproportionate
reliance on one method in 1990 to a more balanced distribution in 2011. While the
unweighted average change in contraceptive prevalence was highest (12 percentage
points) among countries with more balanced method distributions in both 1990 and 2011,
there was no clear pattern in the magnitude of contraceptive prevalence change by
whether countries had a dominant method or not.
15
Table 2. Number of countries with one dominant method of contraception and the
unweighted percentage point change in contraceptive prevalence, 1990 to 2011
Number of
countries
Percentage of
countries
Percentage point change in
contraceptive prevalence
(unweighted)
No dominant method (1990 & 2011)
106
56.4
12.2
Decrease (dominant method in 1990, none in 2011)
30
16.0
8.5
Increase (none in 1990, dominant method in 2011)
13
6.9
11.1
Dominant method (1990 & 2011)
39
20.7
8.7
Dominant methods in 2011
Pill
Traditional methods
Injectables
IUD
Female sterilization
Male condoms
20
11
8
7
4
2
The second measure of concentrated modern method mix indicates the amount and
distribution of modern method prevalence accounted for by the top three modern
methods. It is computed as the difference in prevalence rates between the most prevalent
modern method and the third-most prevalent method, divided by total modern method
prevalence (USAID 2012). Higher values indicate a higher concentration of use on a
limited number of methods (with a maximum value of 1, when all modern method use is
attributable to one method). Declines over time (negative values of absolute change)
indicate movement towards a more balanced distribution of modern methods among
married or in-union women using modern methods.
At the global level, the distribution of modern methods (with the top three methods being
female sterilization, IUD and pill) became more balanced from 1990 to 2011 according to
this measure (see table 1), declining from 0.19 in 1990 to 0.17 in 2011. Wide relative
distances between the first and the third modern methods – showing an unbalanced mix
of modern methods – were in Central Asia (value of 0.72, top three modern methods
16
were IUD, pill and male condom), Southern Asia (value of 0.49, top three modern
methods were female sterilization, pill and male condom), Eastern Africa (value of 0.46,
top three modern methods were injectables, pill and female sterilization) and Western
Europe (value of 0.45, top three modern methods were pill, IUD and male condom).
Married or in-union women in Africa, Northern America, Europe and Oceania had the
most balanced distribution of modern method use among all regions (scores of 0.15 or
lower in 2011). Interestingly, each sub-region of Africa shows modern method use
concentrated on three or fewer methods, but since the types of methods that dominate
vary across sub-regions (e.g., injectables dominate in Eastern Africa while the pill and
IUDs dominate in Northern Africa), the distribution for the region as a whole is more
balanced.
Countries with very high modern method prevalence (over 70 per cent among married or
in-union women) also had the most balanced distributions of modern methods: for
example, Australia, Austria, Canada, Cuba, New Zealand, Paraguay, United Kingdom
and United States of America each had modern method prevalence of over 60 per cent in
2011 and a score on the concentrated modern method use of 0.15 or below. However,
other countries achieved a high prevalence of modern methods with a high method mix
concentration. For example, at similarly high levels of modern contraceptive prevalence,
Dominican Republic, Germany, Portugal and Uzbekistan had a concentrated modern
method use score of 0.50 or higher. There is no evidence that increases in modern method
use over the past 20 years were related to less concentrated modern method distributions
(figure 4). For countries where contraceptive prevalence in 1990 was less than 60 per
cent, there was a small positive correlation (R2 = 0.02) between increasing contraceptive
prevalence from 1990 to 2011 and a decline in concentration of modern method mix over
the same period.
17
Figure 4. Absolute change from 1990-2011 in concentrated modern method mix and
modern contraceptive prevalence for 188 countries, by contraceptive prevalence
rate in 1990
0 .6 0
A bso lute cha ng e in co ncentra te d m o dern m etho d m ix
0 .4 0
Modern method us e les s
than 6 0 per ce nt (1 9 9 0 )
0 .2 0
2
R = 0 .0 1 6 7
0 .0 0
-1 0 .0
Modern method us e 6 0
per cent or more (1 9 9 0 )
0 .0
1 0 .0
2 0 .0
3 0 .0
4 0 .0
5 0 .0
6 0 .0
Linear (Moder n me thod
us e les s than 6 0 per
cent (1 9 9 0 ))
-0 .2 0
-0 .4 0
-0 .6 0
Discussion
We provided estimates of the distribution of contraceptive users by method for 188
countries at two time points, 1990 and 2011, and computed several measures of the
effectiveness and concentration of contraceptive methods used to characterize global,
regional and country-level changes over time. We standardized comparisons in method
mix over time by drawing on annual, model-based estimates of contraceptive prevalence
(total, modern and traditional) and unmet need for family planning, an improvement over
prior studies of contraceptive method mix that faced the common challenges of data with
uneven time periods or partial geographic coverage (Bongaarts and Johansson 2002;
Seiber et al. 2007; Sullivan et al. 2006; Sutherland et al. 2011).
18
Female sterilization and the IUD were the two most common methods used by women
worldwide who were aged 15-49 and married or in a union, representing more than half
of all methods used in both 1990 and 2011. Geographical differences in method mix
profiles were large and change over the past 20 years occurred slowly. Similarly, average
use-effectiveness method mix profiles changed little from 1990 to 2011. The introduction
and adoption of relatively new contraceptive technologies, such as injectables and
implants, or older methods, such as sterilization and pills, are contingent on both supplyside factors (e.g., governmental regulation, public and private sector promotion and
distribution of methods) and demand-side factors (e.g., preferences for stopping or
spacing pregnancies, ease and acceptability of use, perceptions of health side effects or
social opposition). Empirical evidence also suggests that decisions about contraceptive
method use are path-dependent; that is, people are often more prone to adopt or continue
to use the methods they know best (or know best from the experience of friends or
family) rather than adopt or switch to a new or under-utilized method (see Potter, 1999,
for an in-depth analysis of Brazil and Mexico of persistent method mix distributions and
tendencies for the distribution of methods used to become concentrated over time).
Despite the slow changes at the global level, several important changes took place in
select regions, such as a decline in traditional method prevalence in Europe and an
increase in use of injectables in Africa, and at the national level, where the prevalence of
individual methods and their position among other methods have shifted dramatically in
some countries.
We also examined the degree to which a rise in contraceptive prevalence over time was
associated with increases in the average use-effectiveness and decreases in the
concentration of methods used. Despite the objectives set forth in international
agreements on what ideally should happen—that is, improved access to the widest
possible range of safe and effective family-planning methods—there is little empirical
evidence to suggest that increases in contraceptive prevalence since 1990 have been
associated with increased effectiveness of method use or a more balanced modern method
mix for countries.
19
The exploratory measure of effectiveness of total demand captured the degree to which
all women who want to delay or stop childbearing are able to prevent pregnancy
effectively. It provided a broader sense of change in effectiveness in pregnancy
prevention over time and integrated both changes in the effectiveness of methods used by
married or in-union women and changes in the prevalence of unmet need for family
planning. The measure showed greater variability over time and space and, since it is
sensitive to changes in unmet need, perhaps merits consideration as a summary measure
of coverage of family planning among women who want to delay or stop childbearing
and the effectiveness of methods used.
This study has several limitations. First, we focused on women’s utilization of
contraceptive methods and did not take into account characteristics of the supply and
delivery aspects of family planning services or the composition of women’s fertility
preferences (to space or stop childbearing), both of which affect the types of methods that
women use over time. Second, most of the data and all of the computed measures using
model-based estimates of family planning are with reference to reproductive-aged women
who are married or in a cohabiting union. Patterns of method mix profiles among
sexually-active women are likely quite distinct from married or in-union women, and
thus separate estimates are needed for both populations. Third, the measures of method
mix concentration were somewhat problematic. The dominant method indicator (50 per
cent or more of contraceptive use attributed to one method) misses more subtle
differences and changes over time in the distribution of methods. The second measure of
the relative distance between prevalence of the first and the third most common modern
method was more difficult to interpret apart from at a value of 1, only one method is
used. Furthermore, the values indicated a high concentration of modern methods in
subregions of Africa, but at the higher level of Africa, the method mix profile was
relatively balanced due to the fact that in each subregion different methods were
dominant (table 1). We suggest exploring other measures of concentration used in other
substantive research areas.
20
Recent international efforts to expand access to effective contraceptive methods have
brought renewed attention to issues of method mix and quality of care in family planning
services. For example, the Family Planning 2020 initiative, spearheaded by the Bill &
Melinda Gates Foundation, began in 2012 with the goal of providing modern
contraceptive methods to an additional 120 million women in 69 of the world’s poorest
countries by 2020. Over $2.6 billion in financial commitments were made in this regard.
A diverse mix of effective methods theoretically provides more choices for women and
men and better matches of methods to individual needs. Thus, improving the mix of
methods available to women and men could help ensure that individuals are able to
prevent pregnancy in an effective manner, to switch easily to another method if they are
unsatisfied with their current method, to match better their fertility preferences to a
specific contraceptive method (e.g., for those who want to stop childbearing, a permanent
or long-acting method may be preferable to a short-term method) and, in general, to
realize their rights to determine if, when and how many children they want to have. The
evidence examined in this study provides a more qualified view of the potential impact of
increasing the range of methods available to, and used by, women and men on
contraceptive prevalence and unmet need for family planning.
21
References
Ali MM, Cleland J, Shah IH. 2012. Causes and consequences of contraceptive
discontinuation: evidence from 60 demographic and health surveys. Geneva: World
Health Organization.
Alkema L, Kantorova V, Menozzi C, Biddlecom A. 2013. National, regional and global
rates and trends in contraceptive prevalence and unmet need for family planning between
1990 and 2015: a systematic and comprehensive analysis. Lancet 2013; published online
March 12. http://dx.doi.org/10.1016/S0140-6736(12)62204-1.
Bongaarts J, Johansson E. 2002. Future trends in contraceptive prevalence and method
mix in the developing world. Studies in Family Planning 33(1):24–36.
Darroch JE, Singh S. 2011. Estimating unintended pregnancies averted from couple-years
of protection (CYP). Unpublished memo.
http://www.guttmacher.org/pubs/2011/01/24/Guttmacher-CYP-Memo.pdf
Hatcher R, et al. 2011. Contraceptive Technology, Revised 20th edition. Bridging the Gap
Foundation . (see Table 3-2, accessible at
http://www.contraceptivetechnology.com/CTFailureTable.pdf).
Potter, JE. 1999. The persistence of outmoded contraceptive regimes: The cases of
Mexico and Brazil. Population and Development Review 25(4):703-739.
Ross J, Hardee K, Mumford E, Eid S. 2002. Contraceptive method choice in developing
countries. International Family Planning Perspectives 28(1):32-40.
Seiber EE, Bertrand JT and Sullivan TM. 2007. Changes in contraceptive method mix in
developing countries. International Family Planning Perspectives 33(3):117–123.
Sullivan TM, Bertrand JT, Rice J, Shelton JD. 2006. Skewed contraceptive method mix:
why it happens, why it matters. Journal of Biosocial Science 38(4):501-21.
Sutherland EG, Otterness C, Janowitz B. 2011. What happens to contraceptive use after
injectables are introduced? An analysis of 13 countries. International Perspectives on
Sexual and Reproductive Health 37(4):202-208.
United Nations. 1996. Programme of Action Adopted at the International Conference on
Population and Development, Cairo. New York: United Nations.
United Nations, Department of Economic and Social Affairs, Population Division. 2012.
World Contraceptive Use 2012 (POP/DB/CP/Rev2012). Available at
http://www.un.org/esa/population/publications/WCU2012/MainFrame.html
22
United Nations, Department of Economic and Social Affairs, Population Division. 2013.
2013 Update for the MDG Database: Contraceptive Prevalence
(POP/DB/CP/A/MDG2013). Available at
http://www.un.org/en/development/desa/population/theme/mdg/index.shtml
USAID | DELIVER PROJECT, Task Order 4. 2012. A Decade of Monitoring
Contraceptive Security and Measuring Successes and Opportunities around the World.
Arlington, VA: USAID | DELIVER PROJECT, Task Order 4. See also
http://deliver.jsi.com/dlvr_content/resources/allpubs/factsheets/CSIndexWallChart2012.p
df
23
Appendix table 1. Dates of survey data used to compute method mix distributions
for 1990 and 2011
Ea rlier time p erio d
L at er time p erio d
S am e su rv ey
A FR IC A
Ea st ern A f rica
Bu run di
Co mor os
1 98 7
1 99 6
20 10 /1 1
2 00 0
D jib ou ti
Eritrea
Ethio pia
2 00 2
1 99 5
1 99 0
2 00 6
2 00 2
20 10 /1 1
1 98 8/8 9
1 99 2
1 99 2
1 99 1
20 08 /0 9
20 08 /0 9
2 01 0
2 00 2
M ozam biq ue
Réu nion
Rw and a
1 99 7
1 99 0
1 99 2
2 01 1
1 99 7
20 10 /1 1
So uth S u dan
2 00 6
2 00 6
1 99 9
1 98 8/8 9
1 99 1/9 2
20 05 /0 6
2 01 1
2 01 0
K enya
M adag as car
M alaw i
M aur itiu s
So malia
U gand a
U nited R epu blic of T anzan ia
Zamb ia
Zimbab w e
1 99 2
2 00 7
1 98 8/8 9
20 10 /1 1
1 99 6
1 99 1
20 08 /0 9
2 01 1
s am e
Mid d le A frica
An go la
Came roo n
Cen tral A frican R ep ublic
1 99 4/9 5
2 00 6
Ch ad
Co ngo
D emocr atic Rep ub lic o f the C ong o
1 99 6/9 7
2 00 5
1 99 1
2 01 0
20 11 /1 2
2 01 0
Equ ator ia l G u inea
2 00 0
2 00 0
G abo n
Sao To me and P r incipe
2 00 0
2 00 0
2 01 2
20 08 /0 9
1 99 2
1 99 1
1 99 5
2 00 6
2 00 8
1 99 5
1 98 7
1 98 9/9 0
1 98 8
20 10 /1 1
2 01 0
20 10 /1 1
Bo tsw an a
Leso tho
N amibia
1 98 8
1 99 1/9 2
1 98 9
20 07 /0 8
2 00 9
20 06 /0 7
So uth A f rica
1 98 7/8 9
20 03 /0 4
1 98 8
2 01 0
s am e
N orth ern A frica
Alg eria
Egy pt
Libya
M or occo
Su dan
Tun isia
So u th ern A frica
Sw azilan d
We st ern A f rica
Ben in
1 99 6
20 11 /1 2
Bu rkin a Fas o
1 99 2/9 3
20 10 /1 1
Cap e V erde
Cô te d 'Iv oir e
1 98 8/8 9
1 99 4
2 00 5
20 11 /1 2
G ambia
G hana
1 99 0
1 99 1/9 2
2 01 0
2 00 8
G uinea
1 99 2/9 3
2 01 2
2 00 0
1 98 6
1 98 7
2 01 0
2 00 7
2 00 6
G uinea- Bis s au
Liber ia
M ali
M aur itan ia
1 99 1/9 2
2 00 7
N ig er
N ig eria
Sen egal
1 99 2
1 99 0
1 99 2/9 3
2 01 2
2 01 1
20 10 /1 1
1 99 2
1 98 8
2 01 0
2 01 0
Sier ra Leo ne
Tog o
24
s am e
Appendix table 1. (continued) Dates of survey data used to compute method mix
distributions for 1990 and 2011
A SI A
C ent ral A s ia
K azakh stan
K yrg yzs tan
1 99 5
1 99 7
20 10 /1 1
20 05 /0 6
Tajikis tan
2 00 0
2 01 2
Tur kmen istan
2 00 0
2 00 0
U zbek istan
1 99 6
2 00 6
s am e
Ea st ern A s ia
Ch in a
1 98 8
2 00 6
1 99 2
1 99 0/9 2
2 00 7
2 00 2
Jap an
1 99 0
2 00 5
M on go lia
1 99 4
2 01 0
Rep ub lic o f K or ea
1 99 1
2 00 9
2 00 0
1 99 1
2 01 0
2 01 1
Ch in a, H o ng K ong SA R
D em ocr atic Pe op le 's R epu blic of K o rea
So u th ern A sia
Af gh anis tan
Ban glad esh
Bh utan
Ind ia
1 99 4
2 01 0
1 99 2/9 3
20 07 /0 8
1 99 2
1 99 1
2 00 2
2 00 9
Iran ( Is lamic Rep ub lic of)
M aldiv es
N epal
Pa kis ta n
1 99 1
2 01 1
1 99 0/9 1
20 06 /0 7
1 99 3
20 06 /0 7
1 99 5
1 99 1
20 10 /1 1
2 01 2
Sr i L anka
So u th -E as tern A s ia
Camb od ia
Ind on esia
Lao P eo ple's D emoc ratic Rep ub lic
1 99 3
2 00 5
M alays ia
1 98 8
2 00 4
M yan m ar
1 99 1
20 09 /1 0
Ph ilipp ines
Sin gap or e
1 99 3
1 99 2
2 01 1
1 99 7
Thailan d
1 98 9
2 00 9
Timo r-Les te
1 99 1
20 09 /1 0
V ie t N am
1 98 8
20 10 /1 1
1 99 1
2 00 0
2 01 0
2 00 6
We st ern A s ia
Ar men ia
Az erba ija n
Bah rain
1 98 9
1 99 5
G eorg ia
1 99 9/0 0
2 01 0
Iraq
Is rael
1 98 9
1 98 7/8 8
2 01 1
19 87 /8 8
1 99 0
1 98 7
2 00 9
1 99 9
Jo rd an
K uw ait
Leban on
O man
1 99 6
2 00 4
1 98 8/8 9
2 00 0
1 98 7
1 99 6
1 99 8
2 00 7
Q atar
Sau di A rab ia
State o f P alestin e
1 99 6
2 00 6
Sy rian A ra b Rep ub lic
1 99 3
2 00 6
Tur key
1 98 8
2 00 8
U nited A rab Em ira te s
1 99 5
1 99 5
Y em en
1 99 2
2 00 6
25
s am e
s am e
Appendix table 1. (continued) Dates of survey data used to compute method mix
distributions for 1990 and 2011
EU R O PE
Ea st ern E u rop e
Belar us
1 99 5
20 05 /0 6
Bu lgaria
1 99 5
2 00 7
Czech Rep ub lic
1 99 1
2 00 8
H ung ary
1 98 6
19 92 /9 3
Po land
1 99 1
1 99 1
Rep ub lic o f M old ov a
1 99 7
2 00 5
1 99 3
2 00 5
Ro mania
Ru ss ian F ede ration
s am e
1 99 2/9 3
2 00 7
Slo vak ia
1 99 1
1 99 7
U krain e
1 99 9
2 00 7
N orth ern E ur op e
D enmar k
Esto nia
1 98 8
1 99 4
1 98 8
20 04 /0 5
s am e
Fin land
1 98 9
1 98 9
s am e
Irelan d
1 99 8
20 04 /0 5
Latvia
1 99 5
1 99 5
Lithuan ia
1 99 4/9 5
2 00 6
N orw ay
1 98 8/8 9
2 00 5
Sw ed en
1 99 6
1 99 6
U nited K ing do m
1 98 9
20 08 /0 9
So u th ern Eu ro pe
Alb ania
2 00 0
20 08 /0 9
Bo sn ia and H er zego vin a
2 00 0
20 11 /1 2
G reece
Italy
M alta
1 98 3
2 00 1
1 99 5/9 6
1 99 3
19 95 /9 6
1 99 3
M on teneg ro
2 00 0
20 05 /0 6
Po rtu gal
1 99 7
20 05 /0 6
Ser bia
2 00 0
2 01 0
Slo ven ia
1 99 4/9 5
19 94 /9 5
Sp ain
1 99 4/9 5
2 00 6
We st ern E u rop e
Au s tr ia
1 99 5/9 6
20 08 /0 9
Belg ium
1 99 1/9 2
20 08 /1 0
s am e
s am e
s am e
s am e
s am e
Fr ance
1 98 8
2 00 8
G erman y
N etherlan ds
1 99 2
1 99 3
2 00 5
2 00 8
Sw itzer la nd
1 99 4/9 5
19 94 /9 5
s am e
An gu illa
2 00 3
2 00 3
s am e
An tigu a an d B arb ud a
1 98 8
1 98 8
s am e
Bah amas
1 98 8
1 98 8
s am e
Bar bad os
1 98 8
1 98 8
s am e
Cu ba
1 98 7
20 10 /1 1
D omin ica
1 98 7
1 98 7
D omin ican Re pub lic
1 99 1
2 00 7
G renad a
H aiti
1 99 0
1 98 9
1 99 0
2 01 2
LA T IN A M ER I C A A N D TH E C A R I BB EA N
C arib b ean
26
s am e
s am e
Appendix table 1. (continued) Dates of survey data used to compute method mix
distributions for 1990 and 2011
Ja m a i c a
1 98 9
20 02 /0 3
M on t se r ra t
1 98 4
1 98 4
s am e
1 99 5/ 9 6
1 98 4
2 00 2
1 98 4
s am e
Sa i n t L uc i a
1 98 8
1 98 8
s am e
Sa i n t V i n c e n t a n d t he G re n a di n e s
1 98 8
1 98 8
s am e
T ri n id a d a n d T o ba g o
1 98 7
2 00 6
U ni t e d S t a t e s V i r g i n Is l a n ds
2 00 2
2 00 2
1 99 1
2 01 1
Pu e rt o R i c o
Sa i n t K i t t s a nd N e v i s
s am e
C e nt r a l A m e r i c a
Belize
C o st a R i c a
E l S a l v a do r
G ua t e m a l a
1 99 2/ 9 3
2 01 0
1 98 8
2 00 8
1 98 7
2 00 2
H on d ur a s
M e xi c o
1 99 1/ 9 2
1 98 7
20 05 /0 6
2 00 6
N ic a ra gu a
1 99 2/ 9 3
20 06 /0 7
Pa na m a
1 98 4/ 8 5
2 00 9
So u th A m e r i c a
Ar ge n t i n a
2 00 1
20 04 /0 5
B o l i v i a (P l u r i na t i o n a l St a t e o f)
Br az il
1 98 9
1 98 6
2 00 8
2 00 6
C h il e
2 00 1
2 00 6
Co lom b ia
1 99 0
20 09 /1 0
1 98 9
1 99 1/ 9 2
2 00 4
2 00 9
E c ua d o r
G uy a n a
Pa ra g u a y
1 99 0
2 00 8
1 99 1/ 9 2
2 01 1
Su ri na m e
U rug ua y
1 99 2
1 98 6
2 00 6
2 00 4
V e n e z u e l a ( B o l i va r i a n R e p u b l i c o f)
1 99 3
1 99 8
Pe ru
N O R T H E R N A M E R IC A
C a n a da
1 98 4
2 00 2
U ni t e d S t a t e s o f A m e ri c a
1 99 0
20 06 /1 0
Au s tr a l i a
1 99 5
20 05 /0 6
N e w Z e a la n d
1 99 5
1 99 5
s am e
C o o k I sl a n d s
G ua m
1 99 9
2 00 2
1 99 9
2 00 2
s am e
s am e
K ir i ba t i
2 00 0
2 00 9
M a rs ha l l Is l a nd s
1 98 5
2 00 7
N a u ru
2 00 7
2 00 7
s am e
Pa la u
Pa pu a N e w G ui n e a
2 00 3
1 99 6
2 00 3
20 06 /0 7
s am e
O C E A N IA
M e l a n e si a / M i c r o n e si a / P o ly n e s ia
Sa m o a
1 99 8
2 00 9
2 00 6/ 0 7
20 06 /0 7
s am e
T uv a l u
2 00 7
2 00 7
s am e
V a n ua tu
1 99 5
2 00 7
So l om on I sl a n ds
27
Appendix table 2. Total and method-specific contraceptive prevalence (percentage) among married or in-union women of
reproductive age by development group and region, 1990 and 2011
Female
sterilzation
Male
sterilization
Pill
Injectable
Implant
IUD
Male
condom
Vaginal barrier
methods
Other modern
methods
Traditional
methods
17.1
18.9
4.0
2.4
7.9
8.9
0.9
4.1
0.1
0.5
13.0
13.9
4.4
8.0
0.4
0.2
0.1
0.2
7.1
6.1
1.3
0.1
6.1
1.5
0.0
3.2
0.6
0.1
0.1
4.8
1.7
0.0
8.1
8.3
1.0
4.6
2.0
0.0
0.1
5.5
21.5
4.7
4.5
1.0
0.2
16.1
3.7
0.0
0.0
4.8
23.4
2.2
6.4
3.7
0.4
17.5
7.4
0.1
0.1
5.6
3.7
1.9
17.0
0.0
0.0
14.4
9.4
1.2
0.0
20.6
3.8
2.7
20.5
0.5
0.1
11.9
17.7
1.4
0.3
11.0
Latin Amer &Caribbean - 1990
2011
20.9
26.2
0.6
2.3
18.3
14.9
1.3
6.1
0.0
0.3
7.4
6.5
3.4
10.1
0.7
0.2
0.0
0.0
8.3
6.1
Northern America - 1990
2011
24.5
20.8
13.6
11.9
14.2
16.6
0.0
0.1
0.0
0.6
1.5
4.7
9.7
12.0
2.8
0.1
0.9
2.9
4.5
5.2
Oceania - 1990
2011
12.3
11.0
9.3
11.2
22.4
14.3
1.4
3.6
0.0
1.5
1.9
1.8
9.8
11.6
0.1
0.1
0.7
0.0
3.7
4.1
World - 1990
2011
Africa - 1990
2011
Asia - 1990
2011
Europe - 1990
2011
Sources: Model-based estimates based on Alkema et al. (2013) using method-mix computations based on United Nations (2012, 2013).
Appendix table 3. Method-specific proportional share of total contraceptive prevalence among married or in-union women of
reproductive age by development group and region, 1990 and 2011
Female
sterilzation
Male
sterilization
Pill
Injectable
Implant
IUD
Male
condom
Vaginal barrier
methods
Other modern
methods
Traditional
methods
0.31
0.30
0.07
0.04
0.14
0.14
0.02
0.06
0.00
0.01
0.24
0.22
0.08
0.13
0.01
0.00
0.00
0.00
0.13
0.10
0.07
0.00
0.34
0.08
0.00
0.18
0.03
0.01
0.00
0.27
0.05
0.00
0.26
0.27
0.03
0.15
0.06
0.00
0.00
0.18
0.38
0.08
0.08
0.02
0.00
0.28
0.06
0.00
0.00
0.08
0.35
0.03
0.10
0.05
0.01
0.26
0.11
0.00
0.00
0.08
Europe - 1990
2011
0.05
0.03
0.25
0.00
0.00
0.21
0.14
0.02
0.00
0.30
0.05
0.04
0.29
0.01
0.00
0.17
0.25
0.02
0.00
0.16
Latin Amer &Caribbean - 1990
2011
0.34
0.36
0.01
0.03
0.30
0.20
0.02
0.08
0.00
0.00
0.12
0.09
0.06
0.14
0.01
0.00
0.00
0.00
0.14
0.08
Northern America - 1990
0.34
0.19
0.20
0.00
0.00
0.02
0.14
0.04
0.01
0.06
0.28
0.16
0.22
0.00
0.01
0.06
0.16
0.00
0.04
0.07
0.20
0.15
0.36
0.02
0.00
0.03
0.16
0.00
0.01
0.06
0.19
0.19
0.24
0.06
0.02
0.03
0.20
0.00
0.00
0.07
World - 1990
2011
Africa - 1990
2011
Asia - 1990
2011
2011
Oceania - 1990
2011
Sources: Model-based estimates based on Alkema et al. (2013) using method-mix computations based on United Nations (2012, 2013).
29