How Balanced is the Method Mix in Low- and Middle-Income Countries?

WASHINGTON, DC (March 28, 2015) – In the March 2015 issue of Global Health: Science and Practice, a paper by Evidence Project researchers John Ross, Jill Keesbury, and Karen Hardee examines the dynamics of method-mix transitions in low- and middle-income countries, providing important insights for future efforts to expand contraceptive method access and choice.

A country’s method mix provides a profile of the relative level of use of different contraceptive methods. In many countries, the contraceptive method mix is severely unbalanced with a single method accounting for over 50 percent of all contraceptive use. A broader mix expands contraceptive method choice, letting women and couples choose the method that suits them best and change methods as their circumstances and needs change.

“How to expand a country’s method mix is an important policy question,” notes John Ross, lead author of the paper, “Trends in the Contraceptive Method Mix in Low- and Middle-Income Countries: Analysis Using a New ‘Average Deviation’ Measure.”  “We took advantage of the availability of a wide range of national surveys in 123 countries to analyze trends in their method mixes and to detect patterns of improvement among selected countries that have moved away from the dominance of a single method.”

The authors found that the method mix is getting a little broader on average across the 123 countries. In 28 percent of the countries analyzed more than half of users are using a single method, down from 35 percent in a 2006 analysis.

Certain individual countries have improved substantially, with notable positive changes in the composition of the method mix while simultaneously experiencing increases in total contraceptive use. The authors examined 15 such countries and found distinct patterns of improvement, which can provide lessons for other countries.

One such pattern entails the takeoff of one method partially offset by changes among other methods. “Uganda is a good example of this pattern,” explains Karen Hardee, Director of the Evidence Project and another author of the paper. “Here the rise in the injectable is nearly a mirror image of the decline in the share of the traditional methods of rhythm and withdrawal.”

Strategy questions can occasionally face program managers, policymakers, and donors. “While countries should strive to create a better balance in the total method mix, including neglected methods, perhaps in some cases it makes sense to focus resources on a method that is gaining in popularity,” explains John Ross.

“But the bottom line is that decision-makers should keep a sharp eye both on trends in method dominance and in total use to ensure individual choice and equitable access.”

To foster further use and analysis of the data, the complete data set will soon be available on the Global Health: Science and Practice website.