Number of users (or acceptors) by method

Service statistics (program-based) or DHS-type surveys (population-based)

The method mix provides a profile of the relative level of use of different contraceptive methods. A broad method mix suggests that the population has access to a range of different contraceptive methods. Conversely, method mix can signal: (1) provider bias in the system, if one method is strongly favored to the exclusion of others; (2) user preferences; or (3) both.

Regarding what constitutes a desirable method mix, practitioners generally feel that a program should respond to the changing needs of the population at different stages in the reproductive life cycle, and offer reversible methods for those who desire to space pregnancies and permanent methods for those who have completed their desired family size. Thus, programs offering no permanent methods or overemphasizing permanent methods are subject to criticism. Yet within the category of reversible methods, the distribution of acceptors by type of contraceptive will vary by availability of specific methods, costs, local preferences, and other factors, and thus make it difficult to generalize regarding desirable method mix.

Method mix often changes in response to the introduction of a new method in-country, to non-availability of methods due to stockout, to increased need for a method that also protects against sexually transmitted infections (i.e., condoms), and to user preferences. Data on method mix can signal these changes, but do not provide insight into the reasons for the change. Evaluators can use qualitative methods to better understand the clients’ motivations for switching methods.

Because of the problems of monitoring the number of current users based on service statistics, method mix is generally based on acceptors, not on current users, when measured at the program level. The two yield different distributions, since user data reflects the accumulation of long-acting methods from previous years.

Similarly, one expects some discrepancy on method mix calculated from program statistics versus surveys, even in programs with reliable data. (The reason is that program- based statistics reflect activity in the calendar year under study, whereas the survey results include continuing users of long-acting methods who adopted them in previous years and have not needed or chosen to return to the clinic in the calendar year under study). In addition, survey data may include folk methods, non- program methods (e.g., withdrawal), and program methods also available from non-program sources (e.g., pills from pharmacies).

In the case of method mix, the question is not which source of data is better: program- versus population- based. Both are used in forecasting the future contraceptive needs of a country. Many evaluators consider survey data more reliable for assessing preferences for specific methods, because they include clients from both the public and private sector, in addition to those using a non-program method such as withdrawal. However, one must be mindful that in survey data (e.g., the DHS or RHS) the coefficient of variation may be large, and thus affect the stability of the estimate, especially where the percentage using a specific method is very low. Finally, survey data and service statistics sometimes differ, a situation that can arise from inflated service statistics, wastage in the system, or the sale of products outside the intended area for the program (e.g., across borders).

Contraceptive method mix can be one indication of gender balance in contraceptive responsibility within a country or program. Globally, vasectomy, though safer and less costly, is much less widely available and used than female sterilization is. Nearly a third of all contraceptive users rely on female sterilization, while only seven percent rely on vasectomy. In India, the ratio of 35 female sterilizations to 1 vasectomy suggests that the program is heavily biased towards female responsibility for contraception. In many parts of sub-Saharan Africa, vasectomy remains virtually unknown. The condom, rhythm, and withdrawal also require male participation or responsibility. Family planning programs have historically been poor at involving men in programs, interventions, and discussions.  Encouraging greater gender equity in contraceptive practice is one goal of the efforts to involve men as partners in family planning and reproductive health.

Furthermore, varying gender constraints (e.g. domestic, child/elder care responsibilities, masculine gender roles that inhibit positive health seeking behaviors) and opportunities in-country affect men and women’s ability to access specific family planning methods and/or distribution points and may have significant implications on the actual method mix available to clients in the public sector.