Couple-years of protection (CYP)
The estimated protection provided by family planning (FP) services during a one-year period, based upon the volume of all contraceptives sold or distributed free of charge to clients during that period. This includes the provision of FP services for permanent methods, such as sterilization, and the lactational amenorrhea method (LAM).
The CYP for each contraceptive method is calculated by multiplying the number of units distributed (for sale or for free) to clients over a defined period, usually 12 months (could be a calendar year or fiscal year) by a conversion factor that quantifies the duration of contraceptive protection provided per unit distributed and per procedure. The CYPs for each method are then summed over all methods to obtain a total CYP figure.
For some methods like condoms, coital frequency and effectiveness are the most important inputs for the CYP calculation while for methods like intrauterine devices (IUDs) and implants, labelled duration of use and continuation rates are used in the calculation.
The EVALUATION Project undertook an extensive review of the literature and empirical data on a number of the variables that form the underlying assumptions for the calculation of CYP. USAID issued a slightly modified set of conversion factors, which the Agency used since 1997. CYP was updated in 2000 by the EVALUATION Project; in 2011 by the RESPOND Project; and most recently in 2021 by FHI 360, Avenir Health, and USAID.1 The FP methods and conversion factors are endorsed by USAID and are posted on the Agency’s website. The updated factors are as follows:
|Method||CYP Per Unit|
|Sterilization||10 CYP per procedure (Globally)
13 CYP per procedure (India, Nepal & Bangladesh)
|Copper IUD||4.6 CYP per insertion|
|Hormonal IUD||4.8 CYP per insertion|
|Combined Oral Contraceptives (COC) (blister packs of 28 pills)*||0.0667 CYP per pack (i.e., 15 cycles per CYP)|
|Progestin-only Pills (POP) (blister packs of 35 pills)*||0.0833 CYP per pack (i.e., 11.18 cycles per CYP rounded to 12)‡|
|Implants: 3 year (Implanon/ ImplanonNXT, Levoplant)||2.5 CYP per implant|
|Implants: 5 year (Jadelle)||3.8 CYP per implant|
|Injectables||0.25 CYP per dose (Depo Provera) (i.e., 4 doses per CYP)
0.167 CYP per dose (Noristerat) (i.e., 6 doses per CYP)
0.077 CYP per dose (Cyclofem) (i.e., 13 doses per CYP)
|Condoms||0.00833 CYP per unit (i.e., 120 units per CYP)|
|Vaginal Foaming Tablets||0.00833 CYP per unit (i.e., 120 units per CYP)|
|Standard Days Method (SDM)||1.5 CYP per trained adopter|
|LAM||0.25 CYP per user|
|Diaphragm||1 CYP per diaphragm|
|Levonorgestrel 1.5mg for pericoital use||0.033 CYP per pill (i.e., 31 pills per CYP, rounded to 30)‡|
|Hormonal Patch||0.067 CYP per cycle (i.e., 14 cycles per CYP, rounded to 15) ‡|
|Vaginal Ring||0.067 CYP per cycle (i.e., 14 cycles per CYP, rounded to 15)‡|
|Emergency Contraception||0.05 CYP per dose (i.e., 20 doses per CYP)|
*CYP is based on COCs being packaged in packs of 28 pills. USAID currently has long-term agreements with suppliers who package their POPs in packets of 35 pills and does not provide any POPs in 28-day packs. Consequently, separating oral contraceptives into COCs and POPs is necessary.1
‡These estimates are rounded to reflect “USAID’s interest in simplicity (rounding), continuity (with previously used values), and adjustment for suspected wastage.”2
Quantities of pills, condoms, and spermicides distributed to clients; numbers of IUDs and implants inserted; number of injections administered; number of sterilization operations performed; number of trained, confirmed clients of SDM; number of LAM clients during the reference period.
If targeting and/or linking to inequity, outlets can be classified by location (poor/not poor) and CYP can be disaggregated by location.
Service statistics or health management information system, DHIS2
Supply chain data related to FP commodities in warehouse facilities or FP stock delivered to, or in storage at, health facilities should not be used to calculate this indicator. The calculation is based on FP services and products provided to clients. If this information is not available, a proxy CYP can be calculated as noted in the Issues section below.
CYP measures the estimated protection provided by FP based on the volume of contraceptive method distribution to clients to help monitor health system performance and track trends and progress over time. Program managers and donor agencies use it to follow progress in the delivery of contraceptive services to clients at the program and project levels. Because many donors, organizations, and initiatives, such as USAID, IPPF, and FP2020 generally require reporting CYP, this measure is currently one of the most widely used output indicators in international FP programs.
This indicator has several advantages:
- It can be calculated from data routinely collected through programs or projects, and thus minimizes the data collection burden;
- These data can be obtained from all the different service delivery mechanisms (clinics, community-based distributors, social/commercial marketing);
- The CYP calculation is relatively simple to do; and
- CYP allows programs to compare the contraceptive coverage provided by different FP methods.
This indicator should not be used as the sole indicator to measure FP program performance. The principal disadvantages of the indicator are that:
- It is not intuitively easy to understand by those outside the field.
- One cannot ascertain the number of individuals represented by CYP. For example, if a program administers 10,000 injections of Depo Provera, this amount is equivalent to 2,500 CYP. Theoretically, this figure represents 2,500 women protected for 12 months each; however, in fact it may refer to 5,000 women covered for 6 months each or 10,000 women covered for 3 months each.
- CYP reflects distribution to clients and is a way to estimate coverage and not actual use or impact.
- The number of years that are included in the estimates impacts the average duration of use. For example, the same curve was used for estimating continuation for all implants by truncating the data at 3 and 5 years. This method probably slightly overestimates continuation for the shorter implants, especially the 3-year implant.
- Effectiveness of the methods is included in the continuation estimates because discontinuations for all reasons, including due to pregnancy, are looked at together.
- It does not provide information on whether the contraceptive methods are accessible and acceptable to all individuals, nor does it provide any indication of the quality of services.
Regarding the calculation of CYP for long-term methods, most programs “credit” the entire amount to the calendar year in which the client accepted the method. For example, if an FP program performed 100 voluntary surgical contraception procedures in a given year, it would credit all 1000 CYP (100 procedures x 10 years/each) to that calendar year, even though the protection from those procedures would in fact be realized over the subsequent nine years. An alternative approach is to “annualize” this projection, allocating it over a 10-year period. The same principle applies to IUDs and implants. Although the first approach (of crediting the full amount of CYP in the calendar year of acceptance) has been harshly criticized, it represents current practice in most programs that report CYP, probably because it is easier to apply.
CYP calculations are based on the volume of contraceptives distributed to clients who will presumably use them, not on those delivered to facilities where they may remain unused in cartons or on shelves. However, in some projects such as social marketing, it may be impossible to monitor the exact numbers reaching the hands of clients. In these cases, a proxy CYP can be calculated based on the volume of contraceptives delivered to the retailers in question. Given that retailers are unlikely to stock products that move slowly, it is assumed that (after an initial shipment) most contraceptives sold to retailers will make their way into consumers’ hands. If a proxy CYP is calculated using data from logistics management information systems, warehouse supply or delivery, stock-on-hand, or similar sources, those preparing the report should state it is a proxy CYP and provide details on the data source to the users of the information.
Illustrative Computation: Calculations for the number of units of three FP methods that would be required to provide 1,000 CYP1
|Condoms||120,000||120,000 condoms x 0.00833 (1 CYP/120 condoms) = 1,000 CYP|
|COC packets||15,000||15,000 COC packets x 0.067 (1CYP/15 packets) = 1,000 CYP|
|Copper IUDs||217||217 copper IUDs x (4.6 CYP/1 copper IUD) = 1,000 CYP|
long-acting/permanent methods (LAPM), family planning
- Steiner MJ, Sonneveldt E, Lebetkin E, and Jallow F. Updating Couple Years of Protection: Literature Review, Guidance for Updating Existing Methods, and Adding New Methods. FHI 360, Avenir Health, and USAID. August 2021.
- Stover J, Bertrand JT, and Shelton JD. Empirically based conversion factors for calculating couple-years of protection. Eval Rev. 2000;24(1):3-46.
- The RESPOND Project technical meeting. New Developments in the Calculation and Use of CYP and Their Implications for Evaluation of Family Planning Programs. September 8, 2011.