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
The CYP is calculated by multiplying the quantity of each method distributed to clients by a conversion factor, to yield an estimate of the duration of contraceptive protection provided per unit of that method (Wishik and Chen, 1973; Stover, Bertrand, and Shelton, 2000). The CYPs for each method are then summed over all methods to obtain a total CYP figure.
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 USAID system used since 1997. Recently, in 2011, the RESPOND Project updated the CYP conversion factors, which are endorsed by USAID and are posted on the Agency’s website. The updated factors are as follows:
|Method||CYP Per Unit|
|Oral Contraceptives||15 cycles per CYP|
|Condoms (male and female)||120 units per CYP|
|Monthly Vaginal Ring/Patch||15 units per CYP|
|Vaginal Foaming Tablets||120 units per CYP|
|Depo Provera Injectable||4 doses (ml) per CYP|
|Noristerat Injectable||6 doses per CYP|
|Cyclofem Monthly Injectable||13 doses per CYP|
|Copper-T 380-A IUD||4.6 CYP per IUD inserted (3.3 for 5 year IUD, e.g. LNG-IUS)|
|3 Year Implant (e.g. Implanon)||2.5 CYP per implant|
|4 Year Implant (e.g. Sino-Implant)||3.2 CYP per implant|
|5 Year Implant (e.g. Jadelle)||3.8 CYP per implant|
|Emergency Contraceptive Pills||20 doses per CYP|
|Standard Days Method||1.5 CYP per trained adopter|
|Lactational Amenorrhea Method (LAM)||4 active users per CYP (or .25 CYP per user)|
|Sterilization (male and female)*
– India, Bangladesh, Nepal
– Other Asian Countries
– Latin America and the Caribbean
* Note: Because of marked differences in CYP for sterilization by country and by region (based on differences in median age at sterilization), countries should use the median value for their region (assuming their data on age at sterilization conform to those of the region). For more specific data on CYPs and sterilization, consult with national DHS and CDC reproductive health survey records which may provide a historical calculation based on a specific country’s context.
Programs wishing to use country-specific statistics are referred to the Stover, Bertrand, and Shelton (2000) report for the appropriate CYP.
Quantities of pills, condoms, and spermicides distributed to clients; numbers of IUDs and NORPLANT implants inserted; number of injections administered; number of sterilization operations performed; number of trained, confirmed clients of natural FP; 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 logistics management information system
CYP measures the volume of program activity. Program managers and donor agencies use it to monitor progress in the delivery of contraceptive services at the program and project levels. Because USAID and IPPF generally require the organizations they support to report CYP, this measure is currently one of the most widely used indicators of output 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.
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 DepoProvera, 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.
- The validity of the assumptions underlying the choice of conversion factors is open to debate.
- CYP primarily reflects distribution 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, 4, 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 9 years/each) to that calendar year, even though the protection from those procedures would in fact be realized over that and the next nine years. An alternative approach is to “annualize” this projection, allocating it over a nine-year period. The same principle applies to IUDs and the NORPLANT implant. 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.
Ideally, CYP should be based on the volume of contraceptives delivered 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. Rather, the only means of calculating CYP is to base it on the volume of contraceptives delivered to the retailers in question. Given that retailers are unlikely to stock products that move slowly, it is probable that (after an initial shipment) most contraceptives sold to retailers will make their way into consumers’ hands. However, in those instances where the calculation of CYP is based on the volume of products delivered to retailers, not directly to the clients or customers themselves, those preparing the CYP report should clarify this detail to the users of the information.
Illustrative Computation: CYP, based upon conversion factors given in text
|Tubal ligations (globally)||13||130.0|
long-acting/permanent methods (LAPM), family planning
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.