Number of users (or acceptors) by method. This indicator can be calculated for women who are married/in union or among all women of reproductive age.

Data Sources:

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

Purpose:

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, a skewed method mix, in which one method accounts for 50% or more of total use, can signal: (1) provider bias toward a method; (2) user preferences; (3) supply factors that support certain methods; or (4) all of these. Research has found that almost one third of lower- and middle-income countries have a skewed method mix, though the dominant method differs significantly across and within regions (Bertrand et al., 2020).

Regarding what constitutes a desirable or “ideal” 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, such as by offering reversible methods for individuals who desire to space pregnancies and permanent methods for individuals 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 users (or 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 a desirable method mix.

Issues:

Method mix can change in response to the introduction of a new method in-country, the non-availability of methods due to stockout, an increased need for a method that also protects against sexually transmitted infections (i.e., condoms), and/or 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 adopting and switching methods. Furthermore, method mix should not be used as a proxy measure of user preferences, as users may not be using their preferred method. A review of research on this issue found that the proportion of current users with an unsatisfied method preference ranged between 18 to 67% and was related to method continuation and eventual pregnancy outcomes (Burke and Potter, 2023).

Another issue is that the calculation of method mix using data from service statistics is generally based on “acceptors” rather than “current users”, as obtained through population-based surveys. The two yield different distributions and discrepancy between the calculations can be expected, even in programs with reliable health information system 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 demand 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 traditional methods. Survey data and service statistics can also differ due to inflated service statistics (e.g., double counting), 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 accepted, available, and used than female sterilization, and its share of the global method mix is on the decline (Bretrand et al., 2020). Nearly a third of all contraceptive users rely on female sterilization, while less than three percent rely on vasectomy (Haakenstad et al., 2022). In India, the ratio of 36 female sterilizations to <1 vasectomy suggests the persistent unpopularity of vasectomy and that the program is heavily biased towards female responsibility for contraception (Bertrand et al., 2020). The male condom, fertility-awareness based methods, rhythm method, and withdrawal also require male participation or responsibility. Family planning programs have historically been poor at involving men in programs, interventions, and discussions, though efforts to improve men’s and boys’ engagement in family planning have increased. Encouraging greater gender equity in contraceptive practice is one goal of the efforts to involve men as supportive partners in family planning and reproductive health.

Furthermore, varying gender constraints (e.g., lack of agency among women to make decisions about their reproductive health, child/elder care responsibilities, masculine gender roles that inhibit positive health seeking behaviors) 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.

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