Contraceptive prevalence rate among young people
The percent of young women aged 15-24 years who are currently using (or whose sexual partner is using) a contraceptive method. “Currently” is defined as within the past three months. The contraceptive prevalence rate (CPR) is usually reported for women married or in sexual union, but this can be defined by the evaluator based on the local context.
Generally, the measure includes all contraceptive methods (modern and traditional), but it may include modern methods only. Contraceptive methods include condoms, female and male sterilization, injectable and oral hormones, intrauterine devices, diaphragms, spermicides and fertility awareness methods such as lactational amenorrhea and the standard days method. Because only condoms are effective in preventing HIV infections among methods of contraceptives, specific indicators on condom use are also considered.
The indicator is calculated as follows:
(Number of currently sexually active women 15-24 using a contraceptive method / Total number of currently sexually active women 15-24) x 100
Illustrative example based on Uganda DHS 2006 numbers
|All women 15-24||Women currently married or in union 15-24|
|CPR = 490/3646) x 100 = 13.4%||CPR = (292/1528) x 100 = 19.1%|
The total number of women 15-24, disaggregated by marital status, and among them, the number that are currently using a contraceptive method. Data can be further disaggregated by socio-economic status and regional and geographical areas, as well as by age groups from 15-19 and 20-24, as the older age group is more likely to use a modern method of contraception (DHS, 2008).
Population-based surveys such as DHS, MICS
This version of CPR provides a measure of coverage of contraceptive use among young women, taking into account all sources of supply and all contraceptive methods. It is the most widely reported measure of outcome for family planning (FP) programs at the population level.
Technically speaking, CPR is a ratio, not a rate. (Prevalence is measured by a ratio and incidence by a rate.) For a given year, this indicator measures the percentage of sexually active young women who use a form of contraception. To obtain a true contraceptive use rate, the denominator should reflect the population at risk (of pregnancy), i.e., sexually active women who are not infecund, pregnant, or amenhorreic. The numerator should reflect the number of contraceptive users from that population. The international population community uses the term “contraceptive prevalence rate” as defined above; thus, this database endorses this practice to assure consistency.
This indicator is important in capturing impact of FP programs on young women. In 19 sub-Saharan African countries rates of pre-marital sex before the age of 18 rose significantly between 1993 and 2001 and while CPR has also increased for this age group, it has not done so at the same rate (Blanc, 2009). Adolescent and young women generally have limited access than older individuals to FP methods. Levels of contraceptive prevalence among young women have remained low in most countries throughout the world. However, unmarried young women tend to have higher rates of FP compared to married young women. Among all women who are married or in union, adolescents have the lowest rates of contraceptive use and have shown the least change since 2000 (UNFPA, 2010). In Latin America and the Caribbean many countries have higher than 50% CPR among sexually active young women while in sub-Saharan Africa the rate is less than 30% for the same population (DHS, 2006).
The convention in reporting contraceptive prevalence is to base this calculation on women married or in sexual union (even though most DHS-type surveys ask questions of contraceptive use to women of reproductive age, regardless of their marital status). In countries with relatively little sexual activity outside marriage for women, basing prevalence estimates on women in sexual union captures the population at risk of pregnancy. However, in countries with the widespread practice of sexual activity outside of marriage or stable sexual unions, a prevalence estimate based on women in union only would ignore a considerable percent of current users. Thus, researchers and program evaluators generally report percent of sexually active unmarried women using contraception, if appropriate, in addition to contraceptive prevalence, because method mix is very different for those married versus unmarried (in/not in a stable union). Whereas evaluators may theoretically derive the CPR from service statistics on numbers of current users and estimates of the population at risk, current practice is to rely upon population-based sample surveys in order to minimize the problems associated with maintaining a running count of current users and with obtaining accurate population estimates. (The problems include incomplete data, double-counting of users who enter the service delivery system at more than one point, purposeful inflation of service statistics, and poor quality of data due to other activities competing for the attention of those recording the information, to name the primary ones.)
The DHS and RHS are currently the main sources for obtaining national level estimates of prevalence. (“DHS” is used in this database to mean “DHS-type surveys”: the actual DHS, the RHS surveys conducted with technical support from CDC, and other large-scale national surveys conducted by the countries themselves under other auspices). Evaluators may also use smaller scale and/or more focused surveys to estimate the CPR as long as they use probability sampling methods, the essential ingredient for obtaining scientifically sound estimates. Evaluators may also obtain CPR by adding relevant questions to surveys on other topics (e.g., health program prevalence or coverage surveys), assuming appropriate sampling methods and sample sizes.
family planning, adolescent, behavior
Young women’s knowledge about, access to and ability to negotiate use of contraception, including condoms, may be limited by cultural gender norms affecting women’s mobility, exposure to media and FP information, access to health care services, resources to purchase contraception, unbalanced power dynamics within sexual relationships, and fear of side effects from hormonal contraception. Women may be less informed about their fertile times of the month and different FP options, especially in more rural areas, and may be reluctant to seek out information that could make them look sexually active (if unmarried) or promiscuous.
Health care workers may not discuss contraception with young women clients because they are not perceived to be at risk or giving them information may be taken as license to engage in riskier sexual behavior. Providers may not offer FP to young married women, because they assume they may want to start having children or because they feel the woman needs permission from husband. Where rates of female literacy are low, women may not benefit from media and communication strategies that rely on printed materials.
Blanc, AK., Tsui, AO., Croft, TN., Trevitt, JL., Patterns and trends in adolescents’ contraceptive use and discontinuation in developing countries and comparisons with adult women. International perspectives on sexual and
reproductive health 2009.
Khan, S.,Mishra, V.. DHS Youth Comparative Report 2008. Youth Reproductive and Sexual Health. DHS Comparative Reports No. 19. Calverton, Maryland, USA: Macro International Inc. http://www.measuredhs.com/pubs/pdf/CR19/CR19.pdf
UNFPA, How Universal is Access to Reproductive Health? A review of the evidence. 2010. http://www.unfpa.org/public/home/publications/pid/6526
DHS, Uganda DHS, 2006 Final Report (English). Uganda Bureau of Statistics Kampala, Uganda and Macro International Inc. Calverton,