Fertility and family planning are important elements of reproductive health.ppt

Fertility and family planning are essential in promoting public health of community

1. 12/16/24
Family Planning service
&Contraceptive Methods Update
1 By Sintayehu Abebe(MPH/RH, Assistant Professor)

2. Session objectives
12/16/242
At the end of the session you will be able to:
Define family planning/FP
Describe family planning service delivery strategies
Describe barriers and enablers of FP service
Explain components of family planning
Describe importance of contraceptive methods update
Discuss different types of contraceptive methods
State factors affecting effectiveness rate of different
contraceptive methods
Describe common indicators of FP

3. 12/16/243
WHAT IS FAMILY
PLANNING?

4. Introduction
12/16/244
Family planning is defined as the ability of individuals
and couples to anticipate and attain their desired
number of children and the spacing and timing of their
births.
It is achieved through the use of contraceptive methods
and the treatment of involuntary infertility.
Statistic shows increase in the usage of family planning
methods over the last 20 ys.

5. 5
FP has been one of the key public health interventions and a
component of international development assistance:
Demographic (late 1960s and 70s)
Population growth as a threat to food supplies and
natural resources
Health (1980s)
Consequences of high fertility on maternal, infant and
child morbidity and mortality
Human rights (1990s)
Women's rights
Reproductive right
Reproductive health of men and women
Why family planning ?
12/16/24

6. Introduction…
12/16/246
FP is a means of promoting the health of women
and families and is part of a strategy to reduce the
high levels of maternal, infant, and child mortality.
People should be offered the opportunity to determine
the number and spacing of their own children.
Information about FP should be made available, and
access to FP services should be actively promoted for
all individuals desiring them.

7. Introduction…
12/16/247
Offering a wide range of safe, effective and convenient
FP methods encourages more people to use
contraception.
Having more choices helps to get user satisfaction with
their FP method.

8. The ideal contraception method??
12/16/248
Highly effective (low failure rate)
No side effects
Cheap
independent of intercourse
Rapidly reversible
Available and convenient
Comfortable

9. Effective contraception :low failure rate
12/16/249
Failure rate :number of pregnancies that occur
during contraceptive use for one year .
Failure rate can be:
 Perfect use failure rate
 Typical failure rate

10. 12/16/241
0

11. 12/16/2411
Very effective, failure rate <3% :
•Implants,
•IUDs,
•permanent methods.
Effective, failure rate 3% -10% :
•contraceptive pills,
•patches, and rings.
>10% failure rate :
•barrier
•behavioral methods .

12. Fertility among Different Groups
12/16/2412
Fertility levels vary according to:
Women’s educational attainment,
Residence, and
Other social and economic characteristics.
In most surveyed countries, the more years of school
that women have completed, the lower their fertility.

13. Fertility trends
12/16/2413
Education affects fertility through a number of
interrelated factors, including:
Women’s social and economic status,
Status within the household,
Age at marriage,
Family size desires,
Access to FP information and services, and
Use of contraception.
In all countries surveyed, the TFR is lower in urban than
rural areas.

14. Family Planning Delivery Strategies
12/16/2414
•Service delivery strategies need to be tailored to reach
populations in different locations- urban areas, rural
towns, villages, and remote areas.
•The most common service delivery sites include
–Clinics,
–Community-based distribution programs,
–Commercial retail sales,
–Workplace programs,
–Postpartum programs, and private physicians.

15. FP delivery strategy cont…
12/16/2415
1. Clinic-based services
•A clinic-based approach is reasonable in areas where clients
do not live far from the clinic.
•Clinics often have the advantage of being able to provide
methods that are more medically complex, such as IUDs,
implants, Injectable and sterilization.
•In urban areas and rural towns, FP is most often provided by
clinics that integrate it with other health services for women
and children or offer it only on certain days of the week.

16. FP delivery strategy cont…
12/16/2416
2. Community-Based Distribution (CBD)
•In areas that do not have clinics nearby, FP services may be made
available through CBD programs.
•In this approach, CBD workers, usually village women are trained
to educate their neighbors about FP and to distribute certain
contraceptives.
•In some programs, CBD workers also provide some primary health
care services & the workers receive some kind of payment; in
others they are strictly volunteers.
•A midwife, FP nurse, program coordinator, or other staff member
is usually responsible for supervising the CBD workers’ activities
and managing any problems that occur.

17. FP delivery strategies ...
12/16/2417
To establish CBD
oSelection of CBD workers
oTraining (initial/in-service)
oSupervision
oIntegrating into a functional referral system
o Incentives to CBD workers

18. FP delivery strategies ...
12/16/2418
3. Commercial Retail Sales
•If people are willing to obtain contraceptives from sources
outside the health care system, commercial retail sales can
make contraceptive methods very accessible.
•In this approach, contraceptives such as OCPs and condoms
are sold at reduced, subsidized prices in pharmacies, stores,
shops, bars, beauty salons and barber shops and are
advertised on the mass media.

•When this approach is used, retailers should be given
training in basic information about the products and how to
refer people who have problems with a contraceptive

19. Reasons for Not Using Contraceptives
12/16/2419
•Main Reasons for not Intending to Use in sub-saharan
Africa are:
–Currently pregnant or want to have more children.
•Other reasons for not intending to use:
• Concerns with contraceptive side effects
• Religious or other opposition to family planning.

20. Reasons for Not Using Contraceptives …
12/16/2420
Major Reasons in Ethiopia (EDHS)
Fertility-related reasons mainly desire for
more children
Opposition to use
Lack of knowledge
Method-related reasons

21. Barriers to FP service
12/16/2421
Health systems barriers include:
o Long distances to healthcare facilities,
o Stock-outs of preferred methods,
o Lack of policies facilitating contraceptive provision
in schools, and
o Undesirable provider attitudes
Community level barriers comprise:
Experience with contraceptive side effects,
Myths, rumours and misconceptions,
Societal stigma, and
Negative traditional and religious beliefs

22. Enablers of FP service
12/16/2422
Health system enablers consist of:
oPolitical will from government to expand
contraceptive services access,
oIntegration of contraceptive services,
oProvision of couples counseling, and
oAvailability of personnel to offer basic methods
mix
Enablers at a community level:
oFunctional community health system structures,
oCommunity desire to delay pregnancy, and
oknowledge of contraceptive services

23. Components of Family Planning
12/16/2423
Counseling: training, no incentives
Provision of contraceptives: based on guidelines by trained
professionals
Follow up and referral system: informed & the appropriate follow
up, encouraged to return
Record keeping: maintain adequate records
Supervision: ensure that the needs of clients are being met and
service delivery guidelines are being followed
Logistics: Maintenance of an effective logistic and supply system

24. Contraceptive methods update
12/16/2424
Availing contraceptive method mix at the service
delivery point is one criteria of quality of service
FP users and providers have been calling for more
choices
Methods that provide highly effective protection and at
the same time cause fewer side effects, costs less, and
are easier to use

25. The need for contraceptive methods update…
12/16/2425
In response to this need researchers are
Improving existing contraceptives and
Developing new ways to deliver hormones.

26. The main categories of contraceptive methods
12/16/2426
Short-acting contraceptive methods
Long-acting contraceptive methods
Permanent contraceptive methods
Emergency contraception

27. Short-acting contraceptive methods
12/16/2427
Natural family planning methods
•Lactational amenorrhea method (LAM)
•Fertility awareness methods
–Calendar-based methods
•Standard day method (SDM)
•Calendar rthym method
–Symptoms-based methods
•Two day method
•Basal body temperature (BBT) method
•Ovulation method (cervical mucus method)
•Symptothermal

28. 12/16/2428
LAM is a Highly Effective Method
LAM criteria:
Menses not yet returned
Infant less than six months
Woman fully or nearly fully breastfeeding
If any criteria change, start another method

29. 12/16/2429
LAM Advantages
Universally available
At least 98% effective
No commodities/supplies required
Improves breastfeeding and weaning patterns
Postpones use of hormones until infant more
mature

30. 12/16/2430
Fertility Awareness Methods
Means that a woman knows how to tell when the
fertile time of her menstrual cycle starts and ends
A woman can use several ways, alone or in
combination, to tell when her fertile time begins and
ends

31. 12/16/2431
Advantages of Fertility Awareness Methods
No physical side effects and cost
Opportunity for couples to learn more about their
sexual physiology and gain a better understanding of
their reproductive function
Responsibility for FP is shared by both partners

32. 12/16/2432
Disadvantages of Fertility Awareness Methods
Needs the commitment of both partners
Less effective than some methods
Relatively long initial training is needed
Daily monitoring and recording of signs of fertility may be
difficult to some women
Long periods of sexual abstinence may cause marital problem
and psychological stress
Women who have irregular cycles find the method difficult to
use

33. Standard Days Method™
12/16/2433
Description
•Developed by the researchers at the
Institute for RH, Georgetown
University School of Medicine.

•Works by helping women avoid
unprotected intercourse during the
fertile days of menstrual cycle.
 

34. SDM…
12/16/2434
How It Works
•This method works best for women with menstrual cycles
between 26 and 32 days long.
•It identifies days 8-19 of the cycle as fertile days.
•Women should avoid unprotected intercourse from days 8
though 19 of each cycle.

35. How to use the beads
12/16/2435
Women are provided with Cycle Beads™ as a visual aid to
help them identify their cycle length, the day of the cycle, and
the fertile days of the cycle.
Cycle Beads have three different colored beads.
 Red bead the first day of the cycle,
 Brown beads days when pregnancy is most unlikely,
White beads the fertile days.
Cycle Beads have a movable rubber ring to mark the days of
the cycle.

36. SDM…
12/16/2436
Advantages
The SDM is a natural method having no side effects.
It is easy to teach, easy to learn, and easy to use.
It is a low-cost method.
95% effective when used correctly and consistently.

37. Two Day Method
12/16/2437
Relies on a simple algorithm to help women identify when
they are fertile based upon the presence or absence of
cervical secretions.

38. The Two Day algorithm
12/16/2438
yes
Probably fertile

No
yes
Probably fertile
No

Probably not fertile
Do I feel or see
secretions today?
Did I feel or see secretions
yesterday?

39. Two Day Method…
12/16/2439
•Cervical secretions today or yesterday indicate fertile days
when unprotected sex should be avoided.
•The two Day Method is appropriate for women with cycles of
any length
•Couples who can use the Two Day Method successfully are
those who can avoid unprotected sex for about 10-15 days per
cycle.

40. Short-acting contraceptive methods
12/16/2440
Barriers
Male condom (latex, synthetic non-latex e.g. DurexAvanti,
eZ-on, Tectylon)
Female condom (Reality/FC, VA female condom, PATH
woman’s condom)
Diaphragm (SILCS)
Cervical barriers (Lea’s Shield)
Cervical caps (FemCap, Oves)
Vaginal rings e.g. Nuva-ring
Spermicides, jellies, creams

41. Condoms
12/16/2441
•Description:
–Male condoms-a sheath made of non-latex;
–Female condoms-a sheath made of latex inserted into the vagina
•Stage of development: some already in the market and
others in clinical trials.
•Effectiveness: probably similar to other condoms-10 to 15
pregnancies per 100 women per year as typically used.
•What is new? designed to expand variety, encourage use,
cause fewer allergies, or cost less than other available
barrier methods.

42. Vaginal Rings (Nuva-ring)
12/16/2442
Flexible, transparent, and colorless to almost
colorless ring,
Outer diameter of 54 mm and a thickness of
4 mm.
Contains 11.7 mg etonogestrel and 2.7 mg
ethinylestradiol.
One ring per cycle: 3 weeks ring-in & 1
week ring-free
Effectiveness: 1.2 to 1.5 pregnancies per
100 women in the first year as typically
used

43. How to use nuvaring
12/16/244
3
The woman herself can insert Nuva Ring in the vagina.
The physician should advise the woman how to insert and
remove Nuva Ring.
Insertion position e.g. standing with one leg up, squatting, or
lying down.
 Nuva Ring should be compressed and inserted into the
vagina until it feels comfortable.

44. Nuva-ring
12/16/2444
The exact position is not critical for the contraceptive
effect of the ring.
Once inserted it is left in the vagina for 3 wks.
The woman should regularly verify its presence.
Must be removed after 3 weeks of use on the same day &
time of the week as the ring was inserted.
 The withdrawal bleed usually starts 2-3 days after
removal .

45. Cervical Barrier: Leas Shield®
12/16/2445
Description
•Reusable cervical barrier up made of medical
grade silicone rubber.
•Same shape as cervical cap
•Contains a valve in the center and a loop at the
anterior end to facilitate removal.
•It acts by preventing sperm from entering the
cervix.
•The first year failure rate is 9-14%.
•The failure rate varies by parity and concurrent
use of spermicides.

46. Leas Shield…
12/16/2446
•For maximum effectiveness Leas Shield should be inserted in
vagina anytime before intercourse and should be left in for 8
hours after intercourse.
•The shield should never be left in vagina for more than 48
hours, however.
•It should be properly cleaned and stored for future use.

47. Short-acting contraceptive methods
12/16/2447
Hormonal methods
Transdermal e.g. contraceptive patch (Ortho Evra),
spray (Nesterone Metered Dose Transdermal
System)
The pill
COC’s e.g. Microgynon, Nordette, Trinordial,
Marvelon, Seasonale, Yasmin
POP’s e.g. Microlute, Exluton, Microval

48. EVRA Transdermal Patch
12/16/2448
EVRA is a thin, matrix-type
trans dermal patch consisting of
three layers.

Each 20 cm
2
trans dermal patch
contains 6 mg norelgestromin
(NGMN) and 600 micrograms
ethinyl estradiol (EE).

49. EVRA…
12/16/2449
•Only one patch is to be worn at a time.

•Each used patch is removed and immediately replaced with a
new one on the same day of the week (Change Day) on Day
8 and Day 15 of the cycle.
•Patch changes may occur at any time on the scheduled
Change Day.
•The fourth week is patch-free starting on Day 22.

50. Method of administration
12/16/2450
•Applied to clean, dry, hairless, intact healthy skin on the
buttock, abdomen, upper outer arm or upper trunk.
•Each consecutive patch should be applied to a different
place on the skin to help avoid potential irritation.
•It should be pressed down firmly until the edges stick
well.
•No make-up, creams, lotions, powders to prevent
interference with the adhesive properties of the patch, .
•Check the patch daily to ensure continued proper
adhesion.

51. Application of Contraceptive Patch on
Abdomen
12/16/2451
Effectiveness: Patches—0.8 to 1.3 pregnancies per 100
women in the first year

52. New Oral Contraceptives
12/16/2452
•Description: continuous-use products and pills containing
new progestin's.
•Effectiveness: similar to other combined OC’s (6 to 8
pregnancies per women in the first year as typically used).
continuous-use OC’s may be more effective.
•How do they work: deliver progestin alone or with
estrogen, preventing ovulation, thickening cervical mucus, &
suppressing endometrial growth.
•What’s new? continuous-use pill use reduces annual
number of menstrual cycles to four and reduces side effects.
New progestin may reduce side effects.

53. Short-acting contraceptive methods
12/16/2453
Hormonal: Injectables
Progestogen only
DMPA
Net en/Noristerat
Combined
Mesigyna (Norigynon)
Cylofem (Nunelle, Lunella, Cyclo-provera, Novafem,
Feminera)

54. Combined Injectables Contraceptives
12/16/2454
What’s new?
Contain progestin and estrogen
Administered monthly
Provide more regular bleeding cycles
May result in estrogen-related side effects

55. New DMPA
12/16/2455
Subcutaneous depot-medroxy-progesteron(DMPA-SC)
Low dose formulation
Injected into the tissue just under the
skin with a finer, shorter needle
Available only in a pre-filled Uniject syringe
Slower and more sustained absorption
30% lower dose of progestin (104mg/150mg)

56. Long-acting Contraceptive Methods
12/16/2456
IUCD’s
Copper e.g. CuT380A (12 yrs), Multiload 375 (7 yrs)
Progestin-releasing e.g. Mirena (5 yrs), Femilis, Femilis
slim, Fibroplant (3 yrs)
Frameless e.g. Gynefix, fibroplant-lng (3 yrs)

57. New IUDs
12/16/2457
Levonorgestrel Intrauterine
System (Mirena™)
•Releases 25 g of
Levonorgestrel Per 24 hrs
•Duration: 5 Years
•Packaged With Sterile
inserter
•Very effective
–0.1% First-Year Failure
Rate

58. Mirena
12/16/2458
MOA
•Cervical Mucus is Thickened
•Sperm Motility and Function Inhibited
•Endometrium Suppressed
•Ovulation Inhibited

59. Mirena…
12/16/2459
Advantages
•Very effective with the first yr failure rate of 0.1% and five yr
cumulative failure rate of 0.7 %.
•Marked reduction in menstrual blood loss and the systemic level
of hormone is very low.
•Unlike copper IUDs, Mirena provides dramatic relief in
dysmenorrhea.
 
•Once inserted it is effective for 5 years
•Fertility returns rapidly on discontinuation.

60. Mirena…
12/16/2460
Mirena has many non contraceptive benefits.
It has beneficial effect on menorrhagia and
dysmenorrhea
It also reduces the risk of endometrial cancer by
50%.
 

61. Long-acting…
12/16/2461
New implants offer several improvements over Norplant.
•Levonorgestrel implants (Jadelle):
–Deliver same daily dose as norplant
–Effective for up to 5 years
–Two rods instead of six capsules
–Easier to insert and remove than norplant – insertion takes less
than five minutes
•Etonogestrel implants (implanon):
–Single rod provides at least 3 years of protection against preg.
•Nestorone implants:
–Single rod designed specially for breast feeding women
–Effective for up to 2 years

62. Implanon
12/16/2462
Single Implant Rod (4 cm in length and
2 mm in diameter)
Contains 68 mg of progestin
Etonogestrel
Effective for 3 years
6 pregnancies in 26,000 cycles
Inhibits ovulation and thickens cervical
mucus
Rapid return of fertility
Effectiveness: 0.3 to 1.1 preg/100 women in
the 1
st
year of use as typically used

63. 12/16/2463
Permanent Methods of contraceptive
Male sterilization
Vasectomy
Classical
No-scalpel
Female sterilization
Transcervical (through
hysteroscopy)
Chemicals e.g. Quinacrine
Plugs e.g. Adiana procedure
Microcoils e.g. Essure
Tuballigation
Laparotomy
minilaparotomy

64. Female Sterilization: Essure™
12/16/2464
Description
Essure is a new method of female sterilization that uses the
transcervical approach.
How It Works
Essure micro-inserter is placed in proximal portion of each
fallopian tube lumen
Micro-inserter expands upon release and attachs itself in the tube
Subsequent benign local tissue in-growth over a 3 month period –
scarring blocks fallopian tube

65. Essure: How It Works
12/16/2465
Device permanently anchored in occluded fallopian tube,
resulting in permanent contraception.
Essure: Post-Placement Follow-Up
Low pressure hysterosalpigogram (HSG) is recommended 3
months after essure to confirm the tubal occlusion on both sides.
If occlusion is not demonstrated, repeat HSG three months later.

66. Essure…
12/16/2466
Advantages
•Essure requires a trained provider to perform the procedure.
•Using Essure does not require any incision no scar.
•Inserted into the uterine cavity during hysteroscopy no
general anesthesia is required.
•The procedure is completed in 30 minutes, and the client can
go home 45 minutes after the procedure.
•Essure can be inserted in a hospital or outpatient setting.

67. What is Emergency Contraception?
Methods of preventing pregnancy after unprotected sexual
intercourse
Regular oral contraceptives are used in a special higher
dosage within 72 hours (3 days) of unprotected sex
IUDs can also be used for up to 5 days after unprotected sex
ECPs can not interrupt an established pregnancy
12/16/2467

68. Types of ECPs
Progestin-only OC’s – levonorgestrel-only, in preferred
regimen one dose of 1.5 mg or 2 doses of 0.75mg, 12 hrs
apart 88% reduction in risk (1/100 will get pregnant)
Combined OC’s: 2 doses of pills containing ethinyl estradiol
(100 mcg) and levonorgestrel (0.5 mg) taken 12 hrs apart
75 % reduction in risk (2/100 will get pregnant)
12/16/2468

69. ECPs are most effective when taken early
12/16/2469

70. Factors affecting method effectiveness
12/16/2470

71. 12/16/247
1
How to Measure Family planning Use
Sources of data
Measurements
Interpretation

72. INTRODUCTION
12/16/2472
Indicators:-
Are measurements to summarize, represent or reflect
certain aspects of health status.
Provide concrete measures for monitoring program
performance and measuring outcome in FP programs.
Can focus on quantity, quality, or cost.

73. Introduction…
12/16/2473
Within the program level it is important to further
differentiate the components. Inputs (program
resources) are fed into processes (program activities),
which in turn produce output (program results) and
ultimately outcome (population– based results), as
shown in the following sequence:
oInput
oProcess
oOutput and
oOutcome

74. Introduction…
12/16/2474
Inputs are human and financial resources, physical
facilities, equipment, and operational policies that
enable services to be delivered
Process refers to the multiple activities that are carried
out to achieve the objectives of the program. It includes
both what is done and how well it is done
Output refers to the results of these efforts at the
program level

75. Introduction…
12/16/2475
By contrast, the evaluation of outcome refers to measuring the
effect that the program has on the larger social system, usually
the general population of a given target area
Two types of outcome
Effect (intermediate outcome): that which is a relatively direct
and immediate result of program process and output (e.g.,
contraceptive prevalence).
Impact (ultimate outcome): that which is an anticipated result of
program process and output in the long–term (e.g., change in
fertility rates

76. Criteria for selecting indicators
12/16/2476
Valid:-measures the phenomenon it is intended to measure
Reliable:- produces the same results when used to measure
the same phenomenon.

Sensitive:- changes in the indicator reflect changes in the
phenomenon
Operational:- measurable with developed and tested
definitions and standards

77. Criteria for …
12/16/2477
Uni-dimensional:- measures only onephenomenon.
Objective:- unambiguous about what is being
measured and how.
Practical:-measurable on a timely basis and at
reasonable cost.

78. Indicators commonly used to measure the use of
family planning services
12/16/2478
1.Contraceptive prevalence rate
2.Method mix
3.Source of supply (by method)
4.Number of current users
5.Level of ever (past use)
6.User characteristics
7.Unmet need for family planning
8.Demand for family planning

79. 1.Contraceptive prevalence rate
12/16/2479
Defn: proportion of women ages 15-49 using
contraceptive in a given year
CPR=number of women using any contraceptive
method /number of women aged 15 to 49 years
x100
Can be specific to modern and traditional
methods

80. C P R …
12/16/2480
Data Requirements
The total number of women of reproductive
age and of these, the number that are currently
using a contraceptive method
Data Source(s)
Population–based surveys.

81. C P R …
12/16/2481
Purpose and Issues
The CPR provides a measure of population coverage
of contraceptive use, taking into account all sources
of supply and all contraceptive methods
it is the most widely reported measure of outcome
for family planning programs at the population level

82. Prevalence
12/16/2482
The contraceptive prevalence rate for all Ethiopian
women age 15-49 is 20 percent.(EDHS 2011)
The contraceptive prevalence rate is 41 percent for
currently married women, (mEDHS 2019)and
58 percent for sexually active unmarried women.
(EDHS 2016)

83. 2. Contraceptive method mix
12/16/2483
Percentage distribution of contraceptive users by
method
Calculated for each type of method
%using method i x100
%using any method

84. METHOD M I X….
12/16/2484
Data Requirements
Number of users (of acceptors) by method.
Data Source(s):
Service statistics, population based surveys

85. METHOD M I X …
12/16/24
85
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 both.

86. METHOD M I X….
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Data on method mix, obtained both from surveys
and from service statistics, are essential in the
forecasting of commodity and service needs in the
future.

87. 3. Current user
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The number of women (or their partners) of
reproductive age, who are estimated to be using
a contraceptive method at a given point in
time.
 It can be reported by type of method, region,
source of date, or other relevant variable.

88. Current …
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Data Requirements
Counts of women (or their partners) using a
contraceptive method at a particular point in time.
Data Source(s)
Population–based surveys (preferable) &
service statistics

89. Current….
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Purpose and Issues
 provides a summary measure of total program
service volume.
 Prior to the introduction of population–based surveys
to evaluate family planning programs,
Widely used indicator of program output

90. Current..
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One can estimate the number of current users in
the entire population by multiplying the estimated
number of women of reproductive age in sexual
union by the contraceptive prevalence rate (from a
survey).

91. Current…
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Current use in Ethiopia
Use of modern methods among currently married
women has increased from 6% in 2000 EDHS to 41%
in 2019 mEDHS
Largely due to the sharp increase in the use of
injectables, from 3% in 2000 to 27% in 2019.
(mEDHS 2019)

92. 4. Source of supply (by method)
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The percentage distribution of the types of service
delivery points cited by users as the source of their
contraceptive method
If more than one source, then the most recent one
Proportion of contraceptive by method use
attributable to the government program, the private
sector and other relevant sources.

93. Source of supply……Cont’d ….
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Data Requirements
Number of respondents currently using contraception
 the type of method used
 the source of supply of their method (most recently).
Data Source(s)
Population–based surveys

94. Source of supply……Cont’d ….
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This indicator is useful to family planning program
officials to show where contraceptive users obtain their
supplies
 For both evaluating program effectiveness and
forecasting needs
Countries trying to shift the burden for family planning
services from the public to the private sector.

95. Source of supply (by methods)
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96. 5. LEVEL OF EVER(PAST) USE
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The proportion of women of reproductive age who have
ever used a contraceptive method, including those
currently using one.
Provides a crude measure of the extent to which a given
population has experimented with methods of
contraception
first–hand knowledge of contraception by having tried it
at some point

97. LEVEL ……Cont’d ….
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Data Requirements
The number of women of reproductive age who report
having ever used a contraceptive method (including those
currently using one),
The total number of respondents, and marital status
(optional).
Data Source(s)
Population–based surveys

98. LEVEL ……Cont’d ….
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Have you ever used anything or tried in any way to delay
or avoid getting pregnant?
Generally collected as part of the history taken for new
users of contraceptive services
Comparisons of ever use and current use provide
potentially useful information on contraceptive
continuation

99. 6. USER CHARACTERISTICS
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A socio–demographic profile of current users of
contraceptive methods relevant to program planning
and/or marketing.
Relevant characteristics include: age, parity, urban–rural
residence, economic status, and other factors judged
important in the context of a specific country.

100. USER ……Cont’d ….
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DATA REQUIREMENT
Age,
Parity,
Other characteristics of users (and in surveys, of non–
users, for purposes of comparisons).
DATA SOURCE
Population–based surveys; service statistics

101. USER ……Cont’d ….
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Service statistics
Characteristics of clients receiving contraceptive services at
program service delivery points
Monitor how its client population changes over time
Population–based surveys
Characteristics of users obtaining contraceptive services and
supplies from all service and distribution sources.
Detailed information

102. USER ……Cont’d ….
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Of all individuals using contraception what is the
breakdown by (urban/rural residence, educational
level, religion, ethnic group, etc.)
E.G Modern contraceptive use is higher among currently
married women who are living in urban area(48%) than
among those living in rural area(38%) . (mEDHS 2019)

103. 7. Unmet need for family planning
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Proportion of women who:
(1) are not pregnant and not postpartum amenorrhoeic and are
considered fecund and want to postpone their next birth
for 2 or more years or stop childbearing altogether but
are not using a contraceptive method, or
(2) have a mistimed or unwanted current pregnancy, or
(3) are postpartum amenorrhoeic and their last birth in the last
2 years was mistimed or unwanted.
Sample: All women age 15-49, currently married women age
15-49, and sexually active unmarried women age 15-49

104. 8. Demand for family planning
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Demand for family planning=Unmet need for family
planning+ current contraceptive use (any method)
Proportion of demand satisfied=Current contraceptive use
(any method) /(Unmet need + current contraceptive use
(any method)
Proportion of demand satisfied by modern
methods=Current contraceptive use (any modern
method)/(Unmet need + current contraceptive use (any
method))

105. Reading assignment
Read about couple years of protection, contraceptive
continuation rate, contraceptive failure rate and
contraceptive acceptance rate.
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106. Reference
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1.Jane T. Bertrand, Robert J. Magnani, Naomi Rutenberg;
Hand book for family planning program evaluation:
December 1994
2.Health and Family planning Indicators: Office of sustianable
Development: Bureau for Africa: U.S. Agency for
International Development
3.CSA, mEDHS 2019, Addis Abeba Ethiopia ICF
international calcerton meryland &USA marcch 2010
4.Ethiopian Public Health Institute (EPHI) [Ethiopia] and ICF.
2021. Ethiopia Mini Demographic and Health
Survey 2019: Final Report. Rockville, Maryland, USA:
EPHI and ICF.

107. 12/16/24107