Modern Contraceptive Method Mix

Indicator 9

Core Indicator 9 (Estimate Table 9), modern contraceptive method mix, presents the distribution of modern contraceptive users by the method they use, based on the most recent survey data available.

Patterns of contraceptive method mix are complex and reflect preferences affected by societal and cultural norms. Patterns may also reflect issues affecting availability and accessibility, including policies, cost, infrastructure, and provider training. This indicator provides a deeper look into the composition of Core Indicator 2, mCPR, highlighting those methods driving contraceptive use in a country and indicating where there may be issues of acceptability or accessibility of particular methods, or opportunities to expand access to a wider range of methods.

While there is no “right” method mix or “ideal” method, there is general agreement that providing access to a wide variety of methods is both a component of quality of care as well as an important principle of rights-based family planning. Availability of a range of options makes it more likely that women can choose a method that best suits their needs and preferences, and as a result, increases contraceptive use and satisfaction with the method.20 A more diverse method mix also provides women with access to longer acting and more effective methods of contraception, reducing the risk of unintended pregnancy.

Looking across the focus countries, modern contraceptive method mix varies greatly, reflecting both women’s preferences and the diverse contexts in which they live. The map below shows the most commonly used modern method in each country (defined as the single method that makes up the largest proportion of the method mix).

In 27 countries, injectables make up the largest proportion of the method mix—from Benin, where injectables make up just under 30% of the total method mix, to Ethiopia, where 76% of women using a modern method are using injectables. Countries with high method skew, where one method dominates the method mix (making up 60% or more of modern method use), are indicated by a triangle. This can be indicative of preferences and sociocultural norms around particular methods, or it may signify challenges within the healthcare system, such as limited infrastructure, method stock-outs, or provider bias.

Of the 69 focus countries, 33 have sufficient data collected since the time of the London Summit to look at changes in method mix. We compared these countries’ most recent surveys with data from their previous surveys of the same type. The average gap between surveys was 6.4 years, ranging from 1 to 16 years, and the average annual change in method prevalence was calculated for each method. Some countries, like Malawi, saw dramatic growth in mCPR (up 14 percentage points over 5 years), driven by an increase in the prevalence of particular methods (implants and injectables) and a decline in traditional methods. Other countries, like Egypt, saw little change in mCPR but experienced shifts in the method mix, with growth in the use of pills and injectables somewhat offsetting declines in IUD use.

Among those 33 countries with recent trend data, 13 (or 40%) saw increases in the prevalence of LARCs between their two most recent surveys. The fastest growth was seen in Malawi, where LARC prevalence grew by 2 percentage points per year between 2010 and 2015. Kenya, Senegal, and Zimbabwe also saw substantial growth in LARCs, with increases in prevalence of more than 1 percentage point per year. The largest growth in LARC prevalence was seen among unmarried sexually active women in Senegal, where prevalence grew 11 percentage points between the 2012–13 DHS and the 2014 DHS, with growth in both IUDs and implants.

The methods currently seeing the fastest growth in prevalence are injectables and implants, a pattern continuing from last year’s report. While increases in injectables generally continued to support their dominance in the method mix—or method skew in some countries—the growth in implants is increasing the diversity of the method mix in several countries.

20. Ross J, Stover J. Use of modern contraception increases when more methods become available: analysis of evidence from 1982–2009. Glob Health Sci Pract. 2013;1(2):203-212.