Global trends in contraceptive method mix and implications for meeting the demand for family planning

Measuring progress in meeting the demand for family planning requires not only attention to levels and trends in contraceptive prevalence and unmet need for family planning but also assessment of the diversity of contraceptive methods used. We examine changes in contraceptive method mix from 1990 to 2011 for 188 countries and if trends in contraceptive prevalence are associated with the average effectiveness and concentration of methods used. We use annual Bayesian hierarchical model-based estimates of contraceptive prevalence and unmet need for family planning among married or in-union women aged 15-49 and apply the distribution of contraceptive users by method used from surveys at two time points (around 1990 and 2011). Female sterilization and the IUD were the two most common methods used worldwide and geographical differences in method mix profiles were large. Shifts were gradual over the past 20 years in the distribution of users by method and average effectiveness. The evidence does not suggest an association between increases in contraceptive prevalence and improvements towards a more balanced or effective method mix. We propose a measure of the effectiveness of contraceptive demand—one that incorporates unmet need for family planning—as a useful summary measure to describe improvements in meeting family planning demand.