Contraceptive Method Choice in Developing Countries

International Family Planning Perspectives The report of the International Conference on Population and Development issued the following directive: “Recognize that appropriate methods for couples and individuals vary according to their age, parity, family sizepreference and other factors, and ensure that women and men have information and access to the widest possible range of safe and effective family planning methods in order to enable them to exercise free and informed choice.”1 The reality in most countries, however, is far different. Most countries offer only a limited choice of contraceptive methods, and couples cannot easily choose the method that best suits their reproductive needs.2 In fact, international program effort scores for 1994 showed that large proportions of people in most developing countries did not have ready access to a variety of contraceptive methods.3 Couples had essentially no access to the IUD in 30 countries, no access to female sterilization in 37 and no access to vasectomy in 61. Many African countries had low access scores on almost every method. Five years later, in the 1999 ratings for 88 countries, only 65% of countries offered the pill to at least half their population, 54% the IUD, 42% female sterilization, 26% male sterilization and 73% the condom.4 Substantial evidence indicates that a restricted choice of contraceptive methods has constrained the opportunity of individual couples to obtain a method that suits their needs, resulting in lower levels of contraceptive prevalence. One study noted that in Taiwan, each new method seemed to add another layer of use to existing prevalence; similar increases were evident in South Korea, Thailand and Hong Kong.5 A second study found that broadening the choice of contraceptive methods increased overall contraceptive prevalence in Matlab, Bangladesh, where household provision of injectables in early 1977 helped raise contraceptive prevalence from 7% to 20%, the introduction of tubectomy services in 1978 helped increase prevalence by an additional 10 percentage points, and household insertion of IUDs in 1981 elevated prevalence yet further.6 Jain has estimated that the widespread addition of one method to Contraceptive Method Choice in Developing Countries