Deriving national and disaggregated estimates for the demand for family planning satisfied indicator from contraceptive prevalence using household health surveys – BioMed Central

Monitoring Sustainable Development Goals in Family Planning

Methodological Framework for SDG Assessment

This report outlines the methodology used to analyze family planning indicators in low- and middle-income countries, directly contributing to the monitoring of Sustainable Development Goals (SDGs), particularly SDG 3 (Good Health and Well-being) and SDG 5 (Gender Equality). The analysis utilized data from the most recent national health surveys, which employ standardized, multi-stage sampling procedures. To ensure cross-country comparability for global SDG tracking, the study population was restricted to women aged 15 to 49 who were married or in a union.

Key Indicators for SDG Targets 3.7 and 5.6

To evaluate progress towards SDG Target 3.7, which aims to ensure universal access to sexual and reproductive healthcare services, and SDG Target 5.6, which focuses on reproductive rights, four key family planning indicators were calculated:

1. Contraceptive Prevalence Rate, any method (CPRany): The number of partnered women using any contraceptive method, as a percentage of all partnered women aged 15-49.
2. Contraceptive Prevalence Rate, modern method (CPRm): The number of partnered women using a modern contraceptive method, as a percentage of all partnered women aged 15-49.
3. Demand for Family Planning Satisfied, any method (DFPSany): The number of partnered women using any contraceptive method, as a percentage of women with a need for contraception.
4. Demand for Family Planning Satisfied, modern method (DFPSm): The number of partnered women using a modern contraceptive method, as a percentage of women with a need for contraception.

A woman was considered in need of contraception if she was fecund and did not desire a child within the next two years, or if a current pregnancy was undesired. The definition of modern contraceptive methods aligns with established standards and includes:

• Condoms
• Sterilization (male and female)
• Intrauterine devices
• Implants
• Oral contraceptives
• Injectables
• Emergency pills
• Patches, diaphragms, spermicidal agents, vaginal rings, and sponges

Addressing SDG 10: Analysis of Inequalities

Multi-dimensional Inequality Assessment

In alignment with SDG 10 (Reduced Inequalities), this analysis generated estimates for all four indicators across five critical inequality dimensions. This disaggregated approach is essential for identifying and addressing disparities in access to family planning. The dimensions analyzed were:

• National and subnational levels
• Area of residence (urban/rural)
• Wealth quintiles
• Woman’s education level

Statistical Modeling and Validation

A robust analytical approach was employed to model the relationship between contraceptive prevalence and the satisfaction of family planning demand across the inequality dimensions. The process involved several key steps:

1. Model Specification: Separate linear regression models were fitted for DFPSany and DFPSm. The subnational region model was selected for presentation as it comprised more units of analysis, better reflecting diverse contexts relevant to localized SDG implementation.
2. Data Transformation: A logit transformation was applied to the DFPS indicators to constrain predicted values within a realistic [0–1] range.
3. Predictor Selection: The primary predictor was the corresponding contraceptive prevalence rate (CPRany or CPRm). Non-linear relationships were explored using fractional polynomials.
4. Model Validation: A 5-fold cross-validation strategy was used to evaluate the models’ predictive performance, ensuring the reliability of the findings. The out-of-sample accuracy was quantified using bias, mean absolute error, and correlation metrics.
5. Sensitivity Analysis: Further analyses were conducted by restricting the sample to contraceptive rates of 15% or higher to test the stability of the results. All statistical procedures were performed using Stata version 17, accounting for sampling weights and survey design.

SDGs Addressed in the Article

SDG 3: Good Health and Well-being

• The article’s entire focus is on analyzing family planning indicators in low- and middle-income countries. This directly relates to ensuring healthy lives and promoting well-being, as access to family planning is a critical component of public health.

SDG 5: Gender Equality

• The study centers on data from “reproductive-aged women” and their use of contraceptives. Access to family planning is fundamental to women’s empowerment, allowing them to make autonomous decisions about their health and future. By analyzing contraceptive use, the article addresses a key aspect of gender equality and reproductive rights.

SDG 10: Reduced Inequalities

• The article explicitly states that it analyzes family planning indicators across several “inequality dimensions.” It mentions generating estimates by “wealth quintiles, and woman’s education,” as well as by “subnational” regions and “area of residence.” This methodological approach is directly aimed at understanding and highlighting disparities in health access among different population groups, which is the core mission of SDG 10.

Specific SDG Targets Identified

Target 3.7: Ensure universal access to sexual and reproductive health-care services

• This target calls for universal access to family planning services, information, and education. The article directly addresses this by calculating and analyzing key family planning metrics such as “contraceptive prevalence” and “demand for family planning satisfied” (DFPS). These metrics are used globally to measure access to and uptake of family planning services.

Target 5.6: Ensure universal access to sexual and reproductive health and reproductive rights

• This target focuses on ensuring women have access to sexual and reproductive health services. The study’s analysis of contraceptive use among women aged 15-49 is a direct measure of the extent to which this access is being realized. The calculation of indicators like DFPS helps quantify the gap between women’s need for contraception and its actual use, which is central to understanding reproductive rights in practice.

Target 10.2: Empower and promote the social, economic and political inclusion of all

• While the article does not discuss inclusion in broad terms, its methodology is designed to support this target. By disaggregating family planning data by “wealth quintiles” and “woman’s education,” the research provides the evidence needed to identify which population segments are being left behind in terms of access to essential health services. This analysis is a crucial first step for creating policies that promote equitable access and inclusion.

Indicators for Measuring Progress

Indicator 3.7.1: Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods

• The article explicitly calculates and analyzes an indicator it calls “DFPSm” (Demand for Family Planning Satisfied by modern methods). The text defines the denominator for this indicator as “women in need of contraception,” which directly corresponds to the official definition of SDG indicator 3.7.1. The study’s focus on “modern contraceptive methods” also aligns perfectly with this indicator.

Contraceptive Prevalence Rate (related to Target 3.7 and 5.6)

• The article mentions calculating “contraceptive prevalence by any methods (CPRany)” and “contraceptive prevalence by modern methods (CPRm).” Contraceptive prevalence is a globally recognized indicator used to track progress on family planning programs and is fundamental to assessing access to reproductive health services under Targets 3.7 and 5.6.

Disaggregation of Health Indicators by Socioeconomic Status (related to Target 10.2)

• The article implies the use of this measurement approach by stating, “We generated estimates for all four indicators at five levels… wealth quintiles, and woman’s education.” While not a standalone indicator, the practice of disaggregating health data (like DFPSm and CPRm) by wealth and education is the primary method for monitoring Target 10.2 within other goal areas. It measures whether progress is equitable across different socioeconomic groups.

SDGs, Targets, and Indicators Analysis

Source: reproductive-health-journal.biomedcentral.com