Long-Acting and Permanent Methods

 

Welcome to the programmatic area on long-acting and permanent methods (LAPMs) of family planning within MEASURE Evaluation’s Family Planning and Reproductive Health Indicators Database. This is one of the subareas found in the family planning (FP) section of the database. All indicators for this area include a definition, data requirements, data source(s), purpose, issues and—if relevant—gender implications. Long-acting reversible contraception, such as intrauterine devices and implants, and permanent methods (female and male sterilization) of contraception are highly safe and effective methods for spacing or limiting pregnancy. LAPMs have the ability to meet a range of clients’ intentions, and promote greater continuation of FP. Indicators presented here can be used to assess programmatic efforts to expand contraceptive choice through the provision of long-acting and permanent methods. Key indicators to monitor and evaluate long-acting and permanent methods can be found in the links at left.   Full Text Long-acting (intrauterine devices and implants) and permanent methods (female and male sterilization) of contraception are highly safe and provide continuous protection against unwanted pregnancy, have the ability to meet a range of clients’ intentions (i.e., can help them delay, space, or limit births), and promote greater continuation of family planning (FP). Yet, long-acting and permanent methods (LAPMs) are the least available and least used methods in the majority of developing countries. FP programs can best meet their goals by responding to existing unmet need, and unmet need for LAPMs remains particularly high. To do so, however, requires an investment in making available a balanced contraceptive method mix that includes LAPMs among the choices and options. Only then will a program optimize its reach and effectiveness. The core indicators presented here can help programs assess their success at expanding contraceptive choice by providing LAPMs. Indicators related to these methods are best framed in a holistic model such as EngenderHealth’s Supply-Enabling Environment-Demand (SEED) Programming Model . The foundation of the SEED Programming Model is that sexual and reproductive health programs will be more successful and sustainable if they comprehensively address the multifaceted determinants of health and if they include synergistic interventions that: Attend to the availability and quality of LAPM services and other supply-related issues. Quality LAPM services rely on adequate infrastructure, supplies, and equipment being in place. The availability of staff well-trained, skilled, motivated, and supported to provide LAPM services is key; they need to perform to established standards and provide services that are accessible, acceptable, and accountable to the clients and communities they serve. Strengthen health systems and foster an enabling environment to support LAPM services.  The socio-cultural, economic, and political environment influences the functioning and sustainability of FP programs that provide LAPMs (supply), as well as the social norms surrounding healthy behavior (demand). An enabling environment requires supportive cultural norms and policies; adequate resources; good governance, management, and accountability; and gender equity. Improve knowledge of LAPMs and cultivate a demand for them. Many barriers can keep people from realizing their sexual and reproductive well-being, and service availability is often the least of these. Individuals, families, and communities must have the knowledge of the full range of FP methods, capacity, and motivation to ensure sexual and reproductive health. Programs need to advance a positive attitude toward sexual and reproductive health, including LAPMs, address myths and misconceptions, provide evidence-based information about LAPM issues and risks, and promote available services. LAPMs need to be included in the range of behavior change communications interventions—from basic health education and counseling to peer promotion, social marketing, and mass media communication.

Extent to which LAPMs are explicitly included in national RH or FP policies

Definition:

In countries with formal reproductive health (RH) or family planning (FP) policies, this indicator assesses whether long-acting and permanent methods (LAPMs) are specifically included in these documents. In addition, these policies should be evaluated to make sure they are technically sound, based on scientific evidence and grounded in informed choice. The assessment should include the extent to which the national FP policy has a strategic or long-range plan in place to increase access to and use of LAPMs. To measure changes over time, the indicator should consider only those policies developed or modified during a specific reference period, such as the last calendar year.

Data Requirements:

Document review or policy analysis for evidence of that LAPMs are included in a country’s FP or health policy documents.

Data Sources:

A country’s FP, reproductive health, or health policy documents. Supporting documentation should include the policy/plan/guideline itself, it’s status, i.e., draft or final, where or by whom it was issued or published, and an explanation of how the policy/plan/ guideline promotes access to or quality of RH services.

Purpose:

A country that specifically includes LAPMs in its formal policies is more likely to have an enabling environment supportive of contraceptive choice. The inclusion of LAPMs in formal policy statements reflects a country’s recognition of and commitment to effective FP options.

Issue(s):

Evaluators may face difficulty finding an “FP policy” since many countries do not have an explicit policy related to FP but rather encompass FP within a broader RH policy. Furthermore, formal policy statements do not necessarily translate into policy implementation. Other policy challenges, such as insufficient budget allocations or unfavorable import regulations, may circumvent formal policy statements. Conversely, LAPMs may be available through government and private facilities even if not explicitly included in policy documents. In-depth policy analysis should assess all these issues.

Gender Implications:

Policies that exclude particular LAPMs may limit the contraceptive choice of women or men.

Extent to which LAPM supplies/equipment are on the approved import list

Definition:

 

This indicator measures whether a country has included long-acting and permanent method (LAPM) supplies and equipment on its approved import list.  Most developing countries maintain lists of drugs, medical supplies and equipment which are cleared to be legally imported. EngenderHealth’s RESPOND Project has a full list of medical instruments and expendable medical supplies needed to provide LAPM.

Data Requirements:

 

Copy of import list to verify if LAPM supplies and equipment have been included

Data Sources:

Most up-to-date essential drugs, medical supplies and equipment lists from the Ministry of Health or Procurement and Planning Division import list to verify if LAPM supplies and equipment have been included; key informant interviews with personnel from the procurement unit

Purpose:

If the essential supplies and equipment needed to provide LAPM services are not on approved import lists, people will face limited contraceptive choice and/or low quality services. Thus, this indicator can help determine if a country views LAPMs as being essential in satisfying the contraceptive needs of the national population.

Issue(s):

Many of the supplies and equipment for LAPM services are not unique to those services, so it may be hard to tell if sufficient quantities are being acquired to support program needs now or in future. Larger developing countries may produce supplies and equipment domestically, so the import list may not be a true reflection of their availability and/or may reflect a protectionist government policy.

Gender Implications:

 

Import lists that that exclude essential commodities for particular LAPMs may limit the contraceptive choice of women or men.

Percent of CPR accounted for by LAPMs, broken down by method

Definition:

 

Among all users of family planning (FP), the percent using a long-acting or permanent method (LAPM) in a specified timeframe (e.g. one year). This indicator should be calculated separately for each method and then aggregated over all methods to reach a combined percentage.

This indicator is calculated as:

Number of users of LAPMs/number of users of all FP methods  x 100

Related indicators are, Percent of modern method CPR accounted for by LAPMs, broken down by method and Contraceptive prevalence of LAPMs (number of users of LAPMs divided by women of reproductive age).

Data Requirements:

Total number of individuals practicing FP and of these, the number that are currently using LAPM

Data Sources:

Census data, Demographic and Health Surveys, other population-based surveys with detailed contraceptive use data or service statistics

Purpose:

 

This indicator gives a snapshot of how prevalent LAPM use is in any given country or site as well as the prevalence of specific LAPMs.  For FP programs trying to promote LAPMs, this indicator will measure outcome at the population level.

Issue(s):

In countries with rapidly evolving FP programs, data may not be up-to-date.  Also, although evaluators may theoretically derive the CPR accounted for by LAPMs from service statistics on numbers of current users and estimates of total number of FP users, population-based surveys are preferred in order to minimize the problems associated with maintaining a running count of current users (which is needed for the denominator) and with obtaining current population estimates.

Gender Implications:

 

Three of the LAPMs are female methods and one is a male method. Method-specific data can offer a perspective on whether a FP program needs to make more effort to include men. Low use of female LAPM methods, which may be more expensive and may require extra resources to access services than short-acting or traditional methods, may indicate a need to assess gender-based constraints that impact women’s ability to access clinical services. High use of female sterilization may also reflect a gender bias on the part of providers if they do not recognize the importance of contraceptive choice for all clients.

Percent of service delivery points offering a mixture of short-acting modern contraceptive and long-acting reversible contraceptive methods

Definition:

In a specified timeframe (e.g., in the past month or in the past three, six, or twelve months), the percent of service delivery points (SDPs) offering at least two modern temporary methods of contraception (male or female condoms, pills, injections, and spermicides) and offering at least one long-acting reversible contraceptives (LARC) method (intrauterine device [IUD] or implant) on site. This indicator can be disaggregated by SDP type and location (i.e., poor/not poor, rural/urban, and geographic region).

This indicator is calculated as:

(Number of SDPs offering at least two temporary contraceptive methods and at least one LARC method/Total number of surveyed SDPs eligible to offer temporary methods and at least one LARC method on site) x 100.

Data Requirements:

Responses to a facility survey question asking whether or not a facility is eligible to offer the methods/service and if the facility currently provides the methods/service.

The question should specify that the service must be provided onsite rather than as client referrals. Data should be collected for each method provided. Evaluators may also want to ask follow up questions about referrals and the number of days that a method is offered to provide more detail about service provision. Example questions for LARCs are below. For IUD services consider specifying responses by type of IUD service (e.g. interval IUD, postpartum IUD, transcesarean IUD, and IUD after postabortion care) if this is helpful to the design or evaluation of the program.

Main questions:

Optional follow-up questions:

Because of the differences in the type of services offered at particular levels of facilities, evaluators should also tabulate the indicator by facility type to identify policy and program implications at various service delivery levels.

If targeting and/or linking to inequity, classify service delivery points by location (poor/not poor) and disaggregate by location.

Data Sources:

Facility survey

Purpose:

This indicator determines the extent to which facilities are eligible to provide and are currently providing a range of family planning (FP) methods to clients. It is also a long-term indication of whether or not a national FP policy that includes LARCs is being implemented.

Issue(s):

This is an overview indicator that does not address the availability of specific methods. It is important to note the distinction between whether a site offers a given service (in other words that the service is defined to be part of the site’s constellation of services) and whether a site has the resources it needs to actually carry out a given service at an adequate level of quality. The latter is explored more fully in other indicators in this section related to availability of infrastructure, supplies, and equipment; provider training; infection prevention systems; and counseling. A relatively large proportion of interviewees may report that LARC services are offered, however a significant proportion of these sites may not be currently offering the services because they do not have a provider who has been trained in the provision of that service in the past three years or the site may not have all the appropriate supplies and instruments.

Gender Implications:

Gender-sensitive programming offers a wide range of methods so that all women and men can achieve their reproductive intentions. If a low percentage of facilities, or low percentages at certain levels, are offering a balanced contraceptive mix, that may indicate that a program has not yet considered the full range of gender-based constraints that can impact use of contraceptives (need for confidentiality, limited access to resources, etc.).

Percent of facilities offering a permanent method of family planning

Definition:

In a specific timeframe (e.g., in the past month or the past three, six, or twelve months), the percent of facilities offering female sterilization/tubal ligation, and/or male sterilization/vasectomy services on site or through periodic visits by a visiting provider. 

This indicator is calculated as:

(Number of facilities currently offering a permanent method of family planning [FP] on site/Total number of surveyed facilities eligible to offer permanent methods on site) x 100

Data Requirements:

Responses to a facility survey question asking whether or not a facility offers permanent FP services.

The question or questionnaire should specify that the service must be provided onsite rather than as client referrals. Data should be collected separately by method. Evaluators may also want to ask follow up questions about referrals and the number of days that a method is offered to provide more detail about service provision. Example questions are below. For female sterilization consider differentiating between minilap and tubal ligation and/or specify responses by type (e.g. interval, postpartum (<7 days) and, transcesarean). For vasectomy services consider differentiating between vasectomy and no-scalpel vasectomy (NSV).

Main question: Does this facility currently offer _______ services here?

Optional follow-up questions:

If targeting and/or linking to inequity, classify service delivery points by location (poor/not poor) and disaggregate by location.

Data Sources:

Facility survey

Purpose:

This indicator determines the extent to which facilities are providing permanent FP methods to clients. Assessed along with other indicators, it helps programs assess the extent of contraceptive choice. It is also a long-term indication of whether or not a national FP policy which includes long-acting permanent methods (LAPMs) is being implemented.

Issue(s):

It is important to note the distinction between whether a site offers a given service (in other words that the service is defined to be part of the site’s constellation of services) and whether a site has the resources it needs to actually carry out a given service at an adequate level of quality. The latter is explored more fully in other LAPM indicators related to availability of infrastructure, supplies, and equipment; provider training; and counseling. A relatively large proportion of interviewees may report that LAPM services are offered, however a significant proportion of these sites may not be currently offering the services because they do not have a provider who has been trained in the provision of that service in the past three years or the site may not have all the appropriate supplies and instruments.

Number of health providers trained in long acting and permanent services

Definition:

 

In a defined time period (e.g. one year), number of doctors, nurses and auxiliary staff who receive pre-service or in-service training in the provision of long-acting and permanent methods (LA/PMs) of family planning (FP), altogether and broken down by kind of service provider and kind of method.  “Training” can refer to any type of LA/PM training event, regardless of its duration or location.  It involves a trainee getting a thorough understanding of the essential knowledge required to perform the job and progressing from either lacking skills or having minimal skills to being proficient.

Data Requirements:

 

Number of service providers trained in LAPM, disaggregated by sex, type of provider, method(s) trained in, and type of training (pre-service or in-service).

If targeting and/or linking to inequity, classify trainees by areas served (poor/not poor) and disaggregate by area served.

Data Sources:

Training institutions for pre-service trainings; training attendance rosters from project records; public and private facility records of in-service trainings

Purpose:

This indicator determines a key component of the extent to which the health system is able to provide the full range of FP methods to clients.

Issue(s):

Simply having trained staff is not sufficient to ensure access to LAPMs, but must be looked at in combination with other supply-oriented measures. Also, counting “number trained” alone does not capture the quality of the training or the knowledge obtained. It is important that this indicator is complimented with an indicator that assesses competency or mastery of knowledge and/or skills. An example would be, “Number of service providers trained in LAPM who have mastered relevant knowledge.”

Gender Implications:

 

There may be gender implications both in terms of who has access to training (do male or female providers get differential access to certain kinds of training?) and whether male or female methods are more likely to be covered in the training, thereby impacting people’s reproductive choice.

Percent of facilities offering family planning services that provide referrals for LAPM

Definition:

 

In a specified time frame (e.g. one year), percent of facilities offering family planning (FP) services but not providing any particular long-acting or permanent method (LAPM) that provide client referrals to facilities that do provide LAPMs.

This indicator is calculated as:

(Number of FP facilities offering referrals for IUD, implants, male and female sterilization / Total number of surveyed facilities that do not offer these methods) x 100

Data Requirements:

 

Responses to a facility survey question asking whether or not a facility offers LAPM services.

The question or questionnaire should specify that this is for facilities that do not provide LAPM services onsite. Data should be collected separately by method. Evaluators may also want to ask follow up questions about the referral system and if there is any follow-up to see if clients acted on the referrals. For female sterilization consider differentiating between minilap and tubal ligation and/or specify responses by type (e.g. interval, postpartum (<7 days) and, transcesarean). For vasectomy services consider differentiating between vasectomy and no-scalpel vasectomy (NSV).

Main questions:

Optional follow-up questions:

If targeting and/or linking to inequity, classify service delivery points by location (poor/not poor) and disaggregate by location.

Data Sources:

Facility survey

Purpose:

This indicator determines the extent to which facilities have referral systems in place and are assisting clients to access a range of FP methods.

Issue(s):

 

It is difficult to track whether clients use referrals.  Also, this indicator does not reveal if the facility being referred to is currently providing LAPM services, thus creating an additional barrier for clients trying to obtain their preferred FP method.

Gender Implications:

Three of the LAPMs are female methods and one is a male method. Method-specific data can offer a perspective on whether a FP program needs to expand its service for men. Low levels of referrals for female LAPM, which may be more expensive and may require extra resources to access services, may indicate a need to assess gender-based constraints to access to clinical services.

Percent of facilities meeting minimum standards with regard to essential supplies and equipment to support provision of LAPMs

Definition:

 

Percent of facilities meeting minimum standards of quality by specific long-acting or permanent method (LAPM) with regard to equipment, medications and supplies, and trained staff. For the following four LAPMs, minimum quality standards include:

Vasectomy
  • At least one trained provider
  • All 4 IP elements* (see below)
  • Lidocaine
  • NSV instruments** (see below)
Female Sterilization
  • At least one trained provider
  • All 4 IP elements* (see below)
  • Lidocaine
  • ML/LA instruments*** (see below)
Hormonal Implant
Insertion (Norplant®, Jadelle®, Sino-Implant II)
  • At least one trained provider
  • All 4 IP elements* (see below)
  • Cup, Iodine
  • Trocar

Insertion (Implanon®)

  • Cup, Iodine
  • Implanon® Applicator

 Removal (All types)

  • Scalpel Handle, #3, graduated in cm
  • Forceps, Mosquito, Straight, 5"
Intrauterine Device (IUD)
Insertion
  • At least one trained provider
  • All 4 IP elements* (see below)
  • Cup, Iodine
  • Sound, Uterine, Sims, 12.5"
Removal
  • IUD String Retriever

 

 

*Infection prevention (IP) elements (bucket with lid, bucket for high level disinfectant, chlorine powder, puncture resistant container)

**No-scalpel vasectomy (NSV) instruments (NSV dissecting forceps, NSV ringed forceps, 4 mm)

***Minilaparotomy (ML) and laparoscopy (LA) instruments (elevator, uterine, Ramathibodi hook, tubal, Ramathibodi)

EngenderHealth’s RESPOND Project has a full list of medical instruments and expendable medical supplies needed to provide LA/PM.

This indicator is calculated as:

(Number of facilities meeting minimum standard of quality to offer LAPM services / Total number of surveyed facilities eligible to offer LAPM services) x 100

Data should be collected for each LAPM method and broken down by facility type.

Data Requirements:

 

Responses to a facility survey question asking whether or not a facility has all the necessary infrastructure and resources to provide that service and/or a facility assessment based on observation of supplies cabinet; inventory of functional status of equipment and location in relation to the LAPM service delivery area; inventory or medications and supplies; inventory of all staff providing LAPM services and their designations; and information on qualification and continued training related to LAPM services, for staff providing the service on the day of the visit. Data should be collected separately by method. Evaluators may disaggregate data by type of facility, geographic area, or sector (e.g., government, private for profit, private non-profit).

At each facility, the following should be assessed:

If targeting and/or linking to inequity, classify service delivery points by location (poor/not poor) and disaggregate by location.

Data Sources:

Facility survey/Facility assessment

Purpose:

 

This indicator provides information on a facility’s ability to offer a specific LAPM service with a minimum standard of quality. It can be used to identify gaps between planned service standards and actual resources on-site, which are required to provide the LAPM service to the given standard. These gaps will most often reflect problems with the support systems, such as the commodities and logistics systems, staff allocation, or staff training.

One important aspect of this indicator is that it assesses the LAPM resource availability at the delivery site. Evaluators interpret as "not available" any essential items absent from the service delivery area (e.g., forceps sitting in another service delivery area, or supplies locked in a storage closet). This approach more realistically assesses a facility's capability for meeting LAPM service standards.

Issue(s):

It should be noted that the list of equipment for each method is the minimum list needed to provide services of acceptable quality. Also, this indicator does not measure the actual delivery of the LAPM service. Similarly, it does not measure whether service providers followed the right procedures and made the right decisions regarding the course of action for specific clients.

Percent of facilities with appropriate staff to support quality LAPM services

Definition:

 

Percent of facilities with staff trained to provide long-acting and permanent methods (LAPMs), altogether and broken down by method.

This indicator is calculated as:

(Number of facilities with staff trained in LAPM / Total number of surveyed facilities eligible to offer at least one LAPM onsite) x 100

Data Requirements:

 

Among facilities that offer LAPMs, responses to a facility survey question asking about which staff have received pre-service or in-service training on LAPMs, when they were trained, and the content of the training. Evaluators may wish to follow-up with a question regarding the presence of standards of practice or service protocols for LAPM at the facility.

The question should specify that the service must be provided onsite rather than just referring a client for the method. Data should be collected for each method provided.

Because of the differences in the type of services offered at particular levels of facilities, evaluators should tabulate the indicator by facility type to guarantee accurate interpretation of the indicator.

If targeting and/or linking to inequity, classify service delivery points by location (poor/not poor) and disaggregate by location.

Data Sources:

Facility survey or interviews with facility staff

Purpose:

This indicator assists in determining the extent to which facilities are able to provide access to LAPMs based on their human resource capacity. Collecting information on staff trained is one component in measuring the provision of quality services to clients.

Issue(s):

This indicator needs to be tracked along with indicators of health system training protocols. In addition, having trained providers on site does not guarantee client access to high quality services if the service providers are not following the right procedures or making the right decisions regarding the course of action for specific clients, or if other key components of quality, such as essential supplies and equipment are not available.

Gender Implications:

Three of the LAPMs are female methods and one is a male method. Method-specific data can offer a perspective on whether a FP program is providing contraceptive choice for women and men.

Percent of women and men who have heard of at least one LAPM

Definition:

 

Percent of women and men of reproductive age (aged 15-49 years) who can name at least one of the four long-acting or permanent methods (LAPMs): IUD, implant, female sterilization or male sterilization.

This indicator is calculated as:

(Number of women and men surveyed who can name at least one LAPM / Total number of men and women surveyed) x 100

Additional calculations:

Data Requirements:

 

To obtain the data required, an interviewer can ask the respondent which LAPMs she has heard of, or it can be asked in a written survey. The method of questioning will depend on the literacy level of the population of women surveyed. Also, respondents may know of implants or IUD, but may not realize or recall that they are long-acting methods.  Thus, interviewers may ask the respondent to list all the family planning (FP) methods s/he knows of, which may or may not include LAPMs. Programs may be interested in knowing the respondents’ age, marital status and parity.

Data Sources:

Demographic Health Survey (DHS) or other population-based survey

Purpose:

While growing awareness of methods is not sufficient to expand use of contraceptives in general or of any specific method, it is an essential component of vibrant FP programs. This indictor highlights whether that essential component exists in a country or site.  Knowledge of FP methods is generally high in developing countries, but data show that knowledge of LAPMs is often lower than for other methods. This indicator will support program design by indicating whether an enhanced focus on behavior change communication (BCC) is needed, particularly if a program has been trying to promote a particular LAPM or increase their use.

Issue(s):

 

Knowing a particular method exists does not always imply that an individual has sufficient understanding of how the method works, where it is available, or the attitude towards the method, (myths and rumors can create negative impressions).  Likewise, the indicator does not ask where a respondent may have heard of a specific method or how they know about it.

Not all FP programs offer all methods, so the question may not be helpful to understanding programmatic strengths and weaknesses.

Gender Implications:

 

Differential knowledge about LAPMs between men and women may reflect differential access to formal and informal communication channels, such as newspapers, radio, TV, social networks, etc. Any significant differences by sex should be assessed to support BCC program design.

Percent of clients who receive high quality, comprehensive counseling for LAPMs

Definition:

 

Percent of clients in facilities that provide at least one long-acting or permanent method (LAPM) and/or offer referrals for LAPMs who received high quality counseling for LAPMs for example:

This indicator is calculated as:

(Number of observed LAPM counseling sessions that were deemed high quality and comprehensive / Total number of observed LAPM counseling sessions) x 100

Data Requirements:

 

Data compiled from use of a checklist of quality components in a LAPM counseling session collected by trained observers who attend counseling sessions.  See the Sample Medical Monitoring Checklists by the ACQUIRE Project/EngenderHealth, examples.                         

Data should reflect the sex, age and parity of individuals being counseled as well as the sex and age of the provider to support improved counseling skills in cases of provider bias.

If targeting and/or linking to inequity, classify outlets where counseling is taking place by location (poor/not poor) and disaggregate by area served.  Exit interviews can be conducted with clients to determine client's poverty status.

Data Sources:

Facility observation visits or exit interviews

Purpose:

This measurement of quality determines the extent to which staff in facilities that provide LAPMs or referrals are providing clients with thorough and accurate information about their family planning choices. It can also be a proxy indicator for how well service providers have mastered relevant knowledge from an LAPM training. If the evaluator observes the counseling session to be insufficient, the data should be used in a positive, not punitive way to support enhanced counseling skills.

Issue(s):

Evaluators should take into consideration the context in which the observed counseling session is taking place. For example, there may be contextual factors such as the counseling area lacks privacy or there is a long line of clients to be seen that may compromise the quality of counseling services, even if the provider is fully competent to provide high-quality, comprehensive LAPM counseling.

Gender Implications:

Observers should note provider bias related to male or female methods and/or if providers counsel women, men or couples differently. A gender assessment of counseling could highlight if programs need to find better ways to engage men or better ways to understand the constraints women experience in accessing the full range of contraceptive methods. 

Percent of men and women who intend to use an LAPM in the future

Definition:

 

Among men and women of reproductive age (aged 15-49 years) surveyed who are either not currently using any method of contraception and who say they intend to use a contraceptive method in the future or respondents who are currently using a short-acting or traditional method, the percent who say they plan to use a long-acting or permanent method (LA/PM).

“Intend” is operationally defined as the percent of respondents who answer affirmatively to the question, “Do you intend to use an LA/PM in the future?” (Evaluators may have to list what the LA/PMs are.)

This indicator is calculated as:

(Number of women and men who say they plan to use an LA/PM  in the future/ Number of women and men who are either not currently using any method of contraception but plan to or are using a short-acting or traditional method  x 100

Calculations for non users and current short-acting or traditional method users should be made separately.  Calculations can be done at the national or subnational levels.

Alternative definitions: 

Data Requirements:

 

Responses to survey in sample population. If researchers measure degree of intention using a five-point Likert scale, they must decide whether to combine “strong intent to” with “some intent to” to arrive at the total percentage intending to use LAPM.  Data should be disaggregated by respondent’s age, marital status, and parity. 

Data Sources:

 

Demographic and Health Survey (DHS) or other population-based survey

Purpose:

 

For planning purposes, family planning (FP) programs need to understand people’s intentions regarding future method use or method switching in order to design appropriate LAPM training and logistics activities.  This indicator can help support such planning.  In addition, if intentions to use LAPMs are low compared to mature programs, this indicator can highlight the need for enhanced behavior change communication.

Issue(s):

 

Intention to use does not translate directly into future use.  Intentions should be mapped along with CPR trends to assess whether people are generally able to meet their own reproductive health and contraceptive use intentions.  Other planning tools (Reality Check http://www.respond-project.org/pages/pubs/tools.php, SPARCHS) provide concrete planning guidance; this indicator only sets a framework.  Also, the measurement of this indicator relies on the willingness of respondents to truthfully admit their intentions, which may or may not be valid.

Gender Implications:

Three of the LAPMs are female methods and one is a male method. Method-specific data can offer a perspective on whether a FP program is providing contraceptive choice for women and men.