Program Implications of Intent to Use: An Analysis of Women’s Contraceptive Intentions in Ten Low- and Middle-Income Geographies

Yingyi Lin, Bill & Melinda Gates Foundation
Marita Zimmermann, Bill and Melinda Gates Foundation
Anu Mishra, Bill & Melinda Gates Foundation
Michelle O'Brien, Institute for Disease Modeling, Bill & Melinda Gates Foundation

Central to the ongoing debates on having rights-based family planning measures is the need for a woman-centered paradigm and measures of preference-aligned fertility management. While recent studies have investigated the alignment between women’s current preferences and current behaviors, limited evidence exists on aligning women’s current preferences and future behavior—an inquiry that is implicative for responsive program planning. In the 30 years since the 1994 International Conference on Population and Development, we describe the utilization of an understudied family planning indicator—women’s expressed intention to use (ITU) contraceptives—and explores its implications for developing metrics, tracking program success, and mechanistic understanding. We leverage Performance Monitoring for Action program data in ten geographies and assess, (1) cross-sectionally, the extent to which the time-bound measure of ITU concords with ‘unmet need’ and (2) longitudinally, the extent to which women actualize their ITU over time. We demonstrate that the utilization of ITU more accurately identifies women who have demand and who are able/unable to actualizing their ITU over time. We also discuss the limitations of the current ITU metric, making recommendations to data tracking and collection efforts to improve and include ITU as routinely reported family planning indicators for informing programs and policy.

Keywords: Family Planning and Contraception, Sexual and Reproductive Health and Rights, Longitudinal studies , Population Policies

See extended abstract.