Contraceptive Security Indicators Survey

The Contraceptives Security (CS) Indicators toolkit presents tools and resources on family planning and reproductive health (FP/RH) intended for a wide audience, including public and private entities, social actors, family planning services donors, among others. The toolkit content ranges from a high-level perspective on contraceptive security and background on the origins, objectives and methodology of the CS Indicators survey to actionable and interactive resources, including the CS Indicators Reports, databases and the accompanying interactive 2017, 2019, and 2021 Survey Dashboards.

Delve into the details behind the numbers with the newly published qualitative briefs, which synthesize insights across countries from the 2021 CS Indicators survey on the following topics:

• National contraceptive security committees: What are the roles of committees? Who sits on the committees?
• Strategic objectives related to contraceptive security: What are countries’ top priorities in designing their family planning program strategy?
• National FP policies and the private sector: What government policy barriers does the private sector face? What are some government policy incentives for the private sector?
• Contraceptive security overall challenges and successes: What overall health system challenges are countries facing? What challenges do they face specific to supply chain? What have been some recent successes in contraceptive security?
• Impact of the COVID-19 pandemic on government budgets and spending
• Impact of the COVID-19 pandemic: Operational practices to facilitate access to FP services. What mitigating practices have countries put in place to ease the burden of the pandemic on access to family planning? How has the pandemic impacted contraceptive security?

Contraceptive security means everyone is able to choose, obtain and use a wide range of high-quality and affordable contraceptive methods, when they need them, for FP/RH and the prevention of sexually transmitted diseases.

Multiple factors across several sectors contribute to the availability and accessibility of contraceptives within countries, including political commitment, financial capital, partner coordination, capacity, client demand and use, and commodity availability. As demand for FP continues to grow and outpace donor financing, the ability of governments and other stakeholders to direct resources and legislation in support of supply chains and service delivery increases in importance. It is particularly critical that governments work with the private sector to ensure the overall availability of a good mix of contraceptive methods.

USAID, under the USAID/DELIVER Project, developed the CS Indicators in 2009 to help in-country and global aid program managers, advocates and decision makers to measure and track countries’ progress in improving access to contraceptives, particularly for those areas requiring more focused interventions. GHSC-PSM took over data collection in 2017 and conducts the survey every two years. In 2017, 36 countries across Africa, Eurasia, Latin America and the Caribbean responded to the survey. In 2019, 43 countries responded to the survey. Additional history on the development of the survey is available here.

This study’s immediate objective is to continue to document CS outcomes at the country and global levels, contributing to the global knowledge base for FP/RH. The CS Indicators assist stakeholders and countries in obtaining data and monitoring progress in support of initiatives such as FP2020 and achieving the Sustainable Development Goals.

The CS Indicators build off the Strategic Pathway for Reproductive Health Commodity Security (SPARHCS) framework as an approach to assess, identify, and prioritize RH issues around the “7 Cs”: context, commitment, coordination, capital, capacity, commodities, and client demand and use. The CS Indicators were designed to complement the former CS Index, now the Contextual Measures, which help countries identify strengths and weaknesses across five components — financing, supply chain, utilization, access, and health and social environment.

Additional information on the details and usage of the survey are available below:

• Survey Components
• Survey Methodology
• Survey Uses

The CS survey report for 2017 is currently available, with the 2019 report coming in late August. These reports present CS data from 36 and 43 countries, respectively, focusing on findings from key indicators such as leadership and coordination, finance and procurement, policies, commodities, quality and private sector. The reports aim to enable program managers, advocates and decision makers in countries as well as in the global health community to monitor progress toward CS, inform program planning and advocate for improved policies and resources.

• 2017 CS Indicators Report
• 2019 CS Indicators Report
• 2021 CS Indicators Report

The CS survey downloadable datasets are a comprehensive set of all of the CS Indicators surveys conducted to date (from 2010 through 2019). These datasets provide a broader view of the indicator findings by including a summary by country, and a more in-depth view of the indicator finding by providing the raw data for individual country surveys. The datasets for the last two years of the survey (2017 and 2019) also include data on the Contextual Measures (formerly the CS Index) grouped into four main sectors – finance, health and social environment, access and utilization. The CS Index tables from 2003 through 2015 (conducted every three years until 2015) can also be found here. The datasets are easily downloadable into an Excel file.

• 2010 CS Indicators Dataset
• 2011 CS Indicators Dataset
• 2012 CS Indicators Dataset
• 2013 CS Indicators Dataset
• 2014 CS Indicators Dataset
• 2015 CS Indicators Dataset
• 2017 CS Indicators Dataset
• 2019 CS Indicators Dataset
• 2021 CS Indicators Dataset
• CS Index 2003
• CS Index 2006
• CS Index 2009
• CS Index 2012
• CS Index 2015
• CS Index Technical Manual

The CS Indicators Survey includes a number of narrative questions to capture details on, among other topics, the roles and functions of CS committees, policies that hinder or enable private sector distribution of contraceptives, and overall challenges and successes for contraceptive security. The qualitative briefs synthesize respondents' insights in several areas to highlight approaches being applied across countries.

2019 Survey

• Brief 1 - Contraceptive security committees
• Brief 2 – Hindering and enabling policies
• Brief 3 – Policies that increase access to FP
• Brief 4 – Policies that decrease access to FP

2021 Survey

• Brief 1 - Contraceptive security committees
• Brief 2 - Strategic objectives related to contraceptive security
• Brief 3 - National FP policies and the private sector
• Brief 4 - Contraceptive security challenges and successes
• Brief 5 - Impact of COVID-19 on FP: Government budgets and spending
• Brief 6 - Impact of COVID-19 on FP: Operational practices to facilitate access to FP

The new COVID-19 impact dashboard presents global data from the 2021 CS Indicators survey’s Section H, which gauges some of the measures in place to prepare for and alleviate the impacts of pandemics and other emergencies on access to family planning, as well as assessing to what extent the COVID-19 pandemic may have impacted a few key elements of contraceptive security. Viewers have the option to display the aggregate indicator results for all reporting countries (the default option), or to view results for a single country or selection of countries. The dashboard includes the following indicators:

• Is there an emergency preparedness plan in place for pandemics (that includes impact on family planning)? 
• Is there an emergency preparedness plan in place for other types of emergencies (that includes impact on FP)? 
• How did the COVID-19 pandemic impact the frequency of the CS committee meetings in 2020? 
• To what extent did the COVID-19 pandemic affect the approved budget line for contraceptives for the current fiscal year? 
• To what extent has the COVID-19 pandemic affected the amount of government spending for contraceptives in the most recent complete year?

For more narrative context on the impact of the COVID-19 pandemic on family planning and measures put in place by countries to facilitate FP access during the pandemic, refer to qualitative briefs 5 and 6.

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The Harmonized Contraceptive Security (CS) Indicators Dataset (2010-2021) consolidates nine rounds of CS Indicators surveys into a single dataset. The dataset is structured to facilitate cross-national and longitudinal analysis of key CS indicators and made public to encourage widespread use of the data amongst the broader research community.

The harmonized dataset includes 250 variables across 384 country-years – for nearly 50,000 data points – with 63 countries included for at least one survey-year. The dataset’s variables are a mix of recoded data from original CS surveys along with indicators that have been harmonized and/or transformed to facilitate analysis across survey years. For example, where the wording of questions or response options may have changed across survey years, rules were created to harmonize differences across the years and thus to create a single standard indicator for analysis. Additional modifications made to ease analysis include: (a) assigning numerical values for free, categorical, or ordinal survey responses; (b) collapsing highly detailed categories into digestible baskets; and in some cases, (c) creating simplified supra-indicators (e.g., “data availability”) where only detailed or highly-varied indicators existed previously.

The file also includes several worksheets of supporting documentation to ease use and ensure transparency in the coding decisions:

•  “Master Harmonized CS Dataset” contains the master dataset including all 250 variables and 384 country years
•  “Master Coding” lists all variables with a unique coding key, specifies a variable type (raw or derivative), and provides relevant survey years
• “Survey Questions, 2021” provides the full survey question for each variable from the 2021 survey or most recent relevant survey year
•  “Harmonization Rules” provides the rules underlining the dataset’s 36 harmonized variables and outlines the relevant differences between the survey years
• “Transformation Rules” provides the rules underlining the dataset’s 68 transformed variables and specifies the “feeding variables”
• “Cleaning Log” explains instances where the raw data was changed or modified
• “Caveat List” outlines some caveats for specific variables

Finally, the workbook’s three final worksheets supplement the harmonized dataset by providing key context and outcome variables (e.g., GDP,education data, and mCPR). The “Context Variables” worksheet contains the most up-to-date data for the aggregate modern contraceptive prevalence rate (mCPR) for married women. These final three worksheets are formatted to be easily merged with the master harmonized dataset, with links to the sources provided.

When using this data in published research, please cite: USAID Global Health Supply Chain Program-Procurement and Supply Management. "Harmonized CS Indicators Dataset, 2010-2021," March 2023. https://www.ghsupplychain.org/index.php/CSI-Survey-Landing-Page.

For any questions, please reach out to PSMMonitoringandEval@ghsc-psm.org.

Emergency contraception (EC) refers to the contraceptive methods that women can use to prevent pregnancy after unprotected sexual intercourse. EC is a critical component of contraceptive methods mix, as it is the only contraception that can be used after unprotected intercourse, when pre-coital contraception methods were not used or were forgotten, a barrier method failed, or in cases of sexual assault.

GHSC-PSM partnered with the International Consortium for Emergency Contraception to produce this brief, which highlights country policies concerning emergency contraceptive pills (ECPs) as reported by 42 countries in the 2021 CS Indicators Survey, as well as trends from the survey’s findings between 2010 and 2021 across 63 reporting countries. Data are presented on the FP methods offered (including ECPs) in the public and private sectors, inclusion of ECPs on national essential medicines lists, levels of health providers authorized to distribute ECPs in the public sector, FP providers trained in IUD and implant insertion and removal, ECP commodity stockouts at central warehouses and at service delivery points, and on the availability of quality assured ECP products. 

For more information and resources about emergency contraception, you can access the Reproductive Health Supplies Coalition Repository of EC materials at www.cecinfo.org and also visit the website of the European Consortium for Emergency Contraception: www.ec-ec.org.
 

Since the first CS Indicators survey, additional FP-related datasets have been collected, which complement the CS Indicators. While the CS Indicators’ focus is at a high level, focusing on government policy and finances, other datasets explore private sector markets for contraceptives, prices, and other aspects of client access and utilization. Here are some other sources of data on various aspects of CS:

Reproductive Health Supplies Coalition/ForoLAC

The Reproductive Health Supplies Coalition (RHSC), the world’s largest network of reproductive health supplies organizations, is home to the Global Family Planning Visibility Analytics Network (VAN). The VAN is a shared global network that captures and uses supply chain data from multiple sources to ensure: (a) more timely and cost-effective delivery of commodities to countries; (b) more women reached with the right product at the right time; and (c) better coordination on how to allocate limited health resources. One benefit for users of the VAN is enhanced supply chain data visibility to detect and avoid overstocks and anticipate stockouts.

The RHSC is also home to its regional network, the Latin America and Caribbean Forum (ForoLAC). ForoLAC is focused on family planning/reproductive health (FP/RH) commodity security and aims to bring together partners from the LAC region to share their experiences and analyze common barriers with the goal of implementing technical solutions adapted to the region's specific challenges. In collaboration with GHSC-PSM, ForoLAC has collected Contraceptive Security (CS) Indicators 2019 data for seven LAC countries, including Argentina, Bolivia, Chile, Ecuador, Mexico, Nicaragua, and Paraguay. Spanish-language fact sheets are a product of this partnership; they showcase data derived from the CS Indicators survey results in these seven countries as well as in five additional LAC countries. Factsheet data points include FP methods, central-level stockout rates and market barriers, the number of manufacturers for each method, and political/other barriers in each LAC country. The fact sheets will be especially useful for civil society and government officials in advocating to reduce unmet need and bring visibility to regional inequities.

Track 20

Track20 produces annual data for 18 core FP indicators, 13 of which are reported across the 69 FP2020 focus countries. It has also developed innovative tools such as FP Goals, a new model designed to improve strategic planning, the Family Planning Estimation Tool (FPET), which estimates key FP indicators such as contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), Unmet Need, and Demand Satisfied, and the National Composite Index for Family Planning (NCIFP), which measures the existence of policies and guidelines, as well as the extent to which FP program implementation includes measurable dimensions of quality service provision.

Track20 is also working to track country-level FP expenditures by combining information from three sources:

• Kaiser Family Foundation collects data from the largest donors on financial flows for family planning.
• The World Health Organization uses a System of Health Accounts (SHA) framework which produces data on total health expenditures as well as reproductive, newborn, maternal and child health expenditures, to which the category of FP expenditures has been added.
• UNFPA's Family Planning Expenditures Tracking surveys (administered by Netherlands Interdisciplinary Demographic Institute) collects expenditure data on specific projects such as FP.

UNFPA

The UNFPA World Population Dashboard showcases global population data, including fertility rate, information on sexual and reproductive health, and much more. Together, these data shine a light on the health and rights of people around the world, especially women and young people. This dashboard is one of four dashboards housed on the UNFPA website data page, which provides an overview of UNFPA recipient countries, allocation of funding and results. The dashboard numbers come from UNFPA and fellow UN agencies, and are updated annually.

Performance Monitoring for Action

Performance Monitoring for Action (PMA) collects a nationally representative sample of data from households and service delivery points in selected sentinel sites to estimate health indicators on an annual basis in 11 pledging FP2020 countries (Burkina Faso, Côte d’Ivoire, Democratic Republic of Congo (DRC), Ethiopia, Ghana, India, Indonesia, Kenya, Niger, Nigeria and Uganda). PMA questionnaires capture information on many key FP indicators, including demand and utilization, as well as new unique measures of access, choice and quality of FP information and services; and other health indicators.

IQVIA

USAID aims to improve method choice to help strengthen country health systems and ensure wide contraceptive method mix, particularly in vulnerable and underserved populations. GHSC-PSM contracted IQVIA, a leading global provider of advanced analytics, technology solutions and contract research services to the life sciences industry, to provide granular data and analysis, to obtain data services aimed at allowing USAID to conduct a contraceptive procurement analysis and provide a picture of the total market contraceptive situation, with a specific focus on the method mix in: LAC, Benin, Togo, Kenya, Nigeria and South Africa.

The Health Policy Plus (HP+) Project

Funded by USAID and implemented by Palladium, HP+ has developed several FP tools, including:

• The FP Sustainable Development Goals Model (FP-SDGs model) projects medium- and long-term effects of three different FP scenarios in any country to show how investments in FP, education, and the economy and accelerate progress toward the SDGs.
• The Total Market Approach (TMA) Projection Tool estimates the FP and financial impacts of increased commercial sector investment in FP.
• The ImpactNow model estimates the health and economic impacts of FP in the near term. It is designed to model the impacts of different policy scenarios, and to compare the results of those scenarios in advocacy materials.

MEASURE Evaluation FP/RH Indicators Dashboard

This comprehensive database aims to increase the monitoring and evaluation capacity, skills and knowledge of those who plan, implement, monitor and evaluate FP/RH programs worldwide. The database features:

• A menu of the most widely used indicators for evaluating FP/RH programs in developing countries
• 35 technical areas with over 420 key FP/RH indicators, including definitions, data requirements, data sources, purposes and issues
• Links to more than 120 websites and documents containing additional FP/RH indicators

FPwatch

FPwatch was designed to generate evidence on contraceptive availability through surveys administered to all public and private health facilities and outlets. Launched in 2014, FPwatch provided data on the composition, performance and service readiness of the total FP market in five countries (Ethiopia, Nigeria, DRC, Burma and India). This included range and availability of modern FP methods and services, private outlet consumer prices, relative market share by method/outlet type and market readiness for FP service delivery. FPwatch was a PSI research project.

The CS Indicators Survey, with data from 61 countries going back to 2010, provides a valuable source of data for stakeholders to monitor CS trends, via the CS Indicators Harmonized Dataset. However, the indicators were developed based on anecdotal knowledge, practical experience, and only limited studies providing objective evidence that the indicator policies and practices lead to the anticipated family planning and reproductive health (FP/RH) outcomes they were established to bolster—such as increased modern contraceptive prevalence rate (mCPR). In an effort to provide more systematic and rigorous evidence for the FP/RH community, GHSC-PSM has conducted an initial study to identify which assessed policies are most likely to lead to the desired outcome of high mCPR among married women of reproductive age in selected lower- and middle-income countries.

The results of the study can be downloaded in our CS Indicators Framework Issue Brief.