The role of public-sector family planning programs in meeting the demand for contraception in Sub-Saharan Africa

CONTEXT: Commonly used indicators of contraceptive behavior in a population—modern contraceptive prevalence (mCPR), unmet need for contraception, demand for contraception and demand satisfied—are not well-suited for evaluating the progress made by government family planning programs in helping women and men achieve their reproductive goals. METHODS: Trends in these measures in 26 Sub-Saharan African countries between 1990 and 2014 were examined. Trends in a proposed new indicator, the public-sector family planning program impact score (PFPI), and its relationship to mCPR and the family planning effort score were also assessed. Case studies were used to review public family planning program development and implementation in four countries (Nigeria, Ethiopia, Rwanda and Kenya). RESULTS: The four commonly used indicators capture the extent to which women use family planning and to which demand is satisfied, but shed no direct light on the role of family planning programs. PFPI provides evidence that can be used to hold governments accountable for meeting the demand for family planning, and was closely related to policy developments in the four case-study countries. CONCLUSIONS: PFPI provides a useful addition to the indicators currently used to assess progress in reproductive health and family planning programs.