History and current status of reproductive health surveys at CDC

Abstract

Since the development of immunization surveys in the 1950s to evaluate poliomyelitis immunization programs, the Centers for Disease Control and Prevention (CDC) has traditionally used populationbased surveys to evaluate public health programs.1 The use of population-based surveys continued overseas in the smallpox eradication program during the late 1960s and 1970s.2,3 Family planning epidemiology was begun at CDC in the late 1960s, first as an activity, then as the Family Planning Evaluation Division, and later as part of the Division of Reproductive Health (DRH). At first, service statistics systems were developed for local and state health departments.4,5 It quickly became apparent that population-based household surveys would be needed to obtain data on family planning users in the private sector and nonusers.6–9 Jack Smith, chief of the statistics activity, spearheaded the early efforts to improve service statistics systems and to develop populationbased surveys for evaluating family planning programs. In 1979, Smith was the lead researcher for a joint household survey with the Mexican Ministry of Health that was carried out along the U.S.–Mexico border to obtain family planning data on non-Hispanics and Hispanics.10–13 Since that effort, with the development of the random-digit dialing method, statewide surveys on reproductive health have been carried out by telephone in Idaho, Arizona, New York, Hawaii, and Georgia.14,15 The switch to telephone as the survey mode has been due largely to cost considerations. Parallel to the development of family planning survey methodologies in the United States, the Family Planning Evaluation Division, in collaboration with the U.S. Agency for International Development, developed the Contraceptive Prevalence Survey (CPS) for use in developing countries.16 The first of these surveys was conducted in El Salvador in 1975.17 The CPS is a regional or national probability household-based sample survey designed primarily for managing and evaluating family planning programs. This survey collects information on knowledge and use of contraception in relation to desire for more children, choice of contraceptive methods, availability of family planning services, and other program-related factors. The survey provides rapid feedback to program administrators on the use of family planning services and on program success in serving women at risk of unintended pregnancy. To ensure representativeness, the CPS (and subsequent surveys described below) uses a three-stage sampling design. The first stage is a selection of census sectors with probability proportional to size. Within the selected census sectors, a random sample of households is then chosen. In the third stage of the sample design, one woman of reproductive age is selected from each household. In a standardized interview, each woman is asked about her knowledge, use, and attitudes concerning contraceptive methods and sources of contraceptive supplies and services. Results are weighted to compensate for geographic oversampling or undersampling, the selection of one woman per household, and nonresponse differentials. Contraceptive Prevalence Surveys do more than reveal the extent of contraceptive use. They also help administrators evaluate family planning programs, check service statistics, and identify groups of women in need of family planning services. Each CPS provides the rapid feedback necessary to evaluate and improve family planning information and service delivery programs. Because questionnaires are short and usually only several thousand women are interviewed, the surveys can be repeated every few years to gauge the impact of new or reoriented programs undertaken on the basis of earlier findings. The CPS data are especially useful in determining how many women are at risk of unintended pregnancy; that is, how many do not want to become pregnant but may do so because they are fecund, sexually active, and not using contraception. Included among these are women whom family planning services have not yet reached. Identifying these women is of prime importance to program administrators. Around 1980, the CPS evolved into the Family Planning and Maternal Child Health Survey (FP-MCH), which expanded the content of the CPS to include data From the Behavioral Epidemiology and Demographic Research Branch, Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. Address correspondence and reprint requests to: L. Morris, MD, CDC-MS K-35, Behavioral Epidemiology and Demographic Research Branch, 1600 Clifton Road, Atlanta, GA 30333. E-mail: lmorris@ cdc.gov.