Abstract
This article evaluates the use of modern contraceptives among poor women exposed to a family planning voucher program in Cambodia, with a particular focus on the uptake of long-acting reversible contraceptives (LARCs). We used a quasi-experimental study design and data from before-and-after intervention cross-sectional household surveys (conducted in 2011 and 2013) in 9 voucher program districts in Kampong Thom, Kampot, and Prey Veng provinces, as well as 9 comparison districts in neighboring provinces, to evaluate changes in use of modern contraceptives and particularly LARCs in the 12 months preceding each survey. Survey participants in the analytical sample were currently married, non-pregnant women ages 18 to 45 years (N = 1,936 at baseline; N = 1,986 at endline). Difference-in-differences (DID) analyses were used to examine the impact of the family planning voucher. Modern contraceptive use increased in both intervention and control areas between baseline and endline: in intervention areas, from 22.4% to 31.6%, and in control areas, from 25.2% to 31.0%. LARC use also increased significantly between baseline and endline in both intervention (from 1.4% to 6.7%) and control (from 1.9% to 3.5%) areas, but the increase in LARC use was 3.7 percentage points greater in the intervention area than in the control area (P = .002), suggesting a positive and significant association of the voucher program with LARC use. The greatest increases occurred among the poorest and least educated women. A family planning voucher program can increase access to and use of more effective long-acting methods among the poor by reducing financial and information barriers.
Highlights
From 2000 to 2010, contraceptive prevalence among married women of reproductive age in Cambodia increased dramatically and rapidly—from 24% in 2000 to 40% in 2005 and 51% in 2010.1 By 2010, knowledge of contraceptives methods among women was nearly universal.Global Health: Science and Practice 2016 | Volume 4 | Number 2Despite these gains, the use of modern methods, in particular long-acting reversible contraceptives (LARCs) and permanent methods, remained quite low
Our analysis focuses on the average effect of exposure to the voucher program on net change in the use of modern contraceptives, with a focus on the uptake of LARCs
In disaggregated analysis of LARC use, we found that the greater increases in LARC uptake in voucher areas than in control areas took place across age groups, educational status, occupational groups, and socioeconomic levels (Table 6)
Summary
From 2000 to 2010, contraceptive prevalence among married women of reproductive age in Cambodia increased dramatically and rapidly—from 24% in 2000 to 40% in 2005 and 51% in 2010.1 By 2010, knowledge of contraceptives methods among women was nearly universal.Global Health: Science and Practice 2016 | Volume 4 | Number 2Despite these gains, the use of modern methods, in particular long-acting reversible contraceptives (LARCs) and permanent methods, remained quite low. From 2000 to 2010, contraceptive prevalence among married women of reproductive age in Cambodia increased dramatically and rapidly—from 24% in 2000 to 40% in 2005 and 51% in 2010.1 By 2010, knowledge of contraceptives methods among women was nearly universal. Global Health: Science and Practice 2016 | Volume 4 | Number 2. Despite these gains, the use of modern methods, in particular long-acting reversible contraceptives (LARCs) and permanent methods, remained quite low. In 2010, 35% of married women were using modern methods, but only about 17% of these women were using LARCs or permanent methods.[1] By comparison, 15% of modern method users were using the oral pill and 10% were using injectables. Access to a full range of modern contraceptives contributes importantly to reductions in maternal mortality and morbidity, a key development goal More than half of married women said that they did not want more children or they wanted to space births by 2 years or more, and 17% of women in 2010 expressed an unmet need for contraception.[1]
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