"New Users" Are Confusing Our Counting: Reaching Consensus on How to Measure "Additional Users" of Family Planning.

Abstract

In July 2012, the London Summit on Family Planning reenergized the reproductive health field by establishing a new commitment to bring modern contraception to women and girls with an unmet need for family planning—those who say they do not want a child soon or at all but are not currently using contraception. At that time, it was estimated that 222 million women in the developing world had an unmet need for modern contraception.1 Most of these women were concentrated in the world's 69 poorest countries.2 The family planning community committed at the Summit to enabling an additional 120 million women in these 69 countries to use modern contraception by 2020.2–4 The community felt that designating a single number would help rally the community and push forward a renewed focus on family planning.3 Nearly 5 years later, the widely recognized “120 by 20” goal supported by the Family Planning 2020 (FP2020) global partnership can be credited for galvanizing renewed commitment to family planning. However, the new metric of “additional users”—an aggregate metric that estimates how many more modern contraceptive users there are now compared with the estimated 2012 baseline number—has created confusion about the definition and meaning of several other related family planning metrics, including “new users,” “acceptors,” “first-time users,” and “adopters.” It has also raised the question of how service-level metrics collected by programs can be linked to the aggregate concept of “additional users” to assess progress of individual programs toward population changes in contraceptive use at the country level. In this article, which follows from a panel discussion among the 4 coauthors held during the 2016 International Conference on Family Planning, we outline several of the metrics currently used to measure family planning program progress and propose a preferred set of service-level metrics to inform contributions to the FP2020 aggregate-level goal of reaching “additional users.” We also describe 2 approaches—Track20's Family Planning Estimation Tool (FPET) and Marie Stopes International's Impact 2 model—for bridging the gap between service-level measures available in programs' routine service statistics and the aggregate metric of additional users. Finally, we draw attention to the need for more robust data collection systems that allow for the collection of harmonized routine longitudinal metrics rather than focusing solely on visit-based service statistics or cross-sectional household surveys.