For the two countries that had large increases in long-acting and permanent method prevalence, the methods that dominated that change differed: Egypt experienced an 11-point increase in IUD use, whereas Malawi experienced a 10-point increase in reliance on sterilization.
Although our results indicate that long-acting and permanent method use declined in most countries after the introduction of the injectable, we cannot definitively conclude that the popularity of the new method was the cause.
However, adoption of the injectable could replace use of more effective, less expensive long-acting and permanent methods, especially among women who wish to longer delay or permanently avoid future births.
The ditterences in the changes in method use between the two countries are particularly striking with respect to long-acting and permanent methods. In Indonesia, use of such methods decreased among all three contraceptive subgroups: eleven percentage points among spacers, and 23 points and 16 points among younger and older lim-iters, respectively (Table 2).
Part of the reason for this is that 'in general across the developing world, wealthier women are more likely than poorer women to use long-acting and permanent methods
of contraception rather than shorter-acting methods.'
This is a cooperative agreement to improve access, especially at the community level and in rural areas, to affordable, quality family planning services and a wide range of contraceptive methods, including long-acting and permanent methods
. This project is an essential building block in USAID s efforts to help satisfy the high level of unmet demand for family planning in Uganda.
Composition scores indicate that long-acting and permanent methods were least available in Haiti and most available in India (12 vs.
Although there was no association between access and method mix, an increase in the relative availability of long-acting and permanent methods was associated with a method mix with a higher proportion of these methods, as shown by the positive correlation (0.7) and regression coefficient (1.8).
Notes: Method mix=use of long-acting and permanent methods as percentage of all modern method use.
The introduction of long-acting and permanent methods in countries where they are not available could reduce average discontinuation rates through a change in the method mix, but only if these methods are used.
Only one country had an increase in spacers relying on long-acting and permanent methods
, whilst the proportion decreased substantially in three countries and remained stable or showed small declines in the remainder.
Noting that ideally, women would progress from shorter-to longer-acting methods as their families grew, and would switch to a permanent method when they were sure that they wanted no more children, the authors recommend interventions to promote demand for long-acting and permanent methods
among women for whom they are appropriate, while maintaining a broad range of methods for women with varying contraceptive needs.