No one left behind: has the pursuit of FP2020’s 120 million additional users goal left some women behind?

Abstract

Background: An important question is whether the FP2020’s “120 million additional users” goal exacerbated inequities and led to a prioritization of populations within countries where substantial gains towards the goal could be made. We examine FP2020 country data for signs of inequity in gains in modern contraceptive prevalence (MCP). Methods: We selected 11 countries (Bangladesh, Burundi, Ethiopia, Haiti, Malawi, Mali, Nepal, Pakistan, Senegal, Sierra Leone, Uganda, and Zimbabwe) to conduct a bivariate analysis. We evaluated if MCP growth had been equitable by assessing MCP between two surveys stratified by residence, levels of education, age groups, marital status, and wealth. Results: In most countries, MCP increased among rural women and in seven African countries these gains were significant. In six countries, MCP gains were significant both among women with no education and in the lowest wealth group. MCP gains among young women aged 15-19 and 20-24 were seen in four African countries: Malawi, Senegal, Sierra Leone, and Uganda. Conclusions: Our findings suggest that between two surveys since 2010 many countries saw MCP gains across different dimensions of equity and do not suggest a focus on expanded coverage at the expense of equity. As the family planning community begins to look ahead to the next partnership, this analysis can help inform the emerging FP2030 framework, which includes equity as a guiding principle.