Identifying drivers of exemplary family planning performance in low- and middle-income countries between 2000 and 2017

Abstract

Between 2000 and 2017, average modern contraceptive prevalence increased by 7.8 percentage points and demand satisfied with modern methods increased by 12.8 percentage points among 108 low- and middle-income countries (LMICs). What drove these increases as well as which drivers best explain varying family planning performance during this time period remains unclear. We developed a comprehensive framework of potential drivers to investigate, including enabling environment factors and family planning interventions and their outcomes. We used standardized linear regression and Shapley decomposition to evaluate the effect and relative importance of 17 indicators quantifying the drivers. The most important drivers of differential performance across LMICs were: knowledge of methods, desire for limiting, conflict, decision-making to use contraception, education, and income. Based on these findings, we recommend policymakers and programmers invest in expanding method availability and awareness, ensure continuity of family planning services during times of conflict, and continue to prioritize the education and economic well-being of women in order to close gaps in family planning across LMICs.