AMHERST, Mass. - Biostatistics expert Leontine Alkema at the School of Public Health and Health Sciences at the University of Massachusetts Amherst recently was awarded a three-year, $1.4 million grant from the Bill & Melinda Gates Foundation to explore and analyze family planning indicators such as contraceptive use in 69 countries. The main goal is to develop new methods and tools any country can use to monitor and advance national reproductive health.
Improving access to reproductive health services and products is central to a nation's development, Alkema and colleagues point out. To date, most efforts to monitor progress have focused on national estimates, "but such analyses can mask local disparities," Alkema says.
Knowing what is going on within a country at the provincial or district level, for example, is important for programming, she explains. "This grant will help to provide more detailed family planning information at the subnational level using statistical models," focusing at first on a subset of countries and expanding later to all 69 nations.
Alkema's involvement in the estimation of family planning indicators started with developing a statistical model to produce national-level estimates for all countries in the world in collaboration with the United Nations Population Division. She says, "Our modeling work on family planning indicators coincided with the start of Family Planning 2020 (FP2020), a global initiative to expand access to family planning services in the world's 69 poorest countries."
To aid in monitoring progress, in particular by FP2020 monitoring and evaluation officers in each country, Alkema and colleagues developed an online web application called the Family Planning Estimation Tool (FPET), now being used in national workshops and for FP2020 reporting.
"While monitoring at national levels is important for tracking progress, such analyses may mask subnational disparities, or not provide useful information to countries for subnational programming. Hence we started exploring how to obtain information at subnational levels," Alkema explains.
Most recently, she and colleagues used FPET for a subnational analysis in India to analyze and report province-level results on trends in contraceptive demand and use, and unmet need for family planning. She says, "The subnational analysis in India showed great disparities. For example, we found that the percentage of married women who indicate that they do not want more children, or would like to wait before having their next child but are not using any contraceptive method, ranged from 6 to 40 percent."
The grant from the Bill & Melinda Gates Foundation allows Alkema, her UMass Amherst collaborator Krista Gile and others to develop new methods to assess levels and trends in family planning indicators for smaller subnational populations. The end product will include a tool that can be used for in-country monitoring of contraceptive use as well as the total demand and unmet need for modern methods.
"In addition to the challenge of producing estimates of contraceptive use, we will also address the challenge of assessing the size of the population of interest, which are women of reproductive age." Alkema explains. This information can be obtained from censuses but censuses, when they are done, are generally carried out only every 10 years. "The estimation of subnational population sizes in between census years, and for years past a census is another problem to tackle using statistical models."
"To move towards the goal of providing every woman with access to the contraceptive method of her choice, we need better monitoring of family planning indicators, and for that, we need statistical methods." according to Alkema. "I am grateful for the support from the Bill & Melinda Gates Foundation to focus on the stats part of this important goal."