CYP (couple years of protection) : an excellent programmatic indicator that needs refinement
Trias, M.
Profamilia Planificacion Poblacion y Desarollo 7(18): 3-7
1991
ISSN/ISBN: 0122-0977 PMID: 12284751 Document Number: 317940
This work assesses proposed changes in conversion factors for the family planning program indicator "couple years of protection", with a discussion of the proposed changes and citation of references for each method. Unlike most service statistics, couple years of protection allows the total family planning contribution of different contraceptive methods to be totalled and compared. Recently, the US Agency for International Development and the International Planned Parenthood Federation have proposed new conversion factors for calculating couple years of protection for most methods based on careful scrutiny of the average fecundity of method users, rates of continuation and failure, and waste. The fertility of users is not the same for all methods; most candidates for sterilization for example are older than users of oral contraceptives (OCs) or IUDs, and consequently their average fertility has declined. Neither are all methods equally effective, and the couple years of protection indicator should reflect these differences. The proposed conversion factor for OCs has been increased from 13 cycles per couple year of protection to 15 cycles to take into account the 6-20% of users who have been found to use the method incorrectly. 15 cycles was arrived at by assuming that 13% of users employ the method incorrectly. The proposed conversion factor for IUD is 3.5 years of protection per IUD instead of 2.5, on the assumption that of each 100 users, 10 would use the device for an average of 6 months, 45 for an average of 42 months, and 45 for an average of 76 months. The resulting total of 5370 months of use divided by 100 would yield 53.7 months. Subtracting 7% for the expected accidental pregnancies still yields 4 years and 11 months. The old measure of 2.5 years per IUD is apparently outdated. The proposed conversion factor for sterilization has been lowered from 12.5 couple years of protection to 10 per operation to reflect the higher average age and lower fecundity of sterilization acceptors. The revised conversion factor should help combat the excessive enthusiasm for sterilization of some family planning programs that neglect reversible methods appropriate for younger and more fecund women in favor of sterilization, which accumulates many couple years of protection without the same demographic impact. The proposed conversion factor for the condom has been changed from 1 couple year per 100 condoms to 1 per 150 condoms, to reflect the well documented failure rate of 10% per year, plus wastage due to poor storage and the difficult to evaluate but significant use of condoms for purely prophylactic rather than contraceptive purposes. The proposed conversion factor for vaginal creams, foams, and other spermicidal methods was also increased from 100 to 150, largely because of their higher failure rate. The proposed factor for Norplant implants is 3.5 per implant.