More evils of CYP

The use of costs per acceptor and per couple-years of protection (CYP) as indicators of family planning program effectiveness has led to an overemphasis on clinic-based urban services, to the detriment of community-based modes of service delivery aimed at hard-to-reach populations. A shift in program emphasis from barrier or hormonal contraception to long-term methods such as the IUD or sterilization produces disproportionate and counterproductive increases in the program's CYP. A community-based distribution program in rural Ecuador recruited an impressive 1475 new acceptors--largely of the pill and condoms--over 2 years, but the CYP was only 588 because of the method mix. A review of CARE's Population Unit's 1993-95 service statistics for its 22 family planning projects indicated that, while sterilization accounted for 29,885 (0.1%) of the 22,478,444 contraceptive methods distributed, it contributed 23% of the total CYP. Recommended, to remove this bias, is the development of alternative indicators of program effectiveness, including expansion of method mix, logistic effectiveness, method effectiveness and efficiency, client follow-up, quality of provider-client interactions, client access, user satisfaction, and method continuation. To ensure that efforts to serve hard-to-reach populations are given proper recognition, assessments should be based on measures such as distances covered or changes in CYP over time.