One commonly used approach for reporting family planning service levels is to calculate the couple-years of protection (CYP) provided by a program. CYP refers to “the estimated protection provided by contraceptive methods during a one-year period based upon the volume of all contraceptives sold or distributed free of charge to clients during that period…. The term ‘CYP’ reflects distribution and is a way to estimate coverage and not actual use or impact. The CYP calculation provides an immediate indication of the volume of program activity. CYP can also allow programs to compare the contraceptive coverage provided by different family planning methods.”¹ USAID, DFID and many family planning organizations use CYP to measure program performance.^1–6

In the 2009 Adding It Up report,^7–9 we estimated the ratio of unintended pregnancies averted per modern contraceptive user in developing countries. The analysis estimated that in 2008, the average pregnancy rate of the 215 million women in developing countries who wanted to avoid pregnancy but were using either no method or a traditional method was 288 per 1,000, but would have been 39 per 1,000 if they had been using modern contraceptives. Use of modern methods would therefore have averted 249 unintended pregnancies per 1,000 women, or 0.25 per modern contraceptive user.

In response to requests about application of the Adding It Up estimates to CYP service statistics, we described the Adding It Up methodology, discussed its application to CYP and provided data and recommendations to interested colleagues.¹⁰ Noting the lack of clarity and consistency in treatment of method use-failure in CYP conversion factor calculations, we recommended using a ratio of 0.25 unintended pregnancies averted annually per modern contraceptive user for estimating the average impact of current contraceptive service provision. We provided similar ratios for developing regions and subregions and provided data on outcomes of unintended pregnancies and maternal deaths in these areas.

An extensive review of data and methods for calculating CYP conversion factors has been undertaken by Emily Sonneveldt and colleagues at the Futures Institute, Tulane University and USAID.¹¹ Conversion factors for many methods will remain the same, but they are being changed for some methods, and factors for new methods are being added. (For information on current USAID conversion factors and source references, see the USAID website.¹) In light of this new evidence, we make the following revised recommendations for applying Adding It Up findings to estimates of CYP:

• For CYPs calculated using USAID or other conversion factors that take method use-failure into account, use a ratio of 0.288 for estimating unintended pregnancies averted per CYP.
• For CYPs based on conversion factors that do not adjust for use-failure, use a ratio of 0.249.
• In either situation, use the same impact ratio across all developing world regions.

This memo describes the methodological assumptions behind these impact ratios. It also provides information for distributing unintended pregnancies into their components—i.e., unplanned births, induced abortions and unintended pregnancies ending in miscarriages. In addition, it provides estimates of the ratio of maternal deaths averted per 100,000 unintended pregnancies averted. The ratio of unintended pregnancies averted per CYP does not vary across developing countries, since CYP conversion factors are the same across all areas. Estimates of the distribution of unintended pregnancies averted by their outcomes and maternal deaths vary geographically, reflecting differences in women’s characteristics (e.g., marital status, intentions to space or limit future births) and the types of contraceptive methods they use.

Applying the ratios of unintended pregnancies and other events averted to CYP estimates—and interpreting the results—is not straightforward, however. This memo also discusses some of the issues and decisions involved in applying these ratios to CYP. 

Download the full research memo using the link on this page.