CLIENT

Consider the consumer perspective. What cultural norms and beliefs are likely to inhibit/facilitate client acceptance of the method? What behavioral and social network patterns support projections in method uptake? Consider awareness, attitudes, knowledge, practices, beliefs/myths, gender dynamics, need, preferences, and supply constraints as inputs.

Key health and demographic characteristics can provide information about the client perspective: (1) contraceptive prevalence by method and contraceptive method mix, (2) incidence of unplanned pregnancies, (3) unmet need for family planning, (4) current total fertility rate (TFR) and TFR target, (5) current family size and ideal family size, (6) maternal mortality ratio, (7) women of reproductive age seeking abortion services, and (8) population growth.   There may also be research on issues that include the role of men in method choice and use, support in the community/family for family planning methods, and many topics that could affect demand for and uptake of particular NUMs.

Data sources to support client-based assumptions include DHS, RHS, research reports, health management information system (HMIS) reports, service data, qualitative research, and behavioral surveillance studies.

Assumption-building tips:

  • Is there a target audience for the NUM in question? Divide the population into family planning user groups based on the method mix available in that country. Fully understand the potential user group for the NUM. Some guiding questions include:
  • What percentage of women will adopt a new method?  What are the perceived benefits of the method? Who is likely to adopt this method when it is first introduced? Who is likely to adopt it later? In similar programs/countries, what was the adoption rate?
  • What cultural norms and beliefs inhibit/facilitate client acceptance of the method?
  • What impact will the new method have on existing methods? Will the new method be adopted only by new clients? If so, then past trends for existing products may continue at the same rate. If not, estimate how many women using other methods may switch to the new method.
  • What are the specific needs and preferences of women with respect to family planning? Consider geographic and cultural differences. Would one method be more appealing to women in some geographic and/or cultural regions than in others?
  • Where would clients access the NUM, and would they have preferences about where to get their family planning method (i.e., from a community health worker, at a health facility, or in the private sector)?
  • If the client is expected to pay for the NUM, will they be ready and willing to do so? How does the cost of using this NUM over time compare to the cost of using the existing methods?
  • Was there a pilot study completed for the NUM in the country, or another similar country? What did the findings suggest about the acceptability of the method to clients? Would any characteristics of the study group make acceptance more or less likely among the population as a whole? If using pilot data, it is very important to note any major changes in the pilot design compared to the current program—for example, there could be major differences if one project relies on the private sector while the other works through public sector outlets. Additionally, there could also be major differences in outcomes if program inputs—information, education, and communication (IEC) campaigns—are significantly different.
  • IEC campaigns, social marketing strategies, or any other promotional activities for family planning methods are designed to increase usage by making clients more aware of the availability and benefits of a product and/or service. These campaigns have the potential to influence awareness/knowledge/preferences/attitudes of clients. Programs need to consider the planned promotional activities for the NUM and how effective these campaigns will be to motivate method uptake. Usually uptake increases during a concerted campaign, although uptake may fall if the campaign is not sustained. If there are no awareness building and demand-creation activities planned, the method uptake will likely be very low. With NUMs in mind, consider these questions:
  • What is the estimated percentage of increased consumption following a promotional activity? Will interest decrease after the campaign? Will clients continue to use the method? (Consider whether or not a user must return to a service delivery point frequently to obtain the method.) Will new clients continue to adopt it?
  • How strong are social networks in the country, and how fast will positive (or negative) information about a new product permeate a network? If satisfied/dissatisfied clients have a tendency to talk to others about their experience, how will this impact the rate of method uptake?
  • Increasing CPR and reducing unmet need are common goals of family planning programs. For forecasts, the challenge is determining the realistic rate of increase for CPR from one year to the next, looking at the methods already available; which new methods will be introduced and/or scaled; and what are the anticipated growth rates for each method. Each year, especially when new methods are introduced, some clients switch to a more appropriate method for them or become a family planning user for the first time. Questions to consider:
  • What is the projected rate of growth in CPR? Will it be a steady increase during each of the next five years, or will there be a slow increase at first, and then a burst of adoption in later years? Or, will there be a rapid increase at the start of the period, which will taper off as the program progresses? The assumption on rate of increase of CPR will have a significant impact on the forecast.
  • Is the projected growth in CPR realistic? This depends on the maturity of the program and the interventions that are implemented to increase CPR.
  • What has been the previous growth rate for other NUMs in the country?
  • Demographic data can provide information about overall unmet need. However, two assumptions need to be made: (1) what percentage of women of reproductive age will start using this particular method when it is available?; and (2) how quickly will the method become available, based on the service delivery strategy? If there are supply constraints (e.g., if facilities need to order stocks but are not trained to do so, or if the forms for ordering commodities from a central supply unit do not include the NUM), the method will not be readily available and uptake will be affected. (See more under “Availability”).