Moving Toward a Population Level Measure of Person-Centered Contraceptive Need in the United States

Background: Health care systems should be designed to provide the care that people need and want; person-centered metrics are therefore critical data inputs to this process. Materials and Methods: We used multiple national datasets to develop a more person-centered metric for estimating need for contraception, comparing results made using a conventional approach with this new approach. The conventional metric estimates the number of individuals who have a likely need for contraceptive services based on their sexual experience and presumed risk for pregnancy. The new metric estimates the number of individuals who have a self-defined need for contraceptive services based on their current or recent contraceptive method or service use or their expressed desires to use contraception. Results: We found that the overall number of individuals considered to have a need for contraceptive services is roughly similar when comparing the conventional approach (37.8 million) with the new approach (38.3 million or 39.2 million, depending on the survey). However, these numbers represent somewhat different people according to each metric, with the traditional metric misclassifying some individuals who themselves desire to use or not use contraception. Implications: A new, more person-centered metric will better align measurement of contraceptive service need with what people want and will improve estimates of potential demand for care and how many individuals are likely to seek care. This paper provides policymakers and program planners with the thorough methodology and justification for the new metric that will be needed if the new metric is to be accepted and adopted for wide use.