A new opinion article published in Frontiers in Global Women's Health proposes moving beyond coverage-based indicators to assess whether women's contraceptive use reflects genuine choice. The article was authored by ICEH researcher Franciele Hellwig, together with Aluisio J.D. Barros.

For decades, family planning programs have been evaluated primarily through coverage indicators, such as contraceptive prevalence and demand satisfied, that capture whether women use contraception, but not whether that use reflects a free, full, and informed choice. The article argues that these widely used metrics can mask important gaps in the quality and rights-based dimensions of sexual and reproductive healthcare.

The authors highlight three underused signals that current indicators tend to overlook. Distorted method mix, such as high reliance on female sterilization among young, low-parity women, can point to constrained options rather than genuine preference. Contraceptive discontinuation, often interpreted solely as programmatic failure, can also reflect responsive, person-centered care, whether women are switching to a better-suited method or stopping altogether due to a desire for pregnancy or a period of sexual inactivity. Contraceptive autonomy, the ability to make a free, full, and informed decision about contraception, remains largely absent from standardized measurement frameworks.

The article closes with practical recommendations for incorporating autonomy and preference-alignment indicators into national health surveys and program evaluation, aiming to better align global family planning monitoring with sexual and reproductive health and rights principles.

The full article is available here.