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 programs 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 CAREs Population Units 1993-95 service statistics for its 22 family planning projects indicated that while sterilization accounted for 29885 (0.1%) of the 22478444 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.