Achieving Equity in Family PlanningAchieving Equity in Family Planning

Disentangling poverty and place of residence

for family planning strategic planning

Karen G. Fleischman ForeitMEASURE Evaluation PRH

Achieving Equity in Family Planning

Equity begins and ends with measurement

Who shows the disparities? How big are the disparities? How do we know that our interventions are

reaching the people with the disparities? How do we know if we have made an impact?

Achieving Equity in Family Planning

Who is poor?

Relative poverty• Wealth quintiles, usually derived from

household assets Absolute poverty• Defined against some standard of income

and/or expenditures

Achieving Equity in Family Planning

Burkina F

asoGhan

a

Guinea

Liberia M

ali

Mau

ritan

iaNige

r

Nigeria

Senega

l

Sierra

Leone

0

5

10

15

20

25

30 RuralUrban

% U

sing

Mod

ern

FPUrban-rural differences are common

Achieving Equity in Family Planning

Burkina F

asoGhan

a

Guinea

Liberia M

ali

Mau

ritan

iaNige

r

Nigeria

Senega

l

Sierra

Leone

0

5

10

15

20

25

30 Bottom quintileTop quintile

% U

sing

Mod

ern

FP…as are differences by wealth quintile

Achieving Equity in Family Planning

Bottom 2nd 3rd 4th Top0%

10%

20%

30% Urban Rural

Wealth Quintile

% In

terv

iew

ed w

omen

But residence and wealth go together

Kenya 2003

Achieving Equity in Family Planning

Bottom 2nd 3rd 4th Top0%

10%

20%

30% Urban Rural

Wealth Quintile

% In

terv

iew

ed w

omen

…making it hard to interpret differences

Kenya 2003

Achieving Equity in Family Planning

Methods

Secondary analysis DHS standard recode files Separate urban and rural strata Rank by wealth score within strata Create residence-specific wealth quintiles Analyze outcome indicators by residence-

specific quintiles

Achieving Equity in Family Planning

Results

Highly variable residence-specific patterns

Achieving Equity in Family Planning

Wealth and Residence: Ghana 2008

Q1 Q2 Q3 Q4 Q5

-10%

0%

10%

20%

30%

Urban

% U

sing

a M

oder

n M

etho

dQ1 Q2 Q3 Q4 Q5

-10%

0%

10%

20%

30%

% U

sing

a M

oder

n M

etho

d

National

Achieving Equity in Family Planning

Wealth and Residence: Senegal 2005

Q1 Q2 Q3 Q4 Q50%

10%

20%

30%

Urban

% U

sing

a M

oder

n M

etho

d

Q1 Q2 Q3 Q4 Q50%

10%

20%

30%

% U

sing

a M

oder

n M

etho

d

National

Achieving Equity in Family Planning

Wealth and Residence: Zambia 2007

Q1 Q2 Q3 Q4 Q5-10%

0%

10%

20%

30%

40%

50%

60%

Urban% U

sing

a M

oder

n M

etho

dQ1 Q2 Q3 Q4 Q5

-10%

0%

10%

20%

30%

40%

50%

60%

% U

sing

a M

oder

n M

etho

d

National

Achieving Equity in Family Planning

Wealth and Residence: Kenya 2003

Q1 Q2 Q3 Q4 Q5-10%

0%

10%

20%

30%

40%

50%

60%

Urban% U

sing

a M

oder

n M

etho

dQ1 Q2 Q3 Q4 Q5

-10%

0%

10%

20%

30%

40%

50%

60%

% U

sing

a M

oder

n M

etho

d

National

Achieving Equity in Family Planning

Wealth and Residence: Kenya 2008

Q1 Q2 Q3 Q4 Q5-10%

0%

10%

20%

30%

40%

50%

60%

Urban% U

sing

a M

oder

n M

etho

dQ1 Q2 Q3 Q4 Q5

-10%

0%

10%

20%

30%

40%

50%

60%

% U

sing

a M

oder

n M

etho

d

National

Achieving Equity in Family Planning

Limitations of assets-based quintiles

Track over-all trends in family planning outcomes

X Do not match individual consumption measures of poverty

Achieving Equity in Family Planning

Bottom 2nd 3rd 4th Top0%

20%

40%

60%

80%

100%

>1 quintile +/- 1 quintile Exact match

Assets-based Quintile

% M

atch

w/

cons

umpti

on

Match-up between consumption and assets measures of poverty

Ecuador 2004 RHS

Achieving Equity in Family Planning

Bottom 2nd 3rd 4th Top0%

20%

40%

60%

80%

100%

>1 quintile +/- 1 quintile Exact match

Assets-based Quintile

% M

atch

w/

cons

umpti

on

Match-up between consumption and assets measures of poverty

Ethiopia 2005 DHS2004/5 HIES

Achieving Equity in Family Planning

Conclusions

Disaggregate place of residence and relative poverty to identify pockets of greatest disparities and to assess impact

Use consumption-based measures of poverty to monitor uptake of program interventions by the poor

Achieving Equity in Family Planning

Thank you – Merci – Gracias - शु�क्रि�या�

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