Person-Centered Measurement: Ensuring Prioritization of Individuals’ Values, Needs, and Preferences Within the Global Contraceptive Measurement Ecosystem

INTRODUCTION

There is a growing consensus in the global field of contraception that new measures and measurement approaches are needed (Speizer, Bremner, and Farid 2022; Fabic 2022; Senderowicz 2020). Critiques of standard indicators used to monitor and evaluate contraceptive programs—many of which were developed during the height of the population control era and have remained little-changed in the intervening half century (Bradley and Casterline 2014)—highlight the problematic approaches of defining contraceptive use as a universally positive outcome and of classifying contraceptive “need” for women without directly asking them what they need or want (Speizer, Bremner, and Farid 2022; Rothschild, Brown, and Drake 2021; Holt, Galavotti, et al. 2023; Rothschild et al. 2024; Senderowicz 2020). Take, for example, the core indicators used by the Family Planning 2030 (FP2030) initiative to track global progress in family planning (FP) programming (Online Appendix: Supplemental Materials, Table A1): Nine of the 22 indicators measure contraceptive use, focusing on modern methods; three indicators capture aspects of supply-side contraceptive method availability; and another six indicators measure fertility and health outcomes, such as number and percentage of births that are unintended (Track20). Only one indicator measures quality of contraceptive counseling, while another single indicator captures self/joint contraceptive decision-making—an aspect of contraceptive autonomy (Senderowicz 2020). FP2030 has itself highlighted the need for “improving measurement of rights and empowerment principles” (FP2030 2023). Similar critiques have been leveled at the U.S.’s Healthy People 2030 public health initiative, which includes a performance indicator on the use of effective birth control methods (Gomez et al. 2024).

In March 2024, an international expert working group meeting was convened by the International Union for the Scientific Study of Population (IUSSP) in Mombasa, Kenya, under the auspices of “Rethinking Family Planning Measurement with a Reproductive Justice and Rights Lens” (IUSSP 2024). A focus of the expert group meeting and following convenings was to align on a global measurement “ecosystem”—or set of priority indicators—that better reflects principles of human rights and reproductive justice in FP programming. To do so, the group discussed the need for inclusion of indicators related to contraceptive agency, self-efficacy, and autonomy, and social and gender norms relevant to contraception and reproductive health more broadly. In addition, the group discussed the need for measures that explicitly capture people’s individual preferences and subjective experiences. While much of the conversation focused on the need for so-called “person-centered” measures, several discussions during the meeting of what person-centeredness means as applied to measurement and how it in turn relates to principles of human rights and reproductive justice went unresolved. Notably, there was a lack of common understanding of whether measures of agency, empowerment, or one’s intention to use contraception are inherently person-centered (IUSSP 2024). The goal of this commentary is to improve conceptual clarity on person-centeredness in the context of contraception, focusing on the role of person-centered measures in advancing a broader rights-based and justice-informed contraceptive measurement agenda.