1. Disentangling poverty and
place of residence
for family planning strategic planning
Karen G. Fleischman Foreit
MEASURE Evaluation PRH
Achieving Equity in Family Planning

2. 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

3. 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

4. Urban-rural differences are common
30 Rural
Urban
25
% Using Modern FP
20
15
10
5
0
Achieving Equity in Family Planning

5. …as are differences by wealth quintile
30 Bottom quintile
Top quintile
25
% Using Modern FP
20
15
10
5
0
Achieving Equity in Family Planning

6. But residence and wealth go together
Kenya 2003
30% Urban Rural
% Interviewed women
20%
10%
0%
Bottom 2nd 3rd 4th Top
Wealth Quintile
Achieving Equity in Family Planning

7. …making it hard to interpret differences
Kenya 2003
30% Urban Rural
% Interviewed women
20%
10%
0%
Bottom 2nd 3rd 4th Top
Wealth Quintile
Achieving Equity in Family Planning

8. 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

9. Results
 Highly variable residence-specific patterns
Achieving Equity in Family Planning

10. Wealth and Residence: Ghana 2008
30% 30%
Urban
% Using a Modern Method
% Using a Modern Method
Rural
20% 20%
10% 10%
National
0% 0%
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
Achieving Equity in Family Planning

11. Wealth and Residence: Senegal 2005
30% 30%
Urban
% Using a Modern Method
% Using a Modern Method
Rural
20% 20%
10% 10%
National
0% 0%
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
Achieving Equity in Family Planning

12. Wealth and Residence: Zambia 2007
60% 60%
% Using a Modern Method
% Using a Modern Method
50% 50%
40% 40%
30% 30%
20% 20%
Urban
10% 10%
National Rural
0% 0%
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
Achieving Equity in Family Planning

13. Wealth and Residence: Kenya 2003
60% 60%
% Using a Modern Method
% Using a Modern Method
50% 50%
40% 40%
30% 30%
20% 20%
Urban
10% 10%
National Rural
0% 0%
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
Achieving Equity in Family Planning

14. Wealth and Residence: Kenya 2008
60% 60%
% Using a Modern Method
% Using a Modern Method
50% 50%
40% 40%
30% 30%
20% 20%
Urban
10% 10%
National Rural
0% 0%
Q1 Q2 Q3 Q4 Q5 Q1 Q2 Q3 Q4 Q5
Achieving Equity in Family Planning

15. 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

16. Match-up between consumption and
assets measures of poverty
>1 quintile +/- 1 quintile Exact match
100%
% Match w/ consumption
80%
60%
40%
20%
0%
Bottom 2nd 3rd 4th Top
Assets-based Quintile
Ecuador 2004 RHS
Achieving Equity in Family Planning

17. Match-up between consumption and
assets measures of poverty
>1 quintile +/- 1 quintile Exact match
100%
% Match w/ consumption
80%
60%
40%
20%
0%
Bottom 2nd 3rd 4th Top
Assets-based Quintile
Ethiopia 2005 DHS
2004/5 HIES
Achieving Equity in Family Planning

18. 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

19. Thank you – Merci – Gracias -
© 2007 Felix Masi, Courtesy of Photoshare
Achieving Equity in Family Planning