Human subjects research checklist.

Several challenges to validity have been identified with standard approaches used to measure “demand satisfied for modern methods of family planning.” This study explored construct validity of the widely used indicator for “demand satisfied” by comparing the standard definition to alternative definitions of the indicator highlighting dimensions of women’s own perceived demand, choice, and satisfaction. This cross-sectional study of women aged 15–49 years was conducted in Argentina (n = 1492), Ghana (n = 1600), and India (n = 1702) using a two-staged random sampling design. Women were directly asked about their: 1) demand, whether they wanted to use a contraceptive method to prevent pregnancy; 2) choice, whether they had autonomy in decision-making during their last family planning visit; and 3) satisfaction, whether they were satisfied with their method. The values of the standard and alternative indicators were compared. Convergent validity was assessed using logistic regression to explore the association between indicator definition and use of a preferred contraceptive method. In Argentina and India, the percentage of women with demand satisfied after incorporating constructs of demand, choice, and satisfaction was substantially lower than that obtained using the standard definition—a reduction of ~70% in Argentina and ~40% in India. Women who were categorized as having their “demand satisfied” for family planning according to the person-centered dimensions of the alternative indicator were significantly more likely to be using their preferred method of contraception in all three countries (OR: 7.7, 95% CI: 5.31–11.07 in Argentina, OR: 4.83, 95% CI: 2.27–10.27 in Ghana, and OR: 2.07 95% CI: 1.11–3.86 in India) compared to those whose demand was satisfied by only the standard indicator definition. Revising the definition of demand satisfied to reflect the principles of person-centered care offers an opportunity to improve construct validity by ensuring that global measurement efforts align with women’s reproductive rights.

现有用于评估「现代计划生育方法需求已满足」的标准测量方法，已被证实存在多项效度相关挑战。本研究针对这一广泛使用的「需求已满足」指标的结构效度（construct validity）展开探索，通过将标准定义与凸显女性自身感知需求、选择权与满意度维度的替代性指标定义进行对比，完成相关验证。本横断面研究针对15至49岁女性开展，在阿根廷（n=1492）、加纳（n=1600）与印度（n=1702）采用两阶段随机抽样设计完成数据采集。研究直接向受访女性询问三方面信息：1）需求：是否希望使用避孕方法以避免妊娠；2）选择权：在上一次计划生育就诊过程中，其是否拥有决策自主权；3）满意度：是否对当前使用的避孕方法感到满意。研究对标准指标与替代性指标的数值进行了对比，并通过逻辑回归（logistic regression）分析评估聚合效度（convergent validity），以探究指标定义与首选避孕方法使用情况之间的关联。在阿根廷与印度，纳入需求、选择权与满意度维度后，被判定为「需求已满足」的女性占比，显著低于采用标准定义得到的结果——阿根廷占比降幅约70%，印度约40%。相较于仅通过标准指标定义判定为「需求已满足」的女性，在所有三个研究国家中，依据以个体为中心的替代性指标维度被归类为「需求已满足」的女性，使用首选避孕方法的概率显著更高（阿根廷优势比OR=7.7，95%置信区间（confidence interval, CI）：5.31–11.07；加纳OR=4.83，95%CI：2.27–10.27；印度OR=2.07，95%CI：1.11–3.86）。将「需求已满足」的定义修订为契合以个体为中心的照护原则，能够通过确保全球测量工作与女性生殖权利相契合，为提升结构效度提供可行路径。