Assessing family planning progress in exemplar countries: development of a conceptual framework and case study methodology

Family planning (FP) is a critical component of reproductive health, enabling individuals to plan the number and timing of children through various contraceptive methods.We outline the conceptual framework and country case study methodology used by the Exemplars in Family Planning (EFP) project. This was based on the wider Exemplars in Global Health programme, which uses mixed-methods to examine determinants of FP progress in countries that exceed expectations for health outcomes. The EFP project integrates findings from case studies on six such countries, including quantitative analyses of trends and drivers of modern contraceptive prevalence, systematic reviews, policy, programme and financing assessments, and qualitative data collection with policymakers, providers and community actors. Data triangulation across these methods, complemented by consortium input and country workshops, enabled robust validation of findings and identification of cross-cutting themes. This approach produced a nuanced understanding of FP progress by capturing interactions between government programmes (demand and supply), service delivery mechanisms, subnational contexts and individual determinants. Quantitative decomposition and trend analyses quantified the contributions of population characteristics, behavioural factors and interventions, while qualitative and stakeholder data contextualised these findings within local sociocultural, health system and policy environments.This multicountry, mixed-methods analysis led by local researchers and supported by a global consortium enhanced methodological rigour, contextualised findings and enabled cross-country learning on FP progress. It identified key cross-cutting drivers and offers evidence-informed guidance to improve contraceptive uptake and demand satisified, while highlighting the need for context-specific interventions and further longitudinal, multicountry research.