John Ross and colleagues also found a link between the number of modern methods readily available and contraceptive prevalence. In 8 of 36 countries studied, five or six mod- modern methods were available, and in these countries modern contraceptive prevalence averaged over 60%. In five countries three or four modern methods were readily available, and modern prevalence averaged about 40%. In seven countries, where only one or two methods were available, about 25% of couples used modern contraception. In 16 countries no modern methods were readily available. Not surprisingly, in these countries the use of modern contraception was very slight—less than 10% (174). In Ross's study a contraceptive method was considered readily available if at least half the population could obtain the method by spending less than two hours a month and less than 1% of their income—a definition developed by Lapham and Mauldin (94 ).

Among 50 countries surveyed since 1985, modern contraceptive prevalence is at least 45% in 13 countries. In 12 of these 13, at least three methods are widely used, according to a review by Population Reports. In Costa Rica, for example, where modern method prevalence is 58%—among the highest levels in the developing world—four methods each attract many users among married women of reproductive age: oral contraceptives, at 21%; voluntary female sterilization, at 14%; condoms, at 13%; and IUDs, at 8%. The exception among these 13 countries is Brazil, where only two methods, female sterilization, at 27%, and oral contraceptives, at 25%, account for almost all of the modern prevalence rate of 57% (164).

The growing availability of Norplant and injectable contraceptives offers more choices and thus more opportunities to improve program performance and clients' satisfaction. For example, in Kenya use of injectables rose in four years from 3.3% of married women of reproductive age in 1989 to 7.2% in 1993 (85).