RESULTS: On average, national family planning programs improved their effort levels slightly from 1999 to 2004, and again from 2004 to 2009. The average effort in 2009, however, was only about half of maximum; component scores for service measures and for measures of access to contraception did not reach 50% of maximum in 2009. Differences by region and by effort quartile emerged in subgroup analyses. Overall, improvement of women’s health and avoidance of unwanted births were the most important program justifications, ranking higher than fertility reduction, economic development or reduction of childbearing among unmarried adolescents. The subgroups given the most emphasis were poor and rural populations, while unmarried youth and postabortion women received the least. Among external influences, changes in donor and domestic funding were seen as more unfavorable than the merging of family planning programs into broader health services