By Danielle Garfinkel, FPwatch Communications Fellow, PSI
It’s no easy feat to enable an additional 120 million women and girls to use contraceptives. Since 2012, nearly 40 countries have made a commitment to do just that through FP2020, a global movement to expand access to family planning. Yet, progress at the country-level has varied — part of the challenge in tackling contraceptive access is understanding what types of methods are available and where.
Thankfully, a variety of monitoring initiatives allow us to draw key insights from the contraceptive market in FP2020 countries and identify opportunities to shift resources and accelerate progress. PSI’s uniquely comprehensive FPwatch project serves as one of the ways to address the lack of data available to inform family planning policies and programs.
With funding support from the Bill & Melinda Gates Foundation and the Three Millennium Development Goal Fund, this multi-country research initiative studied the public and private family planning (FP) markets in five priority FP2020 countries: Ethiopia, Nigeria, the Kinshasa and Katanga regions of Democratic Republic of Congo (DRC), Myanmar (private market only), and the Uttar Pradesh and Bihar states of India.
Using a robust and consistent methodology – including surveying a representative selection of outlets and a detailed cataloguing of products – FPwatch offers a full picture of the total market for commodities and services in priority FP2020 countries that complements other market tracking data tools. In the context of PSI’s Market Development Approach, FPwatch data provides a crucial snapshot on market performance and promotes improved data for decision-making.
From 2015-2016, FPwatch screened over 80,000 public and private sector outlets with the capacity to sell contraceptive commodities or offer contraceptive services in the five study countries. More than 13,000 outlets were ultimately elected for contraceptive commodity audits and provider interviews.
The study findings were extensive, but several key points emerged:
Drug shops are the new frontier. While drug shops dominate the market composition in Nigeria and DRC, they stock a limited range of methods and aren’t well stocked with long-acting reversible contraceptives (LARCs). This presents an opportunity to improve contraceptive access and choice through drug shops, especially considering that drug shops are often the first point of contact for health seeking behavior among hard-to-reach populations. The FPwatch data has already prompted the government and national working groups to explore options to collaborate with these outlet types in both countries.
Implants are taking off. Implants represent an important share of the contraceptive market in Ethiopia and Nigeria, and even in DRC where they are catching up with condoms. While implants and IUDs are highly acceptable to women, we found generally low availability of these methods. The popularity of the method and the ease of administration presents a strong case for task sharing of implant insertions to Community Health Workers (CHWs), who have demonstrated the ability to distribute these methods in Ethiopia and Nigeria.
Community health workers (CHWs) represent an opportunity for rural contraceptive access. The public community health worker sector dominates contraceptive market composition in both Ethiopia and India. In Ethiopia, the inclusion of Implanon among CHWs has had an important impact on market share, with implant distribution among CHWs representing over a fifth of the total market. In India, public sub-centers, auxiliary nurse midwives, and ASHAs (accredited social health activists) are demonstrating the potential to diversify the contraceptive method mix to include injectables and support broadening the method mix’s away from the current reliance on female sterilization. As trusted members of their communities, these frontline health workers have unique access to hard-to-reach populations, particularly in rural areas.
Around the world, family planning communities have begun converting the results from the FPwatch surveys into actionable strategies towards the FP2020 goal. We encourage you to do the same by:
- Spreading the word! Share this blog or one of the many materials available about FPwatch results.
- Visiting our website to learn about the FPwatch program more in-depth in our five study countries.
- Requesting access to our datasets on Dataverse to conduct additional analysis.
Banner photo: © Population Services International / Banner Photo by: Kiran Thejaswi