New Evidence Links National Policies to Contraceptive Use in Low and Middle-Income Countries

World Population Day 2024?

?World Population Day draws attention to how our global population of over 8 billion people strains resources, infrastructure, and the health of our planet. This, in turn, will cause the world and its inhabitants to become more vulnerable to the changes in our weather, food, political, and societal systems. However, we have powerful tools that are voluntary, deliberate, safe, cheap, and effective: contraceptives. Modern contraceptives give individuals the power to decide when or if to have children and to manage birth spacing, which leads to healthier populations.?

?We are still striving to understand the dynamics and drivers of modern contraceptive usage completely. The rate of unmet contraceptive needs in sub-Saharan Africa is around 25 percent, with many people’s ability to use modern contraceptives limited by their access to these medicines in the communities where they live. Significantly decreasing this unmet need further becomes a stubbornly difficult goal. One of the reasons this is so challenging is not a lot of research has been done on how policies impact contraceptive access. ?

?Insights from the recent study (National Policy Influences of Contraceptive Prevalence and Method Mix Strategy: A Longitudinal Analysis of 59 Low- and Middle-Income Countries, 2010–2021 ) , shed some light on how national policies impact modern contraceptive use (or prevalence; mCPR) and the mix of family planning methods offered in low- and middle-income countries. By understanding the relationship between family planning-related policies and their intended outcomes, governments can craft policies?that are grounded in evidence to reach more people with these essential medicines.?

Financing: It matters who pays?

To provide contraceptives to its citizens, any national government must have available financing to procure them. This financing may come from donors, lenders, or the governments’ own coffers. There has been a drive in recent years to encourage increased resource mobilization for family planning by national governments. These efforts have been focused primarily on ensuring sufficient and reliable funding sources in the face of growing demand, as well as uncertainties in donor funding environments.? However, the benefits extend beyond increasing the availability of contraceptives: they actually drive contraceptive use. Data spanning the last 12 years through the Contraceptive Security Indicators Survey demonstrates that increased national government funding for contraceptives—as a share of total funding— is significantly correlated with higher contraceptive use. ?

?When governments prioritize domestic funding for contraceptives, it can lead to higher contraceptive use. Even more importantly, increased contraceptive use is reflected in reproductive health outcomes that directly influence the health and economy of the country . This “demographic dividend” reaped by countries can be “substantial” according to UNFPA . ?

?Data-driven systems also pay dividends?

?Well-functioning logistics management information systems (LMIS)--or databases used to manage health products from the local facility all the way to the national government--contribute to the effectiveness of a country’s health supply chain. An effective LMIS contributes to the availability of contraceptives by providing managers with the data necessary to reduce stockouts and improve user confidence in the health system; but not all LMISs include FP commodities. ??

?This new research shows that when LMIS systems include contraceptives, the benefits extend beyond the supply chain itself; they are reflected at the population level as increased mCPR. ?While the cost required for the logistics management infrastructure can be burdensome, these findings indicate that it’s a sensible investment, again considering the “demographic dividend”.?

The Big Picture: Encouraging Private-Sector Participation??

The availability of a wide choice of contraceptives has an influence on known levels of contraceptive use. At a personal level, having a selection of contraceptives from which to choose promotes empowerment and autonomy for women. When choices are available, women can select an option which leads to greater satisfaction – reported satisfaction with a contraceptive type is directly related to continuation. In fact, the availability of more choices in the market are strongly correlated with higher mCPR . The current study reaffirms the link between method choice and mCPR – but also highlights the importance of a comprehensive method mix in the private sector. A diverse range of contraceptive methods offered through private sector channels is associated with higher mCPR among married women of reproductive age. Governments can capitalize on this by including more contraceptive options on their national essential medicines list and fostering partnerships with private-sector providers to complement the public sector efforts. ?

Policy Implications and Recommendations?

Policymakers can learn from these results to improve the health and well-being of the population and strengthen key economic sectors.??

Informed and effective policymaking is essential for improving access to the services and resources needed to support a healthy and fulfilling life.?

Sustainable growth is achieved through an integrated and intentional strategy that addresses this objective from two sides: supply – resource development and allocation – and demand,?increasing contraceptive use through an evidence-based and rights-based family planning approach.??

?For more information, read the full article and explore the CSI dashboard .

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