Who, What, Where: an analysis of private sector family planning provision in 57 low‐ and middle‐income countries

Abstract

Abstractobjective Family planning service delivery has been neglected; rigorous analyses of the patterns of contraceptive provision are needed to inform strategies to address this neglect.methods We used 57 nationally representative Demographic and Health Surveys in low-and middle-income countries (2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013) in four geographic regions to estimate need for contraceptive services, and examined the sector of provision, by women's socio-economic position. We also assessed method mix and whether women were informed of side effects.results Modern contraceptive use among women in need was lowest in sub-Saharan Africa (39%), with other regions ranging from 64% to 72%. The private sector share of the family planning market was 37-39% of users across the regions and 37% overall (median across countries: 41%). Private sector users accessed medical providers (range across regions: 30-60%, overall mean: 54% and median across countries 23%), specialised drug sellers (range across regions: 31-52%, overall mean: 36% and median across countries: 43%) and retailers (range across regions: 3-14%, overall mean: 6% and median across countries: 6%). Private retailers played a more important role in sub-Saharan Africa (14%) than in other regions (3-5%). NGOs and FBOs served a small percentage. Privileged women (richest wealth quintile, urban residents or secondary-/tertiary-level education) used private sector services more than the less privileged. Contraceptive method types with higher requirements (medical skills) for provision were less likely to be acquired from the private sector, while shortacting methods/injectables were more likely. The percentages of women informed of side effects varied by method and provider subtype, but within subtypes were higher among public than private medical providers for four of five methods assessed.conclusion Given the importance of private sector providers, we need to understand why women choose their services, what quality services the private sector provides, and how it can be improved. However, when prioritising one of the two sectors (public vs. private), it is critical to consider the potential impact on contraceptive prevalence and equity of met need.keywords family planning, method mix, quality of care, public providers, private providers, lowand middle-income countries

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

“…In 2015, 226 million young people aged 15-24 lived in Africa, accounting for 19% of the global youth population [1]. Data from sub-Saharan Africa suggest that, while a significant number of adolescents have their first sexual experience at an early age (ranging from 2.0 to 27.0% of adolescents under age 15) [2], in many cases they do not use any form of protection to prevent pregnancy or sexually transmitted infections [3,4]. In addition, not all sexual experiences among adolescents are consensual, since the prevalence of coerced sex and sexual abuse at this age remains high (approximately 16% in Zambia) [5,6].…”

Examining trends in family planning among harder-to-reach women in Senegal 1992–2014

“…Low contraceptive uptake contributes to this sustained high fertility: the modern contraceptive prevalence rate (MCPR) in SSA is less than half the rate in other regions (24% versus 53% in Southeast Asia and 81% in East Asia)2, and the unmet need for family planning (FP) is higher3. Within SSA, the MCPR was lower in West Africa than East and Southern Africa4.…”

Partenariat avec le secteur privé pour renforcer la fourniture de la contraception

“…Elles sont souvent le premier guichet pour les femmes et les hommes qui cherchent des informations ou des services de PF. Ces sources représentent la majeure partie de la fourniture de contraceptifs dans le secteur privé en Afrique subsaharienne, en particulier pour les préservatifs, les pilules, les contraceptifs injectables et la contraception d'urgence (17).…”