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Browse POLICY Project (1995-2006) Materials

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  • The need to meet the family planning needs of men and women, coupled with dwindling donor resources, is forcing family planning programs worldwide to confront increasingly difficult financial challenges. One option for expanding the resource base for family planning and reproductive health services in developing countries is to promote the growth of the commercial family planning sector. Using DHS data for 45 countries, this paper demonstrates that (1) the commercial sector plays an important role in national family planning markets, even in countries where contraceptive prevalence is low; and (2) the commercial family planning sector does not always develop coincidentally as prevalence grows or as programs mature. If the commercial sector does not necessarily gain market share as prevalence grows, what factors account for differences in commercial market shares across countries? This paper examines three sets of factors to explain variations in commercial market share across countries: • Microeconomic or household factors. Characteristics of individuals, such as ability to pay or knowledge of contraception, may make them more likely to use the commercial sector. • Macroeconomic or business climate factors. Characteristics of a country and its economy may lead to a larger commercial market share for contraceptive services and commodities. • Programmatic factors. Characteristics of a family planning program, such as government support and method mix, may lead to a larger commercial market share. The commercial market share for family planning is related to many factors, which can be grouped in two categories: external factors, over which there is no control, such as per capita income and the level of urbanization, but which can be exploited or understood as a program constraint; and programmatic factors, which are under the direct or indirect control of the program, such as public sector pricing or program effort. The cross-national analysis shows that broad-based purchasing power, improved knowledge of reproductive health, critical densities of population, and appropriate public policy are each associated with relatively strong commercial sectors. This paper recommends that public health policymakers take steps to integrate the commercial sector into their programs by developing economic and policy environments supportive of its expansion. In many countries, family planning has been provided as if it were a public good. Large public programs were designed to expand service delivery in public sector facilities, while limited attention was paid to growth of the commercial sector, likely assuming commercial sector share would grow as a consequence of growth in general public interest in family planning. This study identifies factors for which key policy support may be able to generate increased use of the commercial sector for family planning.