CONTENTS
Chapters
- Using Oral Contraceptives
- Continuation and Switching
- How Mass Media Can Help
- Pill Counseling
- Keeping Guidelines Up to Date
- Improving Access
HIGHLIGHTS
Population Reports is published by the Population Information Program, Center for Communication Programs, The
Johns Hopkins School of Public Health, 111 Market Place, Suite 310, Baltimore, Maryland 21202-4012, USA
Volume XXVIII, Number 2
Spring, 2000
Series A, Number 10
Oral Contraceptives |
Social Marketing
Social marketing improves access to methods such as OCs by making them widely available, well known, and affordable. The social marketing approach is to offer contraceptives for sale in the commercial sector at subsidized prices, while promoting them in the mass media and where they are sold. Social marketing offers the pill in places where users are already likely to be shopping, including markets, kiosks, and grocery stores, thus often eliminating the need for a special trip to obtain pills.
Social marketing is widespread. In 1998, 40 social marketing programs sold nearly 66 million pill packets to women in 34 countries. These numbers are substantially higher than in 1991, when 18 social marketing programs sold about 22 million pill packets in 17 countries (82, 83).
Some social marketing programs now operate without subsidy, sustaining themselves wholly from the sales of contraceptives. In Colombia PROFAMILIA's social marketing is completely self-sustained, as are programs in Jamaica and Malaysia. Indonesia's Blue Circle social marketing is largely self-sustaining (83).
Commercial Sector
Some clients are willing and able to pay full price for family planning services. Growing numbers of users prefer to pay for pills from the private sector, where they can obtain the quality, convenience, and continuity of service that private providers often offer. The commercial sector includes doctors, pharmacies, clinics, and hospitals that are generally financially independent of government or donor agency subsidies (61).
Promoting expansion of the commercial sector improves access to OCs because it offers users more places to obtain pills. Also, when family planning users switch from the public sector to the commercial sector, public funds can go further to improve access for those who cannot afford full price. Government action can stimulate commercial sector growth. For example, placing the pill on a country's list of essential drugs can reduce import barriers, making OCs less expensive. Such changes can make private sector investment in family planning goods and services more feasible economically and more attractive (61).
Governments can do much to expand the role of the commercial sector in providing OCs and other contraceptives. Indonesia's government launched the Blue Circle campaign in 1987 both to stimulate demand for private family planning services and to expand the number of private providers. As a result the percentage of family planning users obtaining supplies from the private sector rose from 12% initially to 57% a decade later (23, 24, 99).
Links Between Pill Provision
and Other Health Services
Linking family planning services with other health services can make the pill more accessible, especially to women who have not been using any contraceptive method. Clients who may not have sought out a family planning facility can obtain OCs or other methods while receiving other health care. There are several kinds of links:
Postpartum family planning. Maternity care programs can offer the pill and other family planning options. In Honduras, when progestin-only pills and condoms were offered to women after delivery, the percentage choosing family planning after delivery rose from 9% to 30%. Some 61% of women who returned for a 40-day postpartum check-up chose a contraceptive method during the visit (21, 196).
Women not breastfeeding their infants can start combined OCs 21 days after delivery, or they can start progestin-only OCs immediately after delivery. Breastfeeding women can start progestin-only pills at six weeks postpartum, or they can start combined pills either at six months after delivery or when they stop breastfeeding, whichever comes first (85, 245). In either case, women can be given the pills at any convenient time, such as after delivery or at a postpartum check-up, with instructions on when to start using them. Thus these women will not have to make a special trip for supplies when they are ready to start Ocs.
Postabortion family planning. Fewer than one-third of women in Latin America, Africa, and Asia receiving care for postabortion complications have ever used a modern contra-ceptive (185). Women experiencing spontaneous or induced abortion return to fertility almost immediately. Therefore facilities treating women for postabortion complications should also offer family planning counseling and services.
Offering family planning as part of postabortion care can make a dramatic difference in contraceptive use. Many women being treated for postabortion complications want family planning. In Egypt, for example, 62% of postabortion patients decided to use a family planning method after counseling by a specially trained provider. Before family planning counseling was made a part of postabortion care, only 37% of patients decided to use family planning (98). Similarly, in Kenya before family planning counseling became part of postabortion care, only 7% of postabortion patients received contraceptive counseling, and only 3% obtained contraception. Afterwards, 68% of clients were counseled, and 48% received their chosen method (205).
Child health clinics. Offering family planning along with immunization and other child health care services can be simple and successful. For example, immunization clinic workers in Togo selected 1,000 women randomly while their children were being immunized and said just three sentences to each about the availability of family planning methods at the clinic and the health benefits of child spacing. Six months later the average number of new contraceptors per month at the clinic had increased by 54% (97, 196). |
