While a network of clinical services is the backbone of successful family planning programs, other distribution channels such as community-based distribution (CBD) and social marketing help to make supplies more widely available. Such contraceptive methods as oral contraceptives and condoms are well suited to distribution outside of clinics.

Proximity of clinical services. Locating family planning clinics close to where people live is crucial to success. As the geographic density of clinics and other service sites increases, the trip for family planning becomes shorter and quicker for most people (174).

The DHS show that contraceptive prevalence is higher where services are closer, as measured by both travel time and distance (207). In Thailand the median travel time to the nearest family planning facility is short, 15 minutes, and the median distance is only 3 kilometers. Contraceptive prevalence in Thailand is high, at 68%. In the Dominican Republic the distance is also 3 kilometers; the travel time is 20 minutes. Contraceptive prevalence is 56%. In Zimbabwe services are not as convenient. Median travel time is 31 minutes; and the median distance is 5 kilometers. Prevalence is 45%. In Uganda most people have little access. The average person lives 60 minutes and 19 kilometers from the nearest family planning facility. Contraceptive prevalence is only 5%.

In Egypt family planning service sites are accessible to almost everyone (39). Fully 96% of all Egyptian couples live within 4 kilometers and 30 minutes of a family planning facility (207). Convenient access to family planning services, along with widespread access to televised information about family planning, helps to explain rising use of contraception in Egypt, which reached 47% in 1992 (39). (See Lesson 5, Communication.) Even in countries with strong family planning programs, however, urban couples have better access to services than rural couples, largely because it is costly and difficult to extend services to sparsely settled rural areas (104).

Community-based distribution. CBD programs help to deliver family planning information and supplies to people who may not have convenient access to service facilities. CBD is especially useful in the early stages of family planning program development. Where people have had little experience with family planning, CBD overcomes unfamiliarity by bringing family planning close to the people in their communities and by providing culturally sensitive information and service delivery (99). Today, CBD appears to be well suited to reaching couples in sub-Saharan Africa (99, 121).

Many studies have shown that adding CBD to clinic-based family planning services has increased the acceptability and impact of programs (52, 121, 172, 173). A recent study by James Phillips and Wendy Greene, reviewing programs in Nigeria, Mali, Sudan, and Zaire, reports that CBD programs have added an average of three percentage points to a country's contraceptive prevalence rate, independent of all other influences (122).

Social marketing. In some countries social marketing, in which contraceptives are distributed at subsidized prices through established commercial retail outlets, helps to provide convenient access to affordable family planning (69, 173, 181, 228, 236). Condoms, oral contraceptives, and spermicides are the contraceptives most often distributed through social marketing. Some programs also offer injectables and intrauterine devices (IUDs), which clients purchase in pharmacies and take to clinics or private physicians for insertion. Advertising and promotion are keys to the success of social marketing, as they are to conventional commercial sales, because they call attention to specific brands, create an image for them, and help clients understand how to use them, how much they cost, and where to buy them (181). As of 1990 major contraceptive social marketing programs were operating in 19 countries (63). Social marketing programs draw some contraceptive users away from other commercial sources and from free services. Although experience differs widely from one country to another, one estimate is that one-third to one-half of people buying social marketing brands of contraceptives are new users (93).