IWG Meeting the Challenge- Contraceptive Projections and the Donor Gap

Publication date: 2001

� C1 � CHALLENGE M E E T I N G T H E Contraceptive Projections and the Donor Gap T HE INTERIM WORKING GROUP ON REPRODUCTIVE HEALTH COMMODITY SECURITY (IWG) is a collaborative effort of John Snow, Inc. (JSI), Population Action International (PAI), the Program for Appropriate Technology in Health (PATH) and Wallace Global Fund. The IWG was formed in response to a meeting of the Working Group of the Global Initiative on Reproductive Health Commodity Management of UNFPA in January of 2000. At the meeting, UNFPA called on the participation of a wide variety of stake- holders to address the looming crisis represented by the shortfall in contraceptives around the world. The IWG’s objective is to further the goals of the 1994 Programme of Action by raising awareness about the importance of securing reproductive health supplies. The IWG seeks to identify the causes of failures and weaknesses in com- modity systems and to spur actions that will contribute to securing essential supplies for the delivery of repro- ductive health care. The IWG understands the importance of addressing the full range of reproductive health commodities. The group is focusing on contraceptives first, however, due to the widespread lack of consensus within the popula- tion and reproductive health field regarding which com- modities to include in an essential list of supplies. Moreover, there is little information on donor contribu- tions for non-contraceptive reproductive health com- modities. Through its efforts on contraceptive security, the IWG is working to bring together stakeholders to develop strategies for addressing the broader issues of reproductive health commodity supplies in the future. ACKNOWLEDGMENTS Contraceptive Projections and the Donor Gap was written by John Ross and Randy Bulatao, produced by the Family Planning Logistics Management Project of John Snow, Inc. (JSI) through a sub-contract with The Futures Group International (TFGI) and funded by the U.S. Agency for International Development (USAID). The authors wish to express their appreciation to John Stover of TFGI and to staff members of JSI and other organizations who commented on the design and draft of this paper. The authors also thank Patrick Friel and Jagdish Upadhyay of the United Nations Population Fund for data on time trends of donor contributions for contraceptive commodities. This document does not necessarily represent the views or opinions of USAID. This material may be reproduced provided the source is acknowledged. ISBN: 1-889735-09-4 April 2001 � 1 � Contraceptive Projections and the Donor Gap Three trends will together determine the projected growth in demand for contraceptive supplies: the passage of the current large generation of young people into their prime reproductive years; overall population growth; and rising levels of family planning use. In the 87 countries studied, the number of women in their childbearing years is expected to increase by 36 percent between 2000 and 2015, from 529 million to 720 million. The total number of users of modern contraceptive methods is projected to increase during the same period by 79 percent, or 105 million. Increases in the number of people of reproduc- tive age and in their desire to use contraception (as they learn about family planning and gain access to services) will be greatest in Asia and Africa. Some countries will be able to meet the demand for contraceptive supplies and the private sector will fill at least part of the financing gap. However, it is increasing- ly clear that donors will have to assume a substantial part of the burden of ensuring the availability of subsi- dized contraceptives around the world. In the next five years, the gap between the required and available financing for subsidized contraceptive commodities will average about 20 percent. This shortfall could leave 20 million couples without family planning services, leading to elevated rates of unwanted pregnancy, abor- tion, and HIV infection and contributing to maternal and infant deaths and the numbers of orphaned and neglected children. Researchers predict that donor funding will have to increase by US$24 million immediately and 5.3 percent annually thereafter to meet rising public sector demands for contraceptive commodities. Without such a substan- tial increase in donor funding, many countries will not be able to meet growing needs for contraceptives among those who are unable to rely on the private sector. To avoid severe health and socioeconomic problems, donors and concerned agencies must take immediate action to minimize the projected contraceptive shortfall. In calling for universal access to reproductive health services, the Programme of Action of the1994 International Conference on Population and Development (ICPD) mandates a widevariety of actions. Though not the most glamorous of tasks, securing reproductive health supplies is essential to the provision of reproductive health services, and thus to fulfillment of the ICPD agenda. Contraceptive Projections and the Donor Gap addresses issues related to supplying just one type of reproductive health commodity: contraceptives. It begins with an analysis of current and future global demand for contraceptives and lays out the strategies for meeting this demand in those developing countries that depend on supplies from foreign donors. The analysis of demand for contraceptives is based on data from 87 developing countries. It provides an overview of current and projected contraceptive use in these 87 countries, and reviews the factors that contribute to the growing demand for contraceptive supplies.1 The substantial gap between projected future needs and expected donor contributions requires that the donor community be alerted to potential shortfalls and explore additional ways of strengthening contraceptive supply. � 2 � CONTRACEPTIVE PROJECTIONS AND THE DONOR GAP This analysis projects contraceptive commodity needs and costs in the public sector to the year 2015, and compares them with the likely levels of donor contribu- tions. Emphasis is placed on the gap between growing contraceptive needs and expected donor contributions. The health and socioeconomic consequences of this gap between supply and demand are also discussed. The data used in this report come largely from Profiles < PART I > for Family Planning and Reproductive Health Programs2 and focus on 87 “donor-relevant countries” in the devel- oping world, i.e., countries where donors provide contra- ceptive commodities (see Appendix A).3 The authors have further separated data on contraceptive supplies provided by the public and private sectors; developed cost implica- tions; constructed a separate projection for donations of condoms to prevent HIV/AIDS; anticipated what donors may do; and illustrated the gap between projected costs and likely donor contributions. The countries studied are not dependent on donors by choice. In most, local con- traceptive manufacture is not an option due to the eco- nomics of the industry and its requirement for high-tech quality control. Moreover, they include some of the poor- est countries in the developing world, which lack foreign exchange for purchasing the raw materials required to produce contraceptives. Representing every region of the world, the 87 coun- tries include 81 percent of the developing world’s popula- tion outside of China and India. As noted, China and India are excluded because they are self-sufficient in con- traceptive commodities; Brazil is also excluded because it is not donor-dependent. Other omissions fall into three general categories: “graduated” countries such as Thailand, South Korea, Taiwan, Hong Kong, and Singapore; non-donor countries such as Iraq, Libya, North Korea, Saudi Arabia, and the United Arab Emirates; and six countries in the former USSR (the three N u m b er o f U se rs ( in m ill io n s) 133,397,000 171,034,000 210,271,000 238,464,440 0 50 100 150 200 250 300 2000 2005 2010 2015 < FIGURE 1 > PROJECTED NUMBER OF CONTRACEPTIVE USERS, MODERN METHODS, ALL WOMEN N u m b er o f U se rs ( Th o u sa n d s) 0 20,000 40,000 60,000 80,000 100,000 120,000 2000 2005 2010 2015 Rest of Asia Latin America Sub-Saharan Africa Central Asia Rep.Middle East/ North Africa < FIGURE 2 > PROJECTED NUMBER OF CONTRACEPTIVE USERS, MODERN METHODS, ALL WOMEN, BY REGION � 3 � Caucasus countries and Russia, Ukraine, and Moldova). The five Central Asia Republics (CARs) are included, as are five of the largest countries in the developing world (Indonesia, Bangladesh, Pakistan, Mexico, and Nigeria). Contraceptive Users The aggregate number of contraceptive users will rise sharply due to the combined forces of the growing num- ber of couples of reproductive age and rising contracep- tive prevalence. As Figure 1 shows, the total number of users of modern methods is projected to rise by 28 per- cent over the next five years, the equivalent of one addi- tional user for every three or four current users. Between 2000 and 2015, the number of users is project- ed to increase by 79 percent. The 105 million additional users far exceed the number of current users in Latin America and the Middle East/North Africa combined. As Figure 2 indicates, most of the regional increases will come from Asia, which will gain some 37 million users even when China and India are excluded. The number of users in sub-Saharan Africa is projected to triple by 2015, a powerful illustration of the compound- ing effects of both increasing numbers of couples and rising demand for contraceptives (contraceptive preva- lence). Although the total numerical increases will be smaller in other regions, the relative increases will be large. For example, the number of users is projected to increase by 50 percent in Latin America and by 79 per- cent in the Middle East/North Africa. Demographic Pressures: More Couples of Reproductive Age Population growth and, in particular, the movement of the current large youth cohort into the reproductive age, will place strong pressure on commodity supplies in all 87 of the countries studied. According to the United Nations, the number of women of reproductive age (15- 49) will grow by 36 percent, or 191 million, between 2000 and 2015, from 529 million to 720 million (see Figure 3). During the same period, the number of mar- ried women aged 15-49 is projected to grow propor- tionately, from 341 million to 463 million, or more than the total number of married women currently living in all of the Middle East and North Africa. The growth in numbers of people of reproductive age will vary substantially among regions (see Figure 4). By 2015, Asia—again, excluding China and India—is pro- jected to gain 71 million women and sub-Saharan Africa 78 million. Sub-Saharan Africa’s population is smaller than Asia’s but is growing at a much faster rate, resulting in an increase in the number of women in the region of 52 percent, compared with 30 percent in Asia. Logistics Married women aged 15-49 All women aged 15-49 N u m b er o f W o m en (i n m ill io n s) 3 4 0 ,5 6 7 ,0 0 0 3 8 2 ,6 9 0 ,0 0 0 4 2 2 ,9 7 3 ,0 0 0 4 6 3 ,3 8 9 ,0 0 0 7 1 9 ,5 4 8 ,1 3 7 6 5 6 ,7 9 0 ,3 7 3 5 9 4 ,2 3 9 ,1 3 0 5 2 8 ,8 3 0 ,7 4 5 0 100 200 300 400 500 600 700 800 2000 2005 2010 2015 < FIGURE 3 > NUMBER OF ALL WOMEN AND MARRIED WOMEN (15-49) � 4 � systems in sub-Saharan Africa will experience especially sharp growing pains as a result, which in many countries will be compounded by a lack of the skills and infra- structure needed to strengthen those systems. Increases in the number of women of reproductive age will be comparatively modest in other regions: 21 million more women of reproductive age in the Middle East/North Africa, 17 million in Latin America, and only three million in the Central Asian Republics. The challenges of adjusting to such growth will be greatest in Asia and sub-Saharan Africa, where the growth is not only faster, but is occurring primarily among those least able to pay for services. Rising Contraceptive Prevalence: Greater Demand for Contraception The projected rise in demand for contraceptives/contra- ceptive prevalence is the second major contributor to the dramatic increase in commodity needs over the next few years. The proportion of women who will be using modern contraceptive methods from 2000 to 2015 has been projected for each country based on the 15-year declines in total fertility rates (TFRs) reported by the United Nations.4 The resulting figures create the pat- terns shown in Figure 5. The highest levels of contracep- tive prevalence are found throughout Latin America, while contraceptive prevalence is clustered at lower lev- els in other regions. Regional differences will narrow considerably over the course of these 15 years, as the regions with the lowest current contraceptive prevalence experience the greatest increases. Sub-Saharan Africa has the lowest but fastest rising contraceptive preva- lence, according to the rather optimistic United Nations projections for declines in TFR in that region. Method Mix Knowing the specific mix of contraceptive methods used in any given country is essential for projecting commodity needs. A country’s method mix shifts over time as total contraceptive prevalence rises.5 And total contraceptive prevalence tends to increase faster when varied methods are offered to the public through different channels. In the countries studied, the numbers of people using each contraceptive method are as follows: the pill, 40 mil- lion women; the IUD, 32 million; injectables, 21 million; and sterilization, 29 million. In the next 15 years, the increase in demand for contraceptives will vary by method: a 93 percent increase in demand for the pill; 75 percent for the IUD; and 40 percent for injectables. To date, condoms have played a relatively small role in family planning, and vaginal methods such as the foaming tablet an even smaller one. Condom use is expected to triple in the next 15 years, however, largely due to the widespread need to prevent HIV/AIDS and other sexually transmitted infections (STIs). The projections in this report allow for changes in method mix as total prevalence rises, and are based upon patterns registered in approximately 200 national surveys (including Demographic and Health Surveys) taken since 1980. Figure 6 shows the numbers of users by method and region in 2000, with data weighted by population size. N u m b er o f U se rs (i n m ill io n s) Rest of Asia Latin America Sub-Saharan Africa Central Asia Rep.Middle East/ North Africa 0 50 100 150 200 250 300 350 2000 2005 2010 2015 < FIGURE 4 > NUMBER OF WOMEN AGED 15-49 BY REGION � 5 � Sterilization predominates as the most used method of family planning in both Asia and Latin America, while the pill ranks second in both regions (these figures are weighted by population size). The IUD is also important, and is the predominant method in the Middle East/North Africa (MENA) where it edges out sterilization. The pill is important in both the MENA region and sub-Saharan Africa. The IUD is the principal method in the Central Asia Republics. However, overall demand for it is less- ened due to smaller populations in that region and to low IUD prevalence in sub-Saharan Africa. In the 87 countries taken together, the pill is the most common contraceptive method (40 million users), almost twice as many as those who use injectables (21 million). The IUD and sterilization—predominantly of women, but also of men—are not far behind at 32 and 29 million users, respectively. (See Appendix Table D3 for details.) In Asia (excluding China and India) contraceptors use a reasonably wide variety of methods, whereas sterilization and the pill dominate heavily in Latin America. The Middle East/North Africa region essentially offers two methods: the pill and IUD. In sub-Saharan Africa and Asia, the injectable is winning a place. In the Central Asian Republics, only the IUD is important so far. Condoms have played a small role in family planning, and vaginal methods even less. Setting aside the projected demand for condoms, it is unlikely that the current method mix will change appre- ciably for the 87 countries in the aggregate, although it is likely to shift somewhat in particular countries. The method mix tends to change systematically as total prevalence rises over the long term. Sterilization’s large share cannot change quickly, and the IUD is somewhat stable in having a multi-year continuation. Any changes would rest chiefly on changing adoption patterns for resupply methods and only in selected countries. Consequently, the current method mix picture remains useful for global or regional planning. The Public Sector’s Share of Commodity Supply The share of supply that continues to rest upon the public sector in each country varies greatly depending on method mix and the sources of each method. (See Figure 7.) The public sector is responsible for most ster- ilizations carried out in the 87 countries studied. Direct commodity costs for this method, as well as for the IUD, are relatively small. Slightly less than half of pill supplies, about one-third of male condoms, and almost half of vaginal methods are provided by the public sec- tor in the 87 countries. The pill and condom, which account for a large proportion of commodity costs, are C o n tr a ce p ti ve P re va le n ce ( P er ce n t) Middle East/ North Africa 5859 62 64 69 48 55 60 21 27 35 42 55 58 61 63 39 45 50 54 0 10 20 30 40 50 60 70 80 90 100 2000 2005 2010 2015 45 40 50 54 Rest of Asia Latin America Sub-Saharan Africa Central Asia Rep. All Regions < FIGURE 5 > PERCENT CONTRACEPTIVE PREVALENCE FOR MODERN METHODS AMONG MARRIED WOMEN BY REGION � 6 � fortunately the methods best provided by sources other than the public sector. The public sector’s burden in supplying contraceptives is affected by donor contributions, method mix, and the role of the private sector. Some countries, including Saudi Arabia and Libya (excluded from the 87 countries addressed in this paper) are for a variety of reasons not assisted by international donors. There, the public sec- tor plays a greater role. Method mix is another impor- tant factor: only some methods require continuous resupply, since many users rely on sterilization and IUDs. The private sector, including both commercial entities and non-governmental organizations (NGOs), is increasingly involved in providing contraceptive com- modities. This analysis examines the share that contin- ues to rest upon the public sector. Projections of Commodity Needs The projections for commodity needs made in this study reflect the combined effects of an increasing number of users, anticipated changes in the mix of contraceptive methods, the proportion of supplies provided by the public sector, and the average supply needed annually per user. Projected costs per piece are held constant, with no allowance made for inflation. The trends sketched out by this analysis are summarized below. (Appendix tables D1-D6 provide figures for each region on users and commodities, both in the aggregate and by public and private sector involvement.) HIV/AIDS Condom Projections. The HIV/AIDS epi- demic has made the condom of special interest to donors, agencies, and service providers and boosted projections of its use for preventing both disease and unwanted pregnan- cy. The figures presented on condoms for HIV/AIDS pre- vention are included only in the public sector table of com- modities since it is assumed that the very large increase in condom supplies must come primarily through the public sector. The projection methodology is based on the past experiences of countries with high levels of both HIV/AIDS and per capita condom use in order to anticipate possible trends in other countries (see Appendix B for further expla- nation). Per capita condom use has been projected to increase more rapidly in countries with low levels of HIV/AIDS than in countries where HIV/AIDS is already widespread. However, it has been assumed that HIV/AIDS in low-prevalence countries will rise only to an intermedi- ate level by 2015, in contrast to the levels projected for countries where HIV/AIDS is already prevalent. Projections of annual per capita condom use have been multiplied by the growing numbers of men aged 15-59 in each country as projected by the United Nations. The number of con- doms projected to be needed for HIV/AIDS prevention greatly exceeds the number designated for family planning. Final Commodity Numbers. Table 1 shows projec- tions for the growth in commodities needed for each of seven contraceptive methods supplied by the public sec- tor. Figures for sterilization and the IUD reflect the sup- plies needed at the time these methods are adopted, 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 80,000 Rest of Asia Latin America Middle East/North Africa Sub-Saharan Africa Central Asia Republics N u m b er o f U se rs ( Th o u sa n d s) Female Ster. Male Ster. Pill Injectable IUD Condom Vaginals < FIGURE 6 > NUMBER OF USERS FOR MODERN CONTRACEPTIVE METHODS BY REGION FOR THE YEAR 2000 and 2015 to meet subsidized needs. It is anticipated that 88 percent of condoms will be used for HIV/AIDS pre- vention, reflecting the enormous needs related to the epidemic versus the limited use of condoms for pregnan- cy prevention. The implications of the cumulative supply needs for the period 2000-2015 are also striking. For example, the projected increases in the numbers of contraceptive users means that 6.8 billion cycles of pills will be need- ed between 2000 and 2015. when most commodity costs are incurred. The table shows that the annual number of sterilizations for both men and women is projected to double by 2015; the number of IUDs needed will increase by 86 percent; the number of pill cycles needed will increase by 93 percent; and injectables will increase by 42 percent. The largest of all increases will be in condoms for family planning and HIV/AIDS prevention: the numbers needed will more than triple, from 2.5 billion in 2000 to 8.1 billion in 2015, with a cumulative projected need for 84 billion condoms. In other words, 84 billion condoms will need to be produced and supplied by donors between 2000 Method Estimated Yearly Projected Yearly Increase in Annual Cumulative Supplies Need in 2000 Need in 2015 Need 2000-2015 Needed 2000-2015 (piece/procedure) (piece/procedure) (percent) (piece/procedure) Sterilization 2.3 million 4.6 million 100 54 million IUD 6.9 million 12.8 million 86 156.9 million Pill 292.3 million 563.5 million 93 6.8 billion Injectable 52.1 million 73.9 million 42 1 billion Condom 2.5 billion 8.1 billion 224 84 billion Vaginal methods 32.3 million 57.8 million 79 718 million � 7 � < TABLE 1 > PROJECTED SUBSIDIZED CONTRACEPTIVE SUPPLY NEEDS IN DONOR-RELEVANT COUNTRIES 2000-2015 P er ce n t U se rs in P u b lic S ec to r 0 10 20 30 40 50 60 70 80 90 100 Female Sterilization Male Sterilization Pill Injectables IUD Condom Vaginals < FIGURE 7 > PERCENT OF USERS IN THE PUBLIC SECTOR, ALL COUNTRIES FOR THE YEAR 2000 Note: Where country information was not available, unweighted regional averages were used. � 8 � DONOR PROSPECTS This section focuses on likely trends in donor contribu- tions for contraceptive commodities. The past record of such contributions in dollar terms is outlined in the United Nations Population Fund (UNFPA) publication Donor Support for Contraceptives and Logistics, 1999. Between 1990 and 1996, donor support for contra- ceptive supplies increased significantly; since that time, support has been irregular (see Table 2). The spike experienced in 1995 likely reflects the influence of the ICPD in 1994 which called attention to the need for more spending on reproductive health programs gener- ally. The high 1996 figure was the result of unusually high contributions to some countries by a few European donors. As indicated in Figure 8, the supply of contra- ceptive commodities has otherwise been dominated by consistent and large contributions from the United States Agency for International Development (USAID) and the expanding role of UNFPA. UNFPA’s role has included procurement for the World Bank and the Canadian International Development Agency (CIDA), which together with USAID provided 71 percent of total donor support through 1999. Also making signifi- cant contributions were the German Ministry for Economic Cooperation and Development/German < PART II > Agencies for Financial Cooperation (BMZ/KfW) at 10 percent of total donor support, and the International Planned Parenthood Federation (IPPF) and the Department for International Development of the United Kingdom (DFID) at 5-6 percent each. Between 1992 and 1999, the lion’s share of donor contributions went to three contraceptive methods: 35 percent for condoms, 33 percent for the pill, and 18 percent for injectables. IUDs, which are relatively inexpensive and last for several years, constituted only 6 percent of donor support, while vaginal methods received only 2 percent and implants only 3 percent. Donor support for most methods held fairly steady since 1992 with the exception of the pill, which has more recently lost some of its share to injectables. Appendices D7a and b detail donor support in both dol- lar amounts and the methods supported. (Inflation has eaten into the numbers of commodities that USAID con- tributions can purchase; see Appendix C for the average annual rise in commodity costs.) The irregularity of donor contributions since 1995-96 makes it difficult to make projections, and no donor agency has yet provided a firm declaration on the future of its commodity contributions. Two studies currently underway by Population Action International and the Program for Appropriate Technology in Health will provide interesting background information, although respondents from various agencies have not provided 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 TOTALS % BMZ/KfW 10,798 18,312 11,350 9,317 38,071 13,305 8,627 7,976 117,756 9.7% CIDA 1,385 4,514 7,249 0 1,036 2,885 17,069 1.4% DKT 177 0 3,759 5,148 9,084 0.7% EU 180 6,122 6,510 9,215 7,435 644 13,109 43,215 3.6% IPPF 5,843 5,410 6,204 6,165 6,258 6,746 6,003 11,148 3,416 3,016 60,209 5.0% JAPAN 28 315 300 838 36 159 1,676 0.1% NETHERLANDS 102 3,749 2,700 2,584 9,135 0.8% MSI 568 1,173 405 0 0 1,439 61 N/A 3,646 0.3% DFID 4,125 4,712 7,192 10,924 9,205 13,149 7,807 13,188 70,302 5.8% PATHFINDER 700 1,692 462 892 0 N/A 3,746 0.3% PSI 418 1,210 2,323 7,419 7,239 2,885 200 264 21,958 1.8% SIDA 1,297 6 1,400 750 0 514 3,967 0.3% UNAIDS 218 218 UNFPA 14,752 21,499 18,534 27,817 34,087 37,857 37,610 39,861 32,200 14,395 278,612 23.0% USAID 57,636 59,892 39,575 55,142 47,848 51,059 46,481 39,383 63,087 45,522 505,625 41.7% WHO 957 975 628 483 968 1,663 2,099 2,673 481 1,078 12,005 1.0% WORLD BANK 5,000 7,930 1,662 19,137 20,718 54,447 4.5% TOTALS 79,188 87,776 82,847 116,886 118,434 143,895 172,152 137,527 143,191 130,774 1,212,670 100.0% < TABLE 2 > ESTIMATED CONTRACEPTIVE COMMODITY SUPPORT BY DONOR/AGENCY IN US $000 Note: Figures for UNFPA (1995-99) include procurement for the World Bank and CIDA. Source: UNFPA, Donor Support for Contraceptives and Logistics 1999 (New York: UNFPA, 2000). � 9 � usable projections of their budgetary allocations for contraceptive commodities. UNFPA previously extrapolated long-term donor trends beginning in 1990 that showed optimistic increases over the next five to ten years. However, the disappointing experience of the last few years calls these assumptions into question and underscores the need for alternative pro- jections. Figure 9 provides two alternative projections: a flat extension of the average 1997-99 donation level (fol- lowing the 1996 spike) at $137 million, and a 3 percent annual increase. In order to compare the two donor pro- jections to future needs, the commodity projections in Appendix D4 are converted to their cost equivalents (i.e., the cost per method, as explained in Appendix C). In addi- tion, the curve is positioned to start with the line of “best fit” for past donor contributions (i.e., the top line in this figure), which rises according to the need for subsidized contraceptives in the future.6 The Gap As seen in Figure 9, either donor projection points to a large gap between contraceptive needs and supplies. A shortfall for contraceptive commodities of between $140 million and $210 million, annually, is projected by 2015. The gap grows rapidly over the 15-year period; by 2005, it will reach at least $65 million annually from the 3 percent line and perhaps as much as $87 million at current spending levels. In order to meet estimated commodities needs, donor funding will have to increase immediately by $24 million and then rise by 5.3 percent annually thereafter. Since this is unlikely, it is all the more urgent to alert donors to the seriousness of the projected shortfall and to vigorously examine alterna- tive sources of support. The data presented here call attention to the urgent need for the international repro- ductive health community, including donors, to address the funding shortfall. The potential consequences of the funding shortfall for contraceptive commodities are worrisome. More than 100 million women in the developing world have an unmet need for family planning.7 Family planning helps men and women plan pregnancies and prevent unwant- ed childbearing. In addition, condoms distributed through family planning programs also reduce the inci- dence of infections that can lead to death, disability, and infertility. Current and potential users of contraceptives, discouraged by a lack of adequate supplies, may experi- ence elevated rates of unwanted pregnancies and births, maternal and infant morbidity and mortality, abortions, and increased risk of sexually transmitted infections (STIs), including HIV/AIDS. < CONCLUSION > U S $ 0 0 0 IPPFBMZ/KfW EU DFID UNFPA USAID 0 10,000 20,000 30,000 40,000 50,000 60,000 70,000 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 World Bank < FIGURE 8 > PATTERN IN CONTRACEPTIVE SUPPLY, 1990-1999, IN US $000 � 10 � There are societal as well as personal consequences of more unwanted pregnancies and greater incidence of STIs. When contraceptive protection declines substan- tially, health services are forced to handle more preg- nancies, abortions, and sexually transmitted infections. Decisions made by individuals and couples about con- traceptive use also have important implications for pop- ulation growth. Countries already struggling to meet the employment and educational needs of their growing populations will benefit from the slowing in growth that usually results from increased contraceptive use. A recent report estimated that providing modern fam- ily planning services to one million couples could pre- vent 360,000 unintended pregnancies, 130,000 unin- tended births, 190,000 abortions, 40,000 miscarriages, 1,300 maternal deaths, and 8,000 infant deaths.8 However, the projections presented in this paper under- score a gap between required and available financing for commodities of about 20 percent in the next five years. A 20 percent shortfall in commodities in the pub- lic sector could leave 20 million couples worldwide without family planning services. Each year, this would mean an additional 7.2 million unintended pregnancies, 2.6 million unintended births, 3.8 million abortions, 26,000 maternal deaths, and 160,000 infant deaths. In light of inevitable growth in both population and demand for contraceptives, creating effective, swift change in the financing and delivery of family planning and reproductive health services has become one of the central challenges faced by the reproductive health field. How best to address the gap between contraceptive needs and supplies? The active involvement of donors in addressing the shortfall in reproductive health com- modities and the systems that provide them will be an important first step. M ill io n s o f D o lla rs 0 50 100 150 200 250 300 350 400 1990 1995 2000 2005 2010 2015 5.3% annual increase requiredPast financing Projected cost of subsidized contraceptives 3% growth in financing Constant donor financing $24 million gap $210 million gap $140 million gap < FIGURE 9 > DONOR FINANCING FOR COMMODITIES COMPARED WITH PROJECTED NEED � 11 � PROJECTIONS FOR HIV/AIDS CONDOMS Special attention went to the condom projections since they depend heavily upon future needs for HIV/AIDS protection. The available information to support the projections is somewhat fragmentary, but over the years UNFPA has obtained donors’ records on condom dona- tions to some 158 countries. That record, from 1995 through 1999, became the starting point for the HIV/AIDS analysis. A baseline as of 1997 was established as the average annual donations to each country (1995-1999). Since a reliable time trend was unavailable the projection rationale was to use the real world experience to date, to move countries at low condom levels over time toward the higher levels already established by the more active countries. On a per capita basis (per males aged 15-59 as projected by the United Nations), the baseline range for donations ran from zero condoms per male per year to over 20. Because the donations represented use for both family planning and HIV/AIDS, the per capita use for family planning was removed by refer- ence to the tables in the Profiles volume, adjusted to pertain to the public sector only (from DHS surveys showing the public/private division, with social marketing figures where known included in the public part, and NGO figures in the private part). The reductions for family planning use were generally small since condoms for family planning are a minor method in most countries and the public sector share is even smaller. The result was a set of baseline per capita figures for HIV/AIDS protection in the public sector for the 87 countries in this report. Various projection methods were explored to estimate the upward movement of per capita use from 1997 through 2015. These were com- pared in some detail, and alternative projections were run for all coun- tries. It was decided early that the rate of increase should be faster for countries starting at low levels than for those already at quite high levels, most of which have had years of experience with the epidemic and with donor contributions. Proportionately it is more likely that countries at low and intermediate levels will experience a faster relative pace. However, it was also assumed that they would not rise as far in per capita use as countries with the higher HIV/AIDs rates, so an upper limit of 15 per capita use was chosen for countries with an HIV/AIDS rate below one, and 25 for countries at or above one. These choices are partly arbi- trary, but no reliable evidence exists on how fast countries progress toward higher levels of use, and projections must be made, starting from the baseline levels in UNFPA records. After considerable examination two projections, with rather close results, were averaged to produce the final per capita estimates, by year, to 2015, and these were multiplied by the annual numbers of males 15-59 (UN projections) to produce numbers of condoms. Those were added to the family planning portion to yield total condom numbers. These in turn were converted to cost, at 2.58 cents per piece. Wastage was already taken account of in the Profiles tables (through the CYP conversion rules) for family planning, and wastage for HIV/AIDS was already a factor in the end use of the donations recorded by UNFPA. In both projections that follow, the per capita figure for any year is simply a modification of the year before. The first year, 1997, is the three year average from UNFPA records. A. For the first projection, assume that per capita condom use in year t is represented by x(t). Then condom use in the following year is represented by x(t+1) = 1 + .96 x(t) for countries with current HIV prevalence of 1 or more. This for- mula has an upper limit in the future of 25 condoms per capita. The formula is x(t+1) = .5 + .967 x(t) for countries with current HIV prevalence below 1. This formula has an upper limit in the future of 15 condoms per capita. < APPENDIX B > Asia Bangladesh Bhutan Cambodia Indonesia Iran Laos Malaysia Mongolia Myanmar Nepal Pakistan Papua New Guinea Philippines Sri Lanka Vietnam Latin America Bolivia Colombia Costa Rica Dominican Republic Ecuador El Salvador Guatemala Guyana Haiti Honduras Jamaica Mexico Nicaragua Panama Paraguay Peru Trinidad and Tobago Middle East/ North Africa Algeria Egypt Jordan Lebanon Morocco Oman Sudan Tunisia Turkey Yemen Sub-Saharan Africa Angola Benin Botswana Burkina Faso Burundi Cameroon Central African Republic Chad Congo Congo DR Cote d’Ivoire Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritius Mozambique Namibia Niger Nigeria Rwanda Senegal Sierra Leone Somalia South Africa Swaziland Tanzania Togo Uganda Zambia Zimbabwe Central Asia Republics Kazakstan Kyrgyzstan Tajikistan Turkmenistan Uzbekistan < APPENDIX A > LIST OF 87 DONOR-RELEVANT COUNTRIES, BY REGION � 12 � USAID EXPERIENCE WITH COMMODITY INFLATION Prices for contraceptive commodities rise from inflationary pressures, and these are most relevant for USAID and the UNFPA (which togeth- er donated two-thirds of total gifts in 1998) and secondarily for the BMZ/KfW, DFID, the World Bank, and the remainder of donors. Since 1994 USAID has experienced serious increases in commodity costs; apart from Norplant these have run at 25%-45% over the last 6-7 years (table) depending upon the method (the condom price rose from 4.5 cents to 6.6 cents between 1994 and 2000.) On an annual basis the increases were 3% to 6%. COST PER COMMODITY Female Sterilization (per adoption) $10.64 Male Sterilization (per adoption) $5.92 Pill (per cycle) $0.287 Injectable (per injection) $1.10 IUD (per adoption) $1.65 Condom (per piece) $0.0258 Vaginals (per application) $0.099 Source: The above estimates for costs per commodity are based on UNFPA schedules and are derived in Rodolfo A. Bulatao. “Reproductive-health commodity requirements and costs in develop- ing regions, 1999-2015,” Paper prepared for the United Nations Population Fund (New York: UNFPA, 1999). < APPENDIX C >B. The second specification can be expressed in similar terms, but withtwo variations according to whether the prior year’s per capita level is below 1 or equals/exceeds one. This helps to smooth the curve in the first 1-3 years for countries starting at zero or very low per capita levels. If x(t) equals or exceeds one: x(t+1) = x(t) + 2.5 / x(t) for countries with current HIV prevalence of 1 or more. This for- mula has an approximate upper limit in the future of 25 condoms per capita. x(t+1) = x(t) + 1.5/ x(t) for countries with current HIV prevalence below 1. This formula has an approximate upper limit in the future of 15 condoms per capita. If x(t) is below one x(t+1) = x(t) + 2.0 / x(t) for countries with current HIV prevalence of 1 or more. This for- mula has an approximate upper limit in the future of 25 condoms per capita. x(t+1) = x(t) + 1.5/ x(t) for countries with current HIV prevalence below 1, as before. This formula has an approximate upper limit in the future of 15 con- doms per capita. Note that in all these variations the actual per capita level reached by 2015 varies by country, and many do not come near the 15 or 25 limit by then. Note: USAID pays more for contraceptives than the international costs listed under cost per commodity which are used for the projections. 1994 1995 1996 1997 1998 1999 2000 2001 Average Annual Rise (Percent) Condoms 0.045 0.049 0.053 0.053 0.050 0.059 0.066 - 6.3 Lo-Femenal 0.173 0.187 0.197 0.207 0.207 0.217 0.217 0.227 3.8 Lo-Gentrol 0.173 0.187 0.197 0.207 0.207 0.217 0.217 0.227 3.8 Ovrette 0.179 - 0.197 0.207 0.207 0.217 0.217 0.227 3.4 Duofem 0.195 0.195 .210 0.235 0.247 .248 0.243 0.249 3.5 Depo-Provera 0.960 0.960 0.930 0.930 0.930 0.950 0.970 0.970 0.1 Foaming Tablets 0.101 0.104 0.108 0.116 0.119 0.122 0.125 0.128 3.4 IUD 1.087 1.087 1.185 1.213 1.467 1.188 1.451 - 4.8 Female Condom - - - - 0.730 0.730 - - Norplant 23.12 23.80 23.80 23.80 23.80 23.80 23.80 23.80 0.41 USAID COMMODITY PRICES BY CALENDAR YEAR OF PURCHASE (US$) � 13 � Female Male Total Sterilization Sterilization Pill Injectables IUD Condom Vaginals Total 2000 Rest of Asia 10,214 1,481 11,123 7,985 12,188 1,697 152 44,841 Latin America 5,927 282 1,496 511 2,860 397 23 11,494 Middle East/ North Africa 977 80 2,414 296 4,279 343 17 8,406 Sub-Saharan Africa 2,037 185 4,138 4,290 1,435 509 67 12,659 Central Asia Rep. 679 156 312 132 3,340 244 11 4,873 TOTAL 19,833 2,183 19,482 13,213 24,102 3,189 270 82,273 2005 Rest of Asia 11,799 1,611 14,048 9,034 16,302 2,286 194 55,274 Latin America 6,664 500 1,747 491 3,263 611 21 13,296 Middle East/ North Africa 1,330 101 3,020 587 5,510 483 23 11,055 Sub-Saharan Africa 4,542 345 5,792 4,819 2,741 653 89 18,981 Central Asia Rep. 1,212 207 606 189 2,950 405 13 5,583 TOTAL 25,546 2,765 25,213 15,121 30,767 4,438 340 104,189 2010 Rest of Asia 12,969 1,638 16,655 9,582 20,652 2,867 234 64,597 Latin America 7,299 743 1,982 445 3,623 842 19 14,953 Middle East/ North Africa 1,676 122 3,549 903 6,649 631 29 13,560 Sub-Saharan Africa 7,853 550 8,003 5,647 4,482 868 116 27,519 Central Asia Rep. 1,799 262 936 252 2,274 584 14 6,119 TOTAL 31,596 3,315 31,124 16,829 37,680 5,792 411 126,747 2015 Rest of Asia 11,792 1,545 16,507 9,160 21,110 3,148 222 63,483 Latin America 7,878 1,011 2,210 385 3,960 1,092 16 16,553 Middle East/ North Africa 1,879 117 3,835 858 5,544 749 34 13,016 Sub-Saharan Africa 11,917 769 10,670 6,627 6,553 1,066 117 37,721 Central Asia Rep. 2,435 311 1,286 314 1,413 773 14 6,546 TOTAL 35,900 3,753 34,508 17,344 38,580 6,829 404 137,319 < APPENDIX D1 > USERS, PUBLIC SECTOR MODERN CONTRACEPTIVE METHODS 2000-2015, BY METHODS AND REGION (THOUSANDS) � 14 � Female Male Sterilization Sterilization Pill Injectables IUD Condom Vaginals Total 2000 Rest of Asia 1,509 224 9,897 4,978 2,040 3,724 383 22,754 Latin America 3,432 156 3,336 1,034 1,739 1,349 308 11,356 Middle East/ North Africa 247 26 4,060 365 3,291 978 153 9,120 Sub-Saharan Africa 1,126 113 2,778 1,248 739 1,195 246 7,447 Central Asia Rep. 63 7 147 23 98 85 24 447 TOTAL 6,377 527 20,219 7,649 7,907 7,332 1,114 51,124 2005 Rest of Asia 1,915 245 13,076 5,763 3,088 4,621 487 29,195 Latin America 3,796 276 3,775 1,115 2,059 1,955 280 13,257 Middle East/ North Africa 369 34 5,171 769 4,290 1,489 211 12,332 Sub-Saharan Africa 2,005 183 4,673 1,514 1,330 1,474 297 11,476 Central Asia Rep. 76 9 217 33 100 123 28 585 TOTAL 8,162 746 26,912 9,193 10,866 9,662 1,303 66,845 2010 Rest of Asia 2,287 252 16,276 6,246 4,211 5,459 587 35,318 Latin America 4,113 414 4,171 1,173 2,379 2,621 241 15,112 Middle East/ North Africa 496 41 6,185 1,209 5,224 2,041 268 15,463 Sub-Saharan Africa 3,138 268 7,209 1,922 2,116 1,908 349 16,910 Central Asia Rep. 87 11 291 43 95 161 31 720 TOTAL 10,121 985 34,133 10,593 14,025 12,190 1,477 83,524 2015 Rest of Asia 2,507 255 19,729 6,593 5,406 6,180 687 41,358 Latin America 4,354 561 4,501 1,202 2,682 3,306 189 16,795 Middle East/ North Africa 618 47 7,034 1,661 6,023 2,581 326 18,290 Sub-Saharan Africa 4,591 370 10,545 2,428 3,142 2,428 341 23,844 Central Asia Rep. 100 12 369 54 89 203 33 859 TOTAL 12,170 1,244 42,178 11,938 17,342 14,698 1,576 101,146 < APPENDIX D2 > USERS, PRIVATE SECTOR MODERN CONTRACEPTIVE METHODS 2000-2015, BY METHODS AND REGION (THOUSANDS) � 15 � Female Male Sterilization Sterilization Pill Injectables IUD Condom Vaginals Total 2000 Rest of Asia 11,723 1,705 21,020 12,963 14,228 5,421 535 67,595 Latin America 9,359 438 4,832 1,545 4,599 1,746 331 22,850 Middle East/ North Africa 1,224 106 6,474 661 7,570 1,321 170 17,526 Sub-Saharan Africa 3,163 298 6,916 5,538 2,174 1,704 313 20,106 Central Asia Rep. 741 163 459 155 3,438 329 35 5,320 TOTAL 26,210 2,710 39,701 20,862 32,009 10,521 1,384 133,397 2005 Rest of Asia 13,714 1,856 27,124 14,797 19,390 6,907 681 84,469 Latin America 10,460 776 5,522 1,606 5,322 2,566 301 26,553 Middle East/ North Africa 1,699 135 8,191 1,356 9,800 1,972 234 23,387 Sub-Saharan Africa 6,547 528 10,465 6,333 4,071 2,127 386 30,457 Central Asia Rep. 1,288 216 823 222 3,050 528 41 6,168 TOTAL 33,708 3,511 52,125 24,314 41,633 14,100 1,643 171,034 2010 Rest of Asia 15,256 1,890 32,931 15,828 24,863 8,326 821 99,915 Latin America 11,412 1,157 6,153 1,618 6,002 3,463 260 30,065 Middle East/ North Africa 2,172 163 9,734 2,112 11,873 2,672 297 29,023 Sub-Saharan Africa 10,991 818 15,212 7,569 6,598 2,776 465 44,429 Central Asia Rep. 1,886 272 1,227 295 2,369 745 45 6,839 TOTAL 41,717 4,300 65,257 27,422 51,705 17,982 1,888 210,271 2015 Rest of Asia 14,299 1,800 36,236 15,753 26,515 9,328 909 104,841 Latin America 12,232 1,572 6,710 1,588 6,643 4,398 205 33,348 Middle East/ North Africa 2,497 164 10,869 2,519 11,567 3,330 360 31,306 Sub-Saharan Africa 16,508 1,139 21,216 9,055 9,695 3,495 458 61,565 Central Asia Rep. 2,534 323 1,655 368 1,502 976 47 7,405 TOTAL 48,069 4,998 76,686 29,283 55,922 21,527 1,980 238,464 < APPENDIX D3 > USERS, BOTH SECTORS MODERN CONTRACEPTIVE METHODS 2000-2015, BY METHODS AND REGION (THOUSANDS) � 16 � Female Male Total Sterilization Sterilization Pill Injectables IUD Condom Vaginals 2000 Rest of Asia 1,021 148 166,846 31,936 3,483 1,021,049 18,262 Latin America 593 28 22,445 2,046 817 257,829 2,698 Middle East/ North Africa 122 10 36,210 1,184 1,223 228,536 2,092 Sub-Saharan Africa 254 24 62,074 16,444 409 894,245 8,014 Central Asia Rep. 75 17 4,680 524 954 65,201 1,286 TOTAL 2,065 227 292,255 52,133 6,886 2,466,859 32,353 2005 Rest of Asia 1,180 161 210,716 36,139 4,658 1,755,233 23,307 Latin America 666 50 26,212 1,966 932 474,525 2,515 Middle East/ North Africa 166 13 45,292 2,349 1,574 448,062 2,758 Sub-Saharan Africa 568 43 86,855 19,277 783 1,526,826 10,526 Central Asia Rep. 135 23 9,087 758 843 124,995 1,476 TOTAL 2,715 291 378,162 60,490 8,790 4,329,641 40,582 2010 Rest of Asia 1,297 164 249,816 38,331 5,901 2,470,132 28,052 Latin America 730 74 29,737 1,783 1,035 687,473 2,217 Middle East/ North Africa 210 15 53,224 3,612 1,900 660,949 3,421 Sub-Saharan Africa 982 69 120,041 22,579 1,280 2,206,251 13,609 Central Asia Rep. 200 29 14,041 1,006 650 183,847 1,618 TOTAL 3,418 351 466,860 67,311 10,766 6,208,652 48,917 2015 Rest of Asia 1,374 162 286,864 39,602 7,191 3,161,570 32,909 Latin America 780 100 32,889 1,516 1,122 896,297 1,862 Middle East/ North Africa 251 18 60,446 4,869 2,179 873,977 4,033 Sub-Saharan Africa 1,520 100 164,000 26,680 1,932 2,960,617 17,297 Central Asia Rep. 271 35 19,311 1,257 403 241,828 1,734 TOTAL 4,196 414 563,510 73,924 12,827 8,134,288 57,835 15-YEAR CUMULATIVE TOTAL Rest of Asia 19,570 2,555 3,663,792 586,965 84,817 33,674,681 410,311 Latin America 11,101 1,007 445,749 29,431 15,653 9,272,369 37,342 Middle East/ North Africa 2,997 225 782,552 47,968 27,575 8,852,590 49,270 Sub-Saharan Africa 13,070 932 1,712,702 338,652 17,339 30,229,973 196,609 Central Asia Rep. 2,711 417 187,610 14,162 11,535 2,465,296 24,530 TOTAL 49,449 5,134 6,792,405 1,017,178 156,918 84,494,909 718,062 < APPENDIX D4 > COMMODITIES, PUBLIC SECTOR MODERN CONTRACEPTIVE METHODS 2000-2015, BY METHODS AND REGION (THOUSANDS) � 17 � Female Male Family Planning Sterilization Sterilization Pill Injectables IUD Condoms Vaginals 2000 Rest of Asia 151 22 148,465 19,911 583 446,795 45,924 Latin America 343 16 50,065 4,139 497 161,837 36,865 Middle East/ North Africa 31 3 60,895 1,463 940 117,346 18,422 Sub-Saharan Africa 141 14 41,674 4,726 211 143,400 29,668 Central Asia Rep. 7 1 2,202 92 28 10,255 2,931 TOTAL 673 56 303,301 30,330 2,259 879,632 133,810 2005 Rest of Asia 192 24 196,140 23,053 882 554,476 58,570 Latin America 380 28 56,642 4,467 588 234,598 33,590 Middle East/ North Africa 46 4 77,554 3,073 1,226 178,625 25,249 Sub-Saharan Africa 251 23 70,077 6,054 380 176,640 35,205 Central Asia Rep. 8 1 3,251 132 28 14,780 3,363 TOTAL 876 80 403,664 36,778 3,105 1,159,119 155,978 2010 Rest of Asia 233 25 244,140 24,984 1,203 655,080 70,440 Latin America 411 41 62,577 4,695 680 314,345 28,690 Middle East/ North Africa 62 5 92,756 4,839 1,492 244,830 32,307 Sub-Saharan Africa 392 33 108,130 7,687 605 229,040 41,988 Central Asia Rep. 10 1 4,372 172 27 19,335 3,687 TOTAL 1,108 106 511,975 42,378 4,007 1,462,631 177,112 2015 Rest of Asia 262 25 295,948 26,375 1,544 741,628 82,535 Latin America 435 56 67,516 4,810 766 396,602 22,466 Middle East/ North Africa 77 6 105,513 6,640 1,721 309,595 39,148 Sub-Saharan Africa 574 46 158,206 9,709 898 291,355 49,970 Central Asia Rep. 11 1 5,534 215 25 24,323 3,952 TOTAL 1,360 135 632,718 47,749 4,955 1,763,503 198,071 15-YEAR CUMULATIVE TOTAL Rest of Asia 3,362 391 3,534,638 379,042 16,809 9,613,049 1,030,431 Latin America 6,290 560 948,840 72,657 10,129 4,420,031 489,392 Middle East/ North Africa 865 75 1,350,775 63,868 21,575 3,398,096 460,493 Sub-Saharan Africa 5,357 464 1,490,677 112,010 8,247 3,332,667 624,880 Central Asia Rep. 145 17 61,321 2,441 438 274,308 55,897 TOTAL 16,019 1,506 7,386,251 630,017 57,198 21,038,151 2,661,092 < APPENDIX D5 > COMMODITIES, PRIVATE SECTOR MODERN CONTRACEPTIVE METHODS 2000-2015, BY METHODS AND REGION (THOUSANDS) � 18 � Female Male Total Sterilization Sterilization Pill Injectables IUD Condom Vaginals 2000 Rest of Asia 1,172 171 315,312 51,847 4,066 1,467,844 64,186 Latin America 936 44 72,510 6,184 1,313 419,665 39,563 Middle East/ North Africa 153 13 97,105 2,647 2,163 345,881 20,514 Sub-Saharan Africa 394 38 103,748 21,170 620 1,037,645 37,682 Central Asia Rep. 82 18 6,882 616 982 75,456 4,217 TOTAL 2,738 284 595,556 82,463 9,145 3,346,491 166,163 2005 Rest of Asia 1,371 186 406,855 59,192 5,540 2,309,709 81,878 Latin America 1,046 78 82,855 6,433 1,521 709,123 36,105 Middle East/ North Africa 212 17 122,846 5,423 2,800 626,686 28,007 Sub-Saharan Africa 819 66 156,931 25,331 1,163 1,703,467 45,731 Central Asia Rep. 143 24 12,338 890 871 139,775 4,839 TOTAL 3,591 371 781,826 97,268 11,895 5,488,760 196,560 2010 Rest of Asia 1,530 189 493,956 63,315 7,104 3,125,212 98,492 Latin America 1,141 116 92,314 6,479 1,715 1,001,819 30,907 Middle East/ North Africa 272 21 145,981 8,451 3,392 905,779 35,728 Sub-Saharan Africa 1,374 102 228,172 30,266 1,885 2,435,291 55,597 Central Asia Rep. 210 30 18,412 1,178 677 203,182 5,304 TOTAL 4,526 457 978,835 109,689 14,773 7,671,283 226,029 2015 Rest of Asia 1,636 187 582,812 65,977 8,735 3,903,198 115,445 Latin America 1,216 156 100,405 6,325 1,888 1,292,899 24,328 Middle East/ North Africa 329 24 165,960 11,509 3,900 1,183,572 43,181 Sub-Saharan Africa 2,094 146 322,206 36,389 2,829 3,251,972 67,267 Central Asia Rep. 282 36 24,845 1,472 429 266,151 5,686 TOTAL 5,556 549 1,196,229 121,673 17,781 9,897,791 255,907 15-YEAR CUMULATIVE TOTAL Rest of Asia 22,932 2,946 7,198,431 966,008 101,626 43,287,730 1,440,741 Latin America 17,391 1,567 1,394,588 102,088 25,781 13,692,400 526,734 Middle East/ North Africa 3,862 299 2,133,327 111,836 49,151 12,250,686 509,763 Sub-Saharan Africa 18,428 1,395 3,203,379 450,661 25,586 33,562,639 821,489 Central Asia Rep. 2,856 434 248,931 16,603 11,973 2,739,604 80,427 TOTAL 65,468 6,641 14,178,656 1,647,196 214,116 105,533,060 3,379,154 < APPENDIX D6 > COMMODITIES, BOTH SECTORS MODERN CONTRACEPTIVE METHODS 2000-2015, BY METHODS AND REGION (THOUSANDS) � 19 � Method 1992 1993 1994 1995 1996 1997 1998 1999 Average Condom 25 34 34 42 40 37 36 29 35 Oral 41 41 37 33 37 22 24 34 33 Injectable 13 14 14 13 13 27 24 24 18 IUD 11 5 7 4 5 5 7 5 6 VFT 3 2 3 2 2 2 2 1 2 Implant 2 1 3 2 2 3 7 6 3 Foam/Jelly 5 2 1 5 1 4 0 0 2 TOTALS 100 100 100 100 100 100 100 100 100 < APPENDIX D7B > DONOR CONTRIBUTIONS BY METHOD, 1992-1999 (PERCENTAGE) Source: UNFPA, Donor Support for Contraceptives and Logistics 1999 (New York: UNFPA, 2000). METHOD 1992 1993 1994 1995 1996 1997 1998 1999 TOTAL Percent Condom 20.8 40.1 39.9 60.6 68.1 50.9 51.4 37.9 369.7 35.4 Oral 33.7 48.3 44.1 46.9 64.0 30.2 34.4 44.4 346.0 33.1 Injectable 10.5 15.8 16.8 18.0 21.8 37.8 34.3 31.5 186.5 17.8 IUD 9.5 5.6 8.7 5.3 9.2 6.3 9.7 6.5 60.8 5.8 VTF 2.5 2.8 3.4 3.4 4.0 3.0 2.6 1.9 23.6 2.3 Implant 1.6 1.5 3.9 2.9 3.3 4.0 10.4 8.5 36.1 3.5 Foam/Jelly 4.2 2.7 1.3 6.7 1.7 5.3 0.4 0.1 22.4 2.1 TOTAL 82.8 116.8 118.1 143.8 172.1 137.5 143.2 130.8 1,045.1 100.0 < APPENDIX D7A > DONOR CONTRIBUTIONS BY METHOD, 1992-1999 (US $MILLIONS) � 20 � NOTES 1 China and India are excluded from the analysis because they are considered self-sufficient with regard to the provision of contracep- tive supplies. Other smaller countries that do not rely on donors for contraceptive purchases are also excluded. 2 Ross, John, John Stover and Amy Willard. Profiles for Family Planning and Reproductive Health Programs: 116 Countries (Glastonbury, CT: The Futures Group International, 1999). 3 Exclusions made for this study reduced the original listing of 116 countries in Profiles for Family Planning and Reproductive Health Programs to 87. Interested readers should refer to that publication for data on the excluded countries, as well as for information on projections for 2000-2015 of all women, women in union, contra- ceptive users, prevalence of contraceptive use, and contraceptive commodity needs. 4 These rates have been adjusted to agree with the most recent national surveys. For a detailed discussion of the methodology, see Ross, et al. 1999. 5 Ross, et al. 1999. 6 The best fit line was calculated using the least squares regression. 7 Robey, Bryant, John Ross and Indu Bhushan. “Meeting Unmet Need: New Strategies.” Population Reports, Series J43, 1996. (Baltimore: Johns Hopkins School of Public Health, Population Information Program, 1996). 8 The Potential Impact of Increased Family Planning Funding on the Lives of Women and their Families (Washington, DC: The Alan Guttmacher Institute, The Futures Group International, Population Action International and the Population Reference Bureau, in con- sultation with the Population Council, 2000). � C4 � M E E T I N G T H E CHALLENGE Securing Contraceptive Supplies T he Interim Working Group on Reproductive Health Commodity Security (IWG) is a collaborative effort of John Snow, Inc. (JSI), Population Action International (PAI), the Program for Appropriate Technology in Health (PATH) and Wallace Global Fund. Recognizing the important leadership role of the UN Population Fund (UNFPA) in meeting the goals of the 1994 Programme of Action, the IWG’s objective is to further these goals by raising awareness about the importance of securing reproductive health supplies. The IWG seeks to identify the causes of failures and weaknesses in commodity systems and to spur actions that will contribute to securing essential supplies for the delivery of reproductive health care. S E C U R I N G S U P P L I E S F O R R E P R O D U C T I V E H E A L T H Printed on Recycled Paper

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