Madagascar Total Market Initiative Project- Increasing Private Sector Participation in Family Planning in Madagascar: Annex DHS Analysis

Publication date: 2010

Madagascar: Total Market Initiative Project, 2010 Page 1 of 26 Annexure 1: Detailed DHS Analysis Slide 1 Family Planning Market Segmentation Madagascar Total Market Initiative Marie Stopes International Futures Group UNFPA January- December 2010 Slide 2 Madagascar at a glance in 2009… Total Fertility Rate 4.8 children per woman Contraceptive Prevalence Rate Total: 39.9 Modern: 29.2 Unmet Need 19% of married women ages 15- 49 Infant Mortality Rate 48 deaths per 1,000 live births Maternal Mortality Ratio 498 deaths per 100,000 live births Source: 2009 Madagascar DHS Data Madagascar: Total Market Initiative Project, 2010 Page 2 of 26 Slide 3 Demographics P ho to b y W oo d lo us e Slide 4 Source: 2009 Madagascar DHS Demographic Statistics: Age Distribution of Age among Married Women % o f M a rr ie d W om e n Madagascar: Total Market Initiative Project, 2010 Page 3 of 26 Slide 5 Source: 2009 Madagascar DHS Demographic Statistics Where Married Women Live Slide 6 Urban Rural Demographic Statistics Place of Residence According to Standard of Living Source: 2009 Madagascar DHS % W o m e n S ur ve y e d Madagascar: Total Market Initiative Project, 2010 Page 4 of 26 Slide 7 Contraceptive Use Among Married Women All Methods – Including Non-Users Source: 2009 Madagascar DHS Slide 8 Total Fertility Rate Total Fertility Rate (TFR) Source: 1997, 2004, 2009 Madagascar DHS N um b e r o f liv e b ir th s p e r w o m a n Madagascar: Total Market Initiative Project, 2010 Page 5 of 26 Slide 9 Market Segmentation Photo by Luc Legay Slide 10 Sources of Contraceptives The majority of married women rely on the public sector for modern contraceptives. P ho to b y G ro uc ho Madagascar: Total Market Initiative Project, 2010 Page 6 of 26 Slide 11 Standard of Living Index DHS Methodology • Factor analysis of assets including: – Household goods: radio, television, automobile, motorcycle, bicycle, etc. – Household amenities: electricity, improved water and sewage systems – Housing construction: flooring, roofing, wall material, number of rooms Slide 12 Public Private Other Sources of Family Planning -2009 Sources of Family Planning for Married Women by Standard of Living Index Source: 2009 Madagascar DHS Data % M a rr ie d W o m e n Madagascar: Total Market Initiative Project, 2010 Page 7 of 26 Slide 13 Public Private Other Source: 2009 Madagascar DHS Data Sources of Family Planning - 2009 Sources of Family Planning for Married UrbanWomen % M a rr ie d U rb a n W o m e n Slide 14 Public Private Other Source: 2009 Madagascar DHS Data Sources of Family Planning - 2009 Sources of Family Planning for Married RuralWomen % M a rr ie d R ur a l W o m e n Madagascar: Total Market Initiative Project, 2010 Page 8 of 26 Slide 15 Rural Urban Public Sources of Family Planning for Married Women Source: 2009 Madagascar DHS Data Sources of Family Planning - 2009 % M a rr ie d W o m e n w ho u se P ub lic S o ur ce s Slide 16 A Closer Look at Sources of Injectables… P ho to b y M a ss im ili a no S ti cc a Madagascar: Total Market Initiative Project, 2010 Page 9 of 26 Slide 17 Public Private Other Source: 2004 Madagascar DHS % M a rr ie d W o m e n Source of Injectables - 2004 Slide 18 Public Private Other Where Married Women Get Their Injectables… Source: 2009 Madagascar DHS Sources of Injectables - 2009 % M a rr ie d W o m e n Madagascar: Total Market Initiative Project, 2010 Page 10 of 26 Slide 19 Public Private Other Where Married URBANWomen Get Their Injectables… Source: 2009 Madagascar DHS Data Sources of Injectables - 2009 % M a rr ie d U rb a n W o m e n Slide 20 Public Private Other Where Married Rural Women Get Their Injectables… Source: 2009 Madagascar DHS Data Sources of Injectables - 2009 % M a rr ie d R ur a l W o m e n Madagascar: Total Market Initiative Project, 2010 Page 11 of 26 Slide 21 Government Clinic/Pharmacy Government Home/Comm. Private Clinic/Delivery Private Pharmacy Shop, Church, Friend Other Specific Sources of Injectables - 2004 Source: 2004 Madagascar DHS % M a rr ie d W o m e n Slide 22 Government Clinic/Pharmacy Government Home/Comm. Private Clinic/Delivery Private Pharmacy Shop, Church, Friend Other Private Sector Plays Small Role Outside of Highest Wealth Quintile Source: 2009 Madagascar DHS Specific Sources of Injectables - 2009 % M a rr ie d W o m e n Madagascar: Total Market Initiative Project, 2010 Page 12 of 26 Slide 23 Method Mix Photo courtesy of the International Rice Research Institute Slide 24 Source: 2009 Madagascar DHS Modern Contraceptive Method Mix -2009 Modern Method Use by Married Women Madagascar: Total Market Initiative Project, 2010 Page 13 of 26 Slide 25 Married Women – Reliance on Resupply Methods Source: 2009 Madagascar DHS LAM Norplant Male Sterilization Female Sterilization Condom Injections IUD Pill Female Condom % M a rr ie d W o m e n Modern Contraceptive Method Mix -2009 Slide 26 Unmet Need for Family Planning Photo by Christian Bachellier Unmet Need for Family Planning Declined between 2004 and 2009 Madagascar: Total Market Initiative Project, 2010 Page 14 of 26 Slide 27 Unmet Need to Space Unmet Need to Limit Unmet Need for Family Planning - 2004 Unmet Need for all Married Women Source: 2004 Madagascar DHS % M a rr ie d W o m e n Slide 28 Unmet Need to Space Unmet Need to Limit Source: 2009 Madagascar DHS Unmet Need for all Married Women Unmet Need for Family Planning - 2009 % M a rr ie d W o m e n Madagascar: Total Market Initiative Project, 2010 Page 15 of 26 Slide 29 Unmet Need for Urban Married Women Unmet Need to Space Unmet Need to Limit Source: 2009 Madagascar DHS Unmet Need for Family Planning % M a rr ie d U rb a n W o m e n Slide 30 Unmet Need to Space Unmet Need to Limit Source: 2009 Madagascar DHS Unmet Need for Rural Married Women Unmet Need for Family Planning % M a rr ie d R ur a l W o m e n Madagascar: Total Market Initiative Project, 2010 Page 16 of 26 Slide 31 2004 and 2009 Comparison Photo by Francois de Halleux Slide 32 Sources of Family Planning Source: 2004 and 2009 Madagascar DHS Data 2004 2009 Comparison of Sources of Contraceptives 2004 vs. 2009 Madagascar: Total Market Initiative Project, 2010 Page 17 of 26 Slide 33 Specific Sources of Family Planning Comparison of Sources of Contraceptives 2004 vs. 2009 Source: 2009 and 2004 Madagascar DHS Data 2004 2009 Slide 34 URBAN RURAL Sources of Family Planning - 2004 Urban vs. Rural Breakdown Source: 2004 Madagascar DHS Data Madagascar: Total Market Initiative Project, 2010 Page 18 of 26 Slide 35 URBAN Source: 2009 Madagascar DHS Data Sources of Family Planning - 2009 RURAL Urban vs. Rural Breakdown Comparison of the Urban and Rural populations to see where married women in these types of settings get their family planning needs. The rural population has a higher dependency on public/government sources (almost 80%) while the Urban population is about 30% lower. Slide 36 2009 2004 % M a rr ie d W o m e n Source: 2004 and 2009 Madagascar DHS Public Sector Use for Injectables increased among Higher Socio Economic Groups as well Socio Economic Groups Madagascar: Total Market Initiative Project, 2010 Page 19 of 26 Slide 37 2004 2009 Source: 2004 and 2009 Madagascar DHS % M a rr ie d W o m e n Comparison of Unmet Need Levels between 2004 and 2009 Slide 38 U R B A N R U R A L 2004 2009 Public Sector gained largely in Rural Madagascar: Total Market Initiative Project, 2010 Page 20 of 26 Slide 39 Opportunity for Private Sector Slide 40 Urban Rural Place of Residence According to Standard of Living Source: 2009 Madagascar DHS % W o m e n S u rv e y e d A Sizeable Segment exists with Capacity to Pay Socio Economic Groups Madagascar: Total Market Initiative Project, 2010 Page 21 of 26 Slide 41 Largely 25-34 years, Secondary educated, living in Tana, Alaotra Mangoro, Vakinankara, Itasy, Atsinanana, Haute Matsiatra, Boeny and Sava Demographics of Married Women Using Modern Methods in Top Two National Wealth Quintiles (population with willingness/ability to pay) Slide 42 Yet using public sector as a source Demographics of Married Women Using Modern Methods in Top Two Wealth Quintiles and Using Public Sector Sources of Contraceptives (potentially able/willing to pay for contraceptives) Madagascar: Total Market Initiative Project, 2010 Page 22 of 26 Slide 43 Rural Urban Public Sources of Family Planning for Married Women Source: 2009 Madagascar DHS Data % M a rr ie d W o m e n w ho u se P ub lic S o ur ce s Preference for Public Source lower among Urban middle to high socio economic groups Slide 44 Use of Private Sector is Significant too Public Private Other Sources of Family Planning for Married Women by Standard of Living Index Source: 2009 Madagascar DHS Data % M a rr ie d W o m e n Socio Economic Groups Madagascar: Total Market Initiative Project, 2010 Page 23 of 26 Slide 45 Public Private Other Source: 2009 Madagascar DHS Data % M a rr ie d U rb a n W o m e n More so in Urban and Among Higher Socio Economic groups in Rural Urban Rural Socio Economic Groups Socio Economic Groups Slide 46 Similar in Profile to Those with Capacity to Pay Demographics of Married Women Using INJECTABLES in Top Two Wealth Quintiles and Using Public Sector Sources of Contraceptives (potentially able/willing to pay for contraceptives) Madagascar: Total Market Initiative Project, 2010 Page 24 of 26 Slide 47 Demographics of Married Women Using Modern Methods in Top Two National Wealth Quintiles (population with willingness/ability to pay) Slide 48 Demographics of Married Women Using Modern Methods in Top Two Wealth Quintiles and Using Public Sector Sources of Contraceptives (potentially able/willing to pay for contraceptives) Madagascar: Total Market Initiative Project, 2010 Page 25 of 26 Slide 49 Demographics of Married Women Using INJECTABLES in Top Two Wealth Quintiles and Using Public Sector Sources of Contraceptives (potentially able/willing to pay for contraceptives) Slide 50 Demographics of Married Women Who are Non-users and Who Have An Unmet Need (potential market) Madagascar: Total Market Initiative Project, 2010 Page 26 of 26 Slide 51 Married Women With Unmet Need Who are Non-users: Crosstab Region and National Wealth Quintiles Very Low Low Middle High Highe r Total Analamanga 0.00 4.66 12.44 18.91 63.99100.00 Vakinankaratra 6.88 26.32 33.60 21.86 11.34100.00 Itasy 7.46 16.42 32.84 35.82 7.46100.00 Bongolava 7.69 21.15 34.62 28.85 7.69100.00 Haute Matsiatra 18.10 21.90 22.86 21.90 15.24100.00 Amoron'I Mania 20.00 22.11 21.05 21.05 15.79100.00 Vatovavy Fitovinany 45.28 27.04 18.24 7.55 1.89100.00 Ihorombe 37.04 25.93 11.11 18.52 7.41100.00 Atsimo Atsinanana 46.15 16.67 23.08 14.10 0.00100.00 Atsinanana 5.26 34.21 9.21 14.47 36.84100.00 Analanjirofo 11.67 42.50 18.33 22.50 5.00100.00 Alaotra Mangoro 5.38 15.38 24.62 33.08 21.54100.00 Boeny 33.82 16.18 8.82 10.29 30.88100.00 Sofia 40.98 36.89 11.48 6.56 4.10100.00 Betsiboka 60.00 20.00 10.00 6.67 3.33100.00 Melaky 65.00 20.00 0.00 5.00 10.00100.00 Atsimo Andrefana 55.56 11.11 5.93 14.07 13.33100.00 Androy 53.52 30.99 11.27 2.82 1.41100.00 Anosy 53.73 20.90 8.96 2.99 13.43100.00 Menabe 47.37 17.54 12.28 10.53 12.28100.00 Diana 22.81 21.05 8.77 28.07 19.30100.00 Sava 14.71 31.37 29.41 21.57 2.94100.00 Total 22.68 21.14 18.19 17.75 20.26100.00 Row percentage: “Of all the people that live in Analamanga, 63.99% fall in the highest wealth quintile” Very Low Low Middle High Higher Total Analamanga 0.00 3.75 11.62 18.11 53.70 17.00 Vakinankaratra 3.30 13.54 20.10 13.40 6.09 10.88 Itasy 0.97 2.29 5.33 5.96 1.09 2.95 Bongolava 0.78 2.29 4.36 3.72 0.87 2.29 Haute Matsiatra 3.69 4.79 5.81 5.71 3.48 4.62 Amoron'I Mania 3.69 4.38 4.84 4.96 3.26 4.18 Vatovavy Fitovinany 13.98 8.96 7.02 2.98 0.65 7.00 Ihorombe 1.94 1.46 0.73 1.24 0.43 1.19 Atsimo Atsinanana 6.99 2.71 4.36 2.73 0.00 3.43 Atsinanana 0.78 5.42 1.69 2.73 6.09 3.35 Analanjirofo 2.72 10.63 5.33 6.70 1.30 5.28 Alaotra Mangoro 1.36 4.17 7.75 10.67 6.09 5.72 Boeny 4.47 2.29 1.45 1.74 4.57 2.99 Sofia 9.71 9.38 3.39 1.99 1.09 5.37 Betsiboka 3.50 1.25 0.73 0.50 0.22 1.32 Melaky 2.52 0.83 0.00 0.25 0.43 0.88 Atsimo Andrefana 14.56 3.13 1.94 4.71 3.91 5.94 Androy 7.38 4.58 1.94 0.50 0.22 3.13 Anosy 6.99 2.92 1.45 0.50 1.96 2.95 Menabe 5.24 2.08 1.69 1.49 1.52 2.51 Diana 2.52 2.50 1.21 3.97 2.39 2.51 Sava 2.91 6.67 7.26 5.46 0.65 4.49 Total 100.00 100.00 100.00 100.00 100.00 100.00 Column Percentage: “Of all the people that fall in the “higher” quintile, 53.70% live in Analamanga”

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