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HOME: STATE OF WORLD POPULATION 2004: Reproductive Health and Family Planning
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Reproductive Health and Family Planning

Family Planning and Sexual Health
Contraceptive Access and Use
Unmet Need
Choice of Methods
Sexually Transmitted Infections
Quality of Care
Stronger Voices for Reproductive Health
Securing the Supplies
Men and Reproductive Health

Securing the Supplies

The ability to formulate and provide quality reproductive health depends on having in place political support, funding, people, facilities and commodities.

While national programmes often have to cope with adversity—such as scarcities of personnel and facilities, a lack of running water, regular power outages and disruptions of transport—the absence of commodities means that investments and effort will be largely wasted.

“Reproductive health commodity security” involves assuring an adequate and secure supply of essential reproductive health supplies. These commodities must be repeatedly procured, delivered and distributed to where they are needed when they are needed. In many poor countries, reproductive health programmes will depend heavily upon donor assistance for commodities for a long time.

Over the past ten years, donor support for reproductive health supplies, including contraceptives for family planning and condoms for AIDS prevention, has declined, creating a growing gap between generally accepted estimates of need and what is being supplied.

In the early 1990s, just four international donors provided some 41 per cent of overall estimated requirements for contraceptives—pills, intra-uterine devices, injectable contraceptives and condoms. (Systems to accurately quantify the supply and demand for other reproductive health commodities are still under development.) The United States Agency for International Development (USAID), which had dominated public sector contraceptive supply since the 1960s, was the largest, accounting for almost three fourths of the $79 million in reported donor support for 1990.(51)

By 2000, the number of active donors had grown to 12 or more, but total donor support (adjusting for inflation) remained relatively flat during the decade. USAID’s share fell to 30 per cent, while share provided by UNFPA grew to 40 per cent. These agencies and four others (Population Services International, the World Bank, the German Federal Ministry for Economic Development Cooperation and the United Kingdom’s Department for International Development) accounted for 95 per cent of contraceptive commodities provided to developing countries.

In 2001, the Netherlands, the United Kingdom and Canada responded to serious supply shortages in some countries by contributing an additional $97 million to UNFPA for commodities and technical support to strengthen national capacity and improve access. The $224 million in total donor support that year represented an increase of almost 50 per cent over the previous year, but in 2002 (the latest year for which figures are available), the total dropped back to $198 million.

To meet the same 41 per cent share of contraceptive and condom supply needs that donors provided in 1990, their support would need to be around $450 million in 2004. Considerably more would be needed to meet all of the overall projected reproductive health commodity costs and to improve service delivery.

It is unlikely that developing country governments, NGOs and commercial sectors will be able to make up for the lack of growth in donor support for reproductive health commodities. As a result, we can expect commodity shortfalls and disruptions of reproductive health services with grave consequences for the health of women and children.(52)

On top of growing requirements for commodities support, developing countries need both technical support and funding to increase national health programmes’ human, financial and technical capacities to collect, analyse, report and properly use data on reproductive health supply and demand; and to secure, store, and distribute the necessary supplies.

UNFPA’S ROLE AND PRIORITIES. UNFPA leads the global effort to ensure an adequate and steady flow of reproductive health supplies including contraceptives. The Fund is the largest international provider of such supplies, and the only provider for some 25 countries. In 2001 and 2002, it received supply requests from 94 countries totalling $300 million.

UNFPA also helps countries plan for their needs, undertakes advocacy to mobilize stable financing, works with governments and other partners to strengthen national capacity, coordinates partners’ efforts, and collects data on donor efforts to facilitate cooperation and assure accountability.(53)

In 1999, in collaboration with NGO partners, UNFPA began work to develop a global strategy for securing reproductive health supplies.(54) Two important partnership mechanisms have been developed, the Supply Initiative (SI) and the Reproductive Health Supply Coalition.

With funding from the Bill & Melinda Gates Foundation and the Wallace Global Fund, the Supply Initiative has established a web-based information system to consolidate procurement data from UNFPA, USAID and the International Planned Parenthood Federation, and eventually from other donors. In the future, it will forecast each country’s supply needs.

The Reproductive Health Supply Coalition, a diverse partnership, is exploring the possibility of forming a new mechanism to help mobilize resources and promote collaboration. But so far, donors have not shown enough interest to justify such a move.

To strengthen national capacity, UNFPA recently facilitated half a dozen regional workshops where participants—UNFPA field staff and government representatives—developed model plans for the management of reproductive health supplies.

OTHER INITIATIVES. The World Health Organization and UNFPA recently issued a joint draft discussion document titled, “Essential drugs and other commodities for reproductive health services”. Intended in part to ensure a common understanding of the term “reproductive health commodities”, the document draws upon the essential medicines concept introduced by WHO in 1977 and lists commodities needed at the primary health care level (for family planning, maternal and neonatal health, and prevention of reproductive tract infections and HIV) as well as products needed for maternal care at the first referral level. It recognizes four enabling factors needed to ensure sustainable access to these crucial items of care:

  • Rational selection based on a national essential drugs list and evidence-based treatment guidelines;


  • Affordable prices for governments, health care providers and consumers;


  • Sustainable financing through equitable funding mechanisms such as government revenues or social health insurance;


  • Reliable supply systems incorporating a mix of public and private supply services.(55)


In some developing countries, management information systems are providing reliable logistics data for forecasting, procuring and distributing supplies.

THE ROAD AHEAD. Between 2000 and 2015, contraceptive users in developing countries are expected to increase by 40 per cent as the number of reproductive age couples grows by 23 per cent and demand for family planning becomes more widespread.(56) UNFPA has projected contraceptive commodity requirements in 2015 at about $1.8 billion, of which $739 million could be expected to come from donors based on 1990 support levels. These figures include condoms for HIV/AIDS and STI prevention.

Achieving this level of needed support will require: strengthened political leadership in both donor and recipient countries; better advocacy to generate longterm financial support; cost-recovery mechanisms, where appropriate; more effective coordination among the main international partners; new mechanisms in developing countries for planning and monitoring supply use; more reliable, country-generated data; and better accountability on the part of all partners.

17 CONSEQUENCES OF THE FUNDING GAP

Each $1 million shortfall in contraceptive commodity assistance will result in an estimated:

  • 360,000 unintended pregnancies;
  • 150,000 induced abortions;
  • 800 maternal deaths;
  • 11,000 infant deaths;
  • 14,000 deaths of children under five.
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