This week in London, leaders in family planning met at a summit convened by the British government and the Bill & Melinda Gates Foundation. On the PATH blog on Tuesday, Jane Hutchings, leader of our reproductive health program, talked about some of the contraceptive technologies we’re adapting for people who live in the developing world. Today, Jane addresses how to get contraceptives to the people who want them.
Q. We’ve talked about the need to adapt technologies, including contraceptives, so they work for the people who will use them. What else do we need to do to give people who want contraceptives access to them?
A. Let me answer this way: let’s say you live in a small village in Africa and you decide you want to use an injectable contraceptive. So you find someone to watch your children, and you take a day away from your fields or your job, and you walk several kilometers to the health center, and you wait your turn. And then the health worker tells you, “Sorry, but we’re out of that today.”
A case in point: work undertaken by the Gates Foundation revealed that many public hospitals and clinics in Nigeria were stocked out of injectable contraceptives for 60 percent of the year. This is just unacceptable, and it’s the consequence of weak and often underfunded delivery systems. We have to ask, why is it this way and what do we do to move the remedies forward?
Q. What do we do?
Well, PATH is the secretariat of the Reproductive Health Supplies Coalition, which is the largest international forum on family planning and reproductive health. Coalition members include country representatives, donors, nongovernmental organizations and technical agencies, so it’s a really great forum to take on issues like why are there still stock-outs and what’s it going to take to end them? We can shape strategies, build on work that’s already been done, and move forward.
Q. What are some of the strategies that could help make supplies available?
A. Family planning is really multisectoral compared with many other types of primary health care. Vaccines, for example, are often taken care of through the public sector—governments have immunization programs. But as we see the largest population of adolescents ever moving into their reproductive years, we know that public-sector programs can’t fully support their family planning needs.
We have to remember that women may use contraceptive methods over their reproductive lives—as long as 25 years. A healthy woman who is fertile is capable of giving birth a dozen or so times. If she and her husband want two children, let’s say, she needs to be using contraceptives for as many as 20 years. That is one reason why contraceptive choice is so important.
One of the things that PATH is doing is developing total market approaches. We’re looking at which consumer market segments the private sector is best suited to meet and which the public sector can best serve. Then we address how to coordinate across the sectors so the different players can effectively plan how to best meet the needs of the people who compose their markets. Fully taking advantage of the private sector to provide access to contraceptives will help ensure that scarce public-sector resources are most effectively used to meet the needs of people who really don’t have other options.
Q. Where did the total market approach come from?
A. People talk about how you put different products in different market sectors to reach different market segments—it’s not a novel idea. But what’s been really interesting in how PATH and the coalition have evolved the total market approach is the idea that it’s not enough to build up only private-sector providers, say, or just the nongovernmental sector. There’s got to be some coordination across these sectors, because that helps answer questions—how much are you going to need, who are you going to reach, how are you going to reach them? Not everyone has to do everything the same—you can’t do that in these kinds of markets—but some sort of broad coordination across these markets will lead to more rational planning in regard to access to contraception.
Q. Do you have any examples of the total market approach in use?
A. Yes, in Vietnam and Nicaragua. In Vietnam, our work resulted in an operational plan for a total market approach that the government is pursuing. In Nicaragua, the emphasis is more on helping to define private-sector roles, and that work is ongoing.
You know, somebody described the total market approach as really being the endgame for family planning access. Every country is going to have to diversify. There just aren’t enough resources for the public sector to do all of the work, even in Europe or the United States.
Q. When you look to the future of family planning, what are you most excited about?
A. I’m excited about everything! But if I have to pick something out, I think it’s the potential of innovation. That could be product innovation, like a pill you could take before or after sex to protect against pregnancy. If work in that area results in a product, it could be life changing for people. And it’s the same for depo-SubQ in Uniject. If down the road, it’s feasible for women to do their own contraceptive injections—I mean, think about that! It’s huge. And the total markets—if public-sector resources are better focused on meeting the needs of the most vulnerable people that also will have a huge impact.
All of these have the potential to make a big difference in peoples’ lives. And that’s what I think is really exciting.
Uniject is a trademark of BD.