Out-of-pocket spending for contraceptives in Latin America (original) (raw)
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Revista Panamericana de Salud Pública
Objectives. To estimate inequalities in demand for family planning satisfied with modern methods among women in Latin America and the Caribbean, with an emphasis on Brazil and Mexico, and to calculate the scenario for recovery of modern contraceptive coverage by expanding access to long-acting contraceptives (LARC) after the COVID-19 pandemic. Methods. National health surveys from 2006 to 2018 were used to estimate the demand for family planning satisfied with modern methods and how it was affected by the COVID-19 pandemic. The scenario included three variables: coverage, health outcomes, and costs. Considering coverage, United Nations Population Fund data were used to estimate the impact of COVID-19 on access to contraception in Latin America and the Caribbean. Health outcomes were assessed with the Impact 2 tool. Direct investment was used to evaluate cost-effectiveness. Results. Substantial inequalities were found in the use of modern contraceptive methods before the pandemic. We...
The Lancet Global Health, 2019
Background The rise in contraceptive use has largely been driven by short-acting methods of contraception, despite the high effectiveness of long-acting reversible contraceptives. Several countries in Latin America and the Caribbean have made important progress increasing the use of modern contraceptives, but important inequalities remain. We assessed the prevalence and demand for modern contraceptive use in Latin America and the Caribbean with data from national health surveys. Methods Our data sources included demographic and health surveys, multiple indicator cluster surveys, and reproductive health surveys carried out since 2004 in 23 countries of Latin America and the Caribbean. Analyses were based on sexually active women aged 15-49 years irrespective of marital status, except in Argentina and Brazil, where analyses were restricted to women who were married or in a union. We calculated contraceptive prevalence and demand for family planning satisfied. Contraceptive prevalence was defined as the percentage of sexually active women aged 15-49 years who (or whose partners) were using a contraceptive method at the time of the survey. Demand for family planning satisfied was defined as the proportion of women in need of contraception who were using a contraceptive method at the time of the survey. We separated survey data for modern contraceptive use by type of contraception used (long-acting, short-acting, or permanent). We also stratified survey data by wealth, area of residence, education, ethnicity, age, and a combination of wealth and area of residence. Wealth-related absolute and relative inequalities were estimated both for contraceptive prevalence and demand for family planning satisfied. Findings We report on surveys from 23 countries in Latin America and the Caribbean, analysing a sample of 212 573 women. The lowest modern contraceptive prevalence was observed in Haiti (31•3%) and Bolivia (34•6%); inequalities were wide in Bolivia, but almost non-existent in Haiti. Brazil, Colombia, Costa Rica, Cuba, and Paraguay had over 70% of modern contraceptive prevalence with low absolute inequalities. Use of long-acting reversible contraceptives was below 10% in 17 of the 23 countries.
Contraception as Development? New Evidence from Family Planning in Colombia*
The Economic Journal, 2009
There has been considerable debate in the last decade about whether or not family planning programmes in developing countries reduce fertility or improve socio-economic outcomes. This article provides new evidence by studying the expansion of one of the world's oldest and largest family planning organisations -Profamilia of Colombia. It finds that family planning explains less than 10% of Colombia's fertility decline during its demographic transition. As in wealthy countries, however, lowering the costs of first birth postponement produced important socio-economic gains, enabling young women to obtain more education and to work more and live independently later in life.
BMC public health, 2018
Worldwide, the importance of contraception to control fertility has been recognized. A useful indicator of the gap between reproductive preferences and the provision of contraception is "unmet need for contraception". The aims of this paper are to estimate the levels of unmet need for contraception among married and single women, and to explore factors associated with unmet need for contraception for spacing and limiting births in Mexico. We used the Mexican National Survey of Demographic Dynamics 2014, using a sub-sample of 56,797 sexually active women aged 15-49 years who were either currently in union or who had never been in union to estimate the prevalence of unmet need for spacing and limiting births. We applied multivariable binary logistic regressions to examine the relationship between unmet need for spacing and limiting considering associated factors. Unmet need for contraception was estimated at 11.5% among women in union (6.4% limiting; 5.1% spacing), and 28.9%...
Parte II Fertility, Contraception and Reproductive Health in Latin America
2010
Several Latin American countries are close to or have reached below replacement fertility levels, if not for the countries’ average, at least for large socioeconomic or regional groups within the countries. Fertility rates have declined from over six children per woman to around two children in the last 40 years. TThe proximate determinants that allowed for this dynamic were essentially the high prevalence of contraception. Hence, we could easily conclude that people living in this continent have no problems in controlling their fertility, that is, they can keep it down and by using contraceptive methods. Nonetheless, the history and the trends on contraceptive use are not the same around the continent and a deeper look on data shows the enormous problems that still persist after all these years. The objective of this paper is to present a systematization of data on contraceptive use in the last 20 years in selected countries in Latin America and the Caribbean. The overall patterns ...
International Journal for Equity in Health, 2010
Background Colombia is a lower-middle income country that faces the challenge of addressing health inequalities. This effort includes the task of developing measures of socioeconomic position (SEP) to describe and analyse disparities in health and health related outcomes. This study explores the use of a multidimensional approach to SEP, in which socioeconomic inequalities in contraceptive use are investigated along multiple dimensions of SEP. We tested the hypothesis that provision of Public capital compensated for low levels of Human capital. Methods This study used the 2005 Colombian Demographic and Health Survey (DHS) dataset. The outcome measures were 'current non-use' and 'never use' of contraception. Inequalities in contraceptive behaviour along four measures of SEP were compared: the Household wealth index (HWI), Physical capital (housing, consumer durables), Public capital (publicly provided services) and Human capital (level of education). Principal component analysis was applied to construct the HWI, Physical capital and Public capital measures. Logistic regression models were used to estimate relative indices of inequality (RII) for each measure of SEP with both outcomes. Results Socio-economic inequalities among rural women tended to be larger than those among urban women, for all measures of SEP and for both outcomes. In models mutually adjusted for Physical, Public and Human capital and age, Physical capital identified stronger gradients in contraceptive behaviour in urban and rural areas (Current use of contraception by Physical capital in urban areas RII 2.37 95% CI (1.99-2.83) and rural areas RII 3.70 (2.57-5.33)). The impact of women's level of education on contraceptive behaviour was relatively weak in households with high Public capital compared to households with low Public capital (Current use of contraception in rural areas, interaction p = < 0.001). Reduced educational inequalities attributable to Public capital were partly explained by differences in household wealth but not at all by health insurance cover. Conclusions A multidimensional approach provides a framework for disentangling socioeconomic inequalities in contraceptive behaviour. We provide evidence that material circumstances indexed by Physical capital are important socioeconomic determinants while higher provision of Public capital may compensate for low levels of Human capital with respect to modern contraceptive behaviour.
Effect of price and access on contraceptive use
Social Science & Medicine, 1999
The Family Planning Program in Bangladesh has been very successful. The contraceptive prevalence rate (CPR) has increased from 13% in 1979 to 49% in 1996. Now that the program has matured and demand for family planning has been created, the Ministry of Health and Family Welfare (MOHFW) of the Government of Bangladesh is concerned with increasing its ®nancial sustainability. Options to increase ®nancial sustainability include cost sharing and a gradual transition from doorstep to static clinic delivery of contraceptives. Many of these alternatives would involve additional travel time or charges for consumers, and it is important to estimate the eect that these additional prices would have on the use of contraception. The eect of economic constraints, such as cash price and access to services on contraceptive method use, the choice of contraceptive method and provider choice, has been analyzed, taking into account the socioeconomic factors that in¯uence decision-making for individual family members. Two data sources have been used for this analysis: (1) a survey on use of contraception and (2) two baseline surveys of 1993 and 1994 in the two ®eld sites of the MCH-FP Extension Project (Rural) of International Center for Diarrhoeal Disease Research, Bangladesh. No eect of cash prices was found on the probability of use of any contraceptive method, but clients were to a limited extent responsive to price in making choices about contraceptive methods and providers. In addition, couples were less likely to use contraception or choose methods if the travel time to ®xed clinics was greater than 30 min.
Health Policy and Planning
Approximately 214 million women of reproductive age lack adequate access to contraception for their family planning needs, yet patterns of contraceptive availability have seldom been examined. With growing demand for contraceptives in some areas, low contraceptive method availability and stockouts are thought to be major drivers of unmet need among women of reproductive age, though evidence for this is limited. In this research, we examined trends in stockouts, method availability and consumption of specific contraceptive methods in urban areas of four sub-Saharan African countries (Burkina Faso, Democratic Republic of Congo, Kenya and Nigeria) and India. We used representative survey data from the Performance Monitoring for Action Agile Project that were collected in quarterly intervals at service delivery points (SDP) stratified by sector (public vs private), with all countries having five to six quarters of surveys between 2017 and 2019. Among SDPs that offer family planning, we ...
Access to the Emergency Contraceptive Pill Improves Women's Health: Evidence from Chile
SSRN Electronic Journal, 2020
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