Equity of access to family planning services: Does private sector expansion help or hurt?

APHA Scientific Session and Event Listing

Mai Do, DrPH and Sohail Agha, PhD. International Health and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, (504) 988 - 3655, mdo@tulane.edu

The study examines the effects of the commercial sector expansion in contraceptive service delivery on inequality in contraceptive use in several developing countries. Multiple rounds of Demographic and Health Survey (DHS) data are used to compare changes in inequality in modern contraceptive use in Ghana, Kenya, Morocco, Bangladesh, and Indonesia, where the commercial sector share of contraceptive supply has increased over time. Concentration index is used to measure inequality. The main independent variable is household wealth quintile. The commercial sector expanded substantially over time and became an important supplier of contraceptives in the studied countries. Such expansion occurred among all wealth quintiles; and in the case of Indonesia the commercial sector share in contraceptive provision increased more rapidly among lower-income women than among higher-income groups. The expansion of the commercial sector in these countries was accompanied by dramatic increases in modern contraceptive use. Such increases, however, were not uniform across wealth quintiles in all countries. Consequently, socio-economic inequality decreased in some countries but did not change in others. The study indicates that increased commercial sector share of contraceptive provision does not necessarily translate into increased socio-economic inequality in contraceptive use. In fact, in none of the countries did inequality increase significantly at the same time as the commercial sector expanded. The study also suggests that demand for contraceptives was important for the expansion of the commercial sector, implying that under certain circumstances, the commercial sector provision of modern contraceptives could be expanded without negatively affecting equality in contraceptive use.

Learning Objectives:

By the end of the presentation, participants will be able to

1) assess whether the commercial sector expansion of contraceptive service delivery results in increased socio-economic inequality in contraceptive use, and
2) discuss potential conditions, in which the commercial sector growth may occur without increasing inequality in contraceptive use.

Keywords: Contraceptives, Equal Access

Presenting author's disclosure statement:

Any relevant financial relationships? No

The Commercial Sector and Reproductive Health

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA