Reproductive Health and Family Planning
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
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
- 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.
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.