Information on monthly expenditures on contraceptive supplies and services in the public sector and estimated monthly income

Data Sources:

Information from population-based surveys or client exit interviews on contraceptive costs and monthly income; contraceptive fees may also be available from facility records.

Indicator Type:

Percent

Purpose:

This indicator provides a measure of the relative economic burden represented by monthly service and supply costs of contraceptive use. This measure applies specifically to family planning (FP), but evaluators can adapt it to other areas of reproductive health by substituting the cost of the product in question for contraceptives in this definition.

Young women with low incomes experience disproportionately high rates of unwanted pregnancy, notably because of the economic costs of contraception. In the least developed countries, 15% of women have unmet need for FP compared with 7% of women in more developed areas (Focus2030). The need to pay out-of-pocket for contraceptive services and supplies can pose a particularly significant barrier for adolescents and women who lack financial autonomy (HIPs, 2018).

This indicator helps measure the rigor of public financing mechanisms for FP, which directly impacts economic barriers to contraceptive use.

Issues:

This indicator was chosen as a key indicator among several alternatives in large part because the data required for its computation are the most widely available in a reasonably large number of developing country settings. However, evaluators should recognize that the indicator has several important limitations.

One limitation is that the indicator ignores other costs of contraceptive use that may be just as, or perhaps more, important barriers to contraceptive use than direct service or supply costs. For example, FP clients may also incur out-of-pocket expenses for transportation to and from the facility and (possibly) for childcare, as well as opportunity costs of time spent traveling to and from the service delivery point and waiting for FP services once clients reach the facility. Thus, a more accurate measure of the costs of FP services would also include these costs in the computation of the indicator.

Another issue concerns the stream of income that evaluators should consider in computing the indicator. Since not all income (gross income) is likely to be available for use in paying for contraceptive services, a more appropriate specification of the indicator will limit the denominator of the measure to monthly disposable income. Furthermore, since men and women do not have equal access to household financial resources in many societies, a further refinement may be to limit the denominator of the measure to income or wages controlled by the client (especially female clients).

This indicator refers to public sector financing, however, there could be significant variations in costs by sector depending on if the contraceptive was provided from a public versus private source and where the contraceptive was obtained (e.g., pharmacy, clinic, shop, community health worker, hospital, etc.).

For long-acting and permanent methods, it may be hard to calculate what “one month’s supply of contraceptives” would be, particularly if it is discontinued.

Evaluators should recognize, however, that these refinements add to the data requirements for computing the indicator. In many countries, the required information may be available only from special studies. For most practical purposes, the simpler indicator should suffice to guide program management decisions regarding the affordability of contraceptive services. In programs where cost recovery and sustainability are priority management issues, however, the added costs of gathering data required for the more refined measures may be justified.

References:

Focus2030. The Access to Contraception around the World: Situational Analysis and Current Challenges. March 6, 2024. https://focus2030.org/The-access-to-contraception-around-the-world-situational-analysis-and-current#:~:text=Socio%2Deconomic%20factors:%20underprivileged%20populations,income%20countries%20become%20pregnant%20accidentally.

High Impact Practices in Family Planning (HIPs). Domestic public financing: Building a sustainable future for family planning programs. Washington, DC: USAID; 2018 Apr. Available from: https://www.fphighimpactpractices.org/briefs/domestic-public-financing

Ross J.A., W.P. Mauldin, S.R. Green, and E.R Cooke. 1992. Family Planning and Child Survival Program, as Assessed in 1991. New York, NY: The Population Council