Effect of an Expansion in Private Sector Provision of Contraceptive Supplies on Horizontal Inequity in Modern Contraceptive Use: Evidence from Africa and Asia

Author(s): Hotchkiss D, Godha D, Do M

Year: 2010

Abstract:

One strategic approach available to policy makers to improve the availability of contraceptive supplies as well as the sustainability of family planning programs is to expand the role of the private sector in providing access to contraceptive supplies. However, critics of this approach argue that increased reliance on the private sector will not serve the needs of the poor, and could lead to increases in socio-economic disparities in the use of modern contraceptive methods. The purpose of this study is to investigate whether the expansion of the role of private providers in the provision of modern contraceptive supplies is associated with increased horizontal inequity in modern contraceptive use.  The study is based on multiple rounds of Demographic and Health Survey data from four selected countries (Nigeria, Uganda, Bangladesh, and Indonesia) in which there was an increase in the private sector supply of contraceptives.  The methodology involves estimating concentration indices to assess the degree of inequity in contraceptive use by wealth groups across time.  In order to measure modern contraceptive prevalence rate (MCPR) inequity, the study controls for differences in the need for family planning services in relation to household wealth. Overall, the results suggest that the expansion of the private commercial sector supply of contraceptives in the four study countries did not lead to increased MCPR inequity.  In fact, in three of the four study countries (Nigeria, Uganda, and Indonesia), MCPR inequity actually decreased over time; while in the fourth study country (Bangladesh), MCPR inequity fluctuated.  Overall, the results offer support to the premise that government strategies that promote the role of the private commercial sector can help facilitate the achievement of equity objectives.