News - Study links contraceptive stockout to increased unintended pregnancies

A shortfall in contraceptives can lead to a rise in unintended pregnancies among poor, rural, and low-educated women. This situation is demonstrated by a study made by Dr Ian Salas, for which he was given the 2015 Take Stock Hero Award from the Reproductive Health Supplies Coalition.


The Coalition is a global partnership of public, private, and nongovernment organizations that helps low- and middle-income countries have access to a full range of affordable and quality reproductive health supplies.


Dr Salas’ study presents new evidence on the role of subsidized contraceptives in influencing fertility behavior, particularly among Filipino couples who rely on free contraceptives from government. It covers the period 2004, the year that USAID started phasing out its donation of free contraceptives to government, to 2010.


The Philippines, he said, is well-suited for the study due to the following features:


·         Government relied entirely on commodity donations from international aid agencies for its contraceptive supply;

·         Government provided FP services and contraceptives for free, so that changes in supply have a stark connection to contraceptive use;

·         While more than two-thirds of modern contraceptive users get their supply from public health facilities before the supply runs out, at least a quarter of them bought it from the commercial market, so that substitution possibilities between the public and the private sector exists; and

·         The availability of records on the quarterly shipment of donated contraceptives from the country’s central warehouse to different LGU health offices makes it possible to have a fine-grained measure of the public supply situation that prevailed in each province over a period of close to a decade.


The study found that government has a weakly managed supply chain and logistics system for delivering FP stocks from the central warehouse to the public health facilities in the regions, provinces, and cities.


The phaseout of free contraceptives resulted in couples undertaking “compensating behavior” with regard to their contraceptive supply: (1) they switched to the private sector for their supply; and (2) they shifted to other methods such as using traditional methods like withdrawal and periodic abstinence, undergoing sterilization, inducing abortion, or engaging in less sex.


Salas concluded that “fertility was responsive at both types of supply disruption: provinces which experienced bigger reductions in the supply of free contraceptives also had larger increases (or smaller decreases) in birth rates, while temporary supply drops (increases) were followed by rising (falling) birth rates.


Based on the study, the pregnancy risk of women who were most affected by fluctuations in the supply of free contraceptives were generally those living in rural areas, who belonged to the poorest wealth quintile, or who had less than a high school education.


The study presents important lessons for PCPD:


·      PCPD grantees implementing FP service delivery projects should have a reliable source of contraceptives, especially those who are providing them for free to their beneficiaries;

·      In case of disruptions in supply during the period of project implementation, grantees should have alternative sources of supply;

·      PCPD should have a list of reliable sources of FP commodities and should be able to link them with its grantees; and

·      PCPD should promote the use of long-acting or permanent methods of contraception as a viable alternative to barrier and hormonal contraceptives that may be more prone to supply disruption.


Dr. Salas is the Research Economist at the Gates Institute and an Assistant Scientist in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health, where the Gates Institute is based.