On Monday, October 29th, I had the privilege of presenting at the APHA conference on a panel entitled, “Contraception: Global Issues.” My presentation, “A Decade of Measuring Contraceptive Security around the Globe: Achievements and Opportunities,” focused on the latest update of the Contraceptive Security Index in 2012, which was first collected a decade ago in 2003. The new set of data allows for an analysis of trends in CS over the past decade—a decade in which awareness of and support for contraceptive security has greatly increased. Global efforts to improve CS range from international conferences to raise awareness and to mobilize additional resources in support of CS; to assessment, monitoring, and planning tools; to investments in capacity building and system strengthening. The CS Index is one tool that was developed to monitor the impact of these efforts and to track progress in achieving this goal over time.
The CS Index is comprised of 17 indicators arrayed across five primary CS components—supply chain, financing, health and social environment, access, and utilization. It has been updated every three years over the past decade, including around 60 countries in each version (67 countries in 2012) from Asia and the Pacific, Eastern Europe and Central Asia, Latin America and the Caribbean, Middle East and North Africa, and sub-Saharan Africa.
In sum, average CS Index total scores increased significantly from 2003 to 2012. The Latin America and the Caribbean region registered the highest scores; the sub-Saharan Africa region had the lowest. However, global averages for all regions improved from 2003 to 2012, with the greatest progress made in sub-Saharan Africa. Of note, the lowest performing countries in 2003 made most progress in total average scores by 2012; most of these countries were in sub-Saharan Africa. The lowest score registered in 2012 represents a 39 percent increase over the lowest score in 2003.
Global averages for all components also improved from 2003 to 2012, with the supply chain component consistently registering the highest scores; however, the greatest progress was observed in the Finance component. Additional analysis will be conducted with these four data sets to review progress in CS over time; to raise awareness about CS; to help set priorities; and to advocate for more rational resource allocation by country governments and global donors to achieve a secure supply of quality contraceptives.
My fellow panelists also discussed issues related to contraceptive access and use in the United States and around the world. Kate Grindlay, from Ibis Reproductive Health, discussed options for removing barriers to access and use of oral contraceptives by eliminating requirements for prescriptions. A survey conducted by Ibis of 147 countries around the world showed that the majority of countries throughout the developing world generally have oral contraceptives available to women without a prescription and with no screening required. Salahuddin Ahmed, based in Bangladesh with Johns Hopkins University, presented research on the promotion of the Lactational Amenorrhea Method by community-based health workers as an effective method of contraception to expand family planning use in rural Bangladesh. And, finally, Diana Greene Foster of the University of San Francisco’s Center for Reproductive Health presented on a study to determine interest in pericoital contraceptive pills in the US. She noted that about one-half of pregnancies in the US are unintended, and the majority of the women surveyed indicated an interest in having access to an oral contraceptive that can be taken within 24 hours before or after unprotected intercourse to prevent pregnancy. The survey concluded that there was general interest in making this type of oral contraceptive more widely available to women, especially those at risk of unintended pregnancy and those with a history of poor access to contraception.
It was a great panel and generated a great discussion on the topic the important issue of global access to contraception. For more on my work with the USAID DELIVER project helping increase contraceptive security, visit our website.