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Keeping All Options Open: How the Private Sector Helped Senegal Address its Market Challenges for Family Planning and Bring Back Choice to Women

By Dr. Priya Agrawal, Executive Director, MSD for Mothers

April 28, 2016

For many women in the developing world, pregnancy is a high-risk proposition. Phrases meaning "I am pregnant" that are commonly used in Ethiopia and other countries with exceptionally high maternal mortality literally translate to "I have one foot in the grave."

One highly cost-effective way to combat this problem is family planning. That is, if you want to dramatically reduce a woman's risk of life-threatening complications during pregnancy and childbirth, you give her the ability to choose when to have her baby. It's an approach that has become a rallying cry for the global maternal health agenda.

In order to truly empower women in this way, however, we need functioning markets for family planning products and services. And as straightforward and logical as that sounds, many public health systems – and the markets that are supposed to support those systems – fall short.

In 2012, the government of Senegal launched a national family planning action plan as part of a broader commitment to reduce its maternal death rate, which was among the highest in the world. But the preferred contraceptive products weren't widely available. They were in the country, but sat inside the country's central warehouses. They weren't making it across that "last mile" and onto local health facility and pharmacy shelves.

And the supply problem had a distorting effect on demand. Health workers did not recommend the methods of contraception they did not have on hand, and women either didn't bother to ask or didn't know to ask for the contraceptives that weren't there, or simply gave up, dissatisfied with the limited choices presented to them.

Then everything changed. With support from MSD for Mothers, the Bill & Melinda Gates Foundation and implementing partner IntraHealth International, Senegal leaders embraced a distribution model based on commercial sector approaches, known as informed push. Private sector operators were tapped to handle the logistics of transport and delivery, and trained in inventory management techniques, including the use of real-time consumption data, which made them more responsive to demand trends. By aligning business incentives with public health objectives – by creating the kind of competitive market for services that drives efficiency and performance – the contraceptive stock-outs all but vanished. Choice was restored to the marketplace. The women of Senegal can now rely on stocked shelves and an array of contraceptive methods to choose from. The healthcare providers are also able to spend more time with the woman as she plans her family on her own terms. The national contraceptive prevalence rate jumped from 12% in 2012 to 20% in 2014, a 67% surge.

To be sure, we still have a long way to go before we achieve universal access in Africa. In 2015, only 33% of married or "in-union" women aged 15 to 49 living in Africa's least developed countries were using some form of contraception, barely half the average global rate of 64%. One out of five women who wished to stop or delay childbearing weren't using any method of contraception, and among those who were, only half were using a modern method. While the UN forecasts significant jumps in contraceptive prevalence between now and 2030, it also projects that the unmet need for family planning will remain high, above 20% in most regions of the continent.

We know that when the use of contraceptives goes up, the risks of life-threatening complications like hemorrhage and hypertension and other conditions that can result from having too many babies, too close together, go down. We know that higher contraceptive prevalence rates also lead to better educational and economic outcomes for women and girls. It's difficult to attend school or earn an income if you're bearing children one after the other.

With this in mind, let's keep looking for ways to leverage private sector expertise, and foster the kinds of public-private partnerships that can improve markets and better support maternal health. No woman should die while giving life. When it comes to giving mothers their best chance at survival, let's remember that markets matter.

This post is part of the #MarketsMatter expert blog series. Read the full series here.


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Priya Agrawal, BMBCh, MA, MPH, DFSRH Executive Director, MSD for Mothers

Dr. Priya Agrawal is Executive Director of MSD for Mothers — MSD's 500 million dollar, ten-year commitment to ending preventable maternal mortality. She is an Obstetrician and Gynecologist and global women's health expert.

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