CONTRACEPTIVESECURITY

INDEX2006
AToolforPrioritySettingandPlanning
December 2006
This publication was produced for review by the United States Agency for
International Development. It was prepared by the DELIVER project.
CONTRACEPTIVESECURITY
INDEX2006
AToolforPrioritySettingandPlanning
The authors views expressed in this publication do not necessarily refect the views of the United States
Agency for International Development or the United States Government.
DELIVER
DELIVER, a six-year worldwide technical assistance support contract, is funded by the U.S. Agency
for International Development (USAID).
Implemented by John Snow, Inc. (JSI) (contract no. HRN-C-00-00-00010-00) and subcontractors
(Manoff Group, Program for Appropriate Technology in Health [PATH], and Crown Agents Consultancy,
Inc.), DELIVER strengthens the supply chains of health and family planning programs in developing
countries to ensure the availability of critical health products for customers. DELIVER also provides
technical management of USAIDs central contraceptive management information system.
Recommended Citation
DELIVERandTaskOrder1oftheUSAID|HealthPolicyInitiative.2006.Contraceptive Security
Index 2006: A Tool for Priority Setting and Planning.Arlington,Va.:DELIVER,fortheU.S.Agency
forInternationalDevelopment.
DELIVER
John Snow, Inc.
1616 North Fort Myer Drive, 11th Floor
Arlington, VA 22209 USA
Phone: 703-528-7474
Fax: 703-528-7480
Email: deliver_project@jsi.com
Internet: deliver.jsi.com
A
primarygoalofreproductivehealthandfamilyplanningprogramsistoensurethatpeople
canchoose,obtain,anduseawiderangeofhigh-quality,aordablecontraceptivemethods
andcondomsforSTI/HIVprevention.Referredtoascontraceptive security,thisgoalrequires
sustainablestrategiesthatwillensureandmaintainaccesstoandavailabilityofsupplies.
Asglobaldemandforfamilyplanningcontinuestorise,contraceptivesecurity(CS)willbecome
morechallengingtoachieve.Financingforreproductivehealth(RH)andfamilyplanning(FP)
programsisnotkeepingpacewithdemandanddonorresourcesaremoreconstrainedthanever.
CountriesarebeingencouragedtocontributetotheprocurementofRHandFPcommoditiesfrom
theirnationalandlocalbudgets.Despiteinvestmentsinservicedeliveryandlogisticssystems,these
systemsremaininadequateinmanycountries.Atthesametime,increaseddemandcoupledwith
theimpactoftheHIV/AIDSpandemic,healthsectorreforms,limitednationalandinternational
funding,andthebraindrainleavescountriesunabletomeetalloftheirpopulationsRHneeds.
Itremainscriticalthatstakeholdersandprogrammanagersfocusattentiononlong-termCS.Programs
cannotmeettheirclientsRHandFPneedswithoutthereliableavailabilityofhigh-qualitycontraceptive
suppliesandservices.Attainingthepovertyreductionandhealthgoalsadoptedbymanycountrieswill
beslowedunlessimprovementsaremadeinCS.Ensuringcontraceptivesupplyandserviceavailability
toclientsrequiresamulti-sectoralapproach.Tepublicandprivatesectorsmustcooperatetoensure
asupportivepolicyenvironment,appropriateforecastingandprocurementofcommodities,ecient
supplychains,well-trainedproviders,eectiveservicedeliverysystems,anacceptingsocialenvironment,
andadequatenancing.Toplaneectiveinterventionstoreachthisgoal,policymakers,programmanagers,
andinternationaldonoragenciesneedtoknowifandhowtheirprogramsareprogressingtowardCS.
TiswallchartpresentsasetofindicatorsthatcanbeusedtomeasureacountryslevelofCSandto
monitorglobalprogresstowardreachingthisgoal,overtime.Teindicatorsareaggregatedtoestablish
acompositeindex.TeContraceptive Security Index 2006wasrstcalculatedandpresentedin2003;
theContraceptive Security Index 2006presentsanupdateofthosendings.
USES
TeContraceptive Security Index 2006 isapowerfultoolforraisingawarenessaboutcontraceptivesecurity
(CS)andtheinterrelationshipsbetweenprogramcomponents,dierentsectors,andprogramoutcomes.
Atthenationalandinternationallevels,theindexcanbeusedtosetpriorities;andtoplanandadvocate
tosupportpoliciesandotherinterventionsthatpromoteprogresstowardCS.Atthecountrylevel,
itcanhelpidentifyareasofrelativestrengthandweaknesstohelpstakeholderstargettheirresources
moreeectivelyandappropriately.However,becausetheCS IndexpresentsabroadpictureofCSin
acountry,in-depthassessmentsofspeciccomponentsarerequiredtoidentifyissuesthatneedtobe
addressedinnationalCSstrategicplans.
TeCS Indexisalsoausefulguideforhelpingglobaldonorsandlendersdeterminethecountries
mostinneedofassistanceandtodeterminewhatkindofassistancetheyneed.Teindexcanhelp
countrygovernments,donors,andlendersimproveresourceallocationbygivingthemawaytotrack
wherecountriesareonacontinuumofCS.
Withrepeatedmeasurestakenovertime,theindexcanprovideameasureofprogresstowardthe
goalofCS.BydrawingattentiontotheimportanceofCS,thistoolcanhelpdonorsandgovernments
focusonmeetingthegrowingcontraceptiveneedsintothefuture.
CONTRACEPTIVESECURITYINDEX2006 1
MethodologicalConsiderations
TisindexrepresentsacountrysCSsituationatapointintime,althoughtheactualdatawascollected
overaperiodofyears.Itisunavoidablethatindicatorswillbeupdatedfordierentcountriesatdierent
intervals.Ideally,tousetheresultstomonitorprogresstowardthegoalofCSovertime,theindex
willbeupdatedperiodically(e.g.,everytwotothreeyears).
Comparisonscanbedrawnovertimebetweenthe2003and2006ndingsattheaggregatelevel
(i.e.,byregion,component,andtotalscore),aspresentedintheResultssection.However,becauseof
achangeinthedatacollectionmethodologyforsomeofthesupplychainindicators(seetheMethodology,
Denitions, Supply Chainsection),comparisonsacrosstimefrom2003to2006atthecountrylevel
andattheindividualsupplychainindicatorlevelarenotadvisableatthistime.Nonetheless,although
timetrendsneedtobeconsideredwithcautioninthisupdate,theindexsapplicabilityfortheother
purposesmentionedaboveremainsvalid.
RESULTS
Atotalof63countriesarerepresentedinthe2006index,includingthe57countriesfromthe2003
indexplussixadditionalcountriesnewtotheindex.
Table1showstherawdataforthe17indicators,groupedintothevecomponentsthatwereusedto
constructtheCS Index:supplychain,nance,healthandsocialenvironment,access,andutilization.
Tisrepresentsthemostcurrentdataavailable.However,wherenewvalueswerenotavailablein
2006,rawscoresfromthe2003indexareincludedinthisindexasthemostcurrentdataavailable.
Table2showstheweightedscoresbycomponentandtotal.Figure1showsthetotalweightedscores
forthe63countriespresentedintheindex.TerangeofpossiblescoresontheweightedCS Index
is0to100,althoughactualscoresin2006rangefrom35.5to73.2.In2003,therangewas28.1to
68.1.Usingapairedt-test,the2006totalscores,averagedacrossallcountriesincludedinboththe
2003and2006indices,representastatisticallysignicantincreasefrom2003,whichindicatesaggre-
gateimprovement.Figure2comparestotalindexscoresaveragedbyregion.Teobservedincreases
inthetotalindexscorearesignicantonlyinAsiaandthePacic,theMiddleEastandNorthAfrica,
andsub-SaharanAfrica.Teglobalaveragesforthevecomponentsshowasignicantimprovement
ineverycomponentfrom2003to2006(seegure3).Inmostcases,averagesforthecomponent
scoresbyregionalsoshowedimprovement,althoughtheseimprovementswereonlysignicantinthe
followingcases:
Supply Chain:sub-SaharanAfrica
Finance: AsiaandthePacic,EasternEuropeandCentralAsia,andMiddleEastandNorthAfrica
Health and Social Environment:LatinAmericaandtheCaribbeanandsub-SaharanAfrica
Access:EasternEuropeandCentralAsiaandsub-SaharanAfrica
Utilization:AsiaandthePacicandLatinAmericaandtheCaribbean
CONTRACEPTIVESECURITYINDEX2006 2
T
a
b
l
e

1
.

C
o
n
t
r
a
c
e
p
t
i
v
e

S
e
c
u
r
i
t
y

I
n
d
e
x

I
n
d
i
c
a
t
o
r
s
,

R
a
w

D
a
t
a

CONTRACEPTIVESECURITYINDEX2006 3
Table 2. Weighted Component Scores
4 CONTRACEPTIVESECURITYINDEX2006
Figure 1. Total Weighted Scores: 63 Countries
CONTRACEPTIVESECURITYINDEX2006 5
Figure 2. Total Scores Averaged by Region
Figure 2. Total Scores Averaged by Region
Componentscoresforanindividualcountrycanbecomparedwithinayear(maximumweighted
scoreof20foreachcomponent),enablinguserstoidentifycomponentsthatneedattentionand
furtherassessment.Countriescanscoresimilarlyoverall,buthavestrengthsorweaknessesindierent
components.Tishighlightstheneedfortheindicatorstobereviewedwithinthebroadercontext
ofacountry,includingaspectsnotcapturedintheCS Indexbecauseofdatalimitations.Finally,it
isimportanttonotethatmovementinrankupordownbyafewplacesatthecountrylevelmaynot
representsignicantdierencesorchangesinthelevelofcontraceptivesecurity.
BACKGROUND
TeContraceptive Security Index 2006 presentsanupdateofthendingsfromtheContraceptive
Security Index 2003.Tobeconsistentwiththecurrentglobaldenitionofcontraceptivesecurity,the
frameworkatthecoreoftheStrategic Pathway to Reproductive Health Commodity Security (SPARHCS)
wasusedasaconceptualguideindevelopingtheCS Index.Itdenestheprogramandprogramen-
vironmentcomponentsthatarerequiredtoachieveRHcommoditysecurity,whetherforcontracep-
tivesorforotherRHcommodities(seegure4).
TeCS Indexandothereortsthatpromoteandadvancecontraceptivesecurityhavedrawnmuch
neededattentiontotheseissues,andhaveledtoaglobalmovementaroundcontraceptivesecurity.
CONTRACEPTIVESECURITYINDEX2006 6
METHODOLOGY
TeContraceptive Security
Index 2003wasdeveloped
byateamofCSexpertsfrom
USAID,theDELIVERproject
ofJohnSnow,Inc.(JSI),the
POLICYProjectofFutures
Group,andCommercial
MarketStrategies(CMS).Us-
ingthesamemethodologyas
the2003index,theCS Index
2006 wasupdatedbyateam
fromUSAID,DELIVER,and
TaskOrder1oftheUSAID
|HealthPolicyInitiativeof
ConstellaFutures.Tesame
indicatorsanddatasources
weremaintainedforthe2006
indexusingthelatestversion
ofallreferencedocuments.
(Refertonotesbyindicator
below.)Ifnewindicatorvalueswerenotavailablesincethepublicationofthe2003index,the2003
dataarepreservedasthemostcurrentdataavailable.
Figure 4. SPARHCS Framework for Reproductive Health
Commodity Security
TeprocessofconstructingtheCS Index wasplannedtominimizedatacollectioncosts(usingonly
secondarydata),andtomaximizedatareliability,validity,andreplicability.Teselectedindicatorsarea
mixofinputsandoutputs,andprogrammaticandmacro-levelissues.Together,theypaintapicture
ofCSandpromoteacross-sectoralapproachtoaddressingCS.Althoughsomeindicatorsarehighly
correlated,eachrepresentsanimportantaspectofCS.Te17indicatorsarearrayedacrosstheve
CScomponentsdescribedbelow;thecomponentsareaggregatedtocreatetheindex.Fordetailed
informationabouthowmissingdatawerelledintocalculatetheindex,howindicatorswereweight-
ed,andothertechnicalissues,pleaserefertothe Contraceptive Security Index 2003: Technical Manual
(JSI/DELIVERandFuturesGroup/POLICYProject2004).
1
Defnitions
Component I: Supply ChainEachoftheveindicatorsoflogisticsmanagementrepresentsakey
functioninthesupplychainforcontraceptivesupplies.Aneectivesupplychainensuresthecontin-
uoussupplyofsucientquantitiesofhigh-qualitycontraceptivesneededtoachievesecurity.More
eectivemanagementofsuppliesisassociatedwithbetterprospectsforcontraceptivesecurity.
WhentheCS Index 2003 wascalculated,thelargestdatabaseavailablewiththerstfourindicatorslisted
belowwasfromtheapplicationoftheFamilyPlanningLogisticsManagement(FPLM)projectsCom-
posite Indicators for Contraceptive Logistics Management (JSI/FPLMandEVALUATIONProject1999).
2
TistoolwasupdatedandimprovedundertheDELIVERprojectandbecametheLogistics System
Assessment Tool (JSI/DELIVER2004),
3
whichisthesourceoftheupdateddatafortherstfourin-
dicatorsfortheCS Index 2006.TetwotoolsarecomparablebecausetheLSATwasdirectlyderived
CONTRACEPTIVESECURITYINDEX2006 7
fromtheComposite Indicators, howeverthemaximumpossiblescoreforeachindicatorchangedin
thenewtool.Duetothechangeinthedatacollectiontoolandmethodology,comparisonsovertime
atthecountrylevelarediscouragedatthistime.
Storage and distributionTisindicatorassessesstoragecapacityandconditions,
standardsformaintainingproductquality,inventorycontrol,stockouts,howsystem
lossesaretracked,anddistributionandtransportationsystems.
LMIS (Logistics Management Information Systems)Tisindicatorassesses
reportingsystems,validationofdata,andinformationmanagementanduseindecisionmaking.
ForecastingTisindicatorassesseshowforecastsofconsumptionareprepared,up-
dated,validated,andincorporatedintocostanalysisandbudgetaryplanning.
ProcurementTisindicatorassesseshowforecastsareusedtodetermineshort-term
procurementplansandthedegreetowhichcorrectamountsofcontraceptivesareobtained
inanappropriatetimeframe.
Tefthsupply-relatedindicatorisdrawnfromtheresultsoftheFamilyPlanningEort(FPE)survey
(Ross,Stover,andAdelaja2006).
4
Contraceptive policyUndersomecircumstances,locallymanufacturedcontraceptives
canprovideanaordableandsustainableoptionforclients.Inmanycountries,itwillbe
moreeectivetohavepoliciesandregulationsthatfacilitateopenmarketsandtheimpor-
tationofcompetitivelypriced,high-qualityproducts.Tisindicatormeasurestheextent
towhichimportlawsandlegalregulationsfacilitatetheimportationofcontraceptivesupplies
thatarenotmanufacturedlocally,ortheextenttowhichcontraceptivesaremanufactured
withinthecountry.
Component II: FinanceSustainableandadequatenancingfortheprocurementofcontraceptives,
servicedelivery,andotherprogramcomponentsfrominternationaldonorsandlenders,nationalor
localgovernments,households,andthirdpartiesiscriticalforensuringcontraceptivesecurity.Without
acommitmentofnancing,programqualityandaccesswillsuerandCSwillnotbesustainable.
Dataarenotwidelyorreadilyavailabletoobtainanadequatecountry-levelpictureofcontraceptive
nancingbydonors/lenders,thirdparties(e.g.,insurers,employers),ortheprivatesector.Treeindi-
catorsareusedtocapturetheprospectsforgovernmentandhouseholdnancingoffamilyplanning
servicesandcontraceptivesinacountry.TeWorldBanksWorld Development Indicators(WDI)
werethesourcefortheseindicators(IBRD/WorldBank2006).
Government health expenditures as a percentage of total government
spendingAnationalgovernmentscommitmenttopublichealth,specicallytorepro-
ductivehealthandfamilyplanning,iscriticalforCS.Tepoorestsegmentsofapopulation
dependonfreeorsubsidizedhealthservices,oftenprovidedbythegovernmentforessential
preventiveandcurativehealthservices.Tisindicatorisameasureofpoliticalcommitmentto
publichealthspendingasaproxyforgovernmentcommitmenttofamilyplanningprograms.
Greatercommitmenttohealthspendingmeansmorepotentialresourcesforfamilyplanning
programsaspartofoverallgovernmenthealthprograms.Tisindicatorisderivedfrom
twoindicatorsintheWDI:publicexpendituresonhealthasapercentageofgrossdomestic
product(GDP),dividedbytotalgovernmentexpendituresasapercentageofGDP:
(GovExponHealth/GDP)

(TotalGovExp/GDP)
=
(GovExponHealth/TotalGovExp)
8 CONTRACEPTIVESECURITYINDEX2006
Per capita GNIAgreaterabilitytopayforcontraceptivesatthehouseholdlevelis
associatedwithbetterprospectsforCS.Toallowforabettercomparisonacrosscountries,
thisindicatorrepresentstheaverageconsumerspotentialabilitytopayforfamilyplanning
servicesandcontraceptivesexpressedinpurchasingpowerparity(PPP),whichcorrectsfor
thedierencesinthemarketpriceofgoodsineachcountry.
Poverty levelWhilepercapitaincomemeasurestheaverageconsumersabilitytopay,
therearealwaysinequalitiesinthedistributionofincome.Highpovertyratescanthreaten
CSifprovisionsarenotmadetoensureaccesstoservicesandcommoditiesforthepoor.
Higherpovertyratescanindicateagreaterrelianceofthepopulationonthepublicsector,
addingstresstoalreadyoverburdenedsystems.Becausehigherpovertyratesareassociated
withlowerhouseholdincomesandpooreraccesstohealthcare,higherpovertyratesare
alsoassociatedwithpoorerprospectsforcontraceptivesecurity.Tisindicatorisexpressed
asthepercentageofthenationalpopulationlivingbelowthenationallydenedpovertyline.
Component III: Health and Social EnvironmentTehealthandsocialenvironmentcomponent
comprisethreeindicators;thiscomponentisincludedbecauseitiswidelyrecognizedthatotherfactors
inthebroaderhealthandsocialenvironmentcanaectprospectsforcontraceptivesecurityatboth
thecountryandindividuallevels,asdescribedbelow.
GovernanceAhealthierpoliticalenvironmentimprovesprospectsforcontraceptive
security.Anaccountable,stable,eective,andtransparentgovernmentismorelikely
tobecommittedtothehealthandwell-beingofitspopulationandtouseitsresources
appropriatelyforthepublicgood.Internationaldonorsarealsomorelikelytoprovide
nancialandmaterialsupporttosuchagovernment.Teprivatesectorismorelikelyto
investincreatingneworexpandingexistingmarketsforcontraceptives.Tisindicator
isacompositemeasureofgovernancethatincludessixdimensionsofgovernance:voice
andaccountability,politicalstability,governmenteectiveness,regulatoryquality,ruleof
law,andcontrolofcorruption.ItisderivedfromtheWorldBanksGovernance Matters
(Kaufmann,Kraay,andMastruzzi2005).
Womens educationWomenseducationalattainmentisoneofthebestpredictors
ofcontraceptiveuse.Womenwhoareeducatedbeyondprimaryschoolaremorelikelyto
useacontraceptivemethod.Inaddition,incountrieswherewomensstatusisgood,edu-
catedwomenaremorelikelytoadvocatefortheprotectionoffamilyplanningprograms.
Tisindicatorisexpressedasthepercentageoffemalesenrolledinsecondaryschool,
whichisdenedastheratioofthenumberofstudentsenrolledinsecondaryschooltothe
populationintheapplicableagegroup(grossenrollmentratio).Secondaryschoolenrollment
rateswereobtainedfromthePopulationReferenceBureausonlineDataFinderdatabase
(2005 Women of Our World andTe Worlds Youth 2006 Data Sheet).
Adult HIV prevalenceItisincreasinglyrecognizedthatahigherburdenofHIVina
populationcanerodeprospectsforcontraceptivesecurity.HIV/AIDScontributestohigher
levelsofpovertyandthepandemichasputnew,competingdemandsonhealthnancing.
Tisindicatorisexpressedasthepercentageofadultsaged1549
5
whowereinfectedwiththe
HIVvirusattheendof2003.AdultHIVprevalencerateswereobtainedfromtheUNAIDS
Report on the Global HIV/AIDS Epidemic 2005.
CONTRACEPTIVESECURITYINDEX2006 9
Component IV: AccessTethreeaccessindicatorsmeasureaspectsofavailabilityandaccesstomod-
ernmethodsofcontraceptionthedegreetowhichclientscanchoose and obtaintheirmethodof
choice.Familyplanningandreproductivehealthprogramsshouldstrivetooeravarietyofmethods
tomeettheneedsofallclients.
Access to modern family planning methodsReadyandeasyaccessbyclientsto
awiderangeofcontraceptivemethodsisassociatedwithbetterprospectsforcontraceptive
security.Whenfamilyplanningservicesarewidelyavailable,itisverydiculttoreverse
progressinaccessandavailabilityoftheseservicesandsupplies.Tisindicatorfromthe
FPEsurveymeasuresthepercentageofacountryspopulationthathasreadyandeasy
accesstomaleandfemalesterilization,pills,injectables,condoms,spermicides,andIUDs
(Ross,Stover,andAdelaja2006).
6
Public sector targetingPublicsectorfamilyplanningprogramsthatoerheavily
subsidized(andsometimesfree)servicesandcommoditiesaredesignedtomeettheneedsof
thepoorandnear-poorsegmentsofapopulation.Tispublicsectorfundingislimitedin
virtuallyeverycountry.Tedegreetowhichthepoorestpeoplebenetfromthesesubsi-
dizedservices,whilewealthierclientswhocanaordtopayforservicesandcommodities
haveanduseotheroptions,reectsuponthelong-termCSinacountry.Tisindicator
measurestheproportionofacountryscontraceptivesdistributedthroughpublicsector
channelsthatgotopoorandnearpoorfamilyplanningclients.Poor and near poorare
clientswhoareinthelowest40percentofthepopulationasdenedbyastandardofliv-
ingindex(SLI).DatafromDemographicandHealthSurveys(DHS)andReproductive
HealthSurveys(RHS)areusedbothtocomputetheSLIandthedistributionofpublic
sectorFPusersacrossSLIcategories.
7
Spread of access to modern family planning methodsAccesstoawiderange
offamilyplanningmethodsrepresentsachoiceforclients.Accesstoarangeofmethods
canalsomeanthatifonemethodbecomesunavailable,othermethodsareavailableto
clientsintheinterim.Tisconceptofchoiceiskeytocontraceptivesecurity,regardlessof
whatmethodsclientschoose(reectedinComponent V).Tisindicatorisrelatedtothe
accessindicatoraboveanditusesthesamedatafromtheFPEsurvey.Itmeasureswhether
clientshavereadyandeasyaccesstoabroadrangeofatleastthreecontraceptivemethods
byselectingthehighest-scoredmethod,minusthethird-highestscoredmethod,divided
bythesumofaccessscoresforallmethods(Ross,Stover,andAdelaja2006).
Component V: UtilizationTiscomponentcomprisesthreeindicatorsthatmeasureclientsbehavior
intermsofcontraceptiveusewithinthecountryprogramcontext.
Method mixWhiletheaccess indicators(seeComponent IV)measuretheextenttowhich
consumershavereadyandeasyaccesstomethods,thisindicatormeasuresthedegreeto
whichconsumersusearangeofmethods.Tebroadertherangeofmethodsused,the
bettertheprospectsforcontraceptivesecurity,becauseitdemonstratesthatwomenhave
achoiceandarechoosingfromarangeofmethods.Tisindicatorwasmeasuredasthe
dierenceinprevalenceratesbetweenthemostprevalentmodernmethodinacountryand
thethird-mostprevalentmethod,dividedbythetotalmodernmethodprevalence.Ahigher
valueindicatesahigherconcentrationofuseonalimitednumberofmethods,whichis
interpretedasbeingnotconducivetocontraceptivesecurity.Tisindicatorwasderived
fromthemostrecentlyavailableDHSorRHSdatasetforeachcountry.
10 CONTRACEPTIVESECURITYINDEX2006
Unmet need for family planningUnmetneedisindicativeofbarrierstoaccessing
andusingfamilyplanning.Tehigherthepercentageofwomenwithunmetneedfor
contraception,thepoorertheprospectsforcontraceptivesecuritybecauseunmetneed
representsclientswhoexpressaneedtousefamilyplanningbutcannotordonot.Tisin-
dicatormeasuresthepercentageofwomenwhoexpressadesiretospaceorlimittheirnext
pregnancy,orwhowouldhavepreferredtoavoidordelaytheircurrentpregnancy,but
arenotusingacontraceptivemethod.Tisindicatorwasderivedfromthemostrecently
availableDHSorRHSdatasetforeachcountry.
Contraceptive prevalence rate (CPR)Tisindicatoristhemostobviousoutcome
ofcontraceptivesecuritywomenactuallyusingcontraception.Highercontraceptiveuse
isindicativeofbetteraccessandavailabilityofcontraceptivesforthepopulation.Increased
contraceptiveusewillalsoencouragetheimprovedavailabilityinboththepublicandprivate
sectorsthroughpoliticalpressuresandmarketforces.Tisindicatormeasuresthepercentage
ofmarriedwomenofreproductiveagecurrentlyusingamodernmethodoffamilyplanning.
TisdataisfromthePopulationReferenceBureaus2006 World Population Data Sheet.
REFERENCES
Hare,L.,Hart,C.,Scribner,S.,Shepherd,C.,Pandit,T.(ed.),andBornbusch,A.(ed.).2004.SPAR-
HCS: Strategic Pathway to Reproductive Health Commodity Security. A Tool for Assessment, Planning,
and Implementation.Baltimore,Md.:InformationandKnowledgeforOptimalHealth(INFO)
Project/CenterforCommunicationsPrograms,JohnsHopkinsBloombergSchoolofPublicHealth.
InternationalBankforReconstructionandDevelopment(IBRD)/WorldBank.2006.World Devel-
opment Indicators 2006.(http://devdata.worldbank.org/wdi2006/contents/index2.htm)
JohnSnow,Inc./DELIVER.2004.Logistics System Assessment Tool (LSAT).Arlington,Va.:John
Snow,Inc./DELIVER,fortheU.S.AgencyforInternationalDevelopment.
JohnSnow,Inc./DELIVERandFuturesGroup/POLICYProject.2004.Contraceptive Security Index
2003: Technical Manual.Arlington,Va.:JohnSnow,Inc./DELIVER,fortheU.S.Agencyfor
InternationalDevelopment.
JohnSnow,Inc./FamilyPlanningLogisticsManagement(JSI/FPLM)andtheEVALUATION
Project.April1999.Composite Indicators for Contraceptive Logistics Management.Arlington,Va.:
JSI/FPLM,fortheU.S.AgencyforInternationalDevelopment.
Kaufmann,Daniel,AartKraay,andMassimoMastruzzi.May2005.Governance Matters IV: Gover-
nance Indicators for 19962004.(http:/www.worldbank.org/wbi/governance/govdata/)
PopulationReferenceBureau.March2005.2005 Women of Our World.Washington,D.C.:Popula-
tionReferenceBureau.(www.prb.org)
PopulationReferenceBureau.August2006.2006 World Population Data Sheet.Washington,DC:
PopulationReferenceBureau.(www.prb.org)
PopulationReferenceBureau.February2006.TeWorlds Youth 2006 Data Sheet.Washington,DC:
PopulationReferenceBureau.(www.prb.org)
Ross,John,JohnStover,andDemiAdelaja.March2006.Family Planning Programs in 2004: Eorts,
Justications, Inuences, and Special Populations of Interest.WorkingPaper.ChapelHill:MEA-
SURE/EvaluationProjectoftheCarolinaPopulationCenter.
UNAIDS.2005.Report on the Global HIV/AIDS Epidemic 2005.Geneva:UNAIDS.
CONTRACEPTIVESECURITYINDEX2006 11
ADDITIONALRESOURCES
Ashford,L.2002.Securing Future Supplies for Family Planning and HIV/AIDS Prevention.Washing-
ton,D.C.:MEASURECommunication/PopulationReferenceBureau.(http://www.prb.org/pdf/
SecFutureSupplies_Eng.pdf)
Druce,Nel.March2006.Reproductive Health Commodity Security (RHCS) Country Case Studies Synthesis:
Cambodia, Nigeria, Uganda and Zambia.London:DFIDHealthResourceCentre.
FamilyPlanningLogisticsManagement(FPLM)/JohnSnow,Inc.(JSI).2000.Programs Tat Deliver:
Logistics Contributions to Better Health in Developing Countries.Arlington,Va.:FPLM/JSI.
(http://deliver.jsi.com/2002/Pubs/Pubs_Policy/Programs_Tat_Deliver/index.cfm)
Finkle,C.2003.Ensuring Contraceptive Supply Security.Outlookvol2,no3.Seattle:PATH.(http://
www.path.org/les/eol20_3.pdf)
Finkle,CleaT.,JaneHutchings,andJanetVail.2001.Contraceptive Security: Toward a Framework
for a Global Assessment.Seattle:ProgramforAppropriateTechnologyinHealth(PATH).
Quijada,Caroline,TaniaDmytraczenko,andBeauraMensah.July2004.Ensuring Contraceptive
Security within New Development Assistance Mechanisms.Bethesda,Md.:TePartnersforHealth
ReformplusProject,AbtAssociates,Inc.
Rao,Raja,PeterMellon,andDavidSarley.2006.Procurement Strategies for Health Commodities: An
Examination of Options and Mechanisms within the Commodity Security Context.Arlington,Va.:
DELIVER,fortheU.S.AgencyforInternationalDevelopment.
Sarley,David,RajaRao,CarolynHart,LesliePatykewich,PaulDowling,WendyAbramson,Chris
Wright,NadiaOlson,andMarieTien.2006.
Contraceptive Security: Practical Experience in Improving Global, Regional, National, and Local
Product Availability.Arlington,Va.:DELIVER,fortheU.S.AgencyforInternationalDevelopment.
Sine,J.,andS.Sharma,2002.Policy Aspects of Achieving Contraceptive Security.PolicyIssuesinPlanning
andFinanceNo1.Washington,DC:POLICYProject/FuturesGroupInternational.(http://www.
policyproject.com/pubs/policyissues/PI_Eng.pdf)
Taylor,PatriciaA.,NoraQuesada,WendyAbramson,VaruniDayaratna,andLesliePatykewich.
2004.Regional Report: Contraceptive Security in Latin America and the Caribbean. Results and
Recommendations.Arlington,Va.:JohnSnow,Inc./DELIVERandWashington,DC:Futures
Group/POLICYProject,fortheU.S.AgencyforInternationalDevelopment.
UnitedNationsPopulationFund(UNFPA).2002.Reproductive Health Essentials: Securing the Supply.
NewYork:UNFPA.
(http://www.unfpa.org/upload/lib_pub_le/39_lename_securingsupply_eng.pdf)
U.S.AgencyforInternationalDevelopment(USAID).2004.Contraceptive Security: Ready Lessons.
Baltimore,Md.:INFOProject/CenterforCommunicationPrograms,JohnsHopkinsBloomberg
SchoolofPublicHealth,fortheU.S.AgencyforInternationalDevelopment.(http://www.dec.
org,searchundercontraceptivesecurity).
12 CONTRACEPTIVESECURITYINDEX2006
Additional contraceptive security resources are available at the following web sites:
DELIVERproject:(www.deliver.jsi.com)
HealthPolicyInitiative(HPI):(www.healthpolicyinitiative.com)
MaximizingAccessandQuality(MAQ)Initiative:(www.maqweb.org)
PartnersforHealthReformplusProject:(www.phrplus.org)
POLICYProject:(www.policyproject.com)
PopulationActionInternational:(www.populationaction.org)
PSP-OneProject(formerlyCommercialMarketStrategiesProject):(www.psp-one.com)
TeSupplyInitiative:www.rhsupplies.org)
UNFPA:(www.unfpa.org)
USAID:(www.usaid.gov)
TeUSAIDContraceptiveSecurityTeamworkstoadvanceandsupportplanningandimplementation
forcontraceptivesecurityincountries.TeteamprovidestechnicalassistancetoUSAIDmissions,
countrypartners,donors,andinternationalpartners.Teteamcanbecontactedc/oMarkRillingor
AlanBornbusch,CommoditiesSecurityandLogisticsDivision,OceofPopulationandReproductive
Health,BureauforGlobalHealth,mrilling@usaid.govorabornbusch@usaid.gov.
TeReproductiveHealthSuppliesCoalitionisa21-membercoalitionofdonors,multilateralorganizations,
privatefoundations,nongovernmentalorganizations,low-andmiddle-incomecountrygovernments,
andothersdedicatedtoimprovingglobalhealthandthequalityoflifebyensuringaccesstohigh-quality
reproductivehealth(RH)supplies.Tecoalitionworkstosynthesizeandshareinformation,knowledge,
andexperience;improvecoordinationandharmonizationofprograms;anddevelopnewtoolsand
approachestoaddressthechallengesofinadequateandunreliablenancingforRHsupplies,ineciencies
insupplysystems;andinequitiesinaccesstoRHsupplies.Moreinformationcanbefoundat
(www.rhsupplies.org.)
ACKNOWLEDGMENTS
DevelopmentoftheCS Index 2006 was carried out bystafromthe USAIDContraceptive SecurityTeam, the
DELIVERprojectofJohnSnow,Inc.(JSI),andthePOLICYProjectandTaskOrder1oftheUSAID|Health
PolicyInitiativeofConstellaFutures.
FundingforthedevelopmentandpublicationoftheCS Index 2006 wasprovidedbytheU.S.Agencyfor
InternationalDevelopment(USAID)undertheDELIVERproject(HRN-C-00-00-00010-00)implemented
byJohnSnow,Inc.Inaddition,thePOLICYProjectcontributedtothedevelopmentofthiswallchartunder
USAIDcontractno.HRN-C-00-00-00006-00.TisworkcontinuedunderTaskOrder1oftheUSAID
|HealthPolicyInitiativeundercontractno.GPO-I-01-05-00040-00.TaskOrder1isimplementedby
ConstellaFuturesincollaborationwiththeCenterforDevelopmentandPopulationActivities,theWhite
RibbonAlliance,andtheWorldConferenceofReligionsforPeace.
TeauthorsviewsexpressedinthispublicationdonotnecessarilyreecttheviewsoftheUnitedStates
AgencyforInternationalDevelopmentortheUnitedStatesGovernment.
CoverphotographscourtesyofDELIVER.
CONTRACEPTIVESECURITYINDEX2006 13
14 CONTRACEPTIVESECURITYINDEX2006
Formoreinformation,pleasevisit
http://www.deliver.jsi.com.
Theauthors' viewsexpressedinthispublicationdonotnecessarilyrefecttheviewsof
theUnitedStatesAgencyforInternationalDevelopmentortheUnitedStatesGovernment.
DELIVER
JohnSnow,Inc.
1616NorthFortMyerDrive,11thFloor
Arlington,VA22209USA
Phone:703-528-7474
Fax:703-528-7480
Email:deliver_project@jsi.com
Internet:deliver.jsi.com