Contraceptive Projections and the Donor Gap- Meeting the Challenge

Publication date: 2009

1 Contraceptive Projections and the Donor Gap: Meeting the Challenge Contraceptive Projections and the Donor Gap was written on behalf of the Reproductive Health Supplies Coalition (RHSC) by John Ross, Eva Weissman, and John Stover, was produced by the USAID | DELIVER PROJECT through a subcontract with the Futures Institute, and was funded by the United States Agency for International Development (USAID). This publication was produced for the Systems Strengthening Working Group of the Reproductive Health Supplies Coalition. February 2009 3 Contraceptive Projections and the Donor Gap: Meeting the Challenge Contraceptive Projections and the Donor Gap MEETING THE CHALLENGE Contraceptive Projections and the Donor Gap: Meeting the Challenge 4 Contraceptive Projections and the Donor Gap: Meeting the Challenge v Contents Foreword . 1 Acronyms. 3 Introduction . 5 Part I . 7 Countries . 7 Demographic Pressures: More Couples of Reproductive Age. 7 Increasing Demand for Contraceptives. 8 Contraceptive Users .10 Method Mix.12 Donor Support for Commodity Supply.13 Projections of Commodity Needs.13 HIV and AIDS Condom Projections .14 Final Commodity Projections .14 Part II .17 Donor Prospects .17 Past Funding .19 Going Forward.19 APPENDIX A .21 APPENDIX B .23 APPENDIX C .27 APPENDIX D .29 APPENDIX E .35 APPENDIX F.41 APPENDIX G .43 Figures 1. Number of All Women and Married Women (age 15–49) . 8 2. Number of Women Aged 15-49 by Region. 8 3a. Contraceptive Prevalence for Modern Methods Among Married Women Age 15–49 by Region Medium Variant Scenario . 9 3b. Contraceptive Prevalence for Modern Methods Among Married Women Aged 15-49 by Region Unmet Need Scenario. 9 4. Projected Number of Contraceptive Users, Modern Methods, All Women Medium Variant Scenario .10 5a. Projected Number of Contraceptive Users, Modern Methods, All Women, by Region-- Medium Variant Scenario.11 5b. Projected Number of Contraceptive Users, Modern Methods, All Women, By Region-- Unmet Need Scenario .11 6a. Number of Users for Modern Contraceptive Methods by Region for the Year 2008 .12 6b. Modern Contraceptive Method Mix by Region for the Year 2008 .13 7. Donor Expenditures for Population Assistances .17 8. Patterns in Contraceptive Supply, 1997–2007, in US$ Thousands.18 9. Historical Trends in Donor Financing for Commodities, 1990–2007, and Projected Need, 2008–2020.19 Tables 1. Projected Subsidized Contraceptive Supply Needs in Donor-Relevant Countries, 2005–2020 . 15 2. Estimated Contraceptive Commodity Support by Donor/Agency in US$ Thousands. 18 3. Coefficients for Estimating Each Method's Prevalence from Total Prevalence . 24 Contraceptive Projections and the Donor Gap: Meeting the Challenge vi Contraceptive Projections and the Donor Gap: Meeting the Challenge 1 Foreword In 2001, the Interim Working Group on Reproductive Health Commodity Security (RHCS), a forerunner of today’s Supplies Coalition, published what would arguably become one of the most powerful and effective tools for galvanizing international support on behalf of reproductive health commodity security. Titled Contraceptive Projections and the Donor Gap, the report envisioned an increasing shortfall in the availability of donor resources required to satisfy the growing unmet need for contraceptive supplies. It called on global donors to increase their funding by $24 million and to sustain those increases by 5.3 percent annually. It also painted an ominous picture of the potential social and health consequences of failing to do so. Today, the donor gap represents a ubiquitous element in the literature on supply security. The universality of the gap’s message, coupled with visual simplicity of its two increasingly divergent lines, has moved governments worldwide to confront what has come to be known as the “supply challenge.” In 2001, many of those governments and partners in the nongovernmental sector gathered in Istanbul to Meet the Challenge. They called for greater involvement by civil society, for more effective donor coordination, and for strengthened supply chain management systems. In the wake of the conference, a host of new initiatives were launched: the Supply Initiative, the RHInterchange, the Forum of Supply Donors, and (in 2004) the Reproductive Health Supplies Coalition. Those efforts have, in a relatively short period of time, yielded remarkable change - and they have brought to center stage an issue that formerly would have been more at home in the wings. Without a doubt, effective use of the supply gap message by advocates and others played a significant role in that shift. But it was precisely that shift, coupled with a growing awareness of the complexities of the supply challenge that led to calls for an updated global gap. In 2006, the Coalition’s Resource Mobilization and Awareness Working Group initiated that process, calling on Coalition members around the world to contribute to the effort, to update the data on which it was based, and to re- position the gap model as an effective advocacy tool in the years to come. This report is the product of that effort—an effort financed through the USAID | DELIVER PROJECT, but very much the beneficiary of technical support from the Futures Institute, United Nations Population Fund (UNFPA), Population Action International (PAI), and many other Coalition members. The findings of this report present a frank portrayal of past success. But they also do not shy away from the challenges that lie ahead. The dire predictions of 2001 did not, as we now know, come to pass. Donor funding, though highly variable, did—to a large extent—keep pace with the growing demand for contraceptives. But such success, the report points out, offers little room for complacency. Increases in the number of contraceptive users—especially younger users— coupled with the growing demand for condoms for HIV/AIDS prevention means that by the year 2020, an estimated US$424 million will be required in commodity support to satisfy all demand for contraceptives in donor-dependent countries. And even if donor funding were to remain at or near current levels, the shortfall would be almost US$200 million annually, with a cumulative shortfall of about US$1.4 billion over the 2008–2020 period. Only time will tell whether the message of a global donor gap continues to resonate as it has done thus far. Today, more than ever before, the responsibility for ensuring commodity security rests with countries themselves—a trend that may very well diminish the salience of messages, such as the gap, that focus on global trends. And, of course, donor resources, as critical as they may be, remain but one of many factors that undermine commodity security at both global and country levels. Whatever the future holds, what remains clear is that we now have, with this report, a timely and up-to-date portrayal of where we stand with respect to the need for international donor support, the notable progress achieved in a relatively short period of time, and finally the tremendous challenges that lie before us. Contraceptive Projections and the Donor Gap: Meeting the Challenge 2 It is a great honor and privilege for the Reproductive Health Supplies Coalition to take up the mantle as publisher of this seminal report. In doing so, we wish to thank its authors: John Stover and Eva Weissman of the Futures Institute, along with Paul Dowling of the USAID | DELIVER PROJECT and Carolyn Vogel of PAI who, at different stages, orchestrated the contributions of so many Coalition partners. We also wish to thank Howard Friedman and Jagdish Upadhyay of UNFPA, whose insights helped to refine many of the assumptions on which the analysis was based. John Skibiak Director, Reproductive Health Supplies Coalition Contraceptive Projections and the Donor Gap: Meeting the Challenge 3 Acronyms BMZ/KfW German Federal Ministry for Economic Cooperation and Development/- KfW Development Bank CAR Central Asian Republics CIDA Canadian International Development Agency CPR contraceptive prevalence rate CYP couple-year of protection DFID United Kingdom’s Department for International Development DHS Demographic and Health Surveys HIV/AIDS Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome ICPD International Conference on Population and Development IUD intrauterine device MDGs Millennium Development Goals MICS Multiple Indicator Cluster Survey PAI Population Action International PSI Population Services International RH reproductive health RHCS Reproductive Health Commodity Security SIDA Swedish International Development Cooperation Agency STIs sexually transmitted infections TFR total fertility rate UNAIDS Joint United Nations Programme on HIV/AIDS UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development Contraceptive Projections and the Donor Gap: Meeting the Challenge 4 Contraceptive Projections and the Donor Gap: Meeting the Challenge 5 Introduction The goal of universal access to reproductive health services was first put forth in the Programme of Action adopted at the International Conference on Population and Development (ICPD) held in Cairo in 1994. This goal was reinforced in the fall of 2007 when the General Assembly of the United Nations added universal access to reproductive health—to be achieved by 2015—to the Millennium Development Goals (MDGs). Contraceptive prevalence and unmet need for contraception were added to the MDGs indicator framework to measure progress in the coming years. Ensuring that reproductive health commodities are available to all who need them is essential to the provision of reproductive health services and thus to the achievement of the ICPD and MDGs. This report looks at just one component of reproductive health commodities: contraceptives. A follow-up to a report of the same title published in 2001, the report starts with an overview of current demand for contraceptives in 88 developing countries that depend on supplies from donors. Future needs for contraceptive commodities are projected for two scenarios: one assuming that all unmet need for family planning will be satisfied by 2015 as specified in the ICPD and the MDGs, and the other one based on the medium variant projections of the United Nations Population Division—projections that assume a more gradual contraceptive prevalence increase that is based on historical trends. The proportion of future needs that will require donor funding is estimated on the basis of historical funding trends. Those future needs are compared with current donor funding to highlight the “donor gap,” the expected shortfall in commodity funding unless resources for commodities are increased substantially. Box 1. Funding is needed for more than just commodities Achieving the goals of the ICPD and the MDGs will, of course, require more than just investing in family planning commodities. This report covers only a subset of reproductive health (RH) commodities: family planning supplies and condoms for HIV prevention. It does not cover any commodities required for maternal health services, such as prenatal care, obstetric services, postpartum care, and abortion-related services, nor does it cover supplies required for the diagnosis and treatment of sexually transmitted infections (STIs), including HIV AND AIDS. Investing in the commodities required in those areas is just as crucial as investing in contraceptives and HIV condoms. Together with family planning, maternal health services and STI/HIV diagnosis and treatment have a tremendous impact on the welfare of a society, with benefits going far beyond the medical benefits (averting death and morbidity, improving child survival). Improved RH in a country also strengthens the position of women and contributes to economic growth. In addition, commodities themselves constitute only a small portion of what is needed. To improve reproductive health and reach the goal of universal access, countries need to ensure that investments in supplies will complement large investments targeted at strengthening supply chains; service delivery systems; and information, education, and communication activities. Contraceptive Projections and the Donor Gap: Meeting the Challenge 6 Contraceptive Projections and the Donor Gap: Meeting the Challenge 7 Part I CONTRACEPTIVE PROJECTIONS AND THE DONOR GAP Future needs for contraceptive commodities are determined by three key factors: growth in the numbers of women of reproductive age as a consequence of high fertility rates in the past, increasing demand for family planning, and changes in the family planning methods used, particularly the shift from traditional to modern methods as programs mature. In the 88 countries included in this study, the number of women of childbearing age is expected to increase by 33 percent in the next 15 years, from 525 million in 2005 to 696 million in the year 2020. If current unmet need is to be met by 2015, the total number of users of modern methods would increase from 144 million to 252 million, an increase of 75 percent. Even under the more moderate medium variant scenario, the number of modern method users is projected to increase by 49 percent during that same period, from 144 million to 214 million. In both scenarios, around 80 percent of this increase would take place in Asia and sub-Saharan Africa. The private sector provides an important share of family planning services in some countries, and an increasing number of national governments are funding most or all of their own contraceptive commodity requirements. The countries included in this analysis, however, rely on international donors for the majority of their contraceptive needs. To meet current growth rates, donor funding for contraceptives will need to increase by 60 percent, from about US$230 million per year today to about US$370 million by 2020, or by more than 80 percent to more than US$420 million by 2020 to eliminate unmet need.1 Tremendous progress has been made in the last two decades. Annual donor contributions have almost tripled since 1990, rising from less than $80 million a year to more than $220 million in 2007, enabling developing countries dependent on this aid to significantly improve access to family planning services. But millions of couples still do not have access to contraceptives. Only a continued, concerted effort can ensure that we achieve the goal of enabling all families to determine the number and spacing of their children. Countries The study focuses on the 88 countries in the developing world that are mostly dependent on donor-provided contraceptive commodities (see appendix A). All of the following demographic figures concern just those 88 countries. Those countries represent every region of the world and make up 37 percent of the developing world’s population. Several countries with large populations, including China, India, and Brazil are excluded, as they do not require donor assistance. Other countries excluded from the study fall into two categories: countries that have never received donor support such as Libya, North Korea, Saudi Arabia, and the United Arab Emirates; and countries that no longer depend on donor-support (“graduated” countries) such as Thailand, Singapore, and South Korea. Included are the five Central Asian Republics (CAR), as well as four of the largest countries in the developing world (Bangladesh, Indonesia, Nigeria, and Pakistan). Demographic Pressures: More Couples of Reproductive Age According to projections by the United Nations, the number of women of reproductive age (between 15 and 49) will grow by almost 33 percent, or 171 million between 2005 and 2020, from 525 million to 696 million (figure 1). In the same period, the number of married women age 15–49 will grow proportionally, from 347 million to 463 million. 1 Unmet need is estimated based on current levels; as contraceptive use increases, total demand (including unmet need) will also likely increase. Contraceptive Projections and the Donor Gap: Meeting the Challenge 8 307 347 386 424 463466 525 583 639 696 0 100 200 300 400 500 600 700 800 2000 2005 2010 2015 2020Millions Married women aged 15-49 All women aged 15-49 The growth after 2005 in the number of women of reproductive age will vary substantially between regions (figure 2). The number of women in sub-Saharan Africa is projected to increase by 80 million, more than 50 percent, between 2005 and 2020 as large cohorts of youth enter their reproductive years. The growth rate in Asia (excluding China and India) is projected to be only half that of Africa (25 percent), but because of the large number of women living in this region, even this smaller increase will result in an additional 57 million women in the reproductive age category. The increase in the other regions will be more modest; the Middle East/North Africa region is projected to add 23 million women of reproductive age, Latin America 9.4 million, and the CAR 1.7 million. Figure 1. Number of All Women and Married Women (age 15–49) Figure 2. Number of Women Aged 15-49 by Region Increasing Demand for Contraceptives The second major contributor to the dramatic increase in commodity needs in the coming years is the increasing proportion of couples using family planning to achieve their desired family size. In the countries included in this analysis, the percentage of married women using modern contraceptives—on the basis of historical trends (medium variant scenario)—is expected to increase from 33 percent in 2005 to 47 percent by 2020 (see figure 3a, line for all regions). 135 156 179 205 236 61 70 78 85 93207 232 254 273 289 42 46 49 53 55 20 22 23 23 23 0 100 200 300 400 500 600 700 800 2000 2 005 201 0 2015 2020Millions Sub-Saharan Africa Middle East/North Africa Asia and Pacif ic Latin America Asia and Pacif ic Contraceptive Projections and the Donor Gap: Meeting the Challenge 9 Increases are projected for every region, most sharply for sub-Saharan Africa (bottom line). The pace of growth is about the same for the other regions. Figure 3a. Contraceptive Prevalence for Modern Methods Among Married Women Age 15–49 by Region Medium Variant Scenario Figure 3b shows the contraceptive prevalence if all unmet need were to be satisfied by 2015. Prevalence would increase by 44 percent to reach almost 54 percent. The greatest increase would be in sub-Saharan Africa because that region has the lowest current level of contraceptive use and the highest level of unmet need (currently 26 percent of women of reproductive age in that region express a desire to space or limit births but do not have access to contraceptives). In the CAR, 58 percent of women of reproductive age are already using contraceptives; another 11 percent have an unmet need. In the other regions, contraceptive prevalence would have to increase by around 16 to 17 percent to ensure that all women who want to use contraceptives can do so. Figure 3b. Contraceptive Prevalence for Modern Methods Among Married Women Aged 15-49 by Region Unmet Need Scenario 56.4 66.2 60.0 69.2 53.7 41.140.4 24.3 15.4 12.3 37.4 42.8 48.7 56.4 52.2 49.2 58.0 65.5 41.7 46.2 52.1 59.5 69.1 62.8 57.7 54.1 53.5 43.6 37.2 33.4 0 10 20 30 40 50 60 70 80 2000 2005 2010 2015 2020 Sub-Saharan Africa Middle East/North Africa Asia and Pacific Latin America Central Asia Rep. Total 31.3 51.1 60.1 54.6 46.7 25.4 19.8 15.4 12.3 48.7 46.0 42.5 37.4 57.7 55.0 52.2 49.2 52.549.8 46.2 41.7 64.362.5 60.5 57.7 54.1 43.7 40.6 37.2 33.4 0 10 20 30 40 50 60 70 80 2000 2005 2010 2015 2020 Sub-Sahara n Afr ica Middle East/North Afr ica Asia and Pacific Latin America Central Asia R ep. All Regions Pe rc en t Contraceptive Projections and the Donor Gap: Meeting the Challenge 10 Contraceptive Users As figure 4 shows, to achieve the MDGs and ICPD goals by 2015 and to satisfy all donor-dependent contraceptive demand through 2020, the total number of users of modern methods would rise by 75 percent between 2005 and 2020, from 144 million users to 252 million, an increase of almost 110 million couples. Even under the more modest assumptions of the medium variant scenario, the number of users is projected to rise by more than 49 percent to 214 million users. Figure 4. Projected Number of Contraceptive Users, Modern Methods, All Women Medium Variant Scenario As indicated in figures 5a and 5b, the largest current number of contraceptive users will be found in Asia (even excluding India and China). If unmet need is to be met by 2015, this region will see an additional 39 million users by 2020. The largest relative and absolute increases would come from sub-Saharan Africa, which will experience the strongest growth in the population of reproductive age and which has the highest levels of unmet need in the world. Achieving the MDGs and ICPD goals there would lead to a 3.5-fold increase in the number of family planning users, from 19 million in 2005 to 67 million in 2020. Even under the more moderate assumptions of the medium variant projections, the number of users is still expected to increase 2.5 fold to 47 million users. 120 144 167 191 214 181 240 252 0 50 100 150 200 250 300 2000 2005 2010 2015 2020 Millions Medium Variant Scenario Unmet Need Scenario Contraceptive Projections and the Donor Gap: Meeting the Challenge 11 14 19 33 63 67 16 20 25 31 33 68 80 94 113 119 15 17 20 23 24 6 7 8 9 9 0 50 100 150 200 250 300 2000 2005 2010 2015 2020Millions Sub-Saharan Africa Middle East /North Africa Asia and Pac if ic Latin Am erica Central Asia R ep. Figure 5a. Projected Number of Contraceptive Users, Modern Methods, All Women, by Region--Medium Variant Scenario Figure 5b. Projected Number of Contraceptive Users, Modern Methods, All Women, By Region--Unmet Need Scenario 14 19 26 35 4716 20 23 26 2968 80 90 99 108 15 17 20 21 23 6 7 8 8 8 0 50 100 150 200 250 2000 2005 2010 2015 2020Millions Sub-Saharan Africa Middle East/North Africa Asia and Pacific Latin America Central Asia Rep. Contraceptive Projections and the Donor Gap: Meeting the Challenge 12 Method Mix In 2008, in the countries studied, it was determined that about 159 million people use modern contraceptive methods. Of these, the most popular method is the pill, with 43 million users (27 percent of all users); the injectable is the second most popular method, almost 42 million or 26 percent of the total users. Intrauterine devices (IUDs) and female sterilization are not far behind, with 32 and 24 million users, respectively (20 percent and 15 percent). Condoms for family planning are used by 8 percent. Implants and male sterilization play smaller roles, accounting for 2 percent and 1 percent of total users, respectively. Condoms are also used to prevent HIV and other sexually transmitted infections. In the countries included in the 2008 analysis, this is added to the 1.2 billion condoms used primarily for family planning. There are large regional variations in method mix (figures 6a and 6b). Sterilization predominates in Latin America. Close to 40 percent of all users in that region rely on this method; however, the IUD is the preferred method in the CAR and the Middle East/North African region (with shares of total use of 70 percent and 46 percent, respectively). The pill accounts for about one-third of the users in Africa, the Middle East, and Asia, but it is less popular in the other regions. Injectable contraception is now the most popular method in sub-Saharan Africa and Asia (41 percent and 31 percent, respectively). The method mix in Asia (excluding China and India) is relatively well balanced, with a wide variety of methods offered and used; whereas, the distribution in Latin America and the Middle East is more skewed toward one or two methods (in Latin America, sterilization is the predominant method; in the Middle East, the IUD and pill account for almost 85 percent of all use). As contraceptive prevalence increases, the method mix tends to shift, usually toward an increased share of the long-term methods of sterilization and the IUD. In this study, patterns observed in about 200 national surveys taken since 1980 were used to project changing method mix over the years. At low levels of prevalence, traditional methods are often the most popular. The pill and injectables are usually the most often used modern methods. As prevalence increases, traditional method use decreases substantially, and long-term methods begin to dominate. Female sterilization is the most popular method in most countries with high levels of contraceptive use; in Muslim countries, the IUD dominates. Figure 6a. Number of Users for Modern Contraceptive Methods by Region for the Year 2008 Africa 0 10 20 30 40 50 60 70 80 90 100 Sub-Saharan Africa Middle East/North Asia and Pacific Latin America Central Asia Rep.Millions Implant Condom IUD Injectable Pill Male Ster. Female Ster. Contraceptive Projections and the Donor Gap: Meeting the Challenge 13 8% 5% 15% 39% 5% 15% 30% 38% 28% 16% 11% 27% 41% 8% 31% 16% 3% 26% 4% 45% 15% 16% 20% 2.2% 3.4% 2.3% 70% 15% 3% 7% 11% 10% 8% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sub-Saharan Africa Middle East/North Africa Asia and Pacific Latin America Central Asia Rep. Total Female Ster. Male Ster. Pill Injectable IUD Condom Implant Figure 6b. Modern Contraceptive Method Mix by Region for the Year 2008 Donor Support for Commodity Supply To get an estimate of what percentage of total requirements is funded by donors, funding patterns since 2000 were analyzed. Donor funds were disaggregated by region and contraceptive method. (Because there are no separate records of what donors spent in support of sterilization, the analysis focused on the five main resupply methods for which detailed records exist: pills, IUDS, injectables, implants, and condoms.) The analysis found that in the African region, more than 80 percent of contraceptive supplies are provided by donors. In the other regions, much smaller portions of contraceptives were provided by donors, with the majority of contraceptives either supplied by the private sector and financed through out-of-pocket spending by consumers or other private or public funds, or supplied by national governments through domestic budgets. In the Middle East/North Africa and Asia/Pacific regions, as well as in the Central Asian Republics, donor funding accounted for 20 to 25 percent of total commodities supplied. In Latin America and the Caribbean, the donor-provided share was about one-third. Projections of Commodity Needs Commodity needs are projected according to population data, contraceptive prevalence trends, anticipated changes in the contraceptive method mix, proportion of supplies funded by donors, and average annual supply costs per method. The projected costs of contraceptive commodities are based on costs reported by USAID and UNFPA and are assumed to remain constant in these projections (appendix C). The projections are based on the latest demographic and reproductive health data. The numbers of women of reproductive age by country are from the projections by the United Nations Population Division (2006 Series). Contraceptive prevalence is estimated by country and year for two scenarios: —the first one (assuming all unmet need will be satisfied by 2015) assumes contraceptive prevalence for each country in 2015 to be equal to the current level of prevalence, plus the current level of unmet need. Contraceptive prevalence after that is assumed to stay constant. Contraceptive Projections and the Donor Gap: Meeting the Challenge 14 For the second scenario, contraceptive prevalence was estimated on the basis of the time series of total fertility rates (TFRs) that is the medium variant of the projections prepared by the United Nations Population Division. Because unmarried women in many countries make up an appreciable percentage of total users, calculations were made for both married and unmarried women. Country- specific method mix data were used to project the shares of different methods, which change as prevalence rises as explained above. The number of users of the different methods was then calculated by simply multiplying the number of women by the projected contraceptive prevalence and the projected method shares. The number of required commodities was calculated differently for short- and long-term methods. For short-term methods, the required number of commodities is calculated by multiplying the number of users by the number of units (condoms, pill cycles, injections) required to provide a couple with contraceptive protection against pregnancy for one year, also known as one couple- year of protection (CYP). For long-term methods, which provide several years of contraceptive benefit, the required number of commodities is equal to the number of new adopters of the method, estimated as the number of users divided by the average duration of use. Costs were obtained by multiplying the numbers of commodities required by their unit costs. A more detailed description of the methodology and assumptions used can be found in appendix B. Tables in appendices D and E show the data by region, both numbers of users and commodities, for donor-provided commodities and those financed by other sources, separately and combined. HIV and AIDS Condom Projections Estimates of the need for condoms for disease prevention are from the Global Resource Needs Estimates for HIV AND AIDS prepared by the United Nations Programme on HIV/AIDS (UNAIDS).2 Condom use is estimated by country for different population groups including sex workers and clients, men who have sex with men, men and women engaging in casual sex, and married couples. For each population group, current condom use rates are based on survey data or regional averages for countries without data. Historic rates of increasing coverage are projected to continue into the future. Final Commodity Projections Table 1 shows projections of the number of contraceptives required over the period of 2005–2020 for each of the six methods provided by the public sector in the 88 countries studied.3 Data for the long-term methods (sterilization and IUDs) reflect the supplies required at the time that those methods are adopted, because most commodity costs are incurred at that time. In the unmet need scenario, the number of sterilizations for both men and women would be expected to increase by 73 percent over the next 15 years, increasing from 2.0 million new acceptors in 2005 to 3.5 million in 2020. The number of women adopting the IUD would increase by 71 percent over the same period, from 3.7 to 6.2 million. The number of pill cycles and injectables required would increase by 94 percent and 111 percent, respectively. The demand for condoms is projected to increase by 109 percent to 4.2 billion condoms in 2020 (this number includes both condoms used for family planning and those used for HIV/AIDS prevention). Over the next 15 years, donors would be expected to supply in excess of 50 billion condoms. It should be noted that the commodity needs shown in table 1 are for donor-supported contraceptives 2 Financial Resources Required to Achieve Universal Access to HIV Prevention, Treatment, Care, and Support (Geneva: UNAIDS, September 2007). 3 The estimate for the public sector percentage of sterilizations was based on data from DHS surveys. Contraceptive Projections and the Donor Gap: Meeting the Challenge 15 only in the 88 countries included in this study. The global production needs will be much greater because table 1 does not include self-supporting countries such as China and India. See Box 2 below for more information on condom estimations. Table 1. Projected Subsidized Contraceptive Supply Needs in Donor-Relevant Countries, 2005–2020 Unmet Need Scenario Medium Variant Scenario Estimated Yearly Projected Yearly Increase in Annual Cumulative Supplies Projected Yearly Increase in Annual Cumulative Supplies Need in 2005 Need in 2020 Need, 2005– 2020 Needed 2005– 2020 Need in 2020 Need, 2005–2020 Needed, 2005–2020 (piece/ procedure) (piece/ procedure) (percent) (piece/ procedure) (piece/ procedure) (percent) (piece/ procedure) (Millions) (Millions) (Millions) (Millions) (Millions) Sterilization 2.3 3.5 52% 38 3.5 52% 38 IUD 4.1 6.3 53% 69 6.3 53% 69 Pill 210 350 67% 3,880 350 67% 3,880 Injectable 63 114 82% 1,240 114 82% 1,240 Condom* 2,340 4,220 80% 45,930 4,220 80% 45,930 Implant 0.26 0.62 138% 6 0.62 138% 6 Condom requirements include both those for family planning and those for preventing HIV and other sexually transmitted diseases. Box 2. Condom requirements Condom requirements are estimated separately for those used primarily for family planning and those used primarily for prevention of HIV and other sexually transmitted infections. UNAIDS has estimated that the total number of condoms required to cover all risky sex acts would be nearly 13 billion in 2015, and that actual use could rise to as high as 10 billion condoms in 2015 if condoms were universally available and strongly promoted.4 Total need for family planning condoms in low- and middle-income countries has been estimated at almost 5 billion in 2015.5 The total for both purposes would be nearly 18 billion in 2015. In this analysis, we focus only on donor-supported condom use. Because some large countries such as Brazil, China, India, and South Africa do not depend on donors for their condom supply, the requirement for donor support is much less: about 4.4 billion in 2015, of which 2.4 billion are for HIV prevention and 2.0 billion are for family planning. 4 Financial Resources Required to Achieve Universal Access to HIV Prevention, Treatment, Care, and Support (Geneva: UNAIDS, September 2007). 5 J. (Ross, J. Stover, and D. Adelaja, Profiles for Family Planning and Reproductive Health Programs: 116 Countries, 2nd Edition. (Glastonbury, CT: Futures Group, 2005). Contraceptive Projections and the Donor Gap: Meeting the Challenge 16 Contraceptive Projections and the Donor Gap: Meeting the Challenge 17 Part II Donor Prospects Since the International Conference on Population and Development (ICPD) in 1994, donor assistance in population and reproductive health has increased fivefold, from about US$1 billion to just under US$5 billion. Resources for family planning, however, have actually declined by nearly 40 percent from $723 million in 1995 to just $444 million in 2004 (see figure 7.) Compared to HIV/AIDS and basic reproductive health, the decrease is even more dramatic. Although more than 55 percent of total resources went to family planning in 1995, the share in 2004 has shrunk to just 9 percent. HIV, which in 1994 received under 10 percent of total funds, received more than half (54 percent) in 2005. Figure 7. Donor Expenditures for Population Assistances Source: UNFPA. The situation is somewhat better for family planning commodities. The UNFPA’s annual “Donor Support Report for Contraceptives and Condoms,” published since the late 1990s, provides a detailed overview of commodity funding (table 2). After growing rapidly in the mid-1990s, annual donor contributions peaked in 1996 at $172 million, probably under the influence of the ICPD in 1994. The following years saw funds tumbling, remaining for several years in the $140 to $150 million range. Then, 2001 marked a turnaround when substantial increases in support by Canada (Canadian International Development Agency, or CIDA), the Netherlands, and the United Kingdom (Department for International Development, or DFID), which were channeled through UNFPA, brought total support in that year to $224 million. Also beginning in 2001, significant donor funds were channeled through Population Services International (PSI). Since 2003, total funds have fluctuated just above $200 million per year. $723 $566 $651 $720 $607 $518 $606 $725 $405 $444 $237 $499 $441 $370 $497 $516 $492 $791 $1,077 $1,227 $118 $242 $294 $336 $381 $577 $800 $1,328 $1,847 $2,650 $237 $204 $247 $255 $171 $169 $153 $318 $519 $586 $0 $1,000 $2,000 $3,000 $4,000 $5,000 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Basic research and analysis STI/HIV/AIDS Activities Basic RH Services Family Planning Services Contraceptive Projections and the Donor Gap: Meeting the Challenge 18 Table 2. Estimated Contraceptive Commodity Support by Donor/Agency in US$ Thousands The lion’s share of the funding over the past decade (figure 8) was provided by the United States Agency for International Development (USAID) and UNFPA, which together contributed almost 70 percent of total funding. (UNFPA funding includes procurements on behalf of the World Bank, the European Union, and CIDA.) Significant contributions came also from the German Federal Ministry for Economic Cooperation and Development/KfW Development Bank (BMZ/KfW) and the Department for International Development of the United Kingdom (DFID), with 10.0 percent and 6.4 percent of total donor support respectively. PSI, which emerged as a major player in 2001, contributed 9.9 percent of total funds, the vast majority of which are provided by other donors. Figure 8. Patterns in Contraceptive Supply, 1997–2007, in US$ Thousands 0 20,000 40,000 60,000 80,000 100,000 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 U S$ T ho us an ds UNFPA USAID PSI KFW DFID DKT IPPF 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 TOTAL % CIDA 0 2,885 0 0 0 0 0 0 0 0 2,885 0.2% DFID 7,807 13,188 7,317 6,130 16,403 22,289 6,706 4,645 12,074 22,510 119,069 6.4% DKT 3,759 5,148 4,868 7,849 9,643 0 0 4,671 0 35,938 1.9% EU 644 644 0.0% IPPF 3,517 3,016 3,825 3,667 4,226 1,839 2,606 3,981 4,631 2,869 34,177 1.8% JAPAN 36 159 1,657 149 317 473 2,791 0.1% KFW 8,627 7,976 35,482 16,387 20,115 26,912 8,688 13,142 23,628 24,582 185,539 10.0% MSI 61 3,718 3,835 1,100 511 425 1,065 10,715 0.6% PSI 200 264 456 22,359 30,943 26,512 47,831 28,816 14,237 13,427 185,045 9.9% UNFPA 52,441 35,175 42,365 95,851 42,998 58,104 67,301 82,570 74,368 63,892 615,065 33.0% USAID 63,087 45,522 58,665 67,908 49,628 69,400 71,226 65,434 82,685 91,883 665,438 35.7% WHO 367 1,078 1,445 0.1% Other 0 0 0 0 0 0 0 177 0 2,476 2,653 0.1% Grand Total 140,546 114,411 154,635 223,869 177,791 206,156 205,018 204,178 212,096 222,704 1,861,404 100.0% Other includes: Centers for Disease Control (CDC), Dutch Government, Global Fund, Hewlett Foundation, PPSAC/OCEAC, Swedish International Development Coordination Agency (SIDA). Contraceptive Projections and the Donor Gap: Meeting the Challenge 19 The allocation of donor contributions among the different contraceptives has remained relatively constant over the past decade, with 90 percent of total support going to condoms, pills, and injectables. On average, about one-third of the funds went to condoms. The pill, which in the early 1990s had been the dominant method receiving 45 percent of total funding, has since lost ground to the injectable, whose share has grown in the same period from just above 10 percent in the early 1990s to about 30 percent recently. The pill now accounts for 27 percent of the total. Appendices F1a and F1b detail donor support for the different commodities in both dollar amounts and percentage share. In order to compare donor funding with future needs, the commodity projections in appendices D4 and E4 have been converted to their cost equivalents (i.e., the cost per method, as explained in appendix C). Two projections of need are shown: one that is based on meeting unmet need by 2015, and one that is based on the UN Population Division’s medium variant projection of the total fertility rate (TFR). Donor funding is assumed to stay at current levels. Figure 9. Historical Trends in Donor Financing for Commodities, 1990–2007, and Projected Need, 2008–2020 $353 $406$408 $450 $223 $0 $50 $100 $150 $200 $250 $300 $350 $400 $450 $500 1990 1995 2000 2005 2010 2015 2020 j Projected Need - UN Pop Medium Variant Projected Need - Unmet Need met by 2015 Projected Funding - Constant Actual Funding Past Funding In the past, donor funding for commodities has fluctuated substantially from year to year. The trend shows an increase from $79 million in 1990 to nearly $223 million in 2007 (figure 9). The average rate of increase has been 6.3 percent per year in current dollars but has fluctuated between large increases in some years and decreases in others. Donor financing grew at only 4.2 percent annually from 1990 to 1999, then jumped to $224 million by 2001 before dropping back to $205 to $210 million from 2003 to 2006. Going Forward As figure 9 shows, in the year 2020, an estimated $450 million would be required in commodity support in order to satisfy all demand (prevalence plus current unmet need) for donor support M ill io ns o f D ol la rs Contraceptive Projections and the Donor Gap: Meeting the Challenge 20 contraceptives. If donor funding were to remain at or around current levels, the funding would fall short by $227 million. The cumulative shortfall over the 2008–2020 period would be around $1.9 billion. Even under the more moderate medium variant scenario, donor funding would fall $183 million below the required amount in the year 2020 (a cumulative shortfall of more than $1.4 billion). Note that figure 9 shows only the requirements for donor funding for commodities. The total requirements, including domestic and out-of-pocket funds, would be much higher. In 2015, the total requirements would be nearly $720 million in those 88 countries, as opposed to $406 million in donor financing under the UN Population Division Medium Projection. To meet estimated commodities needs, donor funding will thus have to increase by $220 million to $450 million by 2020 to meet unmet need or by $145 million to $306 million to match the medium variant of the UN Population Division projection. The annual growth rate in donor funding required to meet unmet need by 2015 is 7.0 percent, slightly higher than the historical rate of increase. If this goal is achieved, the required growth in funding after 2015 would drop to only 2 percent per year. If the world community wants to achieve the MDGs and ICPD goals by 2015, it is urgent that donors recognize the importance of sustained growth in funding for commodities. Those funding needs represent only a portion of the total financing required to achieve improved reproductive health, but they are a crucial component that cannot be overlooked. Contraceptive Projections and the Donor Gap: Meeting the Challenge 21 APPENDIX A LIST OF 88 DONOR-RELEVANT COUNTRIES Asia (15) Afghanistan Bangladesh Bhutan Cambodia Indonesia Laos Malaysia Mongolia Myanmar Nepal Pakistan Papua New Guinea Philippines Sri Lanka Vietnam Latin America (17) Bolivia Colombia Costa Rica Cuba Dominican Republic Ecuador El Salvador Guatemala Guyana Haiti Honduras Jamaica Nicaragua Panama Paraguay Middle East/North Africa (11) Algeria Egypt Iraq Jordan Lebanon Morocco Somalia Sudan Syria Tunisia Yemen Sub-Saharan Africa (39) Angola Benin Botswana Burkina Faso Burundi Cameroon Central African Republic Chad Congo Côte d'Ivoire Democratic Republic of the Congo Eritrea Ethiopia Gabon Gambia Ghana Guinea Guinea-Bissau Kenya Lesotho Liberia Madagascar Malawi Mali Mauritania Mauritius Mozambique Namibia Niger Nigeria Rwanda Senegal Sierra Leone Swaziland Tanzania Togo Uganda Zambia Zimbabwe Central Europe (1) Romania Central Asian Republics (5) Kazakhstan Kyrgyzstan Tajikistan Turkmenistan Uzbekistan Peru Trinidad and Tobago Contraceptive Projections and the Donor Gap: Meeting the Challenge 22 Contraceptive Projections and the Donor Gap: Meeting the Challenge 23 APPENDIX B This appendix explains the procedures used to generate the projections shown in the text. The sequence of steps went from the prevalence of contraceptive use, to the numbers of users, to the commodities required, and finally to the costs of the commodities, all by method. These projections were done separately for the public and private sectors, and the public sector costs were then contrasted with the projections of needed donor contributions. Data sources included: A. The large body of national surveys conducted since 1980 was used,6 together with estimates from the UNICEF MICS surveys and from other sources listed herein. For the most recent estimates for contraceptive use by method, the primary source was the UN Population Division’s “World Contraceptive Use 2007” wall chart.7 B. The UN Population Division’s 2006 series included estimates and projections8 for numbers of women age 15–49 and total fertility rates (TFRs). UN sources were also used to create a schedule of the percentage of women age 15–49 who are married or in union (numerators of married women taken from the “Wall Chart” mentioned earlier and denominators of all women taken from the UN estimates). For a few countries that were omitted from the Wall Chart, the default value of 64 percent married was used. The percentage of married was held constant during all future years. C. Commodity prices were based on the prices UNFPA and USAID are paying for large- scale purchases of pills, injectables, condoms, implants, and IUDs. The major procedural steps for the calculations follow. Step 1. For country selections, the initial selection was the list of all 152 developing countries in the UN World Population Prospects 2006 series, and many calculations were performed for all of those countries. However, a final selection narrowed the list to 88 countries that are donor relevant, as explained in the text. Step 2. Survey data for contraceptive use by method were assembled from the body of national surveys since 1980 and the latest estimates in the UN Wall Chart. Step 3. Prevalence of total use (contraceptive prevalence rate, or CPR) was projected into the future by converting the UN time series of TFRs to CPRs, using the equation, CPR = 91.7 – (11.75 x TFR). This equation is based on the empirical relation of CPRs to TFRs across all available surveys. The resulting CPR trajectory for each country was adjusted, however, to make it agree at the outset with the latest survey estimate by applying the ratio between the survey CPR and the TFR-generated CPR of the same date to each future CPR estimate. This method worked for most of the final 88 countries; for the few that lacked any survey, the TFR-generated trajectory was kept intact. Step 4. Data included CPRs for all women. Because many unmarried women in numerous countries use contraception, it was important to have CPR estimates for all women as well as for 6 Listed for developing countries since 1980 in J. Ross, J. Stover, and D. Adelaja, Profiles for Family Planning and Reproductive Health Programs: 116 Countries, 2nd ed. (Glastonbury, CT: The Futures Group, 2005). 7 UN Population Division, December 2007. 8 UN Population Division, World Population Prospects: The 2006 Revision, vol. 1 (New York: United Nations, 2007). Contraceptive Projections and the Donor Gap: Meeting the Challenge 24 married women. The series of demographic and health surveys (DHS)9 contains CPR estimates for both groups for many countries, permitting a ratio between the two CPRs that was later applied to produce the numbers of users among all women. For countries lacking CPR data for all women, researchers assumed that all contraceptive use was restricted to married or in-union women, because it turned out that this practice was essentially true for the particular countries that did not include unmarried women in their surveys. Step 5. Data also included projections by method. Those data on contraceptive method mix are available from DHS and other national surveys. We do not expect method mix to remain constant over time as CPR increases. We used data from all DHS to estimate a set of regression equations estimating the proportion of all use that is captured by each method as a function of total contraceptive prevalence. The relationship is nonlinear, so the equations use both CPR and CPR-squared as independent variables. We prepared two sets of equations—one for Muslim countries and one for all other countries—to reflect the fact that sterilization is used less often in Muslim countries than elsewhere. The coefficients of the equations for estimating method mix are shown in table 3. Table 3. Coefficients for Estimating Each Method's Prevalence from Total Prevalence Prevalence Prevalence Squared Constant Non-Muslim Pill 0.001699 –0.000031 0.202379 IUD –0.000597 0.000034 0.052770 Injection 0.000021 -0.000026 0.185536 Vaginals –0.000205 0.000001 0.016995 Condom –0.001138 0.000027 0.061812 Female Steril. 0.007907 –0.000056 0.008369 Male Steril. –0.000687 0.000011 0.021987 Traditional -0.007016 0.000041 0.450292 Muslim Pill 0.004878 –0.000076 0.219724 IUD 0.008687 –0.000055 –0.027092 Injection –0.001470 0.000014 0.092316 Vaginals –0.000960 0.000013 0.026012 Condom –0.000380 0.000004 0.068474 Female Steril. 0.000768 –0.000009 0.084576 Male Steril. 0.001006 –0.000016 0.002058 Traditional –0.012505 0.000125 0.533527 Step 6. Information covered conversion from prevalence to users. The percentage of those using each method in each year was converted to the number of users by simple multiplication, using the UN projections for numbers of all women age 15–49. The same was done to obtain married users by reference to the schedule of proportions married. 9 Taken from the “StatCompiler” of Macro International, accessed on the web, February 19, 2008. Contraceptive Projections and the Donor Gap: Meeting the Challenge 25 Step 7. Numbers of commodities required were obtained by multiplying users of each method by the following in terms of supplies needed per user per year10: Pill 15 cycles Injectable 4 injections Condoms 120 pieces Implants One set of implants accounts for 3.5 years of use (2.5 in the Middle East/North Africa region) IUD One IUD accounts for 3.5 years of use (2 years in the African region) Male and female sterilization One sterilization accounts for 9 years of protection Source: J. Stover, J. Bertrand, and J. D. Shelton, “Empirically Based Conversion Factors for Calculating Couple-Years of Protection,” Evaluation Review 24. No. 1 (February 2000): 3–46. Step 8. Condom requirements were of two types: for family planning and for HIV prevention. Estimates of the use of condoms for family planning are based on national surveys that ask men and women what methods they are using for family planning. Estimates of condom use for disease prevention are based on surveys that ask men and women about condom use at their last sexual encounter. DHS data provide this information for married couples and for those with multiple partners. Special behavioral surveillance surveys provide information on condom use among sex workers and their clients and among men who have sex with men. Step 9. An additional projection was done based on unmet need. The net change for satisfying unmet need is measured by increases in prevalence (CPR), because downward trends in unmet need itself are compromised by changes in desired family size. We, therefore, took as a reference target the prevalence level in 2015 that would result from assuming that current unmet need could be satisfied by 2015. This means simply adding current unmet need to current prevalence (“demand”). All countries had data on prevalence, but only some had information on unmet need; such countries were assigned the unweighted average for unmet need among known countries in their own region. The movement of the CPR into the future toward this target generated an alternative projection for costs. After 2015, it was assumed that countries would stay at the 2015 CPR level. The growth in commodity requirements thereafter is thus solely based on population growth. Step 10: Also included was the donor funding share. The percentage of all family planning supplies that are provided by donors was estimated on the basis of historical donor funding patterns. Step 11: In the final analysis (figure 9), total requirements as calculated on the basis of the five supply methods and 88 donor-dependent countries analyzed were increased by 7.5 percent11 to account for donor funding provided to countries outside the 88 countries, as well as for methods not included in the detailed analysis (such as female condoms and vaginal tablets). 10 Costs were obtained by multiplying the commodity projections with the unit costs. See appendix C for commodity prices used. 11 This percentage is based on an analysis of historical donor funding that showed that in the past, on average, 7.5 percent of funding went to countries such as India, Mexico, and South Africa that were not included in this analysis, because the amount of donor-donated commodities makes up a extremely small portion of overall funding for family planning in those countries. Contraceptive Projections and the Donor Gap: Meeting the Challenge 26 Contraceptive Projections and the Donor Gap: Meeting the Challenge 27 APPENDIX C Appendix C Contraceptive Commodity Costs (US$) Unit Cost Condoms $0.025 Pill $0.212 Injectable $0.866 IUD $0.368 Female Condom $0.767 Implant12 $24.088 Vaginal Tablet $0.005 Female Sterilization $9.090 Male Sterilization $4.950 Costs for implants are assumed to change from $23 for Norplant around 2000 to $20 for Jadelle in 2007 and $5 for Sino-implant in 2010. 12 Cost represents unit costs paid by USAID and UNFPA in 2006. Unit costs were weighted according to the quantities procured by the two agencies. An upward adjustment of 15 percent was applied to account for transportation and wastage costs (not included in the unit costs cited above). Contraceptive Projections and the Donor Gap: Meeting the Challenge 28 Contraceptive Projections and the Donor Gap: Meeting the Challenge 29 APPENDIX D Unmet Need Scenario , Female Sterilization Male Sterilization Pill Injectables IUD FP Condom Implants Total 2005 Asia and Pacific 9,635 976 6,531 4,933 4,024 3,259 100 29,459 Latin America 5,189 163 653 1,850 863 577 59 9,353 Middle East / North Africa 698 4 585 922 5,285 150 11 7,655 Sub-Saharan Africa 1,144 12 4,114 5,704 787 2,578 406 14,745 Central Asia Rep. 374 7 176 89 1,347 226 0 2,219 Total 17,040 1,163 12,058 13,497 12,306 6,790 577 63,432 2010 Asia and Pacific 12,064 1,122 7,693 5,551 4,704 4,122 115 35,372 Latin America 5,994 186 756 2,200 979 669 70 10,856 Middle East / North Africa 870 7 715 1,114 6,343 190 19 9,258 Sub-Saharan Africa 1,816 23 6,403 9,243 1,288 4,030 641 23,444 Central Asia Rep. 429 8 195 107 1,546 247 0 2,532 Total 21,173 1,346 15,762 18,215 14,860 9,259 846 81,462 2015 Asia and Pacific 15,024 1,404 9,088 6,324 5,460 5,122 131 42,553 Latin America 6,897 212 875 2,581 1,106 777 84 12,533 Middle East / North Africa 1,128 12 890 1,368 7,608 249 40 11,296 Sub-Saharan Africa 3,214 47 11,021 16,521 2,340 6,746 1,123 41,011 Central Asia Rep. 518 7 235 126 1,707 282 0 2,876 Total 26,782 1,683 22,109 26,921 18,220 13,176 1,377 110,269 2020 Asia and Pacific 15,906 1,499 9,602 6,482 6,174 5,360 141 45,164 Latin America 7,269 226 921 2,626 1,137 819 89 13,086 Middle East / North Africa 1,327 17 849 1,522 8,520 293 105 12,632 Sub-Saharan Africa 3,966 66 12,605 18,686 2,876 7,607 1,281 47,087 Central Asia Rep. 813 3 387 170 1,176 320 0 2,868 Total 29,281 1,809 24,363 29,485 19,883 14,400 1,616 120,837 Appendix D1 Users Relying on Donor-Financed Commodities Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 30 Female Sterilization Male Sterilization Pill Injectables IUD FP Condom Implants Total 2005 Asia and Pacific 2,002 107 16,045 21,290 8,097 2,505 2,744 52,790 Latin America 1,517 74 2,184 850 1,967 1,322 25 7,939 Middle East / North Africa 331 2 7,030 754 3,863 479 0 12,458 Sub-Saharan Africa 388 25 1,578 1,933 8 198 4 4,135 Central Asia Rep. 1 6 627 126 3,577 495 5 4,837 Total 4,239 214 27,465 24,953 17,512 4,999 2,778 82,159 2010 Asia and Pacific 2,532 119 18,900 23,959 9,464 3,169 3,135 61,277 Latin America 1,749 87 2,528 1,012 2,233 1,534 29 9,172 Middle East / North Africa 418 3 8,605 911 4,636 606 0 15,179 Sub-Saharan Africa 608 45 2,456 3,133 13 309 6 6,570 Central Asia Rep. 1 6 698 150 4,106 540 9 5,510 Total 5,307 260 33,187 29,164 20,452 6,158 3,180 97,708 2015 Asia and Pacific 3,127 154 22,327 27,294 10,984 3,938 3,566 71,390 Latin America 2,025 103 2,927 1,187 2,522 1,780 35 10,579 Middle East / North Africa 544 5 10,699 1,119 5,561 795 0 18,723 Sub-Saharan Africa 1,042 91 4,228 5,600 24 517 11 11,514 Central Asia Rep. 1 6 840 178 4,533 616 23 6,197 Total 6,740 359 41,021 35,377 23,624 7,647 3,635 118,403 2020 Asia and Pacific 3,295 169 23,590 27,973 12,422 4,121 3,854 75,423 Latin America 2,113 113 3,078 1,207 2,592 1,878 37 11,018 Middle East / North Africa 668 7 10,212 1,244 6,228 934 1 19,295 Sub-Saharan Africa 1,294 125 4,836 6,334 29 583 13 13,214 Central Asia Rep. 1 2 1,381 239 3,122 700 141 5,586 Total 7,371 416 43,097 36,998 24,393 8,217 4,046 124,536 Appendix D2 Users, Not Relying on Donor-Financed Commodities Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Female Sterilization Male Sterilization Pill Injectables IUD FP Condom Implants Total 2005 Asia and Pacific 11,637 1,084 22,576 26,223 12,121 5,765 2,844 82,249 Latin America 6,706 237 2,838 2,700 2,830 1,899 84 17,293 Middle East / North Africa 1,029 6 7,615 1,675 9,148 629 11 20,113 Sub-Saharan Africa 1,532 38 5,692 7,637 795 2,776 410 18,880 Central Asia Rep. 374 13 803 215 4,924 721 5 7,056 Total 21,278 1,377 39,523 38,450 29,818 11,789 3,356 145,591 2010 Asia and Pacific 14,595 1,241 26,593 29,510 14,168 7,292 3,249 96,649 Latin America 7,743 274 3,284 3,212 3,212 2,203 100 20,027 Middle East / North Africa 1,288 10 9,320 2,024 10,979 797 20 24,437 Sub-Saharan Africa 2,424 67 8,859 12,376 1,301 4,340 648 30,015 Central Asia Rep. 430 14 893 257 5,652 786 9 8,042 Total 26,480 1,606 48,949 47,379 35,312 15,417 4,026 179,170 2015 Asia and Pacific 18,152 1,558 31,415 33,618 16,444 9,060 3,696 113,943 Latin America 8,922 315 3,802 3,768 3,627 2,557 120 23,112 Middle East / North Africa 1,672 17 11,588 2,487 13,169 1,045 40 30,018 Sub-Saharan Africa 4,256 139 15,249 22,121 2,363 7,263 1,134 52,525 Central Asia Rep. 519 13 1,075 304 6,241 898 23 9,073 Total 33,522 2,042 63,129 62,298 41,844 20,823 5,012 228,672 2020 Asia and Pacific 19,201 1,668 33,191 34,455 18,596 9,481 3,995 120,587 Latin America 9,382 339 3,999 3,833 3,729 2,697 126 24,104 Middle East / North Africa 1,995 24 11,062 2,766 14,748 1,227 106 31,927 Sub-Saharan Africa 5,260 191 17,441 25,020 2,905 8,191 1,294 60,301 Central Asia Rep. 814 5 1,767 409 4,298 1,020 141 8,454 Total 36,651 2,226 67,460 66,483 44,276 22,616 5,661 245,373 Appendix D3 Users, Total Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 31 Female Sterilization Male Sterilization Pill Injectables IUD Total Condom Implants 2005 Asia and Pacific 1,073 109 98,156 19,761 1,151 730,446 29 Latin America 583 18 9,918 7,506 249 390,317 17 Middle East / North Africa 73 0 8,845 3,678 1,494 62,609 5 Sub-Saharan Africa 129 1 63,344 23,369 414 1,348,659 164 Central Asia Rep. 42 1 2,687 361 391 85,890 0 Total 1,900 130 182,951 54,677 3,700 2,617,920 215 2010 Asia and Pacific 1,344 125 115,472 22,174 1,347 929,912 33 Latin America 671 21 11,414 8,851 284 448,245 20 Middle East / North Africa 91 1 10,815 4,443 1,795 90,647 8 Sub-Saharan Africa 206 3 98,681 37,855 683 1,918,320 259 Central Asia Rep. 48 1 2,940 431 446 106,599 0 Total 2,360 150 239,323 73,754 4,556 3,493,723 320 2015 Asia and Pacific 1,674 158 135,708 25,085 1,577 1,183,316 37 Latin America 767 25 13,022 10,161 324 520,491 24 Middle East / North Africa 119 2 13,400 5,454 2,161 138,750 17 Sub-Saharan Africa 376 6 169,558 67,362 1,312 2,912,238 452 Central Asia Rep. 57 1 3,397 513 489 141,375 0 Total 2,993 191 335,085 108,575 5,864 4,896,169 531 2020 Asia and Pacific 1,771 169 142,441 25,752 1,787 1,241,925 41 Latin America 809 27 13,709 10,363 334 547,584 26 Middle East / North Africa 140 2 12,616 6,095 2,431 165,964 51 Sub-Saharan Africa 466 8 193,672 76,062 1,625 3,324,234 515 Central Asia Rep. 89 0 5,342 714 336 154,099 0 Total 3,275 206 367,779 118,985 6,512 5,433,805 632 Appendix D4 Commodities, Provided by Donors Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 32 Female Sterilization Male Sterilization Pill Injectables IUD Total Condom Implants 2005 Asia and Pacific 223 12 241,156 85,286 2,316 81,161 785 Latin America 170 8 33,159 3,451 568 97,448 7 Middle East / North Africa 37 0 106,380 3,007 1,092 36,609 0 Sub-Saharan Africa 44 3 24,303 7,921 4 117,868 2 Central Asia Rep. 0 1 9,598 509 1,037 19,271 2 Total 475 24 414,596 100,174 5,019 352,356 796 2010 Asia and Pacific 284 13 283,701 95,697 2,710 103,324 896 Latin America 196 10 38,160 4,070 647 111,910 9 Middle East / North Africa 47 0 130,074 3,633 1,312 53,004 0 Sub-Saharan Africa 70 5 37,861 12,832 7 167,654 3 Central Asia Rep. 0 1 10,502 607 1,185 23,918 3 Total 596 29 500,297 116,837 5,861 459,810 910 2015 Asia and Pacific 353 17 333,417 108,261 3,173 131,480 1,017 Latin America 225 12 43,534 4,672 740 129,948 10 Middle East / North Africa 60 1 161,158 4,459 1,579 81,131 0 Sub-Saharan Africa 123 11 65,054 22,833 13 254,519 5 Central Asia Rep. 0 1 12,132 721 1,299 31,720 8 Total 762 41 615,295 140,947 6,805 628,797 1,040 2020 Asia and Pacific 371 19 349,958 111,139 3,595 137,992 1,110 Latin America 235 13 45,833 4,764 761 136,712 11 Middle East / North Africa 74 1 151,736 4,984 1,777 97,043 1 Sub-Saharan Africa 153 15 74,305 25,782 16 290,526 5 Central Asia Rep. 0 0 19,078 1,005 891 34,575 47 Total 833 48 640,910 147,674 7,040 696,848 1,174 Appendix D5 Commodities, Provided by Other Sources Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 33 Female Sterilization Male Sterilization Pill Injectables IUD Total Condom Implants 2005 Asia and Pacific 1,296 121 339,311 105,047 3,468 811,606 814 Latin America 754 27 43,078 10,958 818 487,765 25 Middle East / North Africa 110 1 115,225 6,685 2,587 99,217 5 Sub-Saharan Africa 173 4 87,647 31,291 418 1,466,526 166 Central Asia Rep. 42 1 12,285 870 1,428 105,161 1.5 Total 2,375 153 597,546 154,851 8,719 2,970,277 1,011 2010 Asia and Pacific 1,628 138 399,173 117,870 4,058 1,033,236 928 Latin America 867 31 49,574 12,921 931 560,155 29 Middle East / North Africa 138 1 140,889 8,075 3,107 143,651 8 Sub-Saharan Africa 276 8 136,542 50,687 690 2,085,974 262 Central Asia Rep. 48 2 13,442 1,038 1,631 130,517 2.7 Total 2,956 179 739,621 190,591 10,417 3,953,533 1,230 2015 Asia and Pacific 2,028 175 469,125 133,345 4,750 1,314,795 1,055 Latin America 992 37 56,556 14,833 1,064 650,438 35 Middle East / North Africa 179 2 174,558 9,914 3,740 219,881 18 Sub-Saharan Africa 499 16 234,612 90,195 1,325 3,166,757 456 Central Asia Rep. 57 2 15,529 1,234 1,789 173,096 7.6 Total 3,755 232 950,379 249,522 12,668 5,524,967 1,571 2020 Asia and Pacific 2,142 188 492,399 136,891 5,381 1,379,917 1,151 Latin America 1,044 40 59,542 15,127 1,095 684,296 36 Middle East / North Africa 214 3 164,352 11,079 4,207 263,007 51 Sub-Saharan Africa 619 23 267,976 101,844 1,641 3,614,759 520 Central Asia Rep. 89 1 24,420 1,719 1,227 188,674 47 Total 4,108 254 1,008,689 266,659 13,552 6,130,653 1,806 Appendix D6 Commodities, Total Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 34 Contraceptive Projections and the Donor Gap: Meeting the Challenge 35 APPENDIX E Medium Variant Scenario Female Sterilization Male Sterilization Pill Injectables IUD FP Condom Implants Total 2005 Asia and Pacific 9,635 976 6,531 4,933 4,024 3,260 100 29,460 Latin America 5,189 163 653 1,850 863 577 59 9,354 Middle East / North Africa 647 4 580 916 5,206 149 11 7,514 Sub-Saharan Africa 1,144 12 4,114 5,704 787 2,578 406 14,745 Central Asia Rep. 374 7 176 89 1,347 226 0 2,219 Total 16,989 1,163 12,054 13,492 12,227 6,791 577 63,292 2010 Asia and Pacific 12,026 1,120 7,686 5,542 4,691 4,118 115 35,298 Latin America 5,968 186 754 2,190 977 667 70 10,812 Middle East / North Africa 810 7 710 1,106 6,249 189 19 9,091 Sub-Saharan Africa 1,815 23 6,401 9,243 1,288 4,029 641 23,439 Central Asia Rep. 424 8 193 107 1,538 243 0 2,511 Total 21,042 1,343 15,744 18,188 14,743 9,247 846 81,151 2015 Asia and Pacific 14,910 1,396 9,067 6,297 5,423 5,108 130 42,333 Latin America 6,820 211 869 2,549 1,099 771 84 12,402 Middle East / North Africa 1,054 12 883 1,359 7,494 248 39 11,091 Sub-Saharan Africa 3,210 47 11,015 16,520 2,339 6,742 1,123 40,995 Central Asia Rep. 503 7 227 126 1,686 271 0 2,820 Total 26,497 1,674 22,062 26,851 18,041 13,140 1,376 109,641 2020 Asia and Pacific 15,790 1,491 9,583 6,460 6,138 5,346 141 44,949 Latin America 7,197 224 915 2,601 1,130 814 89 12,970 Middle East / North Africa 1,252 17 843 1,514 8,405 292 104 12,427 Sub-Saharan Africa 3,961 66 12,599 18,685 2,876 7,603 1,281 47,071 Central Asia Rep. 798 3 379 170 1,157 310 0 2,816 Total 28,999 1,801 24,318 29,429 19,706 14,365 1,615 120,232 Appendix E1 Users Relying on Donor-Financed Commodities Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 36 Female Sterilization Male Sterilization Pill Injectables IUD FP Condom Implants Total 2005 Asia and Pacific 2,002 107 16,045 21,290 8,097 2,505 2,744 52,789 Latin America 1,517 74 2,184 850 1,967 1,322 25 7,939 Middle East / North Africa 329 2 6,980 749 3,805 471 0 12,337 Sub-Saharan Africa 388 25 1,578 1,933 8 198 4 4,135 Central Asia Rep. 1 6 627 126 3,577 495 5 4,836 Total 4,237 214 27,415 24,948 17,454 4,990 2,778 82,036 2010 Asia and Pacific 2,528 118 18,883 23,918 9,439 3,164 3,131 61,181 Latin America 1,740 87 2,521 1,007 2,228 1,529 29 9,142 Middle East / North Africa 416 3 8,544 905 4,567 597 0 15,032 Sub-Saharan Africa 607 45 2,456 3,133 13 309 6 6,569 Central Asia Rep. 1 6 688 150 4,083 531 9 5,468 Total 5,292 259 33,092 29,112 20,330 6,130 3,176 97,392 2015 Asia and Pacific 3,116 152 22,277 27,177 10,911 3,925 3,555 71,114 Latin America 1,999 103 2,905 1,172 2,506 1,765 35 10,485 Middle East / North Africa 540 5 10,624 1,111 5,478 783 0 18,541 Sub-Saharan Africa 1,041 91 4,226 5,600 24 517 11 11,510 Central Asia Rep. 1 6 811 177 4,477 592 23 6,087 Total 6,697 357 40,843 35,236 23,395 7,582 3,625 117,736 2020 Asia and Pacific 3,284 167 23,544 27,878 12,349 4,108 3,845 75,175 Latin America 2,088 113 3,058 1,196 2,578 1,865 37 10,934 Middle East / North Africa 664 7 10,137 1,238 6,143 922 1 19,112 Sub-Saharan Africa 1,293 125 4,834 6,334 29 583 13 13,211 Central Asia Rep. 1 2 1,353 239 3,071 677 141 5,483 Total 7,330 414 42,925 36,884 24,170 8,154 4,037 123,915 Appendix E2 Users, Not Relying on Donor-Financed Commodities Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 37 Female Sterilization Male Sterilization Pill Injectables IUD FP Condom Implants Total 2005 Asia and Pacific 11,637 1,084 22,576 26,223 12,121 5,765 2,844 82,249 Latin America 6,706 237 2,838 2,700 2,830 1,899 84 17,293 Middle East / North Africa 976 6 7,561 1,665 9,011 621 11 19,851 Sub-Saharan Africa 1,532 38 5,692 7,637 795 2,776 410 18,880 Central Asia Rep. 374 13 803 215 4,924 721 5 7,056 Total 21,226 1,377 39,469 38,440 29,681 11,781 3,356 145,328 2010 Asia and Pacific 14,554 1,238 26,569 29,460 14,130 7,282 3,246 96,479 Latin America 7,708 273 3,275 3,197 3,205 2,197 100 19,954 Middle East / North Africa 1,225 10 9,255 2,011 10,816 787 19 24,123 Sub-Saharan Africa 2,422 67 8,857 12,375 1,301 4,338 648 30,008 Central Asia Rep. 425 14 880 257 5,621 773 9 7,979 Total 26,334 1,602 48,836 47,300 35,073 15,377 4,022 178,543 2015 Asia and Pacific 18,026 1,549 31,345 33,474 16,334 9,033 3,685 113,446 Latin America 8,818 314 3,773 3,722 3,605 2,536 119 22,887 Middle East / North Africa 1,595 17 11,507 2,470 12,971 1,032 40 29,632 Sub-Saharan Africa 4,251 139 15,241 22,119 2,363 7,259 1,134 52,505 Central Asia Rep. 504 13 1,039 303 6,163 862 23 8,907 Total 33,194 2,031 62,905 62,087 41,437 20,722 5,001 227,377 2020 Asia and Pacific 19,075 1,659 33,126 34,338 18,486 9,454 3,986 120,123 Latin America 9,284 337 3,972 3,797 3,708 2,679 125 23,903 Middle East / North Africa 1,916 24 10,979 2,752 14,549 1,214 105 31,539 Sub-Saharan Africa 5,254 191 17,433 25,019 2,905 8,186 1,294 60,282 Central Asia Rep. 799 5 1,732 408 4,228 986 141 8,299 Total 36,329 2,215 67,243 66,314 43,876 22,519 5,652 244,147 Appendix E3 Users, Total Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 38 Female Sterilization Male Sterilization Pill Injectables IUD Total Condom Implants 2005 Asia and Pacific 1,073 109 98,156 19,761 1,151 730,446 29 Latin America 583 18 9,918 7,506 249 390,297 17 Middle East / North Africa 73 0 8,845 3,678 1,494 62,608 5 Sub-Saharan Africa 129 1 63,344 23,369 414 1,348,658 164 Central Asia Rep. 42 1 2,687 361 391 85,890 0 Total 1,900 130 182,951 54,677 3,700 2,617,898 215 2010 Asia and Pacific 1,268 117 112,038 21,480 1,303 888,329 32 Latin America 653 20 11,080 8,561 272 440,486 20 Middle East / North Africa 85 1 10,169 4,265 1,735 87,237 7 Sub-Saharan Africa 177 2 84,437 31,823 574 1,849,034 219 Central Asia Rep. 46 1 2,826 416 427 102,739 0 Total 2,229 142 220,550 66,545 4,312 3,367,824 278 2015 Asia and Pacific 1,419 131 124,003 23,229 1,421 1,036,071 35 Latin America 712 22 12,039 9,508 286 493,609 22 Middle East / North Africa 98 1 11,222 4,852 1,963 126,303 13 Sub-Saharan Africa 251 3 112,317 42,984 810 2,644,798 292 Central Asia Rep. 51 1 3,132 470 440 130,977 0 Total 2,531 158 262,713 81,043 4,919 4,431,758 361 2020 Asia and Pacific 1,543 142 133,731 24,668 1,621 1,114,836 38 Latin America 763 24 12,858 10,303 298 522,391 23 Middle East / North Africa 121 2 11,080 5,631 2,272 154,435 36 Sub-Saharan Africa 356 6 146,611 56,397 1,142 3,121,280 383 Central Asia Rep. 85 0 5,407 666 306 143,988 0 Total 2,868 174 309,687 97,666 5,639 5,056,929 480 Appendix E4 Commodities, Provided by Donors Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 39 Female Sterilization Male Sterilization Pill Injectables IUD Total Condom Implants 2005 Asia and Pacific 223 12 241,156 85,286 2,316 81,161 785 Latin America 170 8 33,159 3,451 568 97,468 7 Middle East / North Africa 37 0 106,380 3,007 1,092 36,610 0 Sub-Saharan Africa 44 3 24,303 7,921 4 117,868 2 Central Asia Rep. 0 1 9,598 509 1,037 19,272 2 Total 475 24 414,596 100,174 5,019 352,379 796 2010 Asia and Pacific 268 12 275,263 92,702 2,622 98,703 877 Latin America 188 10 37,042 3,936 620 110,002 8 Middle East / North Africa 45 0 122,301 3,487 1,268 51,012 0 Sub-Saharan Africa 61 4 32,396 10,787 6 161,600 2 Central Asia Rep. 0 1 10,095 586 1,133 23,052 3 Total 562 27 477,096 111,497 5,649 444,369 890 2015 Asia and Pacific 300 14 304,658 100,250 2,858 115,119 949 Latin America 203 11 40,248 4,372 652 123,269 9 Middle East / North Africa 54 0 134,972 3,967 1,435 73,855 0 Sub-Saharan Africa 87 7 43,092 14,570 8 231,147 3 Central Asia Rep. 0 1 11,188 661 1,167 29,389 6 Total 643 33 534,158 123,821 6,121 572,778 967 2020 Asia and Pacific 325 16 328,559 106,463 3,260 123,871 1,025 Latin America 216 12 42,987 4,737 679 130,456 10 Middle East / North Africa 69 1 133,257 4,604 1,661 90,305 0 Sub-Saharan Africa 124 11 56,250 19,117 12 272,790 4 Central Asia Rep. 0 0 19,312 937 813 32,308 39 Total 733 40 580,365 135,858 6,424 649,730 1,078 Appendix E5 Commodities, Provided by Other Sources Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 40 Female Sterilization Male Sterilization Pill Injectables IUD Total Condom Implants 2005 Asia and Pacific 1,296 121 339,311 105,047 3,468 811,606 814 Latin America 754 27 43,078 10,958 818 487,765 25 Middle East / North Africa 110 1 115,225 6,685 2,587 99,217 5 Sub-Saharan Africa 173 4 87,647 31,291 418 1,466,526 166 Central Asia Rep. 42 1 12,285 870 1,428 105,161 1.5 Total 2,375 153 597,546 154,851 8,719 2,970,277 1,011 2010 Asia and Pacific 1,536 130 387,301 114,181 3,925 987,032 909 Latin America 841 30 48,121 12,497 892 550,488 28 Middle East / North Africa 130 1 132,470 7,752 3,003 138,249 7 Sub-Saharan Africa 238 6 116,833 42,610 580 2,010,634 221 Central Asia Rep. 46 2 12,921 1,002 1,560 125,791 2.6 Total 2,791 169 697,646 178,042 9,961 3,812,194 1,168 2015 Asia and Pacific 1,719 145 428,661 123,479 4,279 1,151,190 983 Latin America 914 33 52,287 13,880 938 616,877 31 Middle East / North Africa 152 2 146,195 8,819 3,398 200,158 13 Sub-Saharan Africa 337 10 155,409 57,555 818 2,875,945 295 Central Asia Rep. 51 1 14,320 1,132 1,607 160,366 6.2 Total 3,174 191 796,870 204,864 11,040 5,004,536 1,328 2020 Asia and Pacific 1,868 158 462,290 131,132 4,881 1,238,706 1,062 Latin America 979 36 55,845 15,040 977 652,847 33 Middle East / North Africa 190 2 144,337 10,235 3,933 244,741 37 Sub-Saharan Africa 480 17 202,861 75,514 1,154 3,394,070 386 Central Asia Rep. 85 1 24,719 1,603 1,119 176,295 39 Total 3,601 214 890,051 233,524 12,063 5,706,659 1,558 Appendix E6 Commodities, Total Modern Contraceptive Methods 2005-2020, By Method and Region (Thousands) Contraceptive Projections and the Donor Gap: Meeting the Challenge 41 APPENDIX F 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 TOTAL Condom 48,701 32,813 46,075 91,041 76,708 63,160 74,332 76,012 73,425 85,278 667,545 Oral 34,511 40,525 71,068 58,053 46,809 58,250 50,747 54,022 58,231 52,386 524,602 Injectable 34,285 26,901 29,547 57,659 36,507 70,422 62,907 57,605 58,410 53,376 487,620 Implant 10,417 6,196 2,820 5,066 5,914 4,018 3,214 5,537 7,214 16,221 66,617 IUD 9,567 6,460 3,213 6,532 6,442 5,723 6,004 3,904 3,993 2,541 54,379 Other Methods 3,066 2,030 1,912 5,520 5,413 4,584 7,815 7,097 10,824 12,902 61,161 TOTAL 140,547 114,926 154,635 223,870 177,792 206,156 205,019 204,178 212,096 222,704 1,861,923 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 Average Condom 35% 29% 30% 41% 43% 31% 36% 37% 35% 38% 35% Oral 25% 35% 46% 26% 26% 28% 25% 26% 27% 24% 29% Injectable 24% 23% 19% 26% 21% 34% 31% 28% 28% 24% 26% Implant 7% 5% 2% 2% 3% 2% 2% 3% 3% 7% 4% IUD 7% 6% 2% 3% 4% 3% 3% 2% 2% 1% 3% Other Methods 2% 2% 1% 2% 3% 2% 4% 3% 5% 6% 3% TOTAL 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Appendix F1B Donor Contributions by Method, 1998-2007 Percentage) Appendix F1A Donor Contributions by Method, 1998-2007 (US$ Million) Contraceptive Projections and the Donor Gap: Meeting the Challenge 42 Contraceptive Projections and the Donor Gap: Meeting the Challenge 43 APPENDIX G Comparison with 2001 Report This report updates an analysis published in 2001 as Meeting the Challenge: Contraceptive Projections and the Donor Gap. There are some differences in methods and data between the two reports, but the results are very similar. This report excludes commodity costs for male and female sterilization because they are relatively small and are not usually classified by donors as commodity costs. There are some differences in the countries included. Five countries that were included in the 2001 report but are now relatively independent of donor financing for commodities were excluded from this report: Iran, Mexico, Oman, South Africa, and Turkey. Six countries that were not in the 2001 report were included in this report because recent data show that they have received significant donor financing: Afghanistan, Cuba, Iraq, Romania, Somalia, and Syrian Arab Republic. Financing for implants was not included in the 2001 report but is included here. The 2001 report used DHS data on source mix to determine the proportion of use that was funded by the public sector, whereas this report uses UNFPA data on donor supplies of commodity by country compared to our estimates of total commodity needs to estimate the donor share of total use. This method resulted in significantly different estimates of the donor share for some countries but a smaller change in the overall donor share. 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