Family Planning Market Report 2020

Publication date: 2020

Family Planning Market Report D E C E M B E R 2 0 2 0 SUPPLIER SHIPMENT ANALYSIS DONOR SPEND ANALYSIS FUTURE OUTLOOK DISCUSSION WITH KEY STAKEHOLDERS GLOBAL MARKETS VISIBILITY PROJECT ACKNOWLEDGEMENTS APPENDIX A – 69 FP2020 COUNTRIES MARKET VOLUMES BY METHOD AND COUNTRY, 2015–2019 APPENDIX B – DATA SOURCES APPENDIX C – ESTIMATING THE TOTAL FP2020 PUBLIC-SECTOR MARKET APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-SPEND VOLUMES APPENDIX E – ADDITIONAL MARKETS VISIBILITY APPENDIX F – KEY TERMS AND DEFINITIONS APPENDIX G – ACRONYMS 3 12 14 15 16 18 28 29 35 36 41 42 3 FROM 2018 TO 2019, THE VALUE OF THE FP2020 PUBLIC-SECTOR MARKET REMAINED LARGELY STABLE ALTHOUGH DECREASES IN VOLUMES AND COUPLE-YEARS OF PROTECTION (CYPS) SHIPPED5 WERE OBSERVED. THESE DECREASES WERE PRIMARILY DRIVEN BY A DECLINE IN IUD AND INJECTABLE VOLUMES BUT WERE PARTLY OFFSET BY INCREASES IN THE VOLUMES OF OTHER METHODS, SUCH AS IMPLANTS, ORALS, AND CONDOMS. THE VALUE OF THE PUBLIC-SECTOR IMPLANT MARKET IN FP2020 COUNTRIES INCREASED DUE TO HIGHER VOLUMES EVEN AS AVERAGE PRICES DECREASED. SIMILAR TO 2018, LONG-ACTING REVERSIBLE METHODS OF CONTRACEPTION (IMPLANTS AND IUDS) COMPRISED ABOUT TWO THIRDS OF CYPS SHIPPED TO THE FP2020 PUBLIC-SECTOR MARKET IN 2019. WHILE THE OVERALL MARKET VALUE IN 2019 REMAINS HIGHER THAN THE HISTORIC LOWS OBSERVED IN 2016 AND 2017, IT HAS NOT REBOUNDED TO THE LEVEL OBSERVED IN 2015. The scope of the 2020 Family Planning Market Report comprises the total FP2020 public-sector market – defined as volumes purchased by institution- al buyers (USAID, UNFPA, Social Marketing Organizations, etc.) and Ministry of Health (MOH) or government-affiliated procurers for the 69 FP2020 fo- cus countries.1 The report covers all product-based modern contraceptive methods and leverages historical supplier-reported shipment data collected from 16 suppliers2 for female condoms, implants, injectables, IUDs3, orals (combined and progestin only), and emergency oral contraceptives. Findings for male condoms are based on data from the Reproductive Health Interchange (RHI).4 Supplier-reported data provides insights into historical pro- curement of contraceptive products, but is not necessarily equivalent to demand for contraceptives, given procurement is impacted by constraints including available funding and production capacity. 1. Defined as countries with a 2010 gross national income per capita less than or equal to $2,500. 2. Participating suppliers represent >97 percent of cumulative volumes within each method in the Reproductive Health Interchange (RHI) database from 2015 to 2019, with the exception of IUDs and emergency contraceptives, which represent 40-70 percent; see Appendix C.1 for further details. Additionally, the total cumulative volumes in the Market Report were greater than the total cumulative volumes seen in RHI for each method from 2015-2019; see Appendix C.5 for further details. 3. IUD is an abbreviation for an intra-uterine device; all IUD quantities shown in this report refer to copper IUDs. Data collection for this year’s report did include the hormonal IUS, and Medicines360, a supplier of the hormonal IUS, was added to the Market Report as a participat- SU PP LI ER S H IP M EN T AN AL YS IS ing supplier. However, a public price for hormonal IUS was not available in the UNFPA Contra- ceptive Price Indicator (which is used as the source of publicly-available pricing information in this report) for 2019 and therefore hormonal IUS volumes are not included in this year’s report. Data from suppliers of the hormonal IUS will be included in future Market Reports once price points become publicly available and data can be aggregated accordingly. 4. For male condoms, RHI has historically provided greater coverage of the market com- pared to supplier shipment data. 5. Couple-Years of Protection (CYP) is the estimated protection provided by contraceptive methods during a one-year period (e.g. 120 condoms provide a couple protection for one year). See Appendix C for further details. 4 This section analyzes trends in shipment volumes, value in USD, and CYPs shipped in the FP2020 public-sector market from 2015 to 2019. Although relatively stable between 2018 and 2019, the total value of the public-sector market in the 69 FP2020 focus countries decreased over the five-year period in scope for this report from $269 million6 in 2015 to $223 million in 2019 (Exhibit 1). Relative increases and decreases in market value have been observed throughout that period with the 2017 $187 million market value being the lowest point recorded during the 2015-2019 period (Exhibit 1). The market value recovered partially in 2018, reaching $226 million, and remained roughly flat in 2019 at $223 million (Exhibit 1). While the value of the public-sector market in the 69 FP2020 focus countries has remained stable with a slight 2 percent decrease between 2018 and 2019, a more significant 13 percent decline was observed with regard to CYPs shipped during that same period (Exhibit 3). The de- crease in CYPs shipped in 2019 relative to 2018 was largely driven by a decline in IUD CYPs, which was partially offset by an increase in implant CYPs from 2018 to 2019. Accordingly, IUDs and implants—the long-acting reversible contraceptives (LARCs) included in the method mix—contin- ued to comprise about two-thirds of the CYP mix relative to short-act- ing methods in 2019 (Exhibit 5), although LARCs only comprised 43 percent of market value in 2019 due to their low cost per CYP (Exhibit 6). From 2015 to 2019, Sub-Saharan Africa’s market share grew from 60 percent to 72 percent of the FP2020 public-sector market captured in this report7 (Exhibit 7). This growth has corresponded with a decrease in Asia’s market share. Within the FP2020 public-sector market, the 10 largest countries (in terms of market value) continued to represent over 50 percent of the total market value in 2019, as they did in 2018 (Exhibit 9). While the list of top 10 markets has changed from year to year, five countries —Bangladesh, Ethiopia, Nigeria, Uganda, and Zimbabwe — have consistently appeared in the top 10 markets from 2015 to 2019. 2019 IUD volumes declined by 30 percent compared to 2018 levels (Exhibit 2) causing a small decrease in the overall market value in 2019 since IUDs have a lower unit cost relative to other methods (Exhibit 4). Conversely, since the IUD has the highest CYP per unit of any method in this report, the decrease contributed the most to the decline in CYPs shipped from 2018 to 2019 (Exhibits 4, 3). The decline was largely driven by a return to pre-2018 levels of procurement in Egypt and India, which received significant spikes in volumes in 2018, indicating that the cyclical nature of country-level procurement may have impacted IUD volume increases from 2017 to 2018 and the decline from 2018 to 2019. The market value of injectables decreased by $12 million (19 percent) in 2019, which constituted the largest decrease in market value for any product category (Exhibit 1). Production constraints for injectables affected supply availability throughout 2019 and contributed to com- paratively lower injectable volumes, CYPs shipped, and market value in 2019 versus 2018. The cyclical nature of procurement may have also contributed to some of the decline seen in 2019. For example, procure- ment of injectables decreased substantially in Bangladesh after large injectable volumes were procured in 2018. Even after discounting the large decline in volumes from Bangladesh however, decreases were still observed across the injectables category. Decreases in the IUD and injectables categories were offset by increas- es in market value for implants, orals, and male and female condoms. Implants comprised 31 percent of all CYPs shipped in 2019, up from 26 percent in 2018 (Exhibit 5). In 2019, as per the UNFPA Contraceptive Price Indicator, unit prices for implants also fell to an average of $8.3678 from $8.50 in 2018 due to the increased number of quality-assured implant suppliers on the market, signaling that more implants could now be procured with the same amount of funding. Notable Market Trends Notable Product Trends SU PP LI ER S H IP M EN T AN AL YS IS 6. All currency reported is in US dollars, unless otherwise noted. 7. Private-sector contraceptive use does not factor into these market share numbers. Additionally, although participating suppliers account for 97 percent of cumulative volumes in RHI, some procurement from domestic suppliers in markets like Bangladesh and India (among others) may not be captured in the shipment data from participating suppliers. Accordingly, it should be noted that market share estimates are based only on available shipment data from participating suppliers. For more detailed information on the Bangladeshi and Indian markets, please refer to Appendix E. 8. Note the $8.367 figure is a weighted average of all implant procurement tracked in the UNFPA Contraceptive Price Indicator (Exhibit 4). As the UNFPA Contraceptive Price Indicator does not break out price by 3-year and 5-year implants, the $8.50 IAP price is used in Exhibit 4 for illustrative cost per CYP calculations. The 2019 UNFPA Contraceptive Price Indicator is available here: https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_ Price_Indicators_2019_V2_-_EXTERNAL.pdf 5 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 1: VALUE OF THE FP2020 PUBLIC-SECTOR MARKET (USD) Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020; [3] UNFPA Contraceptive Price Indicator, 2015–2019; [4] IAP Implant Price Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Year over year and compound annual growth rate numbers were calculated throughout the report using actual values, not the rounded values in the chart. $0M $50M $100M $150M $200M $250M $300M 20192018201720162015 To ta l M ar ke t Si ze (M ill io ns U SD ) $87M $78M $3M $31M $2M $41M $11M $29M $3M $50M $2M $79M $12M $37M $70M $1M $32M $2M $47M $10M $25M $90M $3M $31M $2M $65M $6M $29M $269M $94M $2M $32M $2M $53M $9M $31M $223M $194M $187M $226M Implants IUDs Orals - Emergency Injectables Condoms - Female Condoms - Male Orals - Combined and Progestin Only METHOD YEAR OVER YEAR 2018-2019 COMPOUND ANNUAL GROWTH RATE 2015-2019 Condoms- Female 41% -8% Condoms- Male 8% -4% Implants 5% 2% Injectables -19% -10% IUDs -30% -6% Orals- Combined & Progestin Only 2% -11% Orals- Emergency 34% -1% Total -2% -5% Year over year (YOY): change in the value of the FP2020 public-sector market between 2018-19 Compound Annual Growth Rate (CAGR): [(final value/beginning value)^ (1/number of years)]-1 6 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 2: TOTAL FP2020 MARKET VOLUMES (MALE CONDOMS EXCLUDED)* METHOD YEAR OVER YEAR 2018-2019 COMPOUND ANNUAL GROWTH RATE 2015-2019 Condoms- Female 51% -5% Implants 6% 2% Injectables -16% -8% IUDs -30% -7% Orals- Combined & Progestin Only 3% -6% Orals- Emergency -8% -3% Total -2% -6% *Male condoms are shown separately because the source of the shipment data is RHI whereas all other methods are supplier-reported. See Appendix C for further details. MALE CONDOM SHIPMENT VOLUMES (BILLIONS) 2015 2016 2017 2018 2019 YEAR OVER YEAR 2018-2019** COMPOUND ANNUAL GROWTH RATE 2015-2019 1.35B 1.15B 1.09B 1.30B 1.36B 5% 0% Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020 Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Year over year and compound annual growth rate values were calculated using actual, not rounded, numbers. 0 M 50 M 100 M 150 M 200 M 250 M 300 M 350 M 20192018201720162015 Sh ip m en t Vo lu m es ( M ill io ns ) 10M 10M 9M 10M 8M 4M 168M 7M 97M 25M 114M 6M 50M 22M 22M 59M 6M 118M 211M 218M 11M 11M 13M 81M 6M 127M 11M 8M 20M 68M 6M 131M 249M 244M 317M Implants IUDs Orals - Emergency Injectables Condoms - Female Orals - Combined and Progestin Only 7 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 3: CYPs SHIPPED TO THE FP2020 PUBLIC-SECTOR MARKET METHOD YEAR OVER YEAR 2018-2019 COMPOUND ANNUAL GROWTH RATE 2015-2019 Condoms- Female 51% -5% Condoms- Male 5% 0% Implants 5% 2% Injectables -17% -8% IUDs -30% -7% Orals- Combined & Progestin Only 4% -6% Orals- Emergency -8% -3% Total -13% -4% Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020; [3] USAID, "Couple-Years of Protection (CYP)" Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Year over year and compound annual growth rate values were calculated using actual, not rounded, numbers. 0 M 30 M 60 M 90 M 120 M 150 M 20192018201720162015 CY Ps S hi pp ed (M ill io ns ) 31M 29M 26M 18M 8M 0.3M 14M 0.2M 9M 47M 12M 8M 0.2M 10M 46M 11M 0.3M 0.3M 23M 0.2M 11M 123M 31M 50M 20M 9M 0.3M 0.1M 11M 121M 33M 35M 17M 9M 0.3M 0.2M 11M 105M105M 76M Implants IUDs Orals - Emergency Injectables Condoms - Female Condoms - Male Orals - Combined and Progestin Only 8 SU PP LI ER S H IP M EN T AN AL YS IS METHOD UNITS PER CYP UNIT COST COST PER CYP 2015 2016 2017 2018 2019 2015 2016 2017 2018 2019 Condoms - Female 120.00 $0.49 $0.49 $0.46 $0.47 $0.44 $58.80 $59.28 $55.32 $56.88 $53.28 Condoms - Male 120.00 $0.03 $0.03 $0.02 $0.02 $0.02 $3.24 $3.03 $2.71 $2.64 $2.72 Injectables - 1 month 13.00 $0.85 $0.85 $0.85 $0.85 N/A $11.05 $11.05 $11.05 $11.05 N/A Injectables - 2 month 6.00 $1.15 $1.15 $1.15 $1.15 $1.15 $6.90 $6.90 $6.90 $6.90 $6.90 Injectables - 3 month 4.00 $0.78 $0.80 $0.77 $0.79 $0.75 $3.13 $3.20 $3.09 $3.16 $3.00 Orals - Combined 15.00 $0.29 $0.26 $0.27 $0.24 $0.23 $4.35 $3.95 $4.01 $3.56 $3.51 Orals - Progestin Only 15.00 $0.34 $0.33 $0.32 $0.29 $0.29 $5.10 $4.92 $4.76 $4.40 $4.34 Orals - Emergency 20.00 $0.37 $0.35 $0.26 $0.28 $0.40 $7.40 $7.02 $5.14 $5.52 $7.98 Implants - 3 Year 0.40 $8.50 $8.50 $8.50 $8.50 $8.50 $3.40 $3.40 $3.40 $3.40 $3.40 Implants - 5 Year 0.26 $8.50 $8.50 $8.50 $8.50 $8.50 $2.24 $2.24 $2.24 $2.24 $2.24 IUDs 0.22 $0.30 $0.30 $0.31 $0.30 $0.31 $0.07 $0.06 $0.07 $0.07 $0.07 Sources: [1] UNFPA Contraceptive Price Indicator, 2015–2019; [2] USAID, “Couple-Years of Protection (CYP)", [3] IAP Implant Price EXHIBIT 4: COST PER CYP BY METHOD PER DURATION OF USE (USD) Cost Per CYP By Method in 2019 (USD) $0 $10 $20 $30 $40 $50 $60 Condoms - Female Orals - Emergency Injectables - 2 month Orals - Progestin Only Orals - Combined Implants - 3 Year Injectables - 3 month Condoms - Male Implants - 5 Year IUDs $0.07 $2.24 $2.72 $3.00 $3.40 $3.51 $4.34 $6.90 $7.98 $53.28 N/A indicates method was not listed on the UNFPA Contraceptive Price Indicator in 2019. Implant pricing in this exhibit was taken from the IAP implant price. 9 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 5: CYP MIX (IN TERMS OF CYPS SHIPPED) OF THE FP2020 PUBLIC-SECTOR MARKET EXHIBIT 6: MARKET SHARE PER METHOD IN THE FP2020 PUBLIC-SECTOR MARKET (USD) Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020; [3] UNFPA Contraceptive Price Indicator, 2015–2019; [4] USAID, “Couple-Years of Protection (CYP)” [5] IAP Implant Price. 0% 20% 40% 60% 80% 100% 20192018201720162015 CY P M ix 25% 37% 9% 0.3% 19% 0.2% 9% 27% 45% 7% 0.3% 12% 0.2% 9% 123M 105M 34% 24% 10% 0.4% 19% 0.2% 12% 26% 41% 7% 0.3% 16% 0.1% 9% 31% 33% 8% 0.3% 16% 0.2% 11% 76M 121M 105M CYPs shipped CY Ps M ix Implants IUDs Orals - Emergency Injectables Condoms - Female Condoms - Male Orals - Combined and Progestin Only Note: The sum of percentages for each individual stacked bar may differ from 100% due to rounding. 0% 20% 40% 60% 80% 100% 20192018201720162015 $269M $194M $187M $226M $223M 32% 1% 18% 1% 29% 5% 14% 40% 2% 16% 1% 21% 6% 15% 38% 1% 17% 1% 25% 5% 13% 40% 1% 14% 1% 29% 3% 13% 42% 1% 14% 1% 24% 4% 14% Implants IUDs Orals - Emergency Injectables Condoms - Female Condoms - Male Orals - Combined and Progestin Only Market Value 10 SU PP LI ER S H IP M EN T AN AL YS IS 0% 20% 40% 60% 80% 100% 20192018201720162015 $269M $194M $187M $226M $223M 18% 3% 2% 69% 9% 19% 3% 1% 66% 12% 20% 3% 2% 66% 10% 23% 2% 1% 60% 14% 15% 2% 4% 72% 7% Market Value Latin America & Caribbean Asia & Pacific Sub-Saharan Africa Final Destination Country Not Specified Middle East & North Africa EXHIBIT 7: MARKET SHARE OF FP2020 PUBLIC SECTOR BY REGION (USD) Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020; [3] UNFPA Contraceptive Price Indicator, 2015–2019; [4] IAP Implant Price Note: The sum of percentages for each individual stacked bar may differ from 100% due to rounding. 11 EXHIBIT 8: TOP TEN COUNTRIES IN TERMS OF VALUE, 2019 EXHIBIT 9: VALUE OF 10 LARGEST FP2020 PUBLIC-SECTOR COUNTRIES COMPARED TO VALUE OF ALL OTHER COUNTRIES COMBINED SU PP LI ER S H IP M EN T AN AL YS IS $0M $50M $100M $150M $200M $250M $300M 20192018201720162015 $269M $194M $187M $223M$226M $88M $99M $124M $103M $115M $108M $119M $151M $90M $104M M ar ke t Si ze (M ill io ns U SD ) Top 10 Countries Other FP2020 Countries Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020; [3] UNFPA Contraceptive Price Indicator, 2015–2019; [4] IAP Implant Price * Top countries in this graph are defined by 2019 data and in alphabetical order are: Bangladesh, Congo Dem Rep, Ethiopia, Madagascar, Malawi, Mozambique, Nigeria, Tanzania, Uganda, Zimbabwe. * 10% 48% 7% 7% 5% 4% 4% 4% 4% 4%3% Bangladesh Ethiopia Uganda Congo Dem Rep Nigeria Zimbabwe Malawi Tanzania Madagascar Mozambique Other FP2020 Countries 12 UNFPA’S SPEND ON CONTRACEPTIVES HIT ANOTHER HISTORIC HIGH IN 2019, CONTINUING A STEADY INCREASE IN SPENDING SINCE 2016. USAID’S SPEND DECLINED IN FY20199 VERSUS FY2018, APPROACHING ITS FY2017 LOW. USAID’S SPEND HAS YET TO REBOUND TO LEVELS SEEN IN FY2015. HOWEVER, BETWEEN UNFPA AND USAID, THE AGGREGATE DONOR SPEND REMAINED LARGELY CONSTANT FROM THE 2018 TO 2019 FISCAL YEARS. D O N O R SP EN D A N AL YS IS This section focuses on data from the Procurement Service Branch of UNFPA and USAID’s “Overview of Contraceptive and Condom Shipments” report to understand the historical spend by the two major institutional procurers in the public-sector markets of the 69 FP2020 focus countries. For UNFPA, the value of contraceptives procured increased by 9 percent from 2018 to 2019. In 2019, a total of $162 million was spent on contra- ceptive products, the highest figure seen throughout the 2015-19 period (Exhibit 10). The 2019 growth in UNFPA’s spend was driven by a mix of increased UNFPA program procurement and third-party procurement. Third-party procurement as a percent of total UNFPA spend grew from 10 percent to 17 percent between 2018 and 2019.10 The annual value of USAID’s spend on contraceptives shipped, exclud- ing male and female condoms,11 in FY2019 was $38 million, down 24 percent from FY2018 (Exhibit 11). USAID’s FY2018 spend had increased from a historic low of $34 million in 2017 to $50 million in 2018. Spend throughout FY2016-FY2019, however, represents a significant decrease compared to USAID’s $73 million in annual spend in FY2015, the highest funding level recorded during the 5-year period. In the FY2019 report, USAID indicated that several factors may have contributed to this decrease in FY2019, including savings from strategic sourcing, global production constraints for products like injectables, and a decline in procurement after the relative increase in FY2018.12 Furthermore, missions in certain countries may also be submitting fewer requests for contraceptive procurement funding as USAID continues to implement its “Journey to Self-Reliance” strategy.13 9. USAID Fiscal Year (FY) runs from Oct. 1 to Sept. 30. 10. UNFPA PSB Procurement Values, 2018-2019. 11. The FY2019 report is reflective of family planning funding and does not include HIV/AIDs funded condoms; thus, the report excludes female and male condom values for 2015 to 2019 to compare a consistent data set across years. 12. Overview of Contraceptive and Condom Shipments FY2019 report available here: https:// www.ghsupplychain.org/news/contraceptives-and-condoms-2019-report-published#:~:tex- t=USAID%20has%20published%20the%20Overview%20of%20Contraceptive%20and%20 Condom%20Shipments%20FY2019%20report.&text=The%20overall%20total%20delivered%20 value,year%202019%20was%20%2439.1%20million. 13. USAID’s “Journey to Self-Reliance” strategy fosters cooperation with host country governments to strengthen local capacities, partner with the private sector, and work towards financing self-reliance. USAID information available here: https://www.usaid.gov/selfreliance 13 D O N O R SP EN D A N AL YS IS EXHIBIT 10: UNFPA PROCUREMENT VALUE – CONTRACEPTIVES TO FP2020 COUNTRIES (IN USD) Sources: [1] UNFPA PSB Procurement Values 2015 -2019; [2] USAID Worldwide Contraceptive and Condom Shipments FY2015 – 2019 2018-2019 Year Over Year: +9% 2015-2019 Compound Annual Growth Rate: +11% UNFPA $0M $50M $100M $150M $200M FY2019FY2018FY2017FY2016FY2015 $108M $79M $99M $149M $162M Sh ip m en t Va lu es to F P2 02 0 (M ill io ns U SD ) EXHIBIT 11: USAID WORLDWIDE CONTRACEPTIVE (EXCL. MALE AND FEMALE CONDOMS) SHIPMENT VALUES TO FP2020 COUNTRIES (IN USD) 2018-2019 Year Over Year: -24% 2015-2019 Compound Annual Growth Rate: -15% $0M $10M $20M $30M $40M $50M $60M $70M $80M FY2019FY2018FY2017FY2016FY2015 Sh ip m en t Va lu es to F P2 02 0 (M ill io ns U SD ) $73M $46M $34M $50M $38M USAID 14 FU TU RE O U TL O O K DONOR SPEND ON CONTRACEPTIVES SHIPPED REMAINED ROUGHLY CONSTANT BETWEEN 2018 AND 2019. HOWEVER, OVERALL UNCERTAINTY AROUND THE LONG-TERM TRAJECTORY OF DONOR SPENDING ON CONTRACEPTIVE PROCUREMENT REMAINS A CONCERN. Although UNFPA’s 2019 spend on contraceptives reached its highest level over the 2015-2019 period, there remains a level of uncertainty regarding longer-term donor funding. The UK government has committed £600 million in funding to the sexual and reproductive health space for the 2020-2025 period.14 £425 million of this funding has been committed directly to UNFPA Supplies15 to support the procurement of reproductive health commodities. In the United States, USAID’s spending on the procurement of contra- ceptives has decreased to levels approaching the 2017 historic low, and future commitments to contraceptive procurement remain uncertain.16 These trends are likely to continue beyond the near term. Based on key stakeholder discussions within the sexual and reproductive health community, the 2019 RHSC Global Contraceptive Commodity Gap Analy- sis suggests that reduced or stagnant donor funding will continue well into the next decade17. While the procurement data in this year’s report indicates that the market value of the FP2020 countries’ public sector remained stable in 2019, flat procurement for contraceptives should not be conflated with stagnant demand. Estimates from the 2019 RHSC Global Contraceptive Commodity Gap analysis suggest that the demand for contraceptives continues to grow and that a significant gap will accumulate between demand for, and the ability to provide contraceptives, especially in lower-income countries.18 Many countries’ supply plans remain partially unfunded due to a lack of donor or domestic financing, complicated by a lack of supplies in some instances to fulfill demand. Thus, to meet growing demand in FP2020 countries for safe, effective, and quality-as- sured contraceptive products, donor and/or domestic funding will need to increase, alongside continued initiatives to promote affordability for a broad method mix of quality-assured, family planning products. 14. https://www.gov.uk/government/news/healthcare-for-everyone-must-prioritise-womens-sex- ual-and-reproductive-health-and-rights-says-uk-at-un-general-assembly 15. https://www.unfpa.org/updates/united-kingdom-commits-425-million-family-planning-pre- venting-millions-unintended 16. At the time of report writing, the US Senate Appropriations Committee had proposed bilateral funding for family planning and reproductive health (FP/RH) of $461M in FY2021 with no funding allocated for UNFPA. This Senate proposal represents a 21% decrease compared to the level of FY2021 FP/RH funding proposed by the House. Final negotiations are still continuing https://www.kff.org/news-summary/senate-appropriations-committee-releases-draft-fy-2021- state-and-foreign-operations-sfops-and-labor-health-and-human-services-labor-hhs-appro- priations-bills/ 17. 2019 Commodity Gap Analysis, RHSC. Available at https://www.rhsupplies.org/activi- ties-resources/commodity-gap-analysis/ 18. The 2019 RHSC Commodity Gap Analysis estimates that the number of users of contra- ception in LMICs will reach 487M in 2020 and will grow by another 44 million users by 2025. If donor/ domestic funding levels remains the same, a funding gap of $178M will emerge in 2020, and a cumulative gap of $1.17B will accrue over 2021-2025. https://www.gov.uk/government/news/healthcare-for-everyone-must-prioritise-womens-sexual-and-reproductive-health-and-rights-says-uk-at-un-general-assembly https://www.gov.uk/government/news/healthcare-for-everyone-must-prioritise-womens-sexual-and-reproductive-health-and-rights-says-uk-at-un-general-assembly https://www.unfpa.org/updates/united-kingdom-commits-425-million-family-planning-preventing-millions-unintended https://www.unfpa.org/updates/united-kingdom-commits-425-million-family-planning-preventing-millions-unintended https://www.kff.org/news-summary/senate-appropriations-committee-releases-draft-fy-2021-state-and-foreign-operations-sfops-and-labor-health-and-human-services-labor-hhs-appropriations-bills/ https://www.kff.org/news-summary/senate-appropriations-committee-releases-draft-fy-2021-state-and-foreign-operations-sfops-and-labor-health-and-human-services-labor-hhs-appropriations-bills/ https://www.kff.org/news-summary/senate-appropriations-committee-releases-draft-fy-2021-state-and-foreign-operations-sfops-and-labor-health-and-human-services-labor-hhs-appropriations-bills/ https://www.rhsupplies.org/activities-resources/commodity-gap-analysis/ https://www.rhsupplies.org/activities-resources/commodity-gap-analysis/ 15 H IG H LI G H TS F RO M D IS CU SS IO N W IT H K EY S TA KE H O LD ER S CHAI CONSULTED A NUMBER OF SUPPLIERS, DONORS, AND OTHER SEXUAL AND REPRODUCTIVE HEALTH PARTNERS TO DISCUSS THE TRENDS OBSERVED IN THIS REPORT. Although the public-sector market value in FP2020 countries held steady in 2019, stakeholders continued to express concern about the long-term outlook for donor funding. While estimates show the demand for safe, effective, and quality-assured contraception will continue to grow per the 2019 RHSC Commodity Gap Analysis,19 projections also anticipate a widening funding gap. Considering the production challenges related specifically to the in- jectables market, stakeholders expressed relief that injectable volumes shipped to FP2020 countries did not decrease even further beyond the 16% decline observed from 2018 to 2019. Stakeholders pointed to the positive impact of having multiple injectable supply sources in alleviat- ing the impact of certain production constraints. As in previous years, stakeholders noted that supply-side dynamics influence the procurement data shown in this report. This dynamic is noted in the 2016 RHSC Commodity Gap Analysis,20 as general procure- ment trends "may also reflect a number of factors in addition to user consumption such as the volume necessary to fill supply pipelines and maintain adequate inventory levels from central warehouses to individual service delivery points. Procurement quantities may take into account the volume of supplies already present or on order, inventory holding policies along the supply chain, and wastage or “leakage” of supplies at various levels. Constraints on funding, price, incentives, plans to expand programs in the future, and preferences by donors or the government itself for particular methods or products may also influence what type and what volume of supplies to procure.” Finally, looking forward, stakeholders indicated that the obstacles and setbacks suppliers, procurers, providers, health systems, and users of contraception have faced and continue to face due to the COVID-19 pandemic are likely to impact data for the 2020 calendar year. These obstacles include supply-side challenges, such as manufacturing or API sourcing during the pandemic environment, as well as demand-side challenges. 19. Users of contraception in LMICs are expected to increase by 82.2M by 2030, per the 2019 RHSC Gap Analysis. . 20. 2016 RHSC Commodity Gap Analysis. Available at https://www.rhsupplies.org/uploads/ tx_rhscpublications/Global_Contraceptive_Commodity_Gap_Analysis_2016.pdf 16 G LO BA L M AR KE TS V IS IB IL IT Y PR O JE CT A CK N O W LE D G EM EN TS About the Global Markets Visibility Project The Global Markets Visibility Project is a landmark initiative that has provided the reproductive health community with detailed assessments of the public-sector family planning market across the 69 FP2020 focus countries since 2015. The initiative provides insightful and strategic outputs for donors, MOHs, implementing organizations, and suppliers to develop and implement more effective strategies to enable women in the 69 FP2020 focus countries to use family planning products and services. This report is a joint collaboration between CHAI and the Reproductive Health Supplies Coalition (RHSC). The initial 2015 report comprised data from 11 manufacturers. Each manufacturer entered into a formal MOU with CHAI or provided their information through collaborations with the Generic Manufacturers Caucus for Reproductive Health (GEMs) and i+solutions. Since then, coverage has expanded, and today there are 16 suppliers participating in the project. Donors, suppliers, and partners remain fully committed to this project, expressing strong interest in continuing to strengthen the family planning community’s market knowledge. About the Participating Suppliers Bayer Bayer is a Germany-based life science company with core competen- cies in health care and agriculture. Its contraceptive product portfolio includes contraceptive implants, hormonal IUS, combined and proges- tin-only oral contraceptives, and injectables. CR Zizhu China Resources Zizhu Pharmaceutical Co., Ltd. (CR Zizhu) is a manufac- turer of reproductive health products based in China. Its contraceptive product portfolio includes emergency oral contraceptives and com- bined oral contraceptives. CR Zizhu also manufactures misoprostol and several APIs including levonorgestrel. Cipla Cipla Limited is an India-based generic manufacturer with over 1,500 products in the areas of respiratory diseases, HIV/AIDS, malaria, MDRTB21, and reproductive health. Its contraceptive product portfolio includes emergency contraceptives and combined oral contraceptives. It also manufactures misoprostol. Cupid Cupid Limited is a manufacturer and supplier of quality male condoms, female condoms, and water-based lubricant jelly, based in Nashik, India since 1998. Cupid has been prequalified by WHO/UNFPA for the supply of both male condoms and female condoms for worldwide public distribution. It supplies its products to more than 80 countries worldwide and helps in the prevention of HIV/STIs and unintended pregnancy. Apart from supplying its own brand of products like Cupid Angel & Fantasy, Cupid Limited also provides third-party manufacturing services to major companies like DKT and MSI. Female Health Company Female Health Company is the global public-sector division of Veru Healthcare focusing on urology and oncology, headquartered in Miami, Florida, USA. The Female Health Company is the manufacturer of the FC2 female condom and focuses on the global public health sector business. FC2 is approved by the US FDA and WHO pre-qualified for offering dual protection against sexually transmitted infections and unintended pregnancy. Helm AG Helm AG is a Germany-based, family owned multifunctional distribution company specializing in: chemicals (feedstocks and derivatives), crop protection, active pharmaceutical ingredients and pharmaceuticals, and fertilizers. Until 2017, its main contraceptive product was a 3-month injectable (DMPA). HELM AG was a participating supplier in the FP2020 Global Markets Visibility Project for the FP 2015, 2016, and 2017 Market Reports. In Sep- tember 2017, HELM AG sold its wholly-owned subsidiary company, HELM Medical GmbH, to Sanavita Pharmaceuticals GmbH, a firm based in Germany whose parent company is Braun Beteiligungs GmbH. Following the transaction, HELM AG discontinued its IUD and Injectables business units and consequently the FP 2018, FP 2019, and FP 2020 reports do not contain shipment volumes for IUDs or Injectables from HELM AG. Sanavita Pharmaceuticals will assume responsibility for HELM's male condoms business unit. No supplier shipment data for male condoms from HELM or Sanavita is shown or used for analyses in this report. All shipment data for male condoms in this report is derived from the RHI database. Market Definition, Scope, and Coverage The total FP2020 public-sector market referenced in this report only includes data for the public sector in the 69 FP2020 focus countries, which is defined as volumes purchased by institutional buyers (USAID, UNFPA, SMOs, etc.) and MOH or government-affiliated procurers. Although significant efforts have been deployed to collect as much data as possible, it should be noted that this report may not represent the entirety of institutional purchases for the FP2020 public sector. This report includes data from many but not all suppliers associated with these markets. 21. MDRTB stands for multi-drug resistant tuberculosis. 17 G LO BA L M AR KE TS V IS IB IL IT Y PR O JE CT A CK N O W LE D G EM EN TS Incepta Pharmaceuticals Incepta Pharmaceuticals Ltd. is a pharmaceutical company based in Dhaka, Bangladesh, that manufactures and markets generic drugs. Incepta has a portfolio of more than 500 generic products, in 1,100+ pre- sentations, across various therapeutic areas. Incepta currently exports its products to 71 countries around the world. Its contraceptive product portfolio includes oral (combined and progestin only) and injectable contraceptives. Medicines360 Medicines360 is a US-based, nonprofit global women’s health pharma- ceutical company that seeks to expand access to quality medicines for all women. Medicines360 developed a hormonal IUS that is approved in more than 20 countries worldwide. It is sold under the trade name Liletta® in the U.S. and Avibela® in low- and middle-income countries. Liletta® is a registered trademark of Odyssea Pharma SPRL, an Allergan affiliate. Avibela® is a registered trademark of Medicines360 in its countries of sale. Merck (MSD) Merck & Co., Inc. is a US-based healthcare company which operates as Merck Sharp & Dohme (MSD) outside of the USA and Canada. Its contra- ceptive product portfolio includes the contraceptive implant (IMPLA- NON NXT, which includes a prefilled sterile applicator), oral contracep- tives (EXLUTON & MARVELON) for FP2020 public-sector markets and oral contraceptives (CERAZETTE, EXLUTON, MARVELON & MERCILON) and the contraceptive implant (IMPLANON NXT) and contraceptive vaginal ring (NUVARING) for non-FP2020 markets. Mylan Mylan is a US-based healthcare company with over 7,500 marketed products. Its contraceptive product portfolio includes oral (combined, progestin only, and emergency) and injectable contraceptives, and IUDs. Pfizer Pfizer is a US-based healthcare company. Its contraceptive product portfolio includes a 3-month injectable DMPA IM (Depo-Provera) and 3-month injectable DMPA SC (Sayana Press). Pregna Pregna is a manufacturer of contraceptive products based in India. Its contraceptive product portfolio includes hormonal IUS (Eloira), IUDs, and tubal rings used for female sterilization. PT Tunggal PT Tunggal Idaman Abdi (PT Tunggal) is a pharmaceutical manufacturer based in Indonesia focusing on reproductive healthcare. Its contra- ceptive product portfolio includes a monthly injectable, a 3-month injectable, a combined oral contraceptive, and an emergency oral contraceptive. Shanghai Dahua Shanghai Dahua Pharmaceutical Co., Ltd (Dahua) is a manufacturer of contraceptive implants based in China. On June 30th, 2017, the World Health Organization (WHO) pre-qualified Dahua’s Levoplant (formerly known as Sino Implant II) for three years of use. SMB SMB is a manufacturer of medical devices, including IUDs and surgical sutures, based in India. Its key contraceptive products are IUDs, includ- ing Copper T 380A, TCu 380Ag, TCu 380 Plus, and SMB Cu 375. Techno Drugs Techno Drugs Ltd. is a manufacturer of both human and veterinary medicines based in Bangladesh. Its contraceptive product portfolio includes combined oral contraceptives, implants, and injectables. For injectables, Techno Drugs has also served as a supplier to Helm AG previously. 18 APPENDIX A 22. Female condoms are aggregated with male condoms by country in order to protect data confidentiality. 69 FP2020 COUNTRIES MARKET VOLUMES BY METHOD22 AND COUNTRY, 2015–2019 EXHIBIT A.1: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2015 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 4,728,000 4,500 0 30,000 300,000 Bangladesh 0 50,000 15,100,000 0 24,000,000 Benin 12,169,800 222,536 125,500 66,500 463,602 Bhutan 1,936,800 0 111,000 0 129,999 Bolivia 0 3,500 0 0 0 Burkina Faso 19,747,510 244,044 564,000 35,500 3,555,723 Burundi 5,760,000 134,500 1,639,267 0 520,528 Cambodia 5,730,480 11,000 200,000 30,000 9,484,891 Cameroon 26,245,443 125,052 10,000 46,550 29,079 Central African Republic 0 500 37,900 0 22,881 Chad 100,000 7,600 0 0 0 Comoros 1,303,200 1,008 78,400 0 35,001 Congo Dem Rep 65,606,368 308,230 1,189,200 32,222 3,758,922 Congo Rep 7,104,840 11,000 622,360 0 0 Cote d'Ivoire 100,000 15,664 212,000 0 5,224,561 Djibouti 0 500 296,667 0 79,995 Egypt Arab Rep 0 0 0 258,200 0 Eritrea 0 0 120,000 0 108,000 Ethiopia 31,052,091 1,180,607 2,000,000 650,000 8,478,983 Gambia 2,900 30,048 265,000 0 141,840 Ghana 13,995,000 403,236 1,394,600 0 1,993,464 Guinea 10,080,000 32,500 907,448 0 431,280 Guinea-Bissau 3,384,720 59,400 27,500 0 59,040 Haiti 60,014,400 9,300 421,400 0 201,759 Honduras 10,000,800 93,656 1,725,800 62,000 2,446,065 India 0 0 795,252 1,273,927 325,000 Indonesia 20,000 25,086 0 171,000 0 Iraq 0 0 0 0 0 Kenya 45,779,200 905,900 2,231,000 70,000 3,125,201 Korea Dem Rep 0 0 0 0 0 Kyrgyz Republic 1,527,264 0 80,000 0 0 Lao PDR 10,875,960 20,000 333,000 0 1,530,720 Lesotho 21,016,000 1,500 81,800 0 120,009 Liberia 9,009,780 44,600 846,800 0 396,018 Madagascar 1,500,000 72,722 9,349,250 35,996 595,605 APPENDIX A AP PE N D IC ES 19 APPENDIX A EXHIBIT A.1: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2015 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Malawi 68,274,192 278,786 6,099,200 0 552,795 Mali 39,764,195 195,805 432,840 18,393 908,569 Mauritania 0 86,264 41,200 0 84,384 Mongolia 1,360,800 0 90,000 0 242,382 Mozambique 41,712,000 95,000 3,025,500 0 0 Myanmar 42,251,912 108,156 7,231,700 900 1,134,860 Nepal 8,304,000 127,500 1,067,000 0 2,304,779 Nicaragua 0 2,000 65,050 3,000 188,640 Niger 0 12,700 820,800 10,425 2,226,162 Nigeria 97,478,368 379,591 8,132,250 75,000 2,474,121 Pakistan 290,853,000 210,484 0 3,024,116 0 Papua New Guinea 3,480 100,800 1,327,200 0 12,999 Philippines 0 731,244 0 82,336 4,135,001 Rwanda 18,626,900 28,752 727,667 5,768 265,296 Sao Tome and Prin- cipe 0 0 9,400 0 65,997 Senegal 18,858,530 65,384 760,000 0 1,393,920 Sierra Leone 7,926,120 68,500 726,800 0 1,058,340 Solomon Islands 0 0 15,000 0 0 Somalia 151,200 52,016 197,900 0 207,360 South Sudan 9,036,000 53,100 89,350 0 139,702 Sri Lanka 0 56,000 574,000 130,000 1,589,760 Sudan 3,000 30,568 474,200 0 3,851,868 Tajikistan 24,812,640 3,500 90,000 0 270,000 Tanzania 846,800 1,241,695 9,935,400 194,124 143,397 Timor-Leste 0 12,000 240,000 2,000 79,902 Togo 4,810,000 59,672 495,400 0 261,468 Uganda 35,316,096 258,060 8,235,050 48,300 218,859 Uzbekistan 0 0 701,600 2,408,900 1,989,949 Vietnam 0 0 0 1,005,000 0 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 5,256,000 25,536 14,300 75,000 7,706,239 Zambia 66,167,400 245,900 3,399,400 13,000 3,707,865 Zimbabwe 141,429,280 98,500 889,100 1,900 9,400,083 Other FP2020 Shipment Volumes 85,564,584 1,564,900 352,600 113,550 60,732,503 Total Volumes 1,377,597,053 10,210,602 97,025,050 9,973,607 174,905,366 AP PE N D IC ES Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020. 20 EXHIBIT A.2: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2016 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 1,010,880 14,200 19,000 20,000 211,440 Bangladesh 0 150,000 8,200,000 0 0 Benin 3,708,000 277,028 70,000 27,000 5,040 Bhutan 0 0 237,000 0 0 Bolivia 50,400 67,800 3,000 0 5,760 Burkina Faso 12,911,000 427,800 1,123,500 0 1,600,971 Burundi 14,555,999 1,600 0 0 70,240 Cambodia 5,719,248 58,960 1,000,000 30,000 10,539,359 Cameroon 18,205,048 82,488 482,975 0 500,000 Central African Republic 3,628,800 6,200 147,600 500 262,296 Chad 0 41,024 15,600 0 0 Comoros 1,442,448 1,972 113,000 0 77,040 Democratic Republic of Congo 17,404,997 688,089 0 10,000 1,026,756 Congo Rep 3,600,000 1,008 6,720 29,650 2,880 Cote d'Ivoire 24,570,000 97,256 3,023,395 10,000 997,500 Djibouti 0 0 663,000 0 44,280 Egypt Arab Rep 0 140,000 0 2,680,434 0 Eritrea 0 0 100,000 0 126,640 Ethiopia 63,828,000 1,022,105 7,570,056 751,144 6,625,921 Gambia 2,880,000 20,016 313,000 0 565,200 Ghana 32,898,960 141,432 3,889,100 15,410 2,751,660 Guinea 17,486,000 77,000 90,000 0 512,644 Guinea-Bissau 0 50,000 13,000 0 10,080 Haiti 79,854,000 5,300 0 1,500 30,240 Honduras 27,183,600 0 1,977,000 0 1,385,280 India 5,000 0 23,984 865,062 6,137,520 Indonesia 5,000 350,000 0 120,074 0 Iraq 0 1,000 0 0 0 Kenya 54,090,024 742,864 95,000 37,500 3,403,080 Korea Dem Rep 0 0 905,200 0 0 Kyrgyz Republic 2,440,080 0 0 0 0 Lao PDR 0 53,200 850,600 0 1,405,440 Lesotho 13,263,000 23,452 260,400 0 218,160 Liberia 12,461,280 44,600 0 0 251,040 Madagascar 4,500,000 303,932 1,440,600 0 849,600 Malawi 27,520,000 33,700 2,475,200 0 0 Mali 23,680,704 27,072 25,000 17,300 20,160 APPENDIX A AP PE N D IC ES 21 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020. APPENDIX A EXHIBIT A.2: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2016 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 3,110,400 2,500 39,000 0 164,160 Mongolia 1,540,800 3,100 30,000 0 405,108 Mozambique 59,034,000 0 90,000 13,000 205,920 Myanmar 16,169,472 147,348 1,800 0 7,560,366 Nepal 32,654,280 98,400 25,400 31,950 228,066 Nicaragua 3,000,000 4,008 0 15,000 0 Niger 0 50,400 1,317,700 0 3,141,960 Nigeria 149,734,200 771,763 1,278,600 90,030 3,320,703 Pakistan 108,752,496 800 0 1,872,716 15,120 Papua New Guinea 1,994,400 103,000 22,600 0 11,520 Philippines 0 0 0 1,070,737 0 Rwanda 19,458,000 65,294 1,734,900 0 2,439,900 Sao Tome and Principe 0 0 0 0 63,360 Senegal 5,094,000 179,864 10,000 32,675 860,949 Sierra Leone 1,080,000 73,000 280,200 5,500 955,860 Solomon Islands 0 0 0 0 0 Somalia 0 0 1,950 0 19,000 South Sudan 9,681,120 30,000 150,000 0 172,080 Sri Lanka 0 50,500 650,000 100,000 6,049,600 Sudan 7,216,992 49,104 29,800 3,500 338,345 Tajikistan 17,392,200 0 93,000 25,000 415,440 Tanzania 428,800 986,112 4,741,200 486,000 5,621,360 Timor-Leste 0 10,500 0 0 0 Togo 15,056,128 46,656 315,800 0 27,360 Uganda 19,200,000 234,524 1,184,250 45,200 5,740,520 Uzbekistan 6,228,720 0 848,400 432,800 0 Vietnam 0 0 0 1,096,080 0 West Bank and Gaza 0 0 800 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 6,302,880 0 157,000 75,000 1,141,120 Zambia 32,762,600 142,000 443,000 0 0 Zimbabwe 164,863,000 140,656 661,800 1,800 19,521,550 Other FP2020 Shipment Volumes 20,389,000 1,016,700 392,800 198,850 21,702,220 Total Volumes 1,170,045,956 9,157,327 49,632,930 10,211,412 119,757,814 AP PE N D IC ES 22 EXHIBIT A.3: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2017 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 16,665,408 9,800 59,600 0 365,200 Bangladesh 1,195,200 400,000 7,258,000 0 0 Benin 28,646,399 34,900 30,600 0 0 Bhutan 0 0 0 0 0 Bolivia 2,001,600 94,600 50,400 0 30,000 Burkina Faso 15,050,016 95,300 481,200 0 3,741,150 Burundi 22,039,200 0 17,500 0 169,980 Cambodia 1,929,600 40,056 900,000 60,000 7,082,236 Cameroon 6,658,400 95,200 327,000 0 298,080 Central African Republic 268,999 0 0 0 95,040 Chad 0 0 0 0 0 Comoros 1,267,200 2,520 40,000 0 60,480 Congo Dem Rep 35,914,800 364,828 2,143,580 0 1,380,220 Congo Rep 2,160,000 76,076 32,000 0 720 Cote d'Ivoire 27,994,968 196,600 243,000 0 6,521,413 Djibouti 0 0 0 0 6,480 Egypt Arab Rep 0 40,032 0 375,045 0 Eritrea 8,640,000 12,500 100,000 0 112,560 Ethiopia 77,886,000 1,107,134 7,436,988 440,000 10,794,948 Gambia 5,371,200 16,488 110,000 1,500 235,440 Ghana 0 250,256 106,000 11,500 3,183,960 Guinea 9,518,136 100,000 0 0 30,240 Guinea-Bissau 8,412,624 27,300 2,500 0 2,160 Haiti 84,455,880 4,116 863,400 0 647,304 Honduras 34,884,000 1,440 21,000 0 1,641,840 India 0 0 1,047,488 522,885 2,262,311 Indonesia 0 0 0 0 0 Iraq 316,944 0 0 0 40,032 Kenya 445,000 408,781 437,376 126,000 7,921,836 Korea Dem Rep 0 0 0 0 0 Kyrgyz Republic 7,264,800 0 0 0 0 Lao PDR 3,474,840 65,808 76,800 0 701,040 Lesotho 14,001,000 31,200 165,000 0 176,400 Liberia 8,013,000 36,100 319,000 0 5,760 Madagascar 0 256,618 3,012,800 295,019 1,288,800 Malawi 27,759,000 167,408 1,000,000 36,500 236,700 Mali 20,115,816 209,728 293,000 0 210,240 APPENDIX A AP PE N D IC ES 23 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020. APPENDIX A EXHIBIT A.3: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2017 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 0 10,404 88,600 0 295,920 Mongolia 1,144,800 800 0 37,000 350,160 Mozambique 110,763,420 60,016 1,373,600 23,600 3,278,160 Myanmar 35,536,744 18,936 6,108,125 200 14,780,928 Nepal 24,981,000 211,800 641,000 74,000 4,015,160 Nicaragua 2,911,680 504 0 0 50,000 Niger 979,200 54,100 499,000 7,920 437,040 Nigeria 44,137,048 665,160 3,316,700 0 1,229,445 Pakistan 20,000 900 0 50,090 123,840 Papua New Guinea 1,101,600 30,000 22,000 4,000 82,720 Philippines 0 0 0 0 0 Rwanda 20,606,200 84,062 8,200 13,200 68,400 Sao Tome and Principe 1,108,800 300 28,000 0 98,100 Senegal 7,005,000 67,864 160,000 0 139,140 Sierra Leone 19,728,000 230,400 332,650 16,000 1,087,240 Solomon Islands 0 0 0 0 0 Somalia 0 2,500 3,500 0 0 South Sudan 11,340,000 25,016 150,000 0 20,000 Sri Lanka 4,056,624 65,500 0 0 3,589,760 Sudan 0 36,936 0 6,000 2,123,400 Tajikistan 5,689,200 0 142,000 0 613,440 Tanzania 4,320,184 798,920 2,830,850 177,000 2,885,763 Timor-Leste 1,080,000 20,000 0 0 0 Togo 14,946,200 67,388 140,000 0 25,002 Uganda 78,884,400 297,652 3,895,400 251,000 249,520 Uzbekistan 13,217,540 0 0 0 718,989 Vietnam 21,816,000 12,636 1,196,500 1,239,531 0 West Bank and Gaza 1,944,000 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 7,104,960 64,288 445,000 0 0 Zambia 87,918,794 161,800 3,418,650 0 3,528,960 Zimbabwe 104,901,000 60,496 1,399,200 10,000 12,716,941 Other FP2020 Shipment Volumes 9,942,000 1,058,100 5,912,600 228,950 23,003,805 Total Volumes 1,109,534,426 8,251,267 58,685,807 4,006,940 124,754,403 AP PE N D IC ES 24 EXHIBIT A.4: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2018 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 0 16,500 307,750 0 224,480 Bangladesh 10,771,200 793,064 15,194,000 480,000 20,049,680 Benin 12,966,000 38,100 38,000 0 2,250 Bhutan 0 0 0 0 0 Bolivia 0 73,300 200,000 0 230,022 Burkina Faso 12,008,400 342,940 246,400 0 3,398,400 Burundi 0 4,000 126,400 0 415,332 Cambodia 3,427,200 46,392 700,000 0 11,986,296 Cameroon 9,633,600 112,952 338,000 3,500 100,000 Central African Republic 12,960,000 4,800 108,200 0 39,648 Chad 1,008,000 38,846 187,000 0 5,000 Comoros 1,180,800 0 0 0 3,000 Democratic Republic of Congo 54,908,976 331,170 1,343,100 0 370,560 Congo Rep 0 246,500 0 86,000 12,120 Cote d'Ivoire 25,420,800 139,088 474,800 18,800 3,867,676 Djibouti 396,000 3,200 70,400 0 0 Egypt Arab Rep 0 160,046 0 3,774,650 0 Eritrea 0 2,200 100,000 0 10,025 Ethiopia 25,152,720 1,205,446 7,753,455 600,000 7,896,030 Gambia 0 1,400 160,500 0 660,816 Ghana 33,221,400 282,314 2,423,500 30,500 2,827,200 Guinea 0 0 100,000 0 51,360 Guinea-Bissau 10,310,400 0 6,600 0 42,120 Haiti 101,747,640 34,016 1,827,000 2,000 100,212 Honduras 34,740,000 1,000 107,000 1,100 74,880 India 0 0 102,000 3,221,980 366,065 Indonesia 0 0 0 852,430 0 Iraq 1,000,800 0 0 0 0 Kenya 2,000,000 379,232 470,124 84,225 12,791,937 Korea Dem Rep 0 0 0 0 0 Kyrgyz Republic 0 0 0 0 0 Lao PDR 600,000 0 242,000 0 660,600 Lesotho 8,192,600 7,644 15,000 0 116,682 Liberia 28,800 37,500 705,200 0 32,400 Madagascar 5,001,000 325,344 4,866,200 0 204,800 Malawi 180,945,600 173,874 4,947,825 0 1,250,484 Mali 10,207,200 56,576 1,578,800 0 1,063,635 APPENDIX A AP PE N D IC ES 25 EXHIBIT A.4: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2018 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 0 5,700 86,800 0 711,360 Mongolia 900,000 6,200 0 0 420,000 Mozambique 92,244,400 231,648 3,291,800 10,000 643,680 Myanmar 49,103,616 103,540 2,889,125 5,000 11,190,719 Nepal 16,943,496 176,000 2,170,400 20,000 3,299,530 Nicaragua 11,164,320 2,854 0 12,000 0 Niger 849,600 170,940 914,200 0 658,002 Nigeria 48,724,800 1,023,764 4,731,600 150,800 1,996,764 Pakistan 612,000 10,000 100,000 320,285 0 Papua New Guinea 5,680,800 60,000 5,000 0 424,967 Philippines 2,397,600 0 0 50,450 0 Rwanda 30,399,200 256,072 862,200 0 55,680 Sao Tome and Principe 1,315,008 500 26,000 0 67,080 Senegal 11,052,000 186,336 0 7,000 0 Sierra Leone 1,987,200 153,533 972,800 0 435,480 Solomon Islands 0 0 0 0 0 Somalia 100,800 15,240 100,000 0 0 South Sudan 2,476,000 54,000 340,000 0 610,080 Sri Lanka 0 500 0 0 2,119,680 Sudan 720,000 51,264 0 0 0 Tajikistan 5,083,200 0 138,000 0 595,224 Tanzania 2,868,000 810,780 2,067,300 10,000 1,273,980 Timor-Leste 0 3,900 0 0 0 Togo 14,767,832 75,264 118,400 0 164,154 Uganda 178,114,000 811,576 5,469,525 103,500 4,369,950 Uzbekistan 0 0 0 0 0 Vietnam 21,816,000 0 0 925,250 0 West Bank and Gaza 0 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 1,483,200 37,440 1,093,600 29,700 30,000 Zambia 85,347,400 115,096 1,855,950 0 6,965,040 Zimbabwe 150,850,460 87,500 1,010,975 0 18,265,635 Other FP2020 Shipment Volumes 22,487,648 1,263,200 7,977,325 87,000 10,256,278 Total Volumes 1,317,317,716 10,570,291 80,960,254 10,886,170 133,406,993 APPENDIX A Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020. AP PE N D IC ES 26 EXHIBIT A.5: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2019 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Afghanistan 9,003,000 7,800 617,000 175,800 1,228,896 Bangladesh 3,204,000 265,253 4,383,060 300,000 16,506,300 Benin 103,000 214,400 125,600 10,000 0 Bhutan 1,584,000 0 0 0 0 Bolivia 10,000 78,500 60,000 0 12,240 Burkina Faso 7,013,000 416,984 1,161,500 0 4,800 Burundi 0 130,000 1,080,000 0 343,160 Cambodia 6,724,800 55,780 750,000 50,000 9,370,784 Cameroon 24,774,472 29,780 40,000 15,100 80,640 Central African Republic 0 738 94,900 0 1,615,008 Chad 6,819,120 153,366 379,800 0 226,080 Comoros 1,180,800 0 0 0 0 Democratic Republic of Congo 68,843,680 576,760 3,128,810 0 1,356,466 Congo Rep 0 148,904 19,800 190,405 9,540 Cote d'Ivoire 25,732,600 180,376 492,000 22,000 2,906,090 Djibouti 288,000 0 0 0 218,160 Egypt Arab Rep 11,224,800 333,164 0 490,200 0 Eritrea 0 17,300 100,000 0 10,800 Ethiopia 11,628,720 1,558,934 8,006,045 55,863 7,272,957 Gambia 2,548,800 69,984 140,000 0 105,840 Ghana 11,930,400 390,383 1,515,900 31,653 3,460,660 Guinea 49,433,040 0 666,600 0 287,440 Guinea-Bissau 10,581,904 0 22,500 0 221,436 Haiti 74,402,640 10,000 2,691,800 0 670,896 Honduras 0 144 45,000 0 600,000 India 0 0 0 814,796 38,100 Indonesia 5,000 0 0 1,093,300 0 Iraq 0 0 0 0 308,880 Kenya 38,478,000 366,320 80,000 24,930 3,085,600 Korea Dem Rep 288,000 0 0 0 74,880 Kyrgyz Republic 198,000 0 0 0 0 Lao PDR 1,490,400 0 256,000 0 2,857,608 Lesotho 1,728,000 2,016 140,600 0 117,900 Liberia 13,836,000 9,800 75,000 12,500 0 Madagascar 0 278,616 5,106,200 20,000 1,599,120 Malawi 180,626,600 670,252 6,569,700 0 2,534,400 Mali 25,216,560 293,636 256,200 2,000 682,560 APPENDIX A AP PE N D IC ES 27 EXHIBIT A.5: 69 FP2020 COUNTRIES CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2019 COUNTRY CONDOMS MALE & FEMALE IMPLANTS INJECTABLES IUDS ORALS Mauritania 3,122,000 18,580 46,200 0 813,960 Mongolia 180,000 13,800 103,260 0 600 Mozambique 139,627,576 193,108 4,086,200 10,000 4,518,240 Myanmar 26,785,008 80,100 1,075,000 0 12,987,721 Nepal 13,999,872 224,200 349,800 0 1,750,896 Nicaragua 0 5,484 0 0 0 Niger 15,577,200 116,248 100,000 0 1,416,762 Nigeria 73,063,000 1,217,772 3,150,800 295,000 1,200,240 Pakistan 7,061,600 242,600 204,400 1,070,100 40,320 Papua New Guinea 2,997,800 145,000 572,400 0 364,209 Philippines 2,390,400 200,000 0 0 29,808 Rwanda 28,596,400 213,185 441,000 0 956,160 Sao Tome and Principe 1,058,200 800 19,000 0 100,080 Senegal 10,727,000 142,056 466,000 72,000 986,580 Sierra Leone 3,602,200 274,900 276,000 57,500 454,320 Solomon Islands 0 0 0 0 0 Somalia 0 0 45,000 0 810,000 South Sudan 10,850,000 0 350,000 0 1,004,400 Sri Lanka 4,913 100,508 0 0 2,119,680 Sudan 0 26,800 146,400 0 6,472,122 Tajikistan 4,489,200 0 166,000 0 717,768 Tanzania 30,880,400 421,154 3,895,300 174,590 3,911,247 Timor-Leste 725,760 10,000 220,000 0 340,704 Togo 26,079,160 79,600 274,400 0 569,952 Uganda 156,917,600 414,360 2,899,740 161,500 436,968 Uzbekistan 6,652,800 0 570,000 1,730,000 760,002 Vietnam 0 11,000 490,900 476,950 0 West Bank and Gaza 1,761,120 0 0 0 0 Western Sahara 0 0 0 0 0 Yemen Rep 1,269,600 97,708 498,600 28,100 12,694,226 Zambia 87,024,384 81,456 2,884,600 0 2,113,590 Zimbabwe 122,185,440 186,600 758,000 0 6,225,040 Other FP2020 Shipment Volumes 16,560,800 456,500 6,216,400 219,730 14,807,358 Total Volumes 1,383,086,769 11,232,709 68,309,415 7,604,017 136,410,194 APPENDIX A Sources: [1] Historical Supplier-Reported Shipment Data; [2] RHI Shipment Data, September 2020. AP PE N D IC ES 28 In developing this report’s market analyses, a variety of data sources from partner organizations that provide family planning market data at the global level were reviewed. These databases were assessed based on available metrics, coverage of countries, frequency of updates, and ease of access to identify the most appropriate sources for sustainable analyses, that will be updated as new data becomes available. The fol- lowing provides an overview of the data sources this report relied upon for market analyses: FP2020 Global Markets Visibility Project In early 2014, CHAI, in partnership with RHSC and the FP2020 Market Dy- namics Working Group, launched the Global Markets Visibility Project to help various donors, suppliers, and partners improve their understand- ing of the current market size and trends for key contraceptive markets. CHAI collects historical shipment data by product and country from suppliers for each of the 69 FP2020 focus countries. For the reports published in 2015, 2016, 2017, and 2018, CHAI partnered with Concept Foundation to collect and aggregate shipment data from participat- ing members of the RHSC Generic Manufacturers for Reproductive Health Caucus (GEMs). For the subsequent reports, CHAI has collected shipment data directly from GEMs suppliers. To date, the Global Markets Visibility Project has collected historical shipment data that covers institutional sales (USAID, UNFPA, SMOs, etc.) and MOH tender volumes from 16 manufacturers across five family planning product categories. The main analyses and data reflected in this report in the Supplier Shipment Analysis and associated Appendices are based on the suppli- er shipment data collected through this project. U.S. Agency for International Development (USAID) Overview of Contraceptive and Condom Shipments Report USAID has provided commodities for family planning and reproductive health activities since the mid-1960s. The Overview of Contraceptive and Condom Shipments report is an annual publication that summa- rizes contraceptive and condom shipments sponsored by USAID, by value and unit. For the purposes of this year’s Family Planning Market Report’s Donor Spend Analysis, the FY2015 through FY2019 reports for FP2020 countries were accessed and used to analyze USAID’s spend on contraceptives, excluding male and female condoms, over the period. Values are inclusive of commodity and freight costs and are reported based on the USAID fiscal year which ends on September 30. APPENDIX B — DATA SOURCES The United Nations Population Fund (UNFPA) Procurement Services Branch (PSB) Procurement Data UNFPA is the lead agency within the United Nations system for the pro- curement of reproductive health commodities and has been procuring reproductive health supplies for low- and middle-income countries for over 40 years. For the purposes of this year’s Family Planning Market Report’s Donor Spend Analysis, CHAI worked with UNFPA PSB to deter- mine the value of the contraceptive procurement conducted by UNFPA from 2015 to 2019 for FP2020 countries. Values are inclusive of commod- ity cost and exclude services such as freight, sampling, inspection, and testing and are reported based on the calendar year. Reproductive Health Interchange (RHI)23 Hosted by UNFPA, RHI has historically collected data on past and upcoming contraceptive volume shipments for over 140 countries from the central procurement offices of major contraceptive donors and procurers. This database has been updated at variable times that depend on the frequency of data submissions from the data provider. The database has aimed to capture all of UNFPA’s and USAID’s contra- ceptive purchases, MSI’s and IPPF’s central procurements, government procurement and a few other procuring organizations’ purchases. For this report, the full RHI dataset was downloaded in September 2020. RHI is used as a comparison for the supplier dataset for a high-level understanding of supplier shipment data coverage as well as for male condom data. AP PE N D IC ES 23. RHI was formerly available at https://www.unfpaprocurement.org/rhi-home. On September 21, 2020, the RHI interface was replaced by RH Viz. RHI Viz is a series of public-facing dash- boards, combining historical procurement data with live shipment data from the Global Family Planning VAN. (https://www.rhsupplies.org/activities-resources/tools/reproductive-health-sup- plies-visualizer-rh-viz/). https://www.rhsupplies.org/activities-resources/tools/reproductive-health-supplies-visualizer-rh-viz/ https://www.rhsupplies.org/activities-resources/tools/reproductive-health-supplies-visualizer-rh-viz/ 29 The value of the FP2020 public-sector market was calculated using the most comprehensive available data sources: historical supplier-report- ed shipment data and RHI shipment data. Participating Suppliers’ Representation of the RHI Market Within the RHI shipment data, the suppliers participating in the Global Markets Visibility Project held 97 percent or more of the cumulative shipment volumes from 2015 to 2019 for every category with the excep- tion of IUDs and emergency contraceptives, where suppliers held 42 percent and 69 percent of the volumes, respectively. (Exhibit C.1). APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC-SECTOR MARKET AP PE N D IC ES EXHIBIT C.1: GLOBAL MARKETS VISIBILITY PROJECT PARTICIPATING SUPPLIER VOLUMES WITHIN RHI BY METHOD FOR THE FP2020 PUBLIC-SECTOR MARKET24 METHOD PARTICIPATING SUPPLIER VOLUMES IN RHI 2015-2019 ALL SUPPLIER VOLUMES IN RHI 2015-2019 % OF TOTAL METHOD VOLUMES Condoms - Female 96M 100M 97% Implants 43M 43M 100% Injectables 261M 261M 100% IUDs 6M 14M 42% Orals - Combined & Progestin Only 368M 376M 98% Orals - Emergency 6M 9M 69% Total 781M 803M 97% EXHIBIT C.2: UNIT OF MEASUREMENT METHOD UNIT OF MEASURE Condoms - Female Piece Condoms - Male Piece Implants Set Injectables Vial IUDs Piece Orals - Combined Cycle Orals - Progestin Only Cycle Orals - Emergency Doses Sources: [1] RHI Shipment Data, September 2020 The historical supplier-reported shipment data captured a more comprehensive view of the FP2020 public-sector market for female condoms, implants, injectables, IUDs, and orals relative to RHI, and thus served as the primary data source for these product markets. For male condoms, however, RHI is the more comprehensive data source and CHAI leverages RHI for male condom data. The data is quantified by the units of measurement outlined in Exhibit C.2. 24. Note that the percent of total method volumes in Exhibit C.1 were calculated prior to rounding. 30 EXHIBIT C.3: GLOBAL MARKETS VISIBILITY PROJECT PARTICIPANTS AND PRODUCTS MANUFACTURER CONDOMS - FEMALE IMPLANTS INJECTABLES IUDS ORALS Bayer • • • • Cipla • CR Zizhu • Cupid • Female Health Company • Helm AG • • • Incepta • • Medcines360 • Merck (MSD) • • Mylan • • • Pfizer • Pregna • PT Tunggal • • Shanghai Dahua • SMB • Techno Drugs • • • Historical Supplier-Reported Data To date, the Global Markets Visibility Project has collected historical supplier-reported shipment data from 16 manufacturers – Bayer, Cipla, CR Zizhu, Cupid, Female Health Company, Helm AG, Incepta Pharma- ceuticals, Medicines360, Mylan, Merck (MSD), Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, and Techno Drugs. Collectively, the total volumes cover institutional sales (USAID, UNFPA, MSI, etc.) and MOH tenders across five family planning product categories.25 AP PE N D IC ES Suppliers have cumulatively shipped 103 million female con- doms, 49 million implants, 355 million injectables, 43 million IUDs, 658 million orals (combined & progestin only), and 31 million emergency contraceptives from 2015 to 2019. It is important to note that there were several shipments to procurer (USAID, UNFPA, SMOs) warehouses in non-FP2020 countries, such as Belgium, Denmark, Finland, France, Germany, Netherlands, Norway, Sweden, Switzerland, UK, and USA. Although these volumes were ini- tially shipped to non-FP2020 countries, these shipments were likely to go onto the 69 FP2020 countries. As a result, these non-FP2020 country volumes were included in the total shipments to 69 FP2020 countries after it was confirmed that the specific non-FP2020 country volumes were associated with institutional purchases. Sources: [1] RHI Shipment Data, September 2020 Note: Cumulative totals calculated using actual, rather than rounded numbers. APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC-SECTOR MARKET EXHIBIT C.4: SUPPLIER-REPORTED SHIPMENT VOLUMES TO FP2020 COUNTRIES BY METHOD, 2015-2019 METHOD 2015 2016 2017 2018 2019 CUMULATIVE TOTAL 2015-2019 Condoms – Female 25M 22M 22M 13M 20M 103M Implants 10M 9M 8M 11M 11M 49M Injectables 97M 50M 59M 81M 68M 355M IUDs 10M 10M 4M 11M 8M 43M Orals - Combined & Progestin Only 168M 114M 118M 127M 131M 658M Orals - Emergency 7M 6M 6M 6M 6M 31M 25. Total shipment of oral contraceptives includes combined, progestin-only, and emergency oral contraceptives. 31 CHAI analyzed and assessed the aggregated historical supplier-re- ported shipment data to confirm the coverage across various FP2020 product markets was greater relative to RHI shipment data for the 69 FP2020 countries. The aim of collecting historical volumes of all institutional purchases and MOH tenders directly from suppliers was to address data gaps observed in RHI shipment data which only capture a subset of procurers who chose to submit historical procurement data. Furthermore, although some countries report national procurements, most national procurements are not reported in the RHI database. The cumulative total from 2015 to 2019 for historical supplier-reported shipment volumes to 69 FP2020 countries and procurer warehouses is greater than RHI in every method. AP PE N D IC ES Sources: [1] RHI Shipment Data, September 2020 APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC-SECTOR MARKET * Includes all reporting RHI suppliers to FP2020 countries and procurer warehouses EXHIBIT C.5: SUPPLIER-REPORTED SHIPMENT VOLUMES AS A PERCENTAGE OF RHI REPORTED* VOLUMES BY METHOD, 2015-2019 METHOD 2015 2016 2017 2018 2019 CUMULATIVE TOTAL 2015-2019 Condoms - Female 113% 101% 118% 73% 108% 103% Implants 125% 129% 106% 98% 121% 114% Injectables 184% 119% 122% 143% 109% 136% IUDs 392% 299% 169% 330% 361% 311% Orals - Combined & Progestin Only 193% 162% 224% 185% 135% 175% Orals - Emergency 389% 620% 459% 368% 179% 345% 32 Male Condom Market Historical RHI shipment data for male condoms was used to capture a more comprehensive view of the family planning market for the 69 FP2020 countries. The report used RHI shipment volume data from 2015 to 2019 and included all male condom shipment volumes to the 69 FP2020 countries as well as volumes associated with procurer warehouses in non-FP2020 focus countries.26 The male condom market reflected by the RHI data includes at least 18 manufacturers and 6 funding sources. Sources: [1] RHI Shipment Data, September 2020 EXHIBIT C.6: RHI MALE CONDOMS SHIPMENT VOLUMES, 2015-2019 METHOD 2015 2016 2017 2018 2019 Condoms – Male 1.35B 1.15BB 1.09B 1.30B 1.36B AP PE N D IC ES APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC-SECTOR MARKET The historical supplier-reported volumes for female condoms, implants, injectables, IUDs, and orals, together with RHI shipment volumes for male condoms, represent the estimated FP2020 public-sector market from 2015 to 2019. 26. Total yearly volumes are based on the year that the product was shipped. 33 APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC-SECTOR MARKET Sources: [1] USAID, “Couple-Years of Protection (CYP),” January 2019. EXHIBIT C.7: VOLUMES TO CYPS SHIPPED CONVERSION FACTORS, 2015–2019 METHOD COUPLE-YEARS OF PRO- TECTION (CYP) Condoms - Female 120.00 Condoms - Male 120.00 Implants - 3 Year 0.40 Implants - 4 Year 0.31 Implants - 5 Year 0.26 Injectables - 1 month 13.00 Injectables - 2 month 6.00 Injectables - 3 month 4.00 IUDs 0.22 Orals – Combined 15.00 Orals – Progestin Only* 12.00 or 15.00* Orals – Emergency 20.00 Total FP2020 Public-Sector Market In Terms of CYPs All shipment volumes were translated to CYPs by dividing shipment volumes by each method’s corresponding couple-years of protection (CYP) factor. All shipment volumes were divided by the corresponding CYP fac- tor published by USAID. CYP is the estimated protection provided by contraceptive methods based upon the volume of all methods sold or distributed for free to clients during that period of time.27 Because various methods may have different CYPs associated with different sub-types of that method (e.g. there are different CYP factors for three-, four-, and five-year implants) the corresponding CYP of the method sub-type is used. The following exhibit shows the conversion factors used to translate volumes to CYPs. AP PE N D IC ES * For the conversion of shipment volumes to CYPs shipped, an oral contraceptive unit that provides 28 days of protection is converted to CYPs using a units-per-CYP conver- sion factor of 15, while an oral contraceptive unit that provides 35 days of protection is converted to CYPs using a units-per-CYP conversion factor of 12.28 27. USAID, “Couple-Years of Protection (CYP)”, available at https://www.usaid.gov/glob- al-health/health-areas/family-planning/couple-years-protection-cyp. 28. As per supplier conversations https://www.usaid.gov/global-health/health-areas/family-planning/couple-years-protection-cyp https://www.usaid.gov/global-health/health-areas/family-planning/couple-years-protection-cyp 34 APPENDIX C — ESTIMATING THE TOTAL FP2020 PUBLIC-SECTOR MARKET Value of the Total FP2020 Public-Sector Market The total value of contraceptives was calculated by applying average unit prices to total shipment volumes. Although different prices exist across products and markets, the report estimated implied spend using UNFPA’s Contraceptive Price Indicator, given the Contraceptive Price Indicator is publicly available and consistently updated.29 Finally, the Implant Access Program price of $8.50 was applied to implant volumes Sources: [1] UNFPA Contraceptive Price Indicator, 2015 to 2019; [2] IAP Implant Prices. Notes: [1] For 2015-2018 implants, the Implant Access Program price is used; [2] Otherwise, the price range and unit prices in each year are based on UNFPA’s Contraceptive Price Indicator from 2013 to 2018. In 2019, the average implant price on the UNFPA Contraceptive Price Indicator dipped below $8.50—accordingly, UNFPA’s listed price was used in calculations for 2019. The average price only includes the cost of the product and does not account for additional costs associated with procurement such as testing, insurance, and shipping costs. EXHIBIT C.8: AVERAGE UNIT PRICE PRICE RANGE 2015 2016 2017 2018 2019 Method Minimum Maximum Unit Price Unit Price Unit Price Unit Price Unit Price Condoms - Female $0.44 $0.49 $0.49 $0.49 $0.46 $0.47 $0.44 Condoms – Male $0.02 $0.03 $0.03 $0.03 $0.02 $0.02 $0.02 Implants $8.37 $8.50 $8.50 $8.50 $8.50 $8.50 $8.37 Injectables $0.77 $0.82 $0.81 $0.82 $0.79 $0.81 $0.77 IUDs $0.30 $0.31 $0.30 $0.30 $0.31 $0.30 $0.31 Orals – Combined $0.23 $0.29 $0.29 $0.26 $0.27 $0.24 $0.23 Orals – Progestin Only $0.29 $0.34 $0.34 $0.33 $0.32 $0.29 $0.29 Orals - Emergency $0.26 $0.40 $0.37 $0.35 $0.26 $0.28 $0.40 www.unfpa.org/resources/contraceptive-price-indicator-year-2017, UNFPA, “UNFPA Contra- ceptive Price Indicator –Year 2016”, available at http://www.unfpa.org/resources/contracep- tive-price-indicator-2016, UNFPA, “UNFPA Contraceptive Price Indicator—Year 2015”available at https://www.unfpa.org/resources/contraceptive-price-indicator-2015 AP PE N D IC ES 29. UNFPA, “UNFPA Contraceptive Price Indicator—Year 2019”, available at https://www.unf- pa.org/resources/contraceptive-price-indicator-year-2019, UNFPA, “UNFPA Contraceptive Price Indicator –Year 2018”, available at https://www.unfpa.org/resources/contraceptive-price-indica- tor-year-2018, UNFPA, “UNFPA Contraceptive Price Indicator –Year 2017”, available at https:// 35 To protect customer confidentiality, suppliers were not asked to dis- close customer information associated with shipment volumes. CHAI uses information from USAID, GHSC-PSM, and UNFPA to understand do- nor spend by the two major institutional procurers of family planning commodities. For more information on each of these data sources, refer to Appendix B. APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-SPEND VOLUMES Going forward, CHAI will continue to work closely with the two major institutional procurers of family planning commodities to ensure the data provided is the most accurate and accessible for the purposes of this report. AP PE N D IC ES 36 APPENDIX E – ADDITIONAL MARKETS VISIBILITY This report has historically included supplementary research and analysis using publicly available data sources in three large markets: Bangladesh, India, and Indonesia.30 In this section, the analysis is re- freshed with the latest data for Bangladesh and India. Publicly available data on government procurement has been limited in Indonesia in recent years, so Indonesia has been removed for now from the market visibility analysis. Given the limitations of publicly available data sources, this report cannot confirm that these market visibility analyses represent compre- hensive coverage of the public-sector markets in India and Bangladesh. Rather, the data is meant to be used as initial confirmation of domestic procurement in these markets, that is not covered by the suppliers participating in this report. AP PE N D IC ES 30. Bangladesh and India accounted for a large proportion of the gap between FP2020-re- ported users of product-based methods and users implied by the shipment data based on country-specific comparisons (per 2016 analysis, when markets visibility analysis was added to the FP Market Report). Note: Indonesia also accounts for a notable proportion of the gap between FP2020-reported users of product-based methods and users implied by the shipment data but is currently excluded from the market visibility analysis given limited publicly-available data on procurement in recent years. 37 AP PE N D IC ES Bangladesh The Bangladesh Ministry of Health and Family Welfare (MOHFW) procured 12 million CYPs for the 2019 calendar year, as compared to 17 million CYPs for the 2018 calendar year, 3 million CYPs for the 2017 cal- endar year, 8M CYPs for the 2016 calendar year, and 13 million CYPs for the 2015 calendar year. Procurement contracts for contraceptives from 2015 to 2019 were awarded primarily to regional and local suppliers, including (but not limited to): Essential Drugs Co., HLL Lifecare Ltd, Khu- lna Essential, Maneesh Pharmaceuticals Ltd, M/S, Reneta Ltd., Popular Pharmaceuticals Ltd,32 and Techno Drugs. Only the data from a subset of these manufacturers is included in the supplier shipment data.33 By applying the same prices33 used for 2019 supplier shipment volumes to the volumes from the Bangladesh MOHFW procurement data, the implied value from Bangladesh’s procurement contracts is estimated to be $38 million for 2019, as compared to the $10 million implied by the 2019 supplier shipment data. APPENDIX E – ADDITIONAL MARKETS VISIBILITY Although procurement of contraceptives has fluctuated in Bangladesh, consumption has remained stable. A review of Bangladesh’s supply chain reports revealed that consumption of contraceptive commodities has been fairly consistent—between 10.5 to 13.5 million CYPs—from 2015 to 2019. This analysis relies on data from the Government of Bangladesh’s Min- istry of Health and Family Welfare (MOHFW)34 for 2015, 2016, 2017, 2018 and 2019.35 31. In 2017, Incepta Pharmaceuticals supplied the Ministry of Health and Family Welfare (MOHFW) with injectables via Popular Pharmaceuticals Ltd. Source: Incepta Pharmaceuticals. 32. Manufacturers participating in this report include Techno Drugs from Bangladesh and Popular Pharmaceuticals Ltd (via Incepta Pharmaceuticals). 33. To estimate the market value in Bangladesh and India, the report applies the same pricing assumptions used for supplier shipment analyses (from the UNFPA Contraceptive Price Indicator) throughout the markets visibility appendix. Actual pricing may differ in these markets given the different suppliers at play. However, the UNFPA prices have been applied to maintain publicly available, consistently updated pricing assumptions throughout the report. 34. Government of Bangladesh, Ministry of Health and Family Welfare, “MOHFW Supply Chain Management Portal – National Receive Details; Product Group: Contraceptive; Product Name: ALL; Warehouse; ALL” available at: https://scmpbd.org/index.php/wims-reports/national-re- ceive-details 35. The fiscal year for Bangladesh runs from July 1 to June 30 but, for the purposes of this analysis, monthly procurement data was summed for each calendar year for 2015-2019. https://scmpbd.org/index.php/wims-reports/national-receive-details https://scmpbd.org/index.php/wims-reports/national-receive-details 38 MOHFW SUPPLY CHAIN CONTRACEPTIVE SHIPMENT RECEIPT DETAILS (PUBLICLY-AVAILABLE DATA) PRODUCT NAME SUPPLIER NAME 2015 2016 2017 2018 2019 CONDOM Direct Relief 0 0 0 1,584,000 0 CONDOM ESSENTIAL DRUGS CO. LTD. 50,000,000 68,850,000 0 56,854,800 11,600,800 CONDOM KHULNA ESSENTIAL LATEX PLANT (KELP) 100,000,000 35,000,000 0 62,158,800 95,894,000 CONDOM UNFPA 0 0 1,195,200 10,080,000 0 EMERGENCY CONTRACEPTIVE PILLS (2 TAB/PACK) M/S, RENETA LTD. 100,000 100,000 0 100,000 100,000 IMPLANT (2 ROD) SOCIAL MARKETING COMPANY (SMC) 0 17,000 0 0 0 IMPLANT (2 ROD) TECHNO DRUGS Ltd 0 0 0 385,000 429,054 IMPLANT (2 ROD) USAID 0 0 35,000 0 0 IMPLANT (SINGLE ROD) JAMES INTERNATIONAL 0 5 2,880 0 0 IMPLANT (SINGLE ROD) Merck Sharp & Dohme B.V(MSD B.V.). 0 150,000 3,000 0 0 IMPLANT (SINGLE ROD) MSD-NV Organon, Organon(India) Private Ltd. 50,000 0 199,980 0 0 IMPLANT (SINGLE ROD) UNFPA 0 0 0 200,000 5,000 INJECTABLES (DMPA-IM) Helm-AG 14,000,000 0 0 0 0 INJECTABLES (DMPA-IM) Popular Pharmaceuticals Ltd. 0 0 1,000,000 1,000,000 0 INJECTABLES (DMPA-IM) TECHNO DRUGS Ltd 2,500,000 8,100,000 5,000,000 18,250,000 8,230,000 INJECTABLES (DMPA-IM) UNFPA 0 0 299,997 0 0 INJECTABLES (DMPA-IM) USAID 0 0 1,000,000 914,800 0 IUD (CT-380A) IPAS Bangladesh 0 0 0 9,500 0 IUD (CT-380A) MARIE STOPES CLINIC 0 0 65,000 56,000 0 IUD (CT-380A) SARBAN INTERNATIONAL LTD. 400,000 0 0 0 0 IUD (CT-380A) SMB Corporation Of India 0 0 0 450,000 0 IUD (CT-380A) SOCIAL MARKETING COMPANY (SMC) 73,679 0 0 0 0 IUD (CT-380A) UNFPA 0 0 0 200,000 0 ORAL CONTRACEPTIVE PILL (SHUKHI) HLL Lifecare Limited 22,469,025 0 0 0 0 ORAL CONTRACEPTIVE PILL (SHUKHI) Maneesh Pharmaceuticals Limited 22,289,280 0 0 0 0 ORAL CONTRACEPTIVE PILL (SHUKHI) M/S, RENETA LTD. 20,730,975 54,750,000 0 54,800,125 110,000,001 ORAL CONTRACEPTIVE PILL (SHUKHI) Popular Pharmaceuticals Ltd. 10,800,000 14,250,000 0 16,700,000 0 ORAL CONTRACEPTIVE PILL (SHUKHI) TECHNO DRUGS Ltd 1,710,720 0 0 16,700,000 0 ORAL PILL APON M/S, RENETA LTD. 1,000,000 3,500,000 750,000 4,000,000 1,000,000 AP PE N D IC ES APPENDIX E – ADDITIONAL MARKETS VISIBILITY Source: Bangladesh MOHFW, Supply Chain Management Portal, 2020. 39 India Based on India’s Ministry of Health and Family Welfare (MOHFW)36 Annual Report for the 2019-2020 fiscal year,37 CYPs procured from product-based methods38 totaled 32 million. This number represents a decrease of 19M CYPs, relative to the 51M CYPs procured in the 2018- 19 fiscal year. However, procurement in the 2019-20 fiscal year was closer to the 2015-16 to 2019-20 fiscal year average of 36M CYPs procured annually. The majority of the 2019-20 fiscal year decrease in CYPs (relative to the 2018-19 fiscal year) is attributable to a drop in IUDs procured. CYPs procured from IUDs were 22M in the 2019-20 fiscal year, down from 41M in the 2018-19 fiscal year. Decreases in oral contraceptive procurement also contributed to the overall drop in CYPs.39 However, these decreases were partly offset by increases in CYPs procured from male condoms and injectables. Sterilizations also decreased to 1.2M in the 2019-20 fiscal year, down from 3.5M in the 2018-19 fiscal year.40 36. Government of India, Ministry of Health and Family Welfare, “Annual Report of Department of Health & Family Welfare for the year of 2019-20” ,“Annual Report of Department of Health & Family Welfare for the year of 2018-19”, “Annual Report of Department of Health & Family Welfare for the year of 2017-18”, “Annual Report of Department of Health & Family Welfare for the year of 2016-17”, “Annual Report of Department of Health & Family Welfare for the year of 2015-16”available at: https://main.mohfw.gov.in/documents/publication 37. The fiscal year for India runs from April 1 to March 31. 38. Only modern contraceptive methods from India’s MOHFW reports, including male con- doms, injectables, IUDs, orals, and emergency contraception, are included in this analysis. 39. Note that the Indian MOHFW procures a weekly oral contraceptive that is sold under the names Saheli and Centchroman. USAID does not list a CYP factor for this method, so tthe market visibility analysis uses an approximate CYP factor of 9 strips (with 8 pills per strip) per year, based on demand estimation guidelines for clinics from the Indian MOHFW in the “Reference Manual for Oral Contraceptive Pills” from March 2016: https://nhm.gov.in/images/ pdf/programmes/family-planing/guidelines/Reference_Manual_Oral_Pills.pdf. Prices for the method were calculated by dividing the listed value and quantity of Centchroman under India’s Free Supply Scheme to estimate price per year. Given a lack of data in 2015, 2016 prices were applied for that year. 40. Sterilizations are not included in CYP and market value calculations, as they are not a product-based method of contraception. However, they are included in the MOHFW report: Government of India, Ministry of Health and Family Welfare, “Annual Report of Department of Health & Family Welfare for the year of 2019-20.” Although the MOHFW annual report shipment volumes are based on a fiscal year schedule, instead of the calendar years used in this report, for simplicity the same prices (in Exhibit C.8) were used to estimate the implied annual market value for supplier shipment and MOHFW procurement volumes. These calculations show MOHFW procurement values of approximately $36 million in the 2018-19 fiscal year and $33 million in the 2019-20 fiscal year, compared to the $4 million and $1 million implied by the 2018 and 2019 supplier shipment data. The MOHFW procurement data shows that market value dipped only slight- ly, despite a comparatively large CYP decrease of 19M from the 2018-19 to 2019-20 fiscal years. This trend is largely due to the large decrease in IUD volumes from 2018 to 2019 (a 45 percent decrease) as IUDs have a large CYP factor but are relatively inexpensive. AP PE N D IC ES APPENDIX E – ADDITIONAL MARKETS VISIBILITY https://main.mohfw.gov.in/documents/publication 40 AP PE N D IC ES APPENDIX E – ADDITIONAL MARKETS VISIBILITY ANNUAL REPORTS OF DEPARTMENT OF HEALTH & FAMILY WELFARE (INCLUDES FULL FISCAL YEARS 2015-16 TO 2019-20) QUANTITIES SUPPLIED TO STATES/UTS (PUBLICLY-AVAILABLE DATA) CONTRACEPTIVES 2015-16 2016-17 2017-18 2018-19 2019-20* Condoms (In million pieces) 394.0 432.8 526.8 0.0 378.1 Oral Pills (In lakh cycles) 361.2 312.0 275.3 394.4 384.3 IUDs (In lakh pieces) 60.4 48.1 22.6 88.5 48.3 Tubal Rings (In lakh pairs) 19.0 6.4 14.6 12.4 10.3 Emergency Contraceptive Pills (in lakh packs) 86.1 60.8 50.4 128.0 117.8 Centchroman Contraceptive Pill (Lakh Strips) 0.0 7.1 24.0 170.3 110.3 Injectable Contraceptive (Lakh Doses) 0.0 0.0 27.0 0.0 13.5 Pregnancy Test Kits (in lakhs) 100.1 124.6 180.4 187.0 205.8 EXHIBIT E.2.2 SOCIAL MARKETING SALES OF CONTRACEPTIVES (PUBLICLY-AVAILABLE DATA) CONTRACEPTIVES 2015-16 2016-17 2017-18 2018-19 2019-20* Condoms (Million pieces) 482.2 399.0 483.2 459.5 149.5 Oral Pills (Social Marketing) (lakh cycles) 152.8 194.3 205.3 159.2 34.7 SAHELI (in Lakh tablets) 311.2 321.8 321.8 77.5 0.0 *Figures are Provisional 41 APPENDIX F – KEY TERMS AND DEFINITIONS CYP Couple-Years of Protection (CYP) is the estimated protection provided by contraceptive methods during a one-year period (e.g. 120 condoms provide a couple protection for one year). CYP mix CYP mix refers to the percentage distribution of CYPs shipped by method. Value Value refers to the supplier-reported shipment volume multiplied by the estimated price (from the UNFPA Contraceptive Price Indicator) for specific years. Market Share Market share is the percentage of total value of shipment volumes in a market captured by a certain contraceptive method. Shipments or Shipment Volumes Shipment volumes refers to the amount of a particular contraceptive method that has been transported. Total FP2020 Public-Sector Market The total FP2020 public-sector market is based on volumes purchased by institutional buyers and MOH or government-affiliated procurers based on RHI data (male condoms) and historical supplier-reported shipment data (female condoms, implants, injectables, IUDs, and orals) for the 69 FP2020 focus countries, defined as countries with a 2010 gross national per capita annual income less than or equal to $2,500. Although South Africa made an FP2020 commitment, its GNI was greater than $2,500, and thus South Africa is not included in the FP2020 public-sector market calculations. AP PE N D IC ES 42 APPENDIX G – ACRONYMS CHAI CLINTON HEALTH ACCESS INITIATIVE CYP COUPLE-YEARS OF PROTECTION FP FAMILY PLANNING FP2020 FAMILY PLANNING 2020 GEMS GENERIC MANUFACTURERS FOR REPRODUCTIVE HEALTH IUD INTRA-UTERINE DEVICE LARC LONG-ACTING REVERSIBLE CONTRACEPTIVES MOH MINISTRY OF HEALTH MOHFW MINISTRY OF HEALTH AND FAMILY WELFARE RHI REPRODUCTIVE HEALTH INTERCHANGE RHSC REPRODUCTIVE HEALTH SUPPLIES COALITION UNFPA UNITED NATIONS POPULATION FUND USAID UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT AP PE N D IC ES ACKNOWLEDGEMENTS: This report was produced as part of the landmark FP2020 Global Markets Visibility Project that the Clinton Health Access Initiative, Inc. (CHAI) launched in early 2014 in conjunction with the Reproductive Health Supplies Coalition (RHSC). The shipment data provided by suppliers is the foundation of the report’s analyses and allows CHAI to address information gaps and construct a comprehensive view of the reproductive health commodities market. We would like to thank current participating suppliers: Bayer, CR Zizhu, Cipla, Cupid, Female Health Company, Helm AG*, Incepta Pharmaceuticals, Medicines360, Merck (MSD), Mylan, Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, and Techno Drugs, as well as our partner, Concept Foundation, for their support in collecting and aggregating 2011-2017** data from Generic Manufacturers for Reproductive Health (the GEMS Caucus). We are also grateful to our colleagues from the Consensus Planning Group (CPG), John Snow Inc. (JSI), United Nations Population Fund (UNFPA), the U.S. Department of International Development (USAID), the Global Health Supply-Chain – Procurement and Supply-Management (GHSC-PSM), and FP2020 for their invaluable feedback during the development and refinement of various market analyses. *HELM AG was a participating supplier in the FP2020 Global Markets Visibility Project for the FP 2015, 2016 and 2017 Market Reports. In September 2017, HELM AG sold its wholly-owned subsidiary company, HELM Medical GmbH, to Sanavita Pharmaceuticals GmbH. Refer to page 16 for more information on HELM AG and other participating suppliers. ** CHAI began collecting data directly from suppliers in the GEMS Caucus, starting with the 2018 shipment data.

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