Family Planning Market Report 2021

Publication date: 2021

FAMILY PLANNING MARKET REPORT DECEMBER 2021 CONTENTS THE STATE OF FAMILY PLANNING IN 2020 3 SUPPLIER SHIPMENT ANALYSIS 4 DONOR SPEND ANALYSIS 14 HIGHLIGHTS FROM DISCUSSION WITH KEY STAKEHOLDERS 17 GLOBAL MARKETS VISIBILITY PROJECT ACKNOWLEDGEMENTS 18 APPENDICES 20 ACKNOWLEDGEMENTS 43 3 Notable market trends Notable product trends Donor spend analysis Long-acting reversible contraceptives (LARCs) as a % of couple years of protection (CYPs) shipped from 2016-2020 Implants 43% Injectables 26% Combined and progestin-only orals 18% Condoms (male) 8% Market share per method based on value in 2020 $261M $191M 20202016 2018 ↑ 16% 74% 63% 69% 67% 62% 20202016 2018 Total public-sector market value 29% Increase in market value of combined and progestin-only orals from 2019 to 2020 � 26% Increase in market value of injectables from 2019 to 2020 � 20% Increase in market value of implants from 2019 to 2020 ♀ $170M UNFPA's total spend on contraceptive procurement in FY2020, an increase of 5% from FY2019 $45M USAID’s total spend on contraceptive procurement in FY2020, an increase of 20% from FY2019 THE STATE OF FAMILY PLANNING IN 2020 The public-sector market in the 69 FP2020 focus countries reached a five-year high in 2020 THE STATE OF FAMILY PLANNING IN 2020 The public-sector market in the 69 FP2020 focus countries reached a five-year high in 2020 4 SUPPLIER SHIPMENT ANALYSIS 1 The 69 FP2020 countries (defined as countries with a 2010 gross national income per capita less than or equal to $2,500) emerged from the 2012 London Summit on Family Planning and have historically been the focus of the Family Planning Market Report. The sexual and reproductive health (SRH) community is currently transitioning from the FP2020 to the FP2030 architecture, in which any country will be able to make a human rights-based commitment to sexual and reproductive health. Data collection for this year’s 2020 Family Planning Market Report took place prior to the announcement of the updated FP2030 architecture; accordingly, the Family Planning Market Report focuses on the 69 FP2020 focus countries. CHAI and RHSC will explore how to refine country scope for future report publications, in order to reflect the transition to the FP2030 architecture. 2 IUD is an abbreviation for an intra-uterine device; all IUD quantities shown in this report refer to copper IUDs. Data collection for the 2020 and 2021 Family Planning Market Reports did include the hormonal IUD. However, a public price for the hormonal IUD is unavailable in the 2020 UNFPA Contraceptive Price Indicator and therefore hormonal IUD volumes are not included in the report. Hormonal IUD shipment data will be included in future Market Reports once price points become publicly available on the UNFPA Contraceptive Price Indicator and data can be aggregated accordingly. 3 This report has historically used data from the Reproductive Health Interchange (RHI) to estimate the size of the male condom market. Since the male condom market is quite fragmented, RHI historically has provided greater visibility for that particular method. Additionally, RHI data has historically been used to assess the relative visibility the Family Planning Market Report provides across all methods. In September 2020, however, the SRH community transitioned away from the RHI platform to the Reproductive Health Supplies Visualizer (RH Viz). The 2020 Family Planning Market Report, therefore, now utilizes RH Viz data for male condom volumes and market visibility calculations. See Appendix C for further details. 4 Couple Years of Protection (CYP) is the estimated protection provided by contraceptive methods during a one-year period (for example, 120 condoms provide a couple protection for one year). For all CYP calculations, this report utilizes the CYP factors most recently published by USAID. See Appendix C for further details. 5 The currency reported is in US dollars, unless otherwise noted. The 2021 Family Planning Market Report provides visibility into the public-sector contraceptive market in the 69 FP2020 focus countries1 from 2016-2020. The public-sector volumes that are included in this report’s scope are those purchased by institutional buyers (such as USAID, UNFPA, and social marketing organizations), ministries of health, and government-affiliated procurers for the 69 FP2020 focus countries. The Family Planning Market Report analyzes procurement trends for all product-based modern methods of contraception, based on historical supplier-reported shipment data. This shipment data is collected from 17 suppliers, for methods including female condoms, implants, injectables, IUDs (copper)2, oral contraceptives (combined and progestin-only), and emergency oral contraceptives. Findings for male condoms are based on shipment data from the Reproductive Health Supplies Visualizer (RH Viz).3 Shipment data provides insights into the historical procurement of contraceptive products, but is not necessarily equivalent to demand for contraceptives, given procurement is shaped by key factors such as available funding and production capacity. From 2019 to 2020, the value of the FP2020 public-sector market increased by 16 percent, reaching a five-year high in market value despite the challenges presented by the COVID-19 pandemic. Market volumes also increased during this period, rising by 23 percent. Due to method- specific procurement trends, couple years of protection (CYPs)4 shipped to the FP2020 public-sector market remained constant from 2019 to 2020. The growth of the FP2020 public-sector market from 2019 to 2020 was driven by increased procurement volumes for implants, injectables, and oral contraceptives. CYPs shipped remained constant from 2019 to 2020; however, short-term methods represented a relatively greater proportion of the CYP mix in 202o than in 2019. Nevertheless, long-acting reversible methods of contraception (LARCs, i.e., implants and IUDs) continued to comprise the majority of CYPs shipped to the FP2020 public-sector market in 2020. Despite the COVID-19 pandemic, large-scale procurement disruptions did not take place in 2020. This section analyzes trends in shipment volumes, value in USD, and CYPs shipped in the FP2020 public-sector market from 2016 to 2020. THE TOTAL VALUE OF THE FP2020 PUBLIC-SECTOR MARKET REACHED A FIVE-YEAR HIGH OF $261M IN 2020. THE NUMBER OF CYPS SHIPPED REMAINED STABLE FROM 2019 TO 2020, DUE TO CHANGES IN THE MIX OF CONTRACEPTIVES PROCURED. Notable Market Trends The total value of the public-sector contraceptive market in the 69 FP2020 focus countries increased from $191 million5 in 2016 to $261 million in 2020 (Exhibit 1). Relative increases and decreases in market value were observed through the previous five-year period, with the 2017 market value of $176 million representing the lowest market value seen during that period (Exhibit 1). Overall, the size of the FP2020 public-sector market was $70 million larger in 2020 than in 2016, with the largest increases in market value occurring from 2017 to 2018 (+$47 million) and from 2019 to 2020 (+$37 million) (Exhibit 1). Despite the 16 percent increase in market value observed from 2019 to 2020, the quantity of CYPs shipped remained constant at 112 million in both 2019 and 2020 (Exhibits 1, 3). While the FP2020 public-sector market value increased, the number of CYPs shipped from 2019 to 2020 remained stable. This difference is due to shifts in the mix of contraceptives procured towards methods with a higher cost per CYP. IUD procurement decreased from 2019 to 2020, reducing the number of CYPs shipped by 14 million (Exhibit 3). Although this decrease was partially offset by an increase in CYPs shipped from implants (+8 million), short-term methods made up a higher proportion of the CYP mix overall in 2020 than in 2019 (Exhibits 3, 5). Since short-term methods tend to be relatively more expensive per CYP provided than LARCs, the number of CYPs shipped remained stable despite the increase seen in market value from 2019 to 2020 (Exhibits 3, 4). In terms of regional trends from 2016 to 2020, Sub- Saharan Africa’s market share stayed largely constant, ranging from a low of 64 percent in 2017 to a high of SU PP LI ER S H IP M EN T AN AL YS IS 5 72 percent in 2019 (Exhibit 7). Market share in the Asia and Pacific region increased slightly (by three percent) from 2019 to 2020 (Exhibit 7). Within the FP2020 public- sector market captured in this report6, the 10 largest countries (in terms of market value) represented over 50 percent of the overall market value in 2020, with Bangladesh7 comprising approximately 12 percent of the FP2020 public-sector market (Exhibits 8, 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 each year in the 2016 to 2020 period. Notable Product Trends INCREASED MARKET VALUE WAS DRIVEN BY GROWTH IN THE INJECTABLE, IMPLANT, AND ORAL CONTRACEPTIVE CATEGORIES. CYPS SHIPPED REMAINED RELATIVELY FLAT GIVEN LOWER VOLUMES OF (COPPER) IUDS IN 2020. Although overall market value grew, IUD volumes (comprised of the copper IUD only, as per footnote 2) declined for a second consecutive year in 2020, decreasing by 34 percent compared to 2019 volumes (Exhibit 2). This decrease in volumes only caused a small decline in the 2020 overall market value (-$1 million) as the IUD has a low unit cost (Exhibits 1, 4). However, since the IUD has the highest CYP per unit of any method in this report, the decrease in IUD volumes counter- balanced increases in CYPs shipped from other methods, keeping the overall number of CYPs shipped flat from 2019 to 2020 (Exhibits 4,3). The IUD volume decline was largely driven by decreased procurement in Pakistan, Uzbekistan, and India. All three countries procured notably higher volumes of the IUD in 2019, indicating that some of the decline in IUD volumes may have been cyclical and related to procurement patterns. 6 Private-sector contraceptive use does not factor into these market share numbers. Additionally, 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 also 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. 7 As noted in Footnote 6, the Family Planning Market Report provides visibility into contraceptive procurement trends in Bangladesh with data from the participating suppliers. However, there may be additional suppliers active in the Bangladesh market, beyond the participating suppliers captured in the Family Planning Market Report (see Appendix E for more details). Therefore, although Bangladesh comprised ~12 percent of the FP2020 public-sector market value in this report for 2020 (up from ~4 percent in 2019), that may or may not indicate that overall public-sector contraceptive procurement increased in size in Bangladesh when all participating and non-participating suppliers are considered. For example, if the suppliers participating in the Family Planning Market Report captured relatively larger market share in Bangladesh in one year than they did previously, then the size of the Bangladesh market would appear larger in the Family Planning Market Report, even if overall public-sector contraceptive procurement in Bangladesh were actually to stay flat in total when looking across all suppliers, some of whom may or may not participate in the Family Planning Market Report. 8 Note the $8.261 and $8.367 figures are 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 down 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 2020 and 2019 UNFPA Contraceptive Price Indicators are available here: https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptives_Price_Indicator_2020.pdf https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators_2019_V2_-_EXTERNAL.pdf The market value of injectables increased by 26 percent from 2019 to 2020, reaching a five-year high of $68 million (Exhibit 1). Similarly, the market value of combined and progestin-only orals increased by 29 percent from 2019 to 2020, reaching its highest value ($47 million) throughout the period (Exhibit 1). Although oral contraceptive procurement increased across several countries, the largest increase was observed in Bangladesh. Given the robust domestic procurement environment in Bangladesh, this uptick in oral contraceptive volumes in Bangladesh could perhaps reflect that the suppliers included in the Family Planning Market Report captured further market share in the country in 2020. Finally, implant market value increased by 20 percent from 2019 to 2020, reaching another five-year high, despite capacity restrictions at some manufacturers in 2020 (Exhibit 1). Implants alone contributed 43 percent of the FP2020 public-sector market value in 2020 (Exhibit 6). The implant segment grew despite some capacity restrictions in 2020, thus it is likely that implant volumes may have been even larger if unhindered by these limitations. Increased spend on implant procurement is also notable because in 2020, unit prices for implants fell to an average of $8.2618, down from $8.367 in 2019, based on the UNFPA Contraceptive Price Indicator. This trend is in part attributable to the increased number of quality-assured implant suppliers on the market. SU PP LI ER S H IP M EN T AN AL YS IS https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptives_Price_Indicator_2020.pdf https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators_2019_V2_-_EXTERNAL.pdf 6 Method Year over year 2019-2020* Compound annual growth rate 2016-2020** Condoms- Male -14% -4% Condoms- Female -26% -11% Injectables 26% 14% Orals- Emergency -15% -1% Orals- Combined & Progestin Only 29% 11% IUDs -20% -9% Implants 20% 10% Total 16% 8% *Year over year (YOY): change in the value of the FP2020 public-sector market between 2019-20 **Compound Annual Growth Rate (CAGR): [(final value/beginning value)^(1/number of years)]-1 Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Additionally, year over year and compound annual growth rate numbers were calculated throughout the report using actual values, not the rounded values in the chart. Some differences exist in the historical data for 2016-2019 in this version of the report versus previous versions, due to the transition from RHI to RH Viz for male condom data, as well as a few supplier-reported revisions to historical data, based on updated information. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz shipment data, retrieved August 2021; [3] UNFPA Contraceptive Price Indicator, 2016–2020; [4] IAP Implant Price. Exhibit 1: Value of the FP2020 public-sector market (USD) $0M $50M $100M $150M $200M $250M $300M 20202019201820172016 To ta l M ar ke t Si ze (M ill io ns U SD ) $78M $3M $31M $2M $41M $11M $26M $70M $1M $32M $2M $47M $10M $14M $90M $4M $31M $2M $65M $6M $25M $94M $3M $36M $2M $54M $9M $26M $224M $113M $2M $47M $2M $68M $7M $22M $261M $191M $176M $223M Implants IUDs Orals - Emergency Injectables Condoms - Female Condoms - Male Orals - Combined and Progestin Only SU PP LI ER S H IP M EN T AN AL YS IS 7 Method Year over year 2019-2020 Compound annual growth rate 2016-2020 Condoms- Female -23% -8% Injectables 20% 14% Orals- Emergency 31% 7% Orals- Combined & Progestin Only 34% 15% IUDs -34% -14% Implants 22% 11% Total 23% 12% Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Additionally, year over year and compound annual growth rate numbers were calculated throughout the report using actual values, not the rounded values in the chart. Some differences exist in the historical data for 2016-2019 in this version of the report versus previous versions, due to the transition from RHI to RH Viz for male condom data, as well as a few supplier-reported revisions to historical data, based on updated informatio. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz shipment data, retrieved August 2021. Exhibit 2: Total FP2020 market volumes (male condoms excluded*) 0 M 50 M 100 M 150 M 200 M 250 M 300 M 350 M 20202019201820172016 Sh ip m en t Vo lu m es ( M ill io ns ) 9M 11M 8M 5M 114M 6M 50M 22M 22M 59M 6M 118M 212M 219M 11M 12M 13M 81M 6M 127M 11M 9M 21M 70M 6M 151M 251M 268M 14M 6M 16M 84M 8M 201M 329M Implants IUDs Orals - Emergency Injectables Condoms - Female Orals - Combined and Progestin Only SU PP LI ER S H IP M EN T AN AL YS IS Male condom shipment values (billions) 2016 2017 2018 2019 2020 Year over year 2019-2020 Compound annual growth rate 2016-2020 1.02B 0.60B 1.15B 1.13B 0.96B -15% -1% *Male condoms are shown separately because the source of the shipment data is RH Viz, whereas all other methods are supplier-reported. See Appendix C for further details. 8 Method Year over year 2019-2020 Compound annual growth rate 2016-2020 Condoms- Male -15% -1% Condoms- Female -23% -8% Injectables 21% 14% Orals- Emergency 31% 7% Orals- Combined & Progestin Only 33% 15% IUDs -34% -14% Implants 24% 9% Total -1% 1% Exhibit 3: CYPs shipped to the FP2020 public-sector market 0 M 30 M 60 M 90 M 120 M 150 M 20202019201820172016 CY Ps S hi pp ed (M ill io ns ) 29M 26M 22M 8M 0.3M 14M 0.2M 5M 52M 12M 8M 0.2M 8M 0.3M 31M 56M 20M 9M 0.3M 0.1M 10M 126M 33M 42M 17M 10M 0.3M 0.2M 9M 112M 41M 28M 21M 14M 0.4M 0.1M 8M 112M109M 76M Implants IUDs Orals - Emergency Injectables Condoms - Female Condoms - Male Orals - Combined and Progestin Only SU PP LI ER S H IP M EN T AN AL YS IS Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Additionally, year over year and compound annual growth rate numbers were calculated throughout the report using actual values, not the rounded values in the chart. Some differences exist in the historical data for 2016-2019 in this version of the report versus previous versions, due to the transition from RHI to RH Viz for male condom data, as well as a few supplier-reported revisions to historical data, based on updated information. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz shipment data, retrieved August 2021; [3] USAID, “Couple-Years of Protection (CYP)”. 9 Exhibit 4A: Cost per CYP by method per duration of use (USD) Exhibit 4B: Cost per CYP by method in 2020 (USD) SU PP LI ER S H IP M EN T AN AL YS IS Method Units per CYP Unit Cost Cost per CYP 2016 2017 2018 2019 2020 2016 2017 2018 2019 2020 Condoms - Female 120.00 $0.49 $0.46 $0.47 $0.44 $0.43 $59.28 $55.32 $56.88 $53.28 $51.48 Condoms - Male 120.00 $0.03 $0.02 $0.02 $0.02 $0.02 $3.03 $2.71 $2.64 $2.72 $2.75 Injectables - 1 month 13.00 $0.85 $0.85 $0.85 N/A* N/A* $11.05 $11.05 $11.05 N/A* 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 $0.80 $0.77 $0.79 $0.75 $0.77 $3.20 $3.09 $3.16 $3.00 $3.07 Orals - Combined 15.00 $0.26 $0.27 $0.24 $0.23 $0.23 $3.95 $4.01 $3.56 $3.51 $3.38 Orals - Progestin Only 12.00 $0.33 $0.32 $0.29 $0.29 $0.30 $3.94 $3.80 $3.52 $3.47 $3.60 Orals - Emergency 20.00 $0.35 $0.26 $0.28 $0.40 $0.26 $7.02 $5.14 $5.52 $7.98 $5.18 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 (copper) 0.22 $0.30 $0.31 $0.30 $0.31 $0.37 $0.06 $0.07 $0.07 $0.07 $0.08 *N/A indicates method was not listed on the UNFPA Contraceptive Price Indicator. Implant pricing in this exhibit was taken from the IAP implant price. Sources: [1] UNFPA Contraceptive Price Indicator, 2016–2020; [2] USAID, “Couple-Years of Protection (CYP)”, [3] IAP Implant Price. Cost Per CYP By Method in 2020 (USD) $0 $10 $20 $30 $40 $50 $60 IUDs (copper) Implants - 5 Year Condoms - Male Injectables - 3 month Orals - Combined Implants - 3 Year Orals - Progestin Only Orals - Emergency Injectables - 2 month Condoms - Female $0.08 $2.24 $2.75 $3.07 $3.38 $3.40 $3.60 $5.18 $6.90 $51.48 10 LARCs as a percent of CYPs shipped 2016 2017 2018 2019 2020 74% 63% 69% 67% 62% Exhibit 5: CYP mix (in terms of CYPs shipped) in the FP2020 public-sector market 0% 20% 40% 60% 80% 100% 20202019201820172016 CY P M ix 26% 47% 7% 0.3% 11% 0.2% 8% 109M 34% 29% 11% 0.4% 19% 0.2% 7% 25% 45% 7% 0.3% 16% 0.1% 8% 29% 38% 9% 0.3% 15% 0.2% 8% 76M 126M 112M 37% 25% 12% 0.4% 18% 0.1% 7% 112M CYPs shipped CY Ps M ix Implants IUDs Orals - Emergency Injectables Condoms - Female Condoms - Male Orals - Combined and Progestin Only SU PP LI ER S H IP M EN T AN AL YS IS Note: Some differences exist in the historical data for 2016-2019 in this version of the report versus previous versions, due to the transition from RHI to RH Viz for male condom data, as well as a few supplier-reported revisions to historical data, based on updated information. LARCs as a percent of CYPs shipped were calculated using actual values, not the rounded values in the chart. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz shipment data, retrieved August 2021; [3] UNFPA Contraceptive Price Indicator, 2016–2020; [4] USAID, “Couple-Years of Protection (CYP)”. 11 LARCs as a percent of market value 2016 2017 2018 2019 2020 42% 41% 42% 43% 44% Exhibit 6: Market share per method in the FP2020 public-sector market (USD) SU PP LI ER S H IP M EN T AN AL YS IS Note: Some differences exist in the historical data for 2016-2019 in this version of the report versus previous versions, due to the transition from RHI to RH Viz for male condom data, as well as a few supplier-reported revisions to historical data, based on updated information. LARCs as a percent of market share were calculated using actual values, not the rounded values in the chart. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz shipment data, retrieved August 2021; [3] UNFPA Contraceptive Price Indicator, 2016–2020; [ 4] IAP Implant Price. 0% 20% 40% 60% 80% 100% 20202019201820172016 $191M $176M $223M $224M 41% 2% 16% 1% 21% 6% 13% 40% 1% 18% 1% 27% 6% 8% 40% 2% 14% 1% 29% 3% 11% 42% 1% 16% 1% 24% 4% 11% $261M 43% 1% 18% 1% 26% 3% 8% Implants IUDs Orals - Emergency Injectables Condoms - Female Condoms - Male Orals - Combined and Progestin Only Market Value 12 Exhibit 7: Market share of FP2020 public sector by region (USD) 0% 20% 40% 60% 80% 100% 20202019201820172016 $191M $176M $223M $224M 18% 2% 2% 69% 9% 20% 2% 1% 64% 13% 20% 2% 2% 66% 10% 16% 2% 3% 72% 6% $261M 19% 1% 1% 68% 10% Market Value Latin America & Caribbean Asia & Pacific Sub-Saharan Africa Final Destination Country Not Specified Middle East & North Africa Note: Public-sector, regional market share shown in the graph above is influenced by the relative distribution of FP2020 countries, the majority of which are located in Sub-Saharan Africa. Only a small number of countries from both the Latin America & Caribbean and Middle East & North Africa regions are included among the 69 FP2020 focus countries; trends across the whole of these regions are not captured above. “Destination country not specified” indicates that shipments were received in warehouses for later distribution to the FP2020 countries. Some differences exist in the historical data for 2016-2019 in this version of the report versus previous versions, due to the transition from RHI to RH Viz for male condom data, as well as a few supplier-reported revisions to historical data, based on updated information. Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2021; [3] UNFPA Contraceptive Price Indicator, 2016–2020; [4] IAP Implant Price. SU PP LI ER S H IP M EN T AN AL YS IS 13 Exhibit 8: Top ten countries in terms of value, 2020 Exhibit 9: Value of 10 largest FP2020 public-sector countries compared to value of all other countries combined 12% 44% 6% 7% 6% 5% 5% 4% 4%4%3% Tanzania Bangladesh Uganda Congo Dem Rep Nigeria Zambia Kenya ZimbabweMalawi Ethiopia Other FP2020 Countries Note: Some differences exist in the historical data for 2016-2019 in this version of the report versus previous versions, due to the transition from RHI to RH Viz for male condom data, as well as a few supplier-reported revisions to historical data, based on updated information. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz Shipment Data, retrieved August 2021; [3] UNFPA Contraceptive Price Indicator, 2016–2020; [4] IAP Implant Price. $0M $50M $100M $150M $200M $250M $300M 20202019201820172016 $191M $176M $224M$223M $85M $91M $120M $103M $261M $147M $114M $111M $113M $93M $98M M ar ke t Si ze (M ill io ns U SD ) Top 10 Countries* Other FP2020 Countries * Top countries in this graph are defined by 2020 data and, in alphabetical order are: Bangladesh, Congo Dem Rep, Ethiopia, Kenya, Malawi, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe. SU PP LI ER S H IP M EN T AN AL YS IS 14 DONOR SPEND ANALYSIS 9 Prior to the publication of the 2018 Family Planning Market Report, CHAI and RHSC leveraged data from RHI for donor spend analysis. The 2018, 2019, 2020, and 2021 Family Planning Market Reports have been updated to rely on data from the Procurement Services Branch of UNFPA and from USAID’s “Overview of Contraceptive and Condom Shipments” reports. 10 USAID data on contraceptive shipments is taken from the “Overview of Contraceptive and Condom Shipments FY2020 report.” The FY2020 report is reflective of family planning funding and does not include HIV/AIDs funded condoms; thus, we have excluded female and male condom values for FY2016 to FY2020 to compare a consistent data set across years. The USAID report is available here: https://www.usaid.gov/sites/default/files/documents/CC_FY20.pdf 11 USAID Fiscal Year (FY) runs from Oct. 1 to Sept. 30. Since FY2018, USAID has shared data in the “Overview of Contraceptive and Condom Shipment” reports based on the year in which orders are delivered, rather than shipped to countries. 12 Context from USAID’s “Overview of Contraceptive and Condom Shipments FY2020” report. 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. Additional information is available here: https://www.usaid.gov/selfreliance. This section focuses on data9 from the Procurement Services Branch of UNFPA and USAID’s “Overview of Contraceptive and Condom Shipments” report and is aimed at understanding the historical contraceptive procurement spend by the two major institutional procurers in the public-sector markets of the 69 FP2020 focus countries. UNFPA’S SPEND ON CONTRACEPTIVES REACHED ANOTHER HISTORIC HIGH IN FY2020, HAVING MORE THAN DOUBLED SINCE FY2016. USAID’S SPEND ALSO INCREASED FROM FY2019 TO FY2020 AND HAS BEEN RELATIVELY STABLE BETWEEN FY2016 AND FY2020. UNFPA’s total spend on contraceptive procurement (looking across both UNFPA program procurement as well as third-party procurement) increased by 5 percent from FY2019 to FY2020 to reach a total of $170 million (Exhibit 10). UNFPA’s FY2020 spend on contraceptive procurement was the highest in five years, having increased by $91 million since FY2016 (Exhibit 10). Although UNFPA did initially report some disruptions, the overall impact of COVID-19 on contraceptive procurement was relatively minor. UNFPA worked with governments and missions to underscore the essential nature of contraceptives, and to unblock supply chain bottlenecks. Although overall UNFPA contraceptive procurement spend increased from $162M in FY2019 to $170M in FY2020, third-party procurement as a percent of this total UNFPA spend decreased from 17 percent in FY2019 to 9 percent in FY2020. Specifically, third-party procurement decreased by approximately $13 million (-46 percent) while program procurement increased by approximately $21 million (+16 percent) from FY2019 to FY2020. For USAID, the annual value of contraceptive procurement in FY2020, excluding male and female condoms,10 was $45 million, up 20 percent from FY2019 (Exhibit 11).11 USAID minimized disruptions and the impact of COVID-19 on contraceptive procurement and delivery in 2020 by strategically deploying virtual formats and staff on the ground where possible, as well as utilizing regional distribution centers to alleviate disruptions in the production and shipping of sexual and reproductive health (SRH) commodities.12 USAID’s spend on contraceptive procurement throughout FY2016-FY2020 has been stable, and remains both decentralized and determined by missions in countries. USAID missions in certain countries may be submitting fewer requests for contraceptive procurement funding as USAID continues to implement its “Journey to Self-Reliance”.13 D O N O R SP EN D A N AL YS IS https://www.usaid.gov/sites/default/files/documents/CC_FY20.pdf https://www.usaid.gov/selfreliance 15 D O N O R SP EN D A N AL YS IS Exhibit 10: UNFPA procurement value – contraceptives to FP2020 countries (in USD) Exhibit 11: USAID procurement value (excluding male and female condoms) – contraceptives to FP2020 countries (in USD) $0M $50M $100M $150M $200M FY2020FY2019FY2018FY2017FY2016 Sh ip m en t Va lu es to F P2 02 0 (M ill io ns U SD ) $79M $99M $149M $162M $170M UNFPA USAID $0M $10M $20M $30M $40M $50M FY2020FY2019FY2018FY2017FY2016 $46M $34M $50M $38M $45M Sh ip m en t Va lu es to F P2 02 0 (M ill io ns U SD ) Sources: [1]UNFPA Procurement Services Branch data FY2016 -FY2020; [2] USAID “Overview of Contraceptive and Condom Shipments” reports, FY 2016 – FY2020. 2019-2020 YOY: +5% 2016-2020 CAGR: +21% 2019-2020 YOY: +20% 2016-2020 CAGR: -0.4% 16 DONOR SPEND ON CONTRACEPTIVE PROCUREMENT INCREASED TO A FIVE-YEAR HIGH IN FY2020. HOWEVER, THE LONG-TERM TRAJECTORY OF DONOR SPEND ON CONTRACEPTION IS UNCERTAIN. Although UNFPA’s FY2020 spend on contraceptives reached its highest level over the FY2016-FY2020 period, there is heightened uncertainty regarding longer-term donor funding. For example, in 2019, the UK government committed £600 million in funding to the sexual and reproductive health space, including procurement funding for family planning supplies14 for the 2020-2025 period. For 2021, however, the UK government announced significant cuts in its funding for Official Development Assistance (ODA) due to the impact of the COVID-19 global pandemic on the economy and public finances15, which has included an approximate 85 percent / $180 million cut in its funding to UNFPA Supplies.16 In order to mitigate this shortfall, other donors have been actively working to increase their own commitments to the UNFPA Suppliers Partnership. For example, France announced a multi-year €90 million contribution to the UNFPA Supplies Partnership17, and the United States re- engaged with UNFPA to restore core funding in 2021.18 USAID spend on contraceptive procurement has been less than that of UNFPA, but has been stable from FY2016-FY2020.19 Missions will continue to determine the level of contraceptive procurement spend in individual countries. As per USAID’s “Journey to Self-Reliance” strategy, efforts will continue to strengthen local capacity and work towards domestic self-financing.20 14 https://www.gov.uk/government/news/healthcare-for-everyone-must-prioritise-womens-sexual-and-reproductive-health-and-rights-says-uk-at-un-general-assembly 15 https://www.gov.uk/government/speeches/official-development-assistance-foreign-secretarys-statement-november-2020 16 https://www.unfpa.org/press/statement-uk-government-funding-cuts 17 https://www.unfpa.org/press/support-france-safeguard-health-and-lives-millions-women-and-girls?page=27 18 https://www.state.gov/u-s-engagement-with-the-un-population-fund-unfpa/ 19 President Biden released his FY2022 budget request to Congress on May 28, 2021. Bilateral FP/RH funding included in this request totaled $584 million, which constitutes a 2 percent increase above the FY21 funding level. Proposed funding for UNFPA increased to $56M over the $32.5 million allotted in FY21. On June 28, 2021, the House Committee on Appropriations released its FY2022 State, Foreign Operations, and Related Programs (SFOPs) appropriations bill, proposing funding increases above the Administration’s budget request. The bilateral FP/RH funding included in this bill totaled $760 million, with a total of $70 million in funding allocated for UNFPA. On October 18, 2021, the Senate Appropriations Committee released its version of the FY2022 SFOPs appropriations bill, proposing $650 million in bilateral FP/RH funding and $55 million in funding for UNFPA. At the time of writing, budget conversations were ongoing. Information available at: https://www.kff.org/news-summary/white-house-releases-full-fy-2022- budget-request/ and https://www.kff.org/news-summary/house-appropriations-committee-releases-the-fy22-state-and-foreign-operations-sfops-appropriations-bill/ and https://www.kff.org/news-summary/senate-appropriations-committee-releases-fy-2022-state-and-foreign-operations-sfops-and-labor-health-and-human-services- labor-hhs-appropriations-bills/. 20 See footnote 13 for more information on USAID’s “Journey to Self-Reliance.” 21 In RHSC’s 2021 LEAP analysis, RHSC shifted from providing a spending and gap analysis (typically included in RHSC’s Contraceptive Gap Analysis report) to instead focusing on how supply costs will change going forward. Accordingly, the Family Planning Market Report now incorporates funding gap analysis information from the Guttmacher Institute: For more information, see The Guttmacher Institute’s report “Adding It Up: Investing in Sexual and Reproductive Health 2019”, published in 2020. Available at: https://www. guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019#. 22 RHSC Landscape & Projection of Reproductive Health Supply Needs, 2021. Available at: https://leap.rhsupplies.org/#/contraception. Looking forward, the funding requirement for contraceptive procurement is likely to continue to increase. Estimates from the Guttmacher Institute in 2019 suggest that approximately 218 million women of reproductive age in low-and middle-income countries had an unmet need for contraception.21 In addition to current needs, RHSC’s LEAP (Landscape & Projection of Reproductive Health Supply Needs) analysis suggests that the total number of contraceptive users in low- and middle-income countries will increase by 75 million users by 2030.22 Therefore, the demand for safe, quality-assured, affordable contraception seems likely to continue to grow and outpace the availability of government and donor funding. While the procurement data in this year’s report demonstrates that the public-sector market value in the FP2020 countries increased in 2020, there remain significant unmet needs for modern contraceptive methods in FP2020 countries. These unmet needs may be exacerbated by the uncertainty of future SRH and contraceptive procurement funding. Today, many countries’ supply plans remain partially unfunded due to a lack of donor or domestic financing, a situation which may only be worsened as COVID-19 continues to put pressure and place demands on country and donor resources. Thus, to meet the growing demand from users in FP2020 countries for safe, effective, and quality- assured contraceptive products, donor and/or domestic funding will need to increase, along with the continued pursuit of product affordability and accessibility. D O N O R SP EN D A N AL YS IS 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/speeches/official-development-assistance-foreign-secretarys-statement-november-2020 https://www.unfpa.org/press/statement-uk-government-funding-cuts https://www.unfpa.org/press/support-france-safeguard-health-and-lives-millions-women-and-girls?page=27 https://www.state.gov/u-s-engagement-with-the-un-population-fund-unfpa/ https://www.kff.org/news-summary/white-house-releases-full-fy-2022-budget-request/ https://www.kff.org/news-summary/white-house-releases-full-fy-2022-budget-request/ https://www.kff.org/news-summary/house-appropriations-committee-releases-the-fy22-state-and-foreign-operations-sfops-appropriations-bill/ https://www.kff.org/news-summary/senate-appropriations-committee-releases-fy-2022-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-fy-2022-state-and-foreign-operations-sfops-and-labor-health-and-human-services-labor-hhs-appropriations-bills/ https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019# https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-2019# https://leap.rhsupplies.org/#/contraception 17 HIGHLIGHTS FROM DISCUSSION WITH KEY STAKEHOLDERS 23 JSI/RHSC, “Building Resilient Sexual and Reproductive Health Supply Chains During COVID-19 and Beyond”, 2021. Link available at: https://publications.jsi.com/JSIInternet/ Inc/Common/_download_pub.cfm?id=24430&lid=3 24 Ibid 25 As stated in the 2016 RHSC Commodity Gap Analysis, general procurement 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.” Link available at (following page): https://www.rhsupplies.org/uploads/tx_rhscpublications/Global_ Contraceptive_Commodity_Gap_Analysis_2016.pdf A NUMBER OF SUPPLIERS, DONORS, AND OTHER SRH PARTNERS WERE CONSULTED TO DISCUSS THE TRENDS OBSERVED IN THIS REPORT. In discussing the 2020 public-sector market trends, stakeholders expressed an appreciation for the SRH community’s resilience, and its efforts to prevent large-scale procurement disruptions from taking place throughout 2020, especially in light of the COVID-19 pandemic. Although some manufacturing disruptions were notable at the beginning of the COVID-19 pandemic, a joint JSI/RHSC analysis of SRH supply chains indicates these disruptions were sufficiently resolved to resume procurement processes within “weeks, rather than months.”23 This analysis is consistent with stakeholder feedback. Additionally, stakeholders indicated that COVID-19 disruptions were more pronounced during COVID-19’s first wave, when suppliers and partners first grappled with the challenges of operating during a pandemic. During this first wave, stakeholders throughout the SRH community worked with governments and missions to advocate for policies that would help contraceptive manufacturers navigate lockdowns in affected regions and minimize manufacturing disruptions. Manufacturers also adapted to the changing environment, adopting new procedures and risk mitigation strategies to ensure production could continue throughout the subsequent waves of the pandemic.24 That being said, 2020 did still present certain challenges in terms of contraceptive procurement. For example, in this report, market value is calculated by multiplying supplier shipment volumes against publicly available commodity prices (published in the 2020 UNFPA Contraceptive Price Indicator). Shipping and freight costs are not included in the UNFPA Contraceptive Price Indicator. Stakeholders indicated that shipping costs increased due to COVID-19, and that delivery delays and lead times also increased throughout 2020. Accordingly, stakeholders signaled that public-sector contraceptive procurement for the FP2020 countries may have increased even further in 2020, had greater resources not been required to counter higher shipping and freight costs due to the COVID-19 pandemic. Finally, while the Family Planning Market Report provides a useful overview of contraceptive procurement,25 it does not necessarily show the impact of COVID-19 on contraceptive distribution and uptake in countries. While the market value in terms of contraceptive procurement increased from 2019 to 2020, this report cannot infer how family planning consumption or uptake in countries evolved from 2019 to 2020, since consumption is impacted by a range of factors beyond the scope of this report, such as distribution and supply chain logistics, and the ability of end users to access health services. Therefore, the procurement data from the Family Planning Market Report should not be confounded with demand or delivery data. Finally, stakeholders uniformly expressed uncertainty about the funding environment for contraceptive procurement in the coming years. Stakeholders indicated that the SRH community had been able to weather the COVID-19 pandemic in 2020, in part due to previous funding commitments made in 2019. The SRH community entered 2020 with substantial funding already committed to product orders; however, the announcement of notable cuts to SRH commodity funding in early 2021 has generated a heightened level of uncertainty with regards to procurement funding. Should the global economic context remain challenging (e.g., due to the continued and residual effects of COVID-19), stakeholders expressed concern about the ability to sustain and/ or grow contraceptive procurement, prevent future stockouts, and ensure the continuity of services for end users. Although the public-sector FP2020 market for contraceptive procurement remained resilient throughout 2020, stakeholders highlighted the need for heightened resilience, increased collaboration, and forward-looking approaches to ensure that women and girls can continue to access safe, effective, and quality- assured contraceptive products. 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 https://publications.jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=24430&lid=3 https://publications.jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=24430&lid=3 https://www.rhsupplies.org/uploads/tx_rhscpublications/Global_Contraceptive_Commodity_Gap_Analysis_2016.pdf https://www.rhsupplies.org/uploads/tx_rhscpublications/Global_Contraceptive_Commodity_Gap_Analysis_2016.pdf 18 GLOBAL MARKETS VISIBILITY PROJECT ACKNOWLEDGEMENTS 26 The procurement of products used for sterilization such as tubal rings are not covered in this report. 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 users in the 69 FP2020 focus countries to access family planning products and services. This report is a collaboration between CHAI and the Reproductive Health Supplies Coalition (RHSC). The initial 2015 report was comprised of data from 11 manufacturers. Each manufacturer entered into a formal MOU with CHAI or provided their information through collaborations with the then Generic Manufacturers Caucus for Reproductive Health (GEMs) and i+solutions. Since then, coverage has expanded, and today there are 17 suppliers participating in the project. 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 made to collect as much data as possible, it should be noted that the data in this report may not represent the entirety of contraceptive procurement for the FP2020 public sector. This report includes data from most, but not all, suppliers associated with these markets. About the Participating Suppliers (in alphabetical order) Bayer Bayer is a Germany-based life science company with core competencies in health care and agriculture. Its contraceptive product portfolio includes contraceptive implants, hormonal IUD, combined oral contraceptives, and injectables. Corporate Channels Corporate Channels India Pvt. Ltd. (CCIPL) is a manufacturer of female contraceptive devices based in India, since 1993. CCIPL’s contraceptive product portfolio includes several IUDs (EVE’S Copper T380A, TCu380A Ultra Loadezy, PPIUD, Cu 375, and Cu375SL) that provide long acting reversable contraception, and Tubal Rings26 that provide permanent contraception for women. CCIPL’s Copper T 380A IUD has been prequalified by WHO/UNFPA for global supply, and several products (EVE’S Copper T380A, EVE’S Cu 375 and EVE’S Cu 375 SL) have been CE marked. Cipla Cipla Limited is an India-based generic manufacturer with over 1,500 products in the areas of respiratory diseases, HIV/AIDS, malaria, MDRTB, and reproductive health. Its contraceptive product portfolio includes emergency contraceptives and combined oral contraceptives. It also manufactures misoprostol. CR Zizhu China Resources Zizhu Pharmaceutical Co., Ltd. (CR Zizhu) is a manufacturer of reproductive health products based in China. Its contraceptive product portfolio includes emergency oral contraceptives and combined oral contraceptives. CR Zizhu also manufactures misoprostol and several APIs including levonorgestrel. Cupid Cupid Limited is a manufacturer of both male and female condoms based in India. Its services include contract manufacturing (e.g., Playboy condoms, Trust condoms) and research and development, as well as the marketing and manufacturing of its own branded products. 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. 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 19 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 2015, 2016, and 2017 Family Planning Market Reports. In September 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 2018, 2019, 2020 and 2021 Family Planning Market 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 RH Viz database. Incepta 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+ presentations, across various therapeutic areas. Incepta currently exports its products to 77 countries around the world. Its contraceptive product portfolio includes oral (combined and progestin only) and injectable contraceptives. Medicines360 Medicines360 is a U.S.-based, nonprofit global women’s health pharmaceutical company that seeks to catalyze equitable access to medicines and devices through product development, policy advocacy, and collaboration with global and U.S. partners. Medicines360’s portfolio consists of a hormonal IUD marketed as Avibela in LMICs and Liletta in the U.S. Merck (MSD) Merck is a U.S.-based healthcare company which operates as MSD outside of the USA and Canada. Its contraceptive product portfolio includes contraceptive implants (Implanon NXT, which includes a prefilled sterile applicator), oral contraceptives (Exluton and Marvelon) for FP2020 public-sector markets, and oral contraceptives (Cerezette, Exluton, Marvelon, Mercilon, and for USA/CAN Zoely), contraceptive implants (Implanon NXT) and the contraceptive vaginal ring (NuvaRing) for non-FP2020 markets. Pfizer Pfizer is a U.S.-based healthcare company. Its contraceptive product portfolio includes 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 IUD (Eloira), IUDs, and tubal rings used for female sterilization. PT Tunggal PT Tunggal Idaman Abdi (PT Tunggal) is a pharmaceutical company based in Jakarta, Indonesia, with a focus on reproductive healthcare. Its contraceptive product portfolio includes a monthly injectable, a three monthly injectable, a combined oral contraceptive, and an emergency oral contraceptive. Today, PT Tunggal exports to over 60 countries and in August 2021, its three monthly injectable Triclofem received WHO pre- qualified status. 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, including 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 served as a supplier to Helm AG previously. Viatris (Mylan) Viatris (Mylan) is a U.S. based healthcare company with over 7,500 marketed products. Its contraceptive product portfolio includes oral solids, injectables, and devices. 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 20 APPENDICES 27 Female condoms are aggregated with male condoms by country in order to protect data confidentiality. APPENDIX A - 69 FP2020 Countries: Market volumes by method27 and country, 2016–2020 Exhibit A.1: 69 FP2020 Countries: Contraceptive market volumes by method, 2016 Country Condoms - Male & Female Implants Injectables IUDs Orals Afghanistan 1,010,880 14,200 19,000 170,000 211,440 Bangladesh – 150,000 8,200,000 – – Benin 3,708,000 277,028 70,000 42,000 5,040 Bhutan – – 237,000 – – Bolivia 50,400 67,800 3,000 – 5,760 Burkina Faso 12,911,000 427,800 1,123,500 – 1,600,971 Burundi 14,555,999 1,600 – – 70,240 Cambodia 5,719,248 58,960 1,000,000 30,000 10,539,359 Cameroon 18,205,048 82,488 482,975 11,000 500,000 Central African Republic 3,628,800 6,200 147,600 500 262,296 Chad – 41,024 15,600 – – Comoros 1,442,448 1,972 113,000 – 77,040 Congo Dem Rep 12,403,997 688,089 – 48,345 1,026,756 Congo Rep 3,600,000 1,008 6,720 40,805 2,880 Cote d'Ivoire 16,569,000 97,256 3,023,395 10,000 997,500 Djibouti – – 663,000 10,500 44,280 Egypt Arab Rep – 140,000 – 2,680,434 – Eritrea – – 100,000 – 126,640 Ethiopia 46,914,000 1,022,105 7,570,056 751,144 6,625,921 Gambia 2,880,000 20,016 313,000 1,500 565,200 Ghana 32,898,960 141,432 3,889,100 15,410 2,751,660 Guinea 12,488,000 77,000 90,000 – 512,644 Guinea-Bissau – 50,000 13,000 10,000 10,080 Haiti 35,850,000 5,300 – 1,500 30,240 Honduras 25,005,600 – 1,977,000 26,000 1,385,280 India 5,000 – 23,984 865,062 6,137,520 Indonesia 5,000 350,000 – 120,074 – Iraq – 1,000 – – – Kenya 54,090,024 742,864 95,000 37,500 3,403,080 Korea Dem Rep – – 905,200 – – Kyrgyz Republic 2,440,080 – – – – Lao PDR – 53,200 850,600 29,000 1,405,440 Lesotho 15,762,000 23,452 260,400 1,000 218,160 AP PE N D IC ES 21 Sources: [1] USAID Worldwide Contraceptive and Condom Shipments FY 2016 – 2020; [2] UNFPA PSB Procurement Values 2016 -2020 AP PE N D IC ES Exhibit A.1: 69 FP2020 Countries: Contraceptive market volumes by method, 2016 Country Condoms - Male & Female Implants Injectables IUDs Orals Liberia 16,463,280 44,600 – – 251,040 Madagascar 4,500,000 303,932 1,440,600 43,000 849,600 Malawi 30,371,800 33,700 2,475,200 – – Mali 15,445,704 27,072 25,000 20,000 20,160 Mauritania 3,110,400 2,500 39,000 – 164,160 Mongolia 8,812,800 3,100 30,000 22,000 405,108 Mozambique 59,034,000 – 90,000 13,000 205,920 Myanmar 14,873,472 147,348 1,800 25,000 7,560,366 Nepal 32,161,800 98,400 25,400 31,950 228,066 Nicaragua – 4,008 – 15,000 – Niger – 50,400 1,317,700 – 3,141,960 Nigeria 141,736,200 771,763 1,278,600 90,030 3,320,703 Pakistan 108,752,496 800 – 2,386,371 15,120 Papua New Guinea 1,994,400 103,000 22,600 3,700 11,520 Philippines – – – 1,070,737 – Rwanda 21,038,900 65,294 1,734,900 3,100 2,439,900 Sao Tome and Principe – – – – 63,360 Senegal 11,202,000 179,864 10,000 32,675 860,949 Sierra Leone 1,080,000 73,000 280,200 5,500 955,860 Solomon Islands – – – – – Somalia – – 1,950 – 19,000 South Sudan 9,681,120 30,000 150,000 – 172,080 Sri Lanka – 50,500 650,000 100,000 6,049,600 Sudan 7,216,992 49,104 29,800 6,500 338,345 Tajikistan 19,774,248 – 93,000 98,000 415,440 Tanzania 428,800 986,112 4,741,200 486,000 5,621,360 Timor-Leste – 10,500 – 2,500 – Togo 14,036,128 46,656 315,800 – 27,360 Uganda 19,200,000 234,524 1,184,250 45,200 5,740,520 Uzbekistan 6,228,720 – 848,400 432,800 – Vietnam – – – 1,096,080 – West Bank and Gaza – – 800 – – Western Sahara – – – – – Yemen Rep 6,302,880 – 157,000 75,000 1,141,120 Zambia 32,762,600 142,000 443,000 – – Zimbabwe 104,973,952 140,656 661,800 1,800 19,521,550 Other FP2020 Shipment Volumes 25,573,000 1,016,700 392,800 207,850 21,702,220 Total Volumes 1,038,899,176 9,157,327 49,632,930 11,215,567 119,757,814 22 Exhibit A.2: 69 FP2020 Countries: Contraceptive market volumes by method, 2017 Country Condoms - Male & Female Implants Injectables IUDs Orals Afghanistan 16,665,410 9,800 59,600 100,000 365,200 Bangladesh 1,195,200 400,000 7,258,000 – – Benin 368,399 34,900 30,600 – – Bhutan – – – – – Bolivia 2,001,600 94,600 50,400 – 30,000 Burkina Faso 15,050,020 95,300 481,200 – 3,741,150 Burundi – – 17,500 – 169,980 Cambodia 1,929,600 40,056 900,000 60,000 7,082,236 Cameroon 6,658,400 95,200 327,000 33,500 298,080 Central African Republic 268,999 – – – 95,040 Chad – – – – – Comoros 1,267,200 2,520 40,000 150 60,480 Congo Dem Rep 840,000 364,828 2,143,580 – 1,380,220 Congo Rep 2,160,000 76,076 32,000 500 720 Cote d'Ivoire 11,992,968 196,600 243,000 – 6,521,413 Djibouti – – – – 6,480 Egypt Arab Rep – 40,032 – 375,045 – Eritrea 8,640,000 12,500 100,000 – 112,560 Ethiopia 57,600,000 1,107,134 7,436,988 440,000 10,794,948 Gambia 5,371,200 16,488 110,000 1,500 235,440 Ghana – 250,256 106,000 11,500 3,183,960 Guinea 158,136 100,000 – – 30,240 Guinea-Bissau 6,972,620 27,300 2,500 – 2,160 Haiti 69,455,900 4,116 863,400 – 647,304 Honduras 3,024,000 1,440 21,000 6,000 1,641,840 India – – 1,047,488 522,885 2,262,311 Indonesia – – – – – Iraq 316,944 – – – 40,032 Kenya 229,000 408,781 437,376 126,000 7,921,836 Korea Dem Rep – – – – – Kyrgyz Republic – – – – – Lao PDR 1,929,000 65,808 76,800 – 701,040 Lesotho 14,001,000 31,200 165,000 – 176,400 Liberia 2,853,000 36,100 319,000 – 5,760 Madagascar – 256,618 3,012,800 295,019 1,288,800 Malawi 21,759,000 167,408 1,000,000 36,500 236,700 Mali 17,255,400 209,728 293,000 26,000 210,240 AP PE N D IC ES 23 Exhibit A.2: 69 FP2020 Countries: Contraceptive market volumes by method, 2017 Country Condoms - Male & Female Implants Injectables IUDs Orals Mauritania – 10,404 88,600 1,500 295,920 Mongolia 8,488,800 800 – 53,000 350,160 Mozambique 56,748,000 60,016 1,373,600 23,600 3,278,160 Myanmar 35,136,646 18,936 6,108,125 200 14,780,928 Nepal 16,701,000 211,800 641,000 74,000 4,015,160 Nicaragua 2,911,680 504 – – 50,000 Niger 979,200 54,100 499,000 7,920 437,040 Nigeria 44,137,000 665,160 3,316,700 – 1,229,445 Pakistan 512,480 900 – 495,960 123,840 Papua New Guinea 669,600 30,000 22,000 4,000 82,720 Philippines – – – – – Rwanda 1,631,200 84,062 8,200 13,200 68,400 Sao Tome and Principe 1,108,800 300 28,000 – 98,100 Senegal – 67,864 160,000 – 139,140 Sierra Leone 19,728,000 230,400 332,650 16,000 1,087,240 Solomon Islands – – – – – Somalia – 2,500 3,500 – – South Sudan 11,340,000 25,016 150,000 – 20,000 Sri Lanka 4,056,620 65,500 – 50,000 3,589,760 Sudan – 36,936 – 6,000 2,123,400 Tajikistan 4,687,200 – 142,000 – 613,440 Tanzania 4,320,180 798,920 2,830,850 177,000 2,885,763 Timor-Leste 1,080,000 20,000 – – – Togo 8,466,200 67,388 140,000 5,000 25,002 Uganda – 297,652 3,895,400 251,000 249,520 Uzbekistan 13,217,540 – – – 718,989 Vietnam 21,816,000 12,636 1,196,500 1,239,531 – West Bank and Gaza 1,944,000 – – – – Western Sahara – – – – – Yemen Rep 8,760,960 64,288 445,000 – – Zambia 16,389,600 161,800 3,418,650 – 3,528,960 Zimbabwe 64,653,000 60,496 1,399,200 10,000 12,716,941 Other FP2020 Shipment Volumes 5,859,600 1,058,100 5,912,600 286,950 23,003,805 Total Volumes 625,306,304 8,251,267 58,685,807 4,749,460 124,754,403 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2021. AP PE N D IC ES 24 AP PE N D IC ES Exhibit A.3: 69 FP2020 Countries: Contraceptive market volumes by method, 2018 Country Condoms - Male & Female Implants Injectables IUDs Orals Afghanistan – 16,500 307,750 – 224,480 Bangladesh 12,355,200 793,064 15,194,000 720,000 20,049,680 Benin 12,966,000 38,100 38,000 – 2,250 Bhutan – – – – – Bolivia – 73,300 200,000 10,000 230,022 Burkina Faso 11,720,400 342,940 246,400 – 3,398,400 Burundi 22,039,200 4,000 126,400 – 415,332 Cambodia 3,427,200 46,392 700,000 30,000 11,986,296 Cameroon 9,633,600 112,952 338,000 3,500 100,000 Central African Republic 12,960,000 4,800 108,200 738 39,648 Chad 1,008,000 38,846 187,000 – 5,000 Comoros 1,180,800 – – – 3,000 Congo Dem Rep 49,969,750 331,170 1,343,100 – 370,560 Congo Rep – 246,500 – 86,000 12,120 Cote d'Ivoire 25,420,800 139,088 474,800 23,000 3,867,676 Djibouti 396,000 3,200 70,400 – – Egypt Arab Rep – 160,046 – 3,774,650 – Eritrea – 2,200 100,000 – 10,025 Ethiopia 35,004,720 1,205,446 7,753,455 600,000 7,896,030 Gambia – 1,400 160,500 1,000 660,816 Ghana 33,221,400 282,314 2,423,500 30,500 2,827,200 Guinea 9,360,000 – 100,000 – 51,360 Guinea-Bissau 10,310,400 – 6,600 – 42,120 Haiti 85,745,640 34,016 1,827,000 2,000 100,212 Honduras 24,012,000 1,000 107,000 1,100 74,880 India – – 102,000 3,221,980 366,065 Indonesia – – – 852,430 – Iraq 1,000,800 – – 4,180 – Kenya 2,000,000 379,232 470,124 101,225 12,791,937 Korea Dem Rep – – – – – Kyrgyz Republic 1,432,800 – – 220,800 – Lao PDR 600,000 – 242,000 12,500 660,600 Lesotho 8,192,600 7,644 15,000 10,000 116,682 Liberia 1,180,800 37,500 705,200 – 32,400 Madagascar 5,001,000 325,344 4,866,200 – 204,800 Malawi 166,785,600 173,874 4,947,825 – 1,250,484 Mali 13,067,620 56,576 1,578,800 8,757 1,063,635 Mauritania – 5,700 86,800 – 711,360 25 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2021. AP PE N D IC ES Exhibit A.3: 69 FP2020 Countries: Contraceptive market volumes by method, 2018 Country Condoms - Male & Female Implants Injectables IUDs Orals Mongolia 5,508,000 6,200 – 28,000 420,000 Mozambique 86,133,400 231,648 3,291,800 97,816 643,680 Myanmar 49,103,686 103,540 2,889,125 54,200 11,190,719 Nepal 13,197,480 176,000 2,170,400 60,000 3,299,530 Nicaragua 11,164,300 2,854 – 12,000 – Niger 849,600 170,940 914,200 – 658,002 Nigeria 42,934,272 1,023,764 4,731,600 150,800 1,996,764 Pakistan 758,016 10,000 100,000 486,525 – Papua New Guinea 6,112,800 60,000 5,000 9,964 424,967 Philippines 2,397,600 – – 50,450 – Rwanda 31,860,800 256,072 862,200 11,000 55,680 Sao Tome and Principe 1,112,832 500 26,000 – 67,080 Senegal 16,566,000 186,336 – 7,000 – Sierra Leone – 153,533 972,800 25,500 435,480 Solomon Islands – – – – – Somalia 72,000 15,240 100,000 – – South Sudan 2,476,000 54,000 340,000 – 610,080 Sri Lanka – 500 – 50,000 2,119,680 Sudan 720,000 51,264 – 4,000 – Tajikistan – – 138,000 100,500 595,224 Tanzania 2,868,000 810,780 2,067,300 23,600 1,273,980 Timor-Leste – 3,900 – – – Togo 21,247,832 75,264 118,400 – 164,154 Uganda 124,701,400 811,576 5,469,525 248,500 4,369,950 Uzbekistan – – – – – Vietnam 21,816,000 – – 925,250 – West Bank and Gaza – – – 5,000 – Western Sahara – – – – – Yemen Rep 1,303,200 37,440 1,093,600 51,700 30,000 Zambia 93,849,400 115,096 1,855,950 – 6,965,040 Zimbabwe 66,442,460 87,500 1,010,975 25,000 18,265,635 Other FP2020 Shipment Volumes 4,179,920 1,263,200 7,977,325 123,680 10,256,278 Total Volumes 1,167,367,328 10,570,291 80,960,254 12,264,845 133,406,993 26 Exhibit A.4: 69 FP2020 Countries: Contraceptive market volumes by method, 2019 Country Condoms - Male & Female Implants Injectables IUDs Orals Afghanistan 4,002,000 7,800 617,000 175,800 1,228,896 Bangladesh 1,224,000 265,253 4,383,060 300,000 16,506,300 Benin 103,000 214,400 125,600 52,000 – Bhutan 1,584,000 – – – – Bolivia 10,000 78,500 60,000 – 12,240 Burkina Faso 7,301,000 416,984 1,161,500 41,000 4,800 Burundi – 130,000 1,080,000 26,050 343,160 Cambodia 6,724,800 55,780 750,000 50,000 11,455,614 Cameroon 24,774,470 29,780 40,000 41,100 80,640 Central African Republic – 738 94,900 13,000 1,615,008 Chad 1,008,000 153,366 379,800 20,000 226,080 Comoros 1,180,800 – – 500 – Congo Dem Rep 46,256,800 576,760 3,128,810 211,384 2,297,938 Congo Rep – 148,904 19,800 191,405 9,540 Cote d'Ivoire 25,732,600 180,376 692,050 33,000 2,906,090 Djibouti 288,000 – – – 218,160 Egypt Arab Rep 11,224,800 333,164 – 490,200 – Eritrea – 17,300 100,000 – 10,800 Ethiopia 11,628,720 1,558,934 8,006,045 55,863 9,009,906 Gambia 2,548,800 69,984 140,000 – 105,840 Ghana – 390,383 1,596,700 31,653 4,097,860 Guinea 49,433,000 – 666,600 38,000 287,440 Guinea-Bissau 7,557,900 – 22,500 3,000 221,436 Haiti 68,804,640 10,000 2,691,800 – 670,896 Honduras 10,728,000 144 45,000 – 1,200,000 India – – – 814,796 38,100 Indonesia 5,000 – – 1,093,300 – Iraq – – – – 308,880 Kenya 38,478,000 366,320 80,000 448,930 3,613,720 Korea Dem Rep 288,000 – – – 74,880 Kyrgyz Republic 198,000 – – – – Lao PDR 1,490,400 – 256,000 – 2,857,608 Lesotho 1,728,000 2,016 140,600 – 117,900 Liberia 13,440,000 9,800 75,000 12,500 – Madagascar – 278,616 5,184,400 87,500 1,599,120 Malawi 139,529,000 670,252 6,569,700 – 2,571,300 Mali 25,216,560 293,636 256,200 29,000 682,560 Mauritania 5,000 18,580 46,200 – 813,960 AP PE N D IC ES 27 Exhibit A.4: 69 FP2020 Countries: Contraceptive market volumes by method, 2019 Country Condoms - Male & Female Implants Injectables IUDs Orals Mongolia 180,000 13,800 103,260 103,000 285,600 Mozambique 69,433,000 193,108 4,086,200 31,150 4,518,240 Myanmar 26,785,000 80,100 1,425,000 30,000 13,928,915 Nepal 13,999,870 224,200 349,800 – 2,407,144 Nicaragua – 5,484 – – – Niger 444,000 116,248 100,000 – 1,416,762 Nigeria 60,693,400 1,217,772 3,450,800 325,000 1,200,240 Pakistan 3,749,600 242,600 204,400 1,226,500 40,320 Papua New Guinea 2,997,800 145,000 572,400 – 479,643 Philippines 2,390,400 200,000 – – 29,808 Rwanda 15,346,000 213,185 441,000 27,000 956,160 Sao Tome and Principe 1,260,376 800 19,000 – 100,080 Senegal 12,218,000 142,056 466,000 72,000 986,580 Sierra Leone 5,589,400 274,900 276,000 57,500 468,720 Solomon Islands – – – – – Somalia 28,800 – 45,000 – 810,000 South Sudan 50,000 – 350,000 – 1,004,400 Sri Lanka 4,913 100,508 – – 2,119,680 Sudan – 26,800 146,400 – 6,472,122 Tajikistan 9,572,398 – 166,000 – 717,768 Tanzania 30,880,356 421,154 3,895,300 174,590 4,488,591 Timor-Leste 725,760 10,000 220,000 – 340,704 Togo 26,079,160 79,600 274,400 – 600,192 Uganda 147,135,800 414,360 3,655,140 161,500 436,968 Uzbekistan 6,652,800 – 570,000 1,730,000 760,002 Vietnam – 11,000 490,900 476,950 – West Bank and Gaza 1,761,120 – – – – Western Sahara – – – – – Yemen Rep 1,449,600 97,708 498,600 128,100 12,694,226 Zambia 60,015,740 81,456 2,884,600 14,000 2,615,574 Zimbabwe 140,329,440 186,600 758,000 48,500 16,751,896 Other FP2020 Shipment Volumes 4,840,160 456,500 6,216,400 320,610 14,807,358 Total Volumes 1,147,106,183 11,232,709 70,073,865 9,186,381 156,624,365 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2021. AP PE N D IC ES 28 Exhibit A.5: 69 FP2020 Countries: Contraceptive market volumes by method, 2020 Country Condoms - Male & Female Implants Injectables IUDs Orals Afghanistan 8,783,160 2,000 42,200 280,974 204,954 Bangladesh 943,200 20,000 14,867,040 2,500 82,546,360 Benin 15,000 10,000 762,000 20,000 441,504 Bhutan – – – – – Bolivia 11,000 36,000 50,000 9,500 14,400 Burkina Faso 15,975,300 236,448 3,041,050 98,400 1,565,376 Burundi 18,439,200 193,100 1,176,000 – 336,492 Cambodia 124,272 43,160 400,000 – 4,406,662 Cameroon 15,854,400 123,340 1,034,400 4,500 603,900 Central African Republic 6,480,000 77,700 214,600 – 171,360 Chad 9,273,800 2,200 560,000 – 342,120 Comoros – 500 – – – Congo Dem Rep 77,059,680 1,198,628 966,200 122,000 3,090,000 Congo Rep – 625 21,300 148,600 12,600 Cote d'Ivoire 8,595,000 198,000 987,000 28,500 4,758,577 Djibouti 250,880 200 – – 39,600 Egypt Arab Rep 1,000 53,000 1,387,600 180,030 – Eritrea – 2,000 4,000 – 162,000 Ethiopia 1,968,240 1,290,093 5,458,646 16,600 2,200,276 Gambia – 29,000 193,300 – 150,192 Ghana 11,930,400 316,176 2,059,300 98,850 5,960,232 Guinea 11,091,000 136,800 59,200 – 51,300 Guinea-Bissau 3,024,000 53,400 232,600 – 800,460 Haiti 21,600,000 13,000 – – – Honduras 16,999,200 49,456 690,900 – – India 360 – – 107,884 24,960 Indonesia – – – 1,047,270 – Iraq 37,000 – – – – Kenya 23,732,800 1,527,332 1,360,048 400,750 3,319,772 Korea Dem Rep – – – – – Kyrgyz Republic – – – – – Lao PDR – – 526,000 – 1,600,488 Lesotho 4,378,600 2,900 129,800 1,500 660,780 Liberia 15,774,000 88,200 363,000 – 780,120 Madagascar 11,334,760 473,564 3,635,300 216,000 5,438,960 Malawi 59,106,600 386,442 4,810,000 11,400 1,400,232 Mali 2,954,200 302,288 937,300 31,000 30,960 Mauritania – 3,300 175,600 – 385,344 AP PE N D IC ES 29 Exhibit A.5: 69 FP2020 Countries: Contraceptive market volumes by method, 2020 Country Condoms - Male & Female Implants Injectables IUDs Orals Mongolia 280,800 11,900 75,000 14,400 495,000 Mozambique 106,529,230 133,700 1,136,900 – 2,654,220 Myanmar 17,952,400 87,232 3,463,620 3,500 9,340,812 Nepal 11,695,970 72,500 10,000 – 365,220 Nicaragua 705,600 6,600 – 6,000 – Niger 17,894,740 96,656 389,860 51,300 4,400,010 Nigeria 76,046,500 1,491,608 4,234,600 722,299 2,939,913 Pakistan 30,096,000 95,200 – 192,112 443,520 Papua New Guinea 4,266,600 31,000 – – – Philippines – 403,364 – 30,725 – Rwanda 31,076,000 47,928 58,200 8,000 1,224,009 Sao Tome and Principe – 200 17,400 – 2,700 Senegal 9,345,000 125,000 1,007,072 28,760 1,157,409 Sierra Leone 2,904,688 521,100 1,515,000 29,000 1,741,998 Solomon Islands 10,000 – – – – Somalia – – 8,400 – 95,901 South Sudan 8,640,000 – 250,000 2,500 1,531,920 Sri Lanka – 40,064 30,000 50,000 2,119,680 Sudan 4,320,000 59,944 2,500 6,000 4,651,020 Tajikistan 5,889,600 – – 160,000 496,944 Tanzania 19,067,140 801,040 2,475,000 192,399 6,231,664 Timor-Leste 4,068,000 19,000 118,000 – 126,000 Togo 20,843,800 15,540 316,400 46,000 – Uganda 84,725,600 868,680 2,341,900 138,000 1,789,120 Uzbekistan 6,854,400 – 279,400 830,000 – Vietnam 3,888,000 18,000 146,440 169,350 – West Bank and Gaza 3,335,042 – – – 130,320 Western Sahara – – – – – Yemen Rep 504,000 67,900 70,000 200,000 4,677,940 Zambia 99,441,200 406,532 3,228,400 118,800 5,095,576 Zimbabwe 57,873,000 264,444 2,555,400 69,000 13,756,208 Other FP2020 Shipment Volumes 1,800,000 1,112,700 14,319,600 179,860 22,124,505 Total Volumes 975,790,362 13,666,684 84,193,476 6,074,263 209,091,590 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2021. AP PE N D IC ES 30 APPENDIX B – DATA SOURCES 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 following 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 Dynamics Working Group, launched the Global Markets Visibility Project to help various donors, suppliers, and partners improve their understanding 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 participating members of the former RHSC Generic Manufacturers for Reproductive Health Caucus (GEMs). For the subsequent reports, CHAI has collected shipment data directly from the former 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 17 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 supplier shipment data collected through this project. U.S. Agency for International Development (USAID) 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 summarizes 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 FY2016 through FY2020 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. 28 Previous versions of this report utilized the publicly-available Reproductive Health Interchange (RHI) dataset. On September 21, 2020, the RHI interface was replaced by RH Viz; accordingly, this report has transitioned to using the RH Viz database. The United Nations Population Fund (UNFPA) Procurement Services Branch (PSB) Procurement Data UNFPA is the lead agency within the United Nations system for the procurement 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 determine the value of the contraceptive procurement conducted by UNFPA from 2016 to 2020 for FP2020 countries. Values are inclusive of commodity cost and exclude services such as freight, sampling, inspection, and testing and are reported based on the calendar year. Reproductive Health Supplies Visualized (RH Viz)28 The RH Viz database provides visibility into contraceptive shipment volumes via a series of public- facing dashboards. RH Viz leverages both historical procurement shipment data (from 2008-2016), as well as live procurer shipment data from the Global FP VAN (from 2017 forward). Data provided from the Global FP VAN (in RH Viz) currently reflects shipments from and reported by USAID and UNFPA. RH Viz is used as a comparison point 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 31 APPENDIX C – ESTIMATING THE VALUE OF THE FP2020 PUBLIC-SECTOR MARKET The value of the FP2020 public-sector market was calculated using the most comprehensive available data sources: historical supplier-reported shipment data and RH Viz shipment data. Shipment data is recorded in the following units: Exhibit C.1: 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 AP PE N D IC ES 32 Historical Supplier-Reported Data To date, the Global Markets Visibility Project has collected historical supplier-reported shipment data from 17 manufacturers – Bayer, Cipla, Corporate Channels, CR Zizhu, Cupid, Female Health Company, Helm AG, Incepta, Medicines360, Merck (MSD), Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, Techno Drugs and Viatris (Mylan). Collectively, the total volumes cover institutional sales (USAID, UNFPA, SMOs, etc.) and MOH tenders across five family planning product categories.29 SUPPLIERS HAVE CUMULATIVELY SHIPPED 94 MILLION FEMALE CONDOMS, 53 MILLION IMPLANTS, 344 MILLION INJECTABLES, 43 MILLION IUDS, 711 MILLION ORALS (COMBINED & PROGESTIN ONLY), AND 33 MILLION EMERGENCY CONTRACEPTIVES FROM 2016 TO 2020. It is important to note that there were several shipments to procurer (USAID, UNFPA, SMO) warehouses in non- FP2020 countries, such as Belgium, Denmark, Finland, France, Germany, Netherlands, Norway, Sweden, Switzerland, UK, and USA. Although these volumes were initially shipped to non-FP2020 countries, these 29 Total shipment of oral contraceptives includes combined, progestin-only, and emergency oral contraceptives. shipments were likely to go on to the 69 FP2020 countries. As a result, these non-FP2020 country volumes were included in the total shipments to the 69 FP2020 countries after it was confirmed with suppliers that the specific non-FP2020 country volumes were associated with institutional purchases. CHAI analyzed the aggregated historical supplier- reported shipment data to confirm that coverage across the public-sector FP2020 product markets was greater relative to RH Viz shipment data for the 69 FP2020 focus countries. The aim of collecting historical volumes of all institutional purchases and MOH tenders directly from suppliers was to address data gaps observed in publicly available shipment data which only capture a subset of procurers who chose to submit historical procurement data. Furthermore, although some countries report national procurements, many national procurements are not reported in publicly available databases. The cumulative total from 2016 to 2020 for historical supplier-reported shipment volumes to the 69 FP2020 focus countries and procurer warehouses is greater than RH Viz in every method. Exhibit C.2: Global Markets Visibility Project participants and products Manufacturer Condoms - Female Implants Injectables IUDs Orals Bayer • • • • Cipla • Corporate Channels • CR Zizhu • Cupid • Female Health Company • Helm AG • • • Incepta • • Medcines360 • Merck (MSD) • • Pfizer • Pregna • PT Tunggal • • Shanghai Dahua • SMB • Techno Drugs • • • Viatris (Mylan) • • • Note: Cumulative totals calculated using actual, rather than rounded numbers. Sources: [1] Historical Supplier-Reported Shipment Data. AP PE N D IC ES 33 Exhibit C.4: Supplier-reported shipment volumes as a percentage of RH Viz-reported volumes by method, 2016-2020 Method 2016 2017 2018 2019 2020 Cumulative Total Condoms - Female 119% 141% 76% 136% 94% 112% Implants 153% 169% 116% 140% 144% 141% Injectables 123% 163% 181% 129% 143% 147% IUDs 333% 234% 389% 385% 324% 339% Orals - Combined & Progestin Only 170% 249% 192% 218% 194% 201% Orals - Emergency 434% 1221% 374% 500% 356% 465% AP PE N D IC ES Exhibit C.3: Supplier-reported shipment volumes to FP2020 countries by method, 2016-2020 Method 2016 2017 2018 2019 2020 Cumulative Total Condoms - Female 22M 22M 13M 21M 16M 94M Implants 9M 8M 11M 11M 14M 53M Injectables 50M 59M 81M 70M 84M 344M IUDs 11M 5M 12M 9M 6M 43M Orals - Combined & Progestin Only 114M 118M 127M 151M 201M 711M Orals - Emergency 6M 6M 6M 6M 8M 33M Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2021 34 Male Condom Market RH Viz shipment data for male condoms was used to capture a more comprehensive view of the public-sector family planning market for the 69 FP2020 focus countries. The report used RH Viz shipment data from 2016 to 2020 and included all male condom shipment volumes to the 69 FP2020 focus countries as well as volumes associated with procurer warehouses in non-FP2020 focus countries.30 The supplier-reported volumes for female condoms, implants, injectables, IUDs, and orals, together with RH Viz shipment volumes for male condoms, represent the estimated FP2020 public-sector market from 2016 to 2020. 30 Total yearly volumes are based on the year that the product was shipped. Exhibit C.5: RH Viz male condoms shipment volumes, 2016-2020 Method 2016 2017 2018 2019 2020 Condoms – Male 1.02B 0.60B 1.15B 1.13B 0.96B Sources: [1] RH Viz Shipment Data, retrieved August 2021 35 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 factor published by USAID31. CYP factors calculate the estimated protection provided by different contraceptive methods. Because methods may have different CYPs associated with various 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. 31 USAID refreshed its CYP conversation factors in 2021; these updates have been incorporated into the Family Planning Market Report. USAID, “Couple-Years of Protection (CYP)”, available at https://www.usaid.gov/global-health/health-areas/family-planning/couple-years-protection-cyp. Sources: [1] USAID, “Couple-Years of Protection (CYP),” October 2021. AP PE N D IC ES Exhibit C.6: Volumes to CYPs shipped conversion factors, 2016–2020 Method Per Couple-Years of Protection (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 (copper) 0.22 Orals – Combined 15.00 Orals – Progestin Only 12.00 Orals – Emergency 20.00 https://www.usaid.gov/global-health/health-areas/family-planning/couple-years-protection-cyp 36 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.32 Finally, the Implant Access Program price of $8.50 was applied to implant volumes from 2016 to 2018. In 2019 and 2020, 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 and 2020. 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. To maintain consistency across dollar-value comparisons, this average pricing was applied to all market trends across supplier-reported and RH Viz-reported volumes. 32 UNFPA, “UNFPA Contraceptive Price Indicator—Year 2020”, available at https://www.unfpa.org/resources/contraceptive-price-indicator-year-2020. UNFPA, “UNFPA Contraceptive Price Indicator—Year 2019”, available at https://www.unfpa.org/resources/contraceptive-price-indicator-year-2019, UNFPA, “UNFPA Contraceptive Price Indicator –Year 2018”, available at https://www.unfpa.org/resources/contraceptive-price-indicator-year-2018, UNFPA, “UNFPA Contraceptive Price Indicator –Year 2017”, available at https://www.unfpa.org/resources/contraceptive-price-indicator-year-2017, UNFPA, “UNFPA Contraceptive Price Indicator –Year 2016”, available at http://www. unfpa.org/resources/contraceptive-price-indicator-2016. Notes: [1] For 2016-2018 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. Sources: [1] UNFPA Contraceptive Price Indicator, 2016 to 2020; [2] IAP Implant Prices. AP PE N D IC ES Exhibit C.7: Average unit price Method Price Range 2016 2017 2018 2019 2020 Minimum Maximum Unit Price Unit Price Unit Price Unit Price Unit Price Condoms - Female $0.43 $0.49 $0.49 $0.46 $0.47 $0.44 $0.43 Condoms – Male $0.02 $0.03 $0.03 $0.02 $0.02 $0.02 $0.02 Implants $8.26 $8.50 $8.50 $8.50 $8.50 $8.37 $8.26 Injectables $0.77 $0.82 $0.82 $0.79 $0.81 $0.77 $0.81 IUDs $0.30 $0.37 $0.30 $0.31 $0.30 $0.31 $0.37 Orals – Combined $0.23 $0.27 $0.26 $0.27 $0.24 $0.23 $0.23 Orals – Progestin Only $0.29 $0.33 $0.33 $0.32 $0.29 $0.29 $0.30 Orals - Emergency $0.26 $0.40 $0.35 $0.26 $0.28 $0.40 $0.26 https://www.unfpa.org/resources/contraceptive-price-indicator-year-2020 https://www.unfpa.org/resources/contraceptive-price-indicator-year-2019 https://www.unfpa.org/resources/contraceptive-price-indicator-year-2018 https://www.unfpa.org/resources/contraceptive-price-indicator-year-2017 http://www.unfpa.org/resources/contraceptive-price-indicator-2016 http://www.unfpa.org/resources/contraceptive-price-indicator-2016 37 APPENDIX D – ESTIMATING TOTAL FP2020 DONOR-SPEND VOLUMES To protect customer confidentiality, suppliers were not asked to disclose customer information associated with shipment volumes. CHAI and RHSC use information from USAID, GHSC-PSM, and UNFPA to understand donor spend by the two major institutional procurers of family planning commodities. For more information on each of these data sources, refer to Appendix B. Going forward, CHAI and RHSC 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 38 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 Indonesia33. In this section, the analysis is refreshed 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 comprehensive coverage of the public-sector markets in India and Bangladesh. Rather, the data is meant to be used as an initial view into domestic procurement in these markets, that may not be fully covered by the suppliers participating in this report. Bangladesh The Bangladesh Ministry of Health and Family Welfare (MOHFW) procured34 13 million CYPs for the 2020 calendar year, as compared to 12 million CYPs for the 2019 calendar year, 17 million CYPs for the 2018 calendar year, 3M CYPs for the 2017 calendar year, and 8 million CYPs for the 2016 calendar year. Procurement contracts in 2020 were awarded primarily to regional and local suppliers, including (but not limited to): Essential Drugs Co., Khulna Essential, M/S, Reneta Ltd., Popular Pharmaceuticals Ltd35., Sarban International Ltd., and Techno Drugs. By applying the same prices36 used for 2020 supplier shipment analyses to the volumes from the Bangladesh MOHFW procurement data, the implied value from Bangladesh’s procurement contracts is estimated to be $39 million for 2020, as compared to the $31 million implied by the 2020 supplier shipment data. Although contraceptive procurement 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 9.5 to 13.2 million CYPs—from 2016 to 2020. This analysis relies on data from the Government of Bangladesh’s Ministry of Health and Family Welfare (MOHFW)37 for 2016, 2017, 2018 2019, and 2020.38 33 Bangladesh and India accounted for a large proportion of the gap between FP2020-reported 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 Family Planning 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. 34 Note the Bangladesh MOHFW records procurement in terms of the date of receipt for shipments, rather than date shipped. 35 In 2017, Incepta supplied the Ministry of Health and Family Welfare (MOHFW) with injectables via Popular Pharmaceuticals Ltd. Source: Incepta Pharmaceuticals. 36 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. 37 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-receive-details 38 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 2016-2020. AP PE N D IC ES https://scmpbd.org/index.php/wims-reports/national-receive-details 39 Exhibit E.1: MOHFW supply chain contraceptive shipment receipt details (publicly-available volumes data) Product Name Supplier Name 2016 2017 2018 2019 2020 CONDOM Direct Relief 0 0 1,584,000 0 0 CONDOM ESSENTIAL DRUGS CO. LTD. 68,850,000 0 56,854,800 11,600,800 72,163,600 CONDOM KHULNA ESSENTIAL LATEX PLANT (KELP) 35,000,000 0 62,158,800 95,894,000 44,388,400 CONDOM UNFPA 0 1,195,200 10,080,000 0 0 ECP (2 TAB/PACK) M/S, RENETA LTD. 100,000 0 100,000 100,000 100,000 IMPLANT (2 ROD) SOCIAL MARKETING COMPANY (SMC) 17,000 0 0 0 0 IMPLANT (2 ROD) TECHNO DRUGS Ltd 0 0 385,000 429,054 0 IMPLANT (2 ROD) USAID 0 35,000 0 0 0 IMPLANT (SINGLE ROD) JAMES INTERNATIONAL 5 2,880 0 0 0 IMPLANT (SINGLE ROD) Merck Sharp & Dohme B.V(MSD B.V.). 150,000 3,000 0 0 0 IMPLANT (SINGLE ROD) MSD-NV Organon, Organon (India) Private Ltd. 0 199,980 0 0 0 IMPLANT (SINGLE ROD) UNFPA 0 0 200,000 5,000 0 INJECTABLES (DMPA-IM) Popular Pharmaceuticals Ltd. 0 1,000,000 1,000,000 0 0 INJECTABLES (DMPA-IM) TECHNO DRUGS Ltd 8,100,000 5,000,000 18,250,000 8,230,000 15,250,000 INJECTABLES (DMPA-IM) UNFPA 0 299,997 0 0 0 INJECTABLES (DMPA-IM) USAID 0 1,000,000 914,800 0 0 IUD (CT-380A) IPAS Bangladesh 0 0 9,500 0 0 IUD (CT-380A) MARIE STOPES CLINIC 0 65,000 56,000 0 0 IUD (CT-380A) SARBAN INTERNATIONAL LTD. 0 0 0 0 300,000 IUD (CT-380A) SMB Corporation Of India 0 0 450,000 0 0 IUD (CT-380A) UNFPA 0 0 200,000 0 0 ORAL CONTRACEPTIVE PILL (SHUKHI) M/S, RENETA LTD. 54,750,000 0 54,800,125 110,000,001 50,500,000 ORAL CONTRACEPTIVE PILL (SHUKHI) Popular Pharmaceuticals Ltd. 14,250,000 0 16,700,000 0 12,500,000 ORAL CONTRACEPTIVE PILL (SHUKHI) TECHNO DRUGS Ltd 0 0 16,700,000 0 38,000,000 ORAL PILL APON M/S, RENETA LTD. 3,500,000 750,000 4,000,000 1,000,000 3,500,000 AP PE N D IC ES Source: Bangladesh MOHFW, Supply Chain Management Portal, 2021. 40 India Based on India’s Ministry of Health and Family Welfare (MOHFW)39 Annual Report for the 2020-2021 fiscal year40, CYPs procured from product-based methods41 totaled 44 million. This number was slightly higher than the 2016-17 to 2020- 21 fiscal year average of 41M CYPs procured annually. Injectable procurement continued at similar levels in 2020-2021 as in 2019-2020 (volumes procured were down by only 6 percent in 2020-2021, as compared to 2019-2020, at the time of reporting). IUDs continued to comprise the majority of CYPs provided in the MOHFW basket in 2020-2021; a total of 34M out of 44M CYPs provided were from IUDs. Although the MOHFW reports annual shipment volumes based on a fiscal year schedule, instead of the calendar years used in this report, for simplicity the same prices (in Exhibit C.7) were used to estimate the implied annual market value for supplier shipment and MOHFW procurement volumes. These calculations show MOHFW procurement values of approximately $54 million in the 2019-20 fiscal year and $34 million in the 2020-21 fiscal year, compared to the $1 million and $2 million implied by the 2019 and 2020 supplier shipment data. 39 Government of India, Ministry of Health and Family Welfare, “Annual Report of Department of Health & Family Welfare for the year of 2020-21”, “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”, available at: https://main.mohfw.gov.in/ documents/publication and https://main.mohfw.gov.in/documents/publication/publication-archives 40 The fiscal year for India runs from April 1 to March 31. Accordingly, all values from the most recent year are provisional; not all data has been reported at the time of publishing (for MOHFW reports). 41 Only modern contraceptive methods from India’s MOHFW reports, including condoms, injectables, IUDs, and oral contraceptives, are included in this analysis. AP PE N D IC ES Exhibit E.2: Annual reports of Department of Health & Family Welfare (includes fiscal years 2016-17 to 2020-21) Exhibit E.2.1: Quantities supplied to States/UTs (publicly-available data) Contraceptives 2016-17 2017-18 2018-19 2019-20 2020-21* Condoms (In million pieces) 432.8 526.8 0.0 378.1 397.1 Oral Pills (In lakh cycles) 312.0 275.3 394.4 591.6 427.6 IUDs (In lakh pieces) 48.1 22.6 88.5 87.7 73.8 Emergency Contraceptive Pills (in lakh packs) 60.8 50.4 128.0 195.7 131.7 Centchroman Contraceptive Pill (Lakh Strips) 7.1 24.0 170.3 116.7 117.7 Injectable Contraceptive (Lakh Doses) 0.0 27.0 0.0 31.5 29.3 Exhibit E.2.2: Social marketing sales of contraceptives (publicly-available data) Contraceptives 2016-17 2017-18 2018-19 2019-20 2020-21* Condoms (Million pieces) 399.0 483.2 459.5 507.5 91.8 Oral Pills (Social Marketing) (lakh cycles) 194.3 205.3 159.2 147.1 16.2 SAHELI (in Lakh tablets) 321.8 321.8 77.5 0.0 0.0 *Figures are Provisional https://main.mohfw.gov.in/documents/publication https://main.mohfw.gov.in/documents/publication https://main.mohfw.gov.in/documents/publication/publication-archives 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 (or volumes, if applicable) of shipment volumes in a market captured by a certain contraceptive method. 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 RH Viz data (male condoms) and historical supplier-reported shipment data (female condoms, implants, injectables, IUDs, and oral contraceptives) 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 Gross National Income 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 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 FP2020 FAMILY PLANNING 2020 RHSC REPRODUCTIVE HEALTH SUPPLIES COALITION RH VIZ REPRODUCTIVE HEALTH SUPPLIES VISUALIZER USAID UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT UNFPA UNITED NATIONS POPULATION FUND 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 this report’s analyses and allows CHAI and RHSC to address information gaps and construct a comprehensive view of the reproductive health commodities market. We would like to thank current participating suppliers (Bayer, Cipla, Corporate Channels, CR Zizhu, Cupid, Female Health Company, Helm AG*, Incepta, Medicines360, Merck (MSD), Pfizer, Pregna, PT Tunggal, Shanghai Dahua, SMB, Techno Drugs, and Viatris (Mylan), as well as our partner, Concept Foundation, for their support in collecting and aggregating 2011-2017** data. We are also grateful to our colleagues from the Consensus Planning Group (CPG), John Snow Inc. (JSI), the United Nations Population Fund (UNFPA), the United States Agency for International Development (USAID), the Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM), and FP2030 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 2015, 2016 and 2017 Family Planning Market Reports. In September 2017, HELM AG sold its wholly-owned subsidiary company, HELM Medical GmbH, to Sanavita Pharmaceuticals GmbH. Refer to page 18-19 for more information on HELM AG and other participating suppliers. ** CHAI began collecting data directly from suppliers in the former GEMS Caucus in 2018.

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