Family Planning Market Report

Publication date: 2023

FAMILY PLANNING MARKET REPORT DECEMBER 2023 CONTENTS ACRONYMS 3 INTRODUCTION 4 THE STATE OF FAMILY PLANNING IN 2022 6 SUPPLIER SHIPMENT ANALYSIS 7 GLOBAL PROCURER SPEND ANALYSIS 19 DOMESTIC GOVERNMENT SPEND ANALYSIS 21 HIGHLIGHTS FROM DISCUSSIONS WITH KEY STAKEHOLDERS 25 GLOBAL MARKETS VISIBILITY PROJECT ACKNOWLEDGEMENTS 27 APPENDICES 29 ACKNOWLEDGMENTS 54 3 ACRONYMS CAGR COMPOUND ANNUAL GROWTH RATE CHAI CLINTON HEALTH ACCESS INITIATIVE CYP COUPLE-YEARS OF PROTECTION FP FAMILY PLANNING FP2030 FAMILY PLANNING 2030 IUD INTRAUTERINE DEVICE LARC LONG-ACTING REVERSIBLE CONTRACEPTIVE MOH MINISTRY OF HEALTH MOHFW MINISTRY OF HEALTH AND FAMILY WELFARE RHSC REPRODUCTIVE HEALTH SUPPLIES COALITION RH REPRODUCTIVE HEALTH RH VIZ REPRODUCTIVE HEALTH SUPPLIES VISUALIZER SMO SOCIAL MARKETING ORGANIZATION TPP THIRD PARTY PROCUREMENT USAID UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT UNFPA UNITED NATIONS POPULATION FUND YOY YEAR-OVER-YEAR 4 INTRODUCTION 1 The hormonal IUD was included in the FP Market Report for the first time in 2022 since a publicly available hormonal IUD price was available for the first time that year in the 2021 UNFPA Contraceptive Price Indicator to inform market value calculations. 2 Note: While some methods (e.g., male and female condoms and emergency oral contraceptives) may be used simultaneously with other methods, they have been displayed separately throughout this report for clarity. 3 As agreed upon with FP2030, each year an assessment will be made and countries will be included in the FP Market Report’s scope if they are classified as low- and lower- middle-income countries for that year based on the latest World Bank’s country income classifications (for example, Lebanon is a new addition in this year’s report based on the World Bank’s country income classification for FY23). Historical supplier shipment data is then gathered for any new countries added to the report scope each year to ensure the report looks at the same country scope across the five-year time period. In consultation with FP2030, it was also decided that countries that have recently graduated from low- and lower-middle-income country status (for example, under the FY23 World Bank income classification, only one country, Belize moved to upper-middle income classification) will not be excluded from the report scope since the report covers a historic time period. Due, in part, to data challenges, FP2030 is not presently reporting data on Western Sahara. However, CHAI and the RHSC have kept Western Sahara in scope for the FP Market Report. 4 Further details on commodity prices over time available in Appendix C. 5 For all CYP calculations, this report utilizes the CYP factors most recently published by USAID. See Appendix C for further details. The Family Planning (FP) Market Report, produced jointly by the Clinton Health Access Initiative (CHAI) and the Reproductive Health Supplies Coalition (RHSC), has been published annually since 2015 to enhance visibility into the contraceptive commodities market. Specifically, the report provides insights into public-sector procurement of contraceptives, defined as including volumes purchased by Ministries of Health (MOHs) or other government-affiliated purchasers, the United Nations Population Fund (UNFPA), the United States Agency for International Development (USAID), as well as social marketing organizations (SMOs). The report analyzes procurement trends for all product- based modern methods of contraception which include implants, copper and hormonal1 intrauterine devices (IUDs), oral contraceptives (combined and progestin- only), emergency oral contraceptives, injectables, female condoms, and male condoms.2 Historically, the geographic scope of the FP Market Report encompassed the 69 FP2020 focus countries. However, the 2022 Market Report and this year’s 2023 Market Report now encompass the broader set of all low- and lower-middle-income countries to align with the evolved global partnership and measurement structure for the FP community announced by FP2030 in 2021. This year, the report encompasses 84 in-scope countries3 and covers the years 2018 to 2022. There are four key sections within this report: 1. Supplier shipment analysis: This section is the primary focus of the report and includes an analysis of key public-sector contraceptive procurement trends from 2018 to 2022 based on historical shipment data shared by the 17 participating suppliers in this year’s report. The analysis in this section centers on three primary indicators: · Market volumes (in units), which are shared directly by suppliers and provide insight into how contraceptive procurement for specific methods has evolved over the 2018 to 2022 period. · Market value (in USD), which is calculated by multiplying shipment volumes by method against the relevant average commodity prices each year as per UNFPA’s Contraceptive Price Indicator, which is a publicly available source that is updated annually.4 · Couple-Years of Protection (CYPs) shipped, which are calculated by multiplying shipment volumes by method against the relevant CYP conversion factor for each method. The CYP conversion factor estimates the number of units required of a specific contraceptive method to provide a couple with one year of protection (for example, 120 condoms are estimated to provide a couple with protection for one year).5 While volumes shipped can vary greatly in magnitude by method given different durations of contraceptive protection offered, converting volumes into CYPs shipped by method enables a more standardized comparison of method trends over time. 2. Global procurer spend analysis: This section provides an overview of total spend (in USD) on contraceptive procurement between 2018 and 2022 for UNFPA and USAID specifically, which are the two primary global procurers of contraceptives in the public-sector for in-scope countries. 3. Domestic government spend analysis: Recognizing the important and growing focus within the reproductive health (RH) community to strengthen domestic government financing for contraceptive procurement in in-scope countries, this year’s Market Report includes a new section that summarizes available data across multiple sources about domestic government financing for contraceptive procurement within the in- scope countries. 4. Highlights from discussions with key stakeholders: Finally, this section provides additional commentary from key RH stakeholders, including suppliers, procurers, and technical partners, about the public-sector market trends observed from 2018 to 2022 and future outlook as well as high-level reflections on the commercial-sector contraceptive market in low- and lower-middle-income countries, recognizing that commercial-sector channels are important from both a user access standpoint as well as from a market sustainability perspective. The qualitative commentary in this section adds 5 further color to the quantitative trends shown earlier in the report. The report also includes an appendix that provides additional detail on the analytical approach utilized, key data sources reviewed, further country-level details on procurement volumes, and a deeper dive into the Bangladesh and Indian markets leveraging publicly available procurement data published by those governments. Taken together, these various analyses provide enhanced visibility into the contraceptive market in in-scope countries. For example, the report provides insights into the following sampling of topics: · Evolution of CYPs shipped by method during the 2018 to 2022 time period and key drivers · Methods that are growing as a proportion of total CYPs shipped, market value, and/or market volumes within in-scope countries · Cost per CYP by method and evolution over time · Significant countries in terms of their overall contraceptive market value or volumes for a specific method · Overview of USAID and UNFPA contraceptive procurement spend over time, key drivers and future outlook · Insight into how certain contextual factors (e.g., the COVID-19 pandemic) have influenced the contraceptive commodities market · Countries with notable and/or increasing domestic government expenditure on contraceptive commodities The data and insights contained in this report can help inform decision-making by different stakeholders within the RH community. Continued collaboration across organizations within the RH ecosystem will also be essential to ensure that market data and insights available across different sources are thoughtfully shared, combined, and referenced to further enhance market visibility over time. Such market visibility efforts, including the FP Market Report, are vital for supporting our shared goal of ensuring there is growing and sustained access to affordable and quality contraceptive products in low- and lower-middle- income countries over time. 6 THE STATE OF FAMILY PLANNING IN 2022 Share of 10 largest public-sector countries *The top 10 countries in this graph are defined based on 2022 market value data and, in alphabetical order, are Bangladesh, Democratic Republic of Congo, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Nigeria, Tanzania, and Uganda. Important note for this year’s report: Bangladesh, a top market, experienced a notable decline in market value from 2021 to 2022; Given Bangladesh’s large size, this decline impacts overall market trends from 2021 to 2022 in the 84 in-scope countries. Therefore, this year’s report shows topline trends both including and excluding Bangladesh to provide a more nuanced view. N ot ab le M ar ke t T re nd s G lo ba l P ro cu re r Sp en d An al ys is $50M USAID’s total spend on contraceptive procurement in FY2022, an increase of 42% from FY2021 USAID’s FY2022 procurement spend matched the peak spending level seen in the FY2018-22 period money-bill-waveUNFPA’s total spend on contraceptive procurement in FY2022, an increase of 49% from FY2021 Procurement spend rebounded to levels seen in FY2019/20, following a notable decline in FY2021 money-bill-wave $160M 18% 13% 18% 19% 8% 39% 41% 39% 38% 44% 43% 46% 44% 43% 48% $247M $254M $285M $264M $257M 2018 2019 2020 2021 2022 Bangladesh Rem aining top 10 countries Other in-scope countr ies 37% 24% 18% 11% 10% 0.5% 0.4% 0.1% Implants* Copper IUDs* Injectables Male Condoms Combined & Progestin Only Orals Hormonal IUDs* Emergency Orals Female Condoms M et ho d M ix A na ly si s *Long-Acting Reversible Contraceptives (LARCs), which include implants, copper IUDs, and hormonal IUDs, constituted the majority of the method mix in 2022, as they also did each year in the 2018-2021 period 61% Bangladesh’s market value decreased by $29M from 2021 to 2022, primarily driven by lower procurement of combined & progestin-only orals Public-sector market value trends from 2021-2022 All 84 in-scope countries 83 in-scope countries excluding Bangladesh $264M $257M 2021 2022 $215M $237M 2021 2022 ↑10%↓3% Public-sector CYPs shipped trends from 2021-2022 All 84 in-scope countries 83 in-scope countries excluding Bangladesh 103M 104M 2021 2022 87M 98M 2021 2022 ↑12%↑1% Market share per method based on CYPs shipped, in 2022 (84 in-scope countries) Long-acting reversible methods Short acting methods 77 SU PP LI ER S H IP M EN T AN AL YS IS SUPPLIER SHIPMENT ANALYSIS For the 2023 FP Market Report, shipment data was collected from 17 participating suppliers for implants, copper and hormonal IUDs, oral contraceptives (combined and progestin-only), emergency oral contraceptives, injectables, female condoms, and male condoms. Male condom shipment data was pulled from the Reproductive Health Supplies Visualizer (RH Viz).6 Shipment data provides insights into the historical procurement of contraceptive products but is not necessarily equivalent to the demand for contraceptives, given procurement is shaped by key factors such as available funding and production capacity. 6 This report 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 provided greater visibility for that method. Additionally, RHI data was historically used to assess relative visibility that the FP Market Report provides across all methods. In September 2020, however, the RH community integrated data and functions from siloed tools, like RHI, into the broader Global FP Visibility and Analytics Network (VAN) platform. A public-facing series of dashboards was launched, called RH Viz, and combines historical procurement data with live procurer shipment data from the VAN. The 2023 FP Market Report, therefore, utilizes RH Viz data for male condom volumes and market visibility calculations. See Appendix C for further details. 7 In 2022, Bangladesh procured significantly lower volumes of combined and progestin-only oral contraceptives. Per stakeholder feedback, this decline was primarily driven by accumulation of oral contraceptives during the COVID-19 pandemic in 2020 and 2021, leading to reduced procurement in 2022. Since combined and progestin-only oral contraceptives account for approximately 70 percent of total CYPs shipped for the Bangladesh market between 2018 to 2022 and since Bangladesh is also one of the largest markets out of the 84 countries in-scope for this report, this notable decline in oral contraceptive procurement in Bangladesh in 2022 has significant impact on overall market trends seen across the full set of in-scope countries. 8 The currency reported is in US dollars, unless otherwise noted. Note: Compared to previous years, in 2022, Bangladesh displayed distinctive procurement trends given local market dynamics.7 These distinctive trends impacted overall market trends across the full set of in-scope countries due to the large size of the Bangladesh market. Thus, this section synthesizes key market insights both with and without the inclusion of Bangladesh to offer a more nuanced view of market developments. In 2022, across all in-scope countries, couple-years of protection (CYPs) shipped to the public-sector market increased by 1 percent compared to 2021 (103 to 104 million). Increased volumes of copper IUDs and injectables were the primary drivers of growth. Long- acting reversible methods of contraception (LARCs), which include implants, copper IUDs, and hormonal IUDs, continued to comprise the majority (61 percent) of CYPs shipped in 2022. When excluding Bangladesh, CYPs shipped to the other 83 in-scope countries increased by a more notable 12 percent between 2021 and 2022, with LARCs continuing to account for most CYPs shipped. While CYPs shipped increased slightly across all in- scope countries, the overall market value8 contracted by 3 percent in 2022 relative to 2021, decreasing from $264 million to $257 million. Notably, when Bangladesh is excluded, the value of the public sector market increased by 10 percent from 2021 to 2022 in the other 83 in-scope countries. Finally, overall market volumes decreased by 27 percent in 2022 relative to 2021; this significant drop is primarily due to a decline in oral contraceptive procurement volumes in Bangladesh specifically. Excluding Bangladesh, total market volumes across methods actually increased by 11 percent from 2021 to 2022 in the other 83 in-scope countries. Change in CYPs shipped to the public- sector market, 2021-2022 ↑1% across all 84 in-scope countries ↑12% across 83 in-scope countries (excl. Bangladesh) Change in overall public-sector market value, 2021-2022 ↓3% across all 84 in-scope countries ↑10% across 83 in-scope countries (excl. Bangladesh) Change in overall public-sector market volumes, 2021-2022 ↓27% across all 84 in-scope countries ↑11% across 83 in-scope countries (excl. Bangladesh) 88 SU PP LI ER S H IP M EN T AN AL YS IS Notable Market Trends This section analyzes trends in CYPs shipped, shipment value in USD, and volumes in the public-sector market from 2018 to 2022. 9 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. 10 As noted previously, the FP Market Report provides visibility into contraceptive procurement trends in Bangladesh with data from the participating suppliers. However, there are additional suppliers active in the Bangladesh market, beyond the participating suppliers captured in the FP Market Report (see Appendix E for more details). The quantity of CYPs shipped to the public-sector contraceptive market in the 84 in-scope countries increased by 1 percent (103 to 104 million) from 2021 to 2022 (Exhibit 1.A). The increase in copper IUD procurement (+6 million) from 2021 to 2022 was the primary driver of increase in CYPs. We also observed a notable increase in CYPs shipped for injectables (+4 million) and a slight increase for male condoms (+0.4 million) during the same period. These increases in CYPs shipped were offset by a large decline in CYPs shipped for combined and progestin only orals (-7 million) and a smaller decline for implants (-2 million) from 2021 to 2022. LARCs which include implants, copper IUDs, and hormonal IUDs, increased by 3 percentage points in 2021 from 58 percent in 2021 to 61 percent in 2022 as a share of overall CYPs shipped, continuing to comprise the majority of CYPs shipped (Exhibit 5). Excluding Bangladesh, the quantity of CYPs shipped to the other 83 in-scope countries increased by 12 percent in 2022 from 87 million in 2021 to 98 million (Exhibit 1.B). Across all in-scope countries, the total value of the public-sector contraceptive market decreased from $264 million in 2021 to $257 million in 2022, a 3 percent reduction (Exhibit 2.A). Declines in market value for combined and progestin-only oral contraceptives (-$20 million) and, to a smaller extent, implants (-$5 million) and emergency orals (-$2 million) were the primary drivers of the reduction in overall market value between 2021 and 2022. However, the decline was partially offset by an increase in the market value for injectables (+$14 million), male condoms (+$4 million), female condoms (+$0.6 million) and copper IUDs (+$0.5 million). Market value contracted from 2021 to 2022 across all in-scope countries even though CYPs shipped increased over this period largely because of the increased procurement of copper IUDs in 2022, a method which has a relatively low cost but high CYPs per unit (Exhibit 4.A). The increase in copper IUD procurement in 2022 contributed to the increase in overall CYPs shipped in 2022, while having a relatively minimal impact on the overall market value. Comparatively, the $20 million decline in market value for combined and progestin- only oral contraceptives from 2021 to 2022 had a more notable impact on the overall market value but did not significantly affect CYPs, given the relatively low CYPs per unit for this method (Exhibit 4.A). Excluding Bangladesh, which was the largest contributor to the net overall decline in combined and progestin- only oral contraceptive volumes from 2021 to 2022, the total value of the public sector contraceptive market for the remaining in-scope countries grew from $215 million in 2021 to $237 million in 2022, representing a 10 percent increase (Exhibit 2.B). In terms of regional trends for the 2018 to 2022 period, sub-Saharan Africa’s market share (in terms of market value) increased by 7 percentage points from 2021 to 69 percent in 2022, up from 60 percent in 2018 (Exhibit 7). The Asia and Pacific Region’s market share decreased by 12 percentage points between 2021 and 2022 from a high of 28 percent in 2021 to 16 percent in 2022 (Exhibit 7); this 2022 decrease in market share is primarily due to significantly lower procurement volumes in Bangladesh. Within the public-sector market captured in this report,9 the 10 largest countries (in terms of market value) represented over 50 percent of the overall market value in 2022, with Bangladesh10 comprising approximately 8 percent of the public-sector market (Exhibit 8). Even though Bangladesh continues to be one of the top 10 largest countries in terms of market value, its 8 percent share in 2022 is significantly lower when compared to the 17 percent market share Bangladesh represented on average during the 2018 to 2021 period (Exhibit 9). Overall, the market value for the 10 largest countries also decreased from $149 million in 2021 to $134 million in 2022 (Exhibit 9). While the list of the top 10 markets has changed from year to year, six countries– Bangladesh, Ethiopia, Malawi, Nigeria, Tanzania, and Uganda–have consistently appeared in the list of top 10 markets (in terms of market value) each year, from 2018 to 2022. 99 SU PP LI ER S H IP M EN T AN AL YS IS Notable Method Trends This section analyzes method-specific trends in CYPs shipped, shipment value in USD, and volumes in the public-sector market from 2018 to 2022. 11 Hormonal IUD introduction efforts have been supported by the Hormonal IUD Access Group, which is a global consortium of governments, donors, manufacturers, procurement agencies (UNFPA and USAID/GHSC-PSM), researchers, and service delivery partners that are collaborating to expand access to the hormonal IUD in low- and lower-middle- income countries by ensuring availability of affordable, quality-assured products to facilitate sustainable markets and by supporting countries that are ready to introduce and scale-up the method (e.g., as demonstrated by strong government interest in the method, development of an introduction plan, etc.). More information can be found at the Hormonal IUD Access Portal (https://www.hormonaliud.org/). Across all 84 in-scope countries, copper IUD volumes increased by 32 percent from 2021 to 2022 (Exhibit 3.A). Specifically, copper IUD procurement increased from 4 million units in 2021 to 5 million units in 2022 (Exhibit 3.A). This increase was driven by select countries, including Egypt, Nigeria, Pakistan, and the Philippines, where copper IUD procurement increased in 2022 following lower procurement levels in 2021. Given the copper IUD's relatively low unit cost (Exhibit 4.A), this increase in procurement volumes in 2022 has a relatively negligible (+$0.5 million) impact on the overall market value (Exhibit 2.A). However, since the copper IUD has a relatively high CYP factor per unit, the rise in copper IUD volumes in 2022 does have a more meaningful impact on CYPs shipped (+6 million) from 2021 to 2022 across all in-scope countries (Exhibits 1.A, 4.A). Over the 2018 to 2022 period, copper IUD CYPs shipped were unusually large in 2018 and 2019, primarily due to a significant spike in copper IUD procurement by two large countries, Egypt and India, which notably surpassed their previous copper IUD procurement levels. Several other countries, including Indonesia, Bangladesh, and Uzbekistan, also had relatively larger copper IUD procurement volumes in 2018 and 2019. The decline in copper IUD CYPs shipped observed in 2020 and 2021 is due to both reduced copper IUD procurement volumes in these same countries in the 2020-2021 period, which may be due to cyclical procurement patterns, as well as the impact of the COVID-19 pandemic and associated lockdowns in some key markets. The hormonal IUD category remained relatively stable with a slight decline of 0.1 million CYPs shipped between 2021 to 2022 (Exhibit 1.A) and a volume decline from 0.12 million in 2021 to 0.11 million in 2022 (Exhibit 3.A). The contraction in volumes can be primarily attributed to reduced procurement in Nigeria and Zambia, which had initially placed larger orders in 2021 to scale provider training and enable consumption assessments in the early years of introduction. Hormonal IUD procurement volumes increased in several countries besides these two, as other countries introduced or further scaled up the method.11 The market value of implants decreased by 4 percent from 2021 to 2022 (Exhibit 2.A), with volumes shipped of implants declining from 13.5 million in 2021 to 13.1 million in 2022, across all in-scope countries (Exhibit 3.A). A few countries, including Nigeria, Bangladesh, Burkina Faso, and Philippines, were key contributors to the 2021-22 decline as they procured notably higher implant volumes in the previous one to two years; therefore, the decline in implant volumes in 2022 may be the result of procurement cycles rather than longer- term trends. Over the five-year reference period from 2018 to 2022, however, the CYPs shipped for implants increased at a 5 percent compound annual growth rate (Exhibit 1.A), demonstrating sustained progress in expanding access to implants over time. The market value of injectables across all in-scope countries increased by 30 percent from $47 million in 2021 to $61 million in 2022 (Exhibit 2.A). The injectables volumes shipped also increased from 58 million to 78 million units between 2021 and 2022 (Exhibit 3.A), driven by larger procurement volumes in several countries, including Madagascar, Malawi, Bangladesh, Kenya, and Nigeria. The market value of combined and progestin-only orals fell by 36 percent from $56 million in 2021 to $36 million in 2022 (Exhibit 2.A). In tandem, volumes shipped of combined and progestin-only oral contraceptives also contracted from 258 million in 2021 to 147 million in 2022 (Exhibit 3.A). The decrease in Bangladesh’s oral contraceptive procurement drove the overall decline in oral contraceptive volumes from 2021 to 2022. Stakeholders shared that the Bangladesh government had leftover stock of oral contraceptive pills accumulated during the height of the COVID-19 pandemic (2020 to 2021) contributing to lower volumes procured in 2022. Excluding Bangladesh, oral contraceptive procurement increased by 8 percent from 2021 to 2022 across the remaining 83 in-scope countries. https://www.hormonaliud.org/ 1010 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 1: Total CYPs shipped Exhibit 1.A: Total CYPs shipped to all 84 in-scope countries 31M 34M 41M 40M 38M 58M 43M 28M 19M 25M 0.1M 0.1M 0.1M 0.6M 0.5M 15M 17M 19M 17M 10M 0.5M 0.4M 0.7M 0.7M 0.4M 20M 17M 21M 14M 19M 0.1M 0.2M 0.2M 0.1M 0.1M 10M 10M 9M 11M 11M 134M 122M 119M 103M 104M – 20M 40M 60M 80M 100M 120M 140M 2018 2019 2020 2021 2022 Condoms - Male Condoms - Female Injectables Orals - Emergency Orals - Combined & Progestin Only IUDs - Hormonal IUDs - Copper Implants +1% Method YOY 2021-2022^ CAGR 2018-2022^^ Condoms - Male 4% 2% Condoms - Female -2% -2% Injectables 30% -2% Orals - Emergency -43% -5% Orals - Combined & Progestin Only -42% -9% IUDs - Hormonal -12%* 46% IUDs - Copper 32% -19% Implants -6% 5% Total 1% -6% Exhibit 1.B: Total CYPs shipped to 83 in-scope countries (excluding Bangladesh)** 118M 111M 104M 87M 98M 70M 90M 110M 130M 2018 2019 2020 2021 2022 +12% ^Year-over-year (YOY): change in the value of the public-sector market between 2021-22 ^^Compound Annual Growth Rate (CAGR): [(final value/beginning value)^(1/number of years)]-1 *With regards to Hormonal IUDs, it is important to note that this 12 percent reduction represents a decline of 0.1 million CYPs shipped, and that this type of fluctuation is to be expected given the method is just starting to scale up in in-scope countries. **Aggregate view provided to maintain supplier confidentiality; for additional appropriately aggregated country-level detail, please refer to Appendix A. 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 are calculated throughout the report using actual values, not the rounded values in the chart. Some differences exist in the historical data for 2018-2021 in this version of the report versus previous versions due to the different geographic scope of the report this year (84 in-scope countries) v. last year (83 in-scope countries), as well as some supplier or RH Viz revisions to historical data, based on updated information. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz shipment data, retrieved August 2023; [3] UNFPA Contraceptive Price Indicator, 2018–2022 1111 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 2: Total public-sector market value, in USD Exhibit 2.A: Total public-sector market value in all 84 in-scope countries, in USD $89M $96M $113M $117M $113M $4M $3M $2M $2M $2M$0.3M $0.3M $0.2M $1.3M $1.2M$53M $60M $66M $56M $36M $3M $3M $4M $3M $2M $66M $55M $68M $47M $61M $6M $10M $8M $6M $6M $27M $27M $24M $32M $36M $247M $254M $285M $264M $257M – 50M 100M 150M 200M 250M 300M 2018 2019 2020 2021 2022 Condoms - Male Condoms - Female Injectables Orals - Emergency Orals - Combined & Progestin Only IUDs - Hormonal IUDs - Copper Implants -3% Method YOY 2021-2022 CAGR 2018-2022 Condoms - Male 14% 8% Condoms - Female 10% -1% Injectables 30% -2% Orals - Emergency -47% -9% Orals - Combined & Progestin Only -36% -9% IUDs - Hormonal -12%* 46% IUDs - Copper 30% -12% Implants -4% 6% Total -3% 1% Exhibit 2.B: Total public-sector market value in 83 in-scope countries (excluding Bangladesh)**, in USD $201M $221M $235M $215M $237M 150M 200M 250M 2018 2019 2020 2021 2022 +10% *It is important to note that this 12 percent reduction represents a decline of $0.16 million, and that this type of fluctuation is to be expected given the method is just starting to scale up in in-scope countries. ** Aggregate view provided to maintain supplier confidentiality; for additional appropriately aggregated country-level detail, please refer to Appendix A. 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 are calculated throughout the report using actual values, not the rounded values in the chart. Some differences exist in the historical data for 2018-2021 in this version of the report versus previous versions due to the different geographic scope of the report this year (84 in-scope countries) v. last year (83 in-scope countries), as well as some supplier or RH Viz revisions to historical data, based on updated information. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz shipment data, retrieved August 2023; [3] UNFPA Contraceptive Price Indicator, 2018–2022; [4] USAID, “Couple-Years of Protection (CYP)”. 1212 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 3: Total public-sector market volumes (male condoms excluded) Exhibit 3.A: Total public-sector market volumes in all 84 in-scope countries (male condoms excluded*) 10M 12M 14M 13.5M 13.1M 13M 9M 6M 4M 5M 0.02M 0.03M 0.01M 0.12M 0.11M 217M 251M 283M 258M 147M 9M 9M 14M 13M 8M 82M 71M 85M 58M 78M 13M 22M 18M 13M 12M 344M 373M 420M 359M 263M – 50M 100M 150M 200M 250M 300M 350M 400M 450M 2018 2019 2020 2021 2022 Condoms - Female Injectables Orals - Emergency Orals - Combined & Progestin Only IUDs - Hormonal IUDs - Copper Implants -27% Method YOY 2021-2022 CAGR 2018-2022 Condoms - Female -2% -2% Injectables 34% -1% Orals - Emergency -43% -5% Orals - Combined & Progestin Only -43% -9% IUDs - Hormonal -12%** 46% IUDs - Copper 32% -19% Implants -3% 6% Total -27% -6% Method 2018 2019 2020 2021 2022 YOY 2021-2022 CAGR 2018-2022 Condoms - Male 1.21B 1.17B 1.04B 1.28B 1.33B 4% 2% Exhibit 3.B: Total public-sector market volumes in 83 in-scope countries (excluding Bangladesh*** and male condoms*) 221M 253M 242M 175M 195M 150M 200M 250M 300M 2018 2019 2020 2021 2022 +11% *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. ** It is important to note that this 12 percent reduction represents a decline of 0.01 million units, and that this type of fluctuation is to be expected given the method is just starting to scale up in in-scope countries. *** Aggregate view provided to maintain supplier confidentiality; for additional appropriately aggregated country-level detail, please refer to Appendix A. 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 are calculated throughout the report using actual values, not the rounded values in the chart. Some differences exist in the historical data for 2018-2021 in this version of the report versus previous versions due to the different geographic scope of the report this year (84 in-scope countries) v. last year (83 in-scope countries), as well as some supplier or RH Viz revisions to historical data, based on updated information. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz shipment data, retrieved August 2023; [3] UNFPA Contraceptive Price Indicator, 2018–2022 1313 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 4: Cost per CYP by method, in USD Exhibit 4.A: Cost per CYP by method per duration of use, in USD Method Units per CYP Unit Cost Cost per CYP 2018 2019 2020 2021 2022 2018 2019 2020 2021 2022 Condoms - Male 120.00 $0.02 $0.02 $0.02 $0.02 $0.03 $2.64 $2.72 $2.75 $2.98 $3.27 Condoms - Female 120.00 $0.47 $0.44 $0.43 $0.44 $0.49 $56.88 $53.28 $51.48 $52.32 $59.16 Injectables - 1 month 13.00 $0.85 N/A N/A N/A N/A $11.05 N/A N/A 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 $0.79 $0.75 $0.77 $0.77 $0.72 $3.16 $3.00 $3.07 $3.09 $2.88 Orals - Emergency 20.00 $0.28 $0.40 $0.26 $0.25 $0.23 $5.52 $7.98 $5.18 $5.00 $4.64 Orals - Combined 15.00 $0.24 $0.23 $0.23 $0.21 $0.23 $3.56 $3.51 $3.38 $3.17 $3.48 Orals - Progestin Only 12.00 $0.29 $0.29 $0.30 $0.28 $0.32 $3.52 $3.47 $3.60 $3.40 $3.80 IUDs (hormonal) 0.21 N/A N/A N/A $10.84 $10.84 N/A N/A N/A $2.26 $2.26 IUDs (copper) 0.22 $0.30 $0.31 $0.37 $0.43 $0.42 $0.07 $0.07 $0.08 $0.09 $0.09 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 N/A indicates method was not listed on the UNFPA Contraceptive Price Indicator. Implant pricing in this exhibit uses the IAP implant price. 2021 is the first year that UNFPA Contraceptive Price Indicator has listed separate prices for the 3-year and 5-year implants, but to maintain historical consistency, we continue to use the $8.50 IAP implant price for this illustrative cost per CYP calculation. Exhibit 4.B: Cost per CYP by method in 2022, in USD $59.16 $6.90 $4.64 $3.80 $3.48 $3.40 $3.27 $2.88 $2.26 $2.24 $0.09 $0.00 $10.00 $20.00 $30.00 $40.00 $50.00 $60.00 $70.00 Condoms - Female Injectables - 2 month Orals - Emergency Orals - Progestin Only Orals - Combined Implants - 3 Year Condoms - Male Injectables - 3 month IUDs - Hormonal Implants - 5 Year IUDs - Copper Sources: [1] UNFPA Contraceptive Price Indicator, 2018–2022; [2] USAID, “Couple-Years of Protection (CYP)”, [3] IAP Implant Price. 1414 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 5: CYP mix (in terms of CYPs shipped) in the public-sector market 23% 28% 34% 39% 37% 43% 35% 24% 18% 24% 0.1% 0.1% 0.1% 0.6% 0.5% 11% 14% 16% 17% 10% 0.3% 0.4% 0.6% 0.6% 0.4% 15% 14% 18% 14% 18% 0.1% 0.1% 0.1% 0.1% 0.1% 8% 8% 7% 10% 11% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2018 2019 2020 2021 2022 Condoms - Male Condoms - Female Injectables Orals - Emergency Orals - Combined & Progestin Only IUDs - Hormonal IUDs - Copper Implants 2018 2019 2020 2021 2022 66% 63% 58% 58% 61% LARCs as a percentage of CYPs shipped across 84 in-scope countries 71% 68% 66% 65% 65% LARCs as a percentage of CYPs shipped across 83 in-scope countries, excluding Bangladesh Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Some differences exist in the historical data for 2018-2021 in this version of the report versus previous versions due to the different geographic scope of the report this year (84 in-scope countries) v. last year (83 in-scope countries), as well as some supplier or RH Viz revisions to historical data, based on updated information. LARCs as a percentage 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 2023; [3] UNFPA Contraceptive Price Indicator, 2018–2022; [4] USAID, “Couple-Years of Protection (CYP)”. 134M 122M 119M 103M 104M 1515 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 6: Market share per method in the public-sector market, in USD 36% 38% 40% 45% 44% 2% 1% 1% 1% 1%0.1% 0.1% 0.1% 0.5% 0.5% 21% 24% 23% 21% 14% 1% 1% 1% 1% 1% 27% 21% 24% 18% 24% 3% 4% 3% 2% 2% 11% 10% 8% 12% 14% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2018 2019 2020 2021 2022 Condoms - Male Condoms - Female Injectables Orals - Emergency Orals - Combined & Progestin Only IUDs - Hormonal IUDs - Copper Implants 2018 2019 2020 2021 2022 38% 39% 40% 46% 45% LARCs as a percentage of market value across 84 in-scope countries 42% 44% 49% 53% 49% LARCs as a percentage of market value across 83 in-scope countries, excluding Bangladesh Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Some differences exist in the historical data for 2018-2021 in this version of the report versus previous versions due to the different geographic scope of the report this year (84 in-scope countries) v. last year (83 in-scope countries), as well as some supplier or RH Viz revisions to historical data, based on updated information. LARCs as a percentage of market value 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 2023; [3] UNFPA Contraceptive Price Indicator, 2018–2022; [ 4] IAP Implant Price. $247M $254M $285M $264M $257M 1616 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 7: Share of public sector market value by region, in USD 9% 6% 10% 7% 11% 60% 65% 63% 62% 69% 2% 3% 1% 1% 2% 2% 2% 1% 1% 2% 27% 24% 24% 28% 16% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 2018 2019 2020 2021 2022 Asia & Pacific Latin America & Caribbean Middle East & North Africa Sub-Saharan Africa Final Destination Country Not Specified Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. The share of public-sector market value by region depicted in the graph above is influenced by the relative distribution of low- and lower-middle-income countries, the majority of which are in Sub-Saharan Africa. Only a small number of countries from the Latin America & Caribbean (LAC) and Middle East & North Africa (MENA) regions are included among the 84 in-scope countries, thus the trends captured in this report may not be representative of the entire LAC and MENA regions. Additionally, the market value in the graph above is for the public-sector specifically (as defined earlier in the report) and therefore does not capture commercial-sector market value. The graph above also focuses on the product-based modern methods of contraception defined earlier in the report and therefore does not capture other methods beyond those, e.g., sterilization. Finally, the market value in the graph above reflects shipment data from the 17 participating suppliers only. “Final destination country not specified” indicates that shipments were received in warehouses for later distribution to in-scope countries. Some differences exist in the historical data for 2018-2021 in this version of the report versus previous versions due to the different geographic scope of the report this year (84 in-scope countries) v. last year (83 in- scope countries), as well as some supplier or RH Viz revisions to historical data, based on updated information. Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2023; [3] UNFPA Contraceptive Price Indicator, 2018–2022 $247M $254M $285M $264M $257M 1717 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 8: Top ten countries in terms of value, 2022 8% 7% 6% 6% 5% 5% 4% 4% 3% 3% 48% 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Bangladesh Congo Dem Rep Ethiopia Uganda Nigeria Tanzania Mozambique Kenya Madagascar Malawi Other countries Note: The sum of all bars does not add up to 100% due to rounding. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz Shipment Data, retrieved August 2023; [3] UNFPA Contraceptive Price Indicator, 2018–2022 1818 SU PP LI ER S H IP M EN T AN AL YS IS EXHIBIT 9: Value of ten largest public sector countries compared to value of all other countries combined $45M $33M $50M $49M $20M $95M $104M $111M $100M $115M $106M $117M $124M $114M $122M $247M $254M $285M $264M $257M $M $50M $100M $150M $200M $250M $300M 2018 2019 2020 2021 2022 Other in-scope countries Remaining Top 10 Countries* Bangladesh 2018 2019 2020 2021 2022 57% 54% 56% 57% 52% Top 10 countries as a % of overall market value 18% 13% 17% 19% 8% Bangladesh as a % of overall market value The top 10 countries in this graph are defined based on 2022 market value data and, in alphabetical order, are Bangladesh, Democratic Republic of Congo, Ethiopia, Kenya, Madagascar, Malawi, Mozambique, Nigeria, Tanzania, and Uganda Note: The sum of individual stacked bars for all exhibits may differ slightly from totals due to rounding. Some differences exist in the historical data for 2018-2021 in this version of the report versus previous versions due to the different geographic scope of the report this year (84 in-scope countries) v. last year (83 in-scope countries), as well as some supplier or RH Viz revisions to historical data, based on updated information. Sources: [1] Historical supplier-reported shipment data; [2] RH Viz Shipment Data, retrieved August 2023; [3] UNFPA Contraceptive Price Indicator, 2018–2022 1919 G LO BA L PR O CU RE R SP EN D A N AL YS IS GLOBAL PROCURER SPEND ANALYSIS This section focuses on data from the Supply Chain Management Unit of UNFPA and USAID’s “Overview of Contraceptive and Condom Shipments” report and is aimed at understanding historical contraceptive procurement spend by the two major global procurers in the public-sector markets of the 84 in-scope countries. The focus of this section is therefore on UNFPA and USAID expenditure on contraceptive commodity procurement specifically and, as such, the analysis in this section does not include any spend on programmatic and/or technical assistance from the procurers. 12 2022 UNFPA Supplies Partnership Annual Report. Link: https://www.unfpa.org/ unfpa-supplies-annual-report-2022 13 USAID data on contraceptive shipments is collected from the “Overview of Contraceptive and Condom Shipments FY2022 report”. The FY2022 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 the FY2018 to FY2022 period, in order to ensure the analysis compared a consistent data set across the relevant years. The USAID report is available here: https:// www.ghsupplychain.org/sites/default/files/2023-05/FY22%20C%20and%20C%20 report_18MAY2023.pdf 14 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. UNFPA spend on contraceptives bounced back in FY2022 with procurement spend nearing the peak levels seen in FY2019/20. Similarly, USAID’s contraceptive procurement spend increased from FY2021 to FY2022, matching the highest expenditure level observed over the five-year period from FY2018 to FY2022. UNFPA’s total spend on contraceptive procurement (across both UNFPA program and third-party procurement (TPP)) increased by 49 percent from $107 million in FY2021 to $160 million in FY2022 (Exhibit 10). UNFPA’s FY2022 spend on contraceptive procurement is greater than the average spend ($142M) seen over FY2018-21 (Exhibit 10) and more in line with FY2019 and FY2020 levels. The increase in contraceptive procurement spend is consistent with the anticipated rebound level expressed by stakeholders in the 2022 FP Market Report. The 2022 UNFPA Supplies Partnership Annual Report noted that there were new donor commitments and increased existing donor commitments to the Partnership in 2022.12 The $53 million increase from FY2021 to FY2022 was driven by a $48 million increase (+56 percent) in UNFPA program procurement spend and a $5 million increase (+22 percent) in TPP over this period. In FY2022, TPP comprised 17 percent, approximately $27 million, of the total UNFPA spend. The value of TPP increased by 18 percent compound annual growth rate from FY2018 to FY2022. Between FY2018 to FY2022, third-party procurement as a percentage of total annual UNFPA spend for in-scope countries fluctuated between a range of 9 and 20 percent each year. For USAID, the annual value of contraceptive procurement in FY2022, excluding male and female condoms,13 was $50 million, representing 42 percent growth from FY2021 (Exhibit 11).14 USAID spend has fluctuated between $35 million and $50 million yearly from FY2018-FY2022. USAID spend in FY2022 stands at EXHIBIT 10: UNFPA procurement value—contraceptives to in-scope countries, in USD $137M $162M $162M $107M $160M $M $30M $60M $90M $120M $150M $180M FY2018 FY2019 FY2020 FY2021 FY2022 2021-2022 YOY: +49% 2018-2022 CAGR: +3% Source: UNFPA Supply Chain Management Unit data FY2018 - FY2022 EXHIBIT 11: USAID procurement value (excluding male and female condoms)—contraceptives to in-scope countries, in USD $50M $38M $46M $35M $50M $M $10M $20M $30M $40M $50M $60M FY2018 FY2019 FY2020 FY2021 FY2022 2021-2022 YOY: +42% 2018-2022 CAGR: 0% Source: USAID “Overview of Contraceptive and Condom Shipments” reports, FY 2018 – FY2022. https://www.unfpa.org/unfpa-supplies-annual-report-2022 https://www.unfpa.org/unfpa-supplies-annual-report-2022 https://www.ghsupplychain.org/sites/default/files/2023-05/FY22%20C%20and%20C%20report_18MAY2023.pdf https://www.ghsupplychain.org/sites/default/files/2023-05/FY22%20C%20and%20C%20report_18MAY2023.pdf https://www.ghsupplychain.org/sites/default/files/2023-05/FY22%20C%20and%20C%20report_18MAY2023.pdf 2020 G LO BA L PR O CU RE R SP EN D A N AL YS IS the highest within this timeframe and is in line with the level of spending seen in FY2018. The FY2022 USAID Overview of Contraceptive and Condom Shipments report highlights that additional funding was made available in FY2022 based on gaps identified by the Visibility and Analytics Network Consensus Planning Group (VAN CPG) under the RHSC. USAID spend on contraceptive procurement remains decentralized and determined by country missions. Funding Outlook UNFPA anticipates the same or higher-level procurement spending in 2023 as compared to 2022, taking into account the increased procurement-related spend from the UNFPA Supplies Partnership, TPP, and the Match Fund. Additionally, in 2023, the Partnership received significant commitments from philanthropic organizations and countries.15 The Bill & Melinda Gates Foundation announced a long-term commitment of up to $100 million dedicated to supporting direct commodity procurement. The Children’s Investment Fund Foundation (CIFF) intends to contribute $50 million to broader efforts to address the gap in commodity financing, including support for the UNFPA Supplies 15 Link: https://www.unfpa.org/press/governments-and-philanthropies-commit-increase-investments-end-funding-shortfall-lifesaving 16 President Biden released his FY2024 (October 1, 2023–September 30, 2024) budget request to Congress on March 9, 2023. Bilateral FP/RH funding included in this request totaled $600 million, which constitutes a 14 percent increase above the FY23 approved funding level. Proposed funding for UNFPA increased to $57.5M over the $32.5 million enacted in FY23. On July 11, 2023, the House Committee on Appropriations released its report on the FY2024 State, Foreign Operations, and Related Programs (SFOPs) appropriations bill, proposing funding decreases to the Administration’s budget request. The bilateral FP/RH funding included in this bill totaled $461 million, with a no funding allocated for UNFPA. This bill was approved by the House committee on Sept 28, 2023. On July 20, 2023, the Senate Committee on Appropriations approved its version of the FY2024 SFOPs appropriations bill, proposing $600 million in bilateral FP/RH funding and $35 million in funding for UNFPA. At the time of writing, FY2024 budget conversations were ongoing. Information available at: https://www.kff.org/news-summary/white-house-releases-fy-2023-budget-request/ , https://www.kff.org/news-summary/house-appropriations- committee-approves-the-fy-2024-state-and-foreign-operations-sfops-appropriations-bill/ , https://www.kff.org/news-summary/senate-appropriations-committee-approves-fy- 2024-state-foreign-operations-and-related-programs-sfops-appropriations-bill/ 17 USAID “Journey to Self-Reliance” strategy fosters cooperation with host country governments to strengthen local capacities, mobilize public and private revenues, and accelerate enterprise-driven development. Link: https://www.usaid.gov/documents/1870/journey-self-reliance-fact-sheet Partnership. Being the largest donor to the UNFPA Supplies Partnership, the United Kingdom (UK) recently confirmed that they are working towards renewing their multi-year contribution framework to continue support right up to 2030 at a similar level. The UK is currently providing GBP 264 million over a five-year period. For the period 2024-2026, the UNFPA Supplies Partnership will at a minimum maintain its current annual budget allocation of USD 185 million, of which 75% will be used for RH commodity procurement. Should recent donor announcements be confirmed, it is expected that the annual budget allocation will increase by 10-15%. Moreover, country leaders in some of the in-scope countries announced their focus on enhancing access to family planning by increasing domestic resources for supplies through the UNFPA Country Compact agreements. USAID spend on contraceptive procurement has fluctuated within a relatively stable range from FY2018- FY2022.16 For USAID, missions will continue to determine the level of contraceptive procurement spend in individual countries. USAID will also continue to work towards increased levels of domestic financing as part of its “Journey to Self-Reliance” strategy.17 https://www.unfpa.org/press/governments-and-philanthropies-commit-increase-investments-end-funding-shortfall-lifesaving https://www.kff.org/news-summary/white-house-releases-fy-2023-budget-request/ https://www.kff.org/news-summary/house-appropriations-committee-approves-the-fy-2024-state-and-foreign-operations-sfops-appropriations-bill/ https://www.kff.org/news-summary/house-appropriations-committee-approves-the-fy-2024-state-and-foreign-operations-sfops-appropriations-bill/ https://www.kff.org/news-summary/senate-appropriations-committee-approves-fy- https://www.usaid.gov/documents/1870/journey-self-reliance-fact-sheet 2121 D O M ES TI C G O VE RN M EN T SP EN D A N AL YS IS DOMESTIC GOVERNMENT SPEND ANALYSIS This section summarizes available data on domestic financing for contraceptive procurement looking across three relevant data sources. Specifically, it leverages data on domestic government expenditure on contraceptive commodities18 from USAID’s “Contraceptive Security (CS) Indicators Survey”19 (2017 to 2021), UNFPA’s National Budget Allocation and Spend analysis20 (2018 to 2022), and Track20’s “Family Planning Spending Assessment” (FPSA)21 data (2021) to provide further visibility22 into domestic financing for the subset of the 84 in-scope countries for the FP Market Report, where data is available.23 18 Contraceptive commodity expenditure refers to expenditure associated with procuring contraceptive methods only. It excludes expenditure on contraceptive services, government personnel, etc. 19 The USAID Contraceptive Security Indicator Survey is published every two years with the latest survey data available for 2021. Link: https://www.ghsupplychain.org/CSI-Survey- Landing-Page 20 The UNFPA National Budget Allocation and Spend data is collected through an annual reporting survey of national governments by UNFPA country offices. This survey is conducted in January each year for the previous year. 21 Track20 collects data on family planning spending in low- and middle-income countries using a modified health accounts approach, focusing solely on family planning. In situations where data on actual expenditures on FP are lacking, costing techniques using internationally accepted costing methods and standards are leveraged to estimate expenditures. Results are validated by government officials before publication. Link: https://www.track20.org/pages/data_analysis/FPSA.php#2020Tables 22 There are various sources that report on government expenditure on family planning including the WHO Health System Accounts. However, this report focuses on sources that offer insights specifically on government expenditure on contraceptive procurement, rather than family planning in general which includes services, human resource costs etc. Refer to Appendix B for further details on sources. 23 Refer to Appendix B for further details on the number of in-scope countries across the sources. 24 The Global Financing Facility (GFF), housed at the World Bank, was launched in 2015 as a multistakeholder partnership and financing vehicle to support reproductive, maternal, neonatal, child, and adolescent health, and nutrition. The GFF aims to finance national scale-up plans and improve financing architecture while supporting countries in the transition toward sustainable domestic financing. The USAID-funded Health Policy Plus (HP+) project has examined how family planning has been included in GFF-funded programs and has identified opportunities to leverage the GFF process to support family planning financing. Link: http://www.healthpolicyplus.com/ns/pubs/18472-18851_ FPGFFReport.pdf 25 In the current phase of the UNFPA Supplies Partnership, national governments in 43 countries have signed compact agreements to gradually increase domestic financing for contraceptive supplies. One of the mechanisms to enable this increase in domestic financing is through the UNFPA Supplies Partnership Match Fund where UNFPA matches government contributions for quality-assured reproductive health supplies. The match fund has thus far been accessed by 12 countries. Note: The impact of these agreements on domestic financing is not captured in this report as the time-period in the report predates the compact agreements being finalized in many countries, as per stakeholder discussions. Further information on the compact agreement can be found here: https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA%20Supplies%20Partnership%20 Annual%20Report%202021.pdf, https://www.unfpa.org/press/governments-and-philanthropies-commit-increase-investments-end-funding-shortfall-lifesaving 26 Note that certain countries, like India, have significant domestic financing for contraceptive procurement, but are not included in this analysis as they are not included in the reviewed sources for the period analyzed. More information on the Indian market can be found in Appendix E. 27 The overall trend indicates a slight increase across countries excluding Bangladesh. Including Bangladesh, the CS Indicators Survey data depicts an approximately 16 percent CAGR in aggregate domestic expenditure from 2018 to 2022 for 25 in-scope countries. Given the significant domestic spend on contraceptive procurement in Bangladesh that increased from 11 million in 2017 to 69 million in 2022 (an increase of 56 percent CAGR over 2018 to 2022), including Bangladesh has an outsized impact on aggregate domestic expenditure trends. 28 The World Bank provides data on inflation, e.g., consumer price inflation (percent) and the consumer price index (CPI) by country. More details can be found here: https://data. worldbank.org/indicator/FP.CPI.TOTL.ZG, https://data.worldbank.org/indicator/FP.CPI.TOTL 29 The countries included in Exhibit 13 are those with domestic financing for contraceptive commodities of at least $1 million in the most recent year of available data (i.e., either 2021 or 2022 depending on the data source). However, government expenditure on contraceptive procurement can fluctuate annually so there may be some countries that allocated domestic financing to contraceptive procurement in earlier years but did not report financing in the most recent year. There is growing focus within the RH community to strengthen domestic financing as a viable and sustainable funding source for the procurement of contraceptives in countries. For example, USAID’s Journey to Self-Reliance Strategy, the Global Financing Facility (GFF),24 the UNFPA Country Compact agreements, and the UNFPA Supplies Partnership Match Fund25 all illustrate the community’s commitment to increasing domestic financing for contraceptive procurement. The USAID CS indicators survey (2017-2021) and UNFPA national budget allocation and spend data (2018-2022), which provide visibility into domestic expenditure on contraceptive procurement over time, indicate a slight increase in spending over 2017-2021 or 2018-2022 (depending on the data source) when looking at aggregate data available26 across in-scope countries for the FP Market Report.27 Specifically, for 16 countries in-scope that have provided data over time to UNFPA, the total domestic expenditure reported for contraceptive procurement was $21.6 million in 2018 and $22.9 million in 2022, representing a 1 percent CAGR. For the 24 in-scope countries that have provided data over time to the USAID CS Indicators Survey (excluding Bangladesh), the total government expenditure reported was $64.4 million in 2017 and $70.3 million in 2021, indicating a 2.2 percent CAGR over the five-year period. It’s important to note that the trends observed during the in-scope period may have been influenced by the impact of the COVID-19 pandemic. Additionally, inflation, which was notable in some in- scope markets during this timeframe, may have also impacted the real purchasing power of these domestic financing contributions.28 There is variation by country in terms of domestic financing trends over time. For example, for the in-scope countries that provided data over time, 12 countries had increasing levels of domestic expenditure over time (Exhibit 12). Of these 12 countries, five countries (or 42 percent of the countries), increased their domestic expenditure by more than 30 percent over the past five years. Moreover, based on the most recent available data, out of 48 in-scope countries for the FP Market Report that reported some government expenditure on contraceptives for 2021/2022,29 22 countries allocated https://www.ghsupplychain.org/CSI-Survey-Landing-Page https://www.ghsupplychain.org/CSI-Survey-Landing-Page http://www.healthpolicyplus.com/ns/pubs/18472-18851_FPGFFReport.pdf http://www.healthpolicyplus.com/ns/pubs/18472-18851_FPGFFReport.pdf https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA%20Supplies%20Partnership%20Annual%20Report%202021.pdf https://www.unfpa.org/sites/default/files/pub-pdf/UNFPA%20Supplies%20Partnership%20Annual%20Report%202021.pdf https://www.unfpa.org/press/governments-and-philanthropies-commit-increase-investments-end-funding-shortfall-lifesaving https://data.worldbank.org/indicator/FP.CPI.TOTL.ZG https://data.worldbank.org/indicator/FP.CPI.TOTL.ZG https://data.worldbank.org/indicator/FP.CPI.TOTL 2222 D O M ES TI C G O VE RN M EN T SP EN D A N AL YS IS EXHIBIT 12: Countries with increasing government expenditure on contraceptive procurement (5 year CAGR, most recent data available) Government expenditure >30% CAGR over 5 yrs Government expenditure 10-30% CAGR over 5 yrs Government expenditure 1-10% CAGR over 5 yrs Angola1 Bangladesh1 Honduras2 Madagascar2 Malawi2 Cabo Verde1 Congo Dem Rep2 Rwanda2 Tanzania2 Burkina Faso2 El Salvador1 Kenya1 Source: (1) USAID Contraceptive Security Indicators Survey, 2017-2021; (2) UNFPA National Budget Allocation & Spend 2018-2022 Note: The information presented in Exhibit 12 summarizes data across different sources that utilize varied methodologies (please refer to Appendix B for more details on sources). Expenditure trends may exhibit some variations among different data sources. EXHIBIT 13: Countries with notable annual domestic expenditure on contraceptive procurement (most recent year) Government Expenditure: >$10M Government Expenditure: $5-10M Government Expenditure: $2-5M Government Expenditure: $1-2M Bangladesh1 69.2M Philippines1 9.8M Kenya2 4.7M El Salvador1 2.0M Indonesia3 27.5M Pakistan1 9.2M Ghana1 2.6M Bolivia2 1.7M Ethiopia2 10.6M Angola1 6.7M Tunisia3 2.6M Zimbabwe2 1.5M Vietnam3 6.3M Burkina Faso2 2.1M Guinea1 1.4M DRC2 2.1M Tanzania2 1.4M Uzbekistan3 1.3M Nepal1 1.3M Rwanda2 1.3M Sri Lanka1 1.2M Honduras2 1.1M Sources: (1) USAID Contraceptive Security Indicators Survey 2021; (2) UNFPA National Budget Allocation & Spend 2022; (3) Track20 Family Planning Spend Assessment 2021 Note: The information presented in Exhibit 13 summarizes domestic financing data for the most recent year available (i.e., either 2021 or 2022) looking across different sources that utilize varied methodologies (please refer to Appendix B for more details on sources). Expenditure data may exhibit some variations among different data sources. Levels of domestic financing for contraceptive commodities can fluctuate each year in country. Exhibit 13 captures information specifically for the most recent year with available data and therefore should be considered a snapshot in time. 2323 D O M ES TI C G O VE RN M EN T SP EN D A N AL YS IS domestic funding of at least $1 million in that year for contraceptive procurement (Exhibit 13). To put estimates of domestic expenditure on contraceptive commodities in context for a given country, it is informative to compare those estimates to estimated global procurer (i.e., UNFPA and USAID) spend on contraceptive procurement30 for the same year in country, to directionally approximate the magnitude of total public-sector contraceptive procurement that was financed with domestic resources. See Exhibit 14 below for a summary of whether countries have domestic 30 The estimated value of global procurer spend is calculated using publicly available volumes shipped by UNFPA and USAID to in-scope countries from RH viz and average unit prices from UNFPA Contraceptive Price Indicator 2021-2022. (Further details in Appendix C). expenditure for contraceptive procurement that is estimated to be greater than or less than the total estimated global procurer spend for the most recent year of available data. Note: This analysis is not limited to only those countries with domestic financing greater than $1 million in the most recent year as in Exhibit 13 but rather includes all in-scope countries for the FP Market Report which have available data for the most recent year. EXHIBIT 14: Comparison of annual domestic expenditure on contraceptives to global procurer spend on contraceptives by country (most recent year) Domestic expenditure on contraceptive commodities is greater than est. global procurer spend on contraceptive commodities Domestic expenditure on contraceptive commodities is 50-100% of est. global procurer spend on contraceptive commodities Domestic expenditure on contraceptive commodities is less than 50% of est. global procurer spend on contraceptive commodities Lower-middle- income countries: Low-income countries: Lower-middle- income countries: Lower-middle- income countries: Low-income countries: Angola1 Bangladesh1 Bhutan3 Bolivia2 Cabo Verde1 El Salvador1 Eswatini3 Honduras2 Indonesia3 Kyrgyz Republic1 Pakistan1 Phillippines1 Sri Lanka1 State of Palestine3 Timor-Leste2 Tunisia3 Uzbekistan3 Vietnam3 Ethiopia2 Guinea1 Ghana1 Nepal1 Tajikistan3 Benin2 Cote d’Ivoire2 Kenya2 Lao PDR2 Lesotho2 Mauritania1 Nigeria2 Papua New Guinea2 Senegal2 Tanzania2 Zimbabwe2 Burkina Faso2 Burundi2 Central African Republic2 Chad2 Congo Dem Rep2 Madagascar2 Malawi2 Mali2 Mozambique3 Niger2 Rwanda2 Togo2 Uganda1 Zambia1 Sources: (1) USAID Contraceptive Security Indicators Survey 2021; (2) UNFPA National Budget Allocation & Spend 2022; (3) Track20 Family Planning Spend Assessment 2021; (4) RH Viz 2021-2022; (5) UNFPA Contraceptive Price Indicator, 2021-2022; (6) World Bank Income Classification for FY23 Note: The information presented in Exhibit 14 summarizes data across different sources that utilize varied methodologies (Please refer to Appendix B for more details on sources). Expenditure data may exhibit some variations among different data sources. Levels of domestic financing for contraceptive commodities can fluctuate each year in country as can estimated global procurer spend on contraceptive procurement by country. Exhibit 14 captures information specifically for the most recent year with available data and therefore should be considered a snapshot in time. 2424 D O M ES TI C G O VE RN M EN T SP EN D A N AL YS IS As seen in Exhibit 14, 18 out of 20 countries (or 90 percent) with domestic expenditure on contraceptive commodities greater than estimated global procurer spend on contraceptive commodities in country are lower-middle-income countries, with the exceptions of Ethiopia and Guinea which are low-income countries. On the other hand, a relatively larger proportion (14 out of 25 or 56 percent) of countries with domestic expenditure on contraceptive commodities less than 50 percent of estimated global procurer spend on contraceptive commodities were low-income countries. Consolidating information across data sources, as captured in Exhibits 12, 13, and 14, offers enhanced visibility into the status of and trends related to domestic financing for contraceptive procurement in the low- and lower-middle-income countries with available data. Further enhancing data collection and visibility into domestic expenditure for contraceptive procurement by method across a broader set of countries over time can better equip the RH community to monitor the progress of domestic financing efforts and develop more comprehensive and nuanced perspectives. For example, increased visibility into domestic financing for contraceptive procurement can help the community better answer key questions such as: How is domestic financing for contraceptive procurement growing over time in different country contexts? What factors help drive increased domestic financing for contraceptive procurement? What portion of contraceptive commodity needs remain unmet by either government expenditure or donor financing? What methods are governments more or less likely to finance using domestic resources? The answers to such questions can enable the RH community to better prioritize and design initiatives to bolster domestic financing for contraceptives. The International Family Planning Expenditure Tracking Expert Advisory Group convenes to exchange global perspectives and work towards building congruence across data sources covering family planning expenditures, including domestic financing. Stakeholders have highlighted this advisory group as one potential forum that could be leveraged to progress discussions related to enhancing visibility into domestic financing for contraceptive procurement. 25 HIGHLIGHTS FROM DISCUSSIONS WITH KEY STAKEHOLDERS A number of suppliers, donors, and RH partners were consulted to discuss the trends observed in this report. 31 Roth, L. P., Sanders, J. N., Simmons, R. G., Bullock, H., Jacobson, E., & Turok, D. K. (2018). Changes in uptake and cost of long-acting reversible contraceptive devices following the introduction of a new low-cost levonorgestrel IUD in Utah's Title X clinics: a retrospective review. Contraception, 98(1), 63–68. https://doi.org/10.1016/j.contraception.2018.03.029; Hubacher, D., & Kavanaugh, M. (2018). Historical record-setting trends in IUD use in the United States. Contraception, 98(6), 467–470. https://doi.org/10.1016/j. contraception.2018.05.016 32 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# 33 The costs of providing a range of modern methods of contraception to all women is calculated on a country-by-country basis factoring in cost differentials based on each country’s specific situation, including commodities, service delivery and programmatic costs. More details available here: https://www.unfpa.org/sites/default/files/resource- pdf/Costing_of_Transformative_Results_Chapter_2_-_Cost_of_Ending_Unmet_Need_for_Family_Planning.pdf 34 In the FP Market Report, the commercial sector encompasses volumes purchased by commercial importers, wholesalers, retailers etc. who acquire and sell contraceptive commodities at unsubsidized prices. The supplier shipment data analyzed earlier in the FP Market Report does not include commercial sector volumes but rather encompasses volumes purchased by MOH or other government-affiliated purchasers as well as volumes purchased by global procurers such as USAID, UNFPA, and SMOs. 35 Link: https://leap.rhsupplies.org/#/contraception 36 Note that the responding suppliers may not necessarily be representative of all other participating suppliers. Stakeholders expressed that the public sector market trends were promising as they indicated an overall upward trajectory in contraceptive procurement from 2021 to 2022, leaving aside the unique local market dynamics noted in Bangladesh. Stakeholders also expressed appreciation for the community’s efforts to increase UNFPA procurement funding in 2022 compared to 2021, underscoring the global RH community’s resilience and efforts to safeguard the reproductive health and rights of individuals. Stakeholders also noted that method specific trends aligned with their understanding of market fluctuations, such as the notable spike in copper IUD procurement during 2018-19 and its impact on procurement patterns over the 2018-2022 period. Stakeholders also expressed an interest in monitoring the interplay between copper IUDs and hormonal IUD scale up in the future across in-scope countries, since research conducted in other contexts indicates that the introduction and scale up of hormonal IUD could potentially contribute to increased uptake of copper IUDs.31 Looking forward, stakeholders noted that a significant unmet need for contraception continues to persist. According to Guttmacher Institute’s ‘Adding it Up’ report,32 the unmet need for modern methods of contraception was 218 million women of reproductive age in 2019 across 132 low- and middle-income countries. In a separate study in 2020, Avenir Health estimated that to address the unmet need for family planning in 120 low- and middle-income countries from 2020 to 2030, an estimated total investment33 of $68.5 billion, inclusive of both commodity procurement and programmatic initiatives, is required. Given this context, there is a focus within the RH community to support governments to bolster their ability to finance and procure contraceptive commodities. Simultaneously, stakeholders have expressed interest in developing and/or enhancing “total market” approaches for contraceptives in low- and lower-middle-income countries to both broaden access to new and hard-to-reach users across delivery channels and strengthen overall market sustainability by leveraging and realizing the full range of public- and private-sector opportunities, where possible. Governments in these countries are also increasingly focused on developing total market strategies for various contraceptives. A notable portion contraceptive users in low- and lower- middle-income countries access contraceptives in the commercial sector.34 For example, according to RHSC’s LEAP analysis,35 on average, 18 percent of contraceptive users in low-income countries and 29 percent users in lower-middle-income countries access contraceptives in non-subsidized commercial sector channels. This varies by method with some methods such as orals (38 percent in low-income countries and, 46 percent in lower- middle-income countries) and condoms (57 percent in low-income countries and, 63 percent in lower- middle-income countries) having a relatively notable share of users in the non-subsidized commercial sector as compared to the public-sector and/or subsidized private sector. To support the development of sound total market strategies, the RH community strives to enhance visibility into commercial sector markets across contraceptive methods. To support these efforts and recognizing the valuable insights that suppliers have into the commercial sector in low- and lower-middle- income countries, CHAI and RHSC sought qualitative feedback from suppliers participating in the FP Market Report on commercial sector characteristics, challenges, and opportunities in these countries. For the subset of suppliers that responded,36 commercial sector shipments to low- and lower-middle-income countries were relatively limited compared to their public and SMO sector shipments. Some of the H IG H LI G H TS F RO M D IS CU SS IO N S W IT H K EY S TA KE H O LD ER S https://doi.org/10.1016/j.contraception.2018.03.029 https://doi.org/10.1016/j.contraception.2018.05.016 https://doi.org/10.1016/j.contraception.2018.05.016 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://www.unfpa.org/sites/default/files/resource-pdf/Costing_of_Transformative_Results_Chapter_2_-_Cost_of_Ending_Unmet_Need_for_Family_Planning.pdf https://www.unfpa.org/sites/default/files/resource-pdf/Costing_of_Transformative_Results_Chapter_2_-_Cost_of_Ending_Unmet_Need_for_Family_Planning.pdf 26 primary commercial-sector challenges highlighted by responding suppliers included: 1) the small and nascent commercial sector markets for contraceptives in many low- and lower-middle-income countries, 2) increasing competition with lower-priced non-quality-assured products, which is particularly challenging because of the rising raw material, operating, and regulatory costs faced by some suppliers, and 3) leakage of subsidized product into the commercial sector which impacts financial viability and opportunities in some markets. Looking forward, responding suppliers anticipated that demand would grow in the low- and lower-middle- income country commercial sector over time, especially as women’s purchasing power increases and enabling conditions are put in place to bolster user education and awareness about different methods, and quality considerations, etc. Overall, stakeholders have reiterated that greater visibility into the commercial sector in low- and lower- middle-income countries will be critical to enable more informed decision making, particularly since commercial sector characteristics and how to successfully operate within the commercial sector differs from one country to another, e.g., in terms of supply chain dynamics, policy and regulatory environments, etc. To further enhance commercial sector visibility, it will be vital to continue working collaboratively across governments, suppliers, procurers, implementing partners, and donors to share data and expertise as appropriate to support 37 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 our collective goal of developing sound total market approaches that foster and facilitate sustainable and equitable access to contraceptives across various delivery channels. As suppliers play an important role in enabling greater market visibility, in both the public and commercial sectors, it will also be valuable to continue expanding the list of participating suppliers in this report as feasible (which has already grown from 11 participating suppliers in 2015 to 17 participating suppliers currently). Finally, stakeholders also noted that while the FP Market Report provides a useful overview of contraceptive procurement, it does not necessarily provide a view into the distribution or contraceptive use in countries.37 While CYPs shipped increased from 2021 to 2022, supplier shipment data cannot be used to infer how family planning use in countries changed from 2021 to 2022, since contraceptive use is impacted by a range of additional factors such as distribution and supply chain logistics in-country, provider awareness and training, and end-user access to health services. Therefore, the procurement data and trends from the FP Market Report should not be confounded with user data and trends. Overall, stakeholders found it positive to see an increase in CYPs shipped in 2022 following the decline seen in 2021. These achievements highlight the importance of maintaining robust partnerships moving forward at both the global and country levels to ensure reliable access to effective contraceptive products. H IG H LI G H TS F RO M D IS CU SS IO N S W IT H K EY S TA KE H O LD ER S 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 27 GLOBAL MARKETS VISIBILITY PROJECT ACKNOWLEDGEMENTS 38 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 since 2015 across in-scope markets, specifically the 69 FP2020 focus countries through 2021 and the broader scope of countries defined under the evolved global partnership and measurement structure for the RH community announced by FP2030 in 2021. This year there are 84 in-scope countries. The initiative provides insightful and strategic outputs for donors, MOHs, implementing organizations, and suppliers to develop and implement more effective strategies as well as make better informed decisions that enable users within in-scope countries to access family planning products and services. This report is a collaboration between CHAI and the RHSC. The initial 2015 report comprised data from 11 manufacturers. Since then, coverage has expanded over the years, and this year there are 17 suppliers participating in the project. Market Definition, Scope, and Coverage The total public-sector market referenced in this report only includes data for the public sector, which is defined as volumes purchased by public sector procurers such as the United Nations Population Fund (UNFPA) and the United States Agency for International Development (USAID), ministries of health, government affiliated procurers as well as social marketing organizations (SMOs). 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 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, oral contraceptives, and injectables. 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. 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 reversible contraception, and Tubal Rings38 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. 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. 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 28 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. 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 600 generic products in 1,100+ presentations, across various therapeutic areas. 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 low- and lower-middle-income countries and Liletta in the U.S. Organon & Co. Organon & Co. is a U.S.-based healthcare company. Its contraceptive product portfolio includes contraceptive implants (IMPLANON NXT, which includes a prefilled sterile applicator), oral contraceptives EXLUTON, MARVELON, CERAZETTE, MERCILON, and for USA/CAN ZOELY and the contraceptive vaginal ring (NUVARING). 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 leading manufacturer of contraceptive products based in India. Its contraceptive product portfolio includes hormonal IUD (Eloira), a range of Copper IUDs including Postpartum IUD (recently WHO Prequalified), and tubal rings used for female sterilization. Pregna also supplies other reproductive health products such as Uterine Balloon Tamponade (ESM-UBT), Endometrial Biopsy Curette. 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 prequalified status. Renata Renata is a pharmaceutical company based in Bangladesh. Its contraceptive product portfolio includes combined oral contraceptives, progestin-only oral contraceptives, and emergency oral contraceptive pills. 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 copper 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 29 APPENDICES AP PE N D IC ES 3030 AP PE N D IC ES APPENDIX A 84 IN-SCOPE COUNTRIES: MARKET VOLUMES BY METHOD1 AND COUNTRY, 2018–2022 EXHIBIT A.1: 84 IN-SCOPE COUNTRIES: CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2018 Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Afghanistan – 16,500 307,750 – 224,480 Algeria 5,037,980 – – – 10,080 Angola 26,601,000 – 529,750 – – Bangladesh 12,355,200 793,064 15,194,000 720,000 105,801,680 Belize 864,000 – 20,000 3,000 45,360 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 53,983 3,398,400 Burundi 22,039,200 4,000 126,400 – 415,332 Cabo Verde 2,000,160 3,000 – – 201,600 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 – 10,000 – 86,000 12,120 Congo Dem Rep 49,969,750 399,170 1,343,100 – 370,560 Cote d'Ivoire 25,420,800 139,088 474,800 23,000 3,867,676 Djibouti 396,000 3,200 70,400 – – DPR Korea – – – – – Egypt – 160,046 – 3,774,650 – El Salvador 1,255,968 – 386,100 – 581,040 Eritrea – 2,200 100,000 – 10,025 Eswatini – – – – – 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 2,179,000 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 1 Female condoms are aggregated with male condoms, hormonal IUDs are aggregated with copper IUDs, and combined and progestin-only orals are aggregated with emergency orals by country in order to protect data confidentiality 3131 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals India – – 102,000 3,223,328 366,065 Indonesia – – – 852,430 – Iran – – – – – Kenya 2,000,000 379,232 470,124 101,225 12,791,937 Kiribati – – – – – Kyrgyz Republic 1,432,800 – – 220,800 – Lao PDR 600,000 – 242,000 12,500 660,600 Lebanon 72,000 – – 5,000 60,480 Lesotho 8,192,600 7,644 15,000 18,400 116,682 Liberia 1,180,800 35,000 705,200 – 32,400 Madagascar 5,001,000 325,344 4,866,200 500 204,800 Malawi 166,785,600 223,260 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 – 87,840 Micronesia – – – – – Mongolia 5,508,000 6,200 – 28,000 420,000 Morocco – – – 21,000 – Mozambique 86,133,400 231,648 3,291,800 97,816 51,120 Myanmar 49,103,686 88,540 2,889,125 54,200 14,847,143 Nepal 13,197,480 176,000 2,170,400 60,000 3,299,530 Nicaragua 11,164,300 2,854 – 21,000 – Niger 849,600 170,940 914,200 – 658,002 Nigeria 42,934,272 1,023,764 4,731,600 151,800 2,146,764 Pakistan 758,016 10,000 100,000 498,175 – 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 Samoa – – – – – Sao Tome and Principe 1,112,832 500 26,000 – 67,080 Senegal 16,566,000 186,336 – 7,000 – Sierra Leone – 151,033 972,800 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 State of Palestine – – – 5,000 – Sudan 720,000 51,264 – 4,000 – Syria 1,440,000 – 40,200 40,000 3,255,120 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 – – – 3232 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Togo 21,247,832 75,264 118,400 – 164,154 Tunisia 2,001,600 – – – – Uganda 124,701,400 811,576 5,469,525 248,500 4,369,950 Ukraine 21,033,000 – – – – Uzbekistan – – – – – Vanuatu – – – – – Vietnam 21,816,000 – – 1,075,250 – Western Sahara – – – – – Yemen 1,303,200 37,440 1,093,600 51,700 30,000 Zambia 93,849,400 115,096 1,855,950 – 7,399,200 Zimbabwe 66,442,460 87,500 1,010,975 25,000 18,265,635 Other in-scope country shipments 4,179,902 1,263,200 7,977,325 156,180 9,714,060 Total Volumes 1,226,672,218 10,434,177 81,691,804 12,598,046 225,794,959 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2023. EXHIBIT A.2: 84 IN-SCOPE COUNTRIES: CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2019 Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Afghanistan 4,002,000 7,800 617,000 175,800 1,503,896 Algeria – – – – – Angola 15,060,576 – 300,000 – 1,212,002 Bangladesh 1,224,000 265,253 4,383,060 300,000 115,651,300 Belize – 10,000 15,200 – 50,760 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 Cabo Verde 2,880,000 – 60,000 – 267,120 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 30,000 226,080 Comoros 1,180,800 – – 500 – Congo – 26,300 19,800 191,405 9,540 Congo Dem Rep 46,256,800 907,864 3,128,810 211,384 2,297,938 Cote d'Ivoire 25,732,600 180,376 692,050 33,000 2,906,090 Djibouti 288,000 – – – 218,160 3333 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals DPR Korea – – – – 74,880 Egypt 11,224,800 333,164 – 490,200 – El Salvador 3,049,000 – 160,000 – 84,672 Eritrea – 17,300 100,000 – 10,800 Eswatini 22,008,000 – 82,999 – 4,500 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 – Iran – – – – – Kenya 38,478,000 373,320 80,000 448,930 3,613,720 Kiribati – – – – – Kyrgyz Republic 198,000 – – – – Lao PDR 1,490,400 – 256,000 – 2,857,608 Lebanon 511,200 – – – 64,320 Lesotho 1,728,000 2,016 65,800 – 117,900 Liberia 13,440,000 9,800 75,000 12,500 – Madagascar – 308,616 5,184,400 90,500 1,599,120 Malawi 119,369,000 670,252 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 Micronesia – – – – – Mongolia 180,000 13,800 103,260 103,000 285,600 Morocco – – – 46,100 – Mozambique 69,433,000 202,108 4,086,200 31,150 4,518,240 Myanmar 26,785,000 80,100 1,425,000 30,000 16,447,915 Nepal 13,999,870 224,200 349,800 – 2,407,144 Nicaragua – 5,484 – 9,000 – Niger 444,000 116,248 100,000 – 1,416,762 Nigeria 60,693,400 1,217,772 3,450,800 329,216 1,457,740 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 Samoa – – – – – Sao Tome and Principe 1,260,376 800 19,000 – 100,080 3434 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Senegal 12,218,000 142,056 466,000 72,000 986,580 Sierra Leone 5,589,400 284,900 276,000 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 State of Palestine 1,761,120 – – – – Sudan – 26,800 146,400 – 6,472,122 Syria 1,895,040 – 11,000 – – 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 Tunisia 5,000 – – – – Uganda 147,135,800 414,360 3,655,140 161,500 436,968 Ukraine 21,382,200 – – – – Uzbekistan 6,652,800 – 570,000 1,730,000 760,002 Vanuatu – – – – – Vietnam – 11,000 490,900 596,950 – Western Sahara – – – – – Yemen 1,449,600 97,708 498,600 128,100 12,694,226 Zambia 60,015,740 94,934 2,884,600 14,800 4,628,694 Zimbabwe 140,329,440 186,600 758,000 48,500 16,751,896 Other in-scope country shipments 5,955,160 456,500 6,291,200 341,900 12,749,040 Total Volumes 1,194,564,199 11,520,687 70,703,064 9,400,787 260,150,161 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2023. EXHIBIT A.3: 84 IN-SCOPE COUNTRIES: CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2020 Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Afghanistan 8,783,160 – 42,200 280,974 504,954 Algeria – – – – – Angola 51,788,140 – 500,000 – 1,568,374 Bangladesh 943,200 20,000 14,867,040 2,500 163,162,360 Belize – – – – – Benin 15,000 10,000 762,000 20,000 441,504 Bhutan – – – – – Bolivia 11,000 36,000 50,000 9,500 14,400 3535 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Burkina Faso 26,343,300 236,448 3,041,050 98,400 1,565,376 Burundi 18,439,200 193,100 1,176,000 – 336,492 Cabo Verde 13,512,100 5,000 80,000 – 310,356 Cambodia 124,272 43,160 400,000 25,000 4,406,662 Cameroon 15,854,400 123,340 1,034,400 4,500 603,900 Central African Republic 6,480,000 63,900 214,600 – 171,360 Chad 9,273,800 – 560,000 – 342,120 Comoros – 500 – – – Congo – 625 21,300 148,600 12,600 Congo Dem Rep 77,059,680 1,194,128 966,200 122,000 3,090,000 Cote d'Ivoire 8,642,000 198,000 987,000 28,500 4,758,577 Djibouti 250,880 200 – – 39,600 DPR Korea – – – – – Egypt 1,000 53,000 1,387,600 180,030 – El Salvador 10,127,200 – 50,000 – 467,280 Eritrea – 14,500 4,000 – 162,000 Eswatini – – – – 9,900 Ethiopia 1,968,240 1,290,093 5,458,646 16,600 2,570,348 Gambia – 29,000 193,300 – 150,192 Ghana 11,930,400 316,176 2,059,300 98,850 5,960,232 Guinea 291,000 136,800 59,200 – 51,300 Guinea-Bissau 3,024,000 53,400 232,600 – 800,460 Haiti 21,600,000 11,600 – – – Honduras 16,999,200 49,456 690,900 – – India – – – 107,884 24,960 Indonesia – – – 1,047,270 – Iran – – – – – Kenya 23,732,800 1,527,332 1,360,048 400,750 3,319,772 Kiribati – – – – – Kyrgyz Republic – – – 300 – Lao PDR – – 526,000 – 1,600,488 Lebanon 2,664,000 – – – – Lesotho 4,378,600 2,900 129,800 1,500 660,780 Liberia 15,774,000 81,700 363,000 – 780,120 Madagascar 11,334,760 485,114 3,635,300 216,000 5,438,960 Malawi 59,538,600 386,442 4,810,000 11,400 1,400,232 Mali 2,954,200 297,950 937,300 31,000 30,960 Mauritania – 3,300 175,600 – 385,344 Micronesia – – – – – Mongolia 280,800 11,900 75,000 14,400 495,000 Morocco – – – – – 3636 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Mozambique 106,529,230 124,700 1,136,900 – 2,654,220 Myanmar 17,952,400 52,232 3,463,620 3,500 13,207,812 Nepal 11,695,970 72,500 10,000 – 365,220 Nicaragua 705,600 6,600 – 6,000 – Niger 17,894,740 96,256 389,860 51,300 4,400,010 Nigeria 76,046,500 1,491,608 4,234,600 722,299 2,993,913 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 46,728 58,200 8,000 1,224,009 Samoa – – – – – 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 2,932,688 516,100 1,515,000 29,000 1,741,998 Solomon Islands 10,000 – – – – Somalia – – 8,400 – 77,001 South Sudan 8,640,000 – 250,000 2,500 1,531,920 Sri Lanka – 40,064 30,000 50,000 2,119,680 State of Palestine 3,335,042 – – – – Sudan 4,320,000 59,944 2,500 6,000 4,651,020 Syria 5,927,900 – – – 150,480 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 – Tunisia – – – – – Uganda 84,725,600 878,680 2,341,900 138,000 1,915,410 Ukraine – – – – – Uzbekistan 6,854,400 – 279,400 830,000 – Vanuatu – – 40,000 – – Vietnam 3,888,000 33,000 146,440 169,350 – Western Sahara – – – – – Yemen 504,000 67,900 70,000 200,000 5,177,940 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 in-scope country shipments 4,111,600 1,126,600 14,319,600 193,560 21,995,237 Total Volumes 1,062,158,942 13,649,296 84,863,476 6,113,263 297,152,854 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2023. 3737 AP PE N D IC ES EXHIBIT A.4: 84 IN-SCOPE COUNTRIES: CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2021 Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Afghanistan – 52,000 605,200 142,700 3,670,668 Algeria – – – – – Angola 385,000 – 600,000 – – Bangladesh 6,220,800 845,885 3,926,560 34,500 178,895,520 Belize 122,400 – – – 51,192 Benin 6,000,000 20,000 – 10,000 989,280 Bhutan – – – – – Bolivia – 30,000 – – 291,114 Burkina Faso 43,021,480 894,124 520,000 – 5,993,475 Burundi – 173,200 161,550 30,000 424,800 Cabo Verde – 10,000 150,000 – 318,528 Cambodia – 52,040 – 55,000 5,957,011 Cameroon 880,020 79,880 – 30,000 95,040 Central African Republic 7,200,000 – – – 317,472 Chad 5,784,480 125,976 300,000 – 296,640 Comoros – – – – 30,240 Congo 8,640,000 5,100 6,600 406,275 30,600 Congo Dem Rep 196,001 781,100 2,187,100 6,000 1,274,037 Cote d'Ivoire 8,260,620 150,880 524,600 29,900 6,698,447 Djibouti 561,024 3,000 9,600 – – DPR Korea – – – – – Egypt – 365,090 – – – El Salvador 714,096 – – – 277,920 Eritrea – 35,200 98,400 5,000 171,900 Eswatini – 4,208 72,000 – – Ethiopia 3,041,400 1,716,725 953,200 488,000 2,253,150 Gambia 2,200,610 3,000 189,000 – 671,310 Ghana 30,495,200 193,192 2,715,600 53,000 4,329,200 Guinea 28,223,800 100,000 300,000 22,000 20,700 Guinea-Bissau 7,404,190 20,000 3,600 – 11,280 Haiti – 23,000 410,000 – 268,128 Honduras 43,682,360 26,056 692,200 29,490 651,330 India – – – 574,270 – Indonesia – 51,132 – 335,800 – Iran – – – – – Kenya – 706,740 312,800 3,575 300,240 Kiribati – – – – – Kyrgyz Republic 1,814,400 – – – – Lao PDR – – 222,000 – 20,700 3838 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Lebanon – – – – 285,840 Lesotho 1,640,040 3,795 252,600 2,500 763,434 Liberia 7,407,000 41,300 177,200 4,000 693,504 Madagascar 793,800 194,184 1,510,000 9,500 4,416,048 Malawi 145,520,300 358,416 2,008,000 20,100 218,880 Mali 46,485,520 183,505 778,800 17,000 437,040 Mauritania 3,499,200 19,600 65,400 51,500 355,338 Micronesia – – – – – Mongolia 187,200 6,000 41,250 49,000 286,000 Morocco – – – – – Mozambique 78,397,400 386,696 2,279,000 8,750 1,967,202 Myanmar 37,621,290 24,640 269,380 – 9,473,857 Nepal 9,252,000 130,000 2,470,000 – 4,975,504 Nicaragua 4,896,000 600 85,000 – 276,066 Niger – 151,000 838,000 50,500 1,774,224 Nigeria 102,328,200 1,714,504 2,958,775 81,235 1,047,191 Pakistan 18,892,800 246,400 425,000 260,360 1,450,080 Papua New Guinea 2,535,120 25,000 404,000 – 391,878 Philippines 6,451,200 502,917 9,600 – – Rwanda 21,467,740 130,016 476,400 2,520 584,424 Samoa – – – – – Sao Tome and Principe 346,320 500 24,000 – 126,720 Senegal 5,505,000 130,084 1,845,200 58,500 813,600 Sierra Leone 13,489,920 349,500 974,900 – 1,189,548 Solomon Islands – 10,000 – – – Somalia 504,000 18,000 43,000 20,000 194,292 South Sudan 120,000 41,100 150,000 1,000 – Sri Lanka 1,668,960 104,032 372,800 33,000 – State of Palestine – – – 1,000 – Sudan 7,552,800 77,400 150,625 35,500 100,080 Syria – – 40,700 50,000 524,880 Tajikistan 10,148,400 7,500 – – – Tanzania 605,000 518,707 1,340,000 25,500 6,057,526 Timor-Leste – 36,000 122,000 – 139,680 Togo 12,816,000 76,700 60,000 – 48,396 Tunisia 1,512,000 – – 80,750 – Uganda 420,326,400 463,564 3,640,200 68,400 2,267,860 Ukraine – – – 30 – Uzbekistan – – – 534,360 – Vanuatu – – – – – Vietnam – 40,000 – – – 3939 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Western Sahara – – – – – Yemen – 42,700 – 160,000 – Zambia 72,474,000 430,900 2,903,600 178,945 3,628,512 Zimbabwe 50,475,000 173,324 510,000 15,000 3,813,984 Other in-scope country shipments 2,216,000 422,000 15,751,320 146,450 8,160,126 Total Volumes 1,291,982,491 13,528,112 57,936,760 4,220,910 270,771,636 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2023. EXHIBIT A.5: 84 IN-SCOPE COUNTRIES: CONTRACEPTIVE MARKET VOLUMES BY METHOD, 2022 Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Afghanistan 31,214,376 152,500 1,121,100 21,900 2,795,364 Algeria – – – – – Angola 32,671,200 – – – – Bangladesh – – 6,070,000 6,002 62,531,522 Belize 149,760 – – – – Benin 26,536,132 239,085 312,900 8,500 464,112 Bhutan 187,200 – – – – Bolivia 1,877,800 117,500 210,600 55,500 12,096 Burkina Faso 35,259,792 82,024 1,419,200 37,000 302,400 Burundi 19,347,600 – 1,035,000 900 1,980,788 Cabo Verde 10,000 5,000 – – 332,316 Cambodia 10,811,088 36,000 750,000 55,000 14,661,124 Cameroon 11,557,148 77,848 54,000 27,250 212,292 Central African Republic 733,968 100,000 285,900 – 72,648 Chad 1,542,000 105,684 1,001,700 6,000 578,340 Comoros 993,600 1,500 45,100 – – Congo 8,278,704 6,156 18,700 320,980 50,040 Congo Dem Rep 110,136,644 1,251,538 2,548,500 20,160 3,302,308 Cote d'Ivoire 14,844,000 321,424 568,500 52,100 374,760 Djibouti 83,520 500 8,000 – 5,040 DPR Korea – – – – – Egypt – 240,060 – 1,102,000 – El Salvador 10,404,808 10,000 140,500 9,490 – Eritrea – 42,900 100,000 – 41,040 Eswatini 10,299,000 – 40,000 – – Ethiopia 8,700,000 1,639,292 1,746,000 500,000 1,470,947 Gambia 3,981,168 – 234,800 – 275,040 Ghana 35,615,000 100,776 919,200 17,150 8,366,400 4040 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Guinea 18,177,104 25,700 450,000 20,000 590,610 Guinea-Bissau 504,000 55,000 6,600 – – Haiti 42,307,752 31,800 314,000 – 156,780 Honduras 29,149,920 34,208 1,187,400 15,000 100,800 India 41,000 3,000 – – – Indonesia 8,217,648 12,960 – 293,175 – Iran 3,886,992 – – – – Kenya 10,688,000 1,054,024 1,630,000 32,420 310,240 Kiribati 14,400 – – – – Kyrgyz Republic 3,780,000 – – 300 – Lao PDR – 54,240 184,200 30,000 – Lebanon 655,592 – – 1,822 593,136 Lesotho 15,736,608 10,217 268,600 – 31,140 Liberia – 30,000 30,200 25,000 773,532 Madagascar 5,756,088 445,832 4,883,320 12,715 2,744,208 Malawi 10,663,000 375,736 5,070,000 – 2,678,184 Mali 8,989,348 229,518 1,047,600 3,502 958,428 Mauritania 835,200 19,136 353,400 50,700 577,332 Micronesia – – – – – Mongolia 187,200 6,000 – 56,500 – Morocco 86,400 – – 19,500 – Mozambique 135,561,696 498,796 1,638,400 96,600 4,854,132 Myanmar 18,157,824 55,860 3,120 35,000 13,847,468 Nepal 16,056,000 20,000 2,028,000 – 1,316,288 Nicaragua 3,386,736 11,604 174,000 6,000 – Niger 602,600 238,056 1,056,600 – 2,497,248 Nigeria 100,251,704 652,564 3,943,000 478,410 1,971,832 Pakistan 3,283,776 – 70,000 455,135 – Papua New Guinea 6,753,168 50,000 210,400 – 646,380 Philippines 6,361,352 – – 165,300 – Rwanda 19,064,400 346,036 830,800 12,600 772,452 Samoa – – – – – Sao Tome and Principe 1,153,440 1,000 35,000 100 18,000 Senegal 16,937,000 139,877 279,200 71,000 1,370,160 Sierra Leone 1,247,000 240,000 221,800 – 215,280 Solomon Islands – – – – – Somalia 560,736 103,000 85,000 – – South Sudan 11,030,800 43,348 462,800 – – Sri Lanka 2,270,660 75,000 50,000 30,000 2,214,000 State of Palestine 1,597,536 – – 4,070 – Sudan 1,500,048 59,000 974,900 52,120 462,240 4141 AP PE N D IC ES Country Condoms - Male & Female Implants Injectables IUDs - Copper & Hormonal Orals Syria 2,145,600 – – 25,600 641,520 Tajikistan 157,000 – 35,000 90,000 – Tanzania 13,646,592 1,196,293 1,148,700 – 283,680 Timor-Leste 2,006,640 4,500 50,000 – – Togo 27,769,480 28,286 400,000 2,000 – Tunisia – – – – – Uganda 123,806,320 1,081,296 3,678,400 5,840 186,480 Ukraine 18,383,280 – – – – Uzbekistan 7,488,000 – – 537,860 – Vanuatu 4,500 – – – – Vietnam 25,071,120 – 240,000 100,000 – Western Sahara – – – – – Yemen 1,008,000 69,468 50,000 255,040 900,000 Zambia 86,990,352 239,016 3,000,200 223,360 1,020,240 Zimbabwe 146,889,060 130,000 1,300,000 36,000 – Other in-scope country shipments 2,674,000 863,500 21,702,445 21,380 14,161,929 Total Volumes 1,338,727,180 13,063,658 77,722,785 5,503,981 154,722,296 Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2023. 4242 AP PE N D IC ES 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: • Supplier Shipment Data: 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. In the past, CHAI collected historical shipment data by product and country from suppliers for each of the 69 FP2020 focus countries. The 2022 and 2023 FP Market Reports encompass the broader set of all low- and lower-middle-income countries based on the World Bank country income classification. The 2023 FP Market Report captures data for 84 in-scope countries.2 The classification represents the evolved global partnership and measurement structure for the FP community that was announced by FP2030 in 2021. In the 2023 FP Market Report, shipment data covering global procurer sales (USAID and UNFPA), MOH tender volumes, as well as SMO purchases has been collected from 17 participating manufacturers across five family planning product categories. • U.S. Agency for International Development (USAID) Overview of Contraceptive and Condom Shipments Report: USAID has provided commodities for family planning and reproductive health activities since the mid-1960s. The Overview of Contraceptive and Condom Shipments report is an annual publication that 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 FY2018 through FY2022 reports were accessed and used to analyze USAID’s spend on contraceptives in 84 in-scope countries, 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. • The United Nations Population Fund (UNFPA) Supply Chain Management Unit (SCMU) 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 lower-middle-income countries for over 40 years. For the purposes of this year’s Family Planning Market Report’s Global Procurer Spend Analysis, CHAI worked with UNFPA SCMU to determine the value of the contraceptive procurement conducted by UNFPA from 2018 to 2022 for the 84 in-scope 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):3 The RH Viz database provides visibility into contraceptive shipments volumes via a series of public-facing dashboards. RH Viz combines historical procurement shipment data (from 2008 to 2016) with 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. 2 As agreed upon with FP2030, each year an assessment will be made and countries will be included in the FP Market Report’s scope if they are classified as low- and lower- middle-income countries for that year based on the latest World Bank’s country income classifications (for example, Lebanon is a new addition in this year’s report based on the World Bank’s country income classification for FY23). Historical supplier shipment data is then gathered for any new countries added to the report scope each year to ensure the report looks at the same country scope across the five-year time period. In consultation with FP2030, it was also decided that countries that have recently graduated from LMIC status (for example, under the FY23 World Bank income classification, only one country, Belize moved to upper-middle income classification) will not be excluded from the report scope since the report covers a historic time period. Due, in part, to data challenges, FP2030 is not presently reporting data on Western Sahara. However, CHAI and the RHSC have kept Western Sahara in scope for the FP Market Report. 3 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. 4343 AP PE N D IC ES Additionally, this report’s Domestic Government Spend analysis summarizes data from multiple sources that capture information on domestic financing for contraceptive procurement by country. Domestic financing for other contraceptive-related costs, e.g., service provision, human resources, etc. were out of scope for this analysis since the Market Report is focused on understanding contraceptive procurement trends specifically. The following table provides an overview of the data sources reviewed to inform the domestic government spend analysis: Data source Data referenced in the FP Market Report analysis Frequency of collection Method of collection Country scope Data years reviewed in the FP Market Report analysis Number of countries in this dataset that are included in the FP Market Report scope USAID Contraceptive Security (CS) Indicators Survey Estimate of government expenditure4 on contraceptive commodities in the most recent 12-month period5 Since 2017, data has been collected every two years Survey of national governments Varies;6 63 unique countries captured in the analysis since 2010, with 55 unique countries included since 2017. 2017, 2019, 2021 25 UNFPA National Budget Allocation & Spend Amount spent by national governments on contraceptive procurement in each year Annual Survey of national governments (via UNFPA country offices) 48 countries supported by UNFPA 2018, 2019, 2020, 2021, 2022 16 Track20 Family Planning Spend Assessment (FPSA) Estimate of government expenditure on procurement of modern methods of contraception in the most recent year Annual7 Data produced using a modified System of Health Accounts approach and National Aids Spending Assessment (NASA) methodologies.8 Results are validated by governments. 50 countries 2021 35 Note: The CS Indicators Survey and the UNFPA National Budget Allocation and Spend data sources do not define the specific contraceptives included but rather ask about funding of contraceptive commodities overall. 4 This includes internally generated funds as well as other government funds. Other government include basket funds, World Bank credits or loans, and other funds the donors give to the government (e.g., direct budget support). These are included in government expenditure because governments consider these funds as part of their budgets, count them as part of government funding, and have significant control over how they are spent. 5 Based primarily on the value of commodities actually delivered in that 12-month period. Values are subject to exchange rate fluctuations. 6 USAID Family Planning Priority Countries, USAID Family Planning transitioned countries, and Ouagadougou Partnership countries are prioritized to receive the CS Indicators Survey. The corresponding report of survey data is released up to 12 months later e.g., the 2021 report is based on survey data collected in August - November 2021 reporting on expenditure in the most recently completed fiscal year. 7 This survey is conducted in January each year to capture information for the previous year 8 In situations where data on actual expenditures on FP are lacking, costing techniques using internationally accepted costing methods and standards are leveraged to estimate expenditures. https://www.ghsupplychain.org/CSI-Survey-Landing-Page https://www.ghsupplychain.org/CSI-Survey-Landing-Page https://www.ghsupplychain.org/CSI-Survey-Landing-Page https://www.ghsupplychain.org/CSI-Survey-Landing-Page https://www.ghsupplychain.org/CSI-Survey-Landing-Page https://www.track20.org/pages/data_analysis/FPSA.php#2020Tables https://www.track20.org/pages/data_analysis/FPSA.php#2020Tables https://www.track20.org/pages/data_analysis/FPSA.php#2020Tables https://www.track20.org/pages/data_analysis/FPSA.php#2020Tables 4444 AP PE N D IC ES APPENDIX C – ESTIMATING THE VALUE OF THE PUBLIC-SECTOR MARKET IN 84 IN-SCOPE COUNTRIES The value of the public-sector market across 84 in-scope countries 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 – Copper Piece IUDs - Hormonal Piece Orals – Combined Cycle Orals – Progestin Only Cycle Orals – Emergency Doses Historical Supplier-Reported Data This year’s Market Report includes historical supplier-reported shipment data from 17 manufacturers – Bayer, Cipla, Corporate Channels, CR Zizhu, Cupid, Female Health Company, Incepta, Medicines360, Organon & Co., Pfizer, Pregna, PT Tunggal, Renata, Shanghai Dahua, SMB, Techno Drugs, and Viatris (Mylan). Collectively, the total volumes cover global procurer sales (USAID and UNFPA), MOH tenders and SMO purchases across five family planning product categories.9 Participating suppliers have cumulatively shipped 78 million female condoms, 62 million implants, 373 million injectables, 38 million copper IUDs, 0.3 million hormonal IUDs, 1156 million orals (combined & progestin only), and 52 million emergency contraceptives from 2018 to 2022. It is important to note that there were several shipments to procurer (USAID, UNFPA, SMO) warehouses located in out-of-scope countries, such as Belgium, Denmark, Finland, France, Germany, Netherlands, Switzerland, and the UK. Although these volumes were initially shipped to out-of-scope countries, these shipments were likely to go onto the 84 in-scope countries as confirmed with the suppliers. As a result, these volumes were included in the total shipments to the 84 in-scope countries after it was confirmed with suppliers that these specific out-of-scope country volumes were associated with global procurer purchases. CHAI analyzed the aggregated historical supplier-reported shipment data to confirm that coverage across the public- sector product markets was greater relative to RH Viz shipment data for the 84 in-scope countries. The aim of collecting historical volumes of all global procurer purchases, SMO 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 2018 to 2022 for historical supplier-reported shipment volumes to the 84 in-scope countries and procurer warehouses is greater than RH Viz in every method (Exhibit C.4). 9 Total shipment of oral contraceptives includes combined, progestin-only, and emergency oral contraceptives. 4545 AP PE N D IC ES EXHIBIT C.2: GLOBAL MARKETS VISIBILITY PROJECT PARTICIPANTS AND PRODUCTS Manufacturer Condoms - Female Implants Injectables IUDs - Copper & Hormonal Orals Bayer   • • • • Cipla         • Corporate Channels       •   CR Zizhu         • Cupid •         Female Health Company •         Incepta     •     Medicines360       •   Organon & Co.   •     • Pfizer     •     Pregna       •   Pt Tunggal     •     Renata         • Shanghai Dahua   •       SMB       •   Techno Drugs   • •   • Viatris (Mylan) • • • EXHIBIT C.3: SUPPLIER-REPORTED SHIPMENT VOLUMES TO 84 IN-SCOPE COUNTRIES BY METHOD, 2018-2022 Method 2018 2019 2020 2021 2022 Cumulative total Condoms – Female 13 M 22 M 18 M 13 M 12 M 78 M Implants 10 M 12 M 14 M 14 M 13 M 62 M Injectables 82 M 71 M 85 M 58 M 78 M 373 M IUDs - Copper 13 M 9 M 6 M 4 M 5 M 38 M IUDs - Hormonal 0.02 M 0.03 M 0.01 M 0.12 M 0.11 M 0.3 M Orals - Combined & Progestin Only 217 M 251 M 283 M 258 M 147 M 1156 M Orals - Emergency 9 M 9 M 14 M 13 M 8 M 52 M Note: Cumulative totals calculated using actual, rather than rounded numbers. Sources: [1] Historical Supplier-Reported Shipment Data. 4646 AP PE N D IC ES EXHIBIT C.4 SUPPLIER-REPORTED SHIPMENT VOLUMES AS A PERCENTAGE OF RH VIZ-REPORTED VOLUMES BY METHOD, 2018-2022 Method 2018 2019 2020 2021 2022 Cumulative total Condoms - Female 75% 141% 108% 105% 94% 104% Implants 115% 143% 143% 131% 107% 126% Injectables 179% 129% 136% 102% 109% 128% IUDs - Copper & Hormonal 396% 386% 318% 262% 389% 358% Orals - Combined & Progestin Only 307% 359% 256% 333% 196% 233% Orals - Emergency 537% 674% 580% 394% 272% 455% Sources: [1] Historical Supplier-Reported Shipment Data; [2] RH Viz Shipment Data, retrieved August 2023 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 84 in-scope countries. The report used RH Viz shipment data from 2018 to 2022 and included all male condom shipment volumes to the 84 in-scope countries as well as volumes associated with procurer warehouses in out-of-scope countries.10 The supplier-reported volumes for female condoms, implants, injectables, IUDs, and orals, together with RH Viz shipment volumes for male condoms, represent the estimated public-sector market in 84 in-scope countries from 2018 to 2022. EXHIBIT C.5: RH VIZ MALE CONDOMS SHIPMENT VOLUMES, 2018-2022 Method 2018 2019 2020 2021 2022 Condoms – Male 1.21 B 1.17 B 1.04 B 1.28 B 1.33 B Sources: [1] RH Viz Shipment Data, retrieved August 2023 Total Public-Sector Market in 84 in-scope countries in terms of CYPs All shipment volumes were translated to CYPs shipped by dividing shipment volumes by each method’s corresponding CYP factor. All shipment volumes were divided by the corresponding CYP factor published by USAID. 11 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- 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. 10 Total yearly volumes are based on the year that the product was shipped. 11 USAID refreshed its CYP conversation factors in January 2022; 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. https://www.usaid.gov/global-health/health-areas/family-planning/couple-years-protection-cyp 4747 AP PE N D IC ES EXHIBIT C.6: VOLUMES TO CYPs SHIPPED CONVERSION FACTORS, 2018-2022  Method Couple-Years of Protection (CYP) Method Per CYP Condoms - Female 120 Condoms - Male 120 Implants - 3 Year 0.4 Implants - 5 Year 0.26 Injectables - 1 month 13 Injectables - 2 month 6 Injectables - 3 month 4 IUDs - copper 0.22 IUDs - hormonal 0.21 Orals – Combined 15 Orals – Progestin Only 12 Orals – Emergency 20 Sources: [1] USAID, “Couple-Years of Protection (CYP),” January 2022. Value of the Total Public-Sector Market in 84 in-scope countries The total value of contraceptive procurement in the public sector 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. 12 A publicly available price for hormonal IUDs was published for the first time in the UNFPA Contraceptive Price Indicator in 2021, hence this price has been used for the calculation of hormonal IUD’s market value for 2018-2022 as well. Finally, the Implant Access Program price of $8.50 was applied to implant volumes from 2018. In 2019-2022, the average implant price on the UNFPA Contraceptive Price Indicator varied from the $8.50 Implant Access Program Price; accordingly, UNFPA’s listed price was used in market value calculations for 2019, 2020, 2021, and 2022. 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. EXHIBIT C.7: AVERAGE UNIT PRICE Method Price range 2018 2019 2020 2021 2022 Method Minimum Maximum Unit price Unit price Unit price Unit price Unit price Condoms - Female $0.43 $0.49 $0.47 $0.44 $0.43 $0.44 $0.49 Condoms – Male $0.02 $0.03 $0.02 $0.02 $0.02 $0.02 $0.03 Implants $8.26 $8.68 $8.50 $8.37 $8.26 $8.68 $8.62 12 UNFPA, “UNFPA Contraceptive Price Indicator—Year 2022”, available at https://www.unfpa.org/sites/default/files/resource-pdf/Contraceptive%20Price%20Indicator%202022.pdf UNFPA, “UNFPA Contraceptive Price Indicator—Year 2021”, available at https://www.unfpa.org/sites/default/files/resource-pdf/Contraceptive%20Price%20Indicator%202021.pdf, UNFPA, “UNFPA Contraceptive Price Indicator—Year 2020”, available at https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptives_Price_Indicator_2020. pdf, UNFPA, “UNFPA Contraceptive Price Indicator—Year 2019”, available at https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators_2019_ V2_-_EXTERNAL.pdf, UNFPA, “UNFPA Contraceptive Price Indicator –Year 2018”, available at https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_ Indicators_2018_.pdf. https://www.unfpa.org/sites/default/files/resource-pdf/Contraceptive%20Price%20Indicator%202022.pdf https://www.unfpa.org/sites/default/files/resource-pdf/Contraceptive%20Price%20Indicator%202021.pdf 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_Contraceptives_Price_Indicator_2020.pdf https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators_2019_V2_-_EXTERNAL.pdf https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators_2019_V2_-_EXTERNAL.pdf https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators_2018_.pdf https://www.unfpa.org/sites/default/files/resource-pdf/UNFPA_Contraceptive_Price_Indicators_2018_.pdf 4848 AP PE N D IC ES Method Price range 2018 2019 2020 2021 2022 Method Minimum Maximum Unit price Unit price Unit price Unit price Unit price Injectables $0.77 $0.81 $0.81 $0.77 $0.81 $0.81 $0.79 IUDs - Copper $0.30 $0.43 $0.30 $0.31 $0.37 $0.43 $0.42 IUDs - Hormonal $10.84 $10.84 $10.84 $10.84 $10.84 $10.84 $10.84 Orals – Combined $0.21 $0.24 $0.24 $0.23 $0.23 $0.21 $0.23 Orals – Progestin Only $0.28 $0.32 $0.29 $0.29 $0.30 $0.28 $0.32 Orals - Emergency $0.23 $0.40 $0.28 $0.40 $0.26 $0.25 $0.23 Notes: [1] For 2018 implants, the Implant Access Program price is used; [2] For 2018-2022, the 2021 publicly available price for hormonal IUDs is used; [3] Otherwise, the price range and unit prices in each year are based on UNFPA’s Contraceptive Price Indicator. Sources: [1] UNFPA Contraceptive Price Indicator, 2018 to 2022; [2] IAP Implant Prices. 4949 AP PE N D IC ES APPENDIX D – ESTIMATING TOTAL GLOBAL PROCURER SPEND VOLUMES IN 84 IN-SCOPE COUNTRIES 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 spend on contraceptive procurement by these major global procurers. For more information on each of these data sources, refer to Appendix B. 5050 AP PE N D IC ES APPENDIX E – ADDITIONAL MARKETS VISIBILITY This report has historically included supplementary research and analysis using publicly available data sources in three large markets: Bangladesh, India, and Indonesia.13 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) procured14 5 million CYPs for the 2022 calendar year, as compared to 13 million CYPs for the 2021 calendar year as well as for the 2020 calendar year, 12 million CYPs for the 2019 calendar year, and 17 million CYPs for the 2018 calendar year. The significantly lower procurement levels in Bangladesh in 2022 compared to 2021 (approximately -70 percent decline in volumes procured) aligns with the notable decline from 2021 to 2022 observed in the supplier shipment analysis. The MOHFW procurement data indicates that the reduction in CYPs procured in 2022 as compared to 2021 are primarily driven by combined and progestin-only oral contraceptives. Procurement contracts in 2022 were awarded primarily to regional and local suppliers, including (but not limited to): Essential Drugs Co., Khulna Essential, M/S, Renata Ltd., Popular Pharmaceuticals Ltd., and Techno Drugs. By applying the same prices15 used for 2022 supplier shipment analyses to the volumes from the Bangladesh MOHFW procurement data, the implied value from Bangladesh’s procurement contracts is estimated to be $16 million for 2022, as compared to the $20 million implied by the 2022 supplier shipment data.16 Although contraceptive procurement has fluctuated in Bangladesh, consumption has remained relatively stable. A review of Bangladesh’s supply chain reports17 revealed that consumption of contraceptive commodities in the public sector has contracted slightly by 4 percent from 11 million CYPs in 2018 to 9.5 million CYPs in 2022. This shift occurred in 2020, with contraceptive consumption amounting to 11 million CYPs in 2018, 10.7 million in 2019, and then remained at a fairly consistent level over the past three years, ranging from 9.5 to 9.7 million CYPs between 2020 to 2022. This analysis relies on data from the Government of Bangladesh’s Ministry of Health and Family Welfare (MOHFW)18 for 2018, 2019, 2020, 2021, and 2022.19 13 Per a 2016 analysis (which is when this market visibility analysis was added to the FP Market Report), 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. Note: Indonesia also accounted 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. 14 Note the Bangladesh MOHFW records procurement in terms of the date received for shipments, rather than date shipped. 15 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 Market Visibility Appendix. Actual pricing may differ in these markets given the different suppliers and pricing parameters at play. However, the UNFPA prices have been applied to maintain publicly available, consistently updated pricing assumptions throughout the report. 16 While participating suppliers in the FP Market Report represent a smaller subset of all the suppliers active in the Bangladesh market, the implied Bangladesh market value from the supplier shipment analysis may exceed the estimated value from Bangladesh’s government procurement contracts in some years since the supplier shipment data also includes shipments to social marketing organizations in country and is also calculated based on date shipped, rather than date received that is reported by the Bangladesh MOHFW. 17 Consumption CYP is calculated using data published by the Bangladesh MOHFW consumption trend tracker and the USAID CYP factors. Bangladesh consumption data available here: https://scmpbd.org/index.php/lmis-report/month-wise-consumption 18 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 19 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 2018-2022. https://scmpbd.org/index.php/lmis-report/month-wise-consumption https://scmpbd.org/index.php/wims-reports/national-receive-details 5151 AP PE N D IC ES EXHIBIT E.1: MOHFW SUPPLY CHAIN CONTRACEPTIVE SHIPMENT RECEIPT DETAILS (PUBLICLY AVAILABLE VOLUMES DATA) Product name Supplier name 2018 2019 2020 2021 2022 CONDOM Direct Relief 1,584,000 - - - - CONDOM ESSENTIAL DRUGS CO. LTD. 56,854,800 11,600,800 72,163,600 91,088,400 22,664,800 CONDOM KHULNA ESSENTIAL LATEX PLANT (KELP) 62,158,800 95,894,000 44,388,400 36,794,400 11,202,000 CONDOM UNFPA 10,080,000 - - - 4,428,000 ECP (2 TAB/PACK) M/S, RENETA LTD. 100,000 100,000 100,000 100,000 100,000 IMPLANT (2 ROD) TECHNO DRUGS Ltd 385,000 429,054 - 575,000 899,885 IMPLANT (SINGLE ROD) UNFPA 200,000 5,000 - - - INJECTABLES (DMPA-IM) Popular Pharmaceuticals Ltd. 1,000,000 - - - - INJECTABLES (DMPA-IM) TECHNO DRUGS Ltd 18,250,000 8,230,000 15,250,000 14,000,000 0 INJECTABLES (DMPA-IM) USAID 914,800 - - - - IUD (CT-380A) IPAS Bangladesh 9,500 - - - - IUD (CT-380A) MARIE STOPES CLINIC 56,000 - - - - IUD (CT-380A) SARBAN INTERNATIONAL LTD. - - 300,000 - - IUD (CT-380A) SMB Corporation Of India 450,000 - - - - IUD (CT-380A) UNFPA 200,000 - - - - IUD (CT-380A) Pathfinder - - - 300 300 ORAL CONTRACEPTIVE PILL (SHUKHI) M/S, RENETA LTD. 54,800,125 110,000,001 50,500,000 43,940,000 11,904,000 ORAL CONTRACEPTIVE PILL (SHUKHI) Popular Pharmaceuticals Ltd. 16,700,000 - 12,500,000 11,230,000 5,952,000 ORAL CONTRACEPTIVE PILL (SHUKHI) TECHNO DRUGS Ltd 16,700,000 - 38,000,000 32,800,000 11,904,000 ORAL PILL APON M/S, RENETA LTD. 4,000,000 1,000,000 3,500,000 9,000,000 - Source: Bangladesh MOHFW, Supply Chain Management Portal, 2023. 5252 AP PE N D IC ES India Based on India’s Ministry of Health and Family Welfare (MOHFW)20 Annual Report for the 2022-2023 fiscal year,21 CYPs procured from product-based methods22 totaled 49 million. Copper IUDs continued to comprise the majority of CYPs provided in the MOHFW basket in 2022-2023; a total of 41 million out of 49 million CYPs provided (82 percent) were from copper IUDs. Overall, across methods, the CYPs procured during 2018 to 2022 have remained relatively stable with a -1 percent CAGR. 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 $32 million in the 2022-23 fiscal year, compared to the less than $1 million implied by the 2022 supplier shipment data.23 EXHIBIT E.2: ANNUAL REPORTS OF DEPARTMENT OF HEALTH & FAMILY WELFARE (INCLUDES FISCAL YEARS 2018-19 TO 2022-23) EXHIBIT E.2.1: QUANTITIES SUPPLIED TO STATES/UTs (PUBLICLY-AVAILABLE DATA) Contraceptives 2018-19 2019-20 2020-21 2021-22* (partial year data) 2022-23** Condoms (in million pieces) - 378.1 397.1 205 235.4 Oral Pills (in lakh cylcles) 394.4 591.6 427.6 184.4 217.2 Copper IUDs (in lakh pieces) 88.5 87.7 73.8 27.8 88.3 ECP (in lakh packs) 128 195.7 131.7 2.5 40.6 Centchroman Contraceptive Pill (Lakh Strips) 170.3 116.7 117.7 143.2 54.9 Injectable Contraceptive (Lakh Doses) - 31.5 29.3 - 69.3 EXHIBIT E.2.2 SOCIAL MARKETING SALES OF CONTRACEPTIVES (PUBLICLY-AVAILABLE DATA) Contraceptives 2018-19 2019-20 2020-21 2021-22* (partial year data) 2022-23** Condoms (Million pieces) 459.5 507.5 244.3 126.1 283 Oral Pills (Social Marketing) (lakh cycles) 159.2 147.1 196 4.6 64 SAHELI (in Lakh tablets) 77.5 - - - - *Data reported from the 2021-22 report only covers the time period from April 1, 2021 to Sept 30, 2021, finalized numbers for the entire year have not been reported. **Figures are provisional 20 Government of India, Ministry of Health and Family Welfare, “Annual Report of Department of Health & Family Welfare for the year of 2022-23”, “Annual Report of Department of Health & Family Welfare for the year of 2021-22”, “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”, latest report available at: https://main.mohfw.gov. in/?q=documents/publication 21 The fiscal year for India runs from April 1 to March 31. Accordingly, all values from the most recent year are provisional and include a buffer; not all data has been reported at the time of publishing (for MOHFW reports). 22 Only modern contraceptive methods from India’s MOHFW reports, including condoms, injectables, IUDs, and oral contraceptives, are included in this analysis 23 CHAI and RHSC are continually working to expand the set of participating suppliers in the Market Report in order to further enhance visibility into key markets, including India. https://main.mohfw.gov.in/?q=documents/publication https://main.mohfw.gov.in/?q=documents/publication ACKNOWLEDGMENTS 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 2023 Family Planning Market Report is funded by the UK Foreign, Commonwealth & Development Office (FCDO); we thank FCDO for their invaluable support. 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, Incepta, Medicines360, Organon & Co., Pfizer, Pregna, PT Tunggal, Renata, Shanghai Dahua, SMB, Techno Drugs, and Viatris (Mylan). We are also grateful to our colleagues from Avenir Health, the Foreign, Commonwealth & Development Office (FCDO) of the U.K. Government, FP2030, the Global Health Supply Chain Program – Procurement and Supply Management (GHSC-PSM), John Snow Inc. (JSI), Shaping Equitable Market Access for Reproductive Health (SEMA), the United Nations Population Fund (UNFPA), the United States Agency for International Development (USAID), and the Visibility and Analytics Network Consensus Planning Group under the RHSC (VAN CPG)* for their invaluable feedback during the development and refinement of various market analyses. *The VAN CPG, established in 2020 under the RHSC, collaborates at the global level to address family planning commodity stock imbalances while also planning to prevent those imbalances from occurring at all. Additional information available at: https://www.rhsupplies.org/uploads/tx_rhscpublications/CPG_2020_FINAL.pdf https://www.rhsupplies.org/uploads/tx_rhscpublications/CPG_2020_FINAL.pdf _Hlk118830355 _Hlk147496403 _Hlk147329127 _Hlk115860006 _Hlk147737503 _Hlk115867435 _Hlk147426413 _Hlk147499581 _Hlk147499615 _Hlk147268030 _Hlk115960573 _Hlk147781589 _Hlk147694197 _Hlk147684252 _Hlk150490691 _Hlk147443445 _Hlk151764773 _Hlk151764933 _Hlk147784069 _Hlk147769094 _Hlk83719630 _Hlk151763554 ACRONYMS INTRODUCTION THE STATE OF FAMILY PLANNING IN 2022 SUPPLIER SHIPMENT ANALYSIS GLOBAL PROCURER SPEND ANALYSIS DOMESTIC GOVERNMENT SPEND ANALYSIS HIGHLIGHTS FROM DISCUSSIONS WITH KEY STAKEHOLDERS GLOBAL MARKETS VISIBILITY PROJECT ACKNOWLEDGEMENTS APPENDICES ACKNOWLEDGMENTS

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