World Population Day: A market approach to meet contraceptive need

On World Population Day (July 11, 2015) MEASURE Evaluation draws attention to its ongoing collaboration with the EVIDENCE project to work on what is called the “total market approach” (TMA) to providing family planning.

World Population Day
Photo By Jack Hazerjian, MEASURE Evaluation.

An estimated 225 million women in developing countries would like to delay or stop childbearing but are not using any method of contraception. Family planning reinforces people’s rights to determine the number and spacing of their children and, by preventing unintended pregnancy, family planning prevents deaths of mothers and children, contributing to global efforts to end preventable child and maternal deaths (EPCMD). Some family planning methods also help prevent the transmission of HIV and other sexually transmitted infections.

USAID, other major donors, and many national governments increasingly recognize that to adequately address the unmet need for family planning, there must be effective coordination among three sectors involved in expanding access – the public sector, the nonprofit sector, and the commercial sector. One aspect of such coordination is to avoid one sector taking actions that may harm others and thereby undermine overall efforts to improve and expand services. For example, if the public sector or nonprofit social marketing programs flood a market with no-cost or subsidized contraceptives, it will be difficult for the commercial sector to grow. If that happened, fewer commercial companies would enter the market, which may limit the variety of contraceptive methods available, and, perhaps, prevent some families from having access to the methods they prefer. But to understand how the market is operating, more data are needed.

On World Population Day (July 11, 2015) MEASURE Evaluation draws attention to its ongoing collaboration with the EVIDENCE project to work on what is called the “total market approach” (TMA) to providing family planning. This approach seeks to gather and use data to strengthen collaboration between the three market sectors providing family planning products and services in order to more efficiently segment the market, says Dominique Meekers, PhD, professor of global community health and behavioral sciences at Tulane University in New Orleans – a partner organization with MEASURE Evaluation. “Having an efficiently segmented market will help grow the total market, which will benefit all three sectors,” he says.

Many countries are currently trying to decide whether TMA can help reduce unmet need for family planning. “However, because TMA is a relatively new approach, there is little consistency in how to do it,” he says. “Everyone does it differently, with different indicators. If we have consistency, we can get more complete data, agree on what data are needed, and help countries decide how to best proceed to improve family planning.”

Dr. Meekers and his colleagues at the EVIDENCE project are working now on a practitioners’ guide for implementing TMA. USAID, UNFPA, and large NGOs are all interested in the approach. “There is a lot of momentum, and the unique part of our guide is to help everyone get to the point where it can be done consistently and well,” he says. “This is step by step. This is very practical.”

The guide will illustrate how to conduct a landscaping exercise with key stakeholders (to assess the business climate and the readiness of government and other sectors to participate in a TMA approach), how to conduct a detailed analysis of the family planning market to inform a total market approach, how to develop a TMA plan, and how to monitor and evaluate the plan. “TMA is supposed to make sure that all sectors grow, and that each becomes stronger,” he says. “A proper market analysis will help everyone understand how each sector can use its comparative advantage in the marketplace.”

What TMA means for the future of family planning in low-resource countries is that government, nonprofit, and commercial sectors can work together to fully meet the demand among families who want it – each sector targeting the appropriate population segment with the services it can best provide. Government will be able to allocate its limited resources to providing contraceptive services to those who can’t afford it otherwise. Nonprofits will be able to offer subsidized pricing on a variety of methods that can increase uptake among the marginally poor and harder-to-reach segments of society. And, the commercial sector can offer a wide variety of products to the remainder of the population able to pay market rates for a wide choice of methods.

“We hope our guide will help all countries to consider TMA,” Dr. Meekers says. “Some markets already are optimally spread. In others, the commercial sector has not yet been able to grow. But, it’s a sustainability issue for family planning work because global donors won’t be providing low- or no-cost contraceptives forever.”

For more information on MEASURE Evaluation’s work on family planning, visit