User:R.Ea, Pharm.D Candidate/Contraceptive security

Contraceptive security (CS) is a situation in which people are able to reliably choose, obtain, and use quality contraceptives for family planning and the prevention of sexually transmitted diseases. The term refers primarily to efforts undertaken in low and middle-income countries to ensure contraceptive availability as an integral part of family planning programs. Even though there is a consistent increase in the use of contraceptives in low, middle, and high-income countries, the actual contraceptive use varies in different regions of the world. The World Health Organization (WHO) recognizes the importance of contraception and describes all choices regarding family planning as human rights.

Organizations, usually government health agencies, work to ensure clients have long-term access to a range of high quality contraceptives and other essential health supplies. A framework and tool, the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS), was developed in 2004 by the US Agency for International Development (USAID) and partners to help countries identify and prioritize key commodity security issues; assess current capacity for commodity security among country or regional programs, systems and policies; and shape commodity security strategic plans. Measures taken to provide contraceptive security may include strengthening contraceptive supply chains, forming CS committees, product quality assurance, promoting supportive policy environments, and examining financing options.

Strengthening commodity security requires routine monitoring of donor and government commitment, policies, stakeholder coordination, and supply chain information. Tools including the CS Indicators and the CS Index offer ways of measuring contraceptive security, and allow comparisons over time and across countries. A recent analysis of 48 countries’ CS Index scores between 2003-2012 indicates that all regions improved on measures of supply chain, financing, health and social environment, access, and utilization, with the greatest progress made in sub-Saharan Africa.

Subsidized products, particularly condoms and oral contraceptives, may be provided to increase accessibility for low-income people.

Importance
Contraceptives can prevent unwanted pregnancies in individuals with uteruses, as well as protect individuals from contracting sexually transmitted infections and/or diseases (STIs/STDs). A person's access to contraception is critical for ensuring their optimal health and achieving their reproductive goals as it allows individuals to have control over their body and freedom to decide when to become a parent. It also gives couples the ability to chose how many children to raise and the spacing between each child .

According to the United Nations Department of Economic and Social Affairs' Population Division in 2019, roughly 58% of reproductive-age women (15-49 years) globally needed contraceptive methods; of these, roughly 17% of women have an unmet need for family planning.

Contraceptive security relies on various governmental policies and programs to provide affordable, high-quality contraceptive products for individuals to choose, obtain, and use at their discretion.

Contraceptive security is one way to improve maternal mortality rates. According to the CDC, the maternal mortality rate for 2020 increased 3.7% between 2019 and 2020. In 2017, about 295,000 women worldwide died during and following pregnancy or childbirth which occurred in low and lower middle-income countries.

North America
Access to healthcare is one barrier to contraceptives in North America. Access to healthcare includes cost, health and prescription insurance, having a healthcare provider, and being able to access a family planning clinic or facility, all of which vary among the countries in North America. Many forms of contraceptives require some form of interaction with a healthcare provider, such as a doctor or pharmacist, as they require a procedure or a prescription. Condoms are the most commonly used form of contraceptives since they are available over-the-counter and do not require a prescription. In the study, participants also stated they were less likely to access healthcare and reproductive services due to the fear of perceived stigma, including the stigma around being an immigrant or being a sex worker.

Asia
In Asian countries, such as Pakistan, there are other factors that can influence one's openness to contraceptives, including social constraints and familial restraints. Pakistan follows a conservative cultural approach to family planning and views each child as a gift. This belief and society has made many families reluctant to use contraceptives. The decision to start using contraceptives depends on both partners and both sets of in-laws, which tends to be the greatest barrier for those intending on family planning.

In a study conducted on the Philippines, it was found that the country complied with four of nine WHO recommendations on family planning. Among the five recommendations that were not met were accessibility, availability, and informed-consent -- all three of which may restrict contraceptive security. In the case of the Philippines, the availbility recommendations were unmet due to the law that prohibits the use of emergency contraception in any government hospitals. Regarding accesibility, the reproductive health laws outline ways to provide contraceptives to those with lower-incomes; however, the main constraint that remains is that parental consent is required in the case of an adolescent requesting contraceptives. In China, all forms of contraceptives are free in urban areas.