Family Planning in the Context of Latin America's Universal Health Coverage Agenda

Abstract

Background: Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region.

Methods: We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts.Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket.

Conclusion: Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations.

FIGURE 1

mCPR by Country Among Women Married or in Union (2005–2015) Abbreviation: mCPR, modern contraceptive prevalence rate.

FIGURE 2

Contraceptive Method Mix by Country Among Contraceptive Users Married or in Union (2008–2015) Abbreviations: IUD, intrauterine device; LAC, Latin America and the Caribbean.

FIGURE 3

Availability of Family Planning Methods by Country and Insurance Status Abbreviations: CCSS, Caja Costarricense de Seguridad Social (national SHI scheme); IGSS, Instituto Guatemalteco de Seguridad Social (national SHI scheme); IHSS, Instituto Hondureño de Seguridad Social (national SHI scheme); IUD, intrauterine device; OOP, out of pocket; PHI, private health insurance; SeNaSa, Seguro Nacional de Salud; SHI, social health insurance.

FIGURE 4

mCPR in 5 Countries by Indigenous Status Among Women Married or in Union (2010–2015) Abbreviation: mCPR, modern contraceptive prevalence rate.

FIGURE 5

mCPR in 4 Countries by Insurance Status and Wealth Quintile (Q1=Poorest, Q5=Wealthiest) Among Women Married or in Union (2012–2015) Abbreviation: mCPR, modern contraceptive prevalence rate.