Agha Sohail, Do Mai
Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112, USA.
Health Policy Plan. 2008 Nov;23(6):465-75. doi: 10.1093/heapol/czn035. Epub 2008 Sep 16.
To determine whether an expansion in private sector contraceptive supply is associated with increased socio-economic inequality in the modern contraceptive prevalence rate (MCPR inequality).
Multiple rounds of Demographic and Health Surveys data were analysed for five countries that experienced an increase in the private sector supply of contraceptives: Morocco, Indonesia, Kenya, Ghana and Bangladesh. Information on household assets and amenities was used to construct wealth quintiles. A concentration index, which calculates the degree of inequality in contraceptive use by wealth, was calculated for each survey round.
Socio-economic inequality in the MCPR (MCPR inequality) declined in Morocco and Indonesia, where substantial expansion in private sector contraceptive supply occurred. In both countries, poor women continued to rely heavily on contraceptives supplied by the public sector even as they increased use of contraceptives obtained from the private sector. A marginally significant decline in MCPR inequality occurred in Bangladesh, where the increase in private sector supply was modest. There was no significant overall change in MCPR inequality in Kenya or Ghana. In Kenya, this lack of significant overall change disguised trends moving in opposite directions in urban and rural areas. In urban Kenya, MCPR inequality declined as low-income urban women increased use of contraceptives obtained primarily from the public sector. In rural Kenya, MCPR inequality increased. This increase was associated with a decline in the supply of contraceptives by the public sector and non-governmental organizations to the poorest, rural, women.
The study found no support for the hypothesis that an increase in private sector contraceptive supply leads to higher MCPR inequality. The findings suggest that continued public sector supply of contraceptives to the poorest women protects against increased MCPR inequality. The study highlights the role of the public sector in building contraceptive markets for the private sector to exploit.
确定私营部门避孕药具供应的扩大是否与现代避孕普及率的社会经济不平等加剧（现代避孕普及率不平等）相关。
对五个私营部门避孕药具供应增加的国家（摩洛哥、印度尼西亚、肯尼亚、加纳和孟加拉国）的多轮人口与健康调查数据进行了分析。利用家庭资产和便利设施信息构建财富五分位数。为每一轮调查计算了一个集中指数，该指数计算按财富划分的避孕使用不平等程度。
在私营部门避孕药具供应大幅扩大的摩洛哥和印度尼西亚，现代避孕普及率的社会经济不平等（现代避孕普及率不平等）有所下降。在这两个国家，贫困妇女在增加使用从私营部门获得的避孕药具的同时，仍然严重依赖公共部门提供的避孕药具。在私营部门供应增加幅度较小的孟加拉国，现代避孕普及率不平等略有下降。在肯尼亚或加纳，现代避孕普及率不平等没有总体显著变化。在肯尼亚，这种缺乏总体显著变化掩盖了城乡地区相反的趋势。在肯尼亚城市，随着低收入城市妇女增加主要从公共部门获得的避孕药具的使用，现代避孕普及率不平等下降。在肯尼亚农村，现代避孕普及率不平等增加。这种增加与公共部门和非政府组织向最贫困农村妇女提供的避孕药具供应减少有关。
该研究没有支持私营部门避孕药具供应增加会导致更高的现代避孕普及率不平等这一假设。研究结果表明，公共部门持续向最贫困妇女提供避孕药具可防止现代避孕普及率不平等加剧。该研究强调了公共部门在为私营部门开发的避孕市场建设中的作用。
