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Distribution of contraceptives in the commercial sector of selected developing countries. Summary report.
Columbia, Maryland, Westinghouse Population Center, Health Systems Division. 1974 Apr; 135.The role of the commerical sector in delivering contraceptive products (primarily the pill and condom) is examined in the following 8 developing countries: Turkey, Iran, Thailand, Korea, the Philippines, Venezuela, Panama, and Jamaica. Current status of distribution was obtained from surveys of fertile couples. Recommendations are given for action at both the national and international level: an illustrative marketing plan for increasing commercial distribution is presented. The commerical sector is considered a needed component in helping to meet national population policies; it is suggested that governments and donor agencies help eliminate barriers to increased commercial distribution, and that commercial companies cooperate with these organizations. Major findings are detailed by examining the distribution systems, marketing activities, pricing policies, and consumer attitudes, knowledge and behavior. Major factors which impede or facilitate contraceptive usage and current commerical distribution are given for each country.
[Unpublished] 1990 Jun. viii, 64,  p.To enhance the effectiveness of the Malawi Social Marketing Project's upcoming condom distribution effort, focus group discussions were held in Blantyre and Lilongwe Cities and Mulanje and Mangochi rural districts. The target population was comprised of low-income men and women 20-40 years of age. In Malawi in 1989, 367,000 condoms were distributed by the Ministry of health and 75,000 were sold in the private sector; thus, knowledge of the condom market is limited. Although there was widespread support for the concept of child spacing, no focus group participants were current contraceptive users. Ever-use of the condom was reported by half the urban men and a third of the rural respondents. Condom use was discontinued for reasons such as interference with sexual pleasure, a belief that semen has beneficial health effects for women, the association with prostitution, and fears that condom use facilitates infidelity. There were significant sex differences, with female respondents viewing the condom as a means of preventing pregnancy or spacing children and men valuing the condom's role in disease prevention. Of interest was the finding that men indicated their female partner rejected condom use, while women believed it was the men who objected to this method. Questions on product design revealed no preference for colored condoms. There was a consensus that the brand name should relate explicitly to the condom's function; Protector and Chishango were suggested. Finally, respondents shared concerns that condoms should be priced low enough to be affordable to rural residents (1-10 tambala) and that privacy be available at the distribution site. The degree of misinformation about condom use, different perceptions about its main function, and sensitive nature suggest that the social marketing effort should be preceded by an extensive educational campaign.
Research Triangle Park, North Carolina, Family Health International [FHI], 1989 Nov. , 4,  p.Under contract with the U.S. Agency for International Development (USAID), Family Health International compared 2 brands of condoms for acceptability in Mali, Sri Lanka, and the Dominican Republic. Lifestyle 3, 3.4 mils thick, was compared with Prime, 2.6 mils, to determine whether the thicker of the 2 could be potentially distributed by USAID in developing countries. 65 current condom users, sexually active, and free of STDs for the past year were provided with the Lifestyle 3 condoms, informed that they were thicker, and then interviewed after 1 month of use. 8 condoms were given to each user in the Dominican Republic, and 15 for each in Sri Lanka and Mali. No study data was available for Sri Lanka due to political unrest. Lifestyle 3 was, however, well-accepted in Mali and the Dominican Republic, with additional strength and security cited as extremely desirable factors by over 1/2 of the study participants. Greater protection against both pregnancy and AIDS was considered important. Almost all who were interested in buying the stronger condoms said that they would pay more for them. Lifestyle 3 condoms were also reported to be more comfortable with sensitivity comparable to Prime. The breakage rate for the stronger condom was 1:143, comparable to Consumer Report's March, 1989, study results of 1:140. The Lifestyle 3's labelless silver foil packaging was also found to be overwhelmingly preferred to the standard plastic packaging of other brands. Addition studies of both breakage rates and consumer preference for condom packaging are encouraged. Limited market introduction of Lifestyle 3 is also suggested.
Jakarta, Indonesia, Survey Research Indonesia, 1988 Sep. 40,  p. (SRI - 737)This report of a survey of awareness, usage and attitudes of 2106 men from Jakarta, Surabaya, Medan and Bandung, Indonesia, featuring condoms and the Duo Lima condom in particular, by Survey Research Indonesia, comparing 1988 to 1987, consists of 27 tables and 2 conceptual maps. Many of the data compare location or economic class. Unaided awareness of condoms had decreased from 20 to 16% overall between 1987-1988, while knowledge of vasectomy and Norplant had increased. Use of condoms as the main method fell from 7 to 5%. 10% have ever tried condoms. The main source of purchase was the Apotik (50%), drug store (195) and puskesmas (12%). The most common condom pack size purchased was 12, followed by 3 and 6. Men described condoms' "messiness" as their worst drawback. Most users tried condoms for <1 year, indicating falling off of use. Awareness of the Duo Lima brand has increased to 48%, up from 43% in 1987. It was the 1st brand mentioned by all men; 69% recalled Duo Lima advertising, primarily on radio, on billboards, and in newspapers. Duo Lima was the leading brand with 39% of subjects using it. Perceptual maps placed Duo Lima as an attractive, modestly priced, well advertised brand, the right size, and best suited for family planning.
CONTRACEPTION. 1991 Aug; 44(2):183-90.A small survey to assess the perception and experience of current family planning users and their husbands was carried out in a university family planning clinic. Women routinely visiting the clinic were asked to complete a short screening form. 56 women responded to the questionnaire concerning their attitude to the Femshield. 18 volunteers agreed to enter the study and were given verbal instruction on use of the device. Each volunteer was provided with 3-5 Femshields. Participants were asked to return to the clinic 1 month after admission. A Husband Form was then sent to the home of the volunteers to assess the attitude of their husbands. 13 volunteers returned for the followup visit. 50 Femshields were used. The results showed that the volunteers found the vaginal insertion of the device was acceptable, but the outer and inner rings of the device caused an uncomfortable feeling when having intercourse. The volunteers were more positive about the device than were their partners. Sexual satisfaction for both partners was reduced. A few couples suggested that the device be modified with the bag being smaller and thinner, the outer and inner rings reduced in size and softer, and the device itself being in a prelubricated packet. (author's)
CONTRACEPTION. 1991 Mar; 43(3):263-71.From October 1987-May 1989, a total number of 527 women completed a total of 6291 treatment cycles in 6 centers in China for the study of a triphasic oral contraceptive (OC), Triquilar. The mean age of the subjects was 30.21 +or- 2.84 years. There were 7 pregnancies during the study period. Among them, 5 were patient failures due to a missed pill or incorrect dosage; 1 had taken barbiturates along with Triquilar. Only 1 woman became pregnancy in the 11th treatment cycle without any discernible reason. In most cases, menstrual flow decreased and dysmenorrhea improved as treatment continued. Of the total treatment cycles, the incidence of missed withdrawal bleeding was 0.25%, spotting 0.97%, and breakthrough bleeding 0.48%. Nausea and vomiting were the most common side effects and accounted for 6.4% of the total treatment cycles. This was followed by breast tenderness (3.7%), dizziness (2.4%), and headache (1.6%). Most of these occurred during the 1st few cycles and were alleviated later. By the end of 1 year, the total dropout was 64 cases. The reasons for discontinuation of treatment were: pregnancy 1.33/100 women, menstrual disturbances 0.76, side effects 3.80, other medical reasons 2.09, and personal reasons 4.18. Results confirm that Triquilar is an effective OC with good cycle control and low incidence of side effects. No serious reaction has been reported. It has been well accepted by the Chinese women. However, due to the low dosage of steroids, it is of utmost importance to avoid errors in its use. Not only should the package of the drug carry conspicuous warnings, but also detailed instructions should be given to the women in order to obtain the desired efficacy. (author's)
Working Woman. 1985 Oct; 68, 72, 74.Liberation in combination with legislation gives new life to condoms, which now find their way into the purses, brief cases, and shopping carts of increasing numbers of women. The number of female buyers of condoms has risen from 15% in the mid-1970s to perhaps as high as 40% today, thanks to the increasing number of women who are dissatisfied with contraceptive alternatives and a condom industry that is playing to its growing female audience with new packaging and marketing methods. The condom has a distinct advantage in an age when women are more concerned and knowledgeable about their bodies than ever before. The condom has no side effects. The $200 million-a-year condom industry enjoys a current growth rate in sales of about 12%. This is not too bad for a product that has been termed "16th century technology." Currently, Youngs, Schmid, and approximately 4 dozen other US condom companies mold, dry, test, roll and pack nearly 1000 condoms a minute, 400-500 million condoms a year. The Japanese buy 612 million condoms a year. Fewer than 15% of all US couples use condoms, which account for a quarter of the $800 million-a-year contraceptive industry. The growth in condoms was steady until about 3 years ago when it really started to move. There are 3 reasons for the growth spurt. In 1977, the Supreme Court struck down some lingering blue-nosed state laws that regulated who could buy condoms (not minors), where and why they could be sold (only in pharmacies for "disease control" rather than for contraception), how they could be advertised to the public (not at all), and where they could be displayed (out of sight). At the same time, a number of female contraceptive methods considerably trendier and more sophisticated than condoms fell into public, if not medical, disrepute. Finally, venereal diseases have grown in number to fill a category called sexually transmitted diseases (STDs) that includes more than 30 ailments. Condoms are the only contraceptives that also are effective venereal disease barriers. Consequently, condoms moved from under the counter to in front of it. Most notable of the condom industry's recent innovations have been unisex merchandising. It was decided that a lot more women would buy condoms if the packaging had femine appeal. With or without a yuppie clientele, the condom business is so healthy that existing advertising strictures have not hampered sales. Women are the primary purchasers of condoms in pharmacies and grocery stores.
Singapore Journal of Obstetrics and Gynaecology. 1984 Mar; 15(1 Suppl):119-23.The relative importance of several aspects of oral contraception, i.e., acceptance and compliance, are reviewed. Focuses on reliability, presentation and formulation, cycle control, safety, reversibility, and subjective side effects. Although oral contraceptive (OC) failure may not be such an important event for the population as a whole, it is for the woman who relied on the pills' contraceptive effect. A pill failure in 1 woman may deter many others, who may either stop using OCs or never begin. Data on pill reliability are almost entirely from studies in wrestern nations, and hard data on reliability in the Asian cultural setting may be helpful. The 1st OCs came as 20 tablets in a bottle. Since then different kinds of packaging have been developed, e.g., wheels, bubble strips, differently colored pills for different days. If funds are scarce, however, price-increasing extras will hold little attraction; in such circumstances just 21 tablets in a blister pack will be sufficient. Some types of OCs ensure better cycle control than other. A woman using an OC that does not ensure good cycle control will, at best, ask to be changed to another brand, or she simply will stop taking the pill. The reduced menstrual flow in OC users, which is often claimed in the literature to be an advantage that women appreciate, is often a cause of concern or even discontinuation in Korea. Spotting can be distressing, particularly for Muslim women, but as mutis have now ruled that a woman can still pray when spotting, the negative effect of occasional spotting on motivation will most likely diminish. Doctors may have a good idea of the relative metabolic safety of OC, but field workers, paramedics, and the less well-trained assistants will have a more limited insight. The field workers' influence is a crucial factor. Few of the field workers whose supply OCs and disseminate knowledge actually use OCs themselves. Thus their message will not be very convincing. In the western countries large numbers of teenage girls have been using OCs for some time with no subsequent impairment of fertility. Subjective side effects, such as nausea, may be trivial, but they often discourage women from starting to use OCs or from continuing after the first few months. Subjective side effects are less marked than those experienced with the pills on 15 years ago.
Singapore Journal of Obstetrics and Gynaecology. 1984 Mar; 15(1 Suppl):109-13.In 1966, Singapore's governemnt family planning clinics made available 8 different oral contraceptive (OC) formulations. Over the years, the range of pills offered has changed in accordance with decisions by the Medical Committee. Currently, OCs are available from all 29 maternal and child health centers as well as the National Family Planning Center. These centers are strategically located throughout the island and are easily accessible. Originally, the price of a monthly cycle of pills was S$1.50, but this was reduced to S$1.00 in 1968, however, contraceptives are given free to any person who is unable to pay. The Singapore Family Planning and Population Board has deliberately retained the commercial packaging of the OCs offered in its clinics, lest clients fear that pills offered at such nominal charges are in some way inferior or different from those obtainable from the private sector at higher cost. Following the policy of reorientation in mid-1966, the pill replaced the IUD as the main contraceptive method. By the end of the year, out of 30,440 new acceptors, 46% had chosen OCs, 27% the condom, and 9% the IUD. The popularity of both OCs and the condom continued to rise steadily. In 1974 OCs were chosen by 58% of 18.292 new acceptors and the condom by 40%. Over the next 2 years the gap between OC and condom choice narrowed, and in 1977 the pill was overtaken by the condom. OC acceptance has continued to decline despite intensified motivational and educational approaches through group talks, individual counseling, and a special pamphlet answering some commonly voice fears about OCs. In 1982 the condom was chosen by 64% of new acceptors and OCs by 33%. The fall in the popularity of the pill in recent years has occurred in the wake of periodic press reports from the West about increased risks among older OC users of venous thromboembolism, ischemic heart disease, and cerebrovascular disease, especially among smokers. Despite the decline in acceptance of OCs in favor of condom, there has been an impressive drop in the crude birthrate from 28.3 in 1966 to 17.3 in 1982 and in the total fertility rate from 4.456 to 1.704 over the same period.
Chapel Hill, North Carolina, PSI, 1974 Oct 24. 85 p.By the late 1960s, it was evident that the clinic-based contraceptive distribution system in Kenya was unable to meet the need for family planning in the country. A supplementary distribution system, modelled on the Indian Nirodh (condom) marketing program, was developed. This is the report on a USAID-sponsored pilot project in the social marketing of condoms which extended from April 1972-July 1974. A detailed mass marketing strategy was inaugurated following consultation with local marketing experts and pilot market research planning. Between October 1972 and October 1973, a high-quality lubricated condom was mass-marketed, at a subsidized price, through village shops in rural Kenya. The aim of social marketing is to "sell" both the idea and the product. In both respects, the pilot project was a success. During the test year, 128,000 condoms were sold to vendors with sales to consumers cited at 91,000 and positive attitude changes toward family planning were recorded through a KAP study undertaken as an evaluative tool. The marketing strategy, methodology, promotional activities, and results are described and graphed. As a result of this pilot project, it is concluded that social marketing, using commercial promotional techniques can provide a significant nonmedical supplement to clinical family planning facilities. Promotional activities can be better carried out using commercial rather than in-house information/education/communication personnel. Such programs will probably never be economically self-sufficient. Pills can probably be added to the program.
New York, Population Council, 1979. 125 p.Barrier or conventional methods of contraception--those which physically block the passage of sperm into the uterus or chemically inactivate the sperm in the vagina--are an important group of methods which have been too long ignored. A large and sustained effort to develop new and better barrier contraceptives is sensible and necessary. The effectiveness of the barrier methods is reviewed, including the condom, diaphragm, and vaginal spermicides. Also considered is current acceptability and emerging demand for barrier contraceptives; groups for whom barrier methods have special appeal (adolescents, women over 30, men); using science and technology to improve barrier methods; and the status of current research efforts. The apparent lack of popularity of barrier methods in developing countries is examined, and it is felt that whether these methods can be effective, acceptable contraceptives for a large number of couples in such countries is unknown because the methods have been virtually untried. Recommendations for policy and action are directed at providing supportive family planning services; special programs for adolescents; improvements in packaging and labeling; increasing applied and basic research; and pilot tests in developing countries.
Washington, D.C., U.S. Agency for International Development, March 2, 1978. 2 p.The ideal vaginal contraceptive is described in terms of the requirements of any other contraceptive method, i.e., that it be effective, acceptable, deliverable, and safe. In terms of effectiveness, the spermicidal action should be powerful, long lasting, and ideally instantaneous in action. Overkill should be overwhelming. Some type of active dispersal (such as foaming) is probably mandatory. Regarding acceptability, the contraceptive should be easy and convenient to insert into the vagina, and messiness, running, odor, itching, irritation, residue and probably sensation of heat should be minimized. The aspect of deliverability is a positive feature of this method, since it easily lends itself to household distribution. It would be useful for the product to be conveniently packaged in multiple dose packaging as well as in unit dose packaging suitable for vending machines. Stability of the product with respect to heat, humidity, and other physical forces is very important, and cost should be comparable to condoms. The potential toxicity of these kinds of methods is favorable, since they compare favorably with the alternatives. Preparations ought not to contain heavy metals nor be detrimental to the normal vaginal flora. These products should potentially offer considerable protection from venereal disease.
Family Planning Research Unit, Department of Sociology, The University of Exeter. 1974; 10 p..An acceptability study of C-Film was presented. It was stressed that this study provided no information on the ability of C-Film to prevent pregnancy nor on the reaction of women using C-Film as their sole contraceptive method. This survey, between November 1, 1973, and January 31, 1974, was limited to women who had been fitted with an intrauterine device. Of 187 women approached, 130 agreed to take part in the study and 113 were successfully reinterviewed. Some points which emerged during the interviews were 1) no one had difficulty in comprehending the instructions provided, 2) only 8% found the packaging less than satisfactory, 3) nearly 1/2 mentioned the tendency for C-Film to become sticky which was improved by folding or putting powder on the finger, 4) the major side effect was "irritation" but was sufficient in only 7 cases to stop using C-Film and 5) 85% stated that C-Film had no effect on the enjoyment of the sexual act. Some stated that they would use C-Film as a second method or in the absence of some other method since they had doubts about its reliability. In general, the reaction to C-Film was favorable.