Expanding contraceptive choice in the developing world: Lessons from the Lao People's Democratic Republic and the Republic of Zambia

Abstract

Background and objectives Women need different forms of contraception over their lifetime. In the developed world, they have access to some 20 different methods. In developing countries, only a few options are available. This paper focuses on four under-used methods: intrauterine devices, implants, emergency contraception and female condoms. It examines reasons for their low uptake, strategies used for their adoption, and challenges in sustaining these efforts, in two countries: Laos and Zambia.

Methods In-country documentation and reports from international partners were reviewed; questionnaires were sent and interviews carried out with ministry officials, senior providers, and local representatives of international organisations and international non-governmental organisations.

Results In Laos, the family planning programme is relatively young; its challenges include ensuring the sustainability of services and supplies, improving the quality of IEC to dispel misconceptions surrounding contraception, and developing novel distribution systems to reach rural populations. Zambia has a much older programme, which lost ground in the face of competing health priorities. Its challenges include strengthening the supply chain management, coordinating the multiple groups of providers and ensuring the sustainability of services in rural areas.

Conclusions The contrast offered by Laos and Zambia illustrates the importance of regular evaluation to identify priority areas for improving contraceptive delivery.

KEYWORDS:

• Contraception
• Choice
• Laos
• Zambia
• IUD
• Implant
• Emergency contraception
• Female condom

ACKNOWLEDGEMENTS

The authors express their gratitude to colleagues in different organisations who generously contributed their knowledge and time to these case studies. In particular, they would like to acknowledge:

For Laos: Dr Alongkorn Phengsavanh (National University of Laos), Dr Anan Sacdpraseuth (Mahosot Hospital, Vientiane), Dr Robert Gray (PSI), Dr Kaisone Chounramany (Director, MCHC, Lao MoH), Dr Ketkeo Soudachan (IPPF), Dr Liu Yunguo (WHO), Dr Kunhee Park (WHO), Dr Dominique Ricard (WHO), Mrs Jayne Rowan (PSI), Dr Siriphone Sakulku (UNFPA), Mrs Oulayvanh Sayarath (UNFPA), and Mrs Dana Tilson (PSI).

For Zambia: Mrs Ruth Bweupe (MoH), Dr Davy Chikamata (Concept Foundation), Mr Abraham Chingalika (MoH/UNFPA), Mrs Patricia Kamanga (WHO), Dr David Lusale (Chainama College of Health Sciences – CCHS), Dr Sarai Malumo (UNFPA), Dr Reuben Mbewe (MoH), Mrs Hilda Winna (MoH), and Mrs Mary Zama (Population Council).

Conflict of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and the writing of the paper.

Work to be attributed to: UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP).

Support received from: UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP).

The article is published with permission from the World Health Organization (WHO). The WHO retains copyright of this article.