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Increased depot medroxyprogesterone acetate use increases family planning program pharmaceutical supply costs.

To measure the use rates of depot medroxyprogesterone acetate and oral contraceptives and compare the costs between the two methods to see whether these trends had impacted the pharmaceutical acquisition costs for a family planning program, we compared vendor invoice costs over three time periods, 1992, 1994, and 1999. Visit types and client demographic statistics were tabulated from existing encounter record data sources. A local pharmaceutical chain was queried about their acquisition costs for similar products. Since 1992, depot medroxyprogesterone acetate use has increased from 3 to 17% while oral contraceptive use has decreased from 45 to 40% of contraceptive clients. The cost to our program for depot medroxyprogesterone acetate is $4.75 for 28 days and the average pill package is purchased for $1.35. The cost to our program is 4 times greater for the injection contraceptive user than for the oral contraceptive user. Approximately 80% of our clients have household incomes less than 200% of the poverty level and obtain their services from our program for free. This combination of increasing popularity and the high cost of depot medroxyprogesterone acetate has resulted in a great increase in the pharmacy acquisition cost. The oral contraceptive manufacturers make their products available at large discounts (20-fold reduction), but depot medroxyprogesterone acetate is not provided at a similar discount (2.8-fold reduction). We believe this is because there is no generic or competing product. The high cost of depot medroxyprogesterone acetate could jeopardize our ability to offer this highly effective method of birth control to all women.

Community Health Services↗

The importance of user compliance on the effectiveness of natural family planning programs.

Nowadays, there is an increasing interest in natural family planning methods. The biological basis for the application of natural family planning methods is the recognition of ovulation and, more extensively, of the fertile period. Several studies in the past decade have shown the efficacy of these methods and that the main cause of failure was either a conscious departure from the rules of the method or erroneous application of the method. Another problem affecting natural family planning that has been highlighted is the relatively high discontinuation rate. These features are probably due to low compliance in applying the natural family planning rules, which may be too demanding for a number of couples. In this review, there are comments on the application of natural family planning methods, the discontinuation rates and the failure of the method due to mistakes in the studies carried out in the past 15 years. Steps that can be taken to limit mistakes and discontinuity are also addressed.

Family Planning Services↗

[Fertility decline in China and family planning programs].

"The article looks in detail at the population development in China since the 1950s, highlighting some dramatic changes. In the late 1950s the country was hit by widespread famine, which resulted in increased mortality and decreased fertility. Infant mortality climbed to almost 300/1,000. During the 1960s fertility began to increase again and mortality declined. From the beginning of the 1970s fertility started to decline, dropping from about six to just over two children per woman in the late 1980s. Today, fertility is thought to be below replacement level. The main reason for this fertility decline lies in the highly efficient family planning programmes implemented in China since the 1950s and particularly since the 1970s. The decline in infant mortality and the favourable socio-economic development have also been important factors in the decline in fertility. Although fertility in China is currently at a low level, the country's population is still set to grow." (SUMMARY IN ENG)

Asia↗