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Family Planning and Contraception: Challenge for Sanitary Protection

November 28th, 2016

Ringing in at USD30 billion in retail sales in 2015, sanitary protection remains the second largest product category globally, after nappies/diapers/pants. While over a quarter of all sales are still coming from the developed markets of North America and Western Europe, the demand for the products in these markets has been unfavourably affected by a host of factors. While demographic trends and reusable alternatives often come to mind first, the use of oral contraceptives as one of the aspects of women’s health management needs to be considered as well. Furthermore, as family planning policies are strongly on the agenda in many developing countries, understanding these policies and methods used can prepare the industry for the challenges ahead.

Prevalence of contraceptive use in developed markets

According to studies released by the UN’s Department of Economic and Social Affairs, developed markets show a high prevalence for the use of contraceptives among married and in-union women, aged 15-49-years-old. More specifically, prevalence of pill use averages 25.5% in Northern Europe and 37.5% in Western Europe. Southern Europe shows significant variations, from 49.9% in Portugal and 17.5% in Spain, to just 4.8% in Greece. In North America, Canada shows higher prevalence of pill use at 20.7% vs 16% in the US.

The same study indicates that while there is no universal upward trend across all countries, the prevalence did go up in North America compared to 1994. Use of the contraceptive pill has also gone up in Portugal, Spain and Greece. On the other hand, while still significant, the prevalence of pill use has declined somewhat in a number of countries, due to an apparent shift to other methods, including sterilisation.

Positive impact of the Affordable Care Act in the US

While more research is needed to fully assess the impact of the ACA on contraceptives, a study released in September 2016 in Health Affairs, reviewed whether ACA’s requirement that insurance plans must cover FDA approved contraceptive methods without cost sharing has impacted the use of oral contraceptives.

According to the study, the ACA’s provisions led to more consistent use of generic pills. Nearly 75% of women paid nothing out of pocket for generic pills, compared to 54.9% for brand name pills. For brand-name pills, the new provisions were associated with reduced levels of discontinuation.

It is not only the oral pill

Although the use of oral contraceptives has gone up compared to 1994 (the UN study above), the last few years have seen a shift in methods and types of contraception. However, this does not always mean good news for the disposable hygiene industry.

For instance, according to QuintilesIMS studies, the number of prescriptions for oral contraceptives dropped in Canada between 2011 and 2015, while oestrogen-free and non-hormonal methods, IUDs and fertility tracking apps, gained more popularity. At the same time, other forms of hormonal contraception, namely the patch, the ring and the progestin-only injections, grew 11% between 2011 and 2015. The number of prescriptions for Depo-Provera, an injection containing only progestin, more than doubled over the same period of time. Also, the number of prescriptions for the pill without oestrogen increased 11%, according to the same study. While different from a more traditional pill, these methods (while in use) still impact the menstrual cycle and reduce the need for sanitary protection products.

China and modern family planning

Currently the largest global market in absolute value and volume terms, China is projected to generate USD16 billion and 137 billion units in retail sales of sanitary protection through 2020. While already demonstrating a high level of per capita consumption, especially in towels, the country still offers potential for tampons and pantyliners.

However, modern family planning, supported also by growing incomes and female employment and career growth, could represent a potential barrier in the coming years. The much anticipated relaxation of the one-child policy, while yielding some results, did not generate as much interest among potential parents as the country’s demographers anticipate. The use of contraceptive methods in the country in 2015 remained quite high, including methods that impact menstrual flow. According to the above-mentioned UN study, in 1994, female sterilisation was showing a high level of prevalence in the country, at 35.6%, which dropped to 28.2% in 2015. The use of IUDs, on the other hand, has gone up from 32.8% in 1994 to 39.9% in 2015. The use of the pill remains small and has come down from 3.1% in 1994 to 1.2% in 2015. Although the use of the pill appears small, IUD prevalence is fairly high and on the rise. The use of IUDs reduces and sometimes eliminates altogether, the menstrual flow. Sterilisation can also affect the flow, according to medical studies.

Challenges ahead?

Family planning remains on the agenda, and health organisations around the world encourage the use of contraceptives as a part of comprehensive women’s health policies. This includes modern contraceptives that affect menstrual flow and as a result reduce the need for sanitary protection.

For instance, in Brazil, the prevalence of contraception has gone up between 1994 and 2015. Of the various methods used, the use of the pill has gone up from 19.9% to 24.1%, injectable contraceptives from 1.2% to 3.9%, and IUD from 1.1% to 1.9%. In Russia, in 2015, pill use stood at 13.2% and IUDs at 14.3%.

While trends in the use of contraceptives can vary significantly between countries, a closer look at family planning policies, methods and routines provides additional insight into the marketplace conditions and expectations for the industry, thereby also informing future product development and marketing.

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