AID's experience with contraceptive social marketing : a synthesis of project evaluation findings

CSM sales in 1984 provided nearly 5 million couple-years of protection (CYP's) in the 12 countries and, by optimistic estimate, averted some 890,000 births (or about 2% of live births). Four of the programs were quite successful, providing coverage to 7-15% of eligible couples. CSM's share of the contraceptive users' market ranged from 20-50% in the more successful countries, but was considerably lower elsewhere. The programs have been most effective in reaching urban/semiurban populations among the lower, though not the poorest, income groups; special outreach efforts can increase rural coverage, but at higher costs. Studies suggest that CSM is more cost-effective than clinic- or community-based contraceptive distribution methods, with net operating costs for mature programs ranging from $0-$4 per CYP. It may be unrealistic, however, to expect the programs to achieve both widespread contraceptive coverage and economic self-sufficiency, since only Colombia has succeeded in this. Several other countries have generated enough revenue to cover all operating (though not commodity) costs. A number of elements appear to influence CSM success. Key among these is the use of commercial-sector marketing channels, promotional techniques (e.g., mass media advertising, giveaways), market research techniques, and management models. Most CSM programs are operated within the private sector. Those managed totally within government structures tend to be the least successful, while management by semiautonomous agencies, which allows a host government to maintain oversight of CSM activities, has been very successful in Nepal, Bangladesh, and Egypt. Of external factors affecting CSM, the most crucial is host-government support - most CSM programs that have failed did so because of political and/or regulatory factors.