Background

It has become almost axiomatic that family planning programmes should be coordinated and, to the extent possible, integrated with each other. I believe this is a mistake.

The use of contraceptives in the developing world has accelerated astonishingly in the past 30 years and, while government programmes remain very important, contraceptives and contraceptive services are increasingly supplied through a large variety of independently managed, generally uncoordinated activities. Attempts to coordinate these efforts, however well intentioned, tend to weaken them.

Developing countries

In most developing countries, particularly the poorest ones, couples get their contraceptives primarily from private sources. In Indonesia in 2007, for example, only 22% of modern method users relied on the public sector.1 The other 78%, over 20 million couples, got their family planning from midwives, pharmacies and non-pharmacy stores, including a social marketing programme that today serves 5 million couples. In Bangladesh, a slight majority, 57%, relied on public sources including government field workers in 2004, but the rest counted on pharmacies, shops and private clinics. In Cambodia (2005), modern method users relied on uncoordinated private sources 60% of the time. These included clinics, doctors, shops and community distributors. In the Dominican Republic (2002), more than half of the couples seeking birth control relied on the private sector. And in the Democratic Republic of Congo (2007), where usage is admittedly …