(90) Disparities in Access to Contraceptives and Abortion Medications Between High Income and Low- and Middle-Income Countries (LMICs) Before and During The COVID-19 Pandemic, 2015-2020

Publication Number: 764

Background: Despite the important role of retail pharmacies in promoting access to contraceptives and abortion products in the community, there is limited information on the availability of contraceptives and abortion products by product type at retail pharmacies in high income and LMICs at the country-level.

Objectives: We examine the availability of contraceptives and abortion medications in retail pharmacies for high-income countries (HICs) and LMICs at the country-level before and during the COVID-19 pandemic.

Methods: We conducted a cross-sectional study using quarterly pharmacy retail sales data collected from IQVIA™ MIDAS® in 70 countries from January 2015 through September 2020. For each quarter, we report utilization of contraceptives and abortion medications as defined daily doses (DDD) per 1,000 women and girls of reproductive age (15-49 years) per day.

Results: From 2015 to 2020, global contraceptive use declined 5.8% (76.3 DDD to 71.9 DDD). Contraceptive use in HICs was more than eight times greater than in LMICs t(188.8 DDD vs 21.4 DDD). Oral contraceptives and long acting reversible contraceptives (LARCs) were substantially higher in HICs compared to LMICs (130.9 DDD vs. 17.2 DDD; and 47.1 DDD vs. 0.7 DDD, respectively). Utilization of LARCs, however, increased significantly in LMICs (214%, from 0.2 DDD to 0.7 DDD; p< 0.01), and emergency contraceptive use remained higher in LMICs compared to HICs. LMICs experienced low contraceptive use across categories over time. India had the lowest contraceptive use over time (6.5 DDD to 7.3 DDD), and West Africa experienced the greatest increase in overall contraceptive use, driven by injectables (352%, 7.7 DDD to 34.9 DDD). Compared to the previous year’s quarter, during the first quarter of COVID-19 (Apr-Jun), global contraceptive use declined in all categories except injectables. Abortion products were more common in LMICs compared to HICs; use declined substantially over time in HICs but increased significantly in LMICs (-47.6%, from 2.3 DDD to 1.2 DDD; p< 0.01; and 83.0%, from 3.9 DDD to 7.2 DDD; p< 0.01, respectively). By 2020, Pakistan had the highest abortion medication use followed by Bangladesh (67.0 DDD and 6.4 DDD, respectively).

Conclusions: Despite minimal declines in contraceptive utilization and a shift toward LARCs globally, there are persistent disparities between LMICs and HICs. Utilization of abortion medications, however, is persistently higher in LMICs than HICs. Disparities between high income and LMICs in contraceptive may contribute to worsening disparities in reproductive health. Our findings also suggest that LMICs are more likely to rely on abortion medications from retail pharmacies than HICs which may be related to limited access to contraceptives from the public sector.