Availability and affordability of modern methods of contraception in pharmacies and primary health care facilities of five health networks in Armenia

Abstract

A vast majority of unintended pregnancies are due to contraceptive nonuse, inconsistent use and reliance on ineffective methods of contraception. Among barriers to contraceptive use worldwide are: lack of a method of choice; lack of knowledge about safety, effectiveness and availability of choices; and financial constraints. The use of modern contraceptives in Armenia is low and the primary method of birth control is withdrawal which has a high failure rate. The present study aims to examine the availability and affordability of modern methods of contraception in pharmacies, polyclinics, ambulatories and health posts of five health networks of Armenia. The study utilized a one-time descriptive cross sectional survey design. The instrument consisted of five subsections regarding modern methods of contraceptives. Five trained interviewers were involved in data collection process. The data were entered in the Access database and then exported and analyzed in STATA 7.0 statistical package. Institutional Review Board of the American University of Armenia approved the research. More than 150 healthcare facilities and pharmacies in five health networks participated in the study. The main findings were summarized as availability of at least three methods (method choice), availability of each method of contraception, affordability measured as percentage of yearly wage spent for each method of contraception and utilization reflected in sales/distribution of modern methods per month and available stock of modern contraceptives in pharmacies and primary health care facilities. Survey results have shown that the availability of method choice was quite low in all types of facilities. However, pharmacies provided better choice of modern contraceptives than other types of health facilities. None of the health posts had any method of modern contraception available. While the availability of the method choice was comparably higher in urban facilities, the population in rural areas had much lower access to modern methods of contraception. The availability of condoms and hormonal pills was the highest in all types of facilities. The analysis of yearly costs of modern methods of contraception revealed that intrauterine devices were the cheapest methods of contraception and spermicides were the most expensive ones. Comparison of yearly costs of each method of contraception with yearly wages revealed that most of the modern methods of contraception constituted more than one percent of the yearly wages in all five marzes, which suggested that the modern methods of contraception were not affordable for the population in selected five health networks. Further research and strategies should consider the issues of improved availability of modern methods of contraception in public rural facilities in a short term and all types of facilities in a long term.