Assessing the Potential Market for a Progesterone Contraceptive Vaginal Ring (PCVR) as a New Contraceptive Option in Sub-Saharan Africa Using Needs-Based Market Segmentation

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Globally, over 65 percent of women in their first postpartum year express unmet need for family planning (FP). Developing countries, especially in sub-Saharan Africa, have disproportionately high unmet contraceptive needs compared to other regions, and their young women and new mothers have especially high levels of unmet need for spacing pregnancies. To address some of sub-Saharan Africa’s barriers to effective contraception, there is renewed focus on new methods that offer greater ease of use. Common postpartum FP (PPFP) methods include progestin-only pills, injectable contraceptives, and intrauterine contraceptive devices (IUCDs). New methods under investigation would not require daily action, their use would be controlled by women themselves, and they would require no medical providers nor significant health system infrastructure for service delivery.

Contraceptive vaginal rings hold great potential by offering not only ease of use but a safe and effective FP solution as well. Population Council has developed a variety of vaginal rings for reproductive health (RH). The progesterone contraceptive vaginal ring or PCVR was designed by the Council and other scientists exclusively for lactating women’s PPFP. The PCVR is registered and sold under the brand name of Progering® in Central and Latin America. Taking advantage of sub-Saharan Africa’s prolonged breastfeeding practices, the PCVR is designed exclusively for breastfeeding women and works seamlessly with the Lactational Amenorrhea Method (LAM) to further enhance LAM’s pregnancy protection. In use in Latin America since 1998, the PCVR is now in clinical trials in India, and as part of its pre-introduction assessment in sub-Saharan Africa, Population Council, with funding from the Gates Foundation, is studying the potential market in Kenya, Nigeria, and Sénégal. The market segmentation analysis presented in this report will clarify the PPFP landscape in these three countries and aid PCVR’s effective introduction with an emphasis on increasing access to those under-served.

This exercise’s specific objectives are: 1) to estimate the proportion of PCVR consumers in each country (women aged 15 to 49) likely to use the method based on their fertility experiences and intentions, 2) to describe the segments of consumers through demographic and socio-economic characteristics, and 3) to forecast segment-specific PCVR use estimates by evaluating both current and future need for the product.

This report is based on secondary analysis of nationally representative Demographic and Health Survey (DHS) data for Kenya from 2008 to 2009, Nigeria in 2008, and Sénégal in 2005. The total number of women interviewed in their respective Surveys is 8,444 in Kenya, 33,385 in Nigeria, and 14,602 in Sénégal. Since need drives market behavior, a needs-based segmentation analysis was performed with the DHS data. Segmentation research is valuable for the PCVR because it permits definition of very specific needs-based market segments into which its entire consumer universe, both present and potential, can be discerned. The market segmentation analysis includes three steps and involves cross-tabulation.

The first step of analysis divided the sample of women of reproductive age (WRA) into those who are: 1) breastfeeding four or more times in a day; 2) would like to delay another child by one or more years; 3) have resumed sexual activity after childbirth but are not using any method of contraception; and 4) have resumed sexual activity and are using short-acting or barrier methods.

The second step described the segments identified in the first step with demographic and socio-economic characteristics including age, education, urban or rural residence, marital status, household wealth, children ever born, months since last birth, and participation in household decision-making.

The third step forecast PCVR use estimates for a potential user group by including non-breastfeeding women— women over 25 years old, with or without children—as well as the youngest women of reproductive age (15 to 25 years old) who will be first-time mothers in the near future. These women’s potential need for PCVR is determined by their future childbearing intentions and intent to use contraception (if not using currently). While they are not part of PCVR’s direct market, they can be considered future potential PCVR consumers. Four PCVR uptake scenarios are employed—a conservative five percent, moderate 10 percent, optimistic 15 percent, and ideal 20 percent—for simulating potential PCVR use.