Abstract
Contraceptive use in Nicaragua has dramatically increased over the last 20 years, from 49 percent of currently married women in 1992/93 to 72 percent in 2006/07 (see Figure 1). In spite of this, many inequalities and disparities still exist among certain population groups. This underscores the need for public family planning (FP) resources to be used equitably in favor of poorer women, and for those with greater resources to obtain FP services and contraceptives from the non-state sector.
Non-state providers of FP programs are nongovernmental organizations (NGOs), pharmacies, self financing providers, and services financed by insurance. Together these service providers comprise the total market. Under a total market approach, the government coordinates and supports public and private providers to leverage their comparative advantages to enhance equity and access of FP services.
The Ministry of Health in Nicaragua (MINSA), in coordination with a contraceptive security committee (Disponibilidad Asegurado de Insumos Anticonceptivos, or DAIA Committee), has already identified the need to strategically focus public resources on more vulnerable consumers and promote participation of Nicaraguan Social Security Institute (INSS) and NGOs to provide FP services to those populations with insurance coverage and/or a greater purchasing power.
