Revisiting a Total Market Approach to Contraceptive Security in Honduras

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Background: Although several Total Market Approach (TMA) initiatives to family planning products have been implemented, little research has been conducted to evaluate the outcomes of these interventions. The current article aims to help fill this gap in the literature by examining the effects of a TMA activity implemented in Honduras from 2009 to 2010 called “TMI Honduras” which was led by Abt Associates with assistance from John Snow, Inc.

Methods: Outcomes of the TMA activity were measured quantitatively by comparing family planning data from the 2005-2006 and 2011-2012 Demographic and Health Survey (DHS). Qualitative data on market segmentation strategy and implementation of project recommendations was gathered through stakeholder interviews in August 2013 and April 2014 from members of the Honduran Contraceptive Security Committee.

Results: DHS data suggested a decline in unmet need from 16.8 percent to 10.7 percent and an increase in contraceptive prevalence from 65.2 percent to 73.2 percent between 2005-2006 and 2011-2012; improvements were most notable among the poorest wealth quintiles and in rural areas. Stakeholder interviews suggested moderate initial success in engaging new stakeholders, segmenting the market, and implementing recommendations from the TMA activity. While the Contraceptive Security Committee had a strong and active presence for the first two years following the TMA, political turbulence and organizational changes disrupted progress and thereafter, the group stopped meeting.

Conclusions: The Honduran case demonstrates that a small TMA activity can be successful in bringing together the public, private nonprofit, and private commercial sectors to address unmet need and improve contraceptive prevalence rate. Unfortunately, political realities can derail TMA efforts. The results suggest that even in low-resource settings, the market for contraceptives can be enlarged with government buy-in and initiative. However, the extent to which TMI Honduras influenced improvements in the Honduran contraceptives market is difficult to determine.