Women's Limited Choice and Availability of Modern Contraception at Retail Outlets and Public-Sector Facilities in Luanda, Angola, 2012–2015

Benjamin Nieto-Andrade; Eva Fidel; Rebecca Simmons; Dana Sievers; Anya Fedorova; Suzanne Bell; Karen Weidert; Ndola Prata

doi:10.9745/GHSP-D-16-00304

Figures & Tables

Tables

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TABLE 1.

Demographic and Behavioral Characteristics of Women of Reproductive Age in Luanda, Angola, 2012

Variables	Age Groups
Variables	15–19 (N=451)	20–24 (N=361)	≥25 (N=729)	All (N=1545)
*Sociodemographics*
Age, median	NA	NA	NA	24.0
Marital status
Single	98.2	81.7	39.4	66.5
Married/cohabiting	1.8	18.3	56.0	31.3
Divorced/widowed	0.0	0.0	4.1	2.2
Education
High school or less	55.3	28.8	45.3	44.4
More than high school	44.7	71.2	54.7	55.6
*Sexual Behavior and Fertility Preferences*
Ever had sex	55.0	90.9	91.4	80.6
Ever been pregnant	11.5	49.9	90.4	57.9
Intention to get pregnant at last pregnancy^a
Wanted it at that moment	17.3	27.8	57.7	49.3
Wanted it later	53.8	56.1	28.1	35.2
Did not want more children	28.8	16.1	14.3	15.5
Ideal number of children, mean^b	3.8	3.7	4.3	4.2
Knowledge of modern contraceptives
Condoms	96.7	95.6	93.7	95.0
Oral contraceptive pills	68.9	84.2	87.4	79.7
Injectable	47.2	65.7	84.1	68.9
Female condoms	34.2	42.1	54.7	45.6
IUD	19.1	36.3	54.2	39.6
Implants	18.2	35.7	52.7	38.6
Female sterilization	14.6	26.6	39.4	29.1
Emergency oral contraceptive pills	10.3	21.6	32.8	23.5
Male sterilization	5.3	12.5	22.2	15.0
*Contraceptive Use*^c
Current prevalence of any modern contraception	58.5	64.9	55.9	58.7
Current prevalence of:
Condoms	52.0	46.0	17.7	32.1
Injectables	2.0	6.1	18.8	12.1
Oral contraceptive pills	3.2	11.0	14.1	11.1
Implants	0.4	1.5	2.6	1.9
IUD	0.0	0.0	1.4	0.7
Female sterilization	0.8	0.0	0.8	0.6
Female condoms	0.0	0.3	0.6	0.4
Male sterilization	0.0	0.0	0.0	0.0
Ever used emergency contraceptive pills^d	1.1	6.4	5.8	4.5
Current contraceptive users not using their preferred method^e	15.1	20.7	16.0	17.3
Preferred contraceptive method among women not using their preferred method^f
Injectables	13.6	25.0	31.0	25.6
Condom	31.8	22.7	8.6	17.6
Implants	13.6	4.6	27.6	16.8
Oral contraceptive pills	4.6	13.6	12.1	12.0
Rhythm method	4.6	0.0	1.7	1.6
Female condom	4.6	0.0	0.0	0.8
Female sterilization	0.0	0.0	1.7	0.8
None	13.6	20.5	0.0	9.6
Other	13.6	13.6	17.2	15.2

Abbreviation: IUD, intrauterine device.
All data are reported as percentages unless otherwise noted.
↵a Among women ever pregnant (N=52 among 15–19-year-olds; N=180 among 20–24-year-olds; N=659 among ≥25-year-olds; and N=891 among the entire sample of women).
↵b Among women who have given birth (N=25 among 15–19-year-olds; N=128 among 20–24-year-olds; N=608 among ≥25-year-olds; and N=764 among the entire sample of women).
↵c Among women who have had sex (N=248 among 15–19-year-olds; N=328 among 20–24-year-olds; N=666 among ≥25-year-olds; and N=1245 among the entire sample of women).
↵d The survey did not explicitly include emergency contraceptive pills as an option for current method but included a question on ever use of emergency contraceptive pills.
↵e Among fecund women who have had sex and who are currently using contraception (N=146 among 15–19-year-olds; N=213 among 20–24-year-olds; N=363 among ≥25-year-olds; and N=722 among the entire sample of women).
↵f N=22 among 15–19-year-olds; N=44 among 20–24-year-olds; N=58 among ≥25-year-olds; and N=125 among the entire sample of women.

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TABLE 2.

Availability of Contraceptive Methods by Sector, Luanda, Angola, 2014–2015

Method	Private Sector			Public Sector			Total
Method	2014 (N=1782)	2015 (N=739)	Difference	2014 (N=51)	2015 (N=27)	Difference	2014 (N=1833)	2015 (N=766)	Difference
Any method^a	97.6	86.9	−10.7^***	84.3	59.3	−25.0^*	97.2	85.9	−11.3^***
Male condom	82.3	75.1	−7.3^***	49.0	33.3	−15.7	81.4	73.6	−7.8^***
Oral contraceptive pills^b	58.7	43.8	−14.9^***	54.1	29.6	−24.5^*	58.6	43.3	−15.3^***
Emergency contraceptive pills^b	43.3	35.8	−7.5^**	11.8	11.1	−0.7	42.4	34.4	−7.5^**
Injectables^b	13.1	6.6	−7.56.5^***	19.6	18.5	−1.1	13.3	7.3	−6.0^***

All data for 2014 and 2015 reported as percentages; the differences between 2014 and 2015 are percentage points.
↵*P<.05;
↵** P<.01;
↵*** P<.001.
↵a Any method includes at least one of the following: condoms, oral contraceptive pills, emergency contraceptive pills, injectable methods, hormonal patches, spermicides, intrauterine devices (IUDs), mini-mola or Essure (a non-surgical permanent method for women), and Vasalgel (a long-acting gel similar to no-scalpel vasectomy but likely more reversible). Less than 5% of the outlets overall reported having hormonal patches, female condoms, spermicides, IUDs, vaginal rings, or implants. Only 0.1% reported providing mini-mola or Essure or Vasalgel.
↵b Gas stations, hotels, and bars were not included in the calculation of oral contraceptive pills, emergency contraceptive pills, or injectable availability, since those outlets mainly distribute or sell condoms.

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TABLE 3.

Brand Market Share by Type of Contraceptive Among Outlets Selling the Respective Contraceptive Method, Luanda, Angola, 2015

Contraceptive Method and Brand	% Outlets Offering the Brand	Units Sold Last Month^a	% Units	Value (AKZ) Sold Last Month	% Value
Condoms (N=635 outlets)
Sensual	51.8	17,716	22.8	1,295,650	25.6
Legal	37.3	17,092	22.0	845,000	16.7
Davigra	15.6	12,103	15.6	535,530	10.6
Boss Man	11.8	3,153	4.1	176,240	3.5
Kamasutra	9.6	2,193	2.8	6,300	0.1
Control	6.0	4,711	6.1	611,994	12.1
Durex	3.3	8,576	11.0	948,365	18.7
Generic	1.3	7,527	9.7	293,150	5.8
Other brands (+40)	<5.0 each	4,557	5.9	358,795	7.1
Total for condoms	NA	77,628	100.0	5,071,024	100.0
Oral contraceptive pills (N=357 outlets)
Microgynon	76.6	2,885	66.0	1,058,303	40.6
Microlut	27.7	457	10.4	141,394	5.4
Yasmin	8.6	234	5.3	434,366	16.4
Diane 35	7.8	108	2.5	167,442	6.4
Other brands (+10)^b	<5.0 each	690	15.8	802,642	31.2
Total for oral contraceptive pills	NA	4,374	100.0	2,604,147	100.0
Emergency contraceptive pills (N=255 outlets)
Pilula S	45.4	1,064	38.4	656,100	22.7
Ella	24.3	595	21.5	554,200	19.1
IPL72	20.4	463	16.7	330,700	11.4
Norlevo	14.1	6	0.2	1,086,707	37.5
Other brands (7)^c	<5.0 each	643	23.2	266,518	9.3
Total for emergency contraceptive pills	NA	2,771	100.0	2,894,225	100.0
Injectables (N=54 outlets)
Depo-provera	83.3	260	97.7	21,700	94.1
Mesignya	1.9	n/a	n/a	n/a	n/a
Other brands	<1.0 each	6	2.3	1,360	5.9
Total for injectables	NA	266	100.0	23,060	100.0

Abbreviation: AKZ, Angolan Kwanzas.
↵a Units are individual condoms for condoms; cycles for oral contraceptive pills; packs for emergency contraceptive pills; and individual units for injectables.
↵b Other brands of oral contraceptive pills included Cezarette, Climen, Ella, Gynera, Marvelon, Minygesty, etc.
↵c Other brands of emergency contraceptive pills included CO-Pill, Plan Fam, Levo 72, etc.

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TABLE 4.

Mean Price (Angolan Kwanzas)^a for Main Brands of Contraceptives, Luanda, Angola, 2014–2015

Method and Brand [No. of outlets selling the method in 2014, 2015]	Mean Price per Unit^b (95% CI)		% Change
	2014	2015	% Change
Condoms
Sensual [N=697; N=359]	69.5 (44.3, 72.7)	73.4 (71.2, 75.6)	+5.6%
Legal [N=529; N=237]	36.1 (33.2, 39.0)	46.8 (42.8, 50.8)	+29.8%̂
Davigra [N=267; N=99]	59.5 (55.5, 63.5)	58.9 (45.0, 72.7)	−1.0%
Durex [N=57; N=21]	119.3 (90.8, 147.8)	200.9 (145.1, 256.8)	+68.4%
Boss Man [N=264; N=71]	54.1 (51.2, 57.0)	60.4 (55.7, 65.2)	+11.7%
Oral contraceptive pills
Microgynon [N=840; N=261]	238.8 (231.7, 245.9)	498.5 (448.3, 548.8)	+108.8%̂
Microlut [N=365; N=82]	278.8 (264.5, 293.2)	394.8 (346.0, 443.6)	+41.6%̂
Yasmin [N=51; N=43]	705.5 (651.8, 759.3)	2300.2 (2017.5, 2583.0)	+226.0%̂
Diane 35 [N=69; N=22]	1068.5 (952.9, 1184.0)	1830.7 (1200.3, 2461.1)	+71.3%̂
Emergency contraceptive pills
Pilula S [N=325; N=108]	453.4 (427.3, 479.5)	579.2 (536.0, 622.4)	+27.7%̂
Ella [N=225; N=63]	699.3 (657.5, 741.1)	959.0 (659.5, 1258.6)	+37.1%̂
IPL72 [N=113; N=46]	509.6 (456.0, 563.3)	700.5 (602.8, 798.2)	+37.5%̂
Norlevo [N=109; N=30]	2026.9 (1814.3, 2239.4)	2950.9 (2502.3, 3399.6)	+45.6%^
Injectables
Depo-provera [N=213; N=45]	351.0 (321.0, 281.1)	482.2 (323.0, 641.5)	+37.4%^

̂ Indicates significant changes based on 95% confidence intervals not overlapping between 2014 and 2015.
↵a Prices reflect mostly the private sector. According to the National Health Care System, the public sector must offer health services and medicines for free. The exchange rate as of October 30, 2014, was 99 Angolan Kwanzas for US$1.²⁶
↵b Units are individual condoms for condoms; cycles for oral contraceptive pills; packs for emergency contraceptive pills; and individual units for injectables.