TY - JOUR T1 - Where Women Access Contraception in 36 Low- and Middle-Income Countries and Why It Matters JF - Global Health: Science and Practice JO - GLOB HEALTH SCI PRACT DO - 10.9745/GHSP-D-21-00525 VL - 10 IS - 3 SP - e2100525 AU - Sarah E. K. Bradley AU - Tess Shiras Y1 - 2022/06/29 UR - http://www.ghspjournal.org/content/10/3/e2100525.abstract N2 - Key FindingsBoth the public and the private sectors are key sources of modern contraception, and the private sector has maintained a relatively stable share of the contraceptive market.Our analysis shows a clear pattern between source and modern contraceptive method. Although the private sector is primarily a source for short-acting resupply methods (e.g., condoms and contraceptive pills), our analysis demonstrates that some injectable, implant, and IUD users rely on private sources for these methods.The private sector is disproportionately used by unmarried women, adolescents, urban women, and wealthier women. However, the private sector also serves 1 in every 4 of the poorest contraceptive users and more than 1 of every 4 rural users, on average across countries.Key ImplicationsUnderstanding where women access modern contraception is an important first step for policy makers and program implementers to enhance contraceptive access and equity.Harnessing the potential of all market actors—government, nongovernmental, and private commercial—is key to accelerating progress toward countries' family planning goals to expand contraceptive access and choice and meet the reproductive needs and preferences of current and potential future contraceptive users.We examined where women access modern contraceptives, using recent Demographic and Health Survey data from 36 low- and middle-income countries and disaggregating results by contraceptive method, age, marital status, residence, socioeconomic status, and country income. We used bivariate and multivariate regression analysis to assess how demographic factors are associated with contraceptive source. In pooled analysis across countries analyzed, we found that 34% of users rely on private sources, 63% use public sources, and 3% use other sources. Among private sector users, 41% use pharmacies or drug shops, 11% general shops or markets, 36% private hospitals and clinics, and 12% nongovernmental or faith-based organizations. This analysis demonstrates the importance of the private sector for specific population segments including women in the wealthiest population quintile (odds ratio [OR]: 4.09, P<.001 compared with women in the poorest quintile), adolescents (OR: 2.03, P<.001 compared with women ages 40–49), never married women (OR 1.55, P<.001 compared with ever-married women), and urban women (OR: 1.42, P<.001 compared with rural women). The private sector does not only serve these populations, however. On average across countries analyzed, 22% of the poorest contraceptive users and 27% of rural users use private sources. Leveraging both sectors is key to meeting the reproductive needs of women across all sociodemographic groups in low- and middle-income countries. ER -