Family Planning in the Context of Latin America's Universal Health Coverage Agenda

TLDR

Family planning access in Latin America and the Caribbean has markedly improved over the past five decades, coinciding with widespread adoption of universal health coverage declarations and the rollout of UHC‑oriented financing schemes, though low‑income countries still face stock‑outs and implicit rationing. This study examined how UHC‑oriented financing schemes affect family planning program sustainability and growth across nine LAC countries, proposing targeted steps to expand coverage for poor and marginalized groups. Using 37 indicators on coverage, financing, and inclusion in UHC schemes, the authors performed a desk review of secondary data and in‑country expert interviews to assess contraceptive method status. While modern contraceptive prevalence has risen overall, significant disparities persist—indigenous, uninsured, and poorest women experience 20%, 5%, and 7% lower rates, respectively, and in the poorest quintile insured women have a 16.5‑percentage‑point higher prevalence—highlighting that high‑income countries provide all methods through social insurance, whereas low‑income countries face free provision but stock‑outs and implicit rationing.

Abstract

Countries in Latin America and the Caribbean (LAC) have substantially improved access to family planning over the past 50 years. Many have also recently adopted explicit declarations of universal rights to health and universal health coverage (UHC) and have begun implementing UHC-oriented health financing schemes. These schemes will have important implications for the sustainability and further growth of family planning programs throughout the region.We examined the status of contraceptive methods in major health delivery and financing schemes in 9 LAC countries. Using a set of 37 indicators on family planning coverage, family planning financing, health financing, and family planning inclusion in UHC-oriented schemes, we conducted a desk review of secondary sources, including population surveys, health financing assessments, insurance enrollment reports, and unit cost estimates, and interviewed in-country experts.Findings: Although the modern contraceptive prevalence rate (mCPR) has continued to increase in the majority of LAC countries, substantial disparities in access for marginalized groups remain. On average, mCPR is 20% lower among indigenous women than the general population, 5% lower among uninsured women than insured, and 7% lower among the poorest women than the wealthiest. Among the poorest quintile of women, insured women had an mCPR 16.5 percentage points higher than that of uninsured women, suggesting that expansion of insurance coverage is associated with increased family planning access and use. In the high- and upper-middle-income countries we reviewed, all modern contraceptive methods are typically available through the social health insurance schemes that cover a majority of the population. However, in low- and lower-middle-income countries, despite free provision of most family planning services in public health facilities, stock-outs and implicit rationing present substantial barriers that prevent clients from accessing their preferred method or force them to pay out of pocket.Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Leveraging UHC-oriented schemes to sustain and further increase family planning progress will require that governments take deliberate steps to (1) target poor and informal sector populations, (2) include family planning in benefits packages, (3) ensure sufficient financing for family planning, and (4) reduce nonfinancial barriers to access. Through these steps, countries can increase financial protection for family planning and better ensure the right to health of poor and marginalized populations.