Population Services International (PSI) uses social marketing as a tool to deliver health impact among vulnerable and low-income populations. This approach encompasses the use of commercial marketing techniques to motivate the target audience to voluntarily adopt healthy behaviors and offers and promotes linkages between existing products and services to sustain their behavior. PSI measures accomplishments in terms of Couple Years of Protection (CYPs), a measurement unit widely used by bilateral agencies and governments. One CYP provided can be thought of as one year of protection against an unintended pregnancy. PSI socially markets contraceptives, including condoms, in order to positively impact the reproductive health of low income populations. Masti is a leading condom brand, which has been socially marketed by PSI since 1989. In recent years, the market share has stagnated at approximately 10%. This chapter discusses the evidence-based approach used by PSI to understand the reasons for stagnation in a growing market and the steps that PSI took to make Masti contemporary and relevant to today’s lower income consumers.
TopBackground
The World Health Organization (WHO), is a specialized Agency of the United Nations, and is concerned with international public health. WHO provides leadership on matters of public health, including reproductive health, a subset of which is family planning. WHO has been used as one of the sources, along with material sourced from The United Nations, The World Bank and The United Nations Population Fund (UNFPA), to set up the context of this case study.
The reproductive health context is the primary reason for PSI to socially market contraceptives. PSI provides affordable and accessible contraception options so that low income populations are able to space and limit the number of their children.
When family planning interventions are adopted and scaled up with an equity-driven approach, rapid progress is possible. Family planning assumes importance as it allows individuals and couples to anticipate and attain their desired number of children, and the spacing and timing of their births. It is achieved through the use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy.
Family planning saves lives. It reduces maternal and newborn mortality rates and improves the health and well-being of women and their existing children. UNFPA (2008) estimates have indicated that by preventing pregnancies and unsafe abortions, and by providing reliable access to quality family planning services and information, maternal deaths can reduce by one third, which equates to saving the lives of 100,000 to 175,000 women each year.
Family planning programmes create conditions that enable women to enter the labor force and families to devote more resources to each child, thereby improving family nutrition, education levels and living standards. Slower population growth cuts the cost of social services as fewer women die in childbirth; and demand eases for water, food, education, health care, housing, transportation and jobs. Improved reproductive health in a country strengthens the position of women and contributes to economic growth.
Meeting the need for family planning is one of the most cost-effective investments to alleviate poverty and improve health. Ensuring reproductive health commodities are available to all who need them, is essential to the provision of reproductive health services and family planning. For every woman who dies in childbirth, at least 20 more suffer injuries, infections or disabilities. The vast majority of these deaths occur in sub-Saharan Africa and southern Asia. However, universal access to family planning it is not yet a reality – particularly not among the poorest. UNFPA (2008) reported that worldwide, 200 million women would like to delay or prevent pregnancy, but are not using effective contraception. The demand for contraceptives worldwide is expected to grow by 40 per cent in the next 15 years.
UNFPA (2010) reports that the proportion of women in Southern Asia, aged between 15-49 years and in a union, using any method of contraception, has increased from 39 in 1990 to 48 in 2000 to 56 in 2010.
In India, as per the NFHS-3 (2006), 49% of married women in India use modern family planning methods, consisting of condoms, oral contraceptive pills, long-term methods, injectable contraceptives, emergency contraception and sterilization. 37% of all married women opt for sterilization after they have completed their family size and among the remaining methods of modern contraception, condoms have the highest share.
As per NFHS-3 (2006), condom usage for family planning has more than doubled across the last three periods of the NFHS surveys; from 2.4% in 1992-93 to 3.1% in 1998-99 to 5.2% in 2005-06.
The total condom market consists of three distinct segments, free condoms supplied by the government at the bottom of the pyramid, followed by subsidized socially marketed brands in the middle and commercially marketed brands at the top of the pyramid.