When Donor Support Ends: The Fate of Social Marketing Products and the Markets They Help Create

Executive Summary

Objectives: To assess the performance of social marketing interventions under the manufacturer's model, a model that has the potential to achieve sustainability (defined as continuing contraceptive availability after the withdrawal of donor support), in four middle-income countries.

Methods: Fifteen rounds of data from nationally representative surveys implemented in Morocco, the Dominican Republic, Peru, and Turkey between 1986 and 2003 are analyzed to determine changes in the commercial sector's share of oral contraceptives and condoms before and after the withdrawal of donor support. Attention is paid to changes in lower- and middle-income groups. Wealth quintiles are used as a proxy for economic status. Retail sales data on oral contraceptives (OCs) from 1994 to 2004 were available in Morocco and the Dominican Republic and are examined to determine sales volumes and prices of social marketing and other commercial brands.

Results: In Morocco, the commercial sector's market share of OCs was increasing rapidly prior to the initiation of social marketing activities (which included advertising and promoting a lower priced commercial OC brand) but the increase was concentrated among upper income women. Following the introduction of social marketing, commercial sector share started increasing among lower- and middle-income women. The commercial sector share of OCs among lower- and middle-income women continued to increase after partial withdrawal of donor support. Retail sales of both social marketing and commercial brands increased during the period that social marketing activities were implemented, as well as after donor support was partially withdrawn.

In the Dominican Republic, social marketing influenced public sector OC users to switch to commercial-sector sources. Retail sales of the social marketing brand fluctuated for a decade after graduation before they declined. The United Nations Population Fund's provision of donated contraceptives to the public sector may have influenced these fluctuations. Sales of other commercial brands were steadier and increased slowly after donor support was withdrawn. The commercial-sector share of OCs increased among lower- and middle-income women during the period that social marketing activities were conducted, but fluctuated following withdrawal of donor support.

In Peru, prior to the implementation of social marketing, the commercial-sector share of condoms increased dramatically; the growth was greater among higher-income women. During the period that advertising and promotion activities were conducted, the same trend continued. After the withdrawal of donor support, the commercial-sector share of condoms declined in all wealth quintiles. A change in government policy mandating the provision of free family planning may have had an impact on the commercial sector share.

In Turkey, data are only available for the period following withdrawal of donor support. By the time donor support was withdrawn, the commercial-market share of condoms among lower- and middle-income women was substantial. Following graduation, there was a slight decline in this proportion, although more than half of lower- and middle-income women continued to obtain condoms from the commercial sector.

Conclusions: Contraceptive social marketing interventions implemented under the manufacturer's model can contribute to a higher commercial-sector share of a method among lower- and middle-income women. Furthermore, this share may remain after donor support is withdrawn. The ability of social marketing to effect such a change, however, is predicated on several conditions, including the absence of competition from other sources (such as the public sector); a substantial level of acceptance and use of the method, commercial-sector involvement in contraceptive provision prior to the introduction of social marketing; and commercial partners' commitment to continue funding promotional activities after donor support is withdrawn.