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\title{Family Planning Commodities Requirement in Achieving Replacement-Level Fertility in Ethiopia}
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             \author[1]{Abebaw Andarge  Gedefaw}

             \affil[1]{  DEBRE MARKOS UNIVERSITY}

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\date{\small \em Received: 14 December 2016 Accepted: 4 January 2017 Published: 15 January 2017}

\maketitle


\begin{abstract}
        


Ensuring the availability of modern contraceptive methods both by type and quantity is crucial in the provision of quality primary health care and designing appropriate intervention strategies toward reducing maternal and child mortality. This endeavor therefore, is designed to make family planning commodities requirement projection based on various assumptions with the target of achieving replacement level fertility by 2020 and also estimate costs of family planning commodities. Baseline data were obtained from 2007 census reports, 2011 EDHS and model data for Ethiopian context. The SPECTRUM by using FamPlan model was used to project these outcomes, with analysis restricted to the time period 2011?2020. Spectrum and MS Excel were used to analyze and producing report for this study. The projection result of the study showed that the 2011 CPR of 29% will therefore need to increase to 71% to attain the replacement-level fertility of 2 by 2020. In order to reduce fertility rate, users of contraceptives should also increase accordingly.

\end{abstract}


\keywords{family planning, commodities, replacement-level fertility, ethiopia.}

\begin{textblock*}{18cm}(1cm,1cm) % {block width} (coords) 
\textcolor{GJBlue}{\LARGE Global Journals \LaTeX\ JournalKaleidoscope\texttrademark}
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\textcolor{GJBlue}{\footnotesize \\ Artificial Intelligence formulated this projection for compatibility purposes from the original article published at Global Journals. However, this technology is currently in beta. \emph{Therefore, kindly ignore odd layouts, missed formulae, text, tables, or figures.}}
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\let\tabcellsep& 	 	 		 
\section[{Introduction}]{Introduction}\par
nsuring the availability of modern contraceptive methods both by type and quantity is crucial in the provision of quality primary health care and designing appropriate intervention strategies toward reducing maternal and child mortality (Beta consulting and development firm and UNFPA, 2010).\par
The opportunity of deciding freely the number, spacing and timing of children is a basic human right with proven positive health effects, particularly for women and children, demographic and overall socioeconomic benefits. Meeting unmet need for contraception prevents estimated 30\% of maternal deaths, 20\% child mortality and 36 million years of healthy life lost each year globally \hyperref[b2]{(Kennedy et al., 2013)}. Moreover, reducing unmet need for contraception prevents other adverse consequences. It is evident that access to family planning commodities contributes to universal education, women's empowerment, HIV prevention, poverty reduction and environmental sustainability; thus, it is one of the most cost-effective health and development interventions. To date, there has been little evidence exists regarding family planning commodities requirement including their potential cost  {\ref (Stover et al., 2010)}.\par
Effective and efficient reproductive health programs depend on a reliable supply of essential commodities. However, lack of evidence has contributed to inadequate prioritization and funding for family planning methods and slow progress towards universal access to reproductive health interventions \hyperref[b2]{(Kennedy et al., 2013)}, particularly family planning services. Evidence-based understanding of family planning commodities requirement assists in planning services prioritization and funding.\par
In Ethiopia, a 50\% funding gap was pointed as a predicament against the government's ambition of ensuring commodity security \hyperref[b4]{(London summit, 2012)}. Hence, projections for family planning requirements can help set realistic goals, plan for the service expansion required to meet program objectives and evaluate alternative methods of achieving goals  {\ref (Stover et al., 2010)}. This endeavor therefore, is designed to make family planning commodities projection based on various assumptions with the target of achieving replacement-level fertility by 2020. 
\section[{II.}]{II.} 
\section[{Materials and Methods}]{Materials and Methods}\par
Ideally, quantification for projection is an activity that includes constant monitoring of inventory levels, product consumption rates and other informationincluding programmatic and environmental factorsthat may affect future demand. If the logistics management information system (LMIS) is designed well and kept up-to-date, the staff responsible for quantification and procurement will have with them all the consumption and stock level information they need. While consumption data is considered as the gold standard for contraceptive projection, such data are not always accurate, reliable or readily available ((NIPORT, 2010).\par
Baseline data were obtained from 2007 census reports, 2011 Ethiopian Demographic and Health Survey, previous projection using the FamPlan model \hyperref[b8]{(Zelalem B and Gizachew A, 2014)} and model data for Ethiopia context.\par
Primary outcomes of the projection included contraceptive prevalence rate, number of users and acceptors per methods, commodity requirement and associated costs. The SPECTRUM was used to project these outcomes, with analysis restricted to the time period 2011-2020. Spectrum and MS Excel were used to analyze and producing report for this study. 
\section[{III.}]{III.} 
\section[{Results and Discussion}]{Results and Discussion}\par
The total fertility rate for Ethiopian women was 4.8 in 2011 (EDHS, 2011). The total TFR is projected to attain replacement-level fertility, i.e., two children per women in 2020 (Figure \hyperref[fig_0]{1}). The turn down of fertility is accompanied by an increase in the use of family planning methods which is manifested by the contraceptive prevalence rate (CPR). While other factors like increase at the age of marriage, postpartum insusceptibility and sterility can affect fertility, it is unlikely that further reductions in fertility can be achieved unless there are also supplementary progress in Contraceptive use. Accordingly, the 2011 CPR of 29\% will therefore need to increase to 71\% to attain the replacement-level fertility in 2020. Figure 2 shows the projection of CPR that would be necessary to achieve a TFR of 2 by 2020.   
\section[{b) Users of family planning commodities}]{b) Users of family planning commodities}\par
The number of women of reproductive age who seek services will affect future service delivery requirements for family planning commodities. In order to reduce fertility rate, users of contraceptives should also increase accordingly. Based on this projection, about 11.5 million women of reproductive age group are expected to use family planning methods in 2020 (Figure 3).  
\section[{c) Acceptors of family planning}]{c) Acceptors of family planning}\par
Expanding access to long-acting and permanent methods (LAPCMs) is a key to increasing women's contraceptive choice and addressing the high unmet need, and will contribute towards achievement of the FP2020 goals \hyperref[b6]{(Ngo TD, et al., 2013)}.\par
Therefore, the number of reproductive age women accepting long-acting and permanent family planning methods is estimated by this projection; accordingly, about 3 million more women accept family planning methods in 2020 (Figure 4).  
\section[{d) Family planning methods requirement}]{d) Family planning methods requirement}\par
To meet the growing needs of essential family planning service programs, contraceptives input is a must. This section presents the results of estimated future commodity requirements on the basis of the method-mix assumptions. Commodity requirements per user for condoms, pills, injectables, IUDs, implants, female sterilization are based on EDHS (2011) consumption per couple year of protection (CYP) assumptions.\par
Table  {\ref 1} shows percentage distribution of users by method maintaining the base scenario of percentage distribution. The projection depicts the shift of methods from short-acting to long-acting family planning commodities (Table  {\ref 1}  
\section[{e) Gross cost}]{e) Gross cost}\par
Projection of the costs of family planning requires estimates of the costs of providing services to users including commodities costs. The model used for these projections employs a "cost per user" parameter from GAP analysis.\par
Accordingly, to reach the current objective of achieving replacement level fertility by 2020, the financial requirement for contraceptive commodities for Ethiopia is also estimated to increase from the current requirement. Consequently, there will be an increasing demand for contraceptives and an increasing requirement for government and donor funds for contraceptive procurement needs an additional ETB 42.7 billion from 2011 (Figure 5).  
\section[{IV. Conclusions and Recommendations}]{IV. Conclusions and Recommendations}\par
More family planning commodities are required to increase the current contraceptive prevalence rate of 29\% (EDHS, 2011) to 71\% in turn to achieving a replacement level-fertility by 2020. Hence, all stakeholders should do towards increasing access of family planning commodities in terms of both method mix and quality.     
\section[{V.}]{V.} 
\section[{Projection parameters}]{Projection parameters}\begin{figure}[htbp]
\noindent\textbf{1}\includegraphics[]{image-2.png}
\caption{\label{fig_0}Figure 1 :}\end{figure}
       \begin{figure}[htbp]
\noindent\textbf{} \par 
\begin{longtable}{P{0.07890295358649789\textwidth}P{0.24029535864978901\textwidth}P{0.09504219409282699\textwidth}P{0.16139240506329114\textwidth}P{0.08069620253164557\textwidth}P{0.07352320675105485\textwidth}P{0.12014767932489451\textwidth}}
\tabcellsep \multicolumn{6}{l}{Table1: Distribution of family planning methods requirement by type, 2011-2020.}\\
\tabcellsep \tabcellsep \tabcellsep \multicolumn{2}{l}{Distribution of methods by type}\tabcellsep \tabcellsep \\
Year\tabcellsep Condoms\tabcellsep Pills\tabcellsep Injectables\tabcellsep Implants\tabcellsep IUD\tabcellsep Female sterilization\\
2011\tabcellsep 13.79\tabcellsep 36.2\tabcellsep 47.2\tabcellsep 1.5\tabcellsep 0.6\tabcellsep 0.06\\
2012\tabcellsep 14.2\tabcellsep 35.7\tabcellsep 47.4\tabcellsep 1.8\tabcellsep 0.79\tabcellsep 0.06\\
2013\tabcellsep 13.05\tabcellsep 35.15\tabcellsep 46.98\tabcellsep 2.1\tabcellsep 1.0\tabcellsep 0.05\\
2014\tabcellsep 15.25\tabcellsep 34.52\tabcellsep 46.47\tabcellsep 2.45\tabcellsep 1.24\tabcellsep 0.048\\
2015\tabcellsep 15.90\tabcellsep 33.78\tabcellsep 45.88\tabcellsep 2.86\tabcellsep 1.50\tabcellsep 0.044\\
2016\tabcellsep 16.67\tabcellsep 32.93\tabcellsep 45.20\tabcellsep 3.33\tabcellsep 1.81\tabcellsep 0.041\\
2017\tabcellsep 17.58\tabcellsep 31.91\tabcellsep 44.39\tabcellsep 3.89\tabcellsep 2.17\tabcellsep 0.038\\
2018\tabcellsep 18.68\tabcellsep 30.68\tabcellsep 43.41\tabcellsep 4.56\tabcellsep 2.60\tabcellsep 0.036\\
2019\tabcellsep 20.0\tabcellsep 29.09\tabcellsep 42.10\tabcellsep 5.63\tabcellsep 3.11\tabcellsep 0.033\\
2020\tabcellsep 21.46\tabcellsep 26.83\tabcellsep 40.07\tabcellsep 7.60\tabcellsep 3.98\tabcellsep 0.034\end{longtable} \par
 
\caption{\label{tab_0}}\end{figure}
 		 		\backmatter   			 
\subsection[{Acknowledgements}]{Acknowledgements}\par
This research work was sponsored by Ethiopian Public Health Association. The author thus, would like to express their heartfelt gratitude to the association for the financial support. 			  			 			 			  				\begin{bibitemlist}{1}
\bibitem[Stover et al.]{b7}\label{b7} 	 		\textit{},  		 			J Stover 		,  		 			L Heaton 		,  		 			J Famplan Ross 		,  		 			User's Guide 		.  		 \url{http://www.healthpolicyinitiative.com/Publications/Documents/1256\textunderscore 1\textunderscore FampmanE.pdf}  	 	 		\textit{USAID POLICY Project. Available at}  		 	 
\bibitem[ Total]{b10}\label{b10} 	 		\textit{},  	 	 		\textit{Total}  		42  (3) .  	 
\bibitem[Almost all references mentioned under 'References' and 'Methods' sections above including census (2007) and EDHS (2011) were consulted during projection]{b9}\label{b9} 	 		\textit{Almost all references mentioned under 'References' and 'Methods' sections above including census (2007) and EDHS (2011) were consulted during projection},  		 	 
\bibitem[Zelalem and Gizachew ()]{b8}\label{b8} 	 		\textit{Annex Demographic Data for DemProj: Demographic data-FamPlan Commodity Requirement from},  		 			B Zelalem 		,  		 			A Gizachew 		.  		2014. 2011-2020. Ethiopia; Note.  		 			Department of Reproductive Health, University of Gondar 		 	 	 (Fertility and Family Planning Implications of Ethiopia`s FP2020 Target) 
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