As population and contraceptive use rise in developing countries, demand for reproductive health services and supplies is expected to skyrocket over the coming years.

The concept of universal reproductive health care by 2015, the goal of 179 nations at the 1994 International Conference on Population and Development, requires education and information, especially for women, and the power of individuals to make choices about their own reproductive futures. But reliable, affordable contraceptives and other reproductive health essentials must first be available in order for such choices to have meaning.

Demand for reproductive health essentials is growing:

Contraceptive prevalence in developing countries has increased from around 10 percent in the 1960s to almost 60 percent today--525 million people--with 9 out of 10 users relying on modern methods. But an estimated 350 million couples still do not have access to those modern methods.

The number of users is expected to increase more than 40 percent by 2015, to some 742 million, both from population growth and prevalence of use.

• Global population is now 6.1 billion, with 80 percent of people living in developing countries. The median estimate for 2050 is 9 billion, with 95 percent of the growth in developing countries.

• More than 1 billion young people are between 15 and 24--prime reproductive years--and another 1 billion youngsters are right behind them. Their need for sexual and reproductive health information and services is urgent.

• The average number of live births per woman in the most developed countries is 1.6, compared to 3 in developing countries and 5 in the least developed ones. Among girls ages 15 to 19, the difference is fourfold: 31 births per thousand women in developed countries, 128 per thousand in least-developed countries.

• Some 40 million people were living with HIV/AIDS at the end of 2001, 90 percent of them in developing countries. More than half of new infections are among people ages 15-24.

Brazil, China and India are self-sufficient in contraceptives, but other developing countries must import them, paying with scarce foreign exchange that is also needed for food, medicine and other necessities.

• The most severe contraceptive shortages are in sub-Saharan Africa and Eastern European countries.

• Some 514,000 women die every year from pregnancy-related causes--one per minute--including more than 75,000 from unsafe abortions. Access to reproductive health essentials could save the lives of a quarter of these women.

Donor assistance must increase:

• Most developing countries are trying to increase capacity to meet their own needs in every field, but many will rely on contraceptive essentials supplied by donors for the foreseeable future.

• While demand is rising, donor support for contraceptives is actually declining. It reached its lowest level in five years in 1999. In 2000, US$154 million was contributed, some $80 million below the need.

• Contraceptive cost estimates do not include costs of distribution or ensuring that the product reaches those who need it or that they use it correctly.

• Investment in other facets of reproductive health programmes will be ineffective if commodities are not available to those who want them.

Others must take action:

Governments can improve logistics, systems and infrastructures; offer preferential duty and tax conditions for private-sector commodity marketing; eliminate corruption that diverts supplies; ease manufacturing, sale and import regulations; and support market research and tracking.

• In Zimbabwe, the tariff on imported condoms was reduced from 10 percent to 5 percent. In Senegal, taxes were eliminated on condoms. In Morocco, taxes on drugs were reduced from 57 percent to 10 percent.

• In Bolivia, a government programme broadened the distribution of condoms from pharmacies alone to supermarkets, bars, small shops, discos, universities, liquor stores and brothels.

• A Zimbabwe study found that while pharmacists had the legal right to initiate women on contraceptive pills, few sold them without a doctor's prescription. A government programme now trains them in counseling, and family planning to encourage broader access.

The private sector--pharmaceutical companies, for example--can increase advertising and promotion while keeping commodity prices affordable to as many people as possible.

• A media campaign, mass mailing and telephone hotline promoted the 1998 introduction into Turkey of two injectable contraceptives. Calls to the hotline rose from 558 per month before the effort to 5,000 during the campaign, and sales were double the number expected.