_15_ _Private sector coverage of the family planning market_ had gone for their most recent supply. Fifteen percent<sup>of pill users reported receiving their first</sup> cycle from a private physician, but only 2 percent depended on<sup>private physicians for their most</sup> recent supply (some of these may have been women who had<sup>not yet sought resupply). Furthermore,</sup> many users of oral contraceptives and barrier methods<sup>never receive a medical prescription. Again</sup> from Mexico, 46 percent of pill users purchased their<sup>first cycle at a pharmacy; the number who</sup> relied on pharmacies for their most recent supply increased<sup>to 63 percent, capturing most of the users</sup> who had begun with physicians.

Pharmaceutical firms rely on detailers to market to physicians<sup>and pharmacists. Detailer</sup> promotion includes not only the detailer's direct expenses<sup>but the production of promotional material</sup> and often free samples of the company's product<sup>line. The cost of detailing and sampling was</sup> reported to account for 50 percent of the retail price<sup>of oral contraceptives in Colombia, Iran, and</sup> the Philippines in 1971 (Arthur D. Little 1972,<sup>cited in Lewis and Kenney 1988).</sup> One pharmaceutical company, Schering Ag, has a corporate<sup>policy of not promoting brands for more than</sup> three years following product launch, on the grounds<sup>that after this time the product will either have</sup> achieved market viability or is not worth the effort.

Retail sales are influenced by desire to control fertility,<sup>reliability of supply, purchasing</sup> power of potential users, and competing prices from the<sup>subsidized government and/or NGO sector.</sup> The primary financing source for retail sales is the consumer,<sup>as most insurance and medical plans</sup> do not include medications for outpatients. At this<sup>level of financing, issues of price and price</sup> elasticity of demand are critical.

In an analysis of commercial sales statistics for oral<sup>contraceptives in the Dominican</sup> Republic in 1982-87, Stover (1987) reported a price elasticity<sup>of -1.5 percent. For every I percent</sup> of price difference between competing brands, the<sup>lower-priced brand increased unit sales by 1.5</sup> percent. The impact of price changes is probably<sup>even more pronounced at the extremes of the</sup> distribution, when, for example, free commodities are<sup>introduced or prices are abruptly increased.</sup> Donated commodities have had destabilizing effects<sup>on commercial markets. The</sup> introduction of free government services in Kenya and<sup>Nigeria was associated with drastic reductions</sup> in the private market; one firm in Nigeria closed down its<sup>subsidiary altogether (Lewis and Kenney</sup> 1988). Four years after the initiation of a community-based<sup>distribution (CBD) program in Piauf</sup> State, Brazil, pill prevalence had not increased; the<sup>net effect was to replace the commercial sector</sup> share with free, donated supplies. Finally, a recently completed<sup>retail audit in Guatemala found that</sup> donated commodities "leaked" from the Ministry of Health<sup>and from neighboring countries accounted</sup> for 14 percent of the commercial market in condoms<sup>(The Futures Group 1991).</sup> Price elasticity studies seldom employ abrupt<sup>price increases for fear of disrupting the</sup> market. As part of its economic austerity program,<sup>the government of Peru decontrolled prices in</sup> August 1990. Overnight, the pharmacy price of the<sup>most popular oral contraceptive, Microgynon,</sup> tripled, from US$.50 to US$1.50. Three months<sup>earlier, Microgyion had been introduced into two</sup> CBD programs on a trial basis at prevailing pharmacy<sup>prices. Prior to the pri e increase, distributors</sup> were selling almost as much Microgynon to new clients<sup>as the donated CBD brand, Lo-Femenol,</sup> which sold for US$. 10. After the price increase, Microgynon<sup>sales dropped nearly to zero and had</sup> not recovered 6 months later.

How clinical contraceptive methods are<sup>marketed depends on the availability of</sup> infrastructure, including trained providers and clinical<sup>facilities. Physicians tend to be the primary</sup> commercial providers of IUDs and sterilization;<sup>although many countries permit trained midwives</sup> to insert IUDs, few of them are in private practice.