In Colombia, most contraception is bought out of pocket, not through insurance

Contraceptive coverage is usually reported as a single national percentage, which tells you almost nothing about how people actually obtain it. An analysis of Colombia's national pharmaceutical databases, published in Contraception, takes the question apart by payment channel — and finds a market that is functionally two markets [s1].

What the data covers

The study is a retrospective analysis covering 2020 to 2025, drawing on SISMED, BDUA, and CUM-INVIMA — Colombia's national drug pricing, insurance enrolment, and product registration databases [s1]. It compared pricing (maximum cost per minimum dispensable unit), annual market values, utilisation (defined daily dose per 1000 women-years), and population coverage (couple years of protection) between insurance-covered and out-of-pocket purchase groups [s1].

Using administrative pharmaceutical data rather than survey self-report is what makes the split visible. Household surveys ask whether a person uses contraception; they rarely capture what she paid or through which channel.

The two markets

Out-of-pocket purchases accounted for 78–86% of total contraceptive utilisation by defined daily dose, against 14–22% for insurance-covered purchases [s1].

By value, out-of-pocket groups accumulated 64–70% of the total annual market — $29.9 million to $48.6 million — driven by oral contraceptives and emergency contraception [s1]. Insurance-covered groups accounted for 31–36%, or $17.0 million to $29.0 million, and specialised in subdermal implants [s1].

So the insured channel is the one delivering long-acting reversible methods, and it reaches only eight to 10% of the population [s1].

Where prices diverge, and where they do not

Price behaviour varied sharply by method. Hormonal IUDs showed minimal price variation between channels — $144.00 through insurance versus $145.11 out of pocket [s1]. Injectable contraceptives achieved 72% price reductions [s1].

Emergency contraception went the other way, maintaining substantial price disparities, with out-of-pocket prices up to 25 times higher than insurance-covered prices [s1].

That is the widest gap in the dataset, and it applies to the method with the least flexible timing. Emergency contraception is time-critical by definition; a 25-fold price difference on a product that must be obtained within days is a different kind of barrier from a price difference on a method that can be planned for.

Coverage rose, then stalled

National contraceptive protection increased from 28% in 2020 to 37% in 2022, then stabilised at 33% across 2023 and 2024 [s1]. The authors conclude that the market shows persistent segmentation and structural barriers beyond pricing, and that policy would need both to strengthen insurance-covered service delivery capacity and to reform the out-of-pocket sector [s1].

Chile: the same question as a policy history

A paper published on 26 November in Medwave examines a related access question in Chile, using a different method entirely [s2]. It is a retrospective, qualitative case study of Chile's policy governing access to the emergency contraceptive pill, analysed through Walt and Gilson's policy triangle framework, drawing on a literature review, official reports available online, and document analysis [s2].

The analysis organises the policy process into four historical periods and describes the participation of numerous sociopolitical actors in formulating public policy to secure access, within a context of persistent ideological tensions [s2]. Its conclusion is that although issues were progressively resolved and the policy remains a work in progress, the process contributed to strengthening the reproductive rights of Chilean women, and that the interaction among health authorities, politicians, academic groups, and civil society organisations was central to how it unfolded [s2].

This is policy analysis, not epidemiology. It generates no prevalence estimates and no causal claims, and it should be read as a structured account of how a contested policy developed rather than as evidence about outcomes.

Reading the two together

The pairing is useful precisely because the methods differ. The Colombian study shows what a segmented market looks like once you can see the transactions [s1]. The Chilean study shows the kind of political contest that determines whether a method is available through a public channel at all [s2].

Both concern emergency contraception in particular — in Colombia as the product with the widest price gap between channels [s1], in Chile as the product around which the policy fight occurred [s2].

Neither study measures whether people who wanted contraception got it. Administrative pharmacy data captures purchases, not unmet need; a policy history captures decisions, not their effects on users. The unmet-need question in both countries remains open.

This article is informational and does not constitute medical advice.

Sources

• [s1] Contraceptive market, utilization patterns, and coverage in Colombia (2020-2025). Contraception, 1 November 2025. https://doi.org/10.1016/j.contraception.2025.111285
• [s2] Emergency contraception in Chile: Analysis of public policy according to Walt and Gilson. Medwave, 26 November 2025. https://doi.org/10.5867/medwave.2025.10.3139