Improving Contraceptive Access In India: Private Sector Engagement Is The Way To Go!

The latest round of India’s National Family Health Survey (2019–21) held out a sobering message: we need to pull all stops to make contraceptives more widely available. India's unmet need for contraception stands at 9.4 per cent. This means that even when couples want to adopt a contraception method, it is not readily available.  

This gap has serious health implications: unintended pregnancies, unsafe abortions that risk women's lives, and adverse maternal and child health outcomes due to poor birth spacing. There is also a gender and socio-economic implication: limited access to contraception limits women’s ability to take charge of their lives, pursue education, participate in the workforce, and secure their own and their family’s economic well-being.

Today, India is the world’s most populous nation, exceeding 1.4 billion people and increasing. Globally, the private sector is playing an increasingly important role in achieving sustainable development goals, creating employment, introducing newer technologies, contributing resources, and building markets in emerging economies.  The government and the private sector must come together through private sector engagement (PSE) to ensure more women have more access to more contraceptive options. 

PSEs Can Be The Game Changers

India's public health system plays a crucial role in making contraception affordable, largely through subsidised contraceptives. Engaging the private sector can bring additional financial resources and investments into the family planning program. Private sector involvement can offer diverse service delivery channels, such as pharmacies, clinics, and hospitals, providing multiple points of access for family planning services. By integrating private sector capabilities with public health objectives, India can strengthen its family planning program, making it more effective, comprehensive, and sustainable

PSEs can potentially expand contraceptive access by combining public resources with private sector efficiency and innovation. Staff at private clinics and pharmacies/chemist shops, for instance, can be trained to offer a wider range of contraceptive products and counseling and prescription services. This can expand the service network far beyond government facilities.

Another benefit would be a wider choice to meet different family planning needs of different age groups. Young women (19–29 years) usually require more temporary methods to delay childbirth. The private sector can help expand choice by supporting the availability/launch of new contraceptive methods for the youth. (e.g. scale-up of Progestin-only Pills/ POP which has fewer side effects and is safe for breastfeeding women, vaginal rings, and implants) This can enable young couples to select the method that best aligns with their needs. 

Issues To Be Resolved

The private sector has the potential to complement the public sector for FP services, but the roadmap to engage these two sectors remains a challenge. India envisions institutionalising an approach where the public and private players coordinate to jointly meet the FP needs and leverage each other’s strengths to maximise the reach and quality of services. While contracting out is important to increase access to family planning services, the stakeholders need to go beyond it and explore other partnership models that not only address affordability but also access, quality, and choice.

Another major challenge comes from the regulatory and policy environment. To have the confidence to invest in family planning products and services, the private sector players require a supportive policy environment and a clear financial incentive to invest. Varying interpretations of what is permitted in the private sector (across the heterogeneous group of providers) create uncertainty, hindering enthusiasm and growth. It is thus important to establish an enabling regulatory framework so that private players have confidence and clarity and adhere to quality standards and ethical practices.

Additionally, it is important to consider factors such as the capacity-building needs of private sector partners, data-sharing mechanisms, and the potential for leveraging digital technologies. New technologies and the existing huge digital infrastructure in India offer big opportunities. Innovatively leveraging these can help to rapidly maximize reach and contribute to expanding contraceptive access in India. Private sector involvement can ensure that family planning services are sustainable and scalable. With their business models, private entities can expand successful initiatives and ensure continuity even when public funding fluctuates

Importantly, private sector engagement in the domain of contraceptive access cannot be successful without the buy-in and active involvement of local communities throughout the design, planning, and implementation of such initiatives. The voices and needs of people must be heard and addressed through these partnerships. Effective community engagement strategies are essential to build trust, foster acceptance, and ensure that the services provided through the partnership align with the needs of the target population. This will also require targeted communication campaigns that address concerns, dispel myths, and promote behaviour change so that the demand for contraceptive services is strong and sustained. 

Partnerships will be critical to meet the reproductive and sexual health needs of India’s young. By fostering collaboration between the public and private sectors, leveraging their respective strengths, and proactively addressing potential challenges, private sector involvement can empower India’s young, especially young women, to make informed choices and realise their aspirations. 

The author is India Country Director and Chief of Party, FHM Engage

Dr. Amit Bhanot

Guest Author