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Global Birth Control: Why Choices Are Vital

More than 225 million women want to prevent pregnancies but aren’t using contraception. Making sure they can access a choice of methods is essential. We speak to the experts who say supply chain management is key to women’s reproductive health.

Written by Elizabeth Dwyer Published on Read time Approx. 4 minutes
A woman receives a test at a reproductive health clinic near Johannesburg, South Africa. AP/Jerome Delay

A study released last week by the Guttmacher Institute reported that, though one in four married women who don’t want to get pregnant don’t use birth control, it’s not because they can’t access it. Rather, the majority are concerned about the options available to them. Though safety concerns and dislike of the methods available are understandable reasons not to use birth control, unwanted pregnancies can be a dangerous alternative.

Some experts believe supply chain management can help tackle these challenges.

For instance, with its USAID-funded DELIVER project, the healthcare consultancy John Snow, Inc. is working to make sure healthcare systems in developing countries have all the supplies they need to provide care for local communities. And that means looking beyond trucks, boxes and warehouses, says JSI technical adviser Jane Feinberg.

“I was in India and I saw a provider handing out an emergency contraceptive pill over the counter – but they were handing it out as your daily pill; they were not trained that it was an emergency contraception,” says Feinberg. “Supply chain challenges include broken down trucks – but also poorly trained providers.”

Feinberg and her colleagues Anne LaFond, director of the JSI Center for Health Information, Monitoring and Evaluation, and Leslie Patykewich, director of commodity security for DELIVER, spoke with Women & Girls Hub about getting birth control to the women who need it.

Women & Girls Hub: Which type of birth control methods have the biggest demand, coupled with the most difficulty in delivering them to the women who need it?

Anne LaFond: It varies country by country; it’s not universal. Choice among methods is very important: you want to provide options so people can choose. Some products are harder to provide – those that require the intervention of a provider, like an IUD or injection – but those are also, in many ways, more effective. Some are cheaper to provide than others; some are bulkier to transport. There are logistical challenges to be sure, but we typically advise that it should be a priority of countries to make sure all of these choices are available, so that women are able to make the decision to use the method that’s right for them.

Women & Girls Hub: Why is it so important that a variety of birth control methods reach – and remain stocked in ­– the places women go to get them?

Leslie Patykewich: You don’t want to create a situation that says, “You can only use this,” because then you might lose people. A young person, for example, might like the confidentiality of going to a kiosk to buy their condoms, and it might be worth the price to do so. It’s a matter of understanding the client’s needs and making sure that there are products available that fit their lifestyles and can be accessed by them.

Women & Girls Hub: There’s a lot of interest among supply chain experts about learning from companies like Amazon and DHL, who react nimbly to customer demand. What’s a lesson they can teach us about getting birth control into the hands of more women, more efficiently?

LaFond: Listen to customers: As soon as you write to Amazon and say, “This didn’t go well,” it goes into someone’s inbox and they have to react to it. It’s easy to assume we understand end users, but what we learn is that there’s a whole variety of lifestyles and things that people want.

We want to make it easy for end users to decide on and access a birth control method. We use techniques like human-centered design to understand a bit more from their perspective. What would motivate them to get family planning services, in which area, at what time of day? What would make it easy for them to say, “Yes, today I’m going to choose a birth control method” or “I’m going back every month to get my supplies”?

Women & Girls Hub: How does technology help?

Jane Feinberg: When it comes to talking about expanding delivery, everybody’s always throwing everything on that last-mile agent [community health workers at the village level]. Instead, what burden can you take off them?

An example I like is an app used in countries like Malawi that doesn’t even need a smartphone or tablet: you can use it on a little Nokia candybar phone – something people already own and doesn’t require a lot of data.

At regular intervals, the last-mile agent simply types into the app the stock they have on hand of each product. He or she no longer has to forecast what should be restocked when, or try to remember, “Oh, wait, last time I ordered 200 pills, probably in the summer …” That’s a burden tech and data can take off them. The data they enter moves along the next layers of the supply chain, gets calculated, and their supplies get sent to them at the right timing and in the right quantities.

These types of apps are very, very basic – not a lot of information is being exchanged – yet they provide a level of visibility that just wasn’t there before. It allows vendors, delivery teams and the supply chain layers above them to keep birth control stocked.

Women & Girls Hub: How can we make sure that we reach that last mile – or last 10 kilometers – of women with the birth control variety they need?

Feinberg: Data is critical for understanding which people are getting products – and which aren’t. In many places, we’re getting to that 60 to 80 percent of the population. Countries need to be held accountable for reaching that last 20 percent. Why aren’t they getting health products and services? Are they the poorest, the most remote, the least educated? They are probably harder to get to than everybody else – they are the people who miss out on most everything – so you have to really make your programs very tailored to these people.

Patykewich: There’s no blueprint. What you need are standards and good ideas, and people who can decide how to fit those ideas and standards into their own situations. We’re working to empower governments and NGOs and communities to shape their own programs, to tailor them to people’s needs, which will make them more successful. It’s obvious, but it’s true: You can’t just export solutions that worked somewhere else. What you need is to export ideas and help people adapt them. Adaptation is critical in all of development, but especially in public health.

Feinberg: Ultimately, everything must be done with the client in mind. If you forget that, you’ve broken down your system and your priorities.

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