Author: apal thegutenberg

Reimagining India’s family planning ecosystem: WOHLA’s market development partnerships approach

In India, the awareness and use of an expanded range of contraceptives, particularly hormonal options, have largely remained confined to the health sector. Historically, family planning has been narrowly viewed as a health intervention aimed at maternal health, with limited integration into broader social, economic, and community contexts. This health-centric focus has restricted awareness to traditional methods like sterilization, IUDs, and condoms, while overlooking modern contraceptive options, such as hormonal contraceptives, that address a wider range of reproductive health needs. Furthermore, socio-cultural taboos and minimal cross-sector collaboration have hampered efforts to normalize hormonal contraceptives. Important sectors like private healthcare, Common Service Centers (CSCs), businesses, and NGOs focused on women’s livelihoods have not been effectively engaged, limiting the reach and impact of family planning initiatives. Navigating this space therefore requires not only a comprehensive understanding of the larger environment in which contraceptives access is situated but also an ability to see the interconnectedness between various actors.

This is what the USAID/FHM Engage supported Women’s Health and Livelihood Alliance (WOHLA) is striving to do through its ecosystem approach to bolster the supply and demand of contraceptives and sexual and reproductive health (SRH) products, services, and information to women in underserved communities. WOHLA is targeting all the key market actors in the contraceptives value chain space and their interlinkages through its six-partnerships approach. The synergistic aim of these six partnerships is to improve and expand women’s knowledge of and access to a wide range of contraceptives to help meet their individual SRH needs. Let us take a closer look at how WOHLA is engaging with key stakeholders and deploying its six partnerships to create an enabling environment for the production, distribution, and consumption of contraceptive services and products in India.

1. Fostering new partnerships for manufacturers

Manufacturers face several challenges in expanding access to contraceptives, particularly due to regulatory inconsistencies. A key issue is the lack of harmonization in scheduling: while second-generation oral contraceptive pills (OCPs) are available over-the-counter in the public sector, commercial sector OCPs are restricted to prescription-only due to their Schedule H classification. This inconsistency hampers large-scale promotion and limits product availability. Additionally, manufacturers are seeking sustainable alternatives beyond social marketing companies, which primarily focus on subsidized, price-controlled second-generation OCPs. This limits the diversity of available contraceptive products. High costs associated with inefficient, outdated supply and demand management systems further complicate efforts to scale up production and distribution.

To overcome these barriers, manufacturers are increasingly turning to digital platforms for supply chain management and market expansion. Many have expressed interest in collaborating with FHM Engage to launch innovative OCPs tailored to women’s evolving reproductive needs. A significant component of this collaboration will be working with local partner, Access Health, in advocating for streamlined product scheduling, labeling, and championing the inclusion of new-generation contraceptives in Government of India-endorsed guidelines. These regulatory advancements would enable greater access to modern contraceptives, benefiting a broader population. A key objective is to facilitate partnerships with new supply chain and demand mobilization actors, enhancing private sector investment in both emergency contraceptive (EC) and oral contraceptive (OC) markets.

To support this initiative, WOHLA through co-founding partner, CGF-Samhita, is organizing regular discussions across product segments and regions to incentivize local manufacturers. The goal is to help manufacturers recognize their critical role in women’s empowerment and to encourage them to promote and market new brands and next-generation family planning and sexual/reproductive health products. This approach will not only diversify the market but also advance women’s health and economic empowerment.

2. Facilitating financing for distributors

Distributors of family planning (FP) products play a crucial role as intermediaries between manufacturers and service providers, but they face significant challenges due to limited access to affordable financing. This financial strain hinders their ability to cover promotional expenses, particularly in smaller markets where manufacturers provide minimal marketing support. As a result, contraceptive options have reduced visibility and availability, impacting family planning access in underserved areas. To address this, WOHLA is working with distributors in key states—Delhi, Maharashtra, Karnataka, Meghalaya, and Assam—seeking to secure affordable financing to promote and upgrade their inventories, including newer FP/SRH products. By collaborating with government supported financial inclusion initiatives and banking and financing intermediaries like Appreciate, WOHLA aims to bridge the funding gap through working capital loans tailored for contraceptive inventory expansion. These loans will enable distributors to manage their stock without straining their finances. Additionally, WOHLA is exploring partnerships with distributor aggregators to pool demands of smaller distributors, enabling access to larger funding opportunities and better commercial terms. This approach helps distributors secure credit for both inventory and promotional expenses, ultimately expanding access to modern contraceptives in underserved communities.

3. Leveraging digital health channels and market intelligence

WOHLA’s third partnerships approach focuses on leveraging digital technology and market intelligence to enhance the demand for and supply of family planning (FP) products. To achieve this, WOHLHA is partnering with Pharmarack and Nivi to connect last-mile solution providers with consumers, using digital platforms to optimize FP access.

Pharmarack, India’s largest integrated B2B healthcare platform, combines technology, analytics, logistics, and financing, reaching over 10,000 distributors and 150,000 retailers nationwide. Under FHM Engage, Pharmarack’s platform has been customized to track trade in contraceptive products between distributors and chemists. By gathering data on sales volume, stock levels, and pricing, this system provides valuable insights into high-demand areas, distribution gaps, and trends in contraceptive uptake. This market intelligence is shared with manufacturers and distributors to ensure they align their strategies with consumer needs, improving supply chain efficiency and product availability.

WOHLA’s approach also addresses the growing need for manufacturers to adopt a hybrid model—combining physical and digital channels to connect effectively with last-mile providers. By using geo-tagged referrals and a chatbot linked to local doctors and pharmacies, WOHLA ensures users are directed to trusted healthcare providers, reducing distribution costs and enhancing the reach of sexual and reproductive health (SRH) products. Nivi, a digital health company, complements this strategy with its AI-powered chatbot (askNivi), providing consumers with anonymous, interactive FP guidance. Nivi onboards private service providers and pharmacies, enabling users to scan QR codes in local establishments to access personalized FP messages and referrals. Nivi’s online marketing through platforms like Facebook and YouTube further strengthens connections between providers and consumers, ensuring FP products and services reach youth and underserved communities effectively.

4. Promoting women’s health and economic security

When women are empowered to make informed decisions about their reproductive health, they gain more control over their participation in the workforce, education, and income generation. To extend contraceptive awareness beyond the health sector, India must adopt a multi-sectoral approach. Collaboration between education, media, labor, and women’s empowerment sectors, alongside health, is essential to normalize conversations about family planning and expand access to comprehensive SRH education. Cross-sector partnerships, private sector engagement, and diversified funding are critical to making contraceptive awareness part of broader social, economic, and community efforts. In line with its mission to promote women’s holistic well-being, WOHLA focuses on creating demand for family planning while supporting social inclusion and women’s economic empowerment. WOHLA’s fourth partnership approach “layers” FP demand creation with services that enhance women’s livelihood opportunities. SRH/FP messaging is integrated into Common Service Centers, NGOs working on social inclusion, workplace initiatives, and skilling centers for beauty parlor entrepreneurs. These platforms serve dual purposes: they offer access to social protection schemes, digital and financial literacy, and credit, while also providing trusted spaces for women to discreetly inquire about SRH/FP products and services. This innovative model, led by the Collective Good Foundation (CGF)/Samhita in partnership with the Ministry of Electronics and Information Technology and their ecosystem of NGOs, ensures that SRH information is embedded in initiatives that promote women’s economic security and social inclusion.

5. Stewarding the health marketplace

There is a lack of platforms or coalitions that coordinate entrepreneurs to align private sector actors and advocate for policies that improve access to women’s health services, especially for younger populations. Additionally, broader inter-ministerial and inter-sectoral engagement platforms are missing, which are essential for innovating strategies around contraceptive awareness and for leveraging corporate mandates focused on women’s economic empowerment and leadership. Hormonal contraceptives, which play a crucial role beyond pregnancy prevention by managing conditions like heavy menstrual bleeding, endometriosis, and uterine fibroids, are key to these discussions. Increasing awareness of these medical benefits requires a coordinated effort across sectors. By integrating hormonal contraceptives into broader health and empowerment initiatives through CSCs, private healthcare providers, and NGOs, we can normalize their use and reduce stigma, improving overall women’s health. WOHLA’s fifth partnership approach focuses on creating an integrative platform that fosters cross-sectoral collaboration. By uniting government, private sector actors, and NGOs, WOHLA aims to develop solutions for improving access to family planning (FP) and advancing women’s economic empowerment. Through the CGF/Samhita marketplace, WOHLA connects FP solutions with financing resources, driving greater private sector participation and expanding access to essential FP products like hormonal contraceptives.

6. Engaging the public sector for a supportive policy environment

India’s Vision FP 2030 highlights the critical need to enhance private sector engagement in family planning (FP). Despite efforts to involve the private sector, significant opportunities remain untapped. With government capacity stretched and FP resources dwindling, it’s essential to support government functionaries and program managers in bolstering private sector participation to ensure quality, accessibility, and sustainability of FP services nationwide. Challenges such as data sharing between public and private providers, and maintaining continuity of care, complicate the integration of private sector services into public health systems. Without effective stewardship and cross-sector collaboration, access to contraceptive products and services, especially in underserved regions, remains limited, hindering FP program success. Under this technical assistance through local partner, Access Health, the aim is to create an inclusive, competitive market for contraceptive options by 2030, focusing on regulatory engagement and harmonization efforts to address barriers like drug scheduling. This would ensure that newer contraceptives are available over the counter and included in national guidelines. A key strategy is integrating private AYUSH Medical Officers into the FP service framework, particularly in underserved areas. Future work emphasizes advocating for the inclusion of FP services in public and private insurance schemes, thereby expanding access and strengthening the overall provider base.

WOHLA is pioneering an ecosystem approach to shape a dynamic and sustainable family planning (FP) marketplace in India. Moving beyond traditional, narrow-focused contraceptive awareness initiatives, WOHLA’s comprehensive strategy brings together a diverse range of value chain actors—manufacturers, distributors, service providers, NGOs, private sector entities, and the government. By engaging these stakeholders across both supply and demand-side challenges, WOHLA aims to create a more integrated and efficient FP ecosystem.

The focus is on fostering collaboration to address bottlenecks in access, availability, and awareness of contraceptive options, ensuring a holistic approach to improving women’s health and economic well-being. This multi-stakeholder commitment is essential to advancing FP outcomes, which in turn, can lead to broader positive impacts for communities and the nation. Through this ecosystem approach, WOHLA seeks to build a marketplace where innovation, accessibility, and sustainability thrive, ensuring that contraceptive products and services are available to all women, particularly in underserved regions. By aligning the interests of all value chain actors, WOHLA is setting the stage for long-term, scalable improvements in reproductive health, empowering women and contributing to the country’s overall development.

Navigating Choice: A Quick Guide to Contraceptive Options

Family planning in India has been a critical component of the country’s public health strategy since the early 1950s when India became the first country to launch a national family planning program. The primary goal of the program has been to improve maternal and child health by providing access to contraceptive methods and reproductive health services.

Contraception is the cornerstone of women’s health and autonomy. From that first pill to today’s array of choices, we have witnessed a revolution in women’s health. Each new method represents progress, offering women more control over their reproductive health. According to the World Health Organization, the number of women using modern contraceptive methods increased from 663 million to 851 million between 2000 and 2020.

Women have moved from solely relying on barrier methods or oral contraceptives to having a diverse range of options today. Long-acting reversible contraceptives (LARCs) like implants and intrauterine devices (IUDs) offer convenience and efficacy. Emergency contraceptives (ECs) provide a crucial safety net. Advancements in non-hormonal methods cater to those seeking alternatives.

Understanding the nuances of these choices is essential. Women must educate themselves about the available choices, their efficacy, and any potential side effects. To this end, they must consult with healthcare providers, ask questions, and make informed decisions.

Different choices for differing needs

Contraceptive methods encompass hormonal and non-hormonal approaches, each with unique mechanisms of action and suitability for different individual needs. Let us look at some of the most common options.

Oral contraceptives

Oral contraceptive pills (OCPs), often simply referred to as “the pill”, have continued to evolve since their introduction in the 1960s. Today there are 30+ different brands of combined contraceptive pills, containing different combinations of hormones. The third and fourth-generation formulations that are now available feature newer progestins, with lower dosages of hormones, minimized side effects even as efficacy is maintained, with additional benefits of menstrual cycle regulation and reduction of acne and hirsutism. The advanced OCPs have thus not only improved the contraceptive experience but also have potential implications for women’s overall well-being.

These community champions will be trained with the latest information about contraception, menstrual health, safe sex practices, sexually transmitted infections, nutrition, and personal hygiene. Coached to step up as trainers, they will provide their communities with counseling sessions on modern methods of contraception and other topics.

The health champions will also facilitate linkages between young women who seek their advice and their immediate healthcare providers, including local pharmacies and doctors. This will ensure that women gain uninterrupted, discreet, and optimal access to sexual and reproductive health; family planning, and other services that are available locally.

LARCs: Implants and IUDs

Hormonal contraceptives work by altering the body’s natural hormone levels to prevent pregnancy. Among these, contraceptive implants represent a significant advancement in the LARC category. These small, flexible rods, typically about the size of a matchstick, are inserted subdermally in the upper arm. They provide a sustained release of progestin, effectively suppressing ovulation for up to three years. The efficacy and convenience of implants have been well-documented across diverse populations in Asia, Africa, and South America, making them an increasingly popular choice for women seeking long-term contraception without the need for daily attention.

IUD is another notable LARC option. The hormonal intrauterine system (IUS) offers a dual benefit: not only does it serve its primary function as a contraceptive but is also effective in managing menstrual disorders and alleviating symptoms of endometriosis. Its localized hormone action minimizes systemic side effects, while its long-term cost-effectiveness makes it an attractive option for many women. The non-hormonal copper IUD, on the other hand, offers a hormone-free alternative that can provide protection for up to 10 years.

Rings, barriers, and permanent solutions

For those seeking an alternative to daily pills, the contraceptive vaginal ring (CVR) presents an innovative solution. A small, flexible ring is inserted vaginally once a month, releasing a steady dose of estrogen and progestin hormones that are absorbed through the vaginal lining. This method not only prevents ovulation but also alters the cervical mucus, providing an additional barrier to conception. CVR thus offers the benefits of being effective, convenient, and discreet.

Barrier methods, particularly condoms, maintain their crucial position in reproductive health strategies. Besides preventing pregnancy, condoms also offer protection against sexually transmitted infections, making them an essential component of comprehensive sexual health practice. Their accessibility, ease of use, and lack of hormonal side effects contribute to their ongoing relevance and popularity.

For individuals or couples certain about their future reproductive choices, sterilization offers a permanent solution. Vasectomy, a procedure for male sterilization, is particularly noteworthy for its simplicity and effectiveness. It is a viable option for those who have completed their families or have decided against having children.

The fertility awareness method represents another non-hormonal approach to contraception. This method relies on understanding and tracking natural fertility indicators such as basal body temperature and cervical mucus changes. Although it does require diligence and education, this approach offers an option for women who prefer to avoid hormonal or barrier methods.

Conclusion

The great value of modern contraception is that there is perhaps something out there that fits every individual woman’s life, priorities, and goals. Ongoing research and innovation continue to refine existing methods and explore new technologies. The goal is to improve efficacy, reduce side effects, and expand available options. The commitment to innovation ensures that women have greater access to diverse, reliable contraceptive choices that align with their individual health needs and preferences. This journey of research around contraceptives represents not just medical progress, but a significant step toward greater equality and personal freedom for women everywhere.

Improving health outcomes for women: Medical pluralism may be the way to go

India has a long and rich history of traditional medicine systems, captured succinctly by the acronym AYUSH (Ayurveda, Yoga, Unani, Siddha, along with Homeopathy). Even as debates have raged about whether or not these traditional systems should be integrated into the biomedical mainstream, there is no denying that for a large segment of the population traditional medicine remains the first port of call to meet their health needs. According to National Sample Survey Office (NSSO) data for the year 2022-23, nearly half of India’s population—46% of the rural and 53% of the urban population—utilizes AYUSH healthcare systems. As India aims for universal health coverage by 2030, leveraging this acceptability and reach of AYUSH through its enhanced integration with mainstream healthcare systems will be crucial.

Policy recognizes the need for provider diversity

India’s healthcare framework is being reimagined under the National Health Policy, 2017, which emphasizes holistic healthcare, wellness promotion, disease prevention, and universal access to high-quality healthcare. With a focus on achieving comprehensive health coverage and improving health outcomes, the policy underscores the integration of AYUSH systems into mainstream healthcare delivery.

The policy focus is borne from a recognition of both the strengths of AYUSH and the health worker shortage that plagues India. A 2022 document by the World Health Organization (WHO), titled “Health workforce in India: where to invest, how much and why?”, posits that including AYUSH practitioners can increase the overall density of healthcare providers in India, thereby improving access to healthcare services. AYUSH practitioners can play a role in complementing allopathic providers and enhancing the healthcare workforce in India.

Greater clarity and standardization needed to address women’s health

The potential contribution AYUSH can make to women’s health is currently stymied by a lack of cohesive national policies for AYUSH practitioners, varying state-specific laws, and discrepancies in practice permissions. There is absence of a unified national policy delineating the role of AYUSH practitioners in sexual and reproductive health (SRH) service delivery. While the training curriculum for AYUSH doctors is standardized at the national level by the National Commission for Indian System of Medicine (NCISM), practice laws vary widely between states, affecting how far AYUSH practitioners integrate modern medical practices with traditional methods.

Maharashtra stands out for its progressive approach under the Maharashtra Medical Practitioners (MMP) Act of 1961, which allows AYUSH practitioners to practice modern medicine without additional training. This inclusive policy enhances their capacity to deliver comprehensive women’s health services. Institutions like RA Podar Ayurved Medical College and Hospital in Maharashtra exemplify this integration, where Ayurvedic obstetricians and gynecologists actively perform procedures such as caesarean sections and hysterectomies. AYUSH doctors in Maharashtra, both in private and public sectors, are authorized to prescribe oral contraceptive pills (OCPs), emergency contraception (EC), and conduct intrauterine contraceptive device (IUCD) insertions, demonstrating their diverse role in achieving improved health outcomes for women.

There are other some other efforts to improve AYUSH integration for women’s health. AYUSH networks like the National Integrated Medicine Association (NIMA) and the Kaashyapi Ayurveda Gynaecologists and Obstetricians Foundation (KAGOF) play crucial roles in advocating for and advancing the integration of AYUSH practices. Established in 1948, NIMA represents nearly 2.5 lakh AYUSH doctors across 17 states. The NIMA India Women Forum, with 30-40,000 women members, focuses on women’s health issues and collaborates with NGOs for capacity building. KAGOF focuses on unifying Ayurvedic practitioners and advancing their practices with modern technologies, aiming to standardize AYUSH laws and practices nationally.

Despite these efforts, gaps remain in the provision of guidelines for AYUSH practitioners, particularly in the private sector, where regulatory frameworks are less defined compared to the public sector. In public sector, Per IUCD Reference Manual, AYUSH doctors are authorised to do postpartum IUCD insertions after training. Addressing these gaps requires a multifaceted approach, starting with advocating for clear, national-level policies that uniformly authorize AYUSH practitioners to dispense family planning (FP) products and provide comprehensive women’s health services. This includes aligning AYUSH roles in national FP program guidelines and ensuring consistency in state regulations.

Equally, it is critical to develop specific guidelines and robust training programs for AYUSH practitioners in the private sector. Collaborations between private hospitals, medical colleges, and accredited training institutions can develop standardized training modules that equip practitioners with updated knowledge and skills in SRH care. Continuous professional development programs are essential to ensure AYUSH practitioners are abreast with advancements in SRH services. The Ministry of AYUSH and the Ministry of Health and Family Welfare (MoHFW) must collaborate to develop and implement these guidelines, setting clear standards for AYUSH practice in SRH. Networks like NIMA and KAGOF can facilitate this process by fostering collaboration among AYUSH practitioners and promoting standardization.

AYUSH practitioners’ integration with women’s health services can not only enhance provider diversity but also significantly improve health outcomes. By overcoming regulatory challenges, enhancing training frameworks, and advocating for policy reforms, India can effectively harness the strengths of its traditional medicine systems to achieve universal health coverage and better health outcomes for all.

Paving the way for a bustling health marketplace

For centuries, marketplaces have been synonymous with efficient, productive, and optimal exchange of goods and services. They have served as bustling, convenient spaces where producers showcase and sell their wares, and consumers compare and choose products best suited to their needs, budgets, and preferences.

Recent technological advancements and the unique challenges that countries, economies, and societies faced in the last few years have altered the way marketplaces operate. Most marketplaces today have gone digital, providing producers and consumers with an anonymous, convenient, reliable, and cost-effective experience. But what about the health marketplace?

Inadequate harnessing of digital opportunities

The digital tools and channels available today have the potential to also revolutionize how prospective consumers are reached with life-enhancing health products and services. However, the new possibilities that digital technologies have opened up have not been as effectively leveraged as other sectors to link consumers with the sellers of health products and services. This represents a missed opportunity, especially for a market category like sexual and reproductive health (SRH), where the discreetness and anonymity of purchase that digital offers are highly valued by consumers.

There are multiple reasons for this gap. One, whether due to policy regulations or the unwillingness of key healthcare players to be available on one platform, consumers have to spend more time researching what they need and find out where they can get it. Critically, consumers also lack the information and support necessary to make informed decisions about what is appropriate for them. Health product distributors and service providers are compelled, due to limited budgets, regulatory constraints, or target audience familiarity, to depend on traditional advertising and word of mouth to reach more consumers and expand their reach.

Sub-optimal health marketplaces negatively impact producers and consumers, ultimately leading to poor population-level health outcomes. This hits underserved communities in low- and middle-income countries (LMICs), where good-quality healthcare and products are typically more challenging to access, and sociocultural barriers to uptake far more prominent. In the absence of a bustling health marketplace, nearly all aspects of healthcare are defined by individuals’ social, financial, and geographical realities.

Fixing the broken connection with partnership and innovation

Given the transformative impact access to SRH information and products/services has on women’s health and well-being and that of their families and communities, it represents an area where urgent action is needed to augment reach and address need. This is a broken connection that digital can help fix. The Women’s Health and Livelihoods Alliance (WOHLA) initiative is working to make that happen and to create a thriving marketplace for SRH products and services in India. The wide array of partners that are part of the WOHLA alliance are working
together to revolutionize how women access SRH information, products, and services.

One of WOHLA’s multi-sector partners is Nivi, a digital health company that works to empower individuals with the right information, tools, and resources to make informed decisions about their health and connect them to local products and services. Nivi collaborates with health system actors like health promoters, payors, service and product providers, and manufacturers to create interventions that target, reach, and engage health consumers for different health domains and therapeutic areas, especially women’s health and wellness. Continued connection with these health consumers across their life course/journey (a continuum-of-care approach) and diverse health needs enables Nivi’s partners to understand consumer behaviors and barriers, design and validate tailored solutions, and drive behavior change while promoting accessible and preventative care.

As part of the WOHLA initiative, Nivi is running awareness campaigns on digital media channels to spread information about SRH to young women (19–29 years) starting from five states (Delhi NCR, Maharashtra, Karnataka, Assam, Meghalaya). Through these awareness campaigns, Nivi onboards and engages individuals on its artificial intelligence (AI) powered chatbot—askNivi—where they initiate engagement around the contraceptive use journey. The askNivi contraceptive journey is crafted using a human-centered design (HCD) approach
grounded in behavioral science principles. AI is used to identify an individual’s stage of behavior change and mindset and tailor content accordingly. To reach the broadest possible audience in India, askNivi is accessible in five languages (Hindi, English, Kannada, Marathi, and Assamese).

In addition to onboarding prospective consumers and raising awareness about the basket of choices available to them, askNivi also connects them to the healthcare system. To make this connection possible, Nivi is also onboarding healthcare providers (chemists, clinics, hospitals) to the askNivi conversational marketplace in the five states. As details and geo-tags for providers in the rest of the states become available, Nivi will on-board them as well. For users that go
through the contraceptive journey and are primed for action, askNivi gives a personalized referral to three nearby facilities that provide contraceptive products and services. Through coaching and nudges based on behavioral science principles, askNivi motivates users to take action, including visits to healthcare providers and continued consideration of contraceptive options post-visit.

The askNivi contraceptive journey provides visibility into the consumers’ thought process, their readiness to act, their provider experience (e.g., method-mix availability, facility counseling, and consumer satisfaction) and their post-visit FP journey. The anonymized data and insights are critical in strengthening the healthcare marketplace in these target geographies.

With WOHLA, Nivi aims to reach 20 million individuals and engage 200,000 across five states (24 districts) in nine months by running creative, sensitive, and target-group-focused content. As of May 2024, these ads have garnered 24.4 million impressions, reaching 6.25 million unique people. Over 70 percent of those engaging on the chatbot are women in the 19–29 years age group. More than 2,000 providers are on-boarded on the chatbot for location specific referrals
for products and services.

Lessons to shape and strengthen digital health marketplaces

Nivi’s experience of connecting young women with contraceptive information provides valuable insights for other initiatives and organizations operating within the contraceptive awareness and advocacy landscape. Here are a few key takeaways that can help enhance their program efficacy:

• Transparent and direct communication: To effectively navigate social stigmas surrounding SRH, messaging must be unambiguous and relevant when addressing contraceptive topics. Ensure that digital health platforms are user-friendly, accessible, and tailored to the needs of diverse user groups. This includes designing intuitive interfaces and providing multilingual support.
• Addressing knowledge gaps: It is essential to acknowledge that many users lack foundational knowledge about contraceptive products and services. askNivi is deliberately designed to fill the knowledge gap for those who need more information.
• Sustained user re-engagement: Behavior change is often not immediate. Developing strategies for re-engaging users based on their stage of behavior change and addressing motivation to overcome specific barriers to contraceptive method adoption is paramount. Making the chatbot available 24/7 to provide support whenever users need it, ensures that users can access information and assistance at their convenience.
• Differentiated content strategy: Developing content that caters to distinct user needs is crucial. Younger demographic groups may prioritize information on inexpensive short-term methods conveniently available over the counter, while older women may be more receptive to learning about long-acting reversible contraceptives (LARCs).
• Interactive storytelling techniques: Utilizing engaging digital formats such as carousels or other interactive storytelling methods can significantly enhance user interest and maintain sustained engagement.
• Cultivating trustworthy provider relationships: As much as Nivi targets consumers, it also regularly expands its provider network. Building trust with healthcare providers is time-intensive. Organizations should anticipate that multiple interactions may be necessary to successfully onboard a healthcare professional, such as a physician or pharmacist.

Navigating the SRH space to provide correct, supportive, and engaging information and motivation to act is a tough and sensitive task. However, as Nivi’s work with WOHLA has demonstrated, the use of digital technologies with a well-thought-out, structured end-to-end approach can make it possible to create new markets where girls, women, and their partners are empowered to make the right decisions.

Making Women Thrive: Reproductive Health and Economic Opportunity Hold the Key

When women are given the opportunity to thrive, the entire community thrives…Women’s economic security and rights are the critical foundation for communities, peace, and resilient economies.”—Dr. Atul Gawande, USAID Assistant Administrator for Global Health 

Good health translates into better economic prospects, and this is especially true for women.

Women’s health and economic security ensure not only empowerment and autonomy for women themselves but also growth and progress for their families and communities. Securing these two goals is thus an important priority.

Women’s Health and Livelihood Alliance (WOHLA), a newly launched initiative in India, is working to improve opportunities for better health and work for marginalized women. WOHLA is a joint initiative by the United States Agency for International Development’s (USAID’s) Frontier Health Market Engage project and Samhita’s Collective Good Foundation.

The raison d’etre for WOHLA is clear: when access to quality sexual and reproductive health services increases, women are more likely to be part of the workforce, less likely to miss work due to sickness, and more confident about taking charge of family planning.

Research conducted across multiple countries also suggests that when women enjoy better economic status and greater financial independence, they tend to use reproductive and maternal healthcare services more easily and often. This is particularly true for low and middle-income countries including India¹.

WOHLA’s three-pronged approach

At the core of WOHLA’s strategy is facilitating public-private partnerships focused on supporting a healthcare marketplace that both expands employment opportunities for women and improves their awareness of reproductive and sexual health.

WOHLA plans to achieve this through a three-pronged approach; first, by improving women’s access to information and services around sexual and reproductive healthcare; second, by enhancing women’s financial and digital literacy to promote their participation in the formal workforce; and third, by improving women’s access to credit to better support their investments in health and eligibility for improved economic opportunities. Let us take a closer look at these three drivers.

1. Improving women’s health

Take, for instance, the issue of contraception. Many Indian women want to use better family planning methods but lack access to up-to-date information and cost-effective products and services.

https://www.gatesfoundation.org/equal-is-greater/static/WEE%20health%20outcomes_v7-74aad3fed6bf9b02a0e30f4ddb9b794a.pdf

WOHLA hopes to empower women with the access they need to information, products, and services related to women’s sexual and reproductive health and family planning, by collaborating with its partners. One of the ways in which the initiative intends to achieve this goal is by identifying and training women’s health champions.

These community champions will be trained with the latest information about contraception, menstrual health, safe sex practices, sexually transmitted infections, nutrition, and personal hygiene. Coached to step up as trainers, they will provide their communities with counseling sessions on modern methods of contraception and other topics.

The health champions will also facilitate linkages between young women who seek their advice and their immediate healthcare providers, including local pharmacies and doctors. This will ensure that women gain uninterrupted, discreet, and optimal access to sexual and reproductive health; family planning, and other services that are available locally.

2. Enhancing financial and digital literacy

Financial literacy alters the way women perceive themselves, their work, and their role in the family and communities. When provided with the tools that will make them comfortable with payments, valuations, and estimates, women gain confidence to make more empowered economic decisions, including for their own and their families’ health and well-being.

Hence, WOHLA plans to leverage its partnerships with village-level centers, NGOs, and businesses. It plans to familiarize women with digital tools to help them make more informed financial decisions and improve their confidence and ability to access credit. This is likely to have a positive effect on how women will prioritize preventive healthcare, including sexual and reproductive health. This is also likely to ensure an earlier entry into the labor market and a longer and more fruitful employment experience.

3. Expanding livelihood opportunities for women

WOHLA has been created to serve as a platform and marketplace for women’s health with the primary purpose of mobilizing resources for access to finance, opportunities for livelihood, and implementation of women’s health programs. The organization is facilitating cross-sectoral partnerships with multiple market actors to build core entrepreneurship capabilities of women participants while enabling support interventions to help them scale.

By improving women’s access to digital technology and enabling them to gain knowledge and skills in this area; young girls and women will benefit from a more level playing field to leverage platforms, tools, and services to improve health outcomes and for accessing livelihood opportunities. Based on the needs of entrepreneurs or employed women, WOHLA will also provide support to gain access to government schemes and documents which are targeted at entrepreneurs, such as Government e-marketplace (GeM) registration, Udyam registration (for MSMEs), and artisan cards. This will help underserved girls and women gain several benefits. This includes participation in local trade fairs, collateral-free loans from banks, interest subsidies, and partnership with the Open Network for Digital Commerce (ONDC) to facilitate access to markets for products and services offered by entrepreneurs, over the program period.

https://www.atlantis-press.com/article/25896154.pdf

https://finca.org/en-ca/blog-en-ca/financial-literacy-and-its-role-in-womens-empowerment

Does owning a bank account improve reproductive and maternal health services utilization and behavior in India? Evidence from the National Family Health Survey 2015–16, International Institute for Population Sciences https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6468192/

By mobilizing private sector resources, fostering partnerships, and implementing targeted interventions, WOHLA aims to strengthen the intrinsic link between women’s health and livelihood opportunities.

How do we ensure women have better access to modern contraceptives? Simple. Get all players onboard.

In 1952, India became the first country in the world to initiate a national family planning program, marking a significant milestone in global public health and socio-economic strategy. By advocating for population stability, India, then a recently independent nation from the global south, demonstrated an intuitive understanding of the effect of demographic trends on economic progress. India’s visionary initiative not only affirmed its commitment to sustainable development but also highlighted the attention the country was giving to women’s health.

It is widely known, and empirically proven, that a nation’s growth relies on the health of its populace, particularly that of its women. Seamless and equitable access to quality healthcare, including sexual and reproductive healthcare, empowers women and improves their prospects for earning and saving, thereby facilitating personal and familial advancement. This, in turn, drives national growth and development.

Women’s reproductive health continues to be of crucial importance for India today, especially in view of India’s current demographic landscape and the potential for women’s economic participation in the long term. Research shows that investing in women’s participation yields high returns, with $3 gained for every $1 invested globally (even higher in developed regions). While some low-income countries may need additional investment in infrastructure, the benefits still outweigh the costs (around $2 return per $1 invested). Women who can plan their families are more likely to pursue education and career opportunities, contributing to economic productivity. Enhancing access to and affordability of modern contraceptives, especially for marginalized women, is one such challenge. Both public and private sectors are striving in their own spheres to address this need, but gaps persist.

Modern contraceptives: A complex landscape

Several issues limit women’s access to products and services for reproductive health. Consider, for example, the issue of access to modern contraceptives: a complex landscape with multiple factors at play. Female sterilization remains the most commonly used contraceptive method in India. Though the public health system has made efforts to broaden the contraceptive basket, the availability of temporary, reversible contraceptive options remains limited. This scenario does not fully align with the diverse needs of today’s young women, who prefer temporary birth control that effectively postpones pregnancy and childbirth to allow time for educational, career, and other goals.

The private health sector, which could expand women’s contraceptive options, finds itself limited by stringent regulations and administrative procedures that hinder the introduction of advanced contraceptive methods, like long-acting reversible contraceptives (LARCs). Variations in regulatory requirements across different sub-national regions also lead to inconsistencies and confusion among consumers. These factors inhibit private sector interest, investment, and innovation in the contraceptive marketplace.

Access to a broad range of oral contraceptives in developed countries highlights the importance of comprehensive reproductive health services. This access supports women’s health, autonomy, and socio-economic advancement by providing the means to control fertility and manage reproductive health issues effectively. For young girls and women in India, their evolving contraceptive needs to be acknowledged, and tailored solutions require a change of track. Crucially, it warrants strategies that promote expanded contraceptive choices, streamlined regulations, and consistent access pathways across both public and private healthcare systems.

WOHLA: Fostering a collaborative ecosystem

Women’s Health and Livelihood Alliance (WOHLA) is borne of the need to promote greater collaboration between the various stakeholders operating in or relevant to the women’s sexual and reproductive health space in India. Its aim is to serve as a platform for the government, commercial actors, and NGOs to co-create solutions for improving health outcomes for the most vulnerable Indian women.

India’s young women today have better information about and opportunities for education and work; this incentivizes them to delay having children. Recognizing this shift, WOHLA takes a multi-pronged approach to tackle the challenges surrounding access to modern contraceptive options. The key pivots around which WOHLA will drive collaboration are as follows:

• Policy advocacy and regulatory reform: One of the primary ways in which WOHLA aims to do this is by actively engaging with policymakers to advocate for policy revisions to eliminate barriers and enhance access to contraceptives. This includes lobbying for national guidelines to clearly mention newer contraceptive methods, simplifying the scheduling of drugs as per recent international guidance, facilitating the marketing and promotion of innovative contraceptives in the private sector, and delineating the roles of different healthcare providers (such as AYUSH) in offering contraceptive services. By thus helping to address regulatory obstacles, WOHLA aims to foster a conducive environment for private-sector investment and innovation in the Indian contraceptive market.
• Market expansion and private sector engagement: WOHLA aims to also collaborate with private healthcare and life sciences companies to encourage the introduction of a wider array of contraceptive options. By encouraging private sector participation, WOHLA hopes to enhance the availability and accessibility of advanced contraceptive methods, offering women a broader range of choices tailored to their individual needs.
• Expanding access through provider diversity: Some healthcare providers, including alternative medicine practitioners, are currently restricted from offering contraceptive services in India. WOHLA plans to advocate for expanding the pool of qualified providers authorized to deliver contraceptive counseling and services. The aim is to enhance access, particularly in underserved areas, by leveraging the entire healthcare workforce, thereby addressing gaps in service delivery.
• Public-private partnerships and resource allocation: WOHLA also plans to facilitate collaboration between public and private systems to optimize resource allocation. This will involve identifying areas where resources can be utilized more effectively, streamlining public-private partnerships for financing and service delivery, and leveraging the strengths of both sectors to enhance the affordability of contraceptive services. The private sector in India is well-placed to drive social change by creating compelling campaigns that challenge existing norms and promote new behaviors. The WOHLA initiative aims to bring together government agencies and private/commercial entities across various industries and sectors, including Banking and Finance, Information Technology, and Micro, Small, and Medium-sized Enterprises (MSMEs), to channel resources for the women’s healthcare ecosystem. The goal is to increase awareness of women’s and girls’ issues, consolidate resources, and improve access to reproductive healthcare, thereby promoting gender equity.

By simplifying and broadening access to safe and diverse contraceptives for women, WOHLA aims to empower women to make better, more informed choices about their reproductive health. Further, by roping in private sector involvement, the initiative aims to bolster innovation, not just in women’s health but also their enhanced economic participation. WOHLA’s success would, thus, lie in fostering a healthcare marketplace driven by collaboration and a joint focus on unlocking women’s capacity to choose and thrive.

• Family Planning – A Right and A Choice https://india.unfpa.org/sites/default/files/pub-pdf/FamilyPlan_06-07-2013.pdf
• Closing the women’s health gap: A $1 trillion opportunity to improve lives and economies https://www.mckinsey.com/mhi/our-insights/closing-the-womens-health-gap-a-1-trillion-dollar-opportunity-to-improve-lives-and-economies