Pharmacists on the frontline: Overlooked challenges in the contraceptive supply chain

India’s public health agenda has increasingly prioritised family planning, recognising it as a cornerstone of sustainable development. A key objective is to ensure that reproductive health services are both accessible and effective, aligned with Sustainable Development Goal (SDG) 3.7, which aims to provide universal access to family planning by 2030 (1). The significance of family planning is underscored by initiatives like FP2030, a global partnership focused on expanding contraceptive access, particularly in developing nations. 

India has seen a notable rise in modern contraceptive use, increasing from 47.8 per cent during 2015-16 (NFHS 4) to 56.5 per cent in 2019-21 (NFHS 5). Concurrently, the unmet need for family planning has decreased, falling from 12.9 per cent in 2015-16 to 9.4 per cent in 2019-21 (2), according to the same survey. This trend indicates interest and willingness among people to adopt contraceptives. Notably, the National Health Policy of 2017 has set forth the goal of over 90 per cent coverage of family planning services at both national and sub-national levels by 2025. Expanding the range of available contraceptive options and improving young couples’ access to them will be crucial to achieving these targets.

As we approach the target years for meeting national and global goals, we must examine the challenges that hinder contraceptive access and consider approaches that can accelerate it. Contraceptives, as a vital aspect of family planning, empower individuals to make informed choices about the number and spacing of their children. They also play a significant role in reducing the spread of sexually transmitted diseases and enhancing women’s overall well-being.

Despite a steady global increase in contraceptive use—reaching 65 per cent of women in 2022—India still faces significant barriers in meeting the reproductive needs of its population. These challenges are often compounded by the overlooked role of pharmacists within the contraceptive supply chain. To ensure equitable access to contraception, particularly for young women, it is essential to address these issues.

Let us take a closer look at these hidden challenges and discuss actionable steps to overcome them.

The evolving role of pharmacists in contraceptive access

Pharmacists have emerged as vital players in family planning, serving as trusted advisors for millions seeking accessible reproductive health services. As of NFHS 2019, 29 per cent (~59 million) of users seek FP services from private set-ups (Providers, clinics; groceries and pharmacies). The pharmacy segment is a key service point for contraceptive product provisioning. It is estimated that ~4- 6  per cent of pharmacy business is dependent on FP.  Currently, 60  per cent of private users ( 40 million users) obtain the methods from pharmacies ( condoms, OCPs, EC and MAP)

 In addition, a large number of new users are expected to seek FP services between 2022 – 2026 (an estimated 18.5 million – new users are expected to seek FP methods in India). Pharmacy retail outlets are expected to be the first nodal point to serve new user needs. Despite the significant importance of pharmacy outlets, there is very limited data to understand some of the key aspects of product availability, barriers, enablers, distribution dynamics and current demand

As frontline healthcare providers, they play a crucial role in demystifying and reducing the stigma surrounding contraceptive products, helping to normalise their use in everyday healthcare discussions. For many consumers, especially young women, visiting a local pharmacy is often more convenient than scheduling an appointment with a physician, making pharmacists the first point of contact for contraceptive advice. This shift has expanded their role from merely dispensing products to providing essential medical guidance. However, while pharmacists are recognised as reliable sources of information in family planning, they face significant challenges due to inadequate training/orientation on newer-generation contraceptives, such as oral contraceptive pills (OCPs), implants, and hormonal intrauterine devices (IUDs) (3). Many pharmacists lack access to up-to-date information on the latest innovations in contraceptive methods, leaving them underprepared to offer comprehensive advice. This knowledge gap can hinder their ability to effectively address consumer concerns regarding side effects, long-term benefits, and the suitability of newer contraceptive options for individual needs. Addressing these challenges is essential to empowering pharmacists and enhancing their ability to support family planning efforts in our communities.

Inadequate training on new contraceptive methods: A call for change

Pharmacists play a vital role in patient education, providing essential insights into medications, their side effects, and proper usage. Their accessibility and the trust they enjoy in communities help them counsel patients in real time. However, many pharmacists often face significant challenges due to inadequate training and education on contraceptive methods. Studies have shown (4)  that pharmacists may have knowledge gaps regarding next-generation contraceptives like oral contraceptive pills (OCPs), implants, or IUDs. This lack of comprehensive understanding can hinder their ability to provide accurate and effective counselling. Furthermore, there is a concerning absence of continuous education for pharmacists to keep them abreast of the latest developments in contraception. Without ongoing professional development, they may struggle to stay informed about innovations, benefits, and potential side effects of new contraceptive methods. This knowledge gap is crucial, as it directly impacts the quality of care pharmacists can provide. Digital apps can play a pivotal role in supporting pharmacists by enhancing their knowledge of contraceptives, enabling them to provide better services and guidance to their customers. Digital platforms can offer e-learning modules, webinars, or short courses to help pharmacists stay updated on contraceptive methods. These courses can cover everything from the mechanisms of action to proper patient counselling techniques. Pharmacists can use apps to connect with medical professionals, family planning experts, or peer networks for support on complex cases or questions.

Poor market intelligence on demand and stock volumes: A critical challenge for pharmacists

Pharmacists face a significant challenge in the contraceptive supply chain due to insufficient and often inaccurate data on product demand. This lack of reliable information leads to inconsistent stocking of contraceptive products, forcing pharmacists to rely on educated guesses about consumer needs. As a result, certain methods, like older-generation oral contraceptives or IUDs, may be overstocked, while other options, such as Injectable Contraceptives, could be unavailable when consumers need them most. This uncertainty in demand forecasting undermines pharmacists’ ability to provide comprehensive contraceptive services. The issue is compounded by logistical inefficiencies and a fragmented supply chain. Many pharmacies struggle to maintain adequate stock levels due to shipment delays or gaps in the distribution network. This is particularly detrimental for consumers in rural or underserved communities, who may face long wait times or be compelled to seek alternative, less effective methods of contraception.

The inability to meet consumer demand not only jeopardises pharmacists’ credibility but also poses a public health risk. Unreliable access to contraceptives can lead to increased unintended pregnancies, highlighting the urgent need for improved demand forecasting and robust logistics. By ensuring a consistent supply of contraceptives, we can better support pharmacists in their crucial role as accessible healthcare providers. It is imperative that we address these challenges to enhance the overall effectiveness of contraceptive care.

Financing and inventory issues

Financial constraints faced by retailers and pharmacists, who are often the main point of contact for consumers are another barrier in contraceptive supply management. Due to a lack of access to affordable working capital, frontline retailers are reluctant to stock a broad range of family planning products. This results in a narrow selection of contraceptives and inconsistent availability, which restricts the choices women can make for their reproductive health and autonomy. Small and mid-sized distributors also struggle with financing, making it difficult for them to support retailers with the necessary stock. Previously, many donor programs provided longer-duration cash advances or financing options to help distributors maintain adequate stock levels and manage promotional activities. With the scaling back of these donor efforts, distributors are now left with fewer financial safety nets, making it difficult to invest in inventory, especially for slower-moving or higher-cost contraceptive products. Limited access to affordable financing further complicates their ability to cover promotional expenses, as manufacturers often do not offer structured marketing support in these smaller markets. This financial strain results in reduced availability and visibility of contraceptive options, impacting efforts to expand family planning access in underserved areas. Compounding these issues is a general lack of awareness about available financing solutions (especially those that could provide risk-tolerant loans to help expand contraceptive inventories). Without stronger financial support and improvements in the supply chain, many young women and couples in India will continue to face limited options for family planning.

Cultural and societal barriers : Overcoming misconceptions in contraceptive access

Societal misconceptions surrounding contraceptives also pose a large barrier to access. Myths about side effects and a widespread reluctance among men to use condoms or consider vasectomies contribute to reduced contraceptive uptake. Pharmacists, often the first point of contact for these discussions, for consumers seeking guidance, play a crucial role in combating these misconceptions. They have the opportunity to create awareness and effectively demystify these myths, which is essential for enhancing access to and acceptance of modern contraceptive methods.To address these issues, a multi-faceted approach is necessary. Continuous education on newer contraceptive methods will empower pharmacists to provide better guidance to consumers. Simultaneously, improving access to affordable financing will enable them to maintain adequate inventories, ensuring that contraceptive products along with commodity options for managing side effects are also readily available. Digital apps can help pharmacists navigate cultural and societal barriers by providing them with tools to address misconceptions around contraceptive use, particularly in communities where discussing family planning is taboo. These apps can offer culturally sensitive messaging and multilingual resources tailored to local customs, allowing pharmacists to communicate effectively and respectfully with customers. Additionally, apps can provide pharmacists with evidence-based responses to common myths or concerns, empowering them to debunk misconceptions about contraception and foster open, informed discussions with individuals who might otherwise be hesitant to seek advice. This helps build trust and promote wider acceptance of contraceptives in diverse communities.

Moreover, technological innovations in supply chain management and stronger collaboration between manufacturers, wholesalers, and pharmacists are essential to overcome logistical hurdles. Digital apps can be a transformative tool for pharmacists, providing them with continuous education, real-time information, consultation support, and resources to better serve their customers. By leveraging technology, pharmacists can stay updated, improve customer interactions, and ensure that the right contraceptive methods are recommended based on each individual’s needs, thereby improving overall contraceptive access and knowledge in their communities. By strengthening the support systems around pharmacists, we can enhance their role as key facilitators in the contraceptive supply chain. Acting swiftly to empower pharmacists is critical for improving reproductive health outcomes and achieving broader societal benefits. 

References:

1. https://www.guttmacher.org/article/2022/10/adding-programs-and-system-costs-need-accurate-estimates-true-costs-sexual-and
2. https://dhsprogram.com/pubs/pdf/FR375/FR375.pdf
3. https://samhita.org/wp-content/uploads/2024/07/FHM-Engage-Improving-Market-System-Performance_July-23-2024.pdf
4. https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-021-02864-9