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Digitizing Contraceptive Supply Chains: Empowering Women and Saving Lives Across the Developing World

Unintended pregnancies threaten to shatter financially deprived households. They force women to forgo their education to care for a child, and rip away any semblance of autonomy they had before. This is the likely reality for 214 million women across the developing world who cannot access contraception, resulting in 111 million unintended pregnancies every year. 

Given that developing countries import a significant portion of their medical commodities, the presence of contraceptives in healthcare facilities hinges on the functionality of contraceptive supply chains. However, barring a few countries, lacking investment and international attention has meant that many developing nations operate their supply chains with a completely paper-based approach, characterized by opaque operations and a lack of coordination. Estimates suggest that these inefficient, outdated supply chains lead to contraceptive shortages that are responsible for up to a third of unmet needs for contraception. It is thus imperative to look at digital supply chain technologies that have been implemented so far and rapidly democratize their presence across the developing world.

The issue with manual supply chains

Contraceptives get lost in manual systems that lack data transparency.


Within these systems, data regarding stock status (whether it has been delivered, what stock levels are, and so on) must be shared between supply chain levels physically. This results in unpunctual and uncoordinated reporting. For instance, in Angola, reports of stock status must be physically collected from clinics and pharmacies before they can be shared with managers higher up the chain. Resulting from this are disastrous delays, wherein it takes up to 6 weeks to even notify administrators of a stockout, forcing women to go to facilities that are incessantly stocked out. 


This reproving lack of data creates an industry that acts like a black box, leading to two implications. Firstly, the willingness of manufacturers to produce contraceptives is depleted. When manufacturers are unable to ascertain consumer behavior through data indicating consumption levels, or obtain information about whether their products have been successfully delivered, they are more likely to produce leaner stocks. This compounds existing disincentives to enter developing world markets, given that they yield comparatively lower profits. Secondly, it becomes harder for the myriad of organizations involved in family planning supply chains, such as international organizations, foreign governments, and national agencies, to coordinate with each other. When there is a lack of shared data amongst these actors, collaborating for pooled procurement programmes or targeted interventions becomes near impossible, robbing women of provisions that could be transformative for them. In culmination, this system fosters an environment wherein current contraceptive supplies seldom reach women, and any progress in their distribution is terminated.



Dysfunctional supply chains restrict access to contraception, rendering women helpless in the face of pregnancies that could devastatingly alter their life-course.  Pregnancies often result in fatal complications during the gestational period, and heighten vulnerability to life-threatening diseases. These debilitating degradations to women’s health become far more egregious when they are caused by a pregnancy women never opted into. Additionally, extreme economic deprivation means that an overwhelming portion of women have to engage in transactional sex to survive—as a result, these pregnancies disproportionately impact the most vulnerable women, who do not possess the means to protect their wellbeing. Strengthening contraceptive supply chains could guarantee women the lifeline they are entitled to.

The integration of technology into supply chains

Progress so far has included the creation of national and global databases that track the supply and shipment of various contraceptives, like the Contraceptive Security Indicators Dashboard, or the Global Visibility and Analytics Network (GVAN). These platforms track the flow of products through contraceptive supply chains, the extent of involvement of the private sector and NGOs, and how they collaborate. Their role in promoting data transparency has been massive: in 2022, GVAN helped identify a funding gap of $100 million needed to procure adequate contraceptive supplies. The platform’s data was used to correct for this, allocating $33.3 million new products to avoid severe stockouts. In the long run, these platforms could be adapted to help groups of countries coordinate the pooled procurement of contraceptives, massively increasing supply and decreasing prices. 

 

Past the international scale, governments have also developed data capture methods at national levels. Pakistan piloted the Contraceptive Logistics Management Information System (cLMIS), a national database to input supply chain data, sending monthly updates to finish reports along with alerting managers about stock outs via SMS. In Ethiopia, data was used to verify which products were in highest demand, enabling the government to ration them out more effectively.


However, the presence of these platforms serves no purpose if it is inconvenient for workers to input data on stock levels and instigate corrections for shortages. Systems like Drugs Out of Range (DOOR) in Angola aim to fill this gap, creating data velocity till the last mile. DOOR consists of devices installed at healthcare facilities that allow workers to send instantaneous alerts regarding stock emergencies, by the press of a button, to managers who were previously too high up the chain to access. During the pilot run, as a result of workers being able to make contact with managers, actions to revert stock issues became far more likely: 80 percent of button presses received follow up calls from managers, and 67 percent of low stock alerts led to prompt special deliveries. 


Looking to the future, as Artificial Intelligence (AI) improves, it is pivotal for it to be applied in contraceptive supply chains. Currently, attempts at creating predictive models have been unsuccessful due to poor algorithms and lacking data. Using advanced AI can aid healthcare centers, enabling them to plan for the future and avoid stockouts: for instance, 80 percent of stockouts in pharmacies can be preemptively detected using machine learning algorithms. AI could be especially transformative in countries where supply chain managers often lack training in data analysis to produce their own demand forecasts and adjusted supply plans. Additionally, in contexts of more frequent crises, family planning initiatives are often the first to receive funding cuts. During the COVID pandemic, the UK’s largest cuts in funding for international assistance went to family planning programmes, causing millions of unintended pregnancies and unsafe abortions. AI could aid developing governments in rapidly adjusting contraception distribution, and better predicting and planning for future constraints.

Conclusion

In countries with frail health infrastructure and struggling social safety nets, the role of contraception granting women control over one of the most consequential events in their lives is immense. 

Current efforts to digitize supply chains have yielded promising results, increasing the presence and quality of pivotal data. However, there is still a long way to go. A lack of internet infrastructure in developing countries means that connectivity issues are frequent, rendering platforms and programmes less effective than their potential. Additionally, progress is happening too slowly: technologies used to digitize supply chains are fairly basic, and have already been implemented across the developed world. That makes their widespread absence in many developing countries even more unjustified, and calls for greater investment and attention. It is time to digitize contraceptive supply chains in the developing world and guarantee women the autonomy and freedom they are entitled to.


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