How Enhanced Engagement With The Private Sector Can Expand Access To Family Planning And Bring The World Closer to Universal Health Coverage

The promise of universal health coverage (UHC) is as inspirational as it is aspirational: according to WHO, this means that “all people have access to the full range of quality health services they need, when and where they need them, without financial hardship”. In other words, “leave no one behind”. The global community has set out to achieve this promise by 2030, and nearly all countries have signed on to fulfill it. But according to latest estimates, 30% of the world still cannot access essential health services, meaning more than two billion people are currently being left behind.

Among those left behind are hundreds of millions of sexually active girls and women in low- and middle-income countries (LMICs) who are seeking to avoid pregnancy but lack access to modern contraception. Despite being considered a key element of primary healthcare and linked to a range of positive health outcomes – from lower maternal and child mortality to improved nutrition and longer life expectancy – family planning remains out of reach for too many people in too many places, stifling the promise of UHC and jeopardizing healthy futures for countless families and communities.

This year marks the midpoint moment for the realization of SDG 3 and the whole 2030 Agenda for sustainable development (SDGs), so it is an opportune time to take stock of progress, double down on best practices, and try out new solutions to fill the gaps that remain. With 218 million girls and women in LMICs who want to avoid pregnancy but are not using a modern method of contraception, the reality is that we will not meet our family planning goals without new, innovative approaches to delivering or facilitating care. One approach – hardly new, yet often overlooked – is proactive, intentional engagement with the private sector: an under-tapped resource in the family planning movement.

When people seek to prevent pregnancy by using contraception, they turn to a wide range of methods and service delivery points. In most countries, these service delivery points are typically government clinics and pharmacies, but 34% of women and girls in LMICs access their contraception from the private sector – particularly young, unmarried clients seeking short-acting methods like condoms and pills, and those living in higher-income, urban communities. Even in countries dominated by public sector service provision, family planning commodities might be produced, supplied, distributed, and/or promoted by private sector entities, with many local private brands and information providers enjoying high levels of trust across a wide range of communities. And increasingly, private insurers and employers are offering health coverage packages that include contraception, which may only be available to clients of higher income and employment levels, but provide emerging avenues of access and cost-sharing through engagement with the private sector.

While often referred to in aggregate (“the private sector”), this collection of companies and service providers is diverse, dynamic, and deeply entrenched in both family planning and health systems more broadly – representing an important asset in countries’ efforts to overcome unmet need for contraception and achieve UHC. In fact, many national governments have started to acknowledge this potential and outline specific roles for the private sector in family planning: Nearly all FP2030 commitment-makers have called on the private sector to carry out key functions in their family planning ecosystem, including financing and insurance, workforce development, supply chain and logistics, data, marketing, awareness, quality improvement, ICT, and several others areas crucial to the realization of national family planning goals. Such prioritization and specificity of private sector engagement by LMIC governments signals a new era of openness to a “total market approach,” where health system stakeholders can maximize the efficiency, equity, and sustainability of family planning efforts through cross-sector coordination, placing the country farther along its pathway toward UHC.

Given the size and scope of the private sector in family planning and the expectations set for it by national governments, there is an opportunity to bring these vital actors to the table in a more meaningful, mutually beneficial way – one that harnesses their innovation, expertise, reach, resources, and influence to make sure nobody is left behind. Of course, such engagement is not without risk: there are many examples of private sector entities providing poor quality products and services, charging unreasonably high prices, operating outside of regulations, exacerbating inequities, and conducting business in an otherwise unethical manner. With meaningful engagement, the family planning community and the private sector can navigate these risks jointly and successfully to realize the promise of family planning for all who want it and position family planning as an essential element of UHC.

Private Employer Coverage Opportunities for Family Planning

One approach to expanding access to contraception through the private sector exists in its role as an employer. When companies take on new policies to promote gender equality, women’s empowerment, health and wellbeing, and other goals within their workforce or supply chain, they can ensure that family planning is included – potentially covering thousands of employees at once. The Universal Access Project, for instance, has mobilized more than 20 companies to integrate SRH and family planning into their packages of health services for workers, expanding access to more than two million female supply chain workers across 17 countries. Some participating companies found that these policies also increased productivity, reduced absenteeism, and improved worker-manager relations, giving them both social and financial reasons to sustain the commitment. Through innovative workforce insurance coverage models like these, the private sector can contribute to the community without compromising its bottom line, all while easing the burden on governments to serve certain segments of the population.

Private Sector Digital Health and Self-Care Innovations in Family Planning

The private sector can also help bridge access gaps in family planning through digital health and self-care. When it comes to a sensitive topic like SRH, it is often difficult for health systems to reach certain communities whose sexual activity may be stigmatized – like adolescents and youth, unmarried women, LGBTQIA+, and others. At the same time, there are dozens of fragile and emergency settings without the infrastructure for formal health services, limiting access to family planning. This is where private sector innovation comes in. The budding landscape of startups and technology firms in global health has pioneered a range of digital health solutions that facilitate confidential SRH conversations, information-sharing, service delivery, or care connections between clients and their providers, bypassing traditional barriers to family planning for hard-to-reach groups. There has also been a proliferation of private self-care solutions in family planning that place SRH in the hands of girls and women – enabling critical interventions like injectable contraception or oral contraceptive pills to be sustained even in the face of conflicts, pandemics, and other emergencies.

Driving Demand and Uptake through Private Sector Channels

One final area in which the private sector offers potential for aiding the global push toward 2030 is in demand generation for public health services such as family planning. There is a reason why bottled soda and mobile airtime are more accessible in many rural, low-income communities than basic medicines – and why local authorities, at times, depend on such private sector channels to accomplish public health goals: consumers want them. Social marketing organizations and private franchises understand this, and many have become reliable drivers of contraceptive uptake in LMICs through promotional activities that are proven to expand both access and choice in family planning. By pairing public health messaging with credible private sector brands and their direct-to-consumer marketing channels, the family planning community can enlist the private sector as a facilitator of demand and awareness in public health systems and a key partner in achieving universal access.

Looking Ahead to 2030

By no means comprehensive, these areas of private sector engagement in family planning – employment policy, digital health, self-care, and demand generation – offer valuable models for expanding access to comprehensive family planning and SRH options for girls, women, and others currently being left behind under the status quo. The family planning community should seek to activate a new generation of private sector partners in this ever-important movement.

• For donors and civil society organizations, this could mean greater openness to including the private sector as an implementer in family planning programs – perhaps leveraging private sector infrastructure for last-mile distribution or mobile platforms for direct-to-consumer care and data capture.
• For governments and policymakers, this might mean exploring policies, regulations, incentives, and partnerships that cultivate an enabling environment for private sector innovation, or that carve out specific responsibilities, channels, or market segments for private sector partners.
• For researchers and academics, this might necessitate the creation of new evidence to quantify (and qualify) the impact of private sector contributions and the social or economic advantages of investments in family planning – all of which would help partners optimize their engagement with the private sector.

Instead of competing with the public sector or undermining decades of public health investments, these approaches can be designed to complement or supplement efforts of governments, donors, civil society, and other partners, thereby reaching more people without further straining low-resource health systems. As 2030 quickly approaches, the world cannot afford to pass up opportunities to expand access to family planning and healthcare for all. If we hope to extend the promise of UHC to everyone, the private sector must be a part of – and a partner in – the solution.