The Way Forward
Gender, Equity, and Social Inclusion (GESI) for client-centered supply chains
by Jodi DiProfio (JSI), Carmit Keddem (JSI), Tanya Mahajan (Menstrual Health Action for Impact) & Pam Steele (PSA Ltd.)
218 million women of reproductive age (between 15 and 49 years old) in low- and middle-income countries (LMICs) have an unmet need for modern contraception.¹ Stigma, overburdened health systems, overstretched staff, a lack of discreet facilities, and poor integration between different health areas — leading to incomplete counseling from last-mile health workers — all compound this global unmet need.
This World Contraception Day 2024, we look at how contraceptive supply chains can serve their clients better. We explore how clients can choose the product they want in a safe, discreet, and affordable way.
Consider the multiple identities and life stages of clients
It is critical to recognize that ‘women’ and ‘youth’ are not monolithic categories. A responsive supply chain aims to serve a diverse and complex group of people, with varied needs and experiences, often overlooked by traditional approaches, categorizing clients into men/women, married/unmarried, rural/urban, or in-school/out-of-school polarities when designing contraceptive services and supply chains. We need to embrace an intersectional approach that considers clients’ multiple identities and life stages. This includes recognizing and addressing the specific needs of young people as they navigate traditional and modern socio-cultural choices in sexual partnerships and those of LGBTQI+ youth, who are often overlooked in traditional family planning programs.
A life-course perspective considers the effect of exposures on health outcomes across people’s life spans from a social, behavioral, and biological perspective. By adopting a life-course approach, we can better understand how contraceptive needs evolve as people transition through different stages of adolescence and early adulthood through more mature life stages.
How, then, can supply chains prepare to serve a rich and complex client base with varying needs?
Apply a GESI lens to supply chains
For supply chains to be responsive, reliable, and resilient, Gender, Equity, and Social Inclusion (GESI) play a central role. Because of richer collective perspectives, gender-balanced teams can call on a broader range of skills to reach remote areas, overcome cultural barriers, and connect with marginalized populations to address the needs of underserved populations. Inclusive teams with gender balance and representation from marginalized groups bring varied perspectives that can ensure that supply chains are designed to deliver products to all clients, regardless of who they are and where they live. Participants in a recent study noted that ‘gender-diverse teams were better equipped to address complex challenges and adapt to changing market dynamics. Moreover, organizations that prioritized gender equality in their supply chains reported higher levels of employee satisfaction, retention, and engagement, leading to improved performance and competitiveness’.²
Remove recruitment barriers, fill decision-making positions
Globally, 70% of last-mile health workers are women, but it is estimated that half of their work is unpaid.³
Women should be encouraged to enter the traditionally male-dominated field of supply chain management, and there is a need for more gender-equitable scholarship programs such as LAPTOP and other opportunities prioritizing women’s supply chain management (SCM) training. Internship programs like Girls on the Move offer young female graduates an introduction into employment in SCM, diversifying the workforce while helping women build careers in the field.
To build more inclusive and effective supply chains, it is crucial to remove barriers to participation, hiring, and promotion and to address gaps in remuneration and workplace conditions to attract and retain supply chain managers from diverse and underrepresented backgrounds. Equity indicators should be put in place within contraceptive supply chain performance metrics and evaluations, as should the proper workplace policies to ensure safety and equal opportunities for women and minority groups in contraceptive supply chain logistics roles.
A Gartner survey found in 2022 that women comprise 39% of the global supply chain workforce, but only 19% of senior executives.⁴ For supply chains to be truly client-centered, people of all genders and marginalized individuals need to be in decision-making positions. For this very reason, projects like inSupply Health’s Workforce Development in Public Health Supply Chains aim to ensure that women and other marginalized populations are better represented not just in the supply chain workforce, but also in leadership positions.
Address distribution and delivery
To increase access for all clients, the total market should be leveraged thoughtfully, including both the public and private sectors, pharmacies, direct delivery, and e-commerce models such as the one used by Kasha in Rwanda to circumvent the stigma around contraceptives. In sub-Saharan Africa, Tiko works with community-based service providers to offer young people access to high-quality health services and products at no cost, enhancing market efficiencies.
Gender-responsive data should be collected and used to inform contraceptive supply planning. Technology, as leveraged by Maisha Meds, for example, could help devise gender-responsive supply chain strategies by enhancing supply chain efficiencies and improving real-time consumer data.
Privacy and discretion should be prioritized, and non-contact distribution methods such as vending machines should be fully explored. Health facilities should be staffed with individuals trained to be nonjudgmental and supportive, and facility staff and community health workers should periodically engage in GESI workshops and training.
Private counseling spaces and gender-segregated and menstrual-friendly bathrooms should be built in. This calls for gender-responsive budgeting to ensure funds are allocated to address specific gender needs and disparities.
Break down silos to build intuitive supply chains
Today, in most parts of the world, women’s contraceptive needs are recognized primarily if they are:
- Married
- Fall neatly into the categories of spacing and limiting (delaying their subsequent pregnancy or deciding to stop having children altogether).
This approach, however, misses the complex nuances of the real SRH needs of unmarried women (young or otherwise) or those experiencing menstrual disorders or symptoms of perimenopause that could be managed through hormonal contraception. Heavy menstrual bleeding, an indicator of several menstrual concerns, is recorded to be as high as 38–78% across LMICs⁵, and endometriosis affects 10% of women globally⁶. Research points to the potential of using hormonal contraceptives for treating menstrual disorders, including heavy bleeding, fibroids and endometriosis. A life course perspective would enable providers to address and resolve the lack of access by verticalizing health areas and target groups. Healthy, open interaction between providers and consumers is key.
This blog is part of a series in partnership with Population Council, Reproductive Health Supplies Coalition (RHSC) and Population Services International (PSI) to recognize World Contraception Day. From product development to utilization and beyond, we power contraceptive choices that meet the needs of women and girls worldwide.
References
- Bearak, J., Popinchalk, A., Ganatra, B., Moller, A., Tunçalp, Ö., Beavin, C., Kwok, L., & Alkema, L. (2020). Unintended pregnancy and abortion by income, region, and the legal status of abortion: estimates from a comprehensive model for 1990–2019. The Lancet Global Health, 8(9), e1152–e1161. https://doi.org/10.1016/s2214-109x(20)30315-6
- Cooper, M. (2024). Understanding gender equality initiatives and supply chain resilience in sustainability practices. Research Square (Research Square). https://doi.org/10.21203/rs.3.rs-4278530/v1
- Gartner, Inc. (2022, May 19). Gartner survey reveals increased representation of women in Supply Chain Leadership roles. Gartner, Inc. Newsroom. https://www.gartner.com/en/newsroom/press-releases/2022-05-19-gartner-survey-reveals-increased-representation-of-women-in-supply-chain-leadership-roles
- Sinharoy, S. S., Chery, L., Patrick, M., Conrad, A., Ramaswamy, A., Stephen, A., Chipungu, J., Reddy, Y. M., Doma, R., Pasricha, S., Ahmed, T., Chiwala, C. B., Chakraborti, N., & Caruso, B. A. (2023). Prevalence of heavy menstrual bleeding and associations with physical health and wellbeing in low-income and middle-income countries: a multinational cross-sectional study. The Lancet Global Health, 11(11), e1775–e1784. https://doi.org/10.1016/s2214-109x(23)00416-3
- World Health Organization: WHO & World Health Organization: WHO. (2023, March 24). Endometriosis. https://www.who.int/news-room/fact-sheets/detail/endometriosis
- Jahanfar, S., Mortazavi, J., Lapidow, A., Cu, C., Abosy, J. A., Ciana, H., Morris, K., Steinfeldt, M., Maurer, O., Bohang, J., Oberoi, R. A., & Ali, M. (2024). Assessing the impact of hormonal contraceptive use on menstrual health among women of reproductive age — a systematic review. The European Journal of Contraception & Reproductive Health Care, 1–31. https://doi.org/10.1080/13625187.2024.2373143
