Public Health

On-time delivery: Ensuring reliable reproductive choice in India

Dr. Sudhir Maknikar

PATH has helped leverage the India Post—the world’s largest postal service—into a full-fledged distribution system delivering access to contraceptives for thousands of people in the state of Odisha.

In India, health systems face many obstacles when moving family planning commodities from state warehouses to towns and villages where health care providers and patients need them most. A lack of reliable transportation and other essentials triggers delays in delivery, severely impacting access to contraceptives. Lack of access—often triggered by failures in the supply chain—is a principal barrier to contraceptive use in the country.

PATH’s India office is working with state health systems, governments, and partners to address the gaps that prevent access to family planning commodities such as condoms, oral contraceptive pills, injectable contraceptives, and intrauterine devices (IUDs). With support from the Bill & Melinda Gates Foundation, the family planning supply chain strengthening project provides technical support to eight states in India to improve delivery of contraceptives.

Leveraging the India Post to meet supply chain challenges

A vehicle designated by India Post to transport contraceptives to towns and villages in Odisha, on India’s east coast. Photo: PATH

In Odisha, on India’s east coast, the state’s health system relied for many years on the services of a state-owned vehicle with a government driver to transport family planning commodities to district warehouses. With only one vehicle for a large state, it took at least three months to deliver shipments to all of Odisha. When a given district ran out of supplies—as was frequently the case—there was no chance for replenishment until the next quarter. Especially for women depending on the state-supplied contraceptives, this distribution system jeopardized their access to and choice in family planning.

In response, PATH analyzed several distribution systems that could supplement the existing one. The choice quickly become obvious: India Post, the world’s biggest postal network. With more than 155,000 offices across the country, it has been connecting the subcontinent for 242 years. In January, the state government used India Post to ship its first-ever consignment of family planning supplies from a warehouse in Odisha to depots in five districts.

An illustration of the flow of family planning commodities through India Post. Photo: PATH

The government of Odisha now uses India Post’s express parcel services to transport small quantities of commodities like IUDs, injectable contraceptives, and tubal rings. Larger shipments of condoms, emergency contraceptive pills, and pregnancy testing kits are still supplied through the state-owned transport.

This powerful intervention has strengthened the supply chain and distribution network for contraceptives throughout Odisha. Overall costs are lower, delivery times are faster, and there are no restrictions on the quantities that can be transported. Since the partnership between India Post and the state government began, the state’s health system has been more successful in meeting the urgent demand for contraceptives.

A boon during the COVID-19 crisis

In Odisha, the India Post and state government staff prepare a consignment of family planning commodities for delivery by India Post. Photo: PATH

Until the COVID-19 outbreak in India, the government of Odisha used both its own distribution system and India Post to supply contraceptives to the districts. But the nationwide lockdown closed borders and restricted the movement of vehicles. Soon, districts sounded the alarm: they were running out of contraceptives.

This is when the India Post proved invaluable. Classified as essential, postal services remained functional throughout the lockdown. Since March, the Odisha government has relied on India Post vehicles to dispatch more than 115 consignments of family planning commodities to about 28 districts, charting a 100 percent rate of on-time arrivals.

The project has also demonstrated the huge potential of India Post as a delivery method for other essential medical commodities. PATH is discussing with the governments of other Indian states how to leverage India Post for distribution of family planning commodities and expand it to strengthen the supply chain across the public health spectrum. The success of this intervention has proven, yet again, that innovative approaches can tackle critical health challenges and improve lives.

Dr. Sudhir Maknikar is Director, Family health at PATH’s India Country Program.

Public Health

Study in Delhi shows most women unaware of methods of contraception

India is the second most populous country in the world with 1.21 billion people, sustaining 16.9 percent of the world population. India was the first country in the world to start family planning program way back in 1952 to facilitate the use of family planning services as a step towards reducing the fertility rates, increasing contraceptive prevalence rate (CPR) and reducing the unmet family planning needs. Despite this, 13% of currently married women in India are not using contraception.

The urbanization and industrialization in different parts of country constitutes a major demographic issue.Study was done on the knowledge, attitude and practice of contraceptive measures among women of reproductive age group (15-49) years in an urban slum in the Dwarka Region of Delhi and data was collected.


The present study is aimed to assess the general awareness of contraception and contraceptive measures among married women in the reproductive age group.

Need For Family Planning

Unmet need for family planning is an important indicator for assessing the potential demand for family planning services. Currently married women who are not using any method of contraception but who do not want any more children are defined as having an unmet need for limiting and those who are not using contraception but want to wait two or more years before having another child are defined as having an unmet need for spacing. The sum of the unmet need for limiting and the unmet need for spacing is the unmet need for family planning. Current contraceptive users are said to have a met need for contraception. The total demand for family planning is the sum of unmet need and met need.


These are some of the key findings of the study

  • Most women (88% of the sample studied) were familiar with male and female sterilization as well as implants, IUD and Pills as method of contraception.
  • Most women surveyed were not aware of the methods to delay pregnancy
  • There was lack of brand awareness of the names of the contraceptive pills
  • They were rarely told by health or family planning workers about the side effects and problems they might have and how to have precautions using the various methods of contraception

Key Inference 

In rural areas, women do not make as much use health services as in urban area’s since they are not aware of it. They also tend to be poorly educated and work as homemakers,service workers or laborers.

Studies in rural area of  Dwarka region in Delhi shows that women are less healthy than women in other urban areas, in addition access to and utilization of healthcare services are lower among women.Hence,providing low income rural women with contraceptives care and educating them remains a challenge of family planning services.


In my opinion more information on human sexuality, conception and contraception should be made available early – at primary school level – to eliminate misconceptions about contraceptives.Adolescent should be empowered to take responsibility for the use of contraceptives, by enlightening them with proper and adequate information about their function, usage and methods. Women should have access to confidential counselling and quality contraceptive information and service, including emergency contraception, where appropriate. Community workshops could be provided by collaborating with different sectors in the community such as the churches, non-governmental institutions, health workers and parents to empower adolescents about sexuality and contraception. This will enhance community participation and address issues of culture. An effort should be made to promote active involvement and participation of boys in the reproductive health services. Parents could become partners in this campaign by playing an active role, rather than be stuck in a cultural quagmire. They could do this through education during initiation schools and participating in campaigns organised by the Department of Health.


Download the full study here 


About the author


Purva Gupta is a Management Graduate in Hospital and Healthcare Management, with specialization in Healthcare Informatics from International Institute of Health Management Research, New Delhi. She is highly motivated professional who loves challenges, possesses decision making, leadership and problem solving skills. Please direct all questions and comments on this article to