India’s ambition to become a $5 trillion economy by 2025 hinges significantly on women’s contributions to the country’s growth and prosperity. The G20 Presidency in 2023 prioritized “women-led development”. To advance this vision, equitable access to healthcare and increased labor force participation among women are critical. Access to affordable, high-quality healthcare services plays a vital role in achieving the Sustainable Development Goals (SDGs), particularly those related to maternal and child health, education, and economic stability.

The inclusion of family planning services is a strategic move towards economic and social empowerment. Access to affordable contraceptives not only supports women’s health but also enables sustained workforce participation and educational attainment. Globally, family planning has been recognized as a key enabler of improved workforce participation, enhanced earning potential, and a reduced gender wage gap. In India, family planning services are largely accessed through public health systems, limited public insurance schemes, private insurance, and out-of-pocket expenditures.

The Case for Universal Family Planning Coverage in Public and Private Insurance Schemes

One way to expand access to family planning methods is by including outpatient family planning services in insurance benefit packages. The Ministry of Health and Family Welfare (MoHFW) has already implemented policies that provide free or subsidized access to various family planning methods. Under these schemes, contraceptives are procured by the central government and distributed to states and union territories, which in turn provide them to women through public health facilities such as medical colleges, district hospitals, primary health centers (PHCs), sub-centers, and ASHA workers.

Despite these provisions, many women face barriers to accessing family planning methods due to high costs, limited availability, and cultural stigma. According to the National Family Health Survey (NFHS-5), there is an unmet need for family planning among approximately 70 million women in India, who want to adopt family planning methods but cannot do so for various reasons.

India’s flagship health insurance scheme, Pradhan Mantri Jan Arogya Yojana (PM-JAY), covers a wide range of obstetric and gynecological inpatient procedures. However, it excludes contraceptives for family planning purposes. Including contraceptives in inpatient benefit packages post-childbirth or post-MTP (medical termination of pregnancy) could improve access significantly. Moreover, there is strong epidemiological evidence linking the use of oral contraceptives to a reduced risk of endometrial cancer by approximately 50%. The protective effect increases with longer use and lasts over 20 years after discontinuation.

Challenges in Inclusion

While there is a compelling case for including family planning options in insurance coverage, several challenges persist:

• Categorization of Contraceptives: Contraceptive methods are often classified as elective rather than essential, limiting their inclusion in insurance packages.
• Cultural Stigma and Biases: Societal stigma and biases against hormonal methods hinder the uptake of contraceptives.
• Existing Government Provisions: The availability of free and subsidized contraceptives through government programs reduces the perceived urgency of insurance-based coverage.
• Limited Scope of Private Insurance: Employer-sponsored group insurance plans in the private sector often provide minimal coverage, typically excluding family planning services. This creates financial barriers and disproportionately impacts women.

Path Forward: Dialogue and Policy Advocacy

A multi-stakeholder dialogue involving insurers, regulators, policymakers, and industry representatives is essential to address these challenges and create a roadmap for inclusion. Strategies to redesign insurance packages under public and private schemes should be explored to incorporate family planning methods.

Including family planning services in health insurance coverage is a crucial step towards building a more equitable healthcare system that empowers women with a range of reproductive health choices. Removing financial barriers will ensure that every woman has access to the reproductive health services she deserves, ultimately contributing to a healthier and more prosperous India.

It is time for policymakers and insurers to recognize the transformative potential of universal access to reproductive health and act decisively. These steps will help transition from “women’s development” to “women-led development”, ensuring women are equal partners in India’s growth story.

Views expressed by: Maulik Chokshi, Global Director – Health System Research and Policy, ACCESS Health International

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