How are multiple sections of society deprived of family planning methods even today?
There are wide disparities and inequities in women’s access to healthcare. The total fertility rate is 2.2 according to the fourth National Family Health Survey, in contrast to wanted fertility that is 1.8. Women in India still endure a 13 percent undesired fertility, these are children born because a couple did not have access to or awareness about family planning. Till very recently, India had only five methods of modern contraceptives with a huge focus on sterilization. The introduction of injectable contraceptives, centchroman, and progestin-only pills was a welcome step that has come after 30 years. Yet, women lack awareness and sometimes do not have access to the spacing methods that are best suited to them.
The government does not have the capacity to provide counseling services…
Sadly, access to health services still depends upon where one lives, how educated or rich one is, and to which community one belongs. This limited and unequal access for women from the most underprivileged communities to reproductive health services is a matter of concern. While women have some legislative protection with regard to reproductive rights, this has not become a reality for many Indian women. Focused efforts like Vasectomy Week to highlight the ease and efficacy of male sterilization and Mission Parivar Vikas to popularise spacing methods in high-fertility states is a positive step to bridge the gap and discrimination that exists. The Ministry of Health and Family Welfare launched Mission Parivar Vikas (MPV – Mission Family Welfare) in 2017 to focus intensively on 146 high fertility districts across seven states — Assam, Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Rajasthan, and Uttar Pradesh. These are districts with a total fertility rate (TFR) of 3 or above and account for 44 percent of the country’s population.
How is family planning the need of the hour with India expected to surpass China and become the most populous country of the world by 2022?
Last year, the World Population Prospects: The 2017 Revision, a report published by the Department of Economic and Social Affairs of the United Nations, suggested that India’s population, currently at 1.3 billion, would overtake China’s 1.4 billion, by 2024. Though the numbers are overwhelming, it fails to capture the nuances of India demography, family planning programme and the ongoing efforts of the government and civil society organizations.
Today, India’s population is much younger than China’s. The average age of India’s population is 28 years, and in China, it is 37 years. More than 50 percent of India’s population is below the age of 25 and 65 percent is below the age of 35 years. The question then is whether India as a nation will be able to capitalize on this demographic advantage in the coming years. Can India do as well, if not better, than China? The answer is not clear when we look at the differences between China and India on health, and in particular, reproductive health indicators. China reports an infant mortality rate of 12; India of 37 deaths per 1,000 live births. China reports a maternal mortality rate of 27 deaths per 100,000 live births, India of 130. China has invested in education, employment and health – the combination is the best pill for family planning. The corresponding proportion is 28 percent in India. Clearly, the investments that China has made in enhancing the capabilities of its people are far more than what India has done. India has to cater to the needs of young people and step up investments in improving health, nutrition, promoting and making available spacing methods of contraception and social conditions.
Why women opt for temporary contraception methods even though they have severe side effects as compared to modern family planning methods?
Every contraceptive has side-effects; the key is to prepare women with information and awareness. The public health system fails to counsel women on contraceptive methods, especially on the side-effects and their management. Therefore, women are unable to make informed choices and often opt for traditional methods or use no method at all. It is a woman’s right to choose the contraceptive method that is best suited to her, after considering all variables, including her age, physical condition, experience with any other spacing method, the disposition of her partner or husband, among other things, before deciding the contraceptive that is best suited to her. PFI advocates to expand the basket of choice and to make as many contraceptives accessible and available to people as a matter of upholding sexual and reproductive rights.
What measures do we need to take to avoid ostracism of menstruating women in the society which takes place even today?
Data shows that girls are largely on par with boys up to adolescence, but with the onset of puberty, outcomes for girls begin to diverge and their mobility and agency are restricted. There are over 355 million menstruating women and girls in India, but millions of women do not have access to a comfortable and dignified experience with menstrual hygiene management (MHM). Most boys are unaware of menstruation; however, what is more, shocking is that 71 percent of girls in India report that they did not know about menstruation before their first period.
National-level efforts to improve sanitation do not prioritize Menstrual Health Management or address regressive norms that ostracise young girls and women, especially the vulnerable population. We need to leverage the instruments of behavior change communication – give adolescents, youth and adults access to entertainment programmes, books, games, plays that exhibit positive practices and its benefits. PFI had released a five-part web-series called Sex ki Adalat that addressed menstruation, among other ‘taboo’ topics like masturbation, pornography, virginity, and sex-selection, without inhibition or reluctance. The subject had been dealt with sensitively and with light-hearted wit, but also with the objective of normalizing this conversation. Policymakers also need to align their efforts and strategies for implementing guidelines at the state level.
How lack of proper family planning measures deprive younger generations of their overall well-being?
As captured in the fourth National Family Health Survey (NFHS-4), in India more than half of the currently married women in the ages between 15 and 19 have begun child-bearing; at least 10 percent had sex before the age of 15, 38 percent by 18 years. Rather than a gateway to hastening sexual activity, sex education is clearly a necessity to prevent teenage pregnancy and risky sexual behavior. In a study that addressed the need for contraceptives among adolescents (15 to 19 years), it was found that 26 percent of unmarried boys and 16 percent of unmarried girls reported being in a romantic relationship with a member of the opposite sex. Lack of knowledge and awareness of sexual and reproductive health leave young people vulnerable to untimely and unwanted pregnancy. This could either add to the burden of teenage abortions or early childbearing, which can be both – a cause and a consequence of dropping out of school. Education empowers them to become beneficiaries of better ante-natal care and this leads to a reduction in maternal and child mortality. These indicators point to the need to ensure that information and services for family planning are available to the younger generation.
What are all we yet to achieve in terms of creating proper awareness around family planning and its significance?
There is a dire need to develop and share information on sexual and reproductive health among young men and women in India. A national study indicates that only 15 percent of young men and women in the 15–24 age group had received sex education, although a vast majority expressed the need for such education. The findings from a recent study by Population Council underscore adolescents’ limited awareness of sexual and reproductive matters – how pregnancy occurs and knowledge of contraception, HIV, and safe sex practices, and maternal and newborn care. Among the older adolescents, only 23 to 24 percent of boys and unmarried girls were aware that a woman can get pregnant at first sex, and hardly any (5 percent to 7 percent) knew that a woman is most likely to become pregnant if she engages in sexual relations mid-cycle.
We also need a change in male attitudes and increased participation in sharing the responsibility of family planning, especially with regard to the uptake of vasectomy. If the unmet need for family planning is fulfilled, the country can avert 35,000 maternal deaths and 12 lakh infant deaths in the next five years. Yet, we continue to be hampered a by the limited allocation of budgets and insufficient spending. The ministry should also invest in behavior change communication and entertainment education as a way to increase awareness and introduce new and positive behavior patterns.
How is family planning directly responsible for overall women empowerment?
Access to contraceptives help in delaying, spacing, or limiting pregnancies, which is not only crucial for reducing risk and mortality of both mother and child deaths, but also improving their health, leading to long-term good health. Spacing births can also have far-reaching effects on the growth of the child, thus leading to a reduction in malnutrition and stunting among children under five years. Birth spacing also helps mothers continue their education and achieve their employment goals, an unintended pregnancy can be a cause of dropping out of school. These, in turn, can have an impact on women’s participation in the workforce, productivity, and overall economic growth. Family planning is also a means to ensure that women have awareness, knowledge, and agency to control and manage their bodies and reproductive choices by accessing contraception.
