Family planning programmes should be holistic in understanding socio-cultural constraints and responding to diverse needs across different regions of India — and with a cultural understanding of what women want and need.
At around 1.3 billion people, India, the second most populated country in the world, is expected to soon dislodge China to become the world’s most populated country according to United Nations estimates. India’s population growth poses risks to healthcare access, sustainable development and economic growth of the country, factors which in return, will further drive population growth.
Around the world, development is the best method for controlling population. However, family planning programmes play an important supporting role by also improving maternal and child health. These programmes are an integral part of a working health system. They typically increase access to birth spacing and contraception, which has been proven to reduce malnutrition, lower household costs, and lower maternal and child mortality rates, further driving down fertility rates. They have strong ties to gender equality as women are empowered with the knowledge and agency to make informed decisions about their bodies. Women continue their education and careers to the benefit of national economic growth. This improved literacy and career growth reduces the fertility rate, therefore forming a sustained cycle. However, not all programmes have achieved this balance of reaching replacement level fertility while promoting gender equity and improving health outcomes.
Access to family planning methods is a fundamental human right that should be achieved around the world. Research has shown that globally, 153 million women do not have access to family planning services, and over one-fifth of these women live in India where the needs of women are not effectively addressed in family planning. India’s longstanding family welfare programme of 1952 has evolved over the last fifty years to legalise abortion, increase health workers and incorporate maternal and child health services. However, the programme focused on using female sterilisation to achieve population growth targets. This terminal contraceptive method makes up almost seventy percent of contraceptive use. Sterilisation is still incentivised for women and anyone involved in promoting the decision. There is a clear lack of understanding of this procedure and choice of other safer options. Women are fully burdened with the potential risks of the procedure and responsibility of birth control. Meanwhile, ingrained societal attitudes and gender inequalities reduce the use of safer and cheaper male contraception methods such as vasectomies which only makes up two percent of total contraceptive use. Family planning has been misunderstood as only a women’s issue when in reality its success is largely dependent on male involvement. In theory, the programme is intended to promote the health of families and stabilise the population through voluntary and informed choice. But, in practice, the programme has been insensitive to women’s health and reproductive needs and has perpetuated harmful gender inequalities.
In recent years, after intense pressure, the government has shifted its attention to the unmet contraceptive needs of young couples by promoting birth spacing and introducing free injectable contraception. . At the London Summit on Family Planning in 2017, the government of India renewed its commitment to provide access to family planning services, supplies, and information, aiming to fulfill unmet modern contraceptive needs by 2020.
However, birth spacing and reversible contraceptive methods are still rarely used. According to the 2016 National Family Health Survey, 11.7% of married women and 13.4% of sexually active unmarried women use reversible methods. The response to these new options has been mixed due to controversies concerning their efficacy and safety. There are many myths and misconceptions circulating about modern methods and women’s rights groups have opposed the injectables due to harmful side effects. Even with widespread knowledge and better access to modern contraceptives, practices have leaned heavily towards female sterilisation, particularly among young, rural married women. The government is responsible for adequately educating communities and promoting accurate information on a variety of contraceptives. Although various contraceptive methods have side effects and limitations, it is still pertinent that women have the universal right to knowledge of and access to a wide range of options.
Furthermore, the family planning programme should be holistic in understanding socio-cultural constraints and responding to diverse needs across different regions of India. From the perspective of scientists developing contraceptive methods and public sector government distributing them, these technologies must be developed and promoted with a cultural understanding of what women want and need.
Ultimately, there are a number of factors that need to be addressed for family planning to progress: lack of male involvement in reproductive decisions, misconceptions and fears of modern methods, and socio-cultural constraints to access. The narrow focus of the government on unmet contraceptive needs should also expand, so that it encompasses improvements to the overall reproductive health services and public health infrastructure.
The poor reproductive health in India is evident in the very high rate of maternal mortality and the use of high percentage of sterilisation over modern, non-terminal methods. By comparison, in China, where more strong, coercive methods helped reduce population growth, the most commonly used contraception is the intrauterine device (IUD). The United States offers a wider range of contraceptive methods, of which oral contraceptive pill is the most used. These methods promote birth spacing with lower risks to maternal and infant health. The government of India must consider urgent measures to wide family planning efforts and adequately address women’s needs.
First and foremost, there needs to be improved male engagement and responsibility in family planning. On one hand, the public sector should encourage men from a young age to use male contraceptive methods through advertising and education. On the other hand, family planning programmes have not sufficiently advocated for autonomy of young women to access and choose contraceptives. Young wives in particular have the highest risk of infant mortality but often do not have the autonomy to make their own reproductive decisions. A 2016 study found that contraceptive communication and family planning counselling facilitates male involvement in addition to reducing marital violence, a method that can be increasingly implemented through social services.
Second, there needs to be improved education on contraceptive methods and sex education. Reversible modern methods are still shrouded with misconceptions and lack of knowledge. Women should be made aware of complete and accurate information about the methods including risks and benefits. Even when a wide range of options is technically available, specific methods are still reinforced by the providers and the media. There also needs to be more thorough sex education that addresses the sexual and reproductive needs of young adolescents, many of whom still are not well aware of the variety and types of modern contraception.
A major facilitator of this education on contraceptive methods is the Accredited Social Health Activists (ASHA) programme, which has been instrumental in addressing the unmet need for family planning services. ASHAs have successfully mobilised rural communities and increased the use of maternal and child health services. Increased investment in family planning should be funnelled towards increasing the capacity and quantity of health workers who can provide responsive and regular services. Investments in safe and affordable services, skilled service providers, and quality care from reaching out to women to monitoring and evaluation are all crucial for India’s public health infrastructure.
The success of a family planning programme in India is not only dependent on increasing contraception for stabilising population growth, but also improving health outcomes through knowledge and access. An effective programme must empower women to make choices for their bodies and involve men in family planning. The push towards gender equality is a shared mission among policymakers, researchers, service providers and users. Future family planning must engage men and women in recognising that reproductive health and women’s healthcare is a fundamental human right. Only under these considerations and continued investments can India prosper and progress as a nation.
Jessie Huang is a research intern at ORF Mumbai.
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Jessie Huang is an intern with the Observer Research Foundationoffice in Mumbai. She is a junior at Wellesley College near Boston MARead More +