On World Population Day today, the ministry of health and family welfare should be congratulated for committing to enlarge the scope of contraceptive choices to rejuvenate the family planning programme in the country. This move fulfils the long awaited need for expanding the basket of choice in the public healthcare system.
To deliver quality family planning services in a spirit of voluntarism and within a rights and accountability framework, the Government of India has widely disseminated the standards and operational guidelines for sterilisation across the country over the last few months. These steps would improve the access, choice and quality of family planning services for young men and women who need them.
Though, the Indian national family planning programme began in the early 1950s and has seen some notable successes over the years, it continues to face serious challenges of access, choice, gender, equity and quality. Millions of Indian women wanting to practise family planning are unable to do so due to a lack of access to contraceptives. Even among those who have access, a large proportion may find that only a few methods — or indeed none at all — are appropriate.
The need of the hour is a wider choice to suit varying needs of young couples.
Globally, if voluntary family planning is used to its full potential and all unmet needs are met, then contraceptive use can avert well over half of all maternal deaths. This finding has profound implications for policies on maternal health and child survival and emphasises the urgency of meeting the contraceptive needs of an estimated 32 million women in India whose needs are still unmet.
Again, access to family planning can reduce infant mortality by 10% and childhood mortality by 21%. Family planning, is therefore a key intervention to prevent maternal, infant and childhood mortality.
Indian policy makers have historically treated family planning as a means to achieve numbers in a target-driven approach, regardless of the conditions in which the services are delivered. As a result, infections, side effects and needless deaths of women in sterilisation camps continue to afflict and discredit India’s family planning programme.
The key to enhancing the efficacy of family planning is to improve the quality of care in the government health sub-centres, primary health centres, community health centres and district hospitals through which public services are delivered at the ground level.
Such improvements are necessary if all family planning methods popular within Asia and elsewhere are to be successfully introduced in India. These contraceptives would need an assured supply to the end consumer, in addition to a system to provide counselling and after-care, and manage health conditions affecting the reproductive status of women, such as anaemia. The push to raise the quality of health services has to largely come from the state governments, as they are in charge of conditions in which family planning services are made available, even though contraceptives are provided free of cost by the central government. Further, the government needs to encourage states with better developed public health systems to make available additional contraceptives to women to widen the basket of choice. The occasion is ripe because of the recent record hike in states’ share in central taxes, strengthening their finances.
Initiatives of this nature are long overdue. The method mix scenario in our country is not satisfactory. The government currently offers only five method choices to men and women — female sterilisation, male sterilisation, Intrauterine Contraceptive Device (IUCD), oral contraceptives, and condoms.
In contrast, other countries in the region like Nepal, Bhutan, Bangladesh and Indonesia have seven contraceptive methods available, including injectables and implants. But the Indian government has shied away from introducing them into the family planning programme. This deprives women of the much-needed choice, especially those who cannot afford to purchase them from the open market. The government must initiate the dialogue with various stakeholders to allay myths and misconceptions about contraceptives using latest scientific knowledge and evidence.
In this context, it is important to look at global experiences which show that overall contraceptive use rises with every additional contraceptive method made available. The addition of one method available to at least half the population correlates with an increase of 4-8 percentage points in total use of modern methods.
Women in India must have the right to choose their own method of contraception. Ensuring women’s control over their reproductive lives is essential to realising their human rights — in particular, their right to bodily integrity and privacy and the right to make decisions concerning reproduction free of coercion, discrimination and violence.
Honouring their reproductive rights is a much better way to stabilise population growth than government-mandated targets and a top-down approach of family planning. With improvements in the quality of healthcare services across the board and widening the choice of contraceptives, India’s population concerns will take care of themselves.
(Poonam Muttreja is executive director of Population Foundation of India. The views expressed are personal.)