The recently-concluded fourth International Conference on Family Planning (ICFP 2016) in Bali symbolised the importance being given to family planning, specifically to the approach of ‘global commitments and local actions’. The host country, Indonesia, quadrupled its family planning budget from $65.9 million in 2006 to $263.7 million in 2014. This represents 5% of its GDP — and this has important lessons for India.
India is one of the 69 nations committed to the Family Planning 2020 (FP2020) goals. In 2012, at the London Summit on Family Planning, India committed itself to providing 48 million additional women and girls with access to contraceptives, along with a pledge to commit almost $2 billion till 2020. India is supporting its family planning intervention by financing more than 80% of it with international donors providing technical assistance.
At ICFP 2016, India reaffirmed its commitment to the pursuit of its FP2020 goals, with a key step taken last year with the introduction of injectable contraceptives or DMPA (Depot medroxyprogesterone acetate) to the family planning programme. This measure to widen contraceptive choices needs to run alongside equal emphasis on quality of services and the involvement of communities at the ground level.
The criticism that India is not doing enough for its family planning programmes is mainly in the area of implementation. It is time to have a relook at the overall architecture of delivery. The mechanism and capacity to provide quality family planning services and monitoring thereof needs to be strengthened.
Decades of work in family planning and reproductive health has demonstrated that many socio-cultural elements influence the family planning choices people make. These elements are often rooted in power dynamics within families and communities related to gender, age, ethnicity, marital status, and religion.
In 1980, the Kundam Family Welfare Project in Madhya Pradesh was started to increase awareness about family planning and improve maternal and child health. It encouraged community members to identify their own needs and the community contributed 21% of the funds. It encouraged leadership skills among young people and many leaders agreed that the project was much more efficient than standard approaches.
The National Health Mission relies heavily on community involvement in the implementation and monitoring of the programme. Worldwide, community participation is seen as an essential component to promote family planning.
There is an urgent need today to make women aware of all of the contraceptive choices available as well as their pros and cons. This will empower them in making informed choices. As Indian familial structures are complex, there is also a need to educate men about the various options. This requires implementation of behaviour and social change communication and entertainment-education programmes to influence the social norms and practices.
India has seen several successful models of community interventions for family planning and they can form part of national family planning strategies, thus contributing in our country’s development agenda.
However, for this, the government should increase its spending on health to 3% of GDP by 2022. For India to achieve its FP2020 goals, greater political participation is vital. Better support for ASHA workers at the ground level is significant and, most importantly, focus should be given to the education of the girl child, which will bring the much-needed empowerment of women. And there is not a moment to lose.
PD Rai is Member of Parliament from Sikkim
The views expressed are personal