Family planning in India has always been looked upon as something that is synonymous with regulating family size and reproductive behaviour. However, in 2012, when India made a commitment at the London Summit on Family Planning, this provided the much-needed impetus to re-imagine the agenda of family planning in India. The revamped family planning vision of reaching out to an additional 48 million new users was seen not just as a ‘target’ but rather as a ‘commitment’ to enable users to choose and plan healthier lives for themselves. The Family Planning 2020 goals promised an increased basket of contraceptive choices for women in the country, equity to the poorest and most vulnerable, and improved service delivery, making family planning a matter of women’s rights, gender justice and equity. It enforced the fact that young people, especially women, must have a say in decisions relating to their reproductive health and not be subjected to coercive practices.
Women’s health is not only about technical solutions or contraception but it’s about women’s agency, choice and quality of reproductive health services.
Wide disparities and inequities in women’s access to healthcare persist. Sadly, access to health services still depends upon where one lives, how educated one is, how rich one is, and to which community one belongs. Here are some telling figures: As against the national average of 73% of women who gave birth in institutions, the proportion of women who had no education was 54%; 55% belonged to the lowest wealth quintile; 57% to the Scheduled Tribes; and 68% of these were rural women, according to the National Family Health Survey III.
According to the District Level Household and Facility Survey (DLHS) III figures, nearly 44 million people in India have an unmet need for contraception. Of the 44 million 16.3 million have an unmet need for spacing and 25.5 million an unmet need for limiting methods.
The quality of care (QoC) is the crucial ingredient that has the potential to bridge the gap between an unmet demand and the supply of services, along with ensuring equity and choice. An expanded base of well-served individuals will translate into increased contraceptive prevalence, thereby accelerating reduction in fertility and mortality.
The elements of QoC — choice of method, interpersonal communication (verbal and non-verbal), technical competence, information, follow-up and appropriate constellation of services — will determine the acceptance and more sustained use of the contraception.
The giant leap of the Union government to introduce the injectable contraceptive to the basket of choice in public health centres is a welcome step. Studies show that increased choice accelerates fertility decline and also reduces maternal, neonatal and infant mortality. However, its success hugely depends on the QoC that would be made available by the government.
An important catalyst to improve QoC is responsiveness to service users. Good quality of care creates demand from clients and ensures satisfied clients, who, in turn, come back for services. This has been demonstrated globally and in India.
To implement an effective and sustainable programme, family planning services need to be convenient and adequately meet the requirements of the consumer. One of the ways of accomplishing this could be through the creation of a hub or a one-stop-centre. The constellation of services — such as integrating family planning into other healthcare services, as a subset of reproductive and child health needs, and adding family planning services along with the routine ones, under the same roof — may attract more clientele.
Some of the requirements that are essential for an efficient QoC in the country are: An adequate infrastructure, requisite clinical competencies, positive provider attitudes, incentives, motivation and an acknowledgement that service providers and field workers are the heroes of family planning.
India plays an important role for the world to reach its Family Planning 2020 goals. It shares 40% (48 million) of the total Family Planning 2020 target (120 million) of ensuring access to family planning services to women and girls by 2020. It can be achieved by creating a shared vision and action plan among the key stakeholders for improved reproductive health and family planning services. For the family planning discourse to be meaningful, there is a need for the inclusion of men, and equal sharing of responsibility for family planning between women and men and increased use of contraception. QoC in family planning should be the major focus area in order to ensure the success of family planning programmes. This calls for all — programme managers, service providers, researchers, and consumers — to advocate and commit to the idea that quality matters. Increased efforts need to be made to understand and motivate providers, improve their performance, and help them become active partners in improving not only access to but also the quality of family planning and reproductive health services. The 22% increase in budget allocation for health over the previous year’s budget estimate to Rs 39,533 crore is a welcome step by the government.
It is imperative for the government to stay the course in terms of a sustained policy environment for family planning in the national development agenda and to keep the momentum of the commitment going. It is critical to ensure that the QoC standards are maintained in order to avert another Bilaspur incident in the country, as well as to establish QoC as a basic human right.
Sanjay Jaiswal is a member of the Lok Sabha
The views expressed are personal