The importance of family planning in creating healthier families

Implementing the family planning programme should not be seen only in terms of contraception but through methods of achieving the larger goals of maternal and child health

On August 15, Prime Minister Narendra Modi spoke of the challenges posed by India’s population. It is an appeal urging the nation to view family planning as a means to create healthy families, not just as means of population control. This is in line with the International Conference on Population and Development (ICPD) held in Cairo in 1994, which prompted significant change in population and development issues. The essence of this paradigm shift signified that family planning is not an end in itself, but a means to creating healthier families. Post ICPD, many countries, including India, geared towards reviving the blueprint of population and development policies and programmes. The prime minister’s appeal can be seen as urging state leaders to recognise the links between family planning and quality of life. This is not to say we have not seen a decline in fertility. Many states have achieved replacement levels. Nationally the Total Fertility Rate (TFR) is 2.2, when replacement levels are 2.1. Many districts in high populous states continue to have TFR of 3 and beyond, besides a significant difference in rural and urban India.

Family planning is not an end in itself, but a means to creating healthier families (Getty Images/iStockphoto)

Implementing the family planning programme should not be seen only in terms of contraception but through methods of achieving the larger goals of maternal and child health. There are key critiques of the current family planning programme. First, the overreliance on contraceptive specific targets instead of community needs assessment. Second, the continued emphasis on sterilisation and a decline in use of spacing methods, in some states.

The initiatives of the states towards addressing the root cause of high fertility, including early marriages and early pregnancies have been slow. There are massive variations in the initiatives taken by states to curb child marriages. For example, in Uttar Pradesh, only about 21.2% of child marriages are reported and 14% of married adolescents reported using a contraceptive (National Family Health Survey 4). Addressing child marriage — a social evil — is addressing child rights and a definitive step towards population stabilisation. Uttar Pradesh and Bihar need to look at this closely.

This scenario has significant implications on policy and programme priorities in the family planning programme. Uttar Pradesh, which is intending to reach replacement level fertility, and with approximately 20% of its population in the 15-24 age group, it is critical to place greater emphasis on raising the age of marriage and promote spacing methods uptake among young and low parity couples. The key is to start early: Introduce the concept of planning child birth and providing them with knowledge about its implication for health. This must be done with ensuring that information on contraception choices are given.

It is evident that we need to have state and even district strategies. There are many factors which contribute to lowering the fertility rate until the zero-growth rate is reached, the population is stabilised, and negative growth leads to population decline. This phenomenon is currently being experienced in Western Europe and Japan. Such success stories have evidently been based on scientific evidence and research indicating that investments in delaying the birth of the first child, multiple and closely-spaced pregnancies lead to curbing maternal mortality and infant mortality, eventually bringing down fertility rates. Simply, spacing birth is key.

The current scenario should be seen as an opportunity by state leaders and all stakeholders to make course corrections and cash in on opportunities created by the government, like the “Swatchh Bharat to Swasth Bharat” campaign to implement holistic strategies. Keeping spacing methods and choice-based family planning at the heart of addressing health and wellbeing of the women and child. Going one step further, spacing methods and contraception should be seen as central to maternal and child health, and hence, must be merged with maternal health division across all levels of health departments, in the Centre and in states.

Sunil Mehra is executive Director, MAMTA Health Institute for Mother and Child

The views expressed are personal