Contraception and women’s empowerment: Here’s how safe, reliable contraceptives are freeing women to earn
Safe, reliable and effective contraceptives are bringing benefits that go beyond population stabilisation by keeping girls in school and freeing women to earn.
Women in India are having fewer children than ever before, bringing down the total fertility rate (TFR) from 2.7 children per woman in 2006 to 2.2 in 2016. The decline in TFR, which is the average number of children a woman has in her lifetime, is led by the most populous state of Uttar Pradesh, which showed a decadal reduction from 3.8 to 2.7. Bihar, the state with the biggest families in India, registered a more modest decline from 4.0 in 2006 to 3.4 in 2016.
There was surprisingly no corresponding increase in contraceptive use (any method) during the same period, with women using any method of contraception falling from 56.3% in 2005-06 to 53.5% in 2015-16.
To reach 45 million women not using any modern contraception method — use of which fell from 47.8% in 2015-16 to 48.5% in 2005-06 — the Union health and family welfare ministry last year launched Mission Parivar Vikas in 145 districts across seven states that have the highest fertility rate. These states, which include UP, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam, constitute 44% of the country’s population, so interventions here would have the maximum impact on the country’s population growth.
Along with strengthening quality contraceptive services and uninterrupted access, the programme added three new spacing methods —a three-monthly injectable synthetic progesterone DMPA called Antara, a non-hormonal weekly centchroman pill called Chhaya, and a progestin-only mini pill for lactating mothers – to the contraceptive choices offered to women to prevent, delay and space births.
Much like the birth-control pill drove women’s sexual and economic emancipation in the west in the ’60s, modern contraception is quietly changing lives in India.
“More contraceptive choices, a focused effort to provide information and services to newly married women and post-partum women, a national adolescent health programme, and an emphasis on improving the quality of counselling and follow up care through innovative digital platforms (though not yet at scale) are likely to show significant impact not just on fertility but on the health and empowerment of women, their children and their families,” said Lester Coutinho, deputy director on Family Planning Program at the Bill and Melinda Gates Foundation (BMGF).
Coutinho, whose regional responsibility includes India, cites good practices from the so-called “miracle” economies in East Asia, where access to family planning and other social services brought remarkable change in regional demographics.
“In 1950, the typical East Asian woman had six children; today she has two. Research suggests that the demographic dividend accounts for up to one-third of the rise in income in East Asia between 1965 and 1995, when the annual income per capita in the region (China, Hong Kong SAR, Japan, Republic of Korea and Singapore) more than quadrupled from around $2,000 to nearly $10,000,” said Countinho. “One explanation for this phenomenal growth is that countries simultaneously improved health, education, economic and governance policies, and prioritised expanding access to family planning services,” he said.
Education and economic benefits help society for generations
India’s National Family Health Survey-4 data shows women who have studied for 12 years or more have a TFR of 2.01 children compared to 3.06 for women with no education. “A woman with an education of 12 years or more has her first child at the median age of 24.7 and is more likely to space her children,” said Nitin Bajpai, an independent researcher. The median age of first pregnancy in India is 21.
“Apart from contraception, social indicators that lead to women delaying starting a family and having fewer children are women education and empowerment, delaying the age of marriage, and the family’s improved social status, including female employment, ,” said Bajpai.
“Just delaying marriage and first birth can have a huge impact on not just on TFR and population growth but also on the family’s health, education and income,” he said.
While education and economic independence empowers women to make reproductive decisions that benefit them and their families, they still need modern methods of contraception to prevent, delay and space pregnancies.
Very often, this gap between women’s reproductive needs and contraceptive availability and services is unmet, with the gap being the widest for young and unmarried women, irrespective of age.
“We need to recognise that marriage may not mark the beginning of sexual intercourse in all communities. Barriers like provider biases about contraceptive use or against certain methods impact adolescents and young women more as they are less likely to have information,” said Coutinho.
The challenge is ensuring that women and their partners get all the information. It doesn’t always happen. Less than half (46.5%) women using contraceptives in 2015-16 were told about the potential side effects by a health worker, shows NHFS-4 data. Fear of potential or side effects experienced in the past is a major reason for women discontinuing use.
Safe, reliable and effective contraceptives, however, is expanding the use of modern contraceptives rapidly, which is bringing changes that go beyond population stabilisation.
At a societal level, more girls stay in school, more women are free to work outside their homes and earn an income, which benefits them, their families, the community and the economy.
“Fewer dependents and more adults contributing to the economy help create a national economic boom, which economists call the demographic dividend. Expanding access to modern contraception and family planning programmes is one of the smartest investments a country can make in its future,” said Coutinho.