India’s young shun use of modern day contraceptives
India is failing its girls and women and here’s why. More than half of India’s population in its reproductive age (15-49 years) doesn’t use a modern method of contraception to prevent unwanted pregnancies or spaced births.
That’s an estimated 45 million women not using modern contraception methods. Of them, 31 million don’t use any contraception and 14 million use unreliable traditional methods that carry a three times higher risk of pregnancy compared to using modern methods.
Despite India’s total fertility rate (TFR) falling sharply over the past decade – from 2.7 children per women in 2005-06 to 2.2 in 2015-16 – India is one of the few nations in the world that registered a drop in contraceptive use (any method), from 56.3% in 2005-06 to 53.5% in 2015-16, shows data from the National Family Health Survey (NFHS-4).
Despite more types of contraception methods (see box) now available free under India’s family planning programme, fewer women are using modern methods of contraception — 47.8% in 2015-16 compared to 48.5% in 2005-06.
“Data shows that adding one contraceptive method in an existing basket of choice results in an 8-12% increase in the use of modern contraceptives. India’s population momentum is from its large cohort of young people who need access to contraception and the government needs to make more temporary methods available,” says Poonam Muttreja, executive director, Population Foundation of India.
India revved up its family planning programme last year by launching Mission Parivar Vikas and adding three more free contraception methods over the past year.
All three methods – three-monthly injectable contraceptive DMPA, a non-hormonal weekly centchroman pill, and progesterone-only pills for lactating mothers – are easy to use and can be discontinued when a woman wants to conceive.
“Twenty-four states in India have already attained replacement-level TFR of 2.1 and below and with the launch of Mission Parivar Vikas in 146 high-focus districts with a TFR of 3 or more, we will accelerate services in the high-fertility states of Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam that are home to 44% of the population,” said JP Nadda, Union minister for health and family welfare.
These 145 districts are home to 33 crore people, which is roughly 28% of the country’s population, yet only 22% couples use protection and the unmet need is 40%. Adolescent pregnancy is high in 115 districts, which raises risk of mother and child death. Half of India’s infant deaths and 25-30% maternal deaths occur in these states.
Experts say it will take at least five decades for the population growth rates to drop to zero. If present trends continue, India’s population will start shrinking by 2070.
“Access to quality family planning information and services, particularly oriented to young people, those who are yet to enter their childbearing years, and those who are in their early childbearing years will ensure that population stabilisation continues its normal trend,” said Diego Palacios, country representative for India, UNFPA.
The new focus on youth has also prompted the government to smarten the packaging of condoms, contraceptive pills and emergency contraceptive pills to “influence demand’.
Fulfilling the “unmet need” — couples who don’t want children but are not using any method of contraception — for family planning over the next five years can halve abortion deaths and bring down maternal deaths by a third by helping women choose when and how many children they want.
The challenge is ensuring that couples make informed choices, which often doesn’t happen. Just 46.5% women using contraceptives in 2015-16 were told about the potential side effects by a health worker, shows NHFS-4 data, though the number of women counselled went up from 34.4% in 2005-2006.
Often, couples want options but shy away from asking, which is when service providers such as the village health worker (auxiliary nurse midwife or ANM) and community health workers (accredited social health activists or ASHA) need to step in and start a conversation with the couple and, if needed, with family elders.
Khushboo Lodi, 21, rarely steps out since she got her 12-day-old daughter Shivyani home to her one-room home stocked with unsold onions in Bandori village in Bhopal’s Phanda block. She fusses over her premature baby, who weighs 1.6 kg against a healthy birth weight of 2.5 kg, and is clear that she doesn’t want another child for two to three years.
The village ANM Baby Raja Chaurasia advised Khushboo to ask the staff nurse at the community health centre in Kolar, where she delivered, for the best reversible contraceptive options for her, and she did.
“Doctor didi put a needle (postpartum intra-uterine contraceptive device, or PPIUCD) in my womb before I left hospital and said I should not worry for three years,” she said.
Sterilisation was not an option.“I want another child, but only after Shivyani is older and we earn more from the fields,” said Khushboo, whose husband Ramesh tills a landowner’s farm.
“Emphasis on temporary and reversible methods of contraception, rather than permanent methods, will help India achieve its population stabilisation goals,” said UNFPA’s Palacios.
Unfortunately, sterilisation is a family-planning legacy that has remained a part of mass consciousness since the dark days of forced sterilisation during the Emergency and the years following it when health workers were given incentives for the number of sterilisations done.
Even now, more than one in three women in India opt for sterilisation to stop conceiving, often because they don’t know of other alternatives.
“That’s changed and we’re accelerating improving access to spacing methods through increasing the basket of choices, assuring services, ensuring there is no shortage of products and closely monitoring the programme so that every state reaches the replacement fertility goals of 2.1 by 2025 across India,” said Nadda.