Woman empowerment is the key to ensure that India successfully reduces the existing unmet need among its women and achieves its goal of population stabilisation soon.

Originally published by Lopamurda Ray Saraswati to Financial Express on March 26, 2019

India has had one of the largest and longest running family planning programmes in the world. Yet we are unable to meet the contraceptive needs of our people, which is not only a serious human rights violation but also severely impacting the country’s growth, development and sustainability. Only half of the married women in child-bearing ages use any contraceptive (National Family Health Survey [NFHS], 2015-16).

A major reason has been the continued focus, in practice, on sterilisation, with limited access to the full basket of available contraceptive choices under the National Family Planning Programme. This reinforces the practice of completing family size before opting to adopt contraception.

One sub-population that is hugely affected is youth – among them, neither an appropriate spacing method is available, nor is there an in-depth awareness of methods. Marriage continues to take place in adolescence for large population of girls, and there is an increasing trend toward pre-marital sex, making the need for contraceptive options extremely urgent.

The easiest solution would be extensive campaigns and outreach to ensure that women, particularly the youth, have access to quality contraceptives. However, this is easier said than done. This is the challenge with which the public health system is battling.

Firstly, the non terminal contraceptive choices available are few and mostly women-centric. Women have to choose between oral contraceptive pills, emergency contraceptives and intra-uterine devices (IUDs). Injectables, which were introduced recently into the programme after a long battle, are still not available regularly.

Secondly, irregular supply of contraceptives at the community level coupled with uninspiring service provision dissuade women from continuing to use a nonterminal method. Lack of respectful family planning services, unmarried couples being denied contraception by frontline workers, or provider bias during counselling or service provision, only worsen the situation.

Thirdly, men are hardly brought into the conversation. They aren’t encouraged to participate actively in counselling sessions, nor are they offered condoms and told how to use them (although we know their affinity for its use!). Other male nonterminal methods are not available – an injectable for men has been in trials, but that will take time to become part of the National Family Planning Programme.

Fourthly, contraceptives like implants, condoms for women, diaphragms, etc. are available in the private sector, but education on these is dismal and thus there isn’t a vibrant market for these products, even among those who can afford it.

The burden of bearing children and managing their own reproductive and sexual health falls on women and the programme has failed to anticipate and address the obstacles that women face during pregnancy, delivery and with regard to other dimensions of women’s health.

The NFHS indicates that the unmet need for contraception has been stagnating for the last decade now. Simply put, unmet need is the non-use of any contraception despite a desire to avoid or postpone child bearing. Currently, more than one in ten married women in reproductive ages (15-49 years) and one in five young women (15-24 years) are not availing any family planning method although they do not wish to have a child at the moment.

Our entire health and social support system need to work towards empowering these women to demand spacing methods. Women of reproductive age need to know their reproductive and sexual rights, the options available and suitable to them and should be treated with respect when they demand or receive these services.

A woman need not succumb to secrecy about her choices and must have an equal voice in deciding the timing of her children and family size with her partner. At the same, the programme needs to orient the service providers to identify and respectfully serve the women with unmet need.

Woman empowerment is the key to ensure that India successfully reduces the existing unmet need among its women and achieves its goal of population stabilisation soon.

Looking closely at the NFHS 2015-16 data, we can infer that, states with the highest levels of unmet need and lowest levels of contraceptive prevalence are also the ones where women’s autonomy is the most compromised. A classic case would be a comparison between Bihar with high unmet need (21%) and Kerala where it is low (14%).

Women in Kerala exercise far more autonomy in terms of decision-making regarding health care, household purchases, visits to relatives, operating a bank account, or possessing a mobile phone than do their counterparts in Bihar. In a nutshell, women who exercise agency in most matters are likely to do so in making family life and contraception decisions.

This year began with the Cabinet Committee on Economic Affairs approving continuation of five schemes under the Umbrella Scheme for Family Welfare and Other Health Interventions, which include an overall outlay of INR 2381.84 crore. One of the schemes under this is the free supply and social marketing of contraceptives.

This comes in the backdrop of the global Partners’ Forum for Maternal, Child and Adolescent Health where the Prime Minister of India committed to increasing health spending to 2.5% of the GDP by 2025.

The Ministry of Health and Family Welfare recently launched the second round of ‘Mission Parivar Vikas’, in 145 districts across seven states (Uttar Pradesh, Bihar, Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam).

The mission is expected to address the existing gap in the reach of family planning services. Together, these efforts are well intentioned and aimed at fulfilling the commitments India made at the Family Planning 2020, London Summit in 2012, in which the country committed to providing universal access to quality family planning services.

But like most global commitments that India has made, the country needs to fast-track their implementation. We need to give women the power of autonomy, choice and respect. And in doing so, we need to make men an equal partner by building closer and more equitable spousal relations.

This will not only address women’s rights to family planning, but also help the country achieve its goal of population stabilisation and a healthy demographic dividend.

(The author of the column is Lopamudra Ray Saraswati, RTI International India. Views expressed are the author’s own.)