Family Planning: Need for collective action
Family planning is not an alien concept in India; we had a family planning programme from as early as 1952. But we cannot delay action on prioritising the sexual and reproductive rights of couples any more
By 2026, India's population is projected to be 1,339 million and by the turn of the next decade we will be the most populous nation in the world. Though one may argue that our birth rates have been decreasing, our population momentum will continue upwards due to nearly 51 per cent of people being in the reproductive age group of 15 to 49 years. But this is the narrow purview of numbers. In real terms, family planning is an intimate endeavor that should be seen in the larger framework of sexual and reproductive rights rather than an exercise in population control.
Global evidence has shown that family planning impacts both the health and well-being of women and children. According to data, the unmet needs of women in India is 12.9 per cent, that is, about 29.2 lakh women in the country. The Ministry of Health and Family Welfare (MoHFW) has estimated that if this gap is bridged in the next five years, the country can avert 35,000 maternal deaths and 12 lakh infant deaths. Also, if safe abortion services are coupled with an increase in family planning, savings to the tune of Rs 6,500 crore could be made.
Along with quantitative benefits are the qualitative benefits — the empowerment of women which is inextricably linked to the accessibility and availability of family planning services. The simple act of exercising her right to use a spacing method gives a woman control over her body. It encourages her to be involved in household decisions, enables her to enter the workforce, contribute to the income of the household and, therefore, bring improvement to her quality of life. This courage can result in a wave of strong, independent and confident women.
In an average Indian household the dialogue on family planning does not get this far. Negotiating the topic of contraception, even starting the conversation with their partners or husbands, is a challenge for a lot of women. Also, family planning is viewed as a women's issue and, therefore, the responsibility lies squarely on her shoulders; ironically, without any autonomy to make decisions. The lack of the husband's involvement is not only unfair but a violation of women's sexual and reproductive rights and their health. Husband's involvement does not only mean the use of contraceptives — about 11 per cent men in India use condoms and sterilisation is even lower at 0.3 per cent. We need the men in our country to become allies of their wives in accessing family planning and health services.
We need more men like those from the Chhatarpur village in Madhya Pradesh. Men of this village, who earlier would physically assault their wives and preferred a male child, have now become empathetic partners and believe that the girls and women in their community can achieve anything. The transformation was a result, in part at least, of these men watching the error of their ways being mirrored to them through the edutainment programme Main Kuch Bhi Kar Sakti Hoon. These men are using the method of songs to spread the message of family planning, women's empowerment and gender justice in and around neighbouring villages.
In 2015, the MoHFW made the road to accessing family planning, especially spacing, more accessible by adding three new contraceptives: Centchroman, Progestin-only pills, and Injectables to the basket of choices. Although the roll-out of the new methods was delayed, the Government's Mission Parivar Vikas programme in 146 high-fertility districts has increased the focus on spacing methods.
The 2014 Bilaspur tragedy where 16 young women died due to gross medical negligence was a result of the failure of quality of care. The news was disruptive, to say the least, and resulted in the Devika Biswas vs Union of India ruling. In September 2016, the Supreme Court called for sterilisation camps to be replaced with Fixed Day Services (FDS) in three years. It also called upon State Governments and Union Territories to ensure that family planning was not target-based and made recommendations to improve the implementation of these programmes.
Reports of negligence are still common, though. Recently, 29 women who had undergone sterilisation in Chattisgarh became pregnant. However, we do have examples of the successful implementation of fixed-day services like in the Jehanabad district of Bihar. Using the District Working Groups (DWG) model coupled with FDS, a seamless shift has occurred towards positive family planning practices.
Family planning is not an alien concept in India. Ironically, we were one of the first countries to have a family planning programme as far back as 1952. We institutionalised the concept and created the inverted red triangle that has now become the universal symbol of family planning. But today, we have reached a point where we cannot delay the action on prioritising the sexual and reproductive rights of couples. This is a shared responsibility and we need to act collectively. Planning a family is not just a woman's issue — it is also a man's issue too, it is society's issue, a moral issue and an ethical issue. It is an issue of social justice and human dignity.
(Poonam Muttreja is the Executive Director of Population Foundation of India; Catherine Rhea Roy is Media and Communications Officer Population Foundation of India.)
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