In late July this year, India's Union Minister of State for Health and Family Welfare Dr Bharati Pravin Pawar unveiled the India Family Planning 2030 vision document at the National Family Planning Summit 2022. Pawar indicated that the country has achieved replacement level fertility, with as many as 31 states and union territories reaching a TFR (total fertility rate) of 2.1 or less. In the eight years between 2012 and 2020, the country added more than 1.5 crore additional users for modern contraceptives.
So what does this mean? What is the implication? There are three major conclusions one can infer: first, a huge number of unintended pregnancies have been prevented, unsafe abortions and maternal deaths have been averted. India's efforts at Family Planning have been going on for over seven decades now and this period although the country witnessed a shift from the concept of population control to that of population stabilisation, our numbers have grown by leaps and bounds to achieve replacement level fertility (RLF) which means the level of fertility at which a population exactly replaces itself from one generation to the next. This is possible when a woman has 2.1 children on an average.
But even as this is good news for India, researchers feel there is need to do more so as to see significant changes, going forward. Merely achieving RLF isn't "good enough." According to Preeti Anand from India Health Action Trust, in Uttar Pradesh's city of Lucknow, the uptake of modern contraceptives remains "stubbornly low" despite the significant efforts taken by the government to increase awareness, supply and access to contraceptives.
In a research paper focusing on understanding why people (in Lucknow) are or aren’t using modern methods, what drives their decisions, and who influences them, she, along with her colleagues, found "a steep drop-off (59%) between high awareness of modern contraceptive methods and its intention to use, and an additional drop-off from intention to actual use (9%). The qualitative data shows that behavioural drivers including household decision making dynamics, shame to obtain modern contraceptives, and high-risk perception around side-effects also contribute to low intention to use modern contraceptives.
The data also reveals that strong norms and financial considerations by couples are the driving force behind the decision to use and when to use family planning methods. Four years back, Dr Sanghamitra Singh, Population Foundation of India, had highlighted the "need for greater male participation, both, as enablers and beneficiaries of the family planning aspect in a household." As per Singh, "despite serious efforts and progress, India has yet to achieve its family planning goals."
With over half of its population in the reproductive age group and 68.84 per cent of India's population residing in villages, opportunities are plenty but so are the challenges. As per Singh, "It is still an unrealised dream of the healthcare system to be able to reach the last mile, especially women belonging to scheduled castes and tribes in distant and remote parts of the country.
As a result, the mortality among these groups is high."Scheduled tribes in India have the highest total fertility rate (3.12), followed by SC (2.92), other backward class (OBC) (2.75) and other social groups (2.35). Contraceptive use is the lowest among women from ST (48%) followed by OBC (54%) and SC (55%) while female sterilisation is the highest among women from OBC (40%) followed by SC (38%), ST (35%) and other social groups (61.8%). This means that there is an urgent need for universal and equitable access to quality health services including contraceptive methods.
Srinivas Goli from the Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University in New Delhi, studied the estimated impact of reducing the unmet need for family planning on the key maternal and child health indicators in India from 1993 to 2016, and projecting this for the period from 2016 to 2030. In a paper he submitted in last year, to Science Direct, he found that reduction of the unmet need for family planning averted approximately 56 million unintended pregnancies, 7 million unsafe abortions and 167,000 maternal deaths between 1993 and 2016.
It is expected that an additional 41 million unintended pregnancies, 5 million unsafe abortions and 124,000 maternal deaths can be avoided by reducing the unmet need for family planning to 5% by 2030. "It is expected that approximately 24 pregnancies per 1000 married women, 1.6 abortions per million married women, 10 risk adjusted infant deaths per 1000 live births, and 14 under-five deaths per 1000 live births can be avoided by reducing the unmet need for family planning to 5% by 2030."
India has continued its efforts to expand the range and reach of contraceptive options through rolling out new contraceptives and delivering a full range of family planning services at all levels. Yet, a lot more remains to be done. Until and unless the Family Planning services reach the last person at the last mile, India cannot claim a victory in its truest sense.
