By Dr Kalpana Apte
Family Planning is one of the fundamental individual reproductive rights. It enables people to take decisions about timing, spacing and number of children they want to have.“Family Planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through use of contraceptive methods and the treatment of infertility [1]”
Included in the first development plan of India, Family Planning has been a part of India’s health care from 1951 onwards. In fact, it has a policy level entitlement, with a commitment of access to Family Planning Services being included in the National Population Policy, 2000. It is further strengthened in the Reproductive Maternal Newborn and Child Health plus Adolescent Health (RMNCH+A) Strategy that was launched under the National Rural Health Mission (NRHM) in 2013.
In spite of this strong entitlement, people, especially the poor, women and young people in India do not have adequate access to a rights based comprehensive Family Planning services. This is primarily due to the approach, as the programme is designed to address Population growth and thus does not lend a rights approach to family planning. Often, Family Planning is seen as a solution to stabilize Population growth and therein lies the biggest problem that the FP programme faces.
Population Growth and its effect on development
India is the second most populous country in the world, with 1,336,286,256 (1.3 billion) people (May 2016), nearly a fifth of the world’s population.
Population Growth in India is not due to the fact that families are large and couples have multiple children. This is now in past. Desire for children per family is declining steadily and women don’t want more than 2 children [2]. Primarily, in today’s times the population growth is due to ‘Population Momentum’.
A large number of youth constitute India’s population; about 30 percent of the population is under age 15. This young age structure creates a powerful momentum for future population growth. Many females will soon enter their reproductive years and have children within the next decade. They require services and due to poor health care services, this has remained a challenge.
Rapid Growth of population results in poor quality of life. Unemployment, pressure on infrastructure, decreased production and increased costs of living are some of its effects. Although, there is a parallel discussion on ‘window of opportunity’ and demographic dividend that this population may offer, due to lack of education and skills poverty and lack of infrastructure – ill health go on increasing and supply can not keep up with demand.
- 36% of women chronically undernourished and 55% are anaemic (NFHS-3). This adversely affect women during adolescence, pregnancy and lactation.
- 47% girls married under the legal age of 18 (UNICEF 2013)
- According to the India continues to record one of the highest prevalence of children under five who are underweight
- High rates of maternal death and illness are clearly linked to poverty.
- When a mother dies, the newborn faces a much higher risk of death – as much as 10 times higher than an infant with a mother’s care [3].
- Additionally, children, particularly older girls, are often taken out of school in order to help in the household or to go to work, perpetuating the cycle of poverty.
- Reproductive health, in particular family planning and maternal health services, can help women and adolescent girls avoid unwanted or early births, unsafe abortions, as well as pregnancy-related disabilities.
- This means that women and adolescent girls stay healthier, are more productive, and have more opportunities for education, training, and employment.
- This, in turn, enhances a woman’s individual financial security and earning power, and families benefit from more stable income.
- Women’s increased participation in formal work will also produce macroeconomic gains due to a growing labour force [4].
All these can directly be reduced by a single most effective intervention – Family Planning
Strengthening FP [5] in India can be achieved through:
- Focus on Young people, whether married or unmarried should be able to access and use a contraceptive method, if they wanted to.
- Addressing the Population momentum by focusing on needs of newly married couples and delaying age at marriage
- Shifting focus from permanent methods to spacing methods
- Encourage involvement of private players in contraceptive service delivery
- Increasing state Budgets for training service providers and task shifting from highly medicalized services to more Nursing and paramedical staff
- Promote male involvement in FP
- Research on Newer Methods of contraception to ensure that more modern methods become available to suit every one’s needs
- Strengthen supply chain to ensure steady supply of contraceptive commodities
Fulfilling the unmet need for modern contraception in developing countries would each year:
- Save the lives of 70,000 women from pregnancy-related deaths (in addition to the 100,000 averted by current modern contraceptive use)
- Save the lives of 500,000 newborns (in addition to the 1.1 million new born deaths averted by current modern contraceptive use)
- Avert 52 million unintended pregnancies (a decline by two-thirds)
- Avert 24 million abortions
Family Planning remains the most economical route to development
Reducing population growth by preventing unplanned pregnancies reduces the costs of meeting key development priorities, including: maternal and new born health, gender equality, elimination of poverty and hunger, education, HIV/AIDS, environmental sustainability, climate change and political instability.
Every dollar spent on FP can save up to 6 dollars for achieving other development goals[6]
Family Planning – a national priority
Empowering women to choose the number, timing and spacing of their pregnancies is not only a matter of human rights, but touches on many issues vital to sustainable development including health, education, and women’s status in society.
Universal access to family planning and reproductive isn’t the only path to sustainable development, but without addressing these issues, the impact and effectiveness of other interventions will be less. The costs of putting in place a sound strategy to ensure every one is able to access family planning is minimal. However, costs to address maternal ill health and deaths are very high.
A successful family planning programme offers multiple benefits.
Health Benefits of FP
- Reduces maternal mortality/morbidity
- Reduces infant and child mortality
- Reduces unwanted pregnancies and abortions
- Key intervention in HIV settings e.g. PMTCT
Social and economic benefits of FP
- Improves women’s opportunities
- Improves family wellbeing
- Mitigates adverse effects of population dynamics on
- Natural resources, including food & water,
- Economic growth
- State stability
FPA India, an ISO 9001:2008 certified national NGO which has spearheaded the family planning movement in India. It has been working with communities for over six decades with the objective of improving sexual and reproductive health and rights with a strong focus on access to family planning services. With headquarters in Mumbai, the Association works through 44 branches spread over 18 states of India, reaching out to the poorest and marginalized groups in the community. It reached out to a total of 23,86,985 people in 2015, and provided 72,29,081 services.
Registered as a charitable organization, FPA India possesses a unique 80G certificate valid for 100% tax exemption. Grants to FPA India qualify under the priorities of Schedule VII, clause 135 of the Companies Act 2013 and the New CSR Act of India.
(About the Author: Dr Kalpana Apte, Segretary General, Family Planning Association of India – the largest and only NGO leading the family planning space is India has spent over 25 years in the organisation taking it to new levels of development.)
References:
[1] WHO – http://who.int/mediacentre/factsheets/fs351/en/ ( Accessed on 8Th January, 2017)
[2] National Family Health Survey 2005-06
[3] Starrs, A. and Ten Hoope-Bender, P. 2004. “Dying for Life.” Countdown 2015: Sexual and Reproductive Health and Rights for All.
[4] Birdsall, N. and Sinding, S. 2001. “How and Why Population Matters: New Findings, New Issues”, in N. Birdsall, AC Kelley, and SW Sinding (eds), Population Matters: Demographic Change, Economic Growth, and Poverty in the Developing World. New York: Oxford University Press.
[5] Factsheet on FP Budget in India developed by FPAI and PFI under the Joining Voices Project supported by IPPF
[6] http://www.gatesfoundation.org/What-We-Do/Global-Development/Family-Planning
