Family Planning is a Rights Issue

Starting January 25, thousands of activists and experts from around the globe will gather at Bali, Indonesia, for the 2016 International Conference on Family Planning. It’s an opportunity to take stock of goals that have been met with, and for countries to evaluate how to boost workforces and tweak their approaches toward achieving the new Sustainable Development Goals.

India has a lot to feel proud about. Its population growth rate has dropped considerably – from a near 22% in 1991-2000 to 17.6% in 2001-11. With a fertility rate of 2.3, we are now just 0.2 points away from reaching the replacement level. And the good news is that nearly 60% of our population lives in states where replacement fertility is already reached or will soon meet the target.

That’s the good news. There is plenty however to be done when it comes to how we approach family planning at the policy level. On this count, India lags far behind countries like Sri Lanka and Bangladesh which is surprising given that we were the first country, globally, to have a government-backed family planning program.

For one, India still reports the highest unmet need for contraception worldwide at 21%. In Bihar it is 31% among women between 15-19 years and 33% between 20-24 years. Maternal and neonatal mortality is five times higher among girls who conceive before they hit the age of 20. They are also more likely to experience spontaneous abortions, infections and anemia.

This is largely because on the ground the emphasis on female sterilisation remains extraordinarily high. According to UN data, in India, over 37% of women between 15-49 years use sterilization as a method of contraception. Only 3.1% use a pill and 5.2% rely on condoms.

“The rights perspective on family planning is missing at the policy level and it is high time that this changed”, says Dr Pranita Acharya, gender, poverty and HIV/AIDS specialist at the International Centre of Research on Women. “It is the right of couples to decide when and how many children to have. This is only briefly touched upon at the policy level and forgotten on the ground”.

Other contraceptive choices require counseling and careful monitoring – an investment that most states find burdensome. sterilisation, on the other hand, is a one-time, gunshot intervention. The result is that many women have been sterilized even before they need it.

There is a near complete lack of awareness when it comes to contraceptive choices among married adolescent girls and newly married couples. Filling this gap is critical given that India accounts for 17% of maternal deaths, worldwide. Educating newly married couples about various contraceptive methods could help prevent many more such deaths.
It is also important to involve men in family planning matters, believes Sushma Shende, Program Director, Maternal and Newborn Health, at NGO SNEHA. This will help couples make better informed and collective decisions.

“Considering the socio-economic set-up of the areas in which we work, it is difficult for women to make decisions with respect to FP”, says Shende. “Her husband and mother-in-law play an important role in decisions regarding child bearing and family planning. Moreover, the pressures of bearing and rearing the child is considered to be the responsibility of women so increased awareness amongst the men will make them more supportive and help address misconceptions or fear”.