Planning Families and family planning: challenging inequities and addressing empowerment

I began penning this on the 10^th of October- a day before the world celebrates the International Day of the Girl and a couple of days after most of North India celebrated a festival called ‘Karwa Chauth’. Since 2012, October 11^th has been marked as the International Day of the Girl to highlight issues concerning the gender inequality facing young girls. This day also marks a global movement to recognize the combined efforts required to ensure each girl reaches the goal she sets out to achieve- at school, in society and later in pursuit of a dignified livelihood.

In India, girls need to scale several onerous challenges- that of being able to complete school, avoid being married as children, face inequities in their upbringing, gender violence at home and outside. As someone who has been dabbling in the advocacy and communications space for health and family planning for close to two and a half years now, I am not unfamiliar with the myriad ways in which gender is a foundation for equities and discrimination. Gender inequalities significantly affect women’s access to health and reproductive health services and assertion of their rights. A case in point is NFHS III data that reveals 22% men feel that contraception is women’s business. Studies reveal that contraception decision making often lies with men and male reproductive control of female partners, particularly in the context of intimate partner violence (IPV), can impede contraceptive use and increase risk for contraceptive failure.

Delaying age at first pregnancy, spacing and limiting the number of children helps in empowering women. It allows them to complete their education, enter the labour force, increasing household incomes and assets. It also enhances the capacity of governments to improve human resources and reduce poverty by increasing worker efficiency and household savings rates. The International Conference on Population and Development (ICPD), 1994 underlined the significance of sexual and reproductive rights where more than 179 countries endorsed this and more than 20 years later the unmet need for family planning remains high in developing countries. UNFPA studies conducted in more than 40 developing countries show that the birth rate falls as women gain equality.

I began reading UNFPA’s state of the World Population report, 2017 titled “Worlds Apart: Reproductive health and rights in an age of inequality” earlier this week. It mentions that developing nations with large or emerging youth populations that have been able to reduce gaps in sexual and reproductive health care and promote gender equality also have the potential to reap and maximize a demographic dividend.  In fact, back home, data from the recently released NFHS IV validates that states that have significantly increased their female health workforces in the last 10 years as part of the National Health Mission, have not only witnessed a higher uptake of modern contraceptive methods, but also in reducing child marriages and adolescent pregnancies significantly. 

Like in other developmental arena, the tenets of Rights Based Family Planning assume the AAAQ framework- availability, accessibility, acceptability and quality. Each of these is a universe on its own, and there are gender barriers on each for women to overcome.

In the last few years, the Ministry of Health and Family Welfare has taken concrete steps to improve quality of care of family planning services and methods, especially in the post-Bilaspur (Chattisgarh) scenario and in expanding the basket of contraceptive choices by adding three new modern methods of contraception to the family planning programme. In fact, the recently launched Mission Parivar Vikas initiative takes a micro-planning model to identified high fertility districts- 145 districts in 7 states. However, access to sexual and reproductive health rights is an area that needs inter-sectoral convergence and synergies that cut across government, civil society and private sector involvements. We all need to own up- empowering women, and tangibly addressing inequities needs to go beyond commemoration of specific days and events. You and I need to take responsibility, not shift it…

Population As People

As India marches into the 21st century, the health and wellness of our women is of paramount importance. In this regard, both science and sociology have established that improvements in public health and education have positively affected the nutrition and health of her children and family. Over the last 70 years, we have made visible strides in improving the health indicators for India, however, the time has come for us to join hands and resolve to improve the lives of women through tangible empowerment tools.

One such established tool to empower women and improve their health is to work towards stabilising population. If we take a broad view of the population growth in India over the last three decades, it could be understood by breaking it down into three Ts – T1, T2 and T3:

T1 refers to Too Close: inadequate space between child births puts the health of a woman and her children at grave risks. For every woman who dies of pregnancy related causes, 20 women experience severe illness and morbidity

T2 refers to Too Many (children): unwanted child births take a toll on the health, productivity and life span of women. It is significant to note that the third round of the National Family Health Survey (NFHS III) every woman in India desires around 1.9 children (Desired Fertility Rate). She however, continues to bear 2.3 children (Total Fertility Rate)

T3 refers to Too Early: age at marriage and first pregnancy directly affects population size and women’s health. Twenty-seven per cent (NFHS IV) girls in India continue to be married before they reach 18 years, thus affecting their education and pursuit of optimal livelihood.

The vibrant diversity of our country makes it a unique democracy. We remain committed to view and treat our people as unique citizens with vast untapped potential, not as “numbers” or “subjects” to be controlled.

If we are to remain loyal to the commitments of the fathers of the nation to improve the quality and access to health for all, we need to integrate the government’s effort with support from the private sector and civil society organisations. Women, irrespective of their geographical location and socio-economic situation need to have access to quality health services, and equitable opportunity for education and employment. 70 years is a long time for her to have waited, but she is still hopeful. She is waiting for us to work her out of darkness.