Today, the world is celebrating the 28th World Population Day. The purpose of observing this day is to highlight the urgency and importance of population-control issues like family planning.
The World Population Day was first marked on July 11, 1990 in more than 90 countries. According to the resolution 45/216 taken in December 1990, the United Nations (UN) General Assembly decided to continue observing World Population Day to increase people’s awareness of population issues, including their relations to environment and development. This year, the day coincides with the Family Planning Summit, which is the second meeting of the Family Planning 2020 initiative.
In 2000, the members of the UN pledged to work towards a series of Millennium Development Goals (MDGs), including the target of a three-quarter reduction in the maternal mortality ratio (MMR) of 1990, to be achieved by 2015. This target (MDG5A) and that of achieving universal access to reproductive health (MDG5B) together formed the basic target for MDG5: improving maternal health.
Globally, the MMR fell by 44% in the 25 years from 1990 to 2015 – from a MMR of 385 in 1990 to 216 in 2015. The number of maternal deaths (annual) decreased by 43% from approximately 532000 in 1990 to an estimated 303000 in 2015 (99% of these deaths were supposed to be in developing nations). In the same period, the approximate global life time risk of a maternal death dropped considerably – from 1 in 73 to 1 in 180.
Nigeria and India were estimated to account for over one-third of all maternal deaths worldwide in 2015. India accounts for 45,000 maternal deaths, that is, 15% of the global count. As a member of the UN, India had also pledged to meet the MDG of reducing its MMR by three quarters within 2015.
In accordance with the UN standards, India needed to bring its MMR down to 109 per 1,00,000 live births. However, it fell short of the intended target and could bring the figure down to only 140. Moreover, as of 2015, India’s MMR was reducing at an annual rate of 4.5%, instead of the required 5.5%.
In 2016, the WHO stated that approximately five women in India die every hour due to complications from childbirth. India is a democratic country and the citizens are not mere numbers – they are real lives. The country is known for its cultural values, rich heritages and its diversity.
Most importantly, we consider our country to be a mother. Not surprisingly, we often can not imagine our lives without a mother. On the other hand, maternal death is the death of a woman during her pregnancy or within 42 days of the termination of pregnancy, irrespective of the cause of death (excluding accidental or incidental causes). Isn’t it shameful if we have to lose our mothers during what’s supposed to be a beautiful phase of their lives?
1. Women with unmet needs
Unfortunately, there are millions of people in our country, especially women, who don’t have access to information or the means to prevent pregnancy. In family planning, an unmet need is defined as ‘the percentage of women of reproductive age, either married or in a union, who have an unmet need for family planning’. Basically, women with unmet needs are those who want to stop or delay childbearing but are not using any contraceptive procedures. On the other hand, using contraceptives to plan families empowers and enables women to complete their education, increase their earning capacities and make better decisions while at home.
2. Child marriage
In India, child marriage is a crime, and the legal age for marriage of girls is 18 years. However, many girl children lack proper schooling due to various social and economic reasons. Consequently, underage marriage among these girls is very prevalent. During the National Family Health Survey (NFHS), 2015-16, 7.9% of women between 15 to 19 years were already mothers or were pregnant. Early marriage, childbearing and pregnancy are very harmful for both the mother’s and the child’s health and can even cost their lives. According to some doctors and family planning experts, a girl should marry only after 19 years and plan their child around 21.
3. Unwanted pregnancies and low age gap between siblings
According to the NFHS in 2015-16, around 13% of women (aged 15-49 years) have unmet needs. Of these, 5.7% have unmet need for spacing. But due to the lack of necessary resources, they end up having unwanted pregnancies. It is no wonder that these women cannot space out their pregnancies. In India, many siblings have an age gap of less than three years. The low age gap between siblings affects the lives of both the mother and the children. Ideally, a three-year-gap between two siblings is most necessary for the health of both the mother and the children.
4. Choice of birth control methods
In our country, there are currently many methods of birth control like sterilisations, oral contraceptives, intra-uterine devices (IUDs) and condoms. Relevantly, the percentage of women between 15-49 years who underwent sterilisation (as of 2015) was 36%. However, in developed nations, sterilisation isn’t that common. In India, it is one of the most common methods, for which even the government pays.
According to UN estimates, India is the second most populous country with more than 1.3 billion people, accounting for 17.86% of the world’s population. Therefore, we need to focus on stabilising our population. To this end, the government aims to reduce the present fertility rate of 2.2% by proper family planning.
5. Diseases and health complications
Women often die as a result of complications before, during and after pregnancies and childbirths. The major complications that result in a majority of maternal deaths include severe bleeding (mostly after childbirth), infections, high blood pressure during pregnancy, complications during child delivery and unsafe abortions. Diseases such as malaria and AIDS also play their roles in these deaths.
Maternal health is directly influenced by family planning. And we need to understand that family planning directly affects the health of the child too. Therefore, the responsibility of family planning should be borne both by the father and mother. More importantly, women need to have a substantial voice in this.
Factors that prevent women from receiving healthcare during pregnancies and childbirths include poverty, distance to healthcare centre, lack of proper information, inadequate services, cultural practices and more. To improve maternal health, quality maternal health services must be made accessible to every woman in need of it. The barriers must be identified and addressed at all levels of the health system.
According to this year’s union budget, the government has planned to set up Mahila Shakti Kendras in villages by allocating ₹500 crore across 14 lakh anganwadi centres, under the Integrated Child Development Scheme (ICDS). This will provide ‘one-stop convergent support services for empowering rural women’. Moreover, as per the nationwide scheme to provide financial assistance for pregnant women, ₹6,000 will be transferred directly to the bank accounts of pregnant women who undergo institutional delivery and vaccinate their children.
We need to ensure that the issue of family planning is prioritised. Awareness must be created among the people. Proper sex educations in schools should be given to both boys and girls. And we must start talking about these issues within our families and in society, thereby breaking the taboos. These measures will lead men and women to be well-informed, who can then collectively make a responsible society.
The government too needs to invest more in family planning. The quality of healthcare should be improved by making primary healthcare centres, sub-centres and hospitals more clean and hygienic. Well-trained staff members and all the required state-of-the-art equipments need to be provided. Most importantly, these facilities and services should be provided at minimum costs. In fact, these can be made free for the poor!
Along with these, front-line health workers like the accredited social health activists (ASHAs) and auxiliary nurse midwifes (ANMs) need to be strengthened. A big portion of our budget is being invested for practices like sterilisation. Instead of assigning budget on the right methods and needs, we are choosing easy shortcuts. For this, we must expand the range of choices for population control measures.
Image used for representational purposes only.