India’s first step towards family planning
In 1952, India launched its National Family Planning Programme. This was the first milestone in India’s family planning landscape.
And did you know that India was the first ever country in the world to do so?
The National Family Planning Program defined family planning as “reducing the birth rate to the extent necessary to stabilize the population at a level consistent with the requirement of the national economy.”
Since its inception, the family planning programme has undergone many changes in terms of policy formulation and implementation. In the 1970s, the then Prime Minister, Indira Gandhi executed a forced sterilisation programme which eventually made people averse to the idea of sterilisation. The programme received a lot of backlash as people were sterilised against their will and sometimes even without their knowledge.
India made an effort in the 1990s to adopt the principles emphasised at the United Nations population conference held in Cairo in 1994: namely, that the best results were obtained not by setting contraception targets but rather by improving children’s and women’s health and education, as well as by providing a variety of birth control options.
The next milestone was the National Population Policy launched in 2000 aimed at bringing down the fertility levels without setting a specific target. As a part of this scheme, multiple health clinics were built to address sexual and reproductive health-related issues.
Subsequently, the scope of the existing schemes was expanded and new schemes were introduced to improve the state of family planning in India. In 2002, National Health Policy was introduced and then the National Rural Health Mission was also launched, all of which had family planning as one of the important aspects.
What were the implications of these policies?
Even though male sterilisation had been a dominant method of contraception during the emergency, it didn’t contribute significantly to family planning programme outcomes. Over time, the contribution made by male sterilisation contraceptive method has fallen from 8% to 1%.
Even though condoms started gaining popularity post-1990s owing to the dominance of HIV/AIDS, other contraceptive methods like IUDs and injections haven’t really been that popular. This is because there is lack of standard health care systems that can support these methods.
Female sterilisation, too, has been a very contentious issue owing to the lack of adequate care facilities. Women have been dying in mass sterilisation camps because of sterilisation processes.
There is a lot of information gap when it comes to making choices about which contraceptive method to choose from. Only one in three users in India is aware of various contraceptive methods, their implications, and their side effects.
Since the government is the primary supplier of contraceptives in India, public investment on family planning is essential to guaranteeing everyone has access. However, India’s public health spending is among the lowest in the world at 1.2% of GDP.
The current policy scenario regarding family planning in India
Currently, family planning programmes are formulated under the National Health Mission. While the basket of choices for contraceptives has been expanded under the current initiatives, there is still an important aspect that is missing from the current discourse around family planning.
Most family planning programmes almost always put the burden on women. There needs to be a paradigm shift and the existing programmes need to be reformulated to ensure that men and women are equally a part of the family planning discourse. That is to say that men should be held equally accountable too.
The recent NFHS-5 data also states that as less as one in 10 men relies on condoms as a contraceptive. Male sterilisation is safer and easier than female sterilisation. But despite that, female sterilisation is still the most popular method of contraception. In fact, it has increased from 36% to 37.9% in the last five years. On the other hand, male sterilisation still stands at only 0.3%. According to the NFHS-5 survey, 50% of men in states like Uttar Pradesh, Telangana and Bihar think that contraception is a woman’s business and men shouldn’t be worrying about it.
Another important aspect that is still missing from the family planning landscape in India is that the conversation is almost always around population control, and not women’s health and reproductive rights. The conversation around family planning needs to shift from population control to women’s reproductive rights and access to sexual and reproductive healthcare.
But here’s a silver lining
Some states are taking steps in the right direction to encourage safer contraceptive methods. For instance, Odisha has introduced a family planning kit as a wedding gift for newlyweds. The state introduced this initiative under the state’s Nai Pahal scheme as a part of the National Health Mission.
The kit will contain a booklet on methods and benefits of family planning, a marriage registration form, condoms, oral contraceptive pills, emergency contraceptive pills, and home pregnancy test kits.
While this is surely a remarkable step, it is important to understand that contraception and awareness about the same shouldn’t be limited only to married couples. The same needs to be extended to adolescents, and unmarried men and women as well.
Here’s a related read: India Loves Children, But Ignores Reproductive Health