Often, poor or less educated women find themselves facing deep economic, cultural, and institutional barriers to birth control, and turn to risky forms of pregnancy prevention. If they have access to family planning information and services, innumerable deaths can be avoided. For instance, 136,881,000 India women used some form of modern contraceptives in 2019. As a result of this, 53,354,000 pregnancies, 1,787,000 unsafe abortions and 22,000 maternal deaths were prevented.
To be able to plan a family represents a huge expansion of human freedom. Access to family planning measures allow for equal benefits to resources, services and opportunities, leading to gender empowerment.
Addressing gender while evaluating family planning measures such as contraception and voluntarily sterilization ensures fairness. It allows women to manage their choices and feel free to live their aspirations, thereby creating livelihood and better opportunities for themselves and their family. It allows women to freely decide the number of kids and when to have them (spacing and timing of birth), leading to sustainable population growth. This also results in lower fertility and lower mortality rates in women, fewer unsafe abortions and lower occurrences of HIV. It ultimately helps them achieve their desired family size, leaving time and energy for higher education, and productive employment, thus increasing their economic status. Apart from avoiding pregnancies and deaths at an early age, family planning also leads to lesser complications and lower death rate for children (lower death rate avoids ill-health, wasting or stunting).
Without access to contraceptives, women lack the power to decide when to become pregnant, and also are unable to influence other aspects of life such as education, income, safety, and are left in a lurch for their own futures. Family planning thus provides women the right to decide on the number of children and their timing, and to ensure healthy nutritional outcomes for themselves and their children. Family Planning supports women in their right to be free of coercion.
The cascading effect of enhanced family planning measures also allows children to be more educated (as their mothers will already be), thence creating the human capital of a country. Family planning also saves costs. For every dollar invested in family planning services, more than double the amount is saved in pregnancy linked healthcare costs. A recent study indicated that if India meets its family planning commitments for 2020, it could reduce its overall household expenses by US$ 89.7 billion by 2030.
India was the first country in the world to launch a National Program for Family Planning in 1952. Since then, there have been many transformations in terms of policies and implementation. The latest National Family Health Survey-5 (Phase I), 2019-2020, conducted in a sample of 6.1 lakh households throughout India across 22 states/UTs, revealed that the "Unmet needs of family planning have witnessed a declining trend in most of the Phase-1 States/UTs. The unmet need for spacing which remained a major issue in India in the past has come down to less than 10 per cent in all the States except Meghalaya and Mizoram."
Amongst the 17 surveyed states including Bihar, an increase in the use of modern contraceptives of family planning was witnessed. Barring Manipur, all states reported an increase in the availability of information on the side effects of contraceptive methods. However, the contribution of males in family planning continues to be little as noted by the low uptake of condoms and male sterilization across states.
Nevertheless, family planning is also a tool for social change. It empowers women in their households as they become decision-makers in the family, fewer girls drop out from completing their education due to unplanned pregnancies, increases their participation in the economy as they contribute to earning wages alongside their husbands, leading to lower poverty rates, and high economic growth of oneself and the country.
A woman who can plan her family better ultimately is able to plan her life better and make strategic life choices. On the other hand, if women do not have access to reproductive healthcare, it perpetuates gender inequality; because in many communities, women are judged by their child-bearing capabilities, leading to men taking decisions which impact women's lives including the usage of contraception and how big the family would be.
India's FP2020 goal aims to promote access and choice of family planning services. It continues to expand its range of contraception options by rolling out new devices and options, and has also incorporated family planning in its Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCH+A) Strategy. This is intended to create a long term positive outcome at the household level, along with social and economic empowerment.
And by 2030, UNFPA plans to ensure that women all across the world have access to family-planning services without fear, consequences or cost. The governments, private sector, and civil society must contribute towards making this vision a reality.
(The author is an Associate Professor cum Medical Officer of Urban Health Centre at Community Medicine department of the University College of Medical Sciences, Delhi, and also the Hony. Secy. MIYCN-IAPSM)
