By Choice, Not By Chance

By Choice, Not By Chance

In 1975, 50 years ago India entered what many refer to as the darkest years of its life. Political opinions apart it was the Emergency period in 1975 that is very often remembered for the sterilisation campaigns that marked the family planning blitzkrieg at the time.50 years later it is time to look at what has changed for India and its people and its family planning outcomes.  India’s population today stands at 1.252 billion people and growing. [i]

Background:In 1952, India launched the world first national program emphasizing family planning to the extent necessary for reducing birth rates “to stabilize the population at a level consistent with the requirement of the national economy”. Since then, the family planning program has evolved and the program is currently being repositioned to not only achieve population stabilization but also to promote reproductive health and reduce maternal, infant & child mortality and morbidity.[ii]

Factors influencing Family Planning in India:

·         Unmet needs for family planning- At 21.3% this unmet need means women who want to space by 3 yrs. are underserved.

·         Early age of first Marriage -Delaying the age at marriage and first child birth could reduce the impact of population momentum on population growth.

But all is not dark and gloomy in the area of family planning.  National Family Health Survey data (NFHS 3) data shows that the awareness about family planning is almost 99% in men and women alike. There has been adecline in fertility rate to 2.3(Sample Registration Survey 2013).Use of contraceptives is rising and shows arise by almost 8.1 percentage points.

The government has moved from a target based approach to a more voluntary approach with ‘children by choice ‘being the mantra as against by ‘children by chance’.  The communities are being encouraged to adopt free choice and are being offered an expanding choice of contraceptives both for spacing and limiting their families.

SNEHA is an urban Health NGO that works on four programme pillars, Maternal and Newborn Health, Child Health and Nutrition, Adolescent Health and Sexuality and the Prevention of Violence Programme and has been working on the issue of Family Planning in the Rajiv Gandhi Nagar area in Dharavi in Mumbai since 2011.

SNEHA has a strong community presence and the SNEHA model of family planning uses peer education as the dissemination vehicle to change health seeking behaviours. At SNEHA we follow the cafeteria approach, where women are given the autonomy to choose and make an informed choice. SNEHA also works with Men’s Groups. In our work thus far we have seen in one of our intervention areas an increase in Contraception Prevalence Rate (CPR) from 35% in 2011 to 41% in 2014.  All our work points to the need for enhanced involvement and responsiveness of the health facilities and an uninterrupted supply and the availability for safe spaces for advise and intervention.

Family planning has long term repercussions on economic, social wellbeing of citizens, esp. the poor and vulnerable. Evidence in most low income countries show that spacing of deliveries helps to improve a mother’s health and consequently reduces the chances of babies being born of sub optimal weight. We see that in our work in Dharavi.

As a society we need to understand the socio/cultural/religious context of fertility behavior and sexual decision-making and to engage community “power brokers” and decision-makers in dialogue about family planning and optimal birth spacing. Programs should involve male partners and other individuals that can create an enabling environment for optimal birth spacing.[iii]

A lot can be done and a lot needs to be done. The Sustainable Development Goals have absorbed family planning within goal 3 and 5. Goal 3 talks of health for all at all ages and Goal 5 which calls for Gender Equality and Empowerment of Women and Girls. The new Global Investment Framework for Women’s and Children’s Health emphasizes how investment in family planning contribute to significant reduction in maternal mortality.[iv]

The new CSR bill has health as a big investment area and companies who support family planning will not be supporting family planning alone but a more holistic investment will be made for improved maternal outcomes and subsequent better family and community outcomes.We are facing a pool of 315 million youth, men and women who will be the families of the future. Educating them about their rights and responsibilities regards gender, sexuality and reproductive choices will help stabilize our population growthand healthy communities.  The issue needs a strategic approach and financial outlay and companies can play their part

Companies canexplorea Public Private Model of Partnership to ensure supply and distribution to meet the demand and the public systems can provide the infrastructure and the health personnel to address the issue. Companies can provide centres where procedures can be carried out and messages on family planning can be delivered.  Companies can also be at the forefront of influencing and lobbying with the government and poilitical will to ensure family planning is made the responsibility of every free citizen of India and thus close the gap between the desire to space and the reality of birth spacing patterns by addressing the precursors to change at the individual, community and service delivery levels.  There are only a handful of companies that address the issue of family planning and it is important that family planning is subsumed within the larger goal of improved maternal and child health outcomes that companies are committing monies to.

India is facing a burgeoning population and if all stakeholders collaborate effectively we can be at the forefront of change. The costs are affordable and the returns are high and the time is now.

About the author

Written by Sharmila Kher.

Supported by Anuja Jayaraman ( Director , Research) Sushma Shende ( Director, Maternal and Newborn Health Programme) Ujwala Bapat( Programme Coordinator, Family Planning Programme) www.snehamumbai.org

SNEHA (Society for Nutrition, Education and Health Action)

310, 3rd floor, Urban Health Centre

60 Feet Road, Dharavi, Mumbai 400017

Tel : 91 22 24042627 / 24086011

 


[i]  World Bank

[ii]http://nrhm.gov.in/nrhm-components/rmnch-a/family-planning/background.html

[iii]http://www.coregroup.org/storage/documents/Workingpapers/smrh_OBSI_Overview.pdf

[iv]http://www.who.int/maternal_child_adolescent/news_events/news/2013/Investment-framework-mnch-presentation.pdf?ua=1

 

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