New Delhi: At a time when the central government is planning to introduce the Population Control Bill, “India’s Vision Family Planning 2030” document has said that teenage childbearing and child marriages remain a cause of concern for the country,
Over 118 districts reported more than 10 percent teenage pregnancies. These districts are mostly concentrated in Bihar (19), West Bengal (15), Assam (13), Maharashtra (13), Jharkhand (10), Andhra Pradesh (7), and Tripura (4). Additionally, over 44 percent of the districts in India reported more than 20 percent women marrying before they reach the age of 18 years.
These districts were in Bihar (17), West Bengal (8), Jharkhand (7), Assam (4), 2 each in Uttar Pradesh, Rajasthan and Maharashtra. Coincidentally, these districts also experience low rates of modern contraceptive use. The vision document has highlighted that the use of modern contraceptives among married adolescents and young women remains low.
In the National Family Health Survey 2015-16 (NFHS-4), only 7 percent married adolescents and 26 percent young women were using modern methods of contraception, which increased to 19 percent and 32 percent, respectively in NFHS-5. Both married adolescent girls and young women reported a high unmet need for contraception. In NFHS-4, 27 percent adolescents and 21 percent young women reported unmet need for contraception, which declined to 18 percent and 17 percent respectively in NFHS-5.
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“While multiple factors have been identified that explain low contraceptive use among married adolescents and young women, two most important factors are child marriage and teenage pregnancy,” the Family Planning document said.
Migration and family planning
The reasons for the non-use of contraceptives among women with migrant husbands were mostly driven by lack of contraceptive preparedness before the husband’s arrival, inability to procure contraceptives due to inaccessibility to health facilities, and stigma around procuring contraceptives when the husband was away. Other migration-environment-related reasons included low frontline health worker outreach, myths and side effects of contraceptives, community fertility norms, and poor spousal communication around family planning.
Challenges due to climate change and disaster
The increasing incidences of extreme weather events, particularly, floods every year, are compounding the impacts of climate change. Larger populations and high fertility areas impact the climate crisis and alternatively, the climate crisis, in turn, augments the FP/RH needs of the country. Owing to high migration (due to climate change) the planning and reproductive health (FP/RH) require addressal in terms of contraceptive access, availability of a resilient health system that prioritizes FP/RH.
Accelerating the engagement of private sector
As the country has been witnessing major demographic shifts, the challenge still remains in improving access to contraceptives for young people. In this new era, the importance of the private sector in achieving FP goals is thus becoming increasingly apparent. The presence of the private sector in India cannot be undermined as it consists of 58 percent of the hospitals in the country, 29 percent of beds in hospitals, and 81 percent of doctors.
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NFHS-5 reveals that the private sector is one of the important sources for provision of modern contraceptives. Private sector contributes to 45 percent share of pills and 40 percent share of condoms. For other reversible contraceptives like injectables the share is 30 percent and for IUCD it is 24 percent. Sterilization services however are largely provided by the public sector in India.
“Improving sexual and reproductive health among young people requires comprehensive efforts and actions from various stakeholders. The FP 2030 paradigm will only be complete when its architecture is framed, and components are designed with the active engagement of the adolescents,” the vision document said.
Currently, around 10 lakh Accredited Social Health Activist (ASHA) workers are playing a pivotal role in addressing the changing family planning needs of the population. Male engagement critical for family planning: Reproductive health is a collective responsibility of the couple. Evidence shows that engaging men can improve program outcomes and increase gender equality. While working towards women empowerment, it is critical to also empower and educate men on FP so that they can be responsible partners, family members and friends.
A fact sheet compiled by the vision document has found that Uttar Pradesh which is the most populous State needs to strategize on improving modern contraceptive services for addressing the low contraceptive use, especially in the younger age group. It said that the state needs to focus on the quality of counseling to ensure higher continuation of the method. “Given the adolescent and young population size and relatively low use of modern contraceptive methods among them requires greater program planning and action,” it said.
The district data highlights the districts of focus for the program, and also suggests implementing public-private partnership models to further the FP coverage, quality and access to young and low parity couples.
