Topic: Intra-uterine devices, pills, tubectomy and vasectomy. Medical termination of pregnancy including legal aspects
Question: What are the measures adopted by, to increase the use of contraceptives in India? What are the major factors affecting fertility?
Reference Material-This material is informational alone and is not specifically prepared as an answer for any question. Readers may do their own research before finalising diagnoses according to the characteristics unique to each question. Readers should not proceed without cross-referencing with relevant textbooks as well as standard guidelines available.
In India, the National Health Mission (NHM) and the National Family Planning Programme (NFPP) are two major programs that are aimed at increasing the use of contraceptives and promoting family planning. The government has taken several measures to promote the use of contraceptives and improve the overall reproductive health of the population.
Measures to increase contraceptive use:
The government of India launched the National Family Planning Program in 1951 to control population growth by increasing contraceptive prevalence.
Some key measures are:
1. Setting targets: The government has set targets of replacement level fertility (TFR of 2.1) by 2025 and increasing contraceptive prevalence to 74% by the same year. State/district level targets are also set.
2. Free and low-cost contraceptives: The government provides free or subsidized contraceptives like oral pills, condoms, IUDs, sterilization, etc. especially for poor and rural populations. Local health workers and NGOs distribute subsidized contraceptives. The government has ensured the availability of various contraceptive methods, such as condoms, oral contraceptive pills, intrauterine devices (IUDs), and sterilization services, free of cost at public health facilities.
3. Improving access: The government aims to provide accessible contraceptive options for all through primary health centres, local clinics, accredited private organizations and pharmacies. Doorstep delivery of contraceptives, especially in rural areas, is also done.
4. Conducting education campaigns: The government has initiated mass media campaigns and interpersonal communication programs to raise awareness about family planning, contraceptive methods, and reproductive health services. The family planning programs organize educational campaigns using media, billboards, local meetings, health workers, etc. to spread awareness about contraceptive options, their use, and benefits of family planning. These target both men and women.
5. Promoting female education: Educating women impacts fertility the most. The government aims to promote female education through scholarships, constructing girls’ toilets in schools, midday meals, etc. Female education beyond grade 10 has maximum impact on fertility decline.
6. Improving public healthcare & Integration of family planning with other health services: The government also provides maternal and child healthcare through initiatives like Janani Suraksha Yojana. Lower infant mortality and better healthcare encourage smaller family size and boost contraceptive usage. By integrating family planning services with other health services like maternal and child health care, the government aims to ensure that women have access to a comprehensive range of reproductive health services.
7. Incentivizing smaller families: The government offers incentives to couples who adopt permanent contraceptive methods, such as sterilization, as well as to health workers who motivate couples to use contraceptives. Some states like Rajasthan, Odisha, etc. provide incentives like leave, cash benefits, etc. for those who undergo sterilization after having two children. This aims to motivate people to limit family size.
8.Public-Private Partnerships: The government has also partnered with NGOs and private sector organizations to expand the reach of family planning services and promote the use of contraceptives.
9.Youth-friendly services: Special efforts are being made to provide youth-friendly reproductive health services, including contraceptive counseling and provision, to cater to the needs of the growing adolescent population.
Major factors affecting fertility in India:
Socioeconomic factors: Higher levels of education, particularly for women, and better economic status are associated with lower fertility rates. Higher income and female education, especially beyond secondary level, correlate strongly with lower fertility. Educated women marry and give birth later, have more say in reproductive choices and seek healthcare/contraceptives.
Cultural factors: Social norms, customs, and religious beliefs play a significant role in influencing fertility behavior. Son preference, early marriage, and the desire for large families are some cultural factors that contribute to high fertility rates in some regions. Some religious groups like Muslims have higher TFR due to religious reasons. Certain Hindu castes also have higher TFR due to cultural practices. However, the effect of these factors is declining with increasing income, education, access to healthcare and contraceptives.
Access to healthcare services: Limited access to quality healthcare services, including family planning and reproductive health services, can contribute to higher fertility rates.
Female empowerment: Women’s autonomy and decision-making power within households and communities can impact fertility rates. Empowering women with education, employment opportunities, and access to healthcare can lead to lower fertility rates.
Government policies and programs: Government policies and family planning programs can also influence fertility rates. Effective implementation of these programs can contribute to increased contraceptive use and decreased fertility rates.
Age at marriage: Early marriage leads to prolonged reproductive period and higher fertility for women. Though increasing, mean age at marriage in India is still only 19.3 years. Marriage after 21 years is linked to replacement level fertility.
Son preference: Strong preference for male heirs drives fertility as families continue bearing children until they have desired number of sons. India’s sex ratio shows the skew in sex preference. Son preference is higher in north and west India.
Awareness and use of contraception: Limited knowledge or access to contraceptives leads to higher fertility. Despite increase, contraceptive use is only 54% in India. Barriers include low status of women, misconceptions, cultural/religious beliefs, and lack of access especially in rural and poor areas.
Status of women: Women with more autonomy and freedom have lower fertility. They are empowered to make decisions related to marriage, sexuality, and childbearing. Parts of south and east India have higher female autonomy and lower fertility.
The NHM and NFPP have issued several guidelines to promote family planning and increase the use of contraceptives in India.
These guidelines include the following:
Providing a range of contraceptive options to suit the individual needs of women and men.
Educating and counseling individuals and couples about the benefits of family planning and the available options.
Providing contraceptives free of cost or at subsidized rates to improve accessibility.
Providing quality family planning services, including counseling, information, and follow-up care.
Encouraging male participation in family planning and promoting male methods of contraception.
Ensuring the privacy and confidentiality of individuals seeking family planning services.
In conclusion, the government of India has taken several measures to increase the use of contraceptives and promote family planning. Increasing education and income levels, improving women’s status, ensuring wider access to family planning services and providing better health facilities have been the guiding principles on which India’s population policy and programmes are based. A continued thrust on these enabling factors can help sustain the downtrend in the country’s fertility and population growth rates.
