Equitable Access Will Help Improve Reproductive Health

Context: Pro-active intervention is required to revamp India’s reproductive health status.

Issues associated with India’s state of reproductive health

• Discrimination – Women lacks identity: Women lacked right to take decisions about their own health and well-being, where choices about health depended on someone else’s idea of righteousness.
• Lack of access to family planning methods: Women may want fewer than two children, many cannot access family planning methods that allow them to limit pregnancies.
  • NFHS-4 showed that in 2015-16, nearly 13% women in reproductive age group (15-49 years) had an unmet need for family planning, including 6% of women who had an unmet need for spacing methods.
• Devastating impact of covid pandemic on essential services, especially family planning and sexual and reproductive health, has worsened access to healthcare, putting millions of women at high risk of unintended pregnancies, unsafe abortions, illnesses and even death.
• Rising population despite falling fertility:
  • Phase-1 data from the fifth National Family Health Survey (NFHS-5) shows an impressive decline in the fertility rate in almost all states.
  • Despite this, overall population growth still appears high because of a demographic transition, India has a high proportion of about 30% of young people and adolescents who are either of reproductive age or will soon be.
  • Some modelling studies project that India will reach a peak population of 6 billion by 2048 and it will then decline steeply to 1.12 billion by 2065.
• Social divide: Contraceptive use is lowest among women from Schedule Tribes, at 48%, followed by Other Backward Classes, at 54%, and Schedule Castes, at 55%.
  • Unwarranted arguments against minorities: Many believe that certain religious minorities contribute greatly to India’s population growth, a notion that is not supported by data.
  • Decadal growth rates among all religious groups declining steadily: The decline has been sharper among Muslims than Hindus over the last three decades, at 4.7% and 3.1%, between 2001 and 2011.
• Social development programmes remain out of reach: There is an urgent need for universal and equitable access to quality health services, including family planning.
  • States like Kerala, Tamil Nadu and Andhra Pradesh, have shown that there is a strong link between development and decline in TFR.
  • Higher levels of female education, greater employment opportunities for women, delayed age at marriage and access to a bigger basket of contraceptive choices have made all the difference.

Way forward

• Key steps to ensure that more women in India have access to family planning services,
  • Empowering frontline workers to increase women’s access to contraceptives, especially spacing methods, and introducing a wider range of contraceptive methods for women to choose from, based on their personal choice.
  • Engaging religious leaders in family planning and reproductive healthcare advocacy to encourage public acceptance.
• Behaviour-change communication and development interventions should be geared towards education, with a focus on gender equity.
  • Inclusivity and equity are key when it comes to the distribution and delivery of services, information and commodities across communities and geographies.
  • Governments at the national and state levels must ensure that appropriate measures are put in place so that people’s well-being remains at the heart of all policies, including family planning and reproductive health.