Prime Minister Narendra Modi had last year brought up the issue of family planning, which is of great importance to India but has rarely been addressed by any government. The PM’s speech on India’s 73rd Independence Day opened a window of possibility of an informed public debate on an issue that has often been marred by misconceptions and ghosts of the past, when the Indira Gandhi government callously used its might to install family planning during the Emergency period.
It is important to note that population issues are not just related to numbers of people, they impact the broad spectrum of demographic, health and socio-economic indicators, such as age at marriage, sex ratio, mortality, fertility, poverty, malnutrition, illiteracy and economic growth. From a health and economic sustainability point of view, a recent study titled ‘Cost of Inaction in Family Planning in India: An Analysis of Health and Economic Implications’ observes that India could gain a 13 per cent increase in per capita gross domestic product (PCGDP) over the next 15 years, if it makes adequate investments in family planning. Family planning investments and interventions can save 1.2 million maternal lives and avert 2.9 million infant deaths. It would also reduce household out-of-pocket expenditure on childbirth and child hospitalisation by Rs 77,600 crores.
It has been well established that women’s education, family planning and workforce participation are the most reliable tools to delay age at marriage and first pregnancy and increase spacing between births. Keeping girls in schools, as being promoted under Beti Bachao Beti Padhao programme, raises social and economic prospects for girls and enhances their self-esteem. This leads to outcomes such as low infant, maternal and under-5 mortality rates.
Family planning is a cross–sectoral investment, which impacts all the 17 goals of the sustainable development goals (SDGs), both directly and indirectly. SDG Goal 3 on health and well-being and Goal 5 on gender equality and women’s empowerment have a direct reference to family planning. However, neither, Goals 1 and 2, which are about ending poverty and hunger, nor Goal 4, which focuses on ensuring quality education for all, nor Goal 8, which aims at promoting sustained economic growth, can be achieved without ensuring that every woman has access to quality, rights-based family planning services.
It is imperative for us to understand that more than two-thirds of India’s population is under the age of 35 years, and so the country’s population will continue to grow till 2050 due to population momentum. We should, therefore, make the best use of this demographic dividend and focus on their access to correct information, counselling, health care and nutrition, as enshrined in the National Population Policy. To address this issue, all informed, scientific, and human-centred measures initiated by the state shall be welcomed by one and all.
A ‘healthy’ population
We should focus on creating an ecosystem to include youth in the process of achieving a healthier population. We have witnessed the proactive and productive role of youth in the significant successes of the Swachh Bharat Abhiyan, Beti Bachao Beti Padhao, and Give It Up campaign. These movements were possible only because of the government’s commitment to values of health and human dignity. Population stabilisation measures should be looked at through this prism of governance values.
Keeping the development agenda in mind, in the last five years, the Modi government has introduced many new schemes aimed at reducing maternal and child mortality, and expanding the choices of contraception from 5 to 8 in the public health system. India has already started experiencing a slowdown in population growth and a decline in fertility rate, wherein 25 states and union territories have already reached the replacement level of 2.1 children. Moreover, the National Health Policy 2017 envisages an increase in the health spending up to 2.5 per cent of the GDP by 2025 to meet the additional needs.
Despite these efforts, much remains to be done. Budget allocations for health and family planning need to be raised, the latter being at 4 per cent of the National Health Mission (NHM) budget. About 13 per cent or 30 million women in the reproductive age group (15-49 years) have an unmet need for contraception, indicating women are still not able to access family planning services.
Additionally, as per the National Family Health Survey-4 (NFHS-4), Indian women want less than two children but are not able to access and exercise their agency to use contraceptive methods as per their reproductive choices due to prevailing social norms, such as son preference.
Covid exacerbates the need to act
The ongoing battle with the Covid-19 pandemic has strained the public health sector and changed India’s health priorities monumentally. As a result of the pan-India lockdown, family planning and reproductive health services have been scaled down significantly, leading to limited access for people. It is important to note the evidence from past epidemics such as Ebola and Zika, which indicate that restricted availability of family planning services leads to a rise in maternal and newborn mortality, increases unmet need for contraception, unwanted pregnancies and number of unsafe abortions.
The Ministry of Health and Family Welfare has now included all reproductive health services, including family planning, in its list of essential health services which is a welcome step. The states should ensure that women have easy mobility and unrestricted access to these services.
In the post Covid-19 recovery-revival plan, PM Modi has reinforced that demography is the fourth pillar and a critical source of energy for building a self-reliant India. This, as well as invoking the issue of population from the ramparts of the Red Fort, should be remembered and employed in creating additional social leeway for women to express themselves and make informed choices. The entire political establishment should take a lead from this and further the cause by amplifying the message. Similarly, any politics that hinders the message of family planning shall be eschewed. We are at a juncture in history where avoiding this debate is at our own peril and a great disservice to the nation.
Simultaneously, this human-centred approach shall percolate down to the bureaucratic world as a matter of governance philosophy. A shift from mere monitoring benchmarks to a more individualised approach in family planning services would prove a critical catalyst, the results of which will contribute to India becoming a $5 trillion economy, making us socially, demographically and economically stronger by the day.
This new impetus directly from the Prime Minister’s Office is a positive development and it is incumbent upon each of us in achieving the collective goal of better health and prosperity for our generation and the posterity to come.
Dr Mahendra Munjpara is a physician and Member of Parliament from Gujarat and serves on the Committee of Health and Family Welfare. Views are personal.
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