Ironically, nine states in India — Kerala, Tamil Nadu, Karnataka, Andhra Pradesh, Telangana, Maharashtra, West Bengal, Punjab and Himachal Pradesh — have fertility rates well below the replacement rate. The replacement level is the number of children needed to replace the parents, after accounting for fatalities, skewed sex ratio, infant mortality, etc. Population starts falling below this level. However, in densely populated states like Bihar, Uttar Pradesh, Jharkhand, Chhattisgarh, Rajasthan and Madhya Pradesh, the total fertility rates are still above the replacement rate. Total fertility rates (TFR) indicates the average number of children expected to be born to a woman during her reproductive span of 15-49 years.
One of the reasons for this could be the unmet need for family planning which is 12.9 per cent (National Family Health Survey, 2015-16). This indicates that women want to plan their families but are unable to access family planning services to achieve it. India had made a commitment to ensure a modern Contraceptive Prevalence Rate (mCPR) of 65.9 per cent at the London Summit on Family Planning in 2012, and to reach out to an additional 48 million users. It is still struggling to make good its promise.
India was unable to meet its targets in maternal health in the Millennium Development Goals (MDGs). Its inaction in implementing its family planning policies may directly and indirectly delay the country’s progress towards the Sustainable Development Goals by slowing improvements in health outcomes for women by leading to more unintended pregnancies.
The possibility that country could add an extra population of 149 million by 2031 was recently underscored by a recent study. The report, which studied the cost on inaction in implementing family planning policies, revealed that Bihar (24 million), Madhya Pradesh (14 million), Rajasthan (5 million) and Uttar Pradesh (31 million) would account for one-half of this number. On the other hand, if well implemented, then family planning policies would give women the choice to decide if, when and whether they want to have children. In such a scenario, 1.2 million maternal deaths could be prevented in India in this period, states the study. Bihar would benefit the most by averting the highest number (0.2 million) of maternal deaths.
Perhaps then, it is a good time for the state to consider adopting the ‘contraceptive couple’ strategy. Initiated by Janani, a not for profit, working on family planning, this programme centred on training couples in Bihar as family planning motivators. These couples were from the community and once trained were able to advise their communities about family planning services. Simple yet effective, the strategy focussed on training the husband and wife to be change agents.
The husband-wife team worked to address misconceptions about family planning .The roles and responsibilities of each partner were well defined. For instance, while the wife looked after the women and the mother-in-law, her husband was in charge of advising the men in the family.
Family planning services including counselling on various contraceptives available including IUDs (intrauterine devices) and oral pills proved to be a boon for the women as they could seek advice from a known and trusted person. But, this was not all the motivators spoke about. The couple offered advice to pregnant women about nutrition and child spacing. More importantly, they stressed on the importance of the health of the woman. They explained that a woman should not be the one to bear the burden of family planning and feel compelled to undergo tubal ligation. Men were also educated about the option of no scalpel vasectomy (NSV), which was quicker than tubal ligation and required no surgery.
These couples spread across 38 districts in the state, brought change in their own unique way. If more such couples could be trained, it would only add to existing family planning efforts by overburdened government frontline health workers. Most importantly, this would help to ensure women were not denied their right to reproductive choice.
Swapna Majumdar, Citizen News Service - CNS,
01 October 2019
