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Family planning in india --issues and challenges

Commentary
Family Planning in India --Issues and Challenges
Dr. Rajiv Gupta1, *, Dr. SK Raina2
1Professor, Community Medicine, GMC Jammu 2Associate Professor, Community Medicine, DRPGMC Tanda. ABSTRACT
India is the second most populous country in the world after China. India is in dire need of controlling its burgeoning population otherwise all the developments made since independence would go waste. National Family Welfare Program which was started after independence has not lived up to expectations. A variety of reasons like male/son preference, non-inclusion of males in family planning decisions ,emphasis on permanent methods (Tubectomy), poor quality of services etc. have been ascribed for this. The need of the hour is to focus on optimum utilization of contraceptive methods, using the right mix and including new methods as and when available along with improving quality of client-centred services. Key Words—Family Planning methods, Quality of services, End Users
India was the first country to launch National Family Welfare Program way back in 1952 and since then, the nation has been consistently working towards improving health and reducing fertility for sustainable development .Despite the efforts of last six decades, India is yet to attain that elusive replacement levels of fertility. Family Planning is the surest and the quickest way to better the physical and economic health of a nation. Family Planning is increasingly being recognized as a cost-effective development option, one that improves the health of the people and consequently the labour force, boosts the economy and opens lot of opportunities for the females in particular. As per estimates, only one fourth of total contraceptive users practice modern spacing methods like pills ,condoms, injectables and IUDs(Intra Uterine Devices) (1), and it results in high rates of unplanned pregnancy(2) , inadequate birth spacing with concomitant increase maternal and infant mortality in the country(1,3-6). Estimates further show that 46% of eligible couple do not practice any of the methods of family planning and 21% of the births are unplanned every year. NFHS-3 data shows that two-fifth of all women in 20-24 year age group had married before legal age of 18 years and less than 10% of these young couples had used any contraception. Regarding unmet need among married adolescents, it was 27% and one quarter of this need was for spacing methods. 45% of India's maternal deaths occur in 15-25 year age group where 52% of country's fertility is also clustered reinforces the importance of contraceptive methods. Among the reasons for unwanted births, the preference for male child more so in the rural areas still remains a cause of concern. It has been aptly reflected in the declining sex ratio. Demographers have stated that if all unwanted births were eliminated and the unmet need for contraception was met, total fertility rate in India would drop to replacement level(1). Improving the access to quality family planning tools and services is central to improve the health and well being of women and children ,families and communities across India. In the London summit on Family Planning in 2012, the outcome was in terms of FP 2020 whereby the governments made commitments to address the barriers in access to contraceptives .India had also committed to reaching 48 million new users in addition to sustaining the existing users of family planning. The introduction of inject able contraceptive DMPA- better known as Depo-Provera by Indian Government into the public health system this year is a positive step which will give the women free access to this reversible method of birth control. The focus in the country needs to shift to spacing instead of limiting methods to meet the needs of India's young population reaching its reproductive years. We need to strengthen infrastructure, human resource management, accountability and governance of the public health system which are some of the impediments in the effective delivery of family planning services. Although the national program is supposed to offer a variety of choices (Cafeteria Approach) to the clients, yet the female sterilization has been the mainstay. Despite simpler method of vasectomy being available, the contribution of males to the program has been bare minimum. So the need is to devise strategies to increase male participation in family planning but success in this endeavor has not been fruitful so far. The need for integrated approach where other health problems besides contraception and reproductive health problems are taken care of would be a logical step. While devising integrated approach, lack of women's autonomy in reproductive decision making as well as lack of men's involvement in sexual and reproductive health matters has to be kept in mind. On the research front, a number of new contraceptive technologies are being developed in India and abroad to make contraceptives easy to use, more effective and more acceptable. Developments of late have focused on effective reversible methods of contraception mainly to improve ease of device insertion and removal, the target being the young and nulliparous women. There is compelling rationale for immediate postpartum and post abortion access to IUDs and implants . There is now convincing evidence that immediate post partum access to highly effective reversible contraceptives leads to a reduction in subsequent unintended pregnancies (7,8) and repeat abortions(9,10,11). It has been widely believed that new technologies would act as magic bullets to provide a quick fix but experience over the years has shown that technology alone can not address complex health and development issues. If contraceptive technologies are designed with an understanding the context in which they will be delivered keeping in mind the needs of end users, it is likely to be adopted by the service providers as well as the clients. It is pertinent to add here that while developing new contraceptive technologies, all the stakeholders including scientists, implementing agencies and end users are crucial and a dialogue must be concurrently promoted amongst them. Last but not the least, no program can succeed without political will and support how so ever well it has been conceived. In this context, India needs to raise health spending which was only 1.04% of the GDP in 2013-14 while China spends 2.8 %, Russia 3.6% and South Africa 4.1% of their GDP. The effect of not spending enough on health and family planning in particular can be seen in high maternal and infant mortality rates India faces. The same is also reflected in poor infrastructure, insufficient access and poor health care services. Further, 70% of all out of pocket expenditure on health by Indian people is in the private sector, driving nearly 50 million people into debt and poverty every year. India with a population of more than 1.21 billion needs to take urgent steps in improving the quality of family planning services in particular to attain the much desired fertility levels of replacement. Significant unmet need for both limiting family size as well as spacing births needs to be catered by informed contraceptive choice and appropriate mix of the available methods. 1. National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai, IIPS: International Institute for Population Sciences (IIPS) and Macro International; 2007. Available online at: dhsprogram.com/pubs/pdf/FRIND3/FRIND3-Vol1andVol2.pdf. Last
accessed: July 10th 2016. 2. Bradley SEK, Croft TN, Rutstein SO. The impact of contraceptive failure on unintended births and induced abortions: estimates and strategies for reduction: DHS analytical studies 22. Calverton, Maryland: USA United States Agency for International Development (USAID); 2011. Available online at: pdf/AS22/AS22.pdf. Last accessed: July 10th 2016. 3. Singh A, Chalasani S, Koenig MA, Mahapatra B. The consequences of unintended births for maternal and child health in India. Popul Stud (Camb) 2012;66(3):223–239. 4. Singh A, Mahapatra B. The consequences of unintended pregnancy for maternal and child health in rural India: evidence from prospective data. Matern Child Health J. 2013;17(3):493–500. 5. Tsui AO, McDonald-Mosley R, Burke AE. Family planning and the burden of unintended pregnancies. Epidemiol Rev. 2010;32(1):152–174. 6. Paul VK, Sachdev HS, Mavalankar D, et al. Reproductive health, and child health and nutrition in India: meeting the challenge. Lancet. 2011;377(9762):332–349. 7. Dewey, KG,26. Cohen RJ. Does birth spacing affect maternal or child nutritional status? A systematic literature review. Matern Child Nutr 2007; 3 : 151-73. 8. Pachauri S. Defining an essential package of reproductive 27. and child health services. In: India's family welfare program: Towards a reproductive and child health approach. Population and Human Resources, Operations Division, The World Bank, South Asia Country Department (India, Nepal and Bhutan) Washington D.C., USA; World Bank, 9. Narang R. Measuring perceived quality of health care services in India. Int J Health Care Qual Assur 2010; 23: 171-86. 10. Rama Rao S, Lacuesta M, Costello M, Pangolibay B, Jones H. The link between quality of care and contraceptive use. Int Fam Plann Perspect 2003; 29 : 76-83. 11. Khan ME, Gupta RB, Patel BC. The quality and coverage of family planning services in Uttar Pradesh: Client perspectives. In: Koenig MA, Khan ME, editors. Improving quality of care in India's family welfare programme: The challenge ahead. New York: Population Council; 1999. How to cite this article: Gupta R, Raina SK. Family Planning in India—Issues and
Challenges.international Journal of Epidemiology and Public Health 2016 ;1(1):8-14
Address for correspondence: Dr. Rajiv Gupta, Professor, Community Medicine, GMC Jammu
Date Received: 27th June 2016 Date Accepted: 30th June 2016

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