Changing the narrative on Contraception from ‘Control’ to ‘Choice’
Contraceptive prevalence has a direct impact on reducing maternal and child mortality.
Use of contraception or family planning as it is popularly known in India, is known to provide incredible benefits to individuals and societies. From an individual’s point of view, it provides them the freedom to decide if, when, and how many children to have or not to have a child. It allows individuals to take control of their lives and decide what is best for them and their loved ones. The burden of child bearing and rearing unfortunately falls entirely on women and if they have information and access to contraceptives of their choice it would liberate them from unwanted pregnancies and enable them to live their lives to their fullest and chase their dreams. Almost half of the estimated 48 million pregnancies in India are unplanned or unintended and 33% of them end in an induced abortion. Access to appropriate information on reproduction and contraception at an early age and unhindered access to contraceptives when needed can help prevent women/girls from undergoing unnecessary hardship and anxiety.
Form a country/society’s point of view, use of contraception results in multiple benefits. Contraceptive prevalence has a direct impact on reducing maternal and child mortality. It stabilizes population and ensures that available resources are used optimally and not stretched to its limits. India was among the first countries in the developing world to launch a national family planning program in 1952. Leaders of a newly independent country, with limited resources, felt that a growing population would be a huge barrier to India’s social and economic progress. Over the years the program has kept pace with changing needs and has expanded to include – reproductive, maternal, child and adolescent health (RMNCH+A), adopting a life-cycle approach. Another first India can be proud of, is its Contraceptive Social Marketing Program, launched in the late sixties, which aimed at harnessing the strengths of commercial marketing channels to make available quality, affordable contraceptives. Today, social marketing brands contribute significantly to the condom and OCP market in India and contraceptive social marketing programs exist in over 110 countries.
A huge drawback of India’s family planning program is it foundation is based on ‘control’ and the not rights and choice of individuals. By terming the program as family planning, it is also restrictive and judgmental – as long as it is within the boundaries of family or married adults it is acceptable. These principles are no longer valid and well past their expiry date.
From a population stabilization lens, we have made significant progress with the current national TFR estimated at 2.2, down from 5.9 in 1969. 25 states and Union Territories have already achieved the Net Replacement Fertility rate of 2.1. Modern contraceptive prevalence rate (mCPR) is an impressive 47.8%. The impressive gains at the national level in reality hide the existing regional disparities, especially in large states like Uttar Pradesh, Bihar, Madhya Pradesh and Odisha. In spite of such gains, from time to time there are calls and support for coercive population polices, which are not going to serve any purpose. India’s population will continue to grow and is expected to stabilize around 1.64 billion by 2050 before declining, owing to “population momentum.” A large younger population (over half of India’s population is estimated to be less than 25 years of age and over 65% less than 35) means the population will continue to grow in spite of lower TFR and increased mCPR. Coercive policy can only cause harm, especially to vulnerable sections of the population.
Many progressive laws and judgments like Transgender Act, recognition of live-in relationships, privacy and bodily autonomy recognize that consensual sex is not restricted to married situation or heterosexual encounters. India is a signatory to various International conventions and has committed to uphold sexual and reproductive rights. Post the International Conference on Population and Development held in Cairo in 1994, which recognized the concept of sexual and reproductive rights; India adopted a target free approach for family planning. India is also a signatory to the Convention on Elimination of Discrimination against Women, which guarantees women equal rights in deciding their reproductive goals including the right to decide freely and responsibly on the number and spacing of their children and have access to the information, education and means to enable them to exercise these rights.
It is high time that our policies regarding contraception follow a rights-based, non-judgmental approach and prioritizes individual choices. Unfortunately our policies and programs are still rooted in out-dated principles. Comprehensive sexuality education for adolescents is frowned upon, denying young people correct information which can protect them from traumatic and life threatening situation. There are unnecessary restrictions on advertising over the counter/self-use contraceptives like condoms and emergency contraceptive pills, misplaced moral values trump individual needs. In states like Tamil Nadu there is an illegal ban of emergency contraceptives being sold by chemists. 90% of the chemists surveyed in Tamil Nadu (n=200) as a part of the FRHS India study reported that ECPs are banned in the state. For most, India’s sterilization service seems to be the only choice of contraception, contributing to over 75% of contraceptive prevalence. With an increasing young population there is a need to introduce new methods like implants, hormonal intra uterine contraceptive devices and new generation oral contraceptive pills in the national program so that the right contraceptive choice is available universally and not restricted only to those who can afford them.
We can begin the process by starting to use the term contraception instead of family planning and not use it interchangeably. Contraception has a wider appeal and family planning is a sub-set of it. It would herald our willingness to address the issue from an individual rights and choice perspective. If we respect individual rights and choice, collective good will follow.
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