India's journey in family planning (FP) began in 1952, making it the first nation to adopt a concerted policy program for what was deemed as ‘population control’ then.
Over time, India, like other countries, has embraced the idea of adopting a broader policy approach that aligns with demographic shifts in the population, desire for rapid economic progress, and the evolving demand for new contraceptive products and efforts to encourage informed choices in service delivery settings.
In these seventy years, despite the family planning program undergoing decadal transformations, India has risen to become the world's most populous country, defying earlier projections that this milestone would only be reached by 2034.
From Female Sterilisation to Injectables
The evolution of FP from heavily relying on female sterilisation to embracing diverse contraceptive methods had been gradual. In 2016, the introduction of two new contraceptives, a weekly pill and injectables, aimed to promote spacing (intentional decision to delay between pregnancies by using contraception to ensure better (health outcomes improved well-being) and empower women to exercise their reproductive autonomy.
Simultaneously, the 2016 Mission Pativar Vikar Program of the government played a pivotal role in broadening informed decision making through initiatives such as the Nayi Pahel Kit and Saas Bahu Sammellan, fostering meaningful conversations between health workers and newlyweds, and daughters-in-law and mothers-in-law.
While these initiatives have played a crucial role in promoting openness and empowering women to plan pregnancies through spacing methods, deep-rooted traditional norms, societal pressures for early fertility, and the preference for having sons present formidable challenges to the success of the family planning program as well as women’s reproductive autonomy.
What is important is that India’s family planning program remains committed to empowerment and change, with a progressive vision for 2030 and upcoming introduction of two additional methods: Implants and DMPA Sub Cutaneous (a subcutaneous injectable method has the attribute that it can potentially be used as a self-inject option by women themselves much like insulin).
Beyond Fertility Control: Empowering Women for a Planned Future
India's progress in modern contraceptive use, particularly in previously stagnant states like Uttar Pradesh and Bihar, has led to a remarkable decline in total fertility rate.
However, significant hurdles persist for women, including limited access, restricted bodily and personal autonomy, disapproval from mothers-in-law, all of which hinder contraceptive use among women.
Addressing these challenges necessitates a primary focus on cultivating gender-inclusive programs and dismantling demand-side barriers rooted in early fertility norms and preference for sons, while empowering women with comprehensive support and choices to make informed decisions about their own reproductive health.
By breaking down these barriers, we can foster an environment that safeguards women's autonomy and ensures their reproductive choices are promoted and respected.
Embracing Long-discussed Rights-based Approach
In the realm of family planning, achieving empowerment requires programs to adopt a rights-based approach that addresses the disproportionate pressures faced by women, young people, marginalized populations, and those entering the reproductive age cohorts, recognizing that changing demographics of a larger proportion of young adults that are entering the sexual and reproductive ages.
In a world of evolving relationships beyond marriage, providing comprehensive knowledge about sexuality, consent, conception, and contraception to both women and men, especially the youth, is crucial.
Future programs would also need to embrace new technology and products such over-the-counter contraceptive methods like self-administered DMPA Sub Cutaneous, an easy-to-use injectable contraceptive with a small needle inserted just under the skin.
This self-injectable method is particularly suited for situations where individuals prefer not to visit a health facility or have limited access. However, it is essential to accompany self-injectables with high-quality, supportive counseling support, especially since procurement might occur through pharmacies without involvement of a direct health provider.
Supportive counseling and innovative strategies within tele/ digital health are crucial to empower women and young people with information about protected sex, contraception, achieving fertility goals, and participating fully in the economy.
Women need to be provided guided information on managing contraception, side-effects, maintaining adherence, and minimising disruptions in their desired contraceptive use journeys.
The Role of Men & (Social) Media
Men play a crucial role in family planning, as they are considered decision makers and may be procurers of over-the-counter products for women, but rarely considered users and their participation in discussions with health-workers have been limited.
Involving men in family planning programs, engaging them in dialogues, discussing with them their roles and responsibilities in promoting pleasure-positive relationships are essential to foster shared responsibility and move away from burdening women alone.
Leveraging social media through engaging campaigns and influential champions is also important, along with normalizing contraceptive use and fostering positive messaging from influential figures to break down barriers. This comprehensive approach empowers women in their reproductive autonomy, upholds their right to choose, and ensures robust support within families and healthcare systems.
Empowerment of Women Is A Crucial Link
Women's empowerment is integral to women's full participation in the labor force, and in fostering balance between the dual goals of economic development and population stabilisation at both macro and micro levels.
It acknowledges the importance of respecting individual choices, recognizing the mutual benefits that arise from supporting women's active engagement in the workforce while addressing their unique circumstances and needs.
Investing in quality counselling support and enabling better service delivery and product choices within the family planning program, enshrined in principles of women’s empowerment, holds the potential to prevent 76 million unintended pregnancies, 21 million unplanned births, 26 million unsafe abortions, and 186,000 maternal deaths.
India, being the world's most populous country with a significant proportion of working-age population, stands at the brink of a remarkable demographic opportunity.
If women's empowerment, their reproductive autonomy, and economic opportunity are aligned in a progressive political environment, India could make remarkable progress to achieve an impressive 43 percent increase in per capita GDP by 2061.
(Priya Nanda is a feminist researcher, strategic thinker, gender and Sexual and Reproductive Health Research (SRHR) expert with deep expertise in evaluation, research and program implementation. Priya was formerly with the Bill and Melinda Gates Foundation as a Senior Program Officer. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for the same.)
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