Equal access helps improve reproductive health
Imagine a world where you do not have the right to make decisions about your own health and wellbeing, where decisions about your health depend on others’ ideas about what is right for you and access to medical care is out of reach for you. Unfortunately, this is the reality today for a number of people in India, especially women (bit.ly/3lu5nak). The devastating effects (bit.ly/3zi4IOd) of the Covid pandemic on basic services, particularly family planning and sexual and reproductive health, have worsened access to health care and put millions of women at high risk for unwanted pregnancies, unsafe abortions, and even disease Death.
Phase 1 data from the Fifth National Family Health Survey (NFHS-5) shows impressive declines in the birth rate in almost every state. Nonetheless, demographic change still appears to have high population growth: India has a high proportion – around 30% – of young people and adolescents who are either of childbearing age or who will soon be. This explains why a population continues to grow even if its birth rate falls. Some model studies (bit.ly/2XAEJVu) predict that India will reach a peak population of 1.6 billion by 2048 and then drop sharply to 1.12 billion by 2065.
According to the data, while women want fewer than two children, many do not have access to the family planning methods that allow them to limit pregnancies. NFHS-4 showed that in 2015-16 almost 13% of women in the reproductive age group (15-49 years) had an unmet need for family planning, including 6% of women who had an unmet need for distance methods (bit.ly / 3tNCQjU ).
In addition, contraceptive use is lowest among women from Schedule Tribes at 48% (bit.ly/3CnvKFP), followed by Other Backward Classes at 54% and Schedule Castes at 55%. The situation has likely worsened due to Covid-related restrictions. These trends suggest that inequalities in access to family planning have led to poor health and development outcomes.
Even more damaging are widespread myths and misconceptions about demographic trends in the country, including fertility rates and population growth. Many believe that certain religious minorities are major contributors to India’s population growth, an assumption that is not supported by data. In fact, the decadal growth rates of all religious groups are steadily declining. The decline among Muslims over the past three decades was greater than that of Hindus, at 4.7% and 3.1% between 2001 and 2011 (bit.ly/3nPjLNv). In the period 2001-2011, there was a sharp decline in the population growth rate for Jains (20.5 percentage points), Buddhists (16.7), Sikhs (8.5) and Christians (7). The proportion of Hindus in the Indian population decreased slightly from 80.5% in 2001 to 79.8% in 2011, while the Muslim population saw a slight increase, from 13.4% in 2001 to 14.2% . In absolute terms, the Hindu population grew by 139 million between 2001 and 2011, while the Muslim population grew by 34 million. Contrary to popular belief, the largest decrease in the total fertility rate (TFR) between 2005-06 and 2015 was observed in Muslims (0.8%), followed by Hindus (0.5%), Sikhs (0.4%) and Christians (0 , 3%). -16.
These numbers refute popular beliefs about the reluctance of the minority community to have family planning. In his book entitled The Population Myth, SY Quraishi dissects popular myths about the Muslim fertility rate and pursues Islamic principles that are beneficial to family planning and those that encourage smaller families in religious discourse.
For much of India’s backward communities, social development programs remain inaccessible. There is an urgent need for universal and equal access to quality health services, including family planning. Ensuring access to education, social security and health services, especially sexual and reproductive services, is key to improving birth outcomes.
Countries like Kerala with high Muslim populations as well as Tamil Nadu and Andhra Pradesh have shown us that there is a strong connection between the development and decline of the TFR. Indonesia and Bangladesh, both Muslim-dominated countries, have outperformed India in terms of falling birth rates. A higher level of education for women, better job opportunities for women, a delayed marriage age and access to a wider range of contraceptives have made all the difference.
Key steps to ensure more women in India have access to family planning services include highlighting the benefits they contribute to empowering frontline workers to improve women’s access to contraception, especially distance contraception methods, and the introduction of a wider range of birth control methods that women can choose from based on their personal choices. Involving religious leaders in family planning and advocacy for reproductive health is an important way to promote public acceptance. This practice has been implemented with great success in many programs in other countries.
Behavior change communication and development interventions should be educational, with a focus on gender equality. Inclusiveness and equity are critical when it comes to the distribution and delivery of services, information and goods across communities and regions. National and state governments must ensure that appropriate measures are in place to keep people’s wellbeing at the center of all policies, including family planning and reproductive health. This is critical to achieving our sustainable development goals and leaving no one behind.
Fauzia Khan is a member of the Parliament of the Nationalist Congress Party
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