The awareness about contraception can significantly enhance women's health and contribute to better population management in India
World Population Awareness Fortnight, starting from July 11th, brings attention to the fact that India is the most populous country in the world, having surpassed China last year. According to UN projections, India’s population is expected to peak at 1.7 billion in 2064, beyond which it will decline. Out of 4 births each second across the world, one birth occurs in India. It is important to understand what can be done to balance the resources with the requirements of the population in the country. With only 2.4% of the world’s land, India supports 17.76% of the world’s population.
Nowhere is a discussion on contraception and mother and child health services more relevant and meaningful than here.Demographers use a parameter called Total Fertility Rate (TFR), which is the number of children a woman has in her lifetime. The TFR, which should be 2.1 for the population to remain steady, has already dipped below 2 in 2022. But keeping it within that range will require constant efforts to increase the awareness of the youth and adolescents towards these matters. Moreover, family planning offers many more benefits beyond the prevention of pregnancies.Uttar Pradesh ranks first among the states in India with a population of 257 million and a TFR of 2.18 (2015-16). It is relevant to mention here that our country was the first to launch an official family planning program way back in 1952. In the decades that have followed, the options have increased and so have the availability and accessibility.
With the basket of contraceptive choices available at all government hospitals free of cost, social marketing of contraceptives, and home delivery of contraceptives by ASHAs in rural areas, accessibility to these methods has improved. This has translated to an increase in the Couple Protection Rate by 13%, which is 67% at present, and a decrease in unmet need for family planning of 3.5%, which now stands at 9.4%.The country has made substantial progress in the delivery of family planning services across the country. The reach of family planning services has extended from target couples to eligible couples to all women and adolescent girls and should extend to all men of reproductive age.
Their share in decision-making and supporting women in using these methods makes it imperative for them to have this information as well. They can make an important contribution.If the present discussion gives a message that each couple should be forced to use a contraceptive to limit family size to stabilize the population, that is not true.
Family planning methods should help to fulfil the unmet needs of 9.5% of couples and help many others plan pregnancy at a proper time.According to the Guttmacher Institute, India Country Profile, 2022, between 2015–and 2019, there were a total of 485 lakh pregnancies annually in India, of which 44% were unintended. Of these, 2/3rd of these unplanned pregnancies ended in abortion. It is these couples who are in dire need of contraception.
These abortions could have been avoided had they received counselling and proper contraceptive measures at the right time.Contraception is not just a method of preventing unwanted pregnancies. It is a means to provide freedom to couples to exercise their reproductive rights. The freedom to choose when to plan a pregnancy. It essentially allows responsible voluntary decision-making based on correct knowledge, the right attitude, and access to quality services, which together promote the welfare of the family unit and contribute to the social development of the country.Contraception prevents unwanted pregnancies and many more unwanted situations that follow.
For married couples, it allows them to time their pregnancies and help determine the number of children in the family. It also helps in timing the births, particularly the first and last, about the age of the mother, which is particularly important because teenage pregnancies and pregnancies at a maternal age of 35 years or more carry their risks. Each of these aspects is very important for the welfare of all family members. So, family planning has to emerge from whispers in private quarters to a basic human right and an important aspect of family health and social welfare.Contraceptives are primary prevention for pregnancy and primordial prevention for high-risk pregnancies.
These high-risk pregnancies, if not detected in time and managed properly, can lead to serious complications and even deaths. At the individual level, the morbidity and mortality of the mother and newborn associated with an unplanned pregnancy can be avoided. If all couples had access to family planning services, it would help reduce maternal deaths by 25% and infant deaths by 20%.
Apart from deaths, the diseases associated with HRPs (20-30%) are also prevented. High-risk pregnancies are those pregnancies where the mother/baby has an increased risk of adverse outcomes. This could be due to anaemia, high BP, or high sugar levels during pregnancy. Pregnant women with obesity, twin or breech pregnancy, history of preterm labour, or cesarean section are also HRPs.
This is particularly true for teenage and elderly pregnancies because they have a higher share of morbidity. Moreover, pregnancies beyond the age of 35 have a high risk of congenital anomalies. So, preventing these births improves the quality of the population and reduces the burden on parents in particular and society in general. It also reduces early and late fetal deaths.
Women's health also benefitted from the improvement of nutritional status and the reduction of complications by addressing modifiable risk factors before the next conception, like weight reduction, management of medical illnesses, and allowing a reasonable gap of at least 3 years between two deliveries. Proper use of contraceptive methods would also reduce the need for abortions and thus decrease abortion-related complications like septic abortions and even death.
This issue is most sensitive for unmarried girls who are forced to seek abortion services at unrecognized centres and are unable to seek normal pregnancy care. This also calls for greater awareness about emergency contraceptive pills.Good health of the infant and siblings, proper care, nutrition, and reduced vulnerability to diseases are all seen in families with a limited number of children. Hence, contraceptives play an important role in the overall well-being of the family.Thus, the importance of contraception for the health of women and children is clear and government facilities, NGOs, and private providers are all working to offer and improve family planning services.
The availability of better client-friendly methods, from daily pills to once-a-week pills, lactational pills, self-administered three-monthly injections, devices working for 10 years, along good follow-up facilities, have made modern women’s lives easier.What remains is to connect the dots so that maximum benefits can be reaped from the services. What also needs to be worked upon is the change in attitude of not only the clients but also the caregivers. The clients need to work upon the hesitation in accessing these services and the caregivers need to refrain from underscoring the importance of family planning services. Let us all reflect on our roles as stakeholders in this solvable problem which is so important for our health and progress.In conclusion, the discourse on contraception and maternal health underscores the critical need to prioritize reproductive rights and access to family planning services.
As we bridge the gap between rights and reality, it is imperative to foster an environment where informed choices and comprehensive education empower individuals and couples.
Collaborative efforts among government bodies, NGOs, healthcare providers, and the community are essential to ensure that family planning services are accessible, acceptable, and utilized effectively.
By doing so, we not only enhance maternal and child health but also reduce the risk to women arising from unplanned pregnancies, high-risk pregnancies, and abortion-related complications which are entirely preventable. So, let us all contribute to the broader socio-economic development of our nation. The journey towards a healthier, more informed society begins with each of us advocating for and embracing the significance of contraception in our collective well-being.
(The writer is Assistant Professor, Department of Community Medicine in MLB Medical College Jhansi UP. Views are personal)
