Instead of just focussing on female sterilisation camps, the Government needs to expand the contraceptive choices available to women and shift to non-terminal methods like implants, oral pills and injectables
The Economic Survey this year has taken a closer look at ‘Unleashing Naari Shakti’, or empowering women, who constitute 48 per cent of the Indian population. The Survey talks about re-orienting family planning towards reproductive health and rights, paying greater attention to quality and spacing methods, and doing away with targets and incentives for sterilisation as well as sterilisation camps. This is a significant statement of intention by the Government, but words need to be translated into action.
To create a more productive, egalitarian and sustainable world, it is essential to recognise women as equal stakeholders in human progress. The theme for this year’s International Women’s Day (March 8) was “Empowering Women — Empowering Humanity.” While positive outcomes of women’s empowerment can come from a bouquet of opportunities, such as education and earning capacity, the crucial role of contraception and modern spacing methods in transforming gender inequality has been missing from the national discourse. The heavy skew of Government expenditure on family planning towards female sterilisation has not been debated and questioned in any significant way.
Out of the total family planning outlay of Rs397 crore in the 2013-2014 Budget, as much as 85 per cent was spent only on sterilising females. A recent Economic Survey reveals that tubectomy and laproscopic sterilisations together accounted for 97.4 per cent of the total number of sterilisation operations performed in India in 2012-2013. Male vasectomy procedures, considered much less complicated and risky, accounted for the rest. The gender imbalance in sterilisation is big and worrisome, with women bearing the cross.
Female sterilisation, though a straight-forward operation, is often life-threatening in India due to poor quality, infrastructure and callousness, engendered by the pressure to meet Government-mandated targets. last November’s incident in Bilaspur, Chhattisgarh, is still fresh — 16 women, many of them in the prime of youth, lost their lives in a mass sterilisation camp. Every such incident is not only a tragic loss of life; it is also a setback to family planning efforts.
Instead of employing the ill-conceived strategy of driving family planning through female sterilisation camps, it needs to focus on respecting the reproductive rights of women and expanding the choice available to them in terms of modern spacing methods. The shift from terminal methods like sterilisation to implants, oral pills and injectables is a national imperative because of the reproductive momentum generated by a youthful population. Young women and men need wider contraceptive choices.
Modern spacing methods account for a small fraction (10 per cent) of contraceptive use in India. Between 1998-1999 and 2005-2006, there was a minimal increase (from 6.8 per cent to 10.1 per cent) in the proportion of couples using oral contraceptives, Intra-Uterine Contraceptive Devices and condoms. India’s family planning programme has not, so far, succeeded in providing contraceptives in any significant way to delay the first birth and space subsequent births. It currently offers five methods — female sterilisation, male sterilisation, intra-uterine contraceptive devices, oral contraceptives, and condoms.
In contrast, other countries in the region like Nepal, Bhutan, Bangladesh and Indonesia have seven contraceptive methods available, including injectables and implants. This is significant because global experience shows that overall contraceptive use rises with every additional contraceptive method made available. The addition of one method, made available to at least half the population, correlates with an increase of four to eight percentage points in total use of modern methods.
If the country were to introduce new contraceptives in the public health system, the immediate options are progestin-only pills, injectable contraceptives and implants. The first two are already approved and available in the private sector. The health benefits of increase in contraceptive choices are dramatic: Universal access to reproductive healthcare could prevent two-thirds of unintended pregnancies, 70 per cent of maternal deaths, 44 per cent of newborn deaths, and three quarters of unsafe abortions in the world.
Unfortunately, introduction of new and modern methods of contraception has not been easy in India. It has been contentious, not in the community, not among the women for whom the contraceptive is meant, but among those who have the luxury to debate and oppose, and who do not have to rely on life-threatening sterilisations camps.
While Prime Minister Narendra Modi often speaks eloquently about women’s rights and saving the female child, he is yet to specifically address the issue of reproductive rights of women, around which hinges their personal and social liberation. He should do so now — both in words and action.
(The author is executive director, Population Foundation of India)