India’s chequered family planning push
The nation has been trying to get its population in check through family planning for the past 66 years. It has not gotten it right.
In 2016 — and indeed, during much of India’s history — women disproportionately bore the burden of family planning, according to the latest National Family Health Survey.
The government currently offers people a “basket” of birth control options including sterilization, the birth control pill, condoms and intrauterine devices.
Sterilization in women, called tube ligation, is more dangerous than it is in men. Yet, some state and district health officials continued to set higher targets for recruiting women than men, according to a 2012 Human Rights Watch report. Such targets are in direct violation of a central government policy to only undertake “target-free” family planning.
Andhra Pradesh had some of the highest levels of family planning, where some districts saw as much as 3 in 4 women with tubectomies. Unable to space childbirth, young women have kids and then tie their tubes to prevent additional pregnancies, according to a study by the Centre for Health and Social Justice. Women who got sterilized in Andhra Pradesh were around 23 years old.
A double-edged sword
The Indian government recently doubled payouts to both men and women who undergo tube ligations and vasectomies, according to the Ministry of Health and Family Welfare. It also created an insurance fund of Rs. 2 lakh per doctor a year so they can perform surgeries without fear of litigation. The indemnity fund follows numerous malpractice suits filed against doctors for botched surgeries. In 2014, a Chhattisgarh doctor used non-sterile procedure during surgery on 83 women, resulting in 15 deaths. He had been under pressure to meet district sterilization targets, an investigation revealed.
Some states, including Assam and Rajasthan, use policies to enforce a two-child norm. They place state employees who have more than two kids at a professional disadvantage and prohibit them from standing for elections.
Assam’s two-child policy is almost discriminatory as the state is already at the desired fertility rate. Most women there will likely have only two kids.
A low fertility rate can lead to a disappearing population and a skewed sex ratio if there is a strong preference for boys. Case in point, Sikkim, which has one of the lowest fertility rates and the most skewed sex ratios.
Improve access to contraceptives
Less permanent contraception such as IUDs and birth control, allow women to space child birth appropriately and helps maintain fertility rates.
In 2012, the Indian government said at the London Summit for Family Planning that it’d promote birth spacing through the use of IUDs. However, data shows this did not happen.
Millions of Indian women say they’d like greater access to contraceptives in order to space birth.
The Indian government has set a target of increasing contraceptive access for 48 million women by 2020. It also said it would promote male contraception. There might be some light at the end of the tunnel.