Reproductive Rights of Women Matter - Just Ask Population Experts

India is projected to overtake China as the world’s most populous country by 2027, as per the latest report by United Nations (The World Population Prospects 2019).

However, overall, there is good news around population growth in India. There has been a decline in national Total Fertility Rates to 2.2 with all but seven states below 2.1, the replacement level of fertility (NFHS- 4).

Having said that, a phenomenon called population momentum will ensure that our population will grow to around 167 crores by 2060, after which the population will start decreasing.

Population Momentum: Growth Before Decline

The population momentum is a period of robust population growth if reproduction were reduced to replacement-level fertility. It is a natural consequence of the demographic transition, a population’s shift from high mortality and high fertility to low mortality and low fertility. This momentum towards population growth before it declines occurs because it is not only the number of children per woman that determine population growth but also the number of women in reproductive age.

In a large and populated country, like India, this population momentum, means a large number of young people -often termed as demographic dividend- being in childbearing age and accounting for the majority of population increase in future. This means that if India does not invest in the health and education of their young people, the absolute numbers in the country would continue to grow.

There is enough evidence to suggest that improving literacy and economic conditions for individuals lowers birth rates, that in turn plays a positive role in economic growth.

In such a scenario, it becomes imperative for the policy makers to understand that the demographic dividend will only be realized if we are able to slow down this population momentum. Adequate attention needs to be given towards public health programs that help in lowering fertility through ensuring universal access to contraceptives of choice, particularly for young women.

Population Control Methods Still a Barrier For Women

While India has made tremendous progress in improving life expectancy, decreasing maternal and child mortality, and decreasing fertility rates, the women continue to face huge barriers about whether, when, how often, and with whom to get pregnant.

The latest round of National Family Health survey (NFHS-4) estimated that 13% of Indian women had an unmet need for contraception that corresponds to a staggering 30 million married women who cannot access contraception.

Almost 1 in 20 married women have no access to spacing methods that can have great implications on health and well-being of both, mother and child.

Increasing investments in reproductive health programs through expanding the choice of contraceptives improve the willingness of women to use it.

Evidence from a recent paper suggests that every new method of contraceptive that is made available to all can increase the use of contraceptives by 4-8 percentage points.

India is committed to global initiatives like Family Planning 2020 goals of increasing the number of users adopting modern contraceptive methods. This has seen some shift in focus from terminal methods like sterilization to spacing methods and introduction of new methods like injectable contraceptive, centchroman, and progestin only pills. However, a considerable amount of work is still needed to not only increase the availability and access to this expanded basket of contraceptives but also deliver high quality services through trained and nonjudgmental service providers that provide accurate information around the use of these contraceptives to all users.

While India has shown a decrease in child marriages over the last two rounds of NFHS, one in four women (27%) still get married before the age of 18.

The role of cultural and community norms on roles of men and women that are learned, internalized, and reinforced in patriarchal societies that allow for limited decision making on use and choice of contraceptive are major contributors towards unplanned and unwanted pregnancies.

Coupled with cultural norms of immediate childbearing after marriage in young women, factors such as insufficient knowledge on contraceptives, and limited decision-making power among women are important main reasons for the high levels of early pregnancy in India (Population Foundation of India, 2013).

Need of the Hour

A renewed focus on raising awareness through behavior change communication, increasing community participation, and gender transformative programming among young boys and girls that focus on changing social and cultural norms on fertility and status of women might be the need of the hour. Recent programs, like Beti Bachao Beti Padao, and other similar based on cash incentives for educating and empowering girls need to continue until we are on the right path towards achieving gender equality.

Improving the quality of reproductive health services, addressing beliefs, myths and misinformation around contraceptives, and social & behavior change communication around child marriage, unwanted pregnancy, domestic violence and increased investment in the contraceptive program are needed to achieve the global commitments towards Sustainable Development Goals (SDGs).

Ensuring access to the contraceptive of choice for all women through non-coercive reproductive health policies can empower women with knowledge and agency to control their bodies and reproductive choices and help achieve SDG Goal 5 of gender equality.

India will then be able to reap the fruits of the demographic dividend, improve health and wellbeing for all, and decrease poverty by investing in sexual and reproductive health and rights for all its citizens. The success of the reproductive health program and slowing down population momentum in India hinges on the premise that all women in the country can realize and exercise their reproductive rights.

The author is the Vice President-Public Health Practice at Sambodhi Research & Communications.

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