Equitable access will help improve reproductive health

Phase-1 data from the fifth National Family Health Survey (NFHS-5) shows an impressive decline in the fertility rate in almost all states. Despite this, overall population growth still appears high because of a demographic transition: India has a high proportion—about 30%—of young people and adolescents who are either of reproductive age or will soon be. This explains why a population continues to grow even if its fertility rate declines. Some modelling studies (bit.ly/2XAEJVu) project that India will reach a peak population of 1.6 billion by 2048 and it will then decline steeply to 1.12 billion by 2065.

According to data, while women may want fewer than two children, many cannot access the family planning methods that allow them to limit pregnancies. NFHS-4 showed that in 2015-16, nearly 13% 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 spacing methods (bit.ly/3tNCQjU).

Further, contraceptive use is the lowest (bit.ly/3CnvKFP ) among women from Schedule Tribes, at 48%, followed by Other Backward Classes, at 54%, and Schedule Castes, at 55%. The situation has probably worsened due to covid-related restrictions. These trends indicate that inequities in access to family planning have translated into poor health and development outcomes.

More damaging are prevalent myths and misconceptions about demographic trends in the country, including fertility rates and population growth. Many believe that certain religious minorities contribute greatly to India’s population growth, a notion that is not supported by data. In fact, decadal growth rates among all religious groups are declining steadily. The decline has been sharper among Muslims than Hindus over the last three decades, at 4.7% and 3.1% respectively between 2001 and 2011 (bit.ly/3nPjLNv). During 2001-2011, a steep decline was noted in the population growth rate for Jains (20.5 percentage points), Buddhists (16.7), Sikhs (8.5) and Christians (7). The share of Hindus in India’s population reduced marginally, from 80.5% in 2001 to 79.8% in 2011, while the Muslim population registered a slight increase, from 13.4% in 2001 to 14.2%. In terms of absolute numbers, the Hindu population increased by 139 million during 2001-2011, while the Muslim population grew by 34 million. Contrary to popular belief, the steepest decline in total fertility rate (TFR) was observed among Muslims (0.8%) followed by Hindus (0.5%), Sikhs (0.4%), and Christians (0.3%), between 2005-06 and 2015-16.

These figures belie popular notions of the minority community’s aversion to family planning. S.Y. Quraishi, in his book titled The Population Myth, takes apart popular myths around the Muslim fertility rate, tracing Islamic tenets that are pro-family planning and those that encourage smaller families in the religious discourse.

For a large proportion of India’s backward communities, social development programmes remain out of reach. There is an urgent need for universal and equitable 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.

States like Kerala, which has a high Muslim population, and Tamil Nadu and Andhra Pradesh, have shown us that there is a strong link between development and decline in TFR. Indonesia and Bangladesh, both Muslim-dominated countries, have outperformed India in terms of decreasing fertility rates. Higher levels of female education, greater employment opportunities for women, delayed age at marriage and access to a bigger basket of contraceptive choices have made all the difference.

Key steps to ensure that more women in India have access to family planning services include highlighting the gains they contribute to, empowering frontline workers to increase women’s access to contraceptives, especially spacing methods, and introducing a wider range of contraceptive methods for women to choose from, based on their personal choice. Engaging religious leaders in family planning and reproductive healthcare advocacy is an important way to encourage public acceptance. This practice has been implemented across many programmes in other countries, with great success.

Behaviour-change communication and development interventions should be geared towards education, with a focus on gender equity. Inclusivity and equity are key when it comes to the distribution and delivery of services, information and commodities across communities and geographies. Governments at the national and state levels must ensure that appropriate measures are put in place so that people’s well-being remains at the heart of all policies, including family planning and reproductive health. This is critical to achieve our sustainable development goals, leaving no one behind.

Fauzia Khan is a member of Parliament of the Nationalist Congress Party