Family planning in India

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Map of countries by fertility rate: India's fertility rate is lower than some countries in its neighbourhood, but significantly higher than China and Iran

Family planning in India is based on efforts largely sponsored by the Indian government. From 1965-2009, contraceptive usage has more than tripled (from 13% of married women in 1970 to 48% in 2009) and the fertility rate has more than halved (from 5.7 in 1966 to 2.4 in 2012), but the national fertility rate is still high enough to cause long-term population growth. India adds up to 1,000,000 people to its population every 20 days.[1][2][3][4][5] Continuing at these rates, India is set to reach up to two billion people this century if drastic family planning changes are not made.

Contraceptive usage[edit]

The Red Triangle indicates family planning products and services in India

Women in India are not being fully educated on contraception usage and what they are putting in their bodies,[6] from 2005-2006 data was collected to indicate only 15.6% of women using contraception in India were informed of all their option and what those options actually do.[6] Contraceptive usage has been rising gradually in India; in 1970, 13% of married women used modern contraceptive methods, which rose to 35% by 1997 and 48% by 2009.[2]

Awareness of contraception is near-universal among married women in India.[7] However, the vast majority of married Indians (76% in a 2009 study) reported significant problems in accessing a choice of contraceptive methods,[3] the above table clearly indicates more evidence that the availabity of contraceptives problem for people in India. In 2009, 48.4% of married women were estimated to use a contraceptive method.[3] About three-fourths of these were using female stst sterilization whichs by far the most prevalent birth-control method in India.[3] Condoms, at a mere 3%, were the next most prevalent method.[3] Meghalaya, at 20%, had the lowest usage of contraception among all Indian states. Bihar and Uttar Pradesh were the other two states that reported usage below 30%,[3] it is important to note that sterilization is a common practice in India. They also use camps to enforce sterilization, this process can be done with or without consent.[8] In world-view context, the US has also used sterilization.[9]

Comparative studies have indicated that increased female literacy is correlated strongly with a decline in fertility.[10] Studies have indicated that female literacy levels are an independent strong predictor of the use of contraception, even when women do not otherwise have economic independence.[11] Female literacy levels in India may be the primary factor that help in population stabilisation, but they are improving relatively slowly: a 1990 study estimated that it would take until 2060 for India to achieve universal literacy at the current rate of progress.[10]

Family Planning Program[edit]

In 1952, India became the first country in the world to initiate a family planning program,[12] the Ministry of Health and Family Welfare is the government unit responsible for formulating and executing family planning in India. An inverted Red Triangle is the symbol for family planning health and contraception services in India. In addition to the newly implemented government campaign, improved healthcare facilities, increased education for women, and higher participation among women in the workforce have helped lower fertility rates in many Indian cities, the objectives of the program are positioned towards achieving the goals stated in several policy documents.[13] While India is improving in fertility rates, there are still areas of India that maintain much higher fertility rates.[14]

[15]

In 2017, Ministry of Health and Family Welfare launched Mission Pariwar Vikas, a central family planning initiative, the key strategic focus of this initiative is on improving access to contraceptives through delivering assured services, ensuring commodity security and accelerating access to high quality family planning services. Along with that two contraceptive pills, MPA (Medroxyprogesterone acetate) under Antara program and Chaya (earlier marketed as Saheli) will be made freely available to all government hospitals.[16]

Historical background[edit]

Raghunath Dhondo Karve published a Marathi magazine Samaj Swasthya (समाजस्वास्थ्य) starting from July 1927 until 1953. In it, he continually discussed issues of society's well-being involving population control through use of contraceptives, he explained the use of contraception would help prevent unwanted pregnancies and induced abortions. Karve proposed that the Indian Government should take up a population control programme, but was met with opposition. Mahatma Gandhi was the main opponent of birth control, his opposition was the result of his belief that self-control is the best contraceptive. However, Periyar's views were strikingly different from that of Gandhi, he saw birth control as a means for women to control their own lives.[17]

From the beginning, India's family planning program has been marred by a "vertical approach" rather than working on additional factors, these factors affecting population growth include poverty, education, public health care. Owing to the foreign aid flowing in for the family planning programs, there has always been a foreign intervention in designing the family planning programs in India without assessing the actual socio-economic conditions of the country; in the early 1970s, Indira Gandhi, Prime Minister of India, had implemented a forced sterilisation programme, but failed. Officially, men with two children or more had to submit to sterilisation, but many unmarried young men, political opponents and ignorant, poor men were also believed to have been sterilised, this program is still remembered and criticised in India, and is blamed for creating a public aversion to family planning, which hampered Government programs for decades.[18] After emergency the focus of family planning program shifted to women as sterilising men proved to be politically expensive.[19]

The national family planning program was launched in 1951, and was the world's first governmental population stabilisation program. By 1996, the program had been estimated to have averted 16.8 crore births.[20]

Fertility rate[edit]

India suffers from the problem of overpopulation.[21][22][23] India's current fertility rate as of 2013, is 2.6 births per woman. A fertility rate of this value drastically increases a population over time, although the fertility rate (average number of children born per woman during her lifetime) in India has been declining, it has not reached the average replacement rate yet.The average replacement rate is 2.1. (This rate is said to stabilize a population) Replacement rate can be defined as the rate at which the population exactly replaces itself.[24] Factoring in infant mortality, the replacement rate is approximately 2.1 in most industrialised nations and about 2.5 in developing nations (due to higher mortality). The fertility rates in India have dropped rapidly in rural areas, but are dropping at a stable rate in urban and populated areas,[25] although this seems promising, two-thirds of India's population resides in rural areas, adding to the decreased fertility rate.[25] Discounting immigration and population momentum effects, a nation that crosses below the replacement rate is on the path to population stabilisation and, eventually, population reduction. There have been several factors influencing recent trends in Indian fertility including, but not limited to: limitation of family planning ability, age at marriage/childbirth, and the space between children born to one woman,[13] although India is dealing with major overpopulation issues, the fertility rate and the overall population is declining, which is beneficial for not only the overpopulation issues, but also because there is a healthy amount of economic growth due to the populous amount of young workers entering the workforce.[25]

Historical fertility trend[edit]

The fertility rate in India has been in long-term decline, and more than halved from 1960-2009, from 5.7 births per woman in 1966, it declined to 3.3 births per woman by 1997 and 2.7 births per woman in 2009.[4][5] In 2005 the TFR, (total fertility rate), was listed as 2.9 births per women. Since this time, the country has recorded a steady decline in order to reach the current rate (as of 2014) of 2.3 births per woman.[13]

State and country comparisons[edit]

Twenty Indian states have dipped below the 2.1 replacement rate level and are no longer contributing to Indian population growth.[26]The total fertility rate of India stands at 2.2 as of 2017. Four Indian states have fertility rates above 3.5 - Bihar, Uttar Pradesh, Meghalaya and Nagaland Of these, Bihar has a fertility rate of 4.0 births per woman, the highest of any Indian state. For detailed state figures and rankings, see Indian states ranking by fertility rate.

In 2009, India had a lower estimated fertility rate than Pakistan and Bangladesh, but a higher fertility rate than China, Iran, Myanmar and Sri Lanka.[27]

According to Jin Rou New and colleagues research and data[28] they were able to compile enough data to create the following table.

TABLE 1: Showing data in regards to contraception use in India[28]
State Prevalence of modern contraceptive use in 2015 Unmet need for modern methods in 2015 Demand satisfied with modern methods in 2015 Change in prevalence of modern contraceptive use, 1990–2015 Prevalence of modern contraceptive use in 2030 Unmet need for modern methods in 2030 Demand satisfied with modern methods in 2030 Increase in percentage of users of modern methods required to meet 75% demand satisfied target compared with 2015 Additional number of users of modern methods (millions) required to meet 75% demand satisfied target compared with 2015
Andhra Pradesh 69·8 (65·8 to 73·5) 5·5 (4·5 to 6·7) 92·7 (90·9 to 94·2) 25·1 (14·2 to 36·2) 70·5 (51·4 to 84·2) 6·5 (2·7 to 13·9) 91·5 (79·4 to 96·9) .. ..
Arunachal Pradesh 47·2 (36·4 to 58·0) 23·3 (16·3 to 31·2) 66·9 (55·3 to 77·4) 29·6 (16·9 to 42·3) 55·4 (35·4 to 73·9) 18·9 (9·4 to 31·8) 74·5 (54·1 to 88·4) 8·8 (–3·0 to 20·0) 0·04 (0·02 to 0·06)
Assam 40·9 (28·9 to 52·9) 35·6 (25·5 to 47·7) 53·5 (38·3 to 67·0) 21·7 (7·6 to 35·4) 48·5 (26·0 to 69·1) 28·6 (14·1 to 50·0) 62·9 (35·3 to 82·6) 17·5 (4·1 to 31·0) 1·37 (0·72 to 2·01)
Bihar 26·0 (22·5 to 29·9) 22·9 (20·5 to 25·6) 53·1 (48·0 to 58·3) 6·3 (–1·7 to 13·3) 41·0 (24·4 to 60·0) 21·2 (12·5 to 31·1) 65·6 (46·7 to 82·3) 21·2 (9·9 to 30·7) 5·08 (3·04 to 6·78)
Chhattisgarh 57·0 (46·4 to 67·1) 16·7 (11·2 to 23·6) 77·3 (67·2 to 85·4) 26·0 (–0·5 to 49·1) 60·9 (40·8 to 77·9) 14·9 (6·7 to 26·9) 80·2 (61·6 to 91·9) .. ..
Delhi 58·0 (42·3 to 72·0) 19·6 (11·3 to 31·7) 74·7 (57·9 to 86·2) 6·4 (–12·1 to 23·7) 60·3 (38·7 to 78·0) 18·0 (8·1 to 33·8) 77·0 (54·7 to 90·4) 0·9 (–12·5 to 16·0) 0·54 (0·21 to 0·90)
Goa 25·7 (22·3 to 29·6) 20·1 (17·9 to 22·5) 56·1 (51·0 to 61·1) –10·0 (−20·0 to −0·5) 38·8 (22·7 to 57·5) 20·8 (12·6 to 30·6) 64·9 (45·8 to 81·2) 19·5 (8·1 to 29·5) 0·06 (0·03 to 0·09)
Gujarat 57·6 (41·9 to 71·4) 16·7 ( 9·6 to 27·3) 77·5 (61·6 to 87·9) 13·0 (–5·6 to 30·5) 60·5 (38·8 to 78·7) 15·3 (6·8 to 29·6) 79·7 (58·3 to 91·8) .. ..
Haryana 58·4 (54·0 to 62·5) 13·8 (12·0 to 15·8) 80·9 (77·7 to 83·7) 16·4 (5·9 to 26·7) 60·9 (41·9 to 77·0) 13·8 (6·8 to 24·4) 81·4 (64·4 to 91·7) .. ..
Himachal Pradesh 58·7 (47·8 to 68·8) 15·5 (9·8 to 22·8) 79·1 (68·4 to 87·2) 6·8 (–7·8 to 21·1) 62·1 (41·9 to 78·9) 13·8 (6·1 to 25·5) 81·8 (63·2 to 92·8) .. ..
Jammu and Kashmir 47·6 (32·3 to 62·7) 24·2 (15·0 to 36·0) 66·2 (49·0 to 80·3) 10·4 (–7·7 to 28·2) 53·4 (32·3 to 72·8) 20·9 (10·0 to 36·9) 71·7 (48·1 to 87·7) 8·3 (–6·0 to 23·3) 0·34 (0·11 to 0·57)
Jharkhand 45·9 (35·0 to 56·5) 28·6 (20·7 to 37·7) 61·5 (49·0 to 72·6) 28·4 (4·5 to 46·5) 54·1 (32·8 to 73·1) 22·8 (11·4 to 39·3) 70·2 (46·6 to 86·2) 12·1 (0·0 to 23·4) 1·18 (0·55 to 1·75)
Karnataka 54·1 (49·4 to 58·8) 10·9 (9·3 to 12·7) 83·2 (79·9 to 86·1) 9·0 (–2·0 to 20·1) 59·7 (40·2 to 76·7) 11·4 (5·1 to 20·4) 84·0 (67·6 to 93·6) .. ..
Kerala 54·7 (44·0 to 64·9) 19·6 (13·2 to 27·3) 73·6 (62·6 to 82·6) 3·0 (–11·0 to 17·0) 58·1 (38·6 to 75·0) 17·9 (8·8 to 31·2) 76·4 (56·4 to 89·3) 2·4 (–9·0 to 13·4) 0·55 (–0·18 to 1·25)
Madhya Pradesh 52·4 (47·7 to 57·0) 14·2 (12·4 to 16·3) 78·6 (75·0 to 81·8) 16·5 (–7·1 to 37·8) 58·3 (39·3 to 75·0) 13·9 (6·8 to 23·7) 80·7 (63·8 to 91·5) .. ..
Maharashtra 63·5 (59·1 to 67·5) 11·7 (10·1 to 13·5) 84·4 (81·6 to 86·9) 13·0 (2·2 to 24·0) 65·4 (46·5 to 80·5) 11·5 (5·2 to 21·3) 85·0 (69·4 to 93·8) .. ..
Manipur 14·7 ( 8·9 to 22·3) 40·3 (30·9 to 50·4) 26·8 (16·7 to 38·5) –7·7 (–17·6 to 2·4) 28·8 (13·2 to 48·8) 35·0 (22·2 to 50·9) 44·9 (22·5 to 67·2) 33·8 (21·6 to 44·3) 0·15 (0·11 to 0·19)
Meghalaya 21·1 (18·1 to 24·5) 25·7 (23·1 to 28·5) 45·0 (40·1 to 50·0) 7·6 (1·2 to 13·2) 35·5 (19·8 to 54·3) 25·4 (16·1 to 36·1) 57·9 (38·4 to 76·2) 25·3 (14·1 to 34·7) 0·13 (0·08 to 0·17)
Mizoram 60·1 (48·9 to 70·3) 16·4 (10·2 to 24·4) 78·5 (67·3 to 87·1) 8·7 (–6·5 to 23·5) 63·3 (43·1 to 80·1) 13·5 (5·5 to 25·4) 82·4 (63·7 to 93·6) .. ..
Nagaland 37·0 (21·7 to 54·3) 29·8 (19·8 to 41·3) 55·2 (36·7 to 72·5) 25·0 (8·7 to 43·1) 49·1 (27·7 to 70·8) 23·7 (11·7 to 39·4) 67·2 (43·3 to 85·4) 17·8 (2·4 to 32·2) 0·06 (0·02 to 0·10)
Odisha 48·3 (37·3 to 59·2) 26·6 (18·8 to 36·2) 64·5 (51·4 to 75·5) 15·7 (1·0 to 29·9) 54·8 (34·0 to 73·0) 21·4 (10·7 to 37·8) 71·9 (48·8 to 87·0) 9·2 (–2·9 to 21·0) 1·25 (0·39 to 2·04)
Punjab 60·3 (49·7 to 69·9) 15·1 (9·9 to 21·9) 79·9 (70·2 to 87·3) 12·0 (–2·0 to 25·9) 77·1 (64·2 to 87·0) 14·7 (6·9 to 26·8) 80·7 (62·2 to 91·6) .. ..
Rajasthan 62·3 (51·8 to 71·2) 16·0 (10·8 to 23·0) 79·5 (69·9 to 86·6) 33·9 (20·1 to 46·4) 65·5 (45·2 to 81·3) 13·9 (6·3 to 26·5) 82·4 (63·9 to 92·7) .. ..
Sikkim 48·4 (43·4 to 53·3) 22·3 (19·6 to 25·3) 68·5 (63·6 to 72·8) 16·8 (–1·3 to 32·9) 55·7 (36·3 to 73·3) 18·7 (9·3 to 30·5) 74·7 (55·6 to 88·5) 7·7 (–2·1 to 15·7) 0·02 (0·01 to 0·03)
Tamil Nadu 53·7 (48·9 to 58·5) 11·4 ( 9·8 to 13·2) 82·5 (79·0 to 85·4) 10·8 (–0·2 to 21·5) 59·2 (39·9 to 75·9) 11·7 (5·4 to 20·6) 83·5 (67·0 to 93·2) .. ..
Tripura 43·1 (38·5 to 47·8) 31·9 (27·0 to 37·8) 57·5 (50·8 to 63·5) 14·3 (3·7 to 24·1) 49·8 (29·0 to 68·6) 26·3 (13·8 to 45·3) 65·3 (40·1 to 82·9) 14·7 (4·9 to 23·3) 0·17 (0·10 to 0·22)
Uttar Pradesh 40·7 (29·8 to 52·0) 35·0 (25·8 to 45·5) 53·7 (40·1 to 66·3) 24·1 (11·3 to 36·9) 51·7 (29·8 to 71·2) 26·2 (13·3 to 44·9) 66·2 (41·5 to 84·1) 18·0 (5·5 to 30·2) 9·18 (5·53 to 12·61)
Uttarakhand 50·9 (46·3 to 55·3) 19·9 (17·5 to 22·6) 71·8 (67·7 to 75·6) 15·2 (–8·3 to 36·7) 56·4 (37·7 to 73·7) 17·6 (9·0 to 29·3) 76·1 (57·3 to 89·0) 5·0 (–4·6 to 13·2) 0·26 (0·09 to 0·39)
West Bengal 57·5 (52·9 to 61·9) 21·7 (17·8 to 26·6) 72·6 (66·8 to 77·4) 21·7 (10·8 to 32·3) 59·6 (39·1 to 75·7) 19·9 (10·0 to 37·3) 74·9 (52·1 to 88·1) 2·6 (–6·5 to 10·4) 2·10 (0·51 to 3·44)

Family in Pronatalist India[edit]

India carries a pronatalist attitude towards fertility, with the large family structure creating an environment for new children to learn and grow in Indian culture. Male children are favored over female children, so much so that it is considered among the highest duties of a man, a duty and religious necessity which will bring emotional gratification to the family. Males are raised to be assertive and independent figures, while females are raised to put others before themselves, particularly their family. Families tend to encourage childbearing and expect to provide an environment of support for any new members of the family, raising the children based on Indian family practices and beliefs. Children are not encouraged to be independent or assist the family from an early age, rather the family expects to support and provide for the child until they reach adolescence.[29]

See also[edit]

References[edit]

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  10. ^ a b How Female Literacy Affects Fertility: The Case of India (PDF), Population Institute, East-West Center, December 1990, retrieved 2009-11-25 
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  13. ^ a b c "National Health Mission". Archived from the original on 2013-01-11. 
  14. ^ Rao, Mohan(2004) from population control to reproductive health, Sage Publications, ISBN 0-7619-3269-0
  15. ^ "Health Ministry launches two new contraceptives". pib.nic.in. Retrieved 2017-09-06. 
  16. ^ Rao, Mohan(2004) from population control to reproductive health, Sage publications, ISBN 0-7619-3269-0
  17. ^ "Manas: History and Politics, Indira Gandhi". Sscnet.ucla.edu. Retrieved 2012-08-03. 
  18. ^ Rao, Mohan(2004) from population control to reproductive health, Sage Publications, ISBN 0-7619-3269-0
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  20. ^ http://serendip.brynmawr.edu/local/scisoc/environment/seniorsem03/Overpopulation_in_India.pdf
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  24. ^ a b c "India's Growth Held Back by Overpopulation". PBS NewsHour. Retrieved 2017-03-28. 
  25. ^ "Three states hold the key". The Indian Express. 15 July 2016. Retrieved 1 June 2017. 
  26. ^ CIA, Country Comparison: Total Fertility Rate, The World Factbook, Central Intelligence Agency, retrieved 2009-11-24 
  27. ^ a b New, Jin Rou; Cahill, Niamh; Stover, John; Gupta, Yogender Pal; Alkema, Leontine (2017-03-01). "Levels and trends in contraceptive prevalence, unmet need, and demand for family planning for 29 states and union territories in India: a modelling study using the Family Planning Estimation Tool". The Lancet Global Health. 5 (3): e350–e358. ISSN 2214-109X. doi:10.1016/s2214-109x(17)30033-5. 
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