The choice of whether to be a mother and when to be one, is one of the most important choices a woman makes in her lifetime. It has major implications – not only on a woman’s personal health and well-being, independence, career and ambitions, but it also has far-reaching consequences at the economy-wide level – in addressing poverty and income inequality across households, in achieving family sizes and a demographic dividend helpful for economic growth, in targeting the youth bulge and the corresponding risk of social unrest and political violence, on the level of carbon emissions and in addressing climate change, etc. Yet, millions of women in India and other developing countries around the world are still devoid of this choice. 43.5% of the population in the reproductive age-group in India still do not use modern contraceptives for family planning (NHFS 2019-20), maternal mortality rate (MMR) is still very high in many north-Indian states – at more than 130 deaths per 100,000 live births.
In terms of addressing the unmet needs of family planning and taking control over the population numbers, public policies on family planning in India have had mixed successes. In fact, with the current population of 1.40 billion we are set to become to most populous country in the next one or two years (China, in comparison, stands at an estimated 1.45 billion currently, and is expected to continue to have low fertility rates in the coming years). With effective family planning policies and practices having a significant impact in attaining every one of the 17 Sustainable Development Goals (SDGs), the cost of any more laxity in this direction is very high.
According to research published by the Copenhagen Consensus Center, family planning is endorsed to be the second-best investment for global development after liberalizing trade - and “achieving universal access to contraception could result in long-term health and economic benefits worth $120 for each dollar spent on family planning”. In terms of fulfilling the SDGs, family planning directly impacts poverty, hunger, health, education, inequalities – with household incomes especially for poor households improving with reduced health costs and no. of dependents, and women being to participate more in the labor force. Population control benefits the environment with reduced pressure on natural resources and reduced carbon emissions. At the macroeconomic level, decline in fertility and mortality rates improves economic growth (and labor opportunities) by taking advantage of the demographic dividend with the no. of young dependents growing smaller relative to the working population.
In the recent years, the National Rural Health Mission (NHRM), the SDGs Agenda 2030, the Family Planning 2020 summit, and the National Health Policy 2017 have had a major influence on public policy on family planning in India. With the launch of NHRM in 2005, community level female health workers have been engaging in the communication at the individual level for public health systems. The other policy declarations have stressed on the importance of decentralization and community involvement. Although the NHRM has had a significant influence on major family planning and health indicators, it is notable that the total outlay on family planning has stagnated over the years. This budget allocation to family planning in both the national and state budgets needs to increase, and especially needs to factor in the unfulfilled contraceptive needs of the reproductive age-group. Access to reproductive health services and education on sexual health for adolescents and teenagers also needs to improve.
Apart from provisions on contraceptives and education on sexual health, socio-cultural factors which influence fertility such as age at first birth and gap between kids, education of girls for maternal and infant well-being, opportunities in the labor market for women, etc. need to be addressed better with policy. “The Cost of Family Planning in India” – a study conducted by Population Foundation of India, projects if appropriate investments in family planning are made till 2031, 1.2 maternal lives could be saved, 206 million unsafe abortions could be avoided, one-fifth of costs of delivery care and child-hospitalizations could be reduced, and the Indian GDP could increase by 13%.
The author is the Founding Faculty in Economics, Plaksha University. Views expressed are personal.
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