Centre for Health and Social Justice
India is currently undergoing demographic transition and is in a stage where young people contribute a very significant proportion of the population. This young population is in the reproductive age group and contributes to an apparent surge in population growth, which is referred to as ‘population momentum’ by demographers. In order to address the needs of this young population, we need to review the existing approach to family planning services. In principle, India follows an informed choice and ‘contraceptive basket’ approach. However experience shows that female sterilisation continues to be the method which is most widely available. At the same time, there have been some other changes in contraceptive availability and use which merit attention.
While female sterilisation is the mainstay of India’s family planning, this is certainly not true for most countries. In many Asian countries such as Japan, Republic of Korea, Hong Kong and Singapore, use of condom is widespread with 41 per cent use in Japan. In Northern Europe, vasectomy along with condoms contribute 30 per cent to the contraceptive prevalence rate and in United Kingdom, it is as high as 45 per cent. Compared to the pill, IUD and female sterilisation are used by 37 per cent of couples. In Canada, female sterilisation is as high as 30 per cent but male sterilisation is also being used by 15 per cent of couples. This clearly indicates that the overall preponderance of female methods that is witnessed in India is certainly not a universal global phenomenon.
In addition to the changes in ‘method-mix’, the overall need for contraceptive both at the personal and macro level have changed over the years. Studies also showed that for all methods of tubal occlusion the failure rates were much higher if the intervention was done in the age group of 18-27.
- Include family planning as a core discussion with adolescents keeping in view the new demographic parameters, and gender equality as a core principle. This is included in the existing adolescent health guidelines but not robustly followed.
- Emphasise on men’s involvement and partnership in contraception and parenting. This aspect has not been adequately explored at the programmatic level. Men’s involvement is usually restricted to the promotion of non-scalpel vasectomy.
- Discuss the importance of contraception at marriage (for delaying first pregnancy) and after the birth of the first child (spacing). This is in consonance with the National Population Policy 2000, but evidence indicates that this is hardly done by the health workers.
- Provide appropriate services of high quality for both women and men respecting their choices. The advantage of this holistic approach would not only increase male participation in contraception both through NSV and condom, but would lead to improvement in overall reproductive health of women (ANC, PNC, RTI, etc) and men (RTI/STI, sexual dysfunctions, etc.)
The Specific objective of this intervention is to improve health-seeking behaviour and health equity of 30 villages in selected blocks of Maharashtra, thereby reducing vulnerability to poor reproductive health outcomes.
The Project is being implemented by three organisations – SAMVAD, SAMYAK, Kamdhenu Charitable and is being demonstrated in three districts in Maharashtra namely, Ratnagiri, Solapur and Osmanabad.
The Centre for Health and Social Justice (CHSJ) is a public trust which has been assisting the process of policy implementation and programme-delivery in the health domain through providing a solid evidence-base for the same. Reproductive Health and Rights remains one of the key areas of work for CHSJ. One of the special interest areas of CHSJ is working with Men for Gender Equality. CHSJ has extensive experience working on issues related to men and gender equality. Some of these are:
- CHSJ is a partner in a multi-country research project on Men and Gender Equality Policy Project. The International Centre for Research on Women (ICRW) and Promundo (Brazil) are the lead partners in this project.
- CHSJ is part of a global alliance which has been provided support from the UN Trust Fund on Violence Against Women (VAW) to demonstrate the effect of working with males to address VAW. The project is being implemented in Brazil, Rwanda, Chile and India. Promundo Brazil is the lead partner of this project.
The Overall Objective is to contribute to improved Reproductive Health (RH) status by playing a supportive role in planning families, pregnancy, and new born care in the two blocks of Tuljapur (in the district of Usmanabad), Madha (in the district of Solapur), Maharashtra; and increasing availability and accessibility of services in line with National Rural Health Mission (currently known as National Health Mission).