Every year, World Population Day, which falls on 11 July, serves as a reminder of the burgeoning human population, and its grim implications. For India, the challenge is especially pronounced—by 2024 we are poised to become the most populated country in the world. The theme of World Population Day this year—
Family Planning: Empowering People, Developing Nations—thus was even more significant in the context of the India story.
The role of women in family planning is vital. When women are empowered, they become active participants in decision-making for their family—determining its size, for instance. Enabling women to make informed decisions on whether and when to have children therefore becomes imperative. However, despite the progress made through multiple policy and intervention implementations in the last few decades, there remain some challenges that need to be addressed because for many women in India access to contraceptives is still a problem. A significant number of these women belong to the urban poor population— migrants who move from villages to towns and cities in order to seek better economic opportunities.
"For many women in India access to contraceptives is still a problem. A significant number of them belong to the urban poor population— migrants who move from villages to towns and cities...
With limited financial resources, this migrant force ends up in slum settlements. According to the Census 2011 figures, almost 65.5 million Indians live in urban slums, and this number is expected to cross the 100 million mark in the next five years. Along with problems like lack of clean drinking water and inadequate sanitation systems, this population also suffers due to restricted access to essential healthcare services.
Let's take Kamla's example. The 22-year-old, originally from Gaya in Bihar, works as a domestic helper and lives in a one-room shanty in Noida with her husband, a daily wage labourer, and their two-year-old daughter. With work taking up a large chunk of her time, Kamla is clear that she doesn't want to have another child for a few years. Her priority is earning an income and supporting her husband financially. Although Kamla is happy with her life in Noida on most counts, she faces a constant dilemma because she doesn't know whom to reach out to for information on matters of contraception and reproductive health.
Kamla's story is a familiar one. In my work in the field of public healthcare, I've come across several women like her. Young women, typically in their early 20s, often find themselves dealing with unplanned pregnancies. Having children in quick succession puts their health and the health of their children at great risk. A large number of women die from preventable causes related to pregnancy and childbirth. Linked closely to maternal health is newborn survival—infection and complications during delivery are leadings causes of infant death.
Due to low levels of awareness and limited knowledge of modern contraceptive methods, these women have little agency over their health. Providing for a large family puts a strain on their financial resources, further compromising their quality of life.
"[For women] having a basket of choices is empowering. They are more confident about planning how many children they want and when... This puts them in a position to contribute to not just their families but also the economy.
Recognising the need to reach out to this largely ignored and vulnerable population in the cities, USAID and the Bill & Melinda Gates Foundation launched The Challenge Initiative for Healthy Cities (TCIHC). Covering 31 cities across three states—Uttar Pradesh, Madhya Pradesh and Odisha—the initiative involves working closely with city governments to address family planning and maternal and child health needs among the urban poor.
The first step is identifying the gaps that exist in the areas of family planning and maternal and child health. This is done jointly by the Initiative staff and city officials. The TCIHC staff then provides technical guidance to address these gaps by recommending models and approaches that have been proven successful. Community outreach and behaviour change campaigns are used to create awareness.
Through the Initiative, a comprehensive range of modern contraceptives is made available to poor women, especially in the 15-25 years age group. For women like Kamla, having a basket of choices is empowering. They are more confident about planning how many children they want and when to have them. This puts them in a position to contribute to not just their families but also the economy.
To help women evaluate their options, a central role is played by Accredited Social Health Activists, popularly known as ASHAs. Trained as part of the National Health Mission, these frontline workers are an important source of information on maternal health and family planning. They are equipped to counsel women on a number of issues, including the range of contraceptives available, how to use them, possible side effects, which health facility to go to, etc. Mobilising public and private resources ensures a wider network of health facilities that women can access for free or at subsidised rates.
Empowering women like Kamla by making them aware of their options gives them autonomy over their lives. When not burdened by unwanted pregnancies, women are more productive. They contribute to their family's finances, thereby improving their quality of life. Smaller family units mean that they can afford to provide their children an education and give them a chance to lead a healthy life.
On this World Population Day, governments, as well as civil society organisations, should strengthen their commitment to empower women. Irrespective of their economic strata, all women should have access to high-quality health services. Arming them with the right tools and knowledge about reproductive health will put them in charge of making significant decisions like family planning. And when women are in charge of planning their family, everyone benefits.
This article was originally published in Huffington post on 21 July, 2017