The increased use of contraception across the country has been a major factor in preventing unwanted pregnancies, leading to a decrease in India’s Total Fertility Rate (TFR) to below replacement level, the recently-released data from National Family Health Survey (NFHS 5) has shown.
In just five years, from NFHS 4 (2015-16) to NHFS 5 (2019-20), the use of modern contraceptives for family planning has jumped by 8.7 percentage points – from 47.8 per cent to 56.5 percent.
While as many as 30 out of 36 states/UTs have shown an increase in contraception use, population and reproductive health experts point out that the improvement in Uttar Pradesh’s and Bihar’s numbers have been especially encouraging, given their large populations. In Bihar, the Modern Contraceptive Prevalence Rate has almost doubled — from 23.3 per cent in NHFS 4 to 44.4 per cent in NFHS 5.
“The decrease in fertility is the function of three main factors – the use of contraception, increase in the age of marriage and abortions. In Bihar, while the age of marriage continues to remain low, with 43 per cent girls married under the age of 18 years in NFHS 4, which has decreased marginally to 41 per cent under the age of 18 years in NFHS 5, what has been successful has been the increase in modern contraceptive use. This points to the push in family planning schemes by the state government. But what is most significant in the Bihar case is the increase in education – which has translated into increased use of contraception and increased family planning,’’ says director, Population Council of India, Dr. Niranjan Saggurti.
Saggurti says that for UP, on the other hand, the good news has been that the age of marriage has increased resulting in better family planning choices being made. 21 per cent women under the age of 18 in the state were married as per NFHS 4, which has decreased by 5 per cent in just five years to 16 per cent.
“UP has also shown a very good balanced contraception method mix – with a shift from sterilisation to reversible contraception – which is very good news. The contraception use in UP is being dominated by the use of condoms – which is also very good news – and has reached levels of Haryana or Punjab now,” Dr Saggurti says. In its contraception mix, 40 per cent is now sterilisation while 60 per cent is the use of reversible contraceptive methods.
In UP, the use of contraception has risen by almost 13 per cent – from 31.7 per cent in 2016-16 to 44.5 per cent in 2019-2020. It has also shown a marginal decrease in female sterilisation by 0.4 per cent.
The comparative data of NFHS 5 and NFHS 4 show that the states accounting for the steepest rise in contraception use include Bihar (21%), Goa (35.3%), Dadar and Nagar Haveli and Daman and Diu (24%), Nagaland (24%), Arunachal Pradesh (20.6%). Rajasthan has also shown a significant increase (9 per cent) in this regard.
Andhra Pradesh, Karnataka, Telangana, Tamil Nadu, Madhya Pradesh, Maharashtra, Himachal Pradesh, Puducherry, Rajasthan, Chhattisgarh, West Bengal, Haryana and Goa registered at least 60 per cent contraception use in 2019-2020.
Punjab and Ladakh have reported the sharpest decline while Meghalaya (22.5%) and Manipur (18.2%) have recorded the lowest contraception use in the country.
“The data shows that women want smaller families. While the use of contraception has increased, indicating the improving success of India’s family planning programme, women would have even less pregnancies if they had increased access to contraception and increased agency to make decisions,’’ says Alok Vajpeyi, head of Knowledge Management at Population Foundation of India.
Vajpeyi points out that the NFHS 5 state data reflected the outcome of the Mission Parivar Vikas launched by Government in 2016-17, in which 146 high fertility districts had been identified and family planning and contraceptive use pushed there.
“The Mission ensured that earlier non-use communities in remote areas, with no access to contraception, were not only brought under the fold but that contraception use was pushed in these areas,’’ he says adding that UP’s “progressive population policy” also helped in its decreasing TFR.
“In Bihar, which has a large migrant population, we have seen that during Diwali and Chatt puja, when migrants return home, is when there is a spurt in pregnancies. The next step for Bihar is to specifically target the migrant groups, which the Bihar government will now do,’’ he adds.
Prof K James, director of the International Institute for Population Sciences – the Health Ministry’s partner organisation that carried out the survey – says if TFR correction is undertaken in four states – Bihar, UP, Madhya Pradesh and Rajasthan – it will put India on course for population control.
“One of the most important contributing factors for decreasing TFR is the use of modern contraceptive methods. Despite the fact that the age of marriage of women has not increased significantly in the country, with some states having as much as 30-40 per cent women marrying under the age of 18 years, the family planning programmes are showing results. Once countries attain 60 per cent contraceptive use, they reach replacement levels, says Prof. James.
“Family Planning has been the most enhanced programme in the health sector in India because of the continuing concerns of over-population. But what these results have shown is that it can be achieved with increased contraception and robust health delivery systems – India’s institutional deliveries are now just under 90 percent – and that you don’t require coercive methods or disincentives to achieve population control,” he says.
Prof James points out that the southern states had reached replacement levels decades ago. “It is the northern and central states that have been a problem – but they are showing healthy signs of improvement now,” he adds.
Kerala and Tamil Nadu had reached replacement levels of fertility in the 1990s due to high literacy levels. Andhra Pradesh, which had low female literacy, also reached replacement levels in the early 2000s because of the state government’s “robust family planning programme”.
Experts point out that the decrease of unmet family planning to a single digit, from 12.9 per cent to 9.4 per cent, the decrease in unmet need for spacing (gap between first child and subsequent children) by 1.7 per cent, and the rise in health workers taking up family planning with non-users by over 6 per cent – have also been significant factors in the decrease of TFR in the country.
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