Family planning ( Sociology Optional)

  • Family planning is "the ability of individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births.” - Butler and Clayton (2009)
  • It is achieved through use of contraceptive methods and the treatment of involuntary infertility.
  • In India, the concept of family planning came as a control measure for population growth.
  • Population control and Family Welfare Planning are listed on the concurrent list. The Central government bears virtually the entire cost of the programme.
  • State government and Union Territory administrations are responsible for its implementation. The Central government is also responsible for programme planning, training of functionaries, research and evaluation.

Thinkers and Organisations on family planning

  • In regard to the use of modern methods of contraception, The United Nations Population Fund (UNFPA) says, "Contraceptives prevent unintended pregnancies, reduce the number of abortions, and lower the incidence of death and disability related to complications of pregnancy and childbirth."
  • UNFPA states, "If all women with an unmet need for contraceptives were able to use modern methods, an additional 24 million abortions (14 million of which would be unsafe), 6 million miscarriages, 70,000 maternal deaths and 500,000 infant deaths would be prevented."

Government initiatives and policies

The Government is implementing the National Family Planning Program. It provides voluntary and informed choices to the beneficiaries through a target free approach.

A National Population Policy has been formulated in the year 2000 with the long-term objective of attaining population stabilisation by 2045.

Various initiatives have been taken under the National Family Planning Program providing broad range of services mentioned as follows:

  • New Contraceptive Choices: The current contraceptive basket comprising of Condoms, combined oral contraceptive pills, emergency contraceptive pills, Intrauterine contraceptive uterine device (IUCD) and sterilization has been expanded with inclusion of two new contraceptives- Injectable contraceptive (Antara programme) and Centchroman (Chhaya)
  • Post-partum Intrauterine contraceptive device (PPIUCD) incentive scheme under which PPIUCD services are provided post delivery.
  • Compensation scheme for sterilization acceptors which provides compensation for loss of wages. 
  • National Family Planning Indemnity Scheme (NFPIS) under which clients are compensated in the eventualities of death, complication and failure following sterilization operations. 
  • Family Planning Logistics Management Information System (FP-LMIS): dedicated software has been launched to ensure smooth forecasting, procurement and distribution of family planning commodities across all the levels of health facilities.
  • Mission ParivarVikas: Mission ParivarVikas has been introduced for substantially increasing access to contraceptives and family planning services in seven high focus states having TFR of more than 3 namely Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Jharkhand, Chhattisgarh and Assam..
  • Scheme for Home Delivery of contraceptives by ASHAs at doorstep of beneficiaries has been taken up.
  • Scheme for provision of Pregnancy Testing Kits in the drug kits of ASHA for use in communities.

National Population policy 2000

Targets: The following are the targets of National Population Policy:

  • Achieve zero growth rate of population by 2045.
  • Reduce infant mortality rate of below 30 per thousand live births.
  • Reduce maternal mortality ratio of below 100 per 1, 00,000 live births.
  • Reduce birth rate to 21 per 1000 by 2010.
  • Reduce total fertility rate (TFR) to 2.1 by 2010.

Promotional and Motivational measures for family planning

The following promotional and motivational measures will be undertaken:

  • Panchayats and Zila Parishads will be rewarded and honoured for exemplary performance in universalising the small family norm.
  • The Balika Samridhi Yojana promotes survival and care of the girl child. It gives a cash incentive at the birth of the girl child of birth order 1 or 2.
  • Maternity Benefit Scheme run by the Department of Rural Development will continue. A cash. Incentive of Rs. 500 is awarded to mother’s who have their first child after 19 years of age, for birth of the first or second child only.
  • Facilities for safe abortion will be strengthened and expanded.
  • Local entrepreneurs at village levels will be provided soft loans and encouraged to run ambulance services.
  • Increased vocational training schemes for girls, leading to self-employment will be encouraged.
  • Strict enforcement of Chid Marriage Restraint Act, 1976.
  • Strict enforcement of the Pre-Natal Diagnostic Techniques Act, 1994.
  • Soft loans to ensure mobility of the ANMs will be increased.
  • The 84th Amendment Act has frozen the total number of existing seats in the Lok Sabha on the basis of 1971 Census till 2026.

Salient features of the population policy of Government of India

For the first time, National Population Policy was announced in 1976 to mount “a direct assault on the problem of numbers. Its salient features were:

  • To raise the age of marriage for girls to 18 years and for boys to 21 years.
  • To take special measures to raise the level of female education in all States.
  • Raising the monetary incentive to persons undergoing sterilisation.

National Population Policy 2000 (NPP 2000)

  • It affirms the commitment of the government towards voluntary and informed choice and consent of citizens while availing of productive health care services, and continuation of the target free approach in administering family planning services.
  • The NPP 2000 provides a policy frame work for advancing goals and prioritizing strategies during the next decade, to meet the reproductive and child health needs of the people of India, and to achieve net replacement levels (TFR) by 2010.
  • It is based upon the need to meet and simultaneously address issues of child survival, maternal health, and contraception, while increasing outreach and coverage of a comprehensive package of reproductive and child health services by government, industry and the voluntary non-government sector working in partnership.

Implications of family planning

Effect on women

Family planning programs are hypothesized to affect women's lives in at least six areas. The six aspects are:

  • Personal autonomy/self-esteem - the right to make and stand by one's own decisions; value or regard an individual places on herself
  • Health - both physical and psychological well-being
  • Educational attainment - the ability to obtain an education and the level of educational attainment
  • Employment and economic resources - the nature of employment; acquisition and allocation of resources
  • Family relationships - degree of equality with spouse and role within kinship structure
  • Public standing - ability to participate in public activities and esteem accorded individual women by community.

Effect on society

Household level benefits including:

  • Increasing household savings
  • Increasing investment in individual children - children in smaller families are better educated
  • Increasing work productivity, in particular female work participation

Community/country level benefits including:

  • Increasing the size of the labour force (demographic dividend), and, domestic savings
  • Reducing poverty, and, accelerating the demographic transition.
  • Slowing down population growth and reducing pressure on the environment and natural resources.
  • Making progress towards a sustainable human population.

Challenges on implementation of population policies and family planning

Individuals' attitudes for family planning methods are influenced by some characteristics, such as economic factors, sociocultural factors, environmental factors, location, age, educational, traditional beliefs, religion, family type and level of knowledge.

The main challenges in population policies implementation in India are:

Women denied right to choose

  • Women still have to bear the burden of contraception.
  • In many parts of the country, women still lack the negotiating power in sexual relationships.
  • In the educated class women are coming forward on their own and opting family planning methods, but in lower socio-economic class, women have no say and are forced by family members to have a large family.

Preference for sons

  • The cultural fixations with sons expose the roots of a deeply patriarchal Indian society.
  • Boys are regarded as assets while daughters are treated as a liability.
  • Women are held responsible and harassed.

Pressure from family

  • Newlywed brides are under tremendous pressure from their groom's family to prove their fertility.
  • This compels them to get pregnant sooner.

Lack of safe healthcare services

  • The Medical Termination of Pregnancy Bill has liberalised abortions in 1971.
  • Despite this, many women are still not reaching out to the registered centres for abortion.
  • Reach of safe centre for sterilization are also another issue present in India giving rise to illegal activities such as forced sterilization.
  • Such incidents again create an environment of fear towards birth control.

Fear of permanent infertility among both genders

  • Both men and women harbour a lot of misconceptions about family planning, which stops them from taking up family planning.
  • Most men fear the loss of virility and how it might impact their conjugal life if it causes low libido. Some think that won't be able to do manual labour or life heavy weights if they undergo a vasectomy. The fear of infertility is also quite prevalent.
  • Women worry that intra-uterine devices such as Copper T may cause bleeding. Women also fear to gain weight as a side effect of birth control pills and cancer after Q pills. The fear of infertility is also prevalent among women.

Cultural and religious beliefs

  • Religious prohibition of as contraception and abortions still rule family planning decisions.
  • People refuse to opt for family planning because of cultural and religious beliefs especially Muslim, Paris, and Jain community.
  • They do not allow women to undergo any procedures like MTP or Permanent Family Planning Method.

Socio-economic reasons

  • Although the trend is towards smaller families among the educated, well-to-do families, the majority of families from the lower stratum of society are still going for larger families.
  • Since many of them are daily wage workers, the number of members in the family directly translates to more wage earners.

Early marriage and childbearing

  • Early marriage means the woman has more child-bearing years.
  • This also causes cases of teenage pregnancy, teenage preterm labour, miscarriages, maternal and neonatal morbidity and mortality.

Effect of population policies and family planning in India

The initiatives taken by the Government in implementing the Family Planning Programme have significant impact. India was the first country in the world to establish a government family planning program way back in 1952.

According to 2011 Family Welfare Programme, some major achievements are as follows:

  1. Awareness of one or more methods of contraception.
  2. Increase in contraceptives use over the years.
  3. Knowledge of female sterilization, which is considered to the safest and popular method of modern family  planning.
  4. Increase in the use of condoms.
  5. Increased knowledge about contraceptive pills.
  6. Fertility rate low among educated women.
  7. Fertility rate low among higher income groups.