“We must put our minds together to achieve wonders in the health system. If the supply side of services is in our hand, then why should we have an unmet need for family planning?” asked Dr SK Sikdar, Deputy Commissioner for Family Planning, Ministry of Health and Family Welfare.
The question was apt. According to the National Family Health Survey 2015-16 [NFHS-4], less than half the number of women who went in for sterilisation were told about other forms of contraception, only 42% were informed about related side effects, and less than 6% of married women use a contraceptive to delay the birth of their first child.
These numbers all point towards one direction: the need to strengthen the family planning monitoring system in India. To answer how this could be done, UNFPA and USAID organised a one day consultation in Delhi on September 30, 2019, to draw on the experience and expertise of governments, from the centre and the states, along with partners from civil society. The timing of this meeting was critical. Twenty-five years ago, 179 governments met in Cairo at the historic International Conference on Population and Development (ICPD) to chart a bold new course for the world: putting women and girls at the centre of all conversations. In less than two months, the global community will convene yet again at the Nairobi Summit on ICPD25 to take stock of the progress made and the unfinished business that remains.
“India has made huge leaps in addressing some indicators in our population and reproductive health programmes—maternity mortality has declined, access to reproductive health services has improved, contraceptive prevalence has increased and adolescent girls have more autonomy to make decisions about their health today,” said Ms Ena Singh, Assistant Representative, UNFPA India, “This consultation is all the more relevant this year because it is the 25th anniversary of ICPD which recognised rights and dignity to be essential for individuals to realise their own fertility goals and for global development.”
While representatives from the state governments of Odisha, Rajasthan, Bihar and Uttar Pradesh talked about the current state of monitoring mechanisms, civil society partners stressed on how these systems could be more oriented towards the perspectives of women and youth. The overall consensus was that the current indicators being used for monitoring need to be expanded to stress on quality, dignity and rights.
“We still have a 12.9% unmet need for modern contraception in India,” said Ms Moni Sinha Sagar, Development Assistant Specialist (Innovation) from USAID. “It is crucial we think of strengthening the entire ecosystem for delivering quality services to people, and to look at mechanisms in a way that goes beyond the regular monitoring to a more quality-oriented performance monitoring.”
India has come a long way since ICPD. Health indicators have improved significantly, with the maternal mortality rate declining, access to contraception and reproductive health improving and more women and girls having the power to decide, if, when and how many children they want to have.
Strengthening monitoring systems for family planning is the next big step to ensure quality of services and a more accessible mechanism for women, youth and adolescents, while keeping in mind the need to guarantee rights and dignity of those accessing family planning services.
“We don’t want to track individual women, we need to be able to respect privacy. We don’t want to design a system which, by virtue of tracking, becomes an enforcement. So how can we marry that complex set of actions which take place when women choose contraception or are thinking of choosing contraception with these three ideas—adverse effects, prior counselling and post follow-up? How can we keep that in mind and then come up with a set of indicators that will help us monitor quality and choice more powerfully?” asked Ms Singh.
“Having new indicators for tracking progress of family planning is a huge step forward but how do we come up with doable indicators that will add value to programmes? Every state has a different dynamic. We need to keep that in mind and go to states where it matters the most, and then come up with workable indicators,” Dr Sikdar added.
The meeting provided a platform for global evidence to be reviewed and for understanding how monitoring could go hand-in-hand with counselling, informed choice and quality of care. It also provided a chance to look at the current monitoring mechanisms for family planning through the eyes of civil society.
A quarter of a century ago in Cairo, the global community agreed that every woman and girl should have the right, choice of and access to contraception. A stronger, re-invigorated family planning monitoring system in India will not only guarantee this, it will also help India keep to its commitment of zero unmet need for family planning.
