India has continued to make enormous strides in the area of sexual and reproductive health in the last decade. Recent indicators show that the maternal mortality ratio for the country declined from 130 to 97 maternal deaths per 100,000 live births in the four years between 2014-2016 to 2018-2019, and eight states have already achieved the SDG target of reducing the maternal mortality ratio to below 70. The country’s total fertility rate is now below the replacement level (2.1) according to the latest round of the National Family Health Survey (NFHS) 2019-2021, and the use of modern contraceptive methods by currently married women has increased from 47.8 to 56.5 per cent. The country is now looking forward to realizing its national commitments under the global FP2030 agreement for expanding family planning and improving reproductive health.

UNFPA has played a role in these advances since its 1st Country Programme in 1974 through its advocacy work, its programmatic activities, provision of supplies of reproductive health commodities, work to empower women, support for civil society organizations (CSOs) working on sexual and reproductive health issues, and analysis and use of data. UNFPA has long been a partner with the Government of India in developing and implementing policy in the areas of reproductive health and rights and promotion of gender equality while targeting its programmatic support during the 9th Country Programme in four states and 14 priority districts as decided with the Government.

Aiming to address the high unmet need for family planning and to reduce maternal mortality in India, UNFPA’s 9th Country Programme made major contributions in enhancing the capacities of the health system at the national level and in the four priority states to provide high-quality reproductive health and family planning services with a focus on marginalized populations, young women and adolescent girls. UNFPA provided technical support to improve the continuum of care and to enhance service utilization at the primary, secondary and tertiary levels concentrating in the four priority states of Bihar, Madhya Pradesh, Odisha and Rajasthan.

Introducing two new methods expands the basket of choices available for Indian women to a total of eight, providing further options to realize their reproductive choices.

One result of UNFPA’s technical assistance during the 9th Country Programme has been that over 90 per cent of health facilities in UNFPA’s 14 priority districts provide safe delivery services and at least five reversible contraceptive methods. As India looks forward to continuing the progress it has made under the FP2020 commitments, UNFPA’s work in co-leading a group of organizational focal points and supporting the Ministry of Health and Family Welfare (MoHFW) contributed significantly to the formulation of the FP2030 commitments and the development of the FP2030 vision document of the Government of India, which was launched in 2022. This vision document emphasizes expansion of the reach and range of contraceptives, including for marginalized groups and extending to the last mile, and enhancing the quality of services, including in humanitarian settings.

One of the primary means of preventing maternal deaths is by ensuring that women have access to skilled birth attendants when they deliver. In India, this percentage reaches almost 90 per cent of all births, including by doctors and nurses/midwives. In 2018 the Government of India issued midwifery service guidelines to create a cadre of nurse practitioners in midwifery in order to augment the availability of skilled birth attendants and improve quality of care. UNFPA has been an active partner with the Government in making this vision a reality.

UNFPA’s work in capacity building, mentoring support, regular follow-up and technical support resulted in regularizing maternal death surveillance and review meetings in UNFPA’s 14 priority districts.

To enhance the acceptability of midwifery-led care and harmonize clinical practices, intensive orientation programmes were organized at eight hospitals linked with the NMTIs for doctors, nurses and administrators to develop team spirit in working with the new midwives. In order to enhance the quality of training on midwifery components in the nursing colleges across India, UNFPA supported the training of 1,681 nursing tutors on the midwifery component of the new curriculum. UNFPA advocated with the Medical Council of India (and subsequently the National Medical Commission) to promote adherence to evidence- and rights-based approaches to respectful maternity care and helped to implement recommended evidence-based practices in 11 medical colleges across three states that resulted in significant improvements in standard clinical services, focusing on delivery care and family planning.

UNFPA undertook evidence-based upstream policy advocacy to reverse son preference, address child marriage and empower women and young people, especially girls. For example, UNFPA supported formulation and roll-out of policy directives under the Rajasthan State Women’s Policy (2021) and implementation of the Rajasthan State Action Plan for ending child marriage. UNFPA supported the implementation of the Strategic Action Plan to End Child Marriage in Odisha, the state scheme on valuing daughters, Biju Kanya Ratna, and the state scheme on empowering adolescents, Advika. UNFPA worked with civil society groups, including women’s and youth groups, to contribute to the discussion of child marriage, encouraging a more nuanced discourse that includes structural drivers such as poverty and lack of adolescent autonomy, always advocating for the use of rights-based approaches.

Civil society actors play an important role in promoting the use of human rights-based approaches in advancing UNFPA’s work in promoting gender equality. In one example, dialogues convened by CSOs and their submissions on the subject of the proposed amendment to the minimum legal age at marriage enabled a more informed media discourse on the subject. In India, panchayats are the closest and most accessible government institutions for women seeking redress from harmful practices and have considerable potential to influence social norms and promote gender equality. As part of efforts to prevent GBV and to address harmful practices, during 2022 UNFPA supported the Ministry of Panchayati Raj to build capacities of around 200 representatives from State Institutes of Rural Development and Panchayati Raj to integrate gender and harmful practices into their trainings for Panchayati Raj officials and elected representatives.