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Stagnancy in the Unmet Need for Family Planning in India
Though addressing the unmet need for contraception was one of the immediate objectives of India’s National Population Policy 2000, the available evidence shows that there has been stagnancy in the level of the unmet need for family planning for quite some time. Data from the fourth round of the National Family Health Survey carried out during 2015–16 show that about 13% of couples of reproductive ages wanted to stop childbearing or delay the next birth but did not get the contraceptive services they desired to have. Trends in the level and nature of the unmet need for contraception, whether for spacing or limiting, are examined here on the basis of the data from the series of NFHS rounds. Further, socio-economic and regional differentials in the unmet need have been assessed. It is seen that while socio-economic differentials in the unmet need exist but are not large, there are notable interstate differences, and some states have a high unmet need. Besides, the unmet need has risen in a few states in the recent years. The paper also provides estimates of implications of the unmet need in terms of unwanted births and fertility.
India introduced the family planning programme in the early 1950s along with and as part of the process of planned development. The programme began on a low key, but soon adopted a full-fledged neo-Malthusian approach to lower fertility by creating awareness about the consequences of rapid population growth and providing contraceptive services free of cost. Food shortages of the 1960s led to demands for “strong measures” to control population growth, and the programme was intensified with the introduction of the extension approach, new methods of birth control, sterilisation camps, incentives to acceptors, and acceptor targets. The intensification reached a peak in 1976 aided by the atmosphere of the Emergency, with coercive measures being adopted to make couples accept contraception. But, resentment towards the programme tactics caused a backlash, and the government that came to power after the end of the Emergency ruled out any compulsion in family planning. Yet, the programme as such was not abandoned and continued with some moderation under the label of “family welfare.”
However, the 1990s brought in major changes in the situation and in the public and government mood. There was clear evidence that fertility decline was in progress in India, and the spectre of population explosion no longer dominated public discourses as it often did in the 1960s and 1970s. Moreover, worldwide, there was a broad consensus that applying pressures on couples to accept family planning was unethical. This was reflected in the Swaminathan Committee report (MoHFW 1994) and the International Conference on Population and Development (ICPD 1994), Cairo (UNFPA 1994). By this time, there was evidence that the small-family norm was widely accepted by all sections of the population, and that there was demand for contraceptive services, but some of this demand was not met, either by the programme or by non-government providers, resulting in a substantial unmet need for family planning. The first round of India’s National Family Health Survey (NFHS-1) carried out during 1992–93 revealed that about a fifth of married couples of reproductive age had an unmet need for family planning (IIPS 1995; Radha Devi et al 1996). In the light of this, the new National Population Policy (NPP) of 2000 rejected the target strategy and instead recognised that addressing the unmet need for family planning and reproductive health was the immediate objective (MoHFW 2000: 2).
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