Enhancing the basket of contraceptive choices can reduce maternal mortality rate, says a family planning review

Family planning has made a silent comeback in the national discourses. This time, focussing more on concomitant improvement in the health of the people rather than limiting the number of children.

India had changed its strategy on family planning in 2010 with the other developing countries from that of merely reducing population to that of providing health care services to men and women for fertility control. Free distribution of condoms, permitting over-the-counter sale of emergency contraceptives for women, improving institutional deliveries and providing a package of mother and child health care were all part of this re-defined family planning strategy.

Two years into implementation, a review of this re-defined family planning strategy has now recommended providing safe abortion services and post delivery health care, including enhancing the basket of contraceptive choices to couples.

“For decades, family planning has been viewed mainly as a strategy for controlling population. However, with declining global population growth rates, the need to position family planning as more than just a means of population control has become increasingly evident,” says Poonam Muttreja, executive director of Population Foundation of India that carried out the review.

‘Repositioning Family Planning: A review of evidence on effective intervention’ says India’s family planning policy services should also focus on counselling.

It also recommends involving male health workers for community-based education and counselling, and distribution of contraceptives. As of now, only the Accredited Social Health Activists (ASHA) provide family planning services to women at the community level.

“We need to reorient the role of the female community health workers to provide information, facilitate discussion on the pros and cons of different methods and help clients make an informed choice of a method that is acceptable to him/her,” says the review.

The ‘Repositioning of Family Planning’ approach, discussed at the Summit on Family Planning in London late last year, was endorsed by governments, donors and civil society across the world. “Although not explicitly stated, the emphasis on health and well-being and on voluntary family planning is in keeping with the notion of birth control as a reproductive right,” says the review.

It is now widely opined that family planning reduces maternal mortality — both directly and indirectly. Several studies have also examined the non-contraceptive health benefits of family planning methods on women. Oral contraceptive is shown to reduce at least eight serious diseases and other gynaecological morbidities.

Experts spell out at least four mechanisms through which family planning can directly reduce maternal deaths: reducing the incidence of pregnancies and thus exposure to risks of life threatening pregnancy-related complications, and bringing down the risks of abortions due to the reduction in the number of unwanted/unplanned pregnancies. Every year 50 million of the 190 million women who become pregnant across the world resort to abortions for terminating unwanted pregnancies and about 13 per cent of maternal deaths are due to abortion complications.

Also, contraceptive use reduces risk-per-birth at extreme ages because maternal mortality risk is higher at younger age (below 18) and it enables a longer recovery period between pregnancies.

Of the 300,000 maternal deaths globally, only 1,700 deaths occurred in developed countries where contraceptive use rate is very high (72.4 per cent), according to a study done by Saifuddin Ahmed of Bill and Melinda Gates Institute for Population and Reproductive Health and John Hopkins University. The study suggests that 86,000 maternal deaths in India were averted in 2008 because of contraceptive use, notwithstanding that fact that contraceptive use in India is only 57.6 per cent.

Even with declining average annual growth rates, India continues to add approximately 18 million people annually to its population, because the proportion of people in the reproductive age group is almost 50 per cent. India has not introduced a new contraceptive method in public sector in over 40 years, since IUDs were included in 1965. A number of methods are either unavailable in the public sector basket of choices, or lack trained personnel who can counsel and deliver these methods with adequate standards of care. Moreover, the restricted access to several methods only in the private sector, violates the human rights principles of life saving technologies, the review says while calling for a pro-woman, human rights approach to family planning.

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