Controlling India’s population growth through women’s empowerment is a vision put forward by the current executive director of the Population Foundation of India, Poonam Muttreja. An innovator in areas of social justice and programmes on leadership, she has three decades of experience in the socio-development sector. For the success of population growth-curbing strategies, male engagement must be encouraged and family planning should be as much a male issue, Ms Muttreja said in an interview. Excerpts
Q: As an NGO what is your contribution in implementing the country’s population policy?
A: We work as a partner with the Government and public in implementing community programmes for improving the quality of health and advocacy to put family planning on the political agenda.
Population control in India should be less about sterilisation and more about empowering women. India has a massive population but its control need not be only about reducing numbers.
Q: What is the agenda of Population Foundation of India in view of the size of India’s population?
A: We focus on advance family planning; advocacy for change; reducing infant and child mortality; female morbidity and several other means for achieving population stabilisation. We see family planning as empowering women to complete their education, take up paid work if they choose, be healthy, and raise healthier children and families. We, therefore, work at positioning family planning in women’s empowerment and the human rights framework.
Q: What do you suggest should be the plan of action for defusing the population bomb?
A: Empowering women and ensuring investment in family planning can be a game-changer. The public health system, family planning programmes and communication strategies should be designed to encourage male engagement in family planning. Our six areas of focus include preventing early marriages; postponing first pregnancy; promoting spacing between births; improving quality of care of family planning and reproductive health (RH) programmes; preventing sex selection. The focus is on married and unmarried adolescents as well as married adults.
Q: What are the challenges you face in raising these issues?
A: The biggest of all is the Budget. The share of family welfare was increased only marginally from 4 per cent last year to 5 per cent of the health budget this year. These increases, however, are insufficient to offset the 54 per cent decline in allocations by the Central government to family welfare between 2013-14 and 2015-16. This under-funding of health by government remains a concern.
Q: What has been achieved in terms of the size of India’s population?
A: Population is declining across the country. Twenty states have reached replacement levels. But still we have miles to cover. The poor and marginalised sections of our society don’t have access to counseling, or contraception. They have more than one child very early, which risks the life of both mother and child leading to high maternal morbidity and infant mortality. India spends little on contraception or temporary family planning, even though 70 per cent of the population is in the reproductive age group. Young marriages result in young girls attaining motherhood which combined with lack of healthcare services leads to high national mortality. Undernourished, malnourished, often anaemic women produce undernourished, malnourished and ailing children.
Q: The number of women getting sterilised in India is incredibly high.
A: Eighty per cent of India’s expenditure on family planning is on sterilisation. Only 1.5 per cent is on temporary methods. Seventy per cent of Indian women go for sterilisation and three quarters of those have never had access to a long-lasting but reversible contraceptive. Of 10 million abortions reported, 95 per cent are proxy for contraceptives. Abortion-related morbidity is around 13 per cent. There is almost no planning for family planning.
Q: What methods other than sterilisation are being propagated to contain the size of the population?
A: There is an effort to shift the current practice in family planning from limiting population to giving both men and women the knowledge and means to plan and raise healthy families. We advocate for providing sufficient contraceptives, expanding the spectrum of contraceptive choice, making quality family planning and reproductive health services accessible to all, and improving male participation in maternal and child health programmes at the national and state levels with an aim to make every family a planned family and every child a wanted, healthy child. In India, about 12 per cent happen to be unwanted children.
Q: Are there other types of family planning methods?
A: The Indian scene is pathetic where female sterilisation takes centrestage while Bhutan, Sri Lanka, Bangladesh have much better access to family planning methods. Some new contraceptive methods being used in other countries include female condoms in Argentina and in Brazil hormonal patch implanted in the upper arm which lasts for five years. These are reversible methods yet better than injectibles. Male vasectomy is easiest, totally risk-free and contrary to misconception does not lead to even 1 per cent loss in virility.
Q: Is the burden of containing population only on the women of the country?
A: Unfortunately, yes. Here, there is no male responsibility for population control. Family planning is only a women’s issue. Women are blamed for producing girls. Family planning should be as much a male issue as it is a female one. We never address the men. Only when men wish for and women exercise their reproductive rights will they be better able to contribute towards full participation in controlling population growth rate.
In one PFI entertainment education programme, of 1.4 million phone calls received 60 per cent were from men.
Q: How long will it take to correct the population growth graph?
A: Population stabilisation will happen only if we get more men engaged. We are already late. Precious time has been lost. Family planning should have come into action 65 years ago. As we have a large number of people in the reproductive health age and even if we stick to the two child norm, containing population momentum will be an uphill task.
Q: How do you tackle mindsets of communities? For instance in some communities interfering in child birth decisions or control is a sin or tinkering with God’s/nature’s will?
A: Nowadays things are changing. Economically, people cannot afford to have more children. Families don’t have money to educate their children, to feed them. With costs going so high, people don’t want to have more than two children. Nuclear families and working women are other reasons. There are no means to look after and bring up a child. The concept that only boys look after parents in old age is changing too. As the care giving role is mainly with girls, the longing for a boy is diminishing. Girls can do what boys can. There are instances where girls have been known to have lit the funeral pyre for their father or mother.
Q: What are the roadblocks you feel need to be lifted for achieving population control?
A: Spacing babies is a big issue so is postponing the first child. There is an urgent need to change some social norms for it is very hard for the average Indian woman to negotiate contraception with her husband.
Another big problem with family planning is nobody wants to talk about it post-1977 (when late Prime Minister Indira Gandhi declared a state of Emergency). There was some coercion in terms of sterilisation, especially male sterilisation. There was a huge backlash. Politicians think being engaged with family planning means you lose an election, so they all stay away.