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Opinion

Our gender gap in contraception needs public policy intervention


The recently-released fifth round of our National Family and Health Survey (NFHS-5) highlights that there has been a more than 10 percentage-point increase in the use of contraception among currently married women aged 15-49 years: that is, from 53.5% in 2015-16 to 66.7% in 2019-20. A significant jump has been observed in the use of condoms, which rose from 5.6% to 9.5%. It’s noteworthy that despite the near doubling in the use of condoms, female sterilization continues to be the most popular choice, with an adoption rate of 37.9% (NFHS-5), even many years after the inception of family planning as a concept in India.

This brings forth a glaring gender divide in the methods of contraception used in India. The divide could imply two things. First, it may indicate greater bodily autonomy exercised by women today; in charge of their own lives and bodies, women could be making their own contraception choices, thereby determining when and how they want to plan their children and careers. Alternatively, this divide could also indicate the deep-rooted patriarchy that exploits and subjugates women. To evaluate which of the two are at work, we need to take a diligent look at our data.

According to the NFHS-4, conducted during 2015-16, only about 8% of women were found to make independent decisions on the use of contraception, while for nearly every tenth woman, it was the husband who decided contraception use. The irony is that while it is husbands who decide the method, the actual burden of it falls on women. Ipso facto, female sterilization is the most wide-spread method, with more than a third of India’s sexually-active population opting for it, despite the lower cost and safer procedure of male vasectomy. Interestingly, based on data from NFHS-3 and NFHS-4, we also observe that a higher proportion of women with college or higher levels of education tend to opt for male or female reversible methods of contraception (33.7%) over female sterilization (17.2%). All these facts give credence to the ‘subjugation’ explanation of the divide over the ‘bodily autonomy’ hypothesis outlined above.

These observations have also been highlighted in a recent study published as a working paper by O.P. Jindal Global University in 2021, titled Gender Gap in the Use of Contraception: Evidence from India. The study lends evidence to the pertinent role that women’s education plays in the choice of contraception. The Bihar model is an excellent illustration of this, with the Population Council of India’s director Niranjan Saggurti cited as saying, “The most significant [factor] in the Bihar case is the increase in education—which has translated into increased use of contraception and increased family planning.”

Therefore, in addition to educating children, there is an imperative to impart knowledge about the use and benefits of different methods of contraception to the community at large. It is paramount to target such awareness campaigns at both men and women. Special emphasis should be given to convincing men about the relevance of family planning, and hence, the use of several male contraceptive methods that are safer, cheaper and procedurally simpler than female sterilization. This can be done by utilizing the country’s existing network of community health workers, like Asha workers or Anganwaadi workers or Auxiliary Nurse Midwives. However, currently, most of these frontline workers who have the mandate to disseminate information on family planning are females. Additional male workers could also be deployed to ease direct communication with men.

Additionally, India conspicuously has no law on contraception that makes access to a sound sexual health our legal right, despite it being one of the key indicator variables of the Sustainable Development Goals of the United Nations (SDG indicator 3.7.1). Inclusion of sexual well-being as our legal right under the ambit of law can ensure that there are no unnecessary restrictions on the advertisement and publicity of contraceptives, thus easing people’s access to information and knowledge on them. Further, such a law could also be used to make the availability and accessibility of contraceptives easier by enrolling the services of Primary Health Centres, particularly to improve access in small towns, peri-urban and in rural areas.

With the introduction of a bill to amend the Prohibition of Child Marriage Act, 2006, so as to increase the legal age at marriage of girls from 18 to 21 years, the government has taken a step in the right direction. There exists literature that suggests that an increase in the age of marriage for females reduces the total fertility of women (Maitra, 2004). While this would be a relatively direct result of a higher age of marriage, as it simply reduces the reproductive years of married women, a probable indirect consequence of this move could be an improvement in the bargaining power of women, as it may reduce age gaps between husbands and wives.

Further, exceptional pandemic measures like lockdowns and the exigencies of essential supplies have interrupted contraceptive supply chains. According to the World Health Organization (WHO), family planning has been severely affected during this period, with seven out of ten countries affected. According to United Nations Population Fund, of 114 low/middle-income countries, more than 47 million women were unable to access contraceptives. India alone, as per the report Resilience, Adaptation and Action: MSI’s Response to Covid-19, witnessed 650,000 unwanted pregnancies during the covid pandemic.

Therefore, it is a need of the hour that sexual and reproductive health become a priority at the policy level. Fostering better informed and healthier reproductive behaviour among the country’s masses is a long-term endeavour that should not cease on account of a health emergency.

Sonal Dua, Aditi Singhal & Divya Gupta are assistant professors, O.P. Jindal Global University

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