How do we
reach out to tomorrows parents?
India has 348
million people in the 15-34 age group. This
large base, however, has limited
opportunities for attaining their full
potential because of skewed social and
economic development. The youth in India
demand opportunities to develop skills,
pursue education and gain employment. This
should be the focus of all our development
efforts not only in urban agglomerations but
also in rural India, where a majority of
Indians live.
Will these
young people raise families like previous
generations, when contraceptive choices were
limited and health services were poor, or
will they be informed and empowered people
to adopt a path which moves toward
population stabilisation? The challenge lies
in ensuring that these 348 million draw the
benefits of health and contraceptive
services because they will decide the rate
at which India's population will grow in the
future.
The concern
should also be to reach out to the 0-14 age
group with nutrition, health care and
primary education because they represent the
foundations of the future. Investments made
in good time in formative years will run the
long haul to make for an informed and
educated citizenry.
World
Population
What
is Demographic Transition?
"Demographic
transition" is a model that describes
population change over time. It defines four
clear stages of population growth that
nations often traverse in tandem with their
socio-economic development.
Stage 1:
Typically seen in less developed countries
where birth rates are high but a large
number of people die of preventable causes
leading to a stable population.
Stage 2:
Death rates fall steeply as deaths from
preventable causes are reduced by better
food supply and improved public health, but
birth rates remain high due to high
fertility, poor social development and
limited access to health and contraceptive
services. This often leads to a spurt in
population.
Stage 3:
Birth rates fall but population continues to
grow because there are a large number of
people in the reproductive age group due to
the high fertility of the previous
generations.
Stage 4:
Countries achieve a stable population once
again with low birth and low death rates but
at a higher level of social and economic
development. Population is stable but higher
than in stage one.
This
transition from a stable population with
high mortality and high fertility to a
stable population with low mortality and low
fertility is called demographic transition.
India is currently at the third stage.
Why
are developing countries slow in achieving
demographic transition?
Developing
countries are slow in achieving demographic
transition because of historical reasons. It
the developed world, the industrial
revolution in the 1800s led to overall
development and prosperity, resulting in
lower death and birth rates. The developing
world missed these opportunities which have
been attributed to colonisation, and the
attendant lack of growth. Endemic poverty,
low levels of education, and weak family
planning programmes have kept the average
number of children born to each woman to
more than six in many parts of the
developing world. This prolonged phase of
high population growth has resulted in a
large base of young population which imparts
high momentum to population growth and
prolongs the period of demographic
transition.
India
and Population
What
is meant by population stabilisation?
Population
stabilisation is a stage when the size of
the population remains unchanged. It is also
called the stage of zero population growth.
Global population is said to be stabilizing
when births equal deaths. However, in the
case of individual countries, movement of
people into and outside the country is also
taken into account. Country level population
stabilisation occurs when births plus
in-migration equals deaths plus
out-migration.
For
population stabilisation, a person must die
for every one who is born. But when there
are more young couples starting families
than older people dying, the population
continues to grow. This is called population
momentum.
Thus, there
is often a gap of a few decades between
achieving replacement level fertility (two
children per couple) and population
stabilisation. India has set itself the goal
of attaining replacement levels of fertility
by 2010 to achieve the larger goal of
population stabilisation by 2045 - a gap of
35 years to account for population momentum.
Why
is the population increasing so fast even
when the average number of children per
woman is decreasing?
India
continues to add about 18 million people per
year because more than 50% of the population
is in the reproductive age group. It is this
large base of young people which imparts
momentum to the growth of population. Also,
the number of people entering the
reproductive age group increases by the year
due to the high birth rate of the previous
years.
Population
momentum can be checked by delaying marriage
and child bearing, and by spacing births.
What
are the factors that influence population
growth?
Natural
increase denotes the difference between the
number of births and deaths. The country has
seen declining death rates but the birth
rates remain high; birth rates are high due
to two factors. The first is unwanted and
unplanned fertility - children who are born
because of lack of poor access to
contraceptive services, also known as the
"unmet need". The birth of three
and above three children accounts for 45% of
the 26 million births that take place each
year.
Second is the
desire for larger families (called
"wanted fertility") because of
socio-cultural reasons, particularly
preference for a male child and high infant
mortality. This accounts for 20% of births.
More
significantly, the momentum brought in by
the young age profile of the population
spurs growth. This phenomenon will continue
to add large numbers to India's population
in the coming decades.
Sex
Ratio and Population
What
does the sex ratio of a country indicate?
When
men and women have near equal chances for
survival, there are bound to be near-equal
number of males and females in society. In
India, however, the female population is
much lower than the male population due to
higher mortality among females, particularly
during their reproductive span.
The sex ratio
in the Indian population has been falling
consistently. From 972 women per 1,000 men
in 1901, the sex ratio fell to 933 women per
1,000 men in 2001. This is a cause for
concern as it is a telling indicator of the
health and social status of women in
society, which has a direct and immediate
bearing on other key indicators like child
mortality.
Sex ratio is
also calculated for various age groups, the
most important being 0-6 years. An adverse
sex ratio here shows that less girls are
being born compared to boys and so indicates
discrimination against the female foetus -
this could be at the time of conception,
gestation or delivery. An adverse 0-6 sex
ratio also reveals that socio-cultural
factors are determining survival chances of
the female.
Why
is there concern about falling sex ratio in
the 0-6 age group?
The
fall in the sex ratio for the 0-6 age group
is particularly worrisome as it points to
increased incidence of pre-birth selection.
The easy availability of sex selection
procedures and the unethical practice of
pre-birth sex selection are responsible for
the current situation to a large extent.
The fact that
some of the States which fare well on social
and economic development indicators also
have low 0-6 sex ratio calls for
introspection. Six of the States that have
recorded the steepest declines are from
among the most economically developed ones.
These States and Union Territories are
Chandigarh, Delhi, Gujarat, Haryana,
Himachal Pradesh and Punjab. It is likely
that the aggressive promotion of the small
family norm without the required community
interventions to change the preference for a
male child, along with the easy availability
of sex selective procedures, could be
playing havoc with the birth and survival of
female children.
| Sex
Ratio of 10 Most Populous Countries |
| World |
990 |
| Bangladesh |
952 |
| Brazil |
1,031 |
| China |
943 |
| India |
933 |
| Indonesia |
1,000 |
| Japan |
1,041 |
| Nigeria |
990 |
| Pakistan |
952 |
| Russian
Fed. |
1,136 |
| USA |
1,031 |
Source:
"World Population Prospects. The 2002
Revision", United Nations Population
Division. The World Population Prospects,
2002 report cited here lists India's sex
ratio as 943. The figure for India quoted in
this table, however, cites the latest Indian
census figures.
| 0-6
Sex Ratio |
| Chandigarh |
845 |
| Delhi |
868 |
| Gujarat |
883 |
| Haryana |
819 |
| Himachal
Pradesh |
896 |
| Punjab |
798 |
| India |
927 |
Source:
India Census 2001
What
is being done to prevent sex selective
abortions?
Sex
selective abortions are illegal in India.
The Pre-natal Diagnostic Techniques
(Regulation and Prevention of Misuse) Act,
1994, was enacted and brought into operation
from 1st January, 1996, in order to check
female foeticide. Rules have also been
framed under the Act. The Act prohibits
determination and disclosure of the sex of
foetus. It also prohibits any advertisements
relating to pre-natal determination of sex
and prescribes punishment for its
contravention. The person who contravenes
the provisions of this Act is punishable
with imprisonment and fine.
Recently,
PNDT Act and Rules have been amended keeping
in view the emerging technologies for
selection of sex before and after conception
and problems faced in the working of the
implementation of the Act. These amendments
have come into operation with effect from
14th February, 2003.
Under the
Act, a person who seeks help for sex
selection can face, at first conviction,
imprisonment for a three-year period and be
required to pay a fine of Rs.50,000. Medical
professionals involved in sex selection can
lose their registration and the right to
practice, if convicted under the Act.
However, officials admit that the Act is
difficult to implement because sex selection
happens within the confines of
doctor-patient confidentiality.
Several
Non-Government Organisations are active in
fighting pre-birth sex selection. The issue
is receiving attention of several health
authorities which have begun monitoring
clinics and hospital records for evidence of
sex selection to mount action against them.
Does
a decrease in the number of women enhance
their position?
No.
India remains a highly patriarchal society
where women are marginalised and denied
development benefits. The falling sex ratio
is a reflection of the existing gender bias.
In some
districts with low sex ratios, the adverse
impact is already visible with many men not
being able to find wives. Practices like
polyandry are being reported, as also
"bride price" and "bride
selling" under which women are
"bought"/ "sold" for a
price. Thus, in the prevailing social
context, a further fall in numbers will only
lead to increased violence against women and
denial of rights rather than empowerment.
What's
wrong with preferring a male child?
Indian
society has a marked preference for a male
child, both for perceived economic and
traditional reasons. Apart from being seen
as the rightful and capable heir to family
property and name as well as an important
means to carry the lineage forward, sons are
also seen as providing support to parents in
their old age. A male child is also valued
for the perceived final salvation of the
parents through the performance of their
last rites.
Girls are
often seen as a burden because of the social
evil of dowry that requires parents to spend
large amounts on their marriage. Investments
in a daughter are thought to be wasteful as
she leaves for her husband's home after
marriage, and often cannot share earnings
with her parents.
Where such a
preference exists, parents tend to make more
investments in a male child than in the
female child, be it on nutrition, health,
education or a career. Such discrimination,
overt or covert, is bound to limit
development opportunities available to the
girl child which further reinforces gender
bias.
The obsession
to have at least one male child places
tremendous psychological pressure on women,
with many undergoing frequent abortions
following sex-determination tests. The felt
need, indeed demand, for a male child is
also an important trigger for domestic
violence, with women bearing the brunt for
their perceived "inability" to
provide a male child. This is often used as
an excuse for bigamy and desertion.
Preference for a male child is clearly wrong
because it devalues the female child and
denies her basic rights for survival, growth
and development. Further, male preference
takes its toll on women's lives, reinforcing
male domination and making it difficult to
build a fair, just and equitable society. In
such a skewed situation there can be no
progress in empowering women to become equal
members in society.
How
is the preference for a son an impediment to
population stabilisation?
Son
preference is a major impediment to
population stabilisation as it makes couples
opt for larger number of children in order
to ensure at least one male child in the
family.
Son
preference is evident in every State.
However it is more pronounced in Uttar
Pradesh, Rajasthan, Bihar, Haryana, Madhya
Pradesh, Orissa and Arunachal Pradesh. These
are also the States with high population
growth rates. The weakest son preference is
found in Tamil Nadu, Kerala, Karnataka and
Goa, which are also the States that have
achieved or are near achieving replacement
level fertility. They also have better
male-female ratio and higher female literacy
levels. In richer States like Punjab,
Haryana and Gujarat, couples are opting for
smaller families but male preference leads
to sex selection leading to adverse sex
ratios.
Development
and Population
Is
population a development issue?
Yes, it is. Population is often seen as an
issue of ever growing numbers of people but
the fact is that growing numbers merely
mirror the lack of social and economic
development. Simply put, the lower the
levels of socio-economic development, the
greater the chances that couples in that
group would have more children.
This is best
seen in differences in the various States of
India. For example, Uttar Pradesh has 56.3%
literacy and only 14% of women receive
complete antenatal care. Uttar Pradesh
records an average of four children per
couple, almost double the figure of two
children per couple in Kerala, where almost
every person is literate and every woman
receives complete antenatal care and
delivers in a health institution. Thus,
Kerala with its advanced social development
indices had reached what is called the
"replacement level fertility" two
decades ago while Uttar Pradesh will take
another 20 years to reach that mark, as it
continues to have a high fertility rate (TFR
4.4)
Can
we focus on development and let population
grow unchecked?
No.
Since socio-economic development benefits
take longer time to percolate, it is
important to take steps that would improve
people's access to quality health services
which have a direct bearing on their
reproductive health behaviour. Providing
quality health services, which include
contraceptive services, to those who do not
wish to have children but have no access to
methods of family planning (meeting the
"unmet need"), would avert as many
as 20% of births in India.
Reaching
contraceptive services itself has three
parts to it - a) counselling covering why,
when and how to use a particular method, b)
ensuring easy availability and accessibility
of the chosen method and c) follow up care
to ensure continued and trouble free use of
the method.
Alongside,
adolescent sexual and reproductive health
services need to reach out particularly to
young persons to empower them to make
informed and responsible decisions regarding
their sexual and reproductive behaviour,
including the age at which they would like
to marry and start a family. This will help
the youth to the use of condoms for safe sex
and other contraceptive methods for delaying
the first child and for spacing subsequent
pregnancies.
The goal of
child nutrition must be addressed
separately. The "mid-day-meal"
scheme in schools has increased enrolment as
well as improved the nutritional status of
children. This has proved to be effective in
improving child survival and reduced the
desire for larger families.
Poverty
and Population
Is
sterilizing people an option?
Any
form of coercion is in principle wrong and
militates against basic human values and
violates human rights. The suggestion that
coercive sterilisation is an option flows
from a mindset that looks at people as
targets rather than as human beings with
their own rights and needs.
That apart,
experience of some of the Indian States
clearly shows that it is possible to achieve
replacement levels of fertility without
compromising human rights and liberties. A
comparison of the fertility decline in China
and Kerala shows that Kerala achieved more
than China without ever having to adopt any
coercive policies. China's Total Fertility
Rate (TFR) of 2.8 in 1979 dropped to 2.0 in
1991, while Kerala's TFR of 3.0 in 1979
dropped to 1.8 in 1991. Tamil Nadu had a
similar decline from TFR of 3.6 in 1979 to
2.2. in 1991. Easy access to health services
and women's education helped the fall in
fertility rate in Kerala, while the most
important factor in Tamil Nadu was the
successful child nutrition support programme
with focused interventions to meet
contraceptive needs.
One of the
most important factors which would bring
down fertility levels is to meet the unmet
need for contraception. This step can reduce
fertility levels by almost 20%. Ensuring
child survival can prevent another 20% of
births.
The goal of
child nutrition must be addressed
separately. The "mid-day-meal"
scheme in schools has increased enrolment as
well as improved the nutritional status of
children. This has proved to be effective in
improving child survival and reduced the
desire for larger families.
Gender
and Population
What
needs to be done to reduce maternal
mortality?
The
first step to reducing maternal mortality is
to ensure quality antenatal, natal and
post-natal services that identify high risk
pregnancies and provide timely support. Safe
delivery practices must be ensured through
promotion of institutional deliveries and
training of birth attendants as well as by
making safe delivery kits easily available
to women who still deliver at home.
It is also
important to strengthen the management of
obstetric complications and increase
availability of emergency obstetric
services. Sensitising family and community
members to the danger of obstetric
complications, providing community based
transport facilities, and ensuring quality
emergency obstetric care at the health
centres would greatly reduce deaths due to
delayed medical attention at the time of
delivery.
Adolescent
sexual and reproductive health programmes
help the youth adopt responsible sexual
behaviour, resulting in less number of
teenage pregnancies or unwed pregnancies,
which often culminate in unsafe abortions in
India due to the stigma attached to
pregnancies out of wedlock. Providing easy
access to safe abortion services would help
women terminate unwanted pregnancies without
risking their lives. Efficient contraceptive
service delivery also goes a long way in
avoiding unwanted pregnancies and illegal
abortions.
Improvements
in the overall health and nutritional status
of the girl child and woman are equally
important in improving the survival chances
of women during pregnancy. The dominant
cultural mores and practices often undermine
the health and nutritional requirements of a
woman. As a result, women are not encouraged
to actively seek services often with
disastrous consequences. Hence, there is a
need to work at the individual, family and
community level to bring a change in mindset
so that society comes to regard a woman,
more so a pregnant woman, as a person
deserving the highest priority.
How
is antenatal care important for mother and
child survival?
Antenatal
care covers at least five basic services -
pregnancy monitoring, tetanus toxoid
vaccine, iron and folic acid tablets (IFA)
and nutrition/ safe delivery counselling.
These can help women go through the
pregnancy safely and ensure that the new
born is in good health.
However, many
women are not able to access these basic
services, resulting in avoidable
complications like anaemia, night blindness,
babies with low birth weight or delivery
related haemorrhage.
The impact of
antenatal care on the health and survival of
the mother and the child cannot be
overemphasized. States which reach out good
antenatal care show a marked decline in
infant mortality.
Child
Health and Population
Why
are so many children born with low birth
weight in India?
A
baby weighing less than 2.5 kilograms at
birth is considered a low birth weight baby.
In India, as many as 70% of children are not
weighed at birth.
A child's
nutritional future begins with a women's
nutritional status in adolescence and in
pregnancy. Low birth weight occurs because
of poor maternal health and nutrition and
poor foetal growth. These infants may suffer
from infections, weakened immunity, learning
disabilities, impaired physical development
and, in severe cases, die soon after birth.
A mother
chronically undernourished from youth is
more likely to give birth to an underweight
baby, perpetuating the intergenerational
cycle. Inadequate diet or rest, smoking,
infections, cultural practices that restrict
diet during pregnancy discourage women from
gaining weight and long hours of physical
labour increase the chances of low birth
weight babies.
Timing and
frequency of pregnancies are also of great
importance, with high risks encapsulated in
the phrase "too young, too old, too
many or too close".
Inadequate
intake of other micronutrients - Vitamin A,
iodine, folate, zinc - has a profound impact
on both the mother and the foetus, and on
the outcome of the pregnancy.
Contraception
and Population
What
is contraception?
Contraception is the deliberate
prevention of the conception of offspring by
any of various means. In general, birth
control or contraception is anything that
prevents a woman from becoming pregnant. The
most basic form of contraception is
abstinence. However, abstaining from sex
entails fighting the natural human sex
drive. Medical technology allows
contraception through various means, which
can be temporary or permanent, so that those
not practicing abstinence can control
conception.
The right to
decide freely and responsibly the number and
spacing of children and to have the
information, education and means to do so is
well recognized as an important component of
reproductive rights. Contraceptives enable
men and women to exercise these rights.
What
is the pattern of contraceptive use of
"method mix" in India?
Modern medicine has provided us
with a range of contraceptive choices. The
distribution pattern of usage of various
methods to prevent pregnancies is called
"method mix". India is unique in
that female sterilization is the predominant
method with most couples preferring to
achieve their desired family size and opting
for a permanent method.
Why
have we not been able to bring about a
change in the contraceptive behaviour of
people in spite of our mass media campaigns?
Mass
media campaigns have the potential to
provide visibility to a product, spread
information, build interest and influence
public opinion. They can lead people to the
shop, but cannot always make them buy the
product. The inherent quality of the
product, salesmanship, inducements to try
the product, and after-sales service are
what ultimately influence the decision
towards the purchase and successful use of
the product.
Often, these
basics are ignored when it comes to
promoting contraceptive use, a subject that
demands a higher level of communications
skills because it concerns personal and
intimate choices. The very successful mass
media campaigns of the 1960s and 1970s
brought near-universal knowledge about
contraceptives in India. However, they
failed to translate information into action
because the health system lagged behind in
service delivery.
People in
different phases of change process require
different communication inputs. The various
phases of the change process (understanding,
experimenting, adopting and advocating)
require counselling, service support,
follow-up and creation of opportunities to
espouse the cause. Such a systematic
communication strategy, also called
Behaviour Change Communication, was absent
or not operational till a decade ago.
Why
is the use of spacing methods so low in
India?
The
low prevalence of spacing methods is
attributed to :
-
Lack
of knowledge/access to these methods
-
Poor
counselling and follow-up services
-
Incidence
of method-related complications
aggravated by the poor health status of
women, like anaemia, reproductive tract
infections and sexually transmitted
diseases.
-
Dovetailing
of the contraceptive services with
mother and child health made it
difficult to promote the use of condoms,
which requires the male partner to be
involved. However, in the light of the
looming threat of HIV/AIDS, efforts are
being made to promote condom as a dual
protection method
-
Couples
prefer to have the desired number of
children in quick succession and opt for
sterilization, which reduces their need
for spacing methods
-
Excessive
focus of the family welfare programme on
sterilization also sidelines promotion
of spacing methods
-
India's
family planning programme has largely
failed to encourage the use of
reversible methods, particularly among
young women (age 15-30) who are in the
most fertile years of their reproductive
period. While it has been easier to
design communication campaigns on small
family norms, promoting spacing has not
been successful in the prevailing
context of excessive preference for
sterilization.
Why
is spacing of births important for
population stabilization?
Irrespective
of the number of children, the timing of
births has an independent impact on
population stabilization. Spacing, or the
gap between two successive pregnancies,
would naturally help reduce the momentum of
population growth because children born
later would in turn reach their reproductive
phase at a later date.
Spacing also
ensures better maternal and child health,
which in turn leads to better survival of
children and so diminishes the desire for
larger families.
Spacing is
important not only for reducing births but
also for improving the quality of life of a
population. Well spaced and fewer births not
only promote better mother and child health
but also improve the development
opportunities available for men and women,
be it education, employment or social
cultural participation. These in turn reduce
"wanted fertility" - the number of
children a couple desires to have in the
family.
Hence,
policies and programmes that encourage
spacing between births through temporary
methods of family planning need to be
promoted in a big way.
How
can spacing methods be promoted?
The
key to increasing the use of spacing methods
is enhanced communications on the one hand,
and efficient service delivery on the other.
The importance of communications is brought
out by the fact that 99% of married women
are aware of at least one modern
contraceptive method. However, knowledge
about all the methods, which is a
prerequisite for informed choice, is only
58%, and only 42.8% use any modern method at
all. This is so because counselling and
inter-personal communications, so essential
for informed choice, are not pursued as an
integral part of service delivery by the
health workers.
Communications
and counselling services are essential to
address myths and misconceptions that abound
as also to address method-related problems
that inevitably lead to discontinuation of
contraceptive use. Women need to be treated
with greater respect, and empowered to make
informed choices by educating them about the
various methods and related side-affects.
Follow-up care, particularly in the event of
method related complications, is also
crucial.
Alongside, it
is important to improve the availability of
quality contraceptives as in their absence
no communication effort can be successful.
Social franchising of services through local
practitioners, community based service
providers, and social marketing through
corporates are being tried out in the
country under various programmes.
Why
is it that fewer couples opt for male
sterilization?
Over
a period of time, the population programme
in India has become women-centric, a sea
change from the days when vasectomy or male
sterilization was the dominant method. Of
the couples opting for a permanent method of
contraception, as many as 67.3% chose
vasectomy in 1963. This increased to 75%
during 1976-1977 but dropped steeply to
21.4% in 1980-81, 6.2% in 1990-91 and 2.3%
in 2000-2001.
The drop is
directly attributed to excesses committed
when a target drive mindlessly pushed
vasectomies. The development and promotion
of laparoscopic techniques in female
sterilization had also made it easier for
women to undergo the procedure.
Though
equally easy, non-scalpel vasectomy is not
being preferred due to various myths and
misconceptions. Fear of loss of libido and
strength, method failure, and an attitude
that makes birth control as the
responsibility of the woman explain in large
part the poor acceptance of the method.
Apart from
increasing access to male sterilization
services by making them available on a
regular basis at the level of the primary
health center, there is a need to strengthen
communication support to the programme at
the field level and at the macro level
through mass media campaigns.
If
people prefer a particular method over
others what is wrong in promoting that
method on a large scale?
The
contraceptive needs of couples vary
depending on their life situation. For
instance, a newly married couple may need a
spacing method while a couple completing
their family size may opt for a permanent
method. Also, the needs of a lactating
mother are different from a woman who has
infrequent sex. Logically, it is not
possible for people to opt for any
particular method on a large scale. Ideally,
women and men of varying age groups and
family situations should have the option to
pick and choose from a variety of methods
available.
But if one
method is preferred over all the others, it
is often due to poor information and
knowledge about other options, limited
access to services, cost factors or myths
and misconceptions.
Often, it
also reflects aggressive promotion of a
particular method by service providers
concerned about meeting programme targets. A
case in point is sterilization, which is
irreversible, needs limited follow up and
therefore tends to get promoted over other
methods. This should not be construed to
automatically mean that sterilization is
that most preferred method.
Promoting a
single or few methods limits contraceptive
choice to only women in certain life
situations. Thus, the excessive emphasis on
female sterilization in India means that
only those women who have attained their
desired family size are able to use
contraception. For sustained decline in
fertility rates, it is imperative that we
have a more balanced "method mix".
Why
do some groups oppose the introduction of
injectable contraceptives in India?
New
contraceptive technologies such as the
hormonal injectables and implants are
invasive, longer acting, provider-controlled
and have a high potential for abuse when
they are targeted at women in developing
countries. Besides, injectables also have
higher associated health risks that cannot
be easily addressed with the poor health
infrastructure in India. So, while the usage
may spread with ease, it may simultaneously
breed a new set of health problems for which
the woman may have nowhere to go.
Most Indian
women have poor health status and poor
awareness levels, and when this segment
receives invasive technology, the results
can be disastrous. Screening and follow-up
is the key to effective use of these
technologies. Since these two cannot be
ensured in a system which is hard pressed
for infrastructure and human resources, many
argue that it is best to keep out such
methods, particularly from the public health
service system. Injectable contraceptives
are not a part of the public sector health
and family welfare programme in India but
are available in the market.
Youth
and Population
Why
do we need to focus on youth? Doesn't
reproductive health start at marriage?
How
India's population would grow in the future
depends largely on the 189 million-plus
people in the 15-24 age group. Meeting their
needs for information and guidance regarding
sexual and reproductive health behaviour,
apart from education and employment
opportunities, thus constitutes an important
aspect of population and development
programmes.
Adolescent
sexual and reproductive health programmes
enable them to make responsible and informed
decisions. This is particularly important in
the case of young women, who should be
empowered to exercise their right to greater
control over their sexual and reproductive
lives, free of coercion, discrimination and
violence. Better communication about
sexuality, about gender relations, and about
the avoidance of unwanted pregnancy and
sexually transmitted diseases will improve
the quality of life of young people.
The
importance of focusing on the adolescent
girls and boys is supported by the
following:
-
About
25% of girls in the 15-19 age group have
their first child before the age of 19
in India
-
Pregnancy
before age 18 carries many health risks.
Teenagers are more likely to die in
pregnancy or childbirth than women aged
20-24
-
Adolescent
mothers will have more children as they
are less equipped to negotiate
contraceptive use
-
Adolescents
account for 14% of abortions in India,
according to the International Planned
Parenthood Federation
-
Raising
the mother's age at first birth from 18
to 23 could reduce population momentum
by over 40%, according to the United
Nations Population Fund (UNFPA)
-
Those
under age 25 account for half of all HIV
infections in India, according to the
Joint United Nations Programme on
HIV/AIDS.
Does
giving sex education to adolescents
encourage sexual promiscuity ?
No.
Contrary to popular belief, sex education
does not lead to promiscuity. In fact, such
programmes lead to reduction in anxiety
associated with unsafe sexual encounters and
promote safe sex practices.
In a review
by the World Health Organisation of 1,050
scientific articles on sex education
programmes, researchers found "no
support for the contention that sex
education encourages sexual experimentation
or increased activity. If any effect is
observed, almost without exception, it is in
the direction of postponed initiation of
sexual intercourse and/or effective use of
contraception".
Failure to
provide appropriate and timely information
"misses the opportunity of reducing the
unwanted outcomes of unintended pregnancy
and transmission of sexually transmitted
diseases,, and is, therefore, in the
disservice of our youth", the report
says.
Adolescent
reproductive and sexual health programmes
should take parents and the community into
confidence to build a supportive environment
for the adolescents to exercise their
choices. In the absence of such an
integrated approach, there is a danger of
the programme being resisted on misplaced
fears of increased promiscuity. There is a
need to work with both boys and girls
together so that they appreciate the sexual
and reproductive processes in both the
sexes. This also leads to a proper
understanding and exercising of sexual
rights.
How
does increase in age at marriage affect
population stabilization?
Marriage is near universal in India. Age
at marriage is directly related to the
education and employment opportunities
available to women, with those better
educated and employed marrying later than
those who are uneducated and/or unemployed.
The mean age
at marriage has increased steadily - from 17
years in the 1960s to 20 years in 1990s.
Still, around 43% of women get married
before 18 years, which is the legal age of
marriage in India for women. One of the
reasons for early marriage is also the fear
that the girl may lose her virginity, the
protection of which is considered as a
responsibility of the family and seen as
discharged by marriage.
Early
marriages often lead to early pregnancies,
as most women also conceive immediately
because they lack knowledge and access to
contraceptive services as well as face
family pressure to present an heir within
the first year of marriage. On the other
hand, the desire to prove his
"masculinity" by siring a child
prevents a man from using contraceptive
methods immediately after marriage. Giving
birth to a child is also seen as a means of
securing the marriage as there is greater
pressure on the man to take responsibility
for his wife when she is the mother of his
child. Infidelity and desertion are more
common when the woman has not had a child.
Adolescent pregnancy, within marriage or
otherwise, poses a threat to the health and
survival of the mother and child. Loss of
children makes the couple desire larger
families.
At the macro
level, early marriages and early child
bearing result in faster replacement of
generations, impeding population
stabilization even when the couples opt for
one or two children.
HIV/
AIDS and Population
Why
should we focus on HIV/ AIDS issues in
population programme?
Young
men and women who are sexually active and
who constitute the workforce of the country
are the most vulnerable to HIV/AIDS. Every
14 seconds, a youth is infected with
HIV/AIDS and youth (increasingly women)
account for nearly half of the new cases of
HIV infection worldwide, according to the
United Nations Population Fund (UNFPA) State
of the World Population Report 2003.
High
mortality among youth will result in loss of
productive labour and an increase in the
number of dependants - children and the
elderly. This clearly will bring with it
greater impoverishment, ill-health and
economic decline. Since the ultimate aim of
population programmes is to ensure an
improved quality of life for the people, not
merely reduce numbers, prevention of
HIV/AIDS becomes an important component of
population programmes.
Worldwide,
population growth has been brought down by
reducing death rates and limiting fertility,
not by allowing people to succumb to
disease.
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