ARC - Advocating Reproductive Choices

Need:

The Family Welfare Programme in India has experienced significant growth and adaptation since its inception in 1951. During this period, financial investments in the programme have substantially increased and service delivery points have significantly expanded. Multiple stakeholders, including the private sector and non-governmental sector, have been engaged in providing contraceptive services.

Yet, Unmet need for contraception remains high at 13 % in currently married persons and 27 % in adolescents with a great interstate variation. There has been great decline in the total fertility rate to 2.9 over the years but still we are far from achieving the desired rate. The contraceptive prevalence rate is 56 % but shows a skewed method uptake favoring female sterilization. The method mix also remains restricted to the male condom, Intrauterine device, oral pills and sterilization within the public health sector.

Studies have shown that countries in which all couples have easy access to a wide range of contraceptive methods have a more balanced methods mix2 and higher levels of overall contraceptive prevalence than countries with limited access to various contraceptives (Ross et al, 2002; Magadi and Curtis, 2003). Further, Jain (1989) has estimated that the widespread addition of one method to options available in a country would be associated with an increase of 12% in contraceptive prevalence. A balanced method mix is also an indicator that there is no “systematic limitation of contraceptive choice” (Sullivan et al., 2007). The contraceptive scenario is also characterized by the predominance of non-reversible methods, limited use of male/couple-dependent methods, substantial levels of discontinuation, and negligible use of contraceptives among both married and unmarried adolescents[1].

During recent year Govt. of India has introduced two new Oral Contraceptive Pills and three monthly Injectable in the basket of contraceptive, but this is not sufficient. There is a need for more No. of long acting reversible Contraceptive methods.

In view of above, ARC can put collective resources and put the idea to MOHFW, Govt. of India for inclusion of Implants and Intra-uterine system (IUS) in the basket of contraceptive methods. This can only be achieved by setting up a Technical standing committee  within the ARC in which the organizations/individuals can collectively work and influence the policy makers and program managers for Expending Contraceptive Choices.

Objective of the Technical standing committee:

  • To identify and prioritise newer contraceptive methods such as combined Injectable, Implants specially Implant on and Progesterone loaded IUD, Emergency contraceptive pills which are tested and approved for use Internationally specially in neighboring countries; collect evidences for the same and do advocacy for their inclusion in the National FP program especially for rural and semi urban areas
  • To advocate for inclusion of new and underutilized long term reversible methods in the public and private sector taking the national and international perspectives into consideration.
  • To advocate for wider use of existing methods in the public health system, vis-a-vis increasing the demand and supply.
  • To advocate revival of No-scalpel vasectomy and male participation in the FP program and promotion of the same.

Interventions:

  • To conduct a systematic review of national and international evidence on new and underutilized long acting reversible contraceptive methods recommended by the WHO.
  • To undertake a situational/barrier and stakeholder analysis and develop one year advocacy plans for each of the contraceptive
  • To undertake advocacy activities to engage different audience to present the evidence and facilitate discussion for action.
  • To develop a timeline for priority tasks over a period of two years

Technical standing committee:

Lead Co-lead
FOGSI PFI