India's Family Planning Is About to Get Much Needed Overhaul

There is a very simple reason that India is about to overtake China as the world's most populous nation: Women are having more children in India (2.3 on average) than in China (1.7 on average). That may not sound like a huge difference, but it is when you are building on such a huge population base, and also when the drop down to 2.3 in India has been so recent. The last time China's TFR was that high was in 1980, according to data from the UN Population Division. By contrast, back in 1980 women in India were having more than 4 children each, and that number dropped below 3 scarcely more than 10 years ago. 

One of the big problems with contraception in India is that the government has focused almost all of its attention on female sterilization, as I noted several months ago when a group of women died after receiving botched tubal ligations.

Besides these health risks--which shouldn't exist because tubal ligation is not complex--the focus on female sterilization in India means that Indian women still marry young, have children, and only after having children undergo sterilization. This bunches up the generations and actually causes the Indian population to grow more quickly than would otherwise be the case and, of course, this pattern also holds back the emancipation of women from early marriage, early motherhood, and domination by her husband and mother-in-law.

Finally it seems that India's family planning program is going to get that much needed overhaul, as reported today in the NYTimes.

For decades, India has relied on female sterilization as its primary mode of contraception, funding about four million tubal ligations every year, more than any other country. This year, the government of Prime Minister Narendra Modi will take a major step toward modernizing that system, introducing injectable contraceptives free of charge in government facilities. The World Health Organization recommends their use without restriction for women of childbearing age.

New birth control options have long been advocated by international organizations, among them the United States Agency for International Development and the Bill & Melinda Gates Foundation. They say Indian women — often worn out, anemic and at higher risk of death because they bear children young and often — urgently need methods to delay or space pregnancies.

Amazingly enough, opposition to injectable contraceptives has come especially from "some women’s activist groups that distrust the safety of these methods and believe that profit-hungry Western pharmaceutical companies are pushing them." This is another version of the anti-vaccine mentality, which is so harmful to health in its own sad way. And, perhaps because of this opposition, we shouldn't be expecting changes overnight. The government is moving slowly and cautiously on this new policy.