Delhi has a huge population of around 1.68 crores (Census 2011) which is expected to double by 2040. The population growth is causing stress on the city’s resources. The difference between demand and supply of essentials like water and electricity is widening, while Delhi’s air quality is consistently topping the charts of cities with the worst air pollution levels.
This growth in population can be attributed to the NCR’s vibrant service sector providing one of the highest per capita incomes in the country. Rapid urbanization in the peripheral cities of Faridabad, Ghaziabad, Gurugram, Noida, etc, and their major functional linkages with Delhi translates into a major influx of people every day.
“While development or migration in Delhi cannot be monitored or restrained, steps to control the population using family planning can easily be adapted on individual and administrative levels. There is a need to promote the norms of a small family, and the government, too, needs to understand the true meaning and scope of family planning and implement it efficiently through the Directorate of Family Welfare”, says Barkha, a Delhi-based social researcher.
One gender bears it all
Family Planning is a broad all-encompassing term and means more than just preventing unwanted pregnancies. According to WHO, ‘Access to safe, voluntary family planning is a human right. Family planning is central to gender equality and women’s empowerment.’
According to a study by the Ministry of Health and Family Welfare, about 47% of the married women across Delhi used some method of modern contraception in the financial year 2016-17. Tubectomy or the surgical removal or blocking of fallopian tubes was the most common method used by over 19% of the respondents. In contrast, male vasectomy as contraception stood at only 0.2%.
“More women are subjected to using contraception than men. Like giving birth, the responsibility of family planning lies with the woman. Not only does this notion stem from our patriarchal roots, but also shows how seldom we consider men to take the responsibility of family planning”, remarks Barkha.
Instead of developing a holistic understanding of family planning, the government has reduced it infamously to either forced or incentivised vasectomies/tubectomies. Accredited Social Health Activists or ASHA workers have been assigned the task of educating families on family planning and safe contraception through going door-to-door awareness campaigns. However, data suggests that they haven’t been able to completely break the gender norms nor has the administration attempted to sensitise people against gender stereotyping.
“Over the years, we have informed and educated so many families about opting for vasectomies because they can be reversed under some conditions, as opposed to tubectomies. But the men are reluctant. Either they are scared, or they use their entitlement to push the responsibility on women”, says Veena Tiwari, an ASHA worker. While adding that many women, too, outrightly reject the idea of their husbands getting vasectomies, she says, “Nasbandi sharmnaak lagti hain kuch ko (Some are embarrassed by a vasectomy).”
Ignorance isn’t always bliss
As many as 40% of all women in Delhi, aged 18-21, are already married. More than half of these are pregnant with their first child. “Getting pregnant immediately after marriage – either accidentally or after proper planning, might be ‘happy news’ for those who only want to further their bloodline. But often, the financial stability, mental and physical health of the couple, and their individuality are compromised in such situations. And this isn’t talked about much”, says Barkha.
A domestic worker from Kailash Colony says that she was not consulted by her husband on the decision to have a baby. “Why should my husband ask me? If we are married, we will have kids sooner or later. I had my first child at 18”, she says. When asked if she knows anything about her sexual rights, contraception methods or family planning, she denies it. She subtly adds that her husband has never used protection, and she has never dared to ask him to use one.
Moreover, like many other couples, she also says that they have never talked about how many children they want.
On the other hand, Harshali, an IT employee from Gurgaon, says that she wished she and her husband had used family planning methods before they had their first child a year after their marriage. “I love my son, he’s my world. But when I talk about family planning, I mean that I wish my husband and I had planned our finances well in advance. If we knew that we would be financially stable in, say, four years, then we would have used some contraceptive method. It’s much better than struggling financially while also trying to give the best life to your two-year-old.”
According to Neha Kashyap, Health Manager at RTI International, “There is a need to make the family planning program more aspirational for young couples linking it not only with the health of the family but as a means to achieve more financial stability and fulfil more dreams. That’s what makes more sense to young couples.”
Harshali was only counselled by her gynaecologist about family planning methods after she got pregnant. For her, like many others in Delhi, abortion was not an alternative. This further highlights the need of bringing open dialogues about safe abortion practices into the mainstream, thus helping those who need it but are either too reluctant, ignorant, or unaware.
Gynaecologist Dr Yashi Sharma, talks about ‘GATHER’ and ‘Cafeteria Approach’ as safe modes for counselling people on family planning. ‘GATHER’ is an acronym for Greet, Ask, Tell, Help, Explain, Refer. In this approach, the counsellor ‘gathers’ the couple about their needs, requirements, lifestyles and expectations. They further use the ‘cafeteria’ approach where different alternatives and options of family planning are given to the couple, who then select what suits them the best.
There is a need to sensitize our medical service providers as well as recipients about sexual and reproductive rights, how family planning is more than just contraceptives and what proper family planning entails. The government too needs to work on effective implementation of policies pertaining to family planning, thus tackling the problem at its root cause.
Recently, there have been a lot of talks about the lack of communication among various departments of the centre and the adverse effects of the same. Similarly, the issues of pollution, urban planning, health, women and child welfare, and gender justice cant be viewed in isolation. A synergy is required between the efforts of various departments to optimize the efforts being put in by each of them because a target for one department is often a hurdle for another. Only if the administration and individual strata take relevant efforts, family planning can be made more efficient and healthy.
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