Quality care will boost family planning efforts
Despite population stabilisation being a critical area, budgetary allocations have been skewed and insufficient
Apositive for the health sector in last year’s Union Budget was the stated goal to increase India’s health sector spending from the current 1.15% of GDP — one of the lowest worldwide — to 2.5% by 2025. One needs to look at budgetary provisions from the perspective of family planning.
According to the 2015-16 findings of the National Family Health Survey 4, the total demand for family planning (FP) among currently married women between the ages of 15 and 49 is 66%. The unmet need for FP services is 13%, declining by just 1% over the last decade. Less than half (48%) of currently married women aged 15–49 years use modern contraceptives. Despite evidence that family planning is a critical area from the perspective of reducing maternal and infant mortality, allocations have been skewed and insufficient.
Examining the budgetary allocations and expenditure offers some insight into the reasons for the tardy pace in India’s progress on family planning. The FP component gets about 4% of the total budget available under the National Health Mission’s reproductive and child health flexi-pool. Analysis of data shows that in the financial year 2016-17 only 60.7% of the funds available for family planning were spent. The nature of allocations and spending, whichcurrentlyfocusesdisproportionatelyon terminal methods rather than supporting the policy objectives to promote spacing between children and improving the quality of care, is a matter of concern. For proper spacing of children, women need reversible contraceptive methods. In 2016-17, 64% of the FP budget was allocated to terminal and limiting methods, while just 3.7% went towards spacing methods. There are also serious limitations in the capacity to utilise the funds available for family planningattheimplementationstage.Forinstance, 40%ofthemoneyallocatedforreversiblemethodsremainedunutilised. Adecentralised,participatory planning process that factors in actual needs and resource requirements of districts, and systematic tracking and monitoring of the spending will improve utilisation.
In 2016-17, almost 81% of the FP budget was spent on compensation to beneficiaries, and incentives to frontline workers and health care providers of terminal methods of family planning. The skewed emphasis on targets defeats India’s declared policy of population stabilisation through a rights-based approach to family planning and reproductive health.
There is evidence on the ground to show that when there are improvements in the quality of care, they’ve resulted in a dramatic rise in uptake of family planning services. The government needs to increase allocations and strengthen the systems that would enable better utilisation of family planning budgets.
In Delhi’s political imagination, the real political battle of 2018 begins in Karnataka. It then ends with the three states of Rajasthan, Madhya Pradesh and Chhattisgarh, setting the stage for the Lok Sabha polls of 2019. But before that, in February, three key Northeastern states — Nagaland, Meghalaya and Tripura — go to polls. And to underestimate the importance of these elections for either the people of these states or the national polity would be a mistake.
It is important because the thread of electoral democracy within the constitutional framework binds Nagaland, home to Asia’s oldest insurgency and with a strong conception of its own uniqueness and claims of sovereignty with India. Elections have created and sustained a Naga political elite which stands at the forefront of defending the Indian system and is ready to unfurl the Indian flag. It may not address the alienation of its people entirely — which is why the peace process with rebel groups is so important — but a democratic government provides a channel to articulate some of their concerns. This time around, elections have become contentious. A significant section of Naga civil society and political opinion, tired of the long drawn peace talks and seeking closure, wants a ‘solution before election’. But the Centre is clear that this cannot be a reason to postpone polls. BJP’s general secretary, Ram Madhav, has said the state needs ‘elections for solution’. As the peace talks enter the final lap, Delhi feels having an elected legitimate government in Kohima strengthens its hands.
It is important because it has provided a democratic platform to tribals in a Bengalidominated polity like Tripura to articulate their aspirations. This, among other factors, has weakened the militancy that used to engulf the state till a decade and a half ago.
It is important because democratic
NAGALAND, TRIPURA AND MEGHALAYA MAY BE SMALL STATES. BUT THEIR ELECTIONS — LIKE ELECTIONS ELSEWHERE — PROVIDE AN OPPORTUNITY TO CITIZENS TO NEGOTIATE WITH THEIR POLITICAL ELITES.