The release of the complete report of the National Family Health Survey (NFHS) 5 has become a moment of celebration. With the reduction in the country’s total fertility rate (TFR), improvement in sex ratio, reproductive health, maternal health as well as other important indicators, this edition of the survey is viewed as a significant feat, an enormous step towards transforming our nation.
One of the key indicators, which many celebrate as a historic accomplishment, is the sex ratio of the total population, with a record of 1,020 females per 1000 males.
What Sex Ratio At Birth Tells Us
Asserting this as a mark of a gender-equal society, what one is failing to acknowledge is that the sex ratio at birth (SRB), with only 929 females born per 1,000 males, still narrates a different story.
Correspondingly, although the preliminary Sample Registration System (SRS) Statistical Report findings of 2018 show a positive trend for SRB in comparison to the last report, with the number of females born per 1,000 males going up to 899 in 2016-18 from 896 in 2015-2017, the overall trend shows a steady decline, from 909 in 2011-13 findings to 896 in 2015-17.
On the contrary, the sex ratio in the Census 2011 findings was 940; the NFHS 5 and the SRS data have instead shown a decline rather than surpassing it. But does it all add up?
One can only hope that now with the new findings, safe abortion services will not be impacted, pregnant persons will be able to avail abortions, and that providers will be able to provide services without fear and intimidation.
Total Fertility Rate Dips, But Who Bears the Burden of Contraception?
Another major ‘achievement’: the findings present a steady decline of the TFR from 2.2 to 2.0, indicating India’s ‘stabilising population,’ but family planning indicators highlight that this is at the expense of its women.
Women continue to be disproportionally burdened, and contraception is still something that women have to take care of.
The total contraceptive prevalence rate has seen a huge increase, from 47.8 percent to 56.5 percent, but so has the uptake of female sterilisation; the adoption of male sterilisation remains stagnant, highlighting that the burden of contraception usage still falls upon women.
Without being cynical, we do need to view the data with a pinch of salt. If we were to follow the data, then contraception and family planning check the right boxes, but when we visit hard-to-reach areas, the unmet needs throw quite a spanner.
Being a pre-pandemic survey, these findings also do not take into consideration the unexpected lockdown to contain the spread of COVID-19 in the early March of 2020, which had severely impacted access to contraception and safe abortion services throughout the year.
Contraception and safe abortion had taken a backseat and that continues, which may have resulted in millions of unintended pregnancies forced to term, and when things were getting better, the second wave came as another huge setback.
Even then, the low uptake of reversible methods, such as pills, IUCD and injectables in the NFHS 5 findings, which are even lower than condoms, call to attention the growing need for long-acting reversible contraceptives, such as implants, in the public health sector, which are less invasive and more effective.
If included earlier, they might have even helped in bridging the unmet need during the pandemic when Primary Health Centres/Community Health Centres were turned into COVID-19 isolation centres. Unlike sterilisation or IUCD, implant contraceptives are not at all invasive or intimate and would have improved accessibility.
'Unmet Need for Contraception Is More for Conventional Reversible Methods'
It is high time we realise that the unmet need for contraception is more for conventional reversible methods than for terminal methods of contraception. We need to improve the basket of choices.
With the growing younger population, we need to review policies and programmes that cater to the needs of all, especially the youth. Although the uptake is low, there is still an improvement of around 66 percent in the uptake of reversible methods, which highlights the need to shift the focus from family-planning programmes to a more universal contraceptive programme, bringing in youth in the conversation and shifting the needle from control to choice.
Overall, different indicators, be it literacy, the prevalence of child marriage, or maternal and child health indicators have shown a positive trend towards improvement.
But one cannot fail to observe the disappointing findings in anaemia, women’s empowerment and gender-based violence. Anaemia has shown a drastic increase, and the survey findings are of a pre-pandemic India, when there were no disruptions in the services for providing supplementary nutrition. One cannot imagine the disturbance due to the pandemic.
Similarly, indicators such as women who are earning and have experienced spousal violence, physical violence during any pregnancy or sexual violence by the age of 18 present a distressing truth, with minuscule or no improvement. The situation has worsened further post-pandemic.
'There Is an Immediate Need to Learn From the Data Rather Than Patting Our Back'
The National Commission for Women’s data showed that domestic violence complaints doubled, and there was a drastic increase in child marriage and trafficking of women and girls within the first few months of the pandemic.
Furthermore, as per the Centre for Monitoring Indian Economy (CMIE)’s Consumer Pyramids Household Survey (CPHS) database, a study by Ashoka University, 39 percent of women lost jobs during COVID-19. Further, in comparison to their male counterparts, women were 11 times more likely to not work after COVID-19-induced job loss.
Foregrounding a bitter truth, there is an immediate need to learn from the data rather than pat ourselves on the back. These pre-pandemic findings have not taken into account the turmoil caused by COVID-19, which has not only pushed back our economy but has also impeded the slow progress made in meeting our goals for a gender-equal society and has taken us back by a decade.
At present, the glass is only half full. There is a long way for us to go to become a rights-based society, and that will be possible only through enabling schemes and policies.
(Debanjana is a vocal SRHR advocate working on gender rights and climate justice for the past 17 years. This is an opinion piece and the views expressed above are the author’s own. The Quint neither endorses nor is responsible for them.)
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