Aali Sinha: Education helps?

When India initiated its clinic-based family planning programmes in 1952, it was one of the first countries to do so. With a chequered past, the government's family planning strategy in recent times has been one that is 'target free', making available greater choices in contraceptives and assuring high quality care to increase usage. Presently about 50 per cent of the women in the reproductive age groups report the use of a modern method of contraception in India. However, contraception is almost synonymous with female sterilisation. Since sterilisation is a permanent procedure, the majority of the couples adopting this are those who have achieved their desired family size. Reversible methods that allow for spacing births such as birth control pills, condoms and IUD still have limited coverage in India.

The recently released National Family and Health Survey III data provides interesting insights into the patterns of contraceptive use. Overall, the data reveals an increase in the use of contraception. In states, such as Kerala, Himachal Pradesh, Andhra Pradesh, Gujarat, Karnataka and Maharashtra, contraceptive usage reported by illiterate women is higher than literate women and in most cases this gap widens with increasing levels of education. Out of every 100 illiterate women in reproductive age groups in Himachal Pradesh, 81 report using contraception while out of every 100 women with at least 10 years of education, only 59 do so. Similarly in Kerala the figure stands at 68 and 51 respectively. This contrasts with the popular wisdom that female education has a positive impact on greater levels of contraceptive usage. Though it should be noted here that contraception in most cases means female sterilisation which is the chosen method amongst illiterate women.

Education is however closely linked to the choice of a modern method of contraception. In most of these states the choice shifts from sterilisation to that of reversible methods like pills and condoms with increases in the education levels of women.

This is interesting as reversible methods allow spacing the births, a better family planning practice. Unfortunately, though a greater proportion of educated women do not want to use sterilisation, their need for a desired alternative is not being met as data shows that the more educated women report higher unmet need for contraception. 10 per cent of women with more than 10 years' education report unmet need for contraception compared to less than 5 per cent of illiterate women in Kerala, Andhra Pradesh and Himachal Pradesh.

The low adoption of reversible methods despite the government distributing them for free is due to a lack of awareness and misconceptions regarding the use of birth control pills, condoms and IUD. Many case studies have highlighted the reasons behind this as fear of infertility due to prolonged usage of pills, fear of infection and diseases post IUD insertions and so on. Another reason is the low levels of male involvement in family planning especially when men are the chief decision makers in the household.

The National Population Policy that seeks to focus on the unmet need for contraception has to ensure that reversible methods gain greater accessibility especially in India where girls get married early and also start families early. Further, condom usage is also one of the most important tools to control AIDS transmission. Reversible methods must be promoted more effectively to ensure better health of our women.

The author works at Indicus Analytics and can be contacted at aali@indicus.net