Road from ICPD to SDGs: Health Returns of Reducing Unmet Need for Family Planning in India

Md Juel Rana¹ and Srinivas Goli²

¹ International Institute for Population Sciences, Mumbai - 400088, India
² University of Western Australia, Perth, Australia

5th Asian Population Association Conference, August 2021

Introduction Results

Projected number of pregnancy and unintended pregnancy averted by years between 2016 to 2030 in
 In a global context, several studies make a strong economic case for family planning investments, by
India
attempting to estimate socio-economic, demographic, and health impacts.
Unmet need declined to 0%
Unmet need declined to 0%
 Studies suggest that family planning is the second-best ‘return to investment’ goal (only next to education) Unmet need declined to 5% Unmet need declined to 5%
9 1.45

Unintended pregnancy averted in

among all Sustainable Development Goals (SDGs)

Pregnancy averted in million

8 1.35
 However, the focus of previous research was largely on the ‘economic returns to investment’ in family 7
1.25
6
planning, while it has wider benefits in terms of improving demographic and health outcomes as well 5 1.15

million
 Considering that such investigations are rarely seen in highly populous developing countries like India 4 1.05
3
0.95
2
0.85
 By estimating the impact of family planning on maternal and child health outcomes, this study would 1
0 0.75
contribute in two directions:

2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
2017
2016

2018
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
(i) to communicate to policymakers that family planning impact is beyond the fertility control;
(ii) to advocate that the agenda of family planning is not yet finished.

Projected number of abortion and unsafe abortions averted by years from 1993 to 2030 in India
 The outcome of this analysis may be a useful instrument for policymakers to frame the family planning
Unmet need declined to 0% Unmet need declined to 0%
goalpost for India to achieve the several targets set for SDG-3 by 2030. Unmet need declined to 5% Unmet need declined to 5%
14 190

Abortion averted in million

 This study aims to estimate the impact of reducing the unmet need for family planning on the key

Unsafe abortion averted in

12 180
10 170
maternal and child health indicators in India from 1993 to 2016; then project it for the period from 2016 to 160
8

thousand
2030. 150
6 140
4 130
Data and Methods 2
120
110
0 100

2024
2016
2017
2018
2019
2020
2021
2022
2023

2025
2026
2027
2028
2029
2030

2016

2027
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026

2028
2029
2030
Statistical analyses
o the Family Planning module in the Spectrum based simulation model has been used to estimate
impact of reducing unmet need on health indicators in India.
o This module needs a considerable number of data inputs which have been taken from various sources Projected decline of risk adjusted infant and under-five mortality rates and number of maternal deaths
averted by years from 2016 to 2030 in India
(please see the table below).
Unmet need declined to 0% Unmet need declined to 0%
o The module includes the unmet need as a programme indicator in the model along with contraceptive Unmet need declined to 5% Unmet need declined to 5%
Decline in risk adjusted

20 4.7
infant mortality rate

Maternal deaths averted in

method-mix and source-mix, proximate determinates of fertility.
15 4.2
o Other family planning related input variables include method attributes, and effectiveness of
3.7

thousand
contraceptive methods, impact rates, miscarriage rate, and distribution of fertility-related risk. 10
3.2
o The outcome variables are pregnancy rate and unintended pregnancy averted due to use of 5
2.7
contraception, abortion rate and unsafe abortions averted due to use of contraception, and risk of
0 2.2
2023
2016
2017
2018
2019
2020
2021
2022

2024
2025
2026
2027
2028
2029
2030

2022
2016
2017
2018
2019
2020
2021

2023
2024
2025
2026
2027
2028
2029
2030
maternal, infant and under-five deaths averted.
o In the simulation model, other variables such as total population at base year, total fertility rate, age
specific fertility rates, sex ratio at birth, life expectancy have also been included. Below we have given
Unmet need declined to 0%
the data inputs and sources. Unmet need declined to 5%
Decline in risk adjusted under-

30
five mortality rate

25
Data Inputs Data Sources
Contraceptive method mix and source mix National Family Health Surveys (IIPS and ICF, 2017; IIPS and 20
Macro International, 2007; IIPS and ORC Macro, 2000; IIPS, 1995) 15
Proximate determinants of fertility National Family Health Survey (IIPS, 1995); IIPS and ORC Macro, 10
2000; IIPS and Macro International, 2007; IIPS and ICF, 2017.
5
Child survival National Family Health Survey (IIPS, 1995); IIPS and ORC Macro,
2000; IIPS and Macro International, 2007; IIPS and ICF, 2017. 0
2016

2023

2030
2017
2018
2019
2020
2021
2022

2024
2025
2026
2027
2028
2029

Method attributes Stover, Heaton, & Ross, 2006 (Default setting)

Lactational Amenorrhea Method (LAM)
The effectiveness of contraceptive methods, impact Stover, Heaton, & Ross, 2006 (Default setting)
rates, and miscarriage rate
Post abortion cares
Percent of legal and illegal abortion that need
treatment is taken from the published reports
(proxy)
Inputs for distribution of fertility related risks
National Family Health Survey (IIPS, 1995)
Singh et al., 2018; Cohen, 2009
National Family Health Survey (IIPS, 1995)
Results
Discussion and Conclusions
 The unmet need for family planning in India is anticipated to reduce to 5% by 2030.
 The reported benefits of ensuring family planning for the projected period in this study can only be
realised if the country overcomes the above-discussed hurdles in the path of the family planning program
in India.

Health returns of reducing unmet need for family planning in India during 1993-2016  Safeguarding every pregnancy and making it a planned pregnancy speeds up the advancement in

2016-2030 achieving universal health coverage.

Outcome indicators 1993-2016 Scenario 1 Scenario 2  Thus, India needs to reboot its core family planning investments which dwindling over the period.
(5%) (0%)
 The peripheral frontline health personnel such as accredited social health activist (ASHA) and Anganwadi
Decline in pregnancy rate
27 24 41
(Per thousand married women in aged 15-49 years) workers have a great potentiality to reach the quality contraceptive services with information to the
Number of unintended pregnancies averted
55.9 41.4 70.2 individuals or couples for meeting their reproductive choices and rights.
(Million)
Decline in abortion rate  However, these peripheral health workers may need proper training on a multi-tasking framework and
1.77 1.56 2.65
(Per million married women in aged 15-49 years)
greater incentives for this specified work.
Number of unsafe abortions averted (Million) 7.3 5.4 9.1
 The recent efforts made by the government of India (Mission Parivar Vikash program in 2016, Antara and
Decline in risk-adjusted infant mortality rate
10 10 16
(Per thousand live births) Chhaya in 2017) need to be assessed to achieve their goals in health returns.
Decline in risk-adjusted under-five mortality rate (Per
15 14 24  Perhaps, the effectiveness of these recent programs may be evaluated once the data from the ongoing
thousand live births)
Number of maternal deaths averted (Thousands) 167.1 123.8 209.8 NFHS-5 is released. However, sustenance of this newly launched programs is possible with sustained
Note: Scenario 1 and 2 represent the reduction of unmet need for family planning by 5% and 0% in 2030 respectively budget sanctions.
from the current level

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