Day One Five-Day Training on Contemporary Developments in the Law Relating to Violence and Discrimination against Women Contraceptive Information and Services Zahra Wynne
Contraceptive Information and Services in India A Situational and Legal Analysis
What do we mean by CIS? Access to a wide range of both spacing and limiting methods of contraception Awareness of Information how different regarding the forms of availability and contraception variety of work and their contraception side effects
HRLN Fact Finding Prior to PIL: The Role of ASHAs in the Delivery of CIS • ASHAs have a lack of adequate training and are therefore spreading misinformation regarding CIS • Incentive payments driving promotion of female sterilization • There is a shortfall of almost 350,000 ASHA workers • CIS is not being delivered in many poor, rural communities • Unmet need for CIS is increasing rather than decreasing
National Health Mission’s Plan Regarding CIS • ‘Family planning services would be utilized as a key strategy to reduce maternal and child morbidities and mortalities in addition to stabilizing population’ • ‘All states would be encouraged to focus on promotion of spacing methods, especially Intra-Uterine Contraceptive Devices (IUCDs )’ • ‘Male involvement including male sterilization would be promoted’ • ‘Distribution of contraceptives at the doorstep through ASHAs and other channels will be actively promoted’ • ‘Improved family planning service delivery including access, availability and quality of services; counseling services through dedicated counselors; improved technical competence of the providers and increased awareness among the beneficiaries would be ensured’ Source: NHM Framework for Implementation 2012-2017
Unmet Need 60 50 40 India 30 Global Meghalaya 20 10 0 21.3% 12.3% 55% Source: DLHS 3 & DLHS 4, the Lancet
Consequences of a lack of CIS in India Unwanted Pregnancy Adolescent Infant Death Pregnancy Maternal Unsafe Mortality Abortion Sexually Transmitted Diseases
Methods of Contraception Available in India OCPs ECPs Condoms Male Female IUDs Sterilization Sterilization Source: National List of Essential Medicines of India 2011
Contraceptive Method Mix Female Sterilization (74.4%) Condom (11.4%) Pill (7.5%) IUD (3.7%) Male Sterilization (2.3%) Other Modern Methods (0.6%) Source: Population Foundation of India
The Family Planning Programme Budget Currency 2013-2014 2014-2015 2015-2016 2016-2017 INR (lakh) 61999.35 62863.64 79977.25 77665.45 96,399,503 97,728,191 124,333,112 120,739,174 USD Source: Family Planning Programme Budget 2016, Press Information Bureau, Ministry of Health and Family Welfare
India’s Pledged Budget vs. Actual Budget 233,535,750 120,892,719 Pledged Amount Actual Amount 0 200000000 400000000 Source: Family Planning Programme Budget, Pledged Amount: 1500 crore per year FP2020 Vision, London Family Planning Summit 2016-17 Budget: 77665.45 lakh 2012
Expenditure (%) Female Sterilization (85%) Spacing Methods (1.5%) Others (13.5%) Source: Population Foundation of India
Supply of Contraceptives: The ASHA Doorstep Delivery Service and Supply at PHCs and SCs • The Government of India is supposed to supply contraceptives such as condoms, OCPs and ECPs for free at Primary Health Centers (PHCs) and Sub-Centers (SCs) • In 2011, the Ministry of Health and Family Welfare rolled out a scheme to improve access to CIS by having Accredited Social Health Activists (ASHAs) deliver a variety of contraceptives at the doorstep of households. This initiative was piloted in 233 districts in 17 states with a view to roll it out across the nation Source: Home delivery of contraceptives (Condoms, OCPs, ECPs) by ASHA at the doorstep of beneficiaries, Press Information Bureau, Ministry of Health and Family Welfare
The Reality Haryana: OCPs and ECPS Assam: Essential drugs Chhattisgarh: Emergency have not yet been received under the RMNCH+A Contraceptive Pills not by the state in the current Matrix not available, ASHA available in most facilities year due to budget drug kits in short supply constraints Karnataka: Continues to Maharashtra: Family Jharkhand: Counseling on target permanent methods Planning counseling spacing methods at SC or instead of spacing methods services are not taking PHCs level is non-existent with a focus on female place across facilities or sterilization during outreach visits Meghalaya: Home Delivery Odisha: ECPs were not Uttarakhand: of contraceptives by ASHAs available at most of the Shortages/stock-outs of is almost non-existent and facilities, and knowledge of essentials such as condoms their knowledge and skills ECPs amongst staff was was seen in many facilities on the topic is poor poor visited
Shortfall of ASHA Workers (1 worker per 1000 people) 1,248,000 346,000 Necessary amount Reality on the ground 0 500,000 1,000,000 1,500,000
The Petition: Bihar Voluntary Health Association v UOI (2018) • HRLN and BVHA recently filed a PIL in the Supreme Court demonstrating that both the Central Government and all State Governments and Union Territories have failed to address and ensure adequate access to CIS, citing high levels of unmet need, budget cuts, population control rather than reproductive rights based approaches, and disproportionate focus on female sterilization as evident shortfalls • We focus on the results of these shortfalls: high maternal mortality rates and infant mortality ratios, adolescent pregnancy, STI/Ds, coercive sterilization, and unsafe abortion
Legal Focuses Indian Constitution • Article 15 – Right to Equality • Article 21 – Right to Life CEDAW • Article 14(2)(b) – rural access to adequate health care facilities, including information, counselling and services in family planning • Article 16(e) – the same rights to decide freely and responsibly on the number and spacing of their children and to have access to the information, education and means to enable them to exercise these rights
Prayers of the Petition • Our prayers order and direct the Central and State Governments to: o Comprehensively roll out the ASHA doorstep delivery service across the nation, with a full basket supply of contraceptives o Address the shortfall of approximately 346,000 ASHA workers o Ensure entire basket range of contraceptives are available at all public health care centres o Bring down the unmet need from 21.3% to a negligible rate within the next 5 years o Bring the Family Planning Budget in line with the pledges made the London Family Planning Summit and in the Family Planning Vision 2020 Initiative o Launch a drive promoting male sterilization as a safe, simple and reversible procedure in a move away from female sterilization, an invasive, irreversible procedure o Address the significant imbalance between female and male sterilization o Launch a drive encouraging condom usage in order to promote safe sex and reproductive rights o Implement a mass media campaign to raise awareness regarding CIS
Thank you!
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