The states that need greater focus are the eight EAG states of Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttaranchal as well as Assam and Himachal Pradesh
India needs to significantly increase its budget for family planning if it wants to meet its FP2020 pledge of covering 48 million new users by that year. A study by the Population Foundation of India (PFI), a think tank on population and development issues, shows that India would need to spend about Rs 15800 crores, if not more, during 2013-2020 to meet its commitment of providing additional family planning services through public funded providers. Any delay in doing so, or any gap that may result because of paucity of resources would cost the country dear in terms of high maternal and infant mortality and morbidity, and poor child health resulting from poorly spaced pregnancies. In line with a rights-based perspective and an empowerment approach, women need to be able to have the right to determine the number of children they wish to have.
The states that need a greater focus and commitment are the eight Empowered Action Group states of Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Odisha, Rajasthan, Uttar Pradesh and Uttaranchal as well as Assam and Himachal Pradesh.
The Study notes that family planning, which is almost fully funded by the central government, has received very little attention from it as compared with other health programmes. Family Welfare, which includes the budget for family planning constituted only four per cent of the 2014-15 Health and Family Welfare budget. The family planning components in this budget include central procurement of contraceptives, the funding of social marketing projects, national level IEC and promotional activities and premium for Family Planning Insurance (for compensation against contraceptive failures). These constituted approximately 25 per cent of the total Family Welfare budget of the central government in 2014-15. The share for family planning within the larger Family Welfare budget has been further reduced to around 10-15 per cent with subsequent reductions in contraceptive procurement and social marketing. Other major items in the Family Welfare budget (which constitutes the rest of its 75 per cent share) include, ‘Infrastructure Maintenance’ and funding Family Welfare institutions, such as the National Institute of Health and Family Welfare and the Jansankhya Sthirata Kosh.
Poonam Muttreja, Executive Director, PFI said, “The study on the resource requirements for India to meet its FP2020 commitments indicates that it would need to spend at least Rs. 15,800 crores by 2020 to achieve this goal as well as those of the SDGs. The need of the hour is to work closely with the private sector and civil society to make this promise a reality.”
The central government funds family planning activities in states through two funding channels –the Family Welfare budget head and the National Health Mission (NHM). Though the allocation for family planning increased by 47 per cent from 13-14 to 15-16 under NHM, it still fell short of the required amount. Under the Family Welfare budget, the allocation saw a sharp decline of 54 per cent during the same period. As contraceptives and information, education and communication activities are covered by this budget, the decline is extremely worrying.
At FP2020, India had committed to reaching 48 million new users in addition to sustaining the existing 100 million users of family planning. The focus was to shift to spacing instead of limiting methods to meet the needs of India’s young population reaching its reproductive years.
The PFI study is designed to review the family planning budgetary allocation patterns and expenditure as well as forecast the requirement for meeting the country’s FP2020 commitments. It shows that going by the current rate of increase of mCPR (modern contraceptive prevalence rate), India would have about 32.8 million additional users, i.e., about 15 million short of the committed FP 2020 goal of 48 million. Therefore, India will have to do much more to cover the gap in terms of making available contraceptive supplies, outreach services, and trained manpower to address the needs.
Moreover, the goal crucially hinges on the ability of the government to upscale the coverage of spacing methods. It is the private providers that have been dominating the spacing contraceptive market in the country. Therefore, to meet the goal their participation is crucial. As per the current trend, users covered by the private sector are expected to reach 9.79 million, while the required number should be 21.6 million to meet the goal. This implies a gap of 11.8 million users that are unlikely to be covered by the private market unless the government steps in with additional public resources and involves the private sector through social marketing or franchising mechanisms.
The study shows concern on the allocation of resources. The government’s financial documents do not show any evidence of planned progress towards achieving the desired contraceptive method mix, with a focus on spacing. There continues to exist a significant bias towards limiting methods. About 82 per cent of the NHM flexi pool budget and 71 per cent of the total resources are allocated for compensation, mostly to users of limiting methods and incentives to those providing them. Also, the changing pattern of the Centre-State allocation formula, where states with their tight resources and low priority to family planning activities, are expected to share 40 per cent of the programme funds from their own resources instead of the earlier 25 per cent. This would greatly hamper the meeting of the goal. The PFI commissioned study has recommended a ‘maximum share’ by the centre so that contraceptive supplies and products can be covered.
The study advocates for increased technical support to EAG states for implementing spacing methods. It has also calls for the drawing up of a comprehensive strategy to upscale the social franchising and social marketing mechanisms to promote private sector engagement in the priority states. Quality assurance mechanisms and community involvement to generate contraceptive demand, an intensive analysis of state budgets and a mechanism to track the use of resources are among the other recommendations made.