2. Changes in Demographics

In last sixty years, life expectancy has more than doubled and infant mortality rate has reduced by four times. So the increase in population is primarily due to increased longevity of people due to better healthcare and improved living conditions.

Family structure and composition has undergone major changes in last sixty years. Joint family tradition has significantly fallen apart, family size has shrunken, age at marriage has increased, and literacy level in both men and women has increased. All these changes have major bearing on reproductive decisions and contraceptive preferences.

Although average age at marriage has increased, marriage below legal age is still quite prevalent. In many states, about fifty percent girls at 18 are already married and many are already mothers. Their contraceptive needs require special attention. They are also more susceptible to sexual abuse and violence.

The population pyramid of India suggests that the dominant proportion of population is young. As per 2011 consensus, over 50% population is below 25 and and over 65% below the age of 35..

3. Changes in Fertility and Contraceptive Usage

Overall contraceptive usage has increased, from 13% in 1970s to 56% in 2005 – 06. For rural India this increase is from 37% to 53%.

Total Fertility Rate (TFR) has declined from over 6 in 1950s to 2.7 in 2005, reflecting desire for smaller families.

Over half of sterilization procedures on women are done women below 26. It is particularly common in Andhra Pradesh where the median age of sterilization is just 23.

The most frequently used spacing methods are condoms and rhythm methods (each is used by 5% of married women)

Male sterilization is the least used method. Why?? A good question for policymakers and sociologists.

4. Changes in Contraceptive Availability

In the early days of family planning in India, condoms and vasectomy were the most commonly available methods. Female sterilization, the most widely used method today, did not exist before 1980s. Laparoscopic tubectomy, the preferred method of camps, became popular sometime later.

The family planning program provides five major contraceptive methods: condom, oral pill, the Copper T, and male and female sterilization. There are some technological advances: pills have lowered oestrogen content, Copper Ts are now available in two versions, and the conventional vasectomy is replaced by non scalpel vasectomy (NSV) (Will men now come forward and opt for NSV?).

Additionally, there are some scientifically validated traditional methods such as LAM (Lactation Amenorrhoea Method) and the safe days method (cycle beads).