Sushmitha Ramakrishnan By

Express News Service

CHENNAI: Tamil Nadu is one of the most urbanised states in the country. But the latest National Family Health Survey (NFHS) for 2015-16 has found that the State has seen an eight per cent decline in use of all kinds of contraceptives in the last decade. The decline is five per cent more than the national average.

The steep decline in the use of contraceptives is bad news for women. Experts say this could mean more and more women may either be forced to undergo abortions or use emergency contraceptive pills. Both come with their own side effects and abortions in particular, can have serious long-term impact on women’s health.

According to NFHS 2005-06, 61.4 per cent of the State population used some form of contraceptive, but the recent data puts the figure at 53.2 per cent, with only a two per cent difference in trends between urban and rural population.This has taken experts by shock as modernisation and urbanisation of medical system should have translated to easier access to a variety of modern contraceptives available in the market. The failure of this theory means that more women are opting for Medical Termination of Pregnancy (MTP), according to Poonam Muttreja, executive director, Population Foundation of India.

“The other possibility is more women are using morning-after pills, which on repeated usage can have serious side-effects,” she said. The recent NFHS data also reveals that the total ‘unmet need for family planning’ is 10.1 per cent, which has seen only a 0.1 per cent decrease in the last ten years.

‘Unmet need for family planning’ refers to fecund (capable of bearing children) women who are not using contraception but who wish to postpone the next birth or stop childbearing altogether. While there are no clear studies pointing to the reason why lesser number of people opt for family planning despite a stagnant ‘unmet need’, three factors could have significantly caused the decline.

One, poor access to modern contraceptives; two, low awareness and lower autonomy among women, and finally poor management of the side-effects of contraception. While the percentage of women with whom health workers have discussed contraception has shot up by around 10 per cent in the last decade, the total percentage of health workers discussing family-planning is just around 30 per cent.

“It is counselling and awareness that most women lack. They don’t think family planning is a decision they can take by themselves and they do not have a friendly environment to discuss it with family,” said MC Aruna, a project officer at a Primary Health Centre at Perambalur district.

The data shows that among the population that has opted for family planning, female sterilisation has contributed 93 per cent and everyday pills and condoms account for less than two per cent. Despite reversibility of male sterilisation, its prevalence has dropped from the already low 0.4 per cent to a near-null. This, however, points to the fact that awareness about short-term contraceptives is extremely low among women from both urban and rural areas.

“Devices such as Copper T are not preferred as it hurts men during intercourse. However, very few families consider the pain faced by women,” said Dr NS Kanimozhi, a gynaecologist from Cloudnine Hospitals.

Other options such as vaginal rings and injectable contraceptives are becoming more available in government hospitals. Tamil Nadu government has recently launched the ‘Antara scheme’ that provides free injectable contraceptives to women from 18-45 thrice a year. Such schemes are of particular help to women who do not want to permanently lose their fertility, but merely want to delay pregnancy.

Vasectomy awareness

Vasectomy is reversible and has very little or no short and long term side-effects. Better awareness about the same, and engaging men in sharing the responsibility of family planning, could go on to reduce both unwanted pregnancy and unsafe abortion for their partners.

From the report

Use of any family planning method (currently married women age 15–49 years) fell to 53.2% in 2015-16 from 61.4% (in 2005-06)

Female sterilization has come down to 49.4% from 55.0%

Male sterilization is currently 0.0% from 0.4%