Recently the fourth round of the National Family Health Survey (NFHS-4) report on the variations in the total fertility rate (TFR) of different communities was released.

Details

• Geographic variance: The fertility rate in 23 states and Union territories—including all the southern states—is below the replacement rate while it is higher in a number of states in central, east and north-east India.

1.  Bihar has the highest rate at 3.41, followed by Meghalaya at 3.04 and Uttar Pradesh and Nagaland at 2.74.
2.  Total fertility rate in rural areas was 2.4 while in urban areas it was 1.8.
3.  The nature and scope of the fertilityrelated public health challenge facing state governments varies widely. The most effective way of combating this variance could be assigning a greater role for local bodies in both urban and rural areas.

• Impact of education: Women with 12 years or more of schooling have a fertility rate of 1.7, while women with no schooling have an average rate of 3.1.

1.  Lack of education robs women of reproductive control, feeding into India’s maternal and child health problem.
2.  Combined with younger pregnancies and higher childbearing rates, it also constrains women’s economic choices. This, in turn, reinforces a lack of reproductive control—44% of women who are unemployed use modern contraceptives while 60% of women who are employed for cash do so—perpetuating a vicious cycle.

• Skewed pattern of contraceptive usage: Despite increasing knowledge of contraceptive methods men have not taken up the responsibility of managing fertility. The most popular contraceptive method by far, at 36%, is female sterilization. Male sterilization accounts for a mere 0.3%.

 There are several reasons for reluctance of Indian men to undergo sterilisation:

•  A lack of awareness of sexual and reproductive matters;
•  A paucity of knowledge about appropriate contraceptive methods;
•  Myths and misconceptions (sterilisation leads to loss of virility);
•  Social taboo and sheer logistical limitations
•  Poor access to services, information and counselling on available methods of contraception, their benefits and side effects and management.
•  Health workers at the village level are usually women and they find it difficult to discuss the socioculturally sensitive issue with men.

• Impact of religion: Cultural and geographical factors and the level of development of different states seem to be more important determinants of TFR. In states with higher TFR, all groups show high levels and vice versa.

• Impact of income/ wealth: The section with the lowest income had the highest number of children at 3.2 and the richest had the least, 1.5.  Scheduled tribes, the least developed among social categories, had the highest fertility rate of 2.5, followed by 2.3 for scheduled castes and 2.2 for other backward classes. The upper castes had the lowest fertility rate of 1.9.

• Government’s Schemes for Family Planning
• Mission Parivar Vikas- for substantially increasing the access to contraceptives and family planning services in the high fertility districts of seven high focus states with TFR of 3 and above.
• Scheme for Home delivery of contraceptives by ASHAs wherein ASHAs are delivering contraceptives from door to door in the community.
• National Family Planning Indemnity Scheme (NFPIS) under which clients are insured in the eventualities of deaths, complications and failures following sterilization and the providers/ accredited institutions are indemnified against litigations in those eventualities.