One of the greatest public health achievements in recent history is the expansion in the availability of effective, modern contraceptives, creating a world where every pregnancy is wanted.
This aim is a central pillar of the mission at UNFPA. The State of World Population Report 2022 explores why so many pregnancies remain unplanned even as the widespread availability of modern contraception should make it possible for individuals and couples to exercise their right to decide when to have children.
India’s maternal mortality ratio (MMR) has improved to 103 for the period 2017-19, from 113 in 2016- 18. This is according to the special bulletin on MMR released by the Registrar General of India on March 14, 2022. However, there is a variation in MMR across various states, seven of which unfortunately have a very high score.
The MTP Act enacted in 1971 along with the past and recent amendments has created a conducive policy environment for women, including adolescents, to go for medical abortion of pregnancy under prescribed circumstances. It allows for abortion in a wide range of conditions that include some social or economic ones too.
Unintended pregnancies resulting in abortions, unwanted births, and miscarriages are a key indicator of the need for expanding access to contraception services and information that supports their effective use. We must make pregnancy an aspiration, not an eventuality, by empowering women and girls to make affirmative decisions about sexual activity and motherhood. Family planning and safe abortion are crucial tools in preventing maternal death.
Researchers at the Guttmacher Institute estimate that fully meeting women’s contraceptive needs in lower and middle-income countries and providing antenatal and neonatal care at levels recommended by the World Health Organisation will reduce unintended pregnancies by 68 percent, and unsafe abortion by 72 percent, and maternal deaths by 62 percent.
The key priority for India is to address the unmet need for family planning/contraceptives and improve access to safe abortion services, including medical methods. Expanding the reach and range of reversible contraceptives can prevent early pregnancy and pregnancies at short intervals that jeopardise maternal and newborn health. Informed choice and voluntarism in adopting contraceptives need to be the cornerstone of FP counseling.
Medical abortion can be provided in primary care settings via telemedicine or self-managed – which offers an option for safe abortion.
The Government of India and its development partners need to work together toward a new agenda to strengthen reproductive health services and empower individual choices so that women and girls can exercise their right to bodily autonomy. India has made major inroads in terms of sexual and reproductive health and rights. The population is stabilising, the number of preventable maternal deaths has reduced, and there is an increased uptake of reversible and safe modern methods for family planning.
However, the 2022 State of World Population Report brings to the fore the silent crises of unintended pregnancy, with more than one in seven of the 121 million cases worldwide occurring in India. Despite safe, modern, and reversible contraceptives available, the most popular method remains female sterilisation with its acceptance at 38 percent. Sterilisation cannot delay or space pregnancies, which is important for preventing unintended or mistimed pregnancies, especially in the young population. What is also concerning is that 67 percent of abortions have been classified as unsafe, putting women and young girls at unnecessary risk.
India can lead the way in reversing these numbers. There is a need to invest in research to better understand the drivers and impact of unintended pregnancy. Women and men – everyone – should have access to contraceptives that work for their bodies and circumstances. Sexual reproductive health services should be gender-responsive and stigma-free. And addressing negative social norms should be the need of the hour, said Andrea Wojnar, UNFPA India Rep. and Bhutan Country Director which sums up the strategy for realizing the goals of the mission.
