India has by far the oldest family planning programme in the world and is a key stakeholder towards various global commitments. But India’s success to move the needle from family planning to contraception has not always been successful. With changing times, technology and needs, family planning should be viewed in the larger ‘choice’ ‘sexual and reproductive rights’ conversations, however, at present the focus is towards birth limitation rather than planning, which completely excludes youth and young people from the conversation on sexual and reproductive health and rights (SRHR).The unmet need for modern methods of contraception is at 13%[1], whereas the basket available in public health is limited and the current contraceptive practices are heavily skewed towards female sterilisation.
When it comes to Long Acting Reversible methods of Contraception (LARC), the only LARC available in public health sector is Intra Uterine Contraceptive Device (IUCD), which has not done well in spite of being available for many decades. National Family Health Survey (NFHS)-V phase-1 data of 22 States/UTs shows that out of the 61.29% of women currently using Family Planning Methods, only 50.85% reported to use modern methods. Female sterilization accounts to 30.10%, and merely 3.59% of women in the reproductive age group prefer IUCD.
In recent years, the private sector has introduced new contraceptives such as Hormonal IUCDs and injectable (DMPA). However the lack of investments by private marketers to create a demand for, access to and affordability at which they are offered are some of the issues affecting popularity of LARCs, as only 0.89% women have used injectable contraception for family planning as per NFHS-V phase-1 data and high costs have restricted their reach to Tier I towns only, on the other hand contraceptive implants are not available in the public sector as on date.
The private sector plays an important role in improving access to contraceptives and family planning services. Mission Driven Organisations (MDO), social marketing organisations and NGOs have been able to reach the marginalised population with crucial sexual and reproductive health services and contraceptive options. Data from NFHS-IV shows that private sector accounts for 24% contraceptive provision in India.
In the case of implants, data from various medical and global researches suggest that they are extremely safe and effective method and have been well received in many countries. Approved for use in private sector in India, priced at Rs 2,900 ($42), implants were launched in top five cities with the cost to clients ranging between Rs 3,500 – Rs 15,000 ($50 – 200). However, due to price constraints the product becomes inaccessible to rural and marginalised women. India’s contraceptive needs require a shift towards inclusion and choice. To meet the rising demand for modern methods, it is critical that future programmatic efforts provide methods that are both accessible and acceptable to users. Introducing implants in the public sector would improve choice as well as uptake of modern methods of contraceptives[2].
National surveys of several sub-Saharan African countries have revealed increased implant use as the main driver of improvement in modern contraceptive prevalence rate (mCPR), with gains in implant use alone exceeding combined gains in use of injectables, pills, and IUCDs[3].
In a study[4] conducted in India to determine acceptability, efficacy, safety and return of fertility with Implanon, a subdermal single-rod contraceptive implant, it was found that Implanon was an extremely safe, effective, well accepted method of contraception. The study also highlighted the advantages of this contraceptive method including independence from user compliance, prompt return of fertility after removal and suitability for a wide range of women. Implants make family planning possible throughout reproductive life; it can be used to postpone a first pregnancy, to ‘space’ pregnancies or to provide reversible, long-term contraception when the desired family size is reached. Since implants do not contain an oestrogen, it can also be used by women who do not want to or cannot use combined oral contraceptives (COCs). Moreover, implants are found to 99 percent effective in terms of cost and use in comparison to other contraceptives[5].
India’s CPR is highly dominated by sterilisations, while the unmet needs for contraception are more for the conventional reversible methods than that of terminal methods. Introducing implants in the public sector would not only improve choice and avoid discrimination but it can transform the health and lives of women. Hence, there is a need to include implants in public sector quickly to improve choice and avoid discrimination.
Written by: Debanjana Choudhuri, MSI Reproductive Choices
[1] National Family Health Survey (NFHS) – 4
[2] Population Foundation of India. (2020). Evidence on contraceptive method mix in developing countries: South and South-East Asia. Retrieved from Fileattached-1513326457-Infographic.pdf (populationfoundation.in)
[3] Jacobstein R. Liftoff: The Blossoming of Contraceptive Implant Use in Africa. Glob Health Sci Pract. 2018 Mar 30;6(1):17-39. doi: 10.9745/GHSP-D-17-00396. PMID: 29559495; PMCID: PMC5878070.
[4] Bhatia, P., Nangia, S., Aggarwal, S. et al. Implanon: Subdermal Single Rod Contraceptive Implant. J Obstet Gynecol India 61, 422 (2011).
[5] Federation of Obstetric and Gynaecological Societies of India. (2016). Subdermal implant can boost family planning in India: Experts. Retrieved from https://www.fogsi.org/subdermal-implant-can-boost-family-planning-in-india-experts/
