Reproductive Health

In the context of India where public expenditure on healthcare is low, the private sector plays an important role in delivering healthcare during childbirth. An analysis of the latest round of National Family Health Survey data to estimate the differential probability of caesarean sections in private medical facilities relative to government facilities, and focusing on unplanned C-sections, reveals that the probability of an unplanned C-section is 13.5–14 percentage points higher in the private sector. These results call for a critical assessment of the role of private sector in healthcare in the context of inadequate public provision, expanding private provision and weak governance structures.

The Maternity Benefit Act, 1961, a key legislation in India that enables women to transcend the public–private dichotomy and stake their claim for productive participation in the labour force, saw major amendments in 2017. Four aspects of the amendments—increased maternity leave, maternity leave for adoption and surrogacy, provision of crèche, and paternity leave—are juxtaposed with feminist and constitutional principles as well as ground-level realities and practices. An increase in maternity benefits in law with a neglect of paternity leave and benefits is a lopsided approach that further reinforces gendered division of labour and care work as the domain of women. The social responsibility of employers is emphasised, and a deeper engagement of the state with the policy of parental benefits is advocated.

Using evidences from the Sample Registration System and the third and fourth rounds of the National Family Health Survey, this article shows that the fertility rate continues to be high in the Hindi heartland of the country, and that too among educated women. It also proposes some plausible hypotheses in this regard, which would require validation through further research.

Though addressing the unmet need for contraception was one of the immediate objectives of India’s National Population Policy 2000, the available evidence shows that there has been stagnancy in the level of the unmet need for family planning for quite some time. Data from the fourth round of the National Family Health Survey carried out during 2015–16 show that about 13% of couples of reproductive ages wanted to stop childbearing or delay the next birth but did not get the contraceptive services they desired to have. Trends in the level and nature of the unmet need for contraception, whether for spacing or limiting, are examined here on the basis of the data from the series of NFHS rounds. Further, socio-economic and regional differentials in the unmet need have been assessed. It is seen that while socio-economic differentials in the unmet need exist but are not large, there are notable interstate differences, and some states have a high unmet need. Besides, the unmet need has risen in a few states in the recent years. The paper also provides estimates of implications of the unmet need in terms of unwanted births and fertility.

A concerted policy to harness the demographic dividend is the need of the hour.