New Delhi: Election manifestos in the past have largely failed to incorporate the critical component of public health, focusing, if at all, on insurance-based initiatives alone. India is a country with large swathes of population that are poor, vulnerable, and in need for better access to consistent and equitable public health information and services. Recent studies have shown that India lags behind several countries including Sri Lanka on its expenditure on health, it is time we reaffirm our commitment to preserving the health of the people in the country.
Pratigya Campaign for Gender Equality and Safe Abortion has urged the political parties at the forefront to demonstrate their commitment to prioritizing universal access to quality health services, and increasing the overall budgetary allocations for public health by at least twice the current allocation. While 2.2% of the latest total interim budget is allocated to healthcare, there is an immediate need to increase the allocation for health to at least 5% of the country’s annual budget. The current spending on public health is 1.15-1.5% of the GDP, despite the government stating its ambition to increase it to 2.5%. We seek an immediate increase in the health expenditure to 3.5% of the GDP. There is also a need to increase investments in sexual and reproductive health in general and contraceptive and safe abortion access in particular. Women constitute a significant proportion of the voting population – it was reported that 260.6 million women exercised their right to vote in the 2014 elections for the parliament, and in 16 out of 29 States, more women voted than men. Prioritising women’s health and rights as an election issue is likely to be rewarding, and have positive reverberations on the overall health of the country.
Adolescents, youth and women form an important demographic in the country, whose health needs and rights are likely to impact future generations and other key development indicators such as education, and therefore must be recognised. It is only through political will to safeguard the rights of women that a holistic approach to promoting healthcare for women can be achieved.
Sexual and reproductive health access is an important component of the third Sustainable Development Goal (SDG) – to ensure healthy lives and promote wellbeing for all. The interlinkages between the SDGs and the potential impact of SDG 3 on the others are well researched and documented. From education, gender equality, poverty, reduced inequalities, clean water and sanitation, economic growth, climate action, to partnership for the goals, greater emphasis on ensuring access to quality health services could have transformational effects on all the sustainable development goals as a whole.
Recent reports have shown that there is a high unmet need for contraception and abortion in the country today. 21.3% eligible couples have an unmet need for both limiting and spacing methods of family planning. The National Family Health Survey (NFHS) – IV revealed that over 30 million married women in the reproductive age group were unable to access contraception. This does not even take into consideration the unmet need of contraception among unmarried women and girls. On abortion, government data suggest that only 700,000 abortions take place in medical facilities, and a recent study by The Lancet showed that 73% of the 15 million abortions in India take place outside medical facilities. In terms of the doctor-patient ratio, a study by Ipas Development Foundation demonstrated that there is only one licensed abortion provider for 224,000 women in rural areas in the country. This is an alarming figure highlighting the unmet need of countless women for safe abortion services, and imploring urgent policy interventions to prevent further unsafe abortion related deaths and morbidity.
Better access to timely and safe abortion services, as well as comprehensive contraceptive care need to be urgently addressed for better family health, education and gender outcomes. Providing sexual and reproductive (SRH) health information and access to adolescents, youth, and newly married couples can go a long way in preventing early marriages, encouraging responsible sexual behaviour, advancing the health of entire families, promoting informed choices, and more. Achieving these require greater investments in reproductive health, as well as utilisation of these funds, coupled with improved policies. Increasing the investments and budgetary allocations should also be undertaken for support systems such as ASHAs (Accredited Social Health Workers), AWWs (Anganwadi workers) and ANMs (Auxiliary Nurse Midwives) – who form the backbone of our public health delivery system, in addition to improving infrastructure at public health facilities.
India has made huge strides in the recent past, with the Government of India’s policy think tank leading the way and bringing about lasting transformations on health, education, infrastructure and other indicators. It is time we bolstered our efforts towards preserving the reproductive health and rights of women. The Pratigya Campaign – a coalition of organisations and individuals committed to promoting women’s rights and access to safe abortion in India, has urged political parties to prioritise investments in reproductive health to ensure quality of care, access and an expanded basket of choices.
As per Pratigya Campaign for Gender Equality and Safe Abortion, the party manifestos should clearly articulate the following:
Ensuring access to quality reproductive health services that are voluntary and non-coercive
Ensuring availability of reproductive health information, services and infrastructure
Inclusion of youth in policy-framing to adequately address their SRH needs
Increasing investment in reproductive health
Complete utilisation of budget allocated for reproductive health
Preserving the reproductive rights of women
Some immediate measures that must be implemented are the passing of the amendments to the Medical Termination of Pregnancy (MTP) Act that will enhance access to safe abortion services; revoking two-child norms across parts of the country that prevent individuals with more than two children from contesting local body elections. A two-child norm is regressive, discriminative, misplaced and in violation of individual rights and choices, considering that all but seven States in India have already achieved the replacement level of fertility of 2.1, even as the national estimate is currently at 2.3 and falling rapidly below replacement levels of TFR. Sustainable solutions to challenges in reproductive health access that are embedded in bodily rights and autonomy are the need of the hour.
*Based on press note by ‘Pratigya Campaign for Gender Equality and Safe Abortion’ on the eve of International Women’s Day.