Higher GDP, lower health expenses: A study documents financial benefits of family planning in India

India’s per-capita gross domestic product can rise an additional 13% by 2031 if family planning policies are actively prioritised, according to a new study.

This can also prevent 2.9 million infant deaths and 1.2 million maternal deaths and save households Rs 77,600 crore (20%) of out-of-pocket health expenditure on childbirth and child hospitalisation, it added.

Currently, family planning gets barely 4% of India’s National Health Mission allocations and this share has been stagnant for several years.

“Cost of Inaction in Family Planning in India: An Analysis of Health and Economic Implications”, a study by Population Foundation of India, assessed the cost benefit analysis of family planning interventions at the national level and in four populous states – Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh. These together make for 37% of the country’s population.

The study showed that India needs to implement the following reproductive health strategies to ensure economic gains:

• Target adolescents and youth;
• Ensure a greater resource envelope for family planning in the health budgets of the Centre and states;
• Adopt a multi-sectoral and community engagement;
• Ensure availability and access to quality reproductive health services;
• Invest in women’s education and job opportunities.

The gains that come through these strategies will be more pronounced in the four populous states, the study estimated. A push for family planning can also result in cumulative savings of up to Rs 27,000 crore for the National Health Mission budget.

Why family planning is integral for health of women and children

If the existing set of policies are implemented to their fullest, India can see a definitive and sustained improvement in metrics such as reduced infant and maternal deaths, safer abortions, and overall reduction in unplanned pregnancies, according to the study. These will, in turn, result in benefits of magnitude higher than their immediate financial impact.

Globally, access to safe, voluntary family planning is a considered a human right and is central to concepts of gender equality and women’s empowerment. It is also the most effective pathway to unleashing the socio-economic potential of a healthy youth, as proved in this study by Harvard economists David Bloom and David Canning.

A third of east Asia’s economic boom, the study said, can be credited to favourable changes in population size and age structure, centred around smaller family sizes. This “demographic dividend”, as per estimates, can see nations such as Kenya, Nigeria and Senegal increase their per-capita income by 47% to 87% by 2050 by satisfying their unmet need for family planning.

Family planning offers returns on investment as high as 120 times in terms of the economic benefits it brings through healthcare, according to this study published by the independent Copenhagen Consensus Center in 2014. In marketing jargon, globally family planning is thus considered a “best buy”.

Family planning can deliver the demographic dividend India seeks

Currently wealthy nations in Europe and the Americas are dealing with the economic impact of a rapidly ageing population but India has the largest cohort of young people the world has ever seen. Adolescents and youth (10-24 years) constitute about 1.82 billion (or 26.3%) of the total population in the world. Against this, India’s young population is 364.6 million (30.1%), as per Census 2011.

India’s youth-centric population structure is a powerful asset as it frees up household and state resources that would otherwise be used to support dependent groups. These resources can instead be invested to improve their productivity and to generate economic growth, the study said.

So how does strategic family planning ensure that the young stay productive? It allows them to stay healthy and free of reproductive, sexual and mental health issues and ensures that they stay in school and complete education. It gives them the freedom to enter the job market or start their own enterprise, be more productive at work, increase savings and prioritise spending on things that improve their lives. It also allows the young to start a family at a time when they can offer the best opportunities for their children.

The gains from increased investment on family planning include budgetary savings to the government, increase in per capita GDP and savings on out-of-pocket expenditure to households, as per a recent study by the Population Foundation of India.

Return On Investment From Savings Achieved Via Family Planning

• Rs 27,000 crore: Cumulative savings to the National Health Mission budget
• Rs 77,600 crore: Households savings from out-of-pocket health expenditure
• Rs 6,000 crore: Maternal health programmes
• Rs 3,000 crore: Immunisation costs
• Rs 300 crore: Child health programmes
• Up to Rs 550 crore: Rashtriya Bal Swasthya Karyakram
• Rs 79 crore: Adolescent health programmes
• Rs 4,250 crore: Savings on medical supplies and equipment for maternal, child and adolescent health

More focus needed on related issues–marriage and maternity

As early as 1952, India had launched its own family planning programme, ahead of many nations in this regard. Today, India takes the “cafeteria approach” to family planning which means that it provides multiple choices – eight contraceptive options for men and women at different life stages. These include six spacing methods and two permanent methods. Further, in recent years, the government has pledged to increase investments for family planning: At the 2012 London Summit on family planning, India committed to invest $2 billion and then renewed its commitment for the same in 2017, promising a $3 billion outlay.

Of the funds available for family planning, 80% is directed towards terminal methods of preventing conception, specifically female sterilisation. But family planning investments must also focus on expanding the range of family planning choices for women while addressing inter-linked determinants such as child marriage, age of marriage and adequate spacing between births, according to the study.

For sustained engagement, there is a need to increase the allocation for family planning, especially in states with high total fertility rate. Efforts are required to simultaneously involve community engagement, combining best practices from social and behaviour change initiatives. The budget boost must also be specifically aimed at spacing methods to cater to the needs and preferences of young people.

Both men and women need to be decision makers

A proactive, and results-oriented approach involves more than the public sector’s prescriptivism, but a mindset change which openly embraces that both men and women as equal decision makers in a family is needed, according to the Cost of Inaction in Family Planning in India study. This can ensure the 120 times result mentioned earlier.

India has a massive reproductive age population, and simply cannot afford a step-by-step, graduated rollout of policies and aid, the study said. For swift impact, the first line of intervention must be in providing care and access to reproductive health. But the speed and scale of family planning interventions need to be stepped up, beginning with substantial increases in investments to improve access and quality of services, particularly for spacing methods of contraception.

This article first appeared on IndiaSpend, a data-driven and public-interest journalism non-profit.