Family planning programmes for India

At the heart of the new government's agenda is the question of how to ensure that India grows as strongly and as sustainably as it possibly can. There are different visions of how to achieve this, but one thing is certain: India has the potential to reap dividends from its major demographic transition.

This transition is without comparison in the world. The working-age ratio in India's population is projected to increase from 64% in 2013 to 69% in 2040 – an addition of more than 300 million adults of working-age population.

As the nation’s population continues to grow at a fast rate, family planning continues to be a priority. Now, new research reveals that focusing resources in this area is one of the most effective uses of funds.

Researchers for India Consensus have examined about 100 Indian programmes that align with the development agenda agreed by all nations, called the Sustainable Development Goals or the ‘Global Goals’.

No country has the resources, time and attention to achieve all of the 169 Global Goal targets at once, which cover every aspect of human and planetary well being. It’s important, therefore, to look closely at the Goals, so we can establish which Goals and which government programmes will achieve the most for India. That way, resources can be prioritised to those areas that make the biggest difference.

NITI Aayog invited India Consensus to use its network of economists and internal expertise to assess the costs and benefits of key programmes that work toward achieving some of the Global Goals. This fast-track effort is a first attempt to identify the most effective programmes.

If India were to spend ₹50,000 crore more achieving the Global Goals, focusing on the most phenomenal programmes identified by India Consensus would create extra benefits for India worth ₹20 lakh crore — almost equivalent to the entire Union Budget for 2017-18.

The full study is yet to be released, but already we can share that family planning is a phenomenal investment. The family planning component of the National Health Mission helps families to space their children, and ensures the quality of services and a range of family planning methods are accessible for all.

PR Sodani, Neeraj Sharma, Md Mahbub Hossain, SD Gupta, and DK Mangal of IIHMR University, Jaipur looked at family planning programmes both in Rajasthan and Andhra Pradesh and assessed cost-benefit ratio. Of the two states, it’s most relevant to look at Rajasthan, because this is more similar to the national average in total fertility and unmet need.

This work demonstrates that the annual costs of family planning are small, estimated at around just ₹1200 for every woman helped. The annual cost per person across the whole population is ₹36, because only 12% of women in the reproductive age has an unmet need for contraception.

The benefits, though, can be very large. There are three ways that family planning helps society: it has a 'demographic dividend', it reduces infant mortality, and it reduces maternal mortality.

The first of these, the 'demographic dividend', means that society benefits from having fewer dependents relative to working people. The effect of this can be particularly large and sustained.

Considering health benefits, evidence indicates that appropriate birth spacing — one of the benefits from family planning — reduces the likelihood of child mortality. In Rajasthan, this would mean 1,100 fewer child deaths per year due to better birth spacing. And there would also be a small reduction in maternal mortality. This would occur due to the effect of reducing the number of births, though the effect would be small overall.

The study in Rajasthan shows that if the state’s entire need for family planning were met, the total benefits initially would be worth ₹97 for each person for first year of the programme and will grow to ₹6500 by 2066.

What these benefits mean, together, is that every rupee spent on family planning would create benefits to society worth some 32 rupees.

That is an excellent return on investment. In fact, even accounting for bottlenecks in service provision and shortfalls of nurses and facilities, the return on investment remains phenomenal.

India is in the midst of a major demographic transition, with hundreds of millions of people reaching working age. India is expected to be—by an order of magnitude—the largest single contributor to the global workforce over the next three decades. The changes ahead require careful attention from policy-makers. The large benefits of sustained investment in family planning are certainly very clear.

(Dr Bjorn Lomborg is President of the Copenhagen Consensus Center, Shireen Vakil heads the Policy and Advocacy unit of the Tata Trusts)