A Girl and a Boy, Are a Bundle of Joy: A Rise in Gender-Equitable Fertility Preferences in India.

Within the last decade, declining son preference in Asia has given rise to gender-equitable fertility preferences. These include daughter preference, gender indifference, and gender balance. Using five rounds of the India National Family Health Surveys, I investigate the sources of the trends in shifting parental preferences for the gender of their children. Over more than a quarter-century period (1992-1993 to 2019-2021), I find a significant decline in son preference from 40 to 18 percent and an increase in gender-equitable preferences among most subpopulations. Multivariate analysis shows that for all survey years, education and frequent exposure to television significantly increased the odds of gender-equitable preferences. In the last decade, community norms supporting women's employment are also associated with gender-equitable preferences. In addition, decomposition analysis shows that compared to compositional change, social norm change accounts for two-thirds of the rise in gender-equitable preferences. These findings suggest that rising norms of gender equality have the potential to dismantle gender-biased preferences in India.

Challenges in Introducing New Contraceptive Methods: A Case Study of India.

Increasing choice and introducing new contraceptive methods in the National Family Welfare Program in India could play a significant role in increasing adoption of contraception and meeting the unmet need of a large proportion of couples. However, inclusion of any new contraceptive method in India has to face many challenges at different steps: from clinical trials, administrative processes, acceptance in the national program, and reaching the intended beneficiaries. Having a good product is necessary but not sufficient for widespread accessibility, acceptance, and use. This article reviews the challenges based on the available policy documents, literature review, and discussions with senior program managers of the Ministry of Health and Family Welfare and development organizations. It concludes that comprehensive strategic planning is needed to address all possible barriers to ensure new contraceptive access at an affordable price by the beneficiaries it is intended for.

Mainstreaming of emergency contraception pill in India: challenges and opportunities.

BACKGROUND: Emergency Contraception Pill (ECP) is an essential intervention to prevent unwanted pregnancies. However, its use has remained low due to various barriers including reservations among medical fraternity. MATERIALS AND METHODS: This paper presents findings on barriers to ECP's easy access for potential users from (i) a cross-sectional survey of providers' attitudes, beliefs, and practices and interviews with key opinion leaders, (ii) three consultations organized by Population Council with policymakers and public health experts, and (iii) evidence from scientific literature. RESULTS: The major barriers to easy access of ECP include misconceptions and reservations of providers (disapproval of ECP provision by CHWs, opposition to its being an OTC product, and myths, misconceptions, and moral judgments about its users) including influential gynecologists. CONCLUSION: For mainstreaming ECP, the paper recommends educational campaign focusing on gynecologists and CHWs, relaxing restrictive policy on advertisement of ECP, involving press media and strengthening supply chain to ensure its regular supply to ASHA (CHW).

Medical barriers to emergency contraception: a cross-sectional survey of doctors in North India.

BACKGROUND: Some medical doctors in India have publicly expressed opposition to making emergency contraceptive pills (ECPs) easily accessible, even though ECPs are included in the method mix of the Ministry of Health and Family Welfare program and as an over-the-counter (OTC) product. Such opposition affects access to ECPs by influencing policy, procurement, and distribution, besides stigmatizing the ECP user. This study was conducted to assess ECP knowledge, attitudes, and practices of doctors in North India. METHODS: A cross-sectional survey of 83 doctors who provide ECPs, randomly selected from 3 cities in the state of Uttar Pradesh, was conducted in 2011. The quantitative data were complemented by 19 in-depth interviews with purposively selected senior gynecologists and other opinion leaders. RESULTS: All surveyed physicians cited the correct dose and regimen for ECPs. However, the large majority of those surveyed believed that ECPs work by preventing implantation. (The best evidence currently indicates that ECPs do not work by preventing implantation.) Most doctors also believed incorrectly that ECPs have several contraindications and side effects. They also had strong reservations against OTC provision of ECPs by pharmacists and community health workers (CHWs) and negative attitudes toward ECP users, which serve as serious medical barriers to mainstreaming use of ECPs. CONCLUSION: Physicians and their professional associations exert a strong influence on the operationalization of national contraceptive policies. Evidence-based advocacy and educational campaigns targeting doctors are needed to address and resolve their reservations about ECPs, particularly about its provision as an OTC product and its distribution by CHWs. Partnerships with medical associations can help reduce doctors' negative attitudes and create a conducive environment for influencing clinical practices. Such changes are needed to increase the availability and use of ECPs as part of a package of a full range of contraceptive method options to prevent unwanted pregnancy among the most vulnerable populations.