Jaipur, One of the globally acclaimed universities and renowned research institutions, IIHMR University, Jaipur, has been implementing project PMA 2020 in Rajasthan. Performance Monitoring and Accountability or PMA 2020 involves India as one of the program countries out of the other 10 countries which include, Ghana, Ethiopia, Kenya, Burkina Faso, Indonesia, Nigeria, Uganda, and Democratic Republic of Congo. The project is implemented by IIHMR University, Jaipur in collaboration with Bill & Melinda Gates Institute for Population and Reproductive Health at the Johns Hopkins Bloomberg School ofPublic Health and International institute for Population Sciences and Ministry of Health & Family Welfare. .Project is funded bythe Bill and Melinda Gates Foundation. .
According to Dr. Anoop Khanna, Principal Investigator, Rajasthan for PMA 2020 and Professor at IIHMR University “Performance Monitoring and Accountability 2020 (PMA2020) uses innovative mobile technology to routinely gather rapid-turnaround, cost-effective population data on family planning and water, sanitation and hygiene.” He added, “PMA 2020 is a project that focuses on important indicators that monitor family planning. The project has recently concluded round one and will provide information every 6 month till 2017 and once a year from 2018. Round one included 4874 households and 297 health facilities which were surveyed from June-September, 2016 on reproductive health in the state. It has been observed that in the state of Rajasthan the overall family planning has been given more importance in the recent years.”
According to the project findings, more than ½ of married women are using modern contraceptive methods, where the use of birth control pill is up from 5% in 2005-06 to 7% in 2016 and the use of injectable has increased. Male condoms are used by 10% of married women which is up from 6% in 2005-06. Although Female sterilization is the most common form of contraception, it has decreased over the last decade.
According to the project findings in round one Dr. Anoop Khanna further added, “The current level of unmet need for family planning in Rajasthan is 15% which is slightly below the level 10 years ago which shows that the overall demand for family planning is increasing. The unmet need for limiting (i.e those who do not want another child) has increased while the unmet need for spacing (i.e those who wish to have another child) has slightly declined. This presents an opportunity to expand access to long-acting methods, especially reversible methods, to enable women to meet their reproductive goals. Thus, the total unmet need for family planning in married women in Rajasthan between 15-49 years is 15% where 10% is for limiting and 6% is for spacing.”
Inequitiesare not just a part of the income being distributed but these inequities are also found at the family planning level wherethe report findings specify that poor women have more unintended pregnancies than wealthy women. Among women in the poorest wealth quintile, 22% reported that their last pregnancy was unintended, compared to 12% in the wealthiest quintile. Increased access to contraception, and especially highly effective long-acting methods like IUDs and implants, may help prevent unintended pregnancies, particularly among poorer women.
Even though multiple healthcare facilities offer contraceptive facilities, for many women other more effective reversible methods remain out of reach. More than three-fourths of public facilities offer at least 3 modern contraceptive methods. Among public facilities, 77% offer at least 3 modern contraceptive methods and 38% offer 5 or more modern contraceptive methods. About 96% of Community Health Centers (CHCs) and 87% of Primary Health Centers (PHCs) offer 3 or more methods, while approximately 92% of public hospitals offer 5 or more methods.
The findings of the project on Adolescent Reproductive health specifies that Young women start to use family planning several years after they become sexually active and, often, after they have already given birth. The median age when women first start using contraception is 22.2 years. However, the median age at first sex is 18.3 years and the median age at first birth is 21.0 years. The pattern is even more pronounced when looking specifically at women living in urban areas who have their first birth at age 21.0, but do not start using family planning until almost three years later, at age 23.1. By that time, women in urban areas have, on average, 2.1 children. This suggests that unmet need for young, urban women may be especially high, and presents an opportunity to expand family planning offerings and increase contraceptive coverage for this group.
In Rajasthan, data collection is led by the Indian Institute of Health Management Research (IIHMR) University in Jaipur. A sample of 147 enumeration areas (EAs) was drawn by the International Institute for Population Sciences from a master sampling frame. In each EA households and private health facilities were listed and mapped, with 35 households randomly selected in each EA. Households were surveyed and occupants enumerated. All eligible females ages 15 to 49 were contacted and consented for interviews. The final completed sample included 4,874 households (97.2% response rate), 5,262 females (96.0% response rate) and 297 health facilities (96.1% response rate). The first round of data collection was conducted between June and September 2016.