CHAPTER THREE: PROJECTING FAMILY PLANNING AND DEMOGRAPHIC PARAMETERS UNDER ASSUMPTION OF REDUCTION IN UNMET NEED 3.1 Introduction: The immediate objective of National Population Policy, 2000 was to meet the unmet need for contraception. According to NFHS 2, the current level of unmet need for spacing was 8.3 percent and limiting was 7.5 percent for the country. Understanding the implications, in this chapter we have attempted to estimate the family planning and demographic parameters under the assumption of reduction in unmet need. The goal setting for this chapter is reduction of unmet need by one percent in every year till 2010. In other words, the unmet need will be reduced from its current level of 15.8 percent to 7 percent by 2010. This is a reasonable and feasible assumption for population and family planning projections for the country. With this goal setting, we have estimated the family planning and demographic parameters for India till 2010. The inputs for the base year 2001 are same as that of NFHS-2, 1998-99. The demographic parameters are total population, population in broad age group, Crude birth rates, Total Fertility Rate, and Infant Mortality Rate etc. The family planning estimates include the projected users of family planning by methods, family planning use by source, total cost on family planning, total revenue etc. The detailed output on these estimates are given in Appendix 1. 3.2. Basic Inputs in projecting family Planning parameter For projection of family planning parameters, we need to estimate the demographic parameters. The basic input required is the five-year age distribution of population. For this purpose, the age distribution of population for 2001 is assumed to be the same as that of Sample Registration System 1998 (SRS, 1998). This is because; age distribution of 2001 29
census is not available yet. We used the provisional population of 2001 to get the population in each five year age group. The estimated population (in 000 s) by each age group and sex is given in Table 3.1. The total population remains the same for each sex as we are using the percentage distribution. Table 3.1: Estimated Population of India by Age (000 s), 2001 Age Group Male Female 0-4 62159 56018 5-9 64285 58993 10-14 65347 58497 15-19 54722 47591 20-24 48346 46104 25-29 44096 42138 30-34 38783 38668 35-39 34002 3232 40-44 29220 27266 45-49 23376 20325 50-54 19657 18838 55-59 14344 13881 60-64 13282 13385 65-69 9032 9419 70-74 6375 6445 75-79 3188 2974 80+ 2656 2479 Total 532870 494257 The other input required is life expectancy at birth. We use the same methodology for estimating life expectancy as discussed in Chapter 1. The estimated life expectancy for male and female are given in table 3.2. Table 3.2: Estimated Life Expectancy by Sex, India Year 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Life expectancy in years (Male) 62.9 63.3 63.7 64.1 64.4 64.8 65.2 65.5 65.8 66.1 Life expectancy in years (Female) 64.9 65.4 65.8 66.3 66.7 67.2 67.6 68 68.5 68.9 30
The estimated life expectancy for females will be higher than males. While the projected life expectancy for females by 2010 is estimated to be 68.9 years, the same for males is 66.1 years. At present also, the life expectancy of females is higher than that of males. 3.3 Method Mix in Family Planning Use: For this exercise, we consider only officially approved modern methods of family planning. These include condoms, female sterilisation, IUD, male sterilisation and pills. Since the use of other methods is negligible, those are not included in the projection. The current use of these methods of family planning in 2001 is assumed to be same as that of 1998-99 (from NFHS 2). These methods were converted to method mix. The method mix means share of each method among all methods used. The method mix for 2001 and 2010 is given below. The method mix of the 2010 is assumed on the basis of relatively high users of pills and condoms. For example, it is assumed that the method mix in use of condoms will increase from 7.2 percent in 2001 to 10 percent by 2010 while that of pill use will increase from 4.9 percent in 2001 to 11.8 percent by 2010. Given the unpopularity of IUD and male sterilisation, we assume that the prevalence would be same as that of 2001. The use of female sterilisation in method mix will decline from 79.7 percent to 70 percent by 2010. Table 3.3: Method Mix in use of family Planning Methods 2001 2010 IUD Female Sterilisation Male Sterilisation 7.2 4.9 3.7 79.7 4.4 10.00 11.8 3.7 70.0 4.4 Total 100 100 31
Given the thrust on spacing methods it is assumed that condom and pill use will increase marginally and that of female sterilisation will decline. 3.4. Source of Family Planning: In India, the main source of family planning are usually categorised as public sectors and private sectors. We retained the same classification. The projected use of family planning by source for each method for base year and end year is given below. The use of any of these methods from all the sources in any given period adds to 100. Table 3.4: Family Planning Use by Sources Methods IUD Female Sterilisation Male Sterilisation Public Sector Private Sectors Others 2001 2010 2001 2010 2001 2010 15.26 21.28 54.1 85.3 88.6 10.00 30.00 40.00 75.00 80 43.14 41.94 43.1 13.1 8.9 50.00 50.00 50.00 20.00 15.00 41.6 36.7 2.5 1.2 2.0 40.00 20.00 10.00 5.00 5.00 It is assumed that the use of family planning methods from public source will decline and that of private source will increase over the years. For example, in year 2001, condom users through public sector was 15 percent which will reduce to 10 percent by 2010 while that of the private sector will increase from 43 percent to 50. In case of female sterilisation, the share of public sector will decline from 85 percent in 2001 to 75 percent in 2010 while that of private sector will increase from 13 percent in 2001 to 20 percent in 2010. In case of pills the share of public sector will increase from 21 percent in 2001 to 30 percent by 2010 while that of the private sector will also register an increase from 42 percent to 50 percent during this period. 3.5 Effectiveness and method attribute in use of family planning: The effectiveness of each method is assumed to remain the same through out the period. The effectiveness of 32
condom is assumed to be 81 percent while that of the pill is 92 percent, IUD is 96 percent and sterilisation is 100 percent. It is inbuilt in the SPECTRUM package. Table 3.5: Effectiveness of family planning methods Methods 2001 2010 IUD Female sterilisation Male Sterilisation 81 92 96 100 100 81 92 96 100 100 3.6. Method Attribute: The method attribute is also assumed to be constant throughout the period. The method attribute for each method for 2001 and 2010 is given in table 3.6 Table 3.6: Method Attributes Methods 2001 2010 /CYP Cycle IUD Duration of use (in years) Female sterilisation (Average age) Male Sterilisation (Average age) 100 15 3.5 36 36 100 15 3.5 36 36 3.7. Revenue from family Planning Services: The revenue and cost aspect of family planning are not touched by any researcher. This is because in India and in many developing countries the family planning service is a free service and so people do not pay directly. But during late 1980s and 1990s, the private sector also emerged as an important source of family planning service provider (People are willing to pay for better services). In India the family planning service was free till 1996. Till today, all the family planning services are free except that of condom. Due to higher wastage of condoms, the government is charging 10 paise per condom. The services such as female sterilisation, male sterilisation, IUD and pills are 33
supplied at free of cost. But the private sector charges fee for all the services performed. So far, there is no estimated cost either by a researcher or govt on use of family planning. In this chapter, we try to estimate the fees per user using the data from NFHS 2. In NFHS 2, the question was asked about how much fees is charged / how much it cost you for all users of modern methods (Q :S333). Also for condom and pill users, the question was asked next, For that cost how many condom/pills cycles do you get? From this information, we have computed the mean cost, mean number of pieces and mean cost per user. This is carried out for users from the private sector as well as from other sources. The computed value is given below The mean cost of the family planning methods for 2001, by source is estimated from NFHS 2 data for each method. It is given in table 3.7. The cost referred is the mean cost of family planning methods. As we had discussed, the family planning is a free service under public sector, we have computed the same for those who were using from other than government sector. It may be noted that the mean cost of condom per user per packet is about Rs 10.4 and the mean number of pieces per packet is 4. Thus, the mean cost of condom per piece is Rs 2.434. If it is assumed that one user will use 100 pieces for one year then the cost of condom per user per annum will be Rs 243. As we know the condom pieces are charged 10 paise in public sector and the user cost will be around Rs 10 per user. However, the same from other source is estimated as Rs 194. In case of pills, the mean cost is estimated to be Rs 344 from private sector and it amounts to Rs 269 from other sources. The mean cost of IUD from private sector is Rs 279 while that from the other is Rs 147. In case of female sterilisation, the mean cost from the private sector is Rs 2111, while that from other sources is Rs 1260. The 34
cost of male sterilisation from private sector is Rs 1025. Thus, the mean cost in private sector is highest for all the methods and there are a substantial number of users from this sector also. Table 3.7: Fees of family planning methods by source (Mean) Mean cost per user (Rs) Mean Number of pieces Cost Per pieces (Rs) Cost per 100 pieces in Rs(user) Mean cost per user (Rs) Mean Number of pieces Cost Per pieces (Rs) Private Others Public 10.43 4.28 2.434 243.4 11.96 13.54 0..88 344.4 9.55 4.91 1.945 194.5 12.28 17.8 0.69 269.09 0.10 10.00 Cost per 13 ccles in Rs(user) IUD (Per IUD in RS) 279.04 147.55 0 Female Sterilisation(Per Sterilisation in RS) 2111 1260 0 Male Sterilisation (Per Sterilisation in RS) 1024.94 -- 0 0 0 3.8. Cost of Family Planning Services: It is assumed that the cost in private sector is half of its revenue and in other sectors; it is three fourths of its revenue. Also it is assumed that the cost in public and private sector is same. Accordingly, the cost of family planning methods by source is given below. Table 3.8: Cost of Family Planning Users (Rs) Family Planning Methods IUD Female Sterilisation Male Sterilisation Private Public Others 121.69 172.20 139.52 1055.53 602.47 121.69 172.20 139.52 1055.53 602.47 145.88 201.82 110.66 944.73 -- Since the number of cases of male sterilisation from other sources is not found the same is assumed as that of the public sectors. To validate the cost, we have also collected the statistics from the Annual report of Ministry of Health and Family Welfare. The supply of Nirodh under free distribution of conventional contraceptives for 1998-99 is given below 35
Table 3.9: Budget Estimate and Revised Estimate of s and s in India Plan NonPlan Oral s (MALA-N) Plan NonPlan Budget estimate 1998-99 (Rs in Crs) 5000.00 5000.00 1500.00 1500.00 Revised Estimates 1998-99(Rs in Crs) 5000.00 5000.00 1500.00 1500.00 Budget Estimates 1999-2000(Rs in Crs) 5000.00 5000.00 1500.00 1500.00 In 1997-98, 499 million pieces of condom were procured at the cost of Rs 45.40 crores. The cost per piece is found to be 91 paise and so per user is Rs 91. This is the only manufacturing cost and costs of others are to be included. During 1998-99, order of tableting 539 lakh cycles have been placed. This gives an approximation of the cost of family planning services, mainly the manufacturing cost. 3.9. Proximate Determinants: The proximate determinants for base year and final year are given in table 3.10. The proximate determinants for base year are taken from NFHS 2. It is assumed that the percentage of women aged 15-49 in union will decline from 56.5 percent in 2001 to 45 percent in 2010. The postpartum insusceptibility will decline from 8.6 months in 2001 to 8 months in 2010 while that of induced abortion will increase from 1.7 percent in 2001 to 3 percent by 2010. Table 3.10: Proximate Determinants for Base Year and Final Year Proximate Determinant 2001 2010 Percent of women 15-49 in union Postpartum Insusceptibility (months) Induced abortion Sterility 56.5 8.6 1.7 3.8 45.0 8.0 3.0 3.0 The value on proximate determinants are based on the observed values as found in NFHS 2 while for that of 2010 are based on assumptions. It is assumed that the induced abortion and sterility will increase by the course of time. 36
3.10. Summary Demographic Indicators: With all these information, we have projected the population by age, other demographic estimates like birth rate, infant mortality rate, dependency ratio etc. The age sex pyramid and demographic estimates are given in Appendix. Only summary Tables of demographic estimates and that of family planning estimates are given here (Table 3.11 and 3.12). 37
Table 3.11: Summary Demographic Indicators under goal of reducing unmet need by one percent per year till 2010. Estimates 2001 2005 2010 Total Population (Billion) Male Population Female Population Percent 0-4 Percent 5-14 Percent 15-49 Percent 15-64 Percent 65+ Percent females 15-49 Sex ratio Median age Dependency Ratio 1.03 0.53 0.49 11.51 24.06 51.20 60.24 4.14 51.25 107.8 22 0.59 1.09 0.56 0.53 9.97 22.29 53.78 63.04 4.7 53.67 107.29 24 0.51 1.16 0.60 0.56 8.69 19.50 56.29 66.78 5.04 55.98 106.7 25 0.42 Mortality Male Life Expectancy Female Life Expectancy Total Life Expectancy IMR Under 5 Mortality Rate Vital rates CBR per 1000 CDR per 1000 Rate of Natural increase (Percentage) Doubling Time Annual births (Millions) Annual Deaths (Millions) Fertility TFR GRR NRR Mean age of Child Bearing Child Woman Ratio 62.9 64.9 63.9 74.8 107.5 24.1 8.0 1.6 43.5 24.75 8.27 3.00 1.46 1.28 28.0 0.47 64.4 66.7 65.5 67.7 95.7 21.3 7.5 1.38 50.6 23.23 8.20 2.62 1.28 1.13 27.7 0.39 66.1 68.9 67.5 59.9 82.9 18.0 7.1 1.09 64.0 20.84 8.24 2.11 1.03 0.93 27.3 0.32 From the table, it may be noted that the total population will be around 1.09 billion by 2005 and 1.16 billion by 2010. About 25 million births are projected in 2001, which will be declined to 23 million in 2005, and 21 million in 2010. On the other hand, the total number of deaths would vary marginally. It would be around 8.27 million in 2001 and 8.24 million by 2010. In other words, we will be adding more than 15 million population annually even with a decline in birth rate. The age structure of the population suggests that the percentage of 38
population in 0-4 age group is 11.51 percent in 2001 which will be declining to 9.97 percent in 2005 and 8.69 percent in 2010. The median age of the population will increase from 22 years in 2001 to 24 years in 2005 and 25 years by 2010. The dependency ratio will be declining from 59 percent in 2001 to 51 percent in 2005 and 42 percent in 2010. On the fertility aspect, the TFR will decline from 3.00 from 2001 to 2.62 in 2005 and 2.11 in 2010. In other words the replacement level of fertility would be achieved by 2010 even under the assumption of meeting the unmet need of family planning. The infant mortality rate continues to be higher. The projected life expectancy will be 64 years in 2001 which will be around 67 years in 2010. The life expectancy for females is projected to be 69 years and that of males is 66 years by 2010. The estimated IMR and under five mortality rate are projected to be on higher side than expected. 3.11: Projected Family Planning Indicators The family planning estimates are given in the table 3.12. With the reduction on unmet need, of one percent per annum, the contraceptive prevalence rate is likely to be increased from 42.58 percent in 2001 to 50 percent in 2005 and 60 percent in 2010. The total number of married women in reproductive age group is likely to increase from 143 million in 2001 to 145 million by 2005 and further declined to 141 million by 2010. The total number of users of family planning services will be around 60 million by the year 2010. The table also provides the family planning as commodities. The total number of condom pieces stood at 532 million in 2001 which would increased to 727 million by 2010. In case of female sterilisation, the total numbers would decline from 4.91 million in 2001 to 4.36 million in 2005 and 3.54 million by 2010. The reducing number is due to the assumption of reduction in female sterilisation and increased use of spacing methods. The total number of pills 39
required will be 44 million in 2001 which would increased to 63 million by 2005 and 85 million by 2010. All the methods, except that of female sterilisation will register positive growth while the female sterilisation will register fluctuating tends. With respect to the cost and revenue, it is estimated that the Gross Cost will be around 133 million US dollar in 2001 which will increase to 238.4 million dollar by 2010 at the current process. The revenue is 91 million US $ in 2001 which can match the cost by 2010. However, these estimates are to be used cautiously. Table 3.12: Summary of Family Planning Estimates Estimates 2001 2005 2010 Average effective ness Women in Reproductive age (Million) Married Women in Rep age (Million) Users (Million) Acceptors (Million) Gross Cost (Million Us $) Revenue (Million US $) Births (Million) Abortions (Thousand) 0.98 253.32 143.23 60.99 6.18 133.36 90.82 24.75 19.85 0.98 282.16 145.06 62.13 5.69 186.54 151.95 23.23 32.45 0.97 313.59 141.12 60.64 4.87 238.36 235.12 20.84 50.25 Commodities (Millions) Female sterilisation IUD Male Sterilisation Growth Rates s Female Sterilisation IUD Male Sterilisation 531.86 4.91 0.78 0.49 43.57 12.21 1.53 13.47 24.51 35.19 632.71 4.36 0.78 0.55 62.91 7.37 5.22 4.31 15.1 21.84 727.45 3.54 0.74 0.60 84.57 1.99 3.82 3.83 20.65 11.27 40
3.12. Family Planning Users by Source: The users of family planning by methods for selected years is given in Table 3.13. For condom, the total number of users is projected to be 4.43 million in 2001 which will increase to be 6.06 million by 2010. With respect to sources, the private sector will contribute as he largest source followed by others. The dependency on public sector for condom will decline from 0.68 million in 2001 to 0.61 million by 2010. With respect to pills, the total number of users will increase from 2.9 million in 2001 to 5.64 million by 2010. In case of pill, the private sector will be a major source of provider followed by public sectors and others. In case of IUD the total number of users will reduce marginally from 2.28 million in 2001 to 2.26 million in 2010. The dependency on private sector will be higher than public sector and others by 2010. In case of female sterilisation the total number of female sterilisation will decline from 48.67 million on 2001 to 42.43 million by 2010. The public sector would continue to be a main source for female sterilisation followed by private sector and others. In case of male sterilisation, the total number of users will increase from 2.7 million in 2001 to 4.24 million in 2010. The public sector contributes to be the largest provider followed by private sectors and others. From this table, it is clear that the dependency on permanent methods continued to be on public sector while in case of spacing methods the public sector will take the lead 41
Table 3.13: Distribution of Projected Users by Source (Million): Methods Public Sector Private Sectors 2001 0.68 1.91 2005 0.68 2.44 2008 0.65 2.81 2010 0.61 3.03 2001 2005 2008 2010 IUD 2001 2005 2008 2010 Female Sterilisation 2001 2005 2008 2010 Male Sterilisation 2001 2005 2008 2010 0.62 1.06 1.43 1.69 1.24 1.11 0.99 0.90 41.69 37.93 34.42 31.83 2.41 2.94 3.25 3.39 1.22 1.91 2.46 2.82 0.99 1.07 1.12 1.13 6.40 7.60 8.22 8.49 0.24 0.40 0.54 0.64 Others 1.84 2.16 2.34 2.42 1.07 1.22 1.20 1.13 0.06 0.14 0.19 0.23 0.59 1.36 1.85 2.12 0.05 0.12 0.17 0.21 Total 4.43 5.27 5.79 6.06 2.90 4.19 5.10 5.64 2.28 2.32 2.30 2.26 48.67 46.88 44.5 42.43 2.70 3.46 3.96 4.24 42