For World Contraception Day, we spoke with Mansharan Seth, (Director, William J. Clinton Foundation; WomenLift Health Leadership Journey Alumna, India ’23) to discuss the ongoing challenges and opportunities in ensuring equitable access to contraception in India. In Part 1 of this two-part blog series, Mansharan shares insights on the importance of the day, the gaps that remain in contraceptive access, and her journey working in the field.
Edited excerpts below:
Can you tell us about World Contraception Day and its importance?
World Contraception Day is a day dedicated to promoting awareness, education, and access to contraception to improve reproductive health and empower individuals to make informed decisions about their family planning. Globally today there are 257 million women with an unmet need for modern contraception – for India, the unmet need for a ‘modern contraceptive method’ stands at 9.4% of all women in the 15-49 age bracket. This amounts to around 26 million married women in India – these are women who have no desire to plan a family but are also not using any contraception due to a variety of reasons. This data doesn’t account for unmarried women and adolescents. Even today, there is a heavy bias towards female sterilization which stands at nearly 38%. World Contraceptive Day serves as an important reminder of the road that we still need to travel when it comes to equitable access to sexual and reproductive health and rights.
What are the current challenges and gaps in the field that still need to be addressed?
There are three parts to the challenge.
Demographics: India has 253 million adolescents, and more than 370 million youth, all with diverse sexual health needs. Right from the age of 10, girls experience body changes that lead to specific hygiene and menstrual health needs and as they grow into young adulthood, there’s a need for education about safe sex or the prevention of STIs. There are also people who are newly married, who may want to plan their first child. There are people who have completed their families and hence they may have an entirely different need for a safe long-acting method of contraception. In a nutshell, access to contraception must accommodate women of all ages and life stages for their specific fertility needs.
Stigma: Every individual, including a woman, should be able to enter a store and implement her right to a contraceptive method. Can we go into a store or pharmacy without hesitation and say, can I buy an emergency contraceptive? No.
Access to modern methods: Beyond access to physical services, there is a need for greater access to and availability of contraceptive methods and knowledge Though the modern contraceptive prevalence rate (mCPR) in India is at 56.5%, female sterilization remains high at 37.9%, and traditional methods are also gaining ground in the country. In my opinion, both our public and private sectors can work together much more effectively, via partnership models to create better last-mile access for contraceptives.
What is the tension between fertility control and access to contraception?
The tension between fertility control and contraceptive access lies in transitioning the conversation. With the Total Fertility Rate (TFR) stable in India at 2, it needs to change from planning a family to equitable, comprehensive sexual and reproductive health and rights. It is simply the ability and the agency to own your fertility and it need not lie in the context of family planning. We still have a long way to go, but it’s crucial to make this shift.
What inspired you to work in the field of sexual and reproductive health (SRH) and how has your journey shaped your approach to leadership in public health?
The transition to SRH was an accidental one for me – I come from the private sector with a long decade-old body of work in marketing and transitioned to the non-profit sector, and started working on maternal health and anemia, which extended to reproductive health. I feel like I finally found my calling and happy place on this planet.
Working in sexual and reproductive health has given me the opportunity to meet women, and discuss their contraception needs. SRH sits within public health, but we cannot ignore wider social constructs and factors around it—does a women have the agency to plan her own fertility or even to step out of the home to access a method? Can a woman go out and meet community health workers? Or what impact does the pressure of a male child have on the family size?
As a leader in public health – this has had a tremendous impact on me. One important aspect to consider is the role of social behaviour and social norms in addressing public health challenges. It’s important to recognize that individual behaviour change is distinct from community behaviour change, and both are essential for driving meaningful change. Secondly, all our health systems must be gender-responsive, gender-equitable, and gender intentional as we move towards our gender-related and health-related SDGs (Sustainable Development Goals).
Looking back at your career, is there a project that you have led that you are particularly proud of?
One project that is particularly close to my heart is our work on the concept of ‘on-demand’ or ‘peri-coital’ contraception. Despite the global uptake of modern contraceptive methods over the past 20 years, nearly 8% of women of reproductive age—around 164 million women—still have an unmet need for contraception. One reason for this is low frequency of intercourse, which could be due to couples living apart, younger couples meeting sporadically, or those nearing menopause.
For these women, taking a daily oral contraceptive may not be necessary, but they may prefer a pill that can be taken only at the time of sex, meeting an episodic rather than continuous need. This insight led to our exploration of ‘on-demand’ contraception, which began about two years ago. We observed how women were using emergency contraceptive (EC) pills and found that many were using them as an ‘on-demand’ option. Initially, we thought this might be limited to younger women, but our research revealed it also applied to older women and various other cohorts, including migrant populations. This project allowed us to explore product development and regulatory aspects, and while there’s more work to be done, we’re proud of leading this exploratory effort. Perhaps one day we’ll see an ‘anytime pill’ available for women who need it.
WomenLift Health’s flagship India Leadership Journey is a leadership development experience designed to enhance the power and influence of emerging women leaders tackling complex public health challenges in the country. We are currently accepting applications for the forthcoming 2025 India Leadership Journey until October 25, 2024.
