Costing of Family Planning Methods in India

Year: March 2019

Collaborator: One Health Trust, previously (Centre for Disease Dynamics, Economics & Policy) CDDEP

Team: Sarang Deo, Abhishek Kumar

Background

Family planning (FP) interventions are crucial for safe motherhood, reducing unwanted pregnancies, abortions, and related complications. Universal access to FP can prevent hundreds of thousands of newborn and maternal deaths annually and significantly lower unplanned pregnancies. In developing countries, timely FP use can reduce maternal deaths by 32%, infant mortality by 10%, and childhood mortality by 21%. Despite India’s long-standing FP program since 1952, the 2015-16 National Family Health Survey (NFHS-4) shows low usage of methods like condoms (5.6%), pills (4.1%), and IUDs (1.5%) among women aged 15-49. Consequently, India’s unintended pregnancy rate remains high at 70 per 1,000 women in 2015, exceeding the global average.

About the Study

This study estimated the unit cost of delivering six Family Planning (FP) methods in public health and social franchising systems. These include condoms, oral contraceptive pills (OCPs), Female and Male Sterilization, Injectables, Intrauterine Contraceptive Devices (IUCD). Additionally, the study aimed to forecast the future requirements of each FP method mentioned above for scaling up of FP services for a period of five years (2020-2025).

Methodology

Four study districts from Rajasthan and Punjab were chosen: Barmer, Dhaulpur, Firozpur, and Tarn Taran based on two categories: Total Fertility Rate (TFR) less than 3, and TFR greater than 3. Selection criteria also included low contraceptive use prevalence, prevalence of female sterilization during the study period, high TFR, and high unmet needs. Within each district, four health facilities were selected: one District Hospital (DH), one Community Health Centre (CHC), one Primary Health Centre (PHC), and one Sub Centre (SC). The study employed an activity-based costing (ABC) approach to conduct the costing exercise.

Outcomes

Female sterilization has the highest average unit cost at district hospitals (DHs), followed by community health centres (CHCs), with male sterilization performed at few DHs costing 3,077 INR per unit. The unit cost of IUCD ranges between 1,300-1,900 INR, injectables cost 385 INR at DHs and CHCs, while they costed 570 INR at primary health centres (PHCs). Oral contraceptive pills (OCPs) and condoms cost 5 INR and 2 INR per unit respectively.

To meet family planning service requirements from 2020 to 2025, the government needs to spend approximately INR 109 billion based on the existing contraceptive mix, with female sterilization accounting for 75% of interventions requiring INR 26.6 billion. The report has been submitted.