Costing of Family Planning Methods in India: An Analysis of Four Districts in Uttar Pradesh

Background

Family planning (FP) initiatives play a vital role in promoting safe motherhood by preventing unwanted pregnancies, abortions, and associated health complications. Evidence suggests that ensuring universal access to FP services has the potential to save hundreds of thousands of newborn and maternal lives each year, while also drastically reducing the number of unplanned pregnancies. However, despite India’s family planning program being in place since 1952, National Family Health Survey (NFHS-4) data reveals low adoption rates of contraceptive methods among women aged 15-49. Consequently, India’s unintended pregnancy rate remains higher than the global average.

About the Study 

The project calculated the unit cost for two types of service delivery systems i.e. government public health system and social franchising/social marketing system, delivering the family planning interventions namely condoms, pills, IUCDs, Sterilisations for India and estimated the cost of interventions for five years for India (2018-2022). The report on devising facility-based costing of family planning methods to arrive at the resource requirement at the national level to meet family planning goals outlined in Family Planning 2020 policy documents has been submitted.

Methodology

The study conducted in four districts of Uttar Pradesh– Agra, Deoria, Jhansi and Mau– based on Total Fertility Rate (TFR) <3, TFR>3; low contraceptive use prevalence; prevalence of female sterilization during the study period; high TFR; and high unmet needs. Within each district, five facilities were selected: two district hospitals (DHs), one community health centre (CHC), one primary health centre (PHC) and one sub centre (SC). Male and female district hospitals exist separately in Uttar Pradesh; thus one male DH and one female DH were selected per district. An Activity based costing was used to arrive at bottom-up cost estimates.

Outcomes

Female sterilization is the most prevalent family planning method, as has been noted elsewhere, and provides the lowest cost per CYP at an average of INR 246 per CYP across facility types. Male sterilization remains an underutilized FP method, even though it provides a low cost per CYP at just INR 260 per CYP in the public sector. Condoms and OCPs provide the lowest per unit cost of FP methods. Thus, efforts should be undertaken to promote the use of OCPs and condoms as part of the move away from limiting methods and towards greater mix-method use.