User:Kwallabear/Family planning

Family planning in India is based on efforts largely sponsored by the Indian government. In the 1965–2009 period, contraceptive usage has more than tripled (from 13% of married women in 1970 to 48% in 2009) and the fertility rate has more than halved (from 5.7 in 1966 to 2.6 in 2009), but the national fertility rate is still high enough to cause long-term population growth. India adds up to 1,000,000 people to its population every 15 days. However, forecasted growth rate may be inaccurate due to high disparities in education among Indian females and Indian states. An increase in education rates has been associated with a decline in the national fertility rate of India. As of 2015, the national fertility rate among Indian females is 2.2 children per female, which is approximately 3 times less than India's national fertility rate in the 1960's. This shift in national fertility rate may also reflect a marked change in family planning practices within India.

India's Ministry of Health and Family Welfare states that if adequate family planning access resources become available and accessible, India would reduce the number of infant deaths by 1,200,000. Some of the most prevalent forms of contraception used in India today include sterilization, which is the most common method, followed by use of condoms and oral contraceptive pills. However, the use of intrauterine devices (IUD's) remains markedly lower.

There is also a wide variation in the demand for family planning services and methods in different Indian states, with Manipur having the lowest demand (23.6%) while Andhra Pradesh has the highest (93.6%). Levels of social independence and attitudes towards domestic violence have been shown to influence demand for family planning services and resources. However, more research is necessary to determine other predictive factors to gauge demand for family planning. Economic and cultural barriers also impede the delivery of family planning resources to all women on a national level. A lack of cohesive infrastructure in developing countries poses one great hurdle to physically delivering oral contraceptives and medications to woman residing in non-urban areas. Additionally, the expensiveness of modern contraceptives limits women from regularly accessing these resources. Culturally, the use of contraceptives is discouraged and antagonized. However, it is important to note that this sentiment varies greatly among castes, social classes, education status, and geographic location.

Debate exists regarding the widespread acceptance of family planning practices within India. Some parties argue that longer life expectancy, coupled with lower birth rates, allow working-age individuals to accumulate more wealth since they need to support fewer dependents. Conversely, other studies indicate that family planning can reduce the birth rate and cause the country's population to shrink. This debate has garnered national attention, and legislation has been passed and is being considered in the Indian Parliament to resolve these issues.

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Family Planning in Transgender and Gender Diverse Individuals
Overall, transgender and gender diverse individuals face multiple barriers to achieving family planning goals. This community experiences lack of access to reproductive health care settings where they feel accepted, safe, and understood; reproduction help; pregnancy care; and contraception. A barrier that gets in the way of becoming parents is the cost involved with fertility preservation options. For Example, the use of sperm cryopreservation in the United States is less than 5% while countries such as the Netherlands, Australia and Israel have higher rates; this may be the result of challenges navigating health insurance coverage. Other common concerns that arise when seeking pregnancy include having to stop or delay of hormonal therapy, worsening of gender dysphoria with treatment related to pregnancy.

Interventions use to facilitate gender transition such as hormone therapy and gender affirming surgeries (e.g., genital surgery, and chest surgery) can temporarily or permanently impact the chance of becoming pregnant. The World Professional Organization for Transgender Health (WPATH) and American Society for Reproductive Medicine (ASRMA) recommend offering counseling on the impact on family planning and transitioning to all transgender individuals Even though many transgenders and gender-nonbinary youth express desire to receive fertility counseling and recommendations from professional organization, studies indicate that only a small portion have these conversations with their health care team. Health care professionals attribute lack of knowledge of reproductive health in this community, knowledge limitation due to lack of data on long term effects of hormonal intervention to the inconsistency in discussion around family building

Studies have shown that transgender men can still become pregnant even in the absence of menstruation caused by gendered affirming therapy in the form of testosterone. Inconsistent hormonal therapy such as missed doses, incomplete dosing, or switching therapy regimen, mostly due to barriers noted earlier, may also lead to breakthrough ovulation which can contribute to increase chances of unintended pregnant. Highlighting the need of contraception on transgender men (who have conserved reproductive organs) on testosterone if pregnancy is not desire Furthermore, testosterone can cause abnormal vaginal development in fetuses with assigned female at birth genitalia (especially in the first trimester of pregnancy), becoming a concern for transgender men who conceived while on hormone therapy. Moreover, condoms are one of the most common contraceptive methods in transgender men, while another subset report no contraception use which can lead to unintended pregnancies. Some challenges to adopting a form of family planning method among this population varies depending on the method. For instance, fear of prevention of masculinization with use of estrogen-based contraceptives, gender dysphoria with the use of contraceptive devises inside cervical/pelvic cavity. Additionally, negative experiences in the health care system related gender identity, and denial of health care based on gender identity makes it difficult for this community to access health care, and family planning resources.