EVOLUTION OF NATIONAL FAMILY

PLANNING PROGRAM & THE NATIONAL

POPULATION POLICY

Kumaravel IlangovanSecond sem MPH student

Family Planning is Still a Good Investment

Reducing numbers of abortions Prevention of maternal deaths Improvements in child health Promotion of gender equality HIV/AIDS – prevention of

mother-to-child transmission Cost-effective

Outline1) Major milestones in evolution of India’s FP

programmes

2) Cairo Conference 1994

3) Reasons for high population growth

4) Definition of Reproductive Health

5) India after 1994 ICPD

6) National Population Policy 2000 A.D

7) Summary

8) Further Discussions in this Topic

9) Conclusion

Milestones in Evolution of India’s FP Programmes

1952 – “urgency of the problems of Family Planning (FP) & advocated a reduction in the birth rate

1956 – expansion of FP clinics in both rural & urban areas and recommended a autonomous central family planning board, with state level boards.

1961 – the provision of sterilization facilities in all health facility centers. Maharashtra organized “sterilization camps” in rural areas. Extension education approach, small family norm message.

Cont’d 1963 – The Director of FP “a shift from the

clinic approach to a community based approach to be implemented by auxiliary nurse midwives (1/10,000 population) located in PHC’s.

1965 – Introduction of Intra Uterine Device (IUD)

1969-74 FP services provided, All India Hospital post partum program, MTP act1971.

1974-79 during emergency Smt.Indira Gandhi formulated a population policy, which permitted states to go for compulsory sterilization.

Cont’d 1977 – A revised policy formulated by

Janata government. Term FP replaced by “Family Welfare”. Child marriage restraint act was passed in 1978.

1983 National Health Policy was established.

1980-85 Strengthening of MCH, FW. 1985-90 Inclusion various programmes

under MCH 1991- Karunakaran committee appointed. 1993- submitted a report to NDC in which

it pleaded for NPP 1992-97 CSSM

1994 Cairo Conference

Official name: International Conference on Population and Development

ICPD was a watershed in the history of thinking on population issues.

It represented a “quantum leap” approach for population and development policies as it involved a shift from the earlier emphasis on population control & demography to sustainable development and recognition of the need for Reproductive Health(RH) and (RR) Rights addressing the “lifetime approach”

Two fundamental changes in most of the countries

Root cause of High Fertility Expand the existing FW programmes beyond

the contraceptive delivery to include a range of RHS

Broader & more holistic. Earlier Total fertility rate(TFR) and Contraceptive prevalence rate.

ICPD replaced them with quality of care, informed choice, Gender factor, Women empowerment & Accessibility to a whole gamut of RHS.

Reasons for High Population Growth in India

Large size of population in the reproductive age

Higher fertility due to unmet need for contraception

High wanted fertility due to high IMR Male child preference Over 50% of girls marry below the age of

18, resulting in a typical reproductive pattern of “too early, too frequent, too many”

Milestones cont’d 1996 – Target free approach, review of

Safe motherhood component of CSSM 1997-02 Reproductive and Child Health

(RCH) (CSSM plus STI & RTI components)2000 – National Population Policy2002 – National Health Policy2002-07 – Planning for RCH-II2005 – RCH-II and NRHM2007to12 – NRHM2013 to 2017 – NRHM extended

Definition of Reproductive Health WHO defines reproductive health

within the frame work of definition of health as “a state of complete physical, mental, social well-being and not merely absence of disease or infirmity, the RH addresses the reproductive processes, functions and systems at all stages of life. It implies that people are able to have a responsible, satisfying and safe sex life & that they have the capability to reproduce & the freedom to decide when, how often to do so.

India after ICPD 1994 The GOI had reviewed the NFWP on the basis

of various surveys, reports & studies. Following facts were found:

1. Targets & incentives distorted the program implementation. Targets set at the central& state levels were never appreciated by the population and health workers at large;

2. Significant gaps was existed in infrastructure and outreach services;

3. Choice of contraceptive was limited;4. Involvement of males was poor;5. Quality of service was poor that lead to

complications and generate distrust among users;

Cont’d

Low budget allocation resulted in gaps in staffing, facilities, package of services;

Training and reorientation program of staff was not uniform throughout country.

There was hardly any skill development in training; and

Overlapping of FP services.

National Population Policy2000

Vision Statement:Aims to improve the quality of lives people lead;

Provide them with opportunities and choices with a comprehensive, holistic and multi sectoral agenda for population stabilization;

Objectives Short Term : fulfill unmet need for

contraception, strengthening the health infrastructure, integrating the services for Reproductive and Child Health.

Medium Term :effective implementation of inter-sector strategies to substantially reduce the TFR by 2010.

Long Term : to sustain the economic growth, social development and eco-conservation, stabilize the population by 2045

Demographic Targets of NPP-2000 India (2010)

Fulfilling the Unmet Need for RCH Free and compulsory education for children under-

fourteen Reducing the school dropout between boys and

girls to 20 percent Bringing IMR < 30 Bringing MMR < 100 Increasing Immunization against VPDs to 100

percent Encouraging the increase in average age at

marriage of girls Increasing Institutional Deliveries to 80 percent > delivery by trained persons to 100 percent Making contraceptive of choice available to 100

percent population

Cont’d Enhancing the IEC coverage for

RTI/STI/AIDS to cent percent population Integrating allopathy with ISM for

betterment of RCH services Encouraging the small family norm to

substantially reduce TFR Coordinating the activities of social sector

development to make family welfare program public oriented

Strategies for NPP-2000, India Decentralize the Plan and Program

Implementation Convergence in services at delivery

points Women Empowerment to mitigate

nutrition/health problems of females Strengthening child survival and child

health Meeting the unmet need for FW Special services for slums Attending Adolescents Increasing Male Participation

Cont’d Diverse health care providers Collaboration with and commitments

from NGO and the private sector Mainstreaming of Indian systems of

Medicine and Homeopathy Research on RCH and Contraceptive

technology Care for older population Information, Education & Communication

Cont’d NPP is Gender sensitive

Primary theme is provision of quality services and supplies & arrangement of basket of choices. People must be free and enable to access quality health care.

Substantial differences are visible between states in the achievement of basic demographic indicators.

Summary It has been a unique event in the history

of Public Health in India that in the year 2000 that the Population Policies have been released at the country and state level with the goal of stabilizing Population in a large subcontinent which currently constitutes one-seventh of world’s population. It is now for students of Public Health to see, how the proposed goals and objectives have been achieved.

Conclusion