This presentation discuss the evolution of India's National Family Planning Program and National Population Policy 2000, significant impact of 1994 Cairo conference on country's Reproductive health approach.
2.
Reducing numbers of abortions
Prevention of maternal deaths
Improvements in child health
Promotion of gender equality
HIV/AIDS – prevention of motherto-child transmission
Cost-effective
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Major milestones in evolution of India’s FP
programmes
Cairo Conference 1994
Reasons for high population growth
Definition of Reproductive Health
India after 1994 ICPD
National Population Policy 2000 A.D
Summary
Further Discussions in this Topic
Conclusion
4.
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.
5.
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.
6.
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
7.
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”
8.
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.
9.
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”
10. 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 Policy
2002 – National Health Policy
2002-07 – Planning for RCH-II
2005 – RCH-II and NRHM
2007to12 – NRHM
2013 to 2017 – NRHM extended
11.
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
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The GOI had reviewed the NFWP on the basis of
various surveys, reports & studies. Following facts
were found:
Targets & incentives distorted the program
implementation. Targets set at the central& state
levels were never appreciated by the population
and health workers at large;
Significant gaps was existed in infrastructure and
outreach services;
Choice of contraceptive was limited;
Involvement of males was poor;
Quality of service was poor that lead to
complications and generate distrust among users;
13.
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.
14. 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;
15.
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 ecoconservation, stabilize the population by 2045
16.
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
17.
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
18.
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
19.
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
20.
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.
21.
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.
Hinweis der Redaktion
From mid 1950 onwards, as a result of rapid fall in death rates, there were unprecedented high levels of natural growth. This sudden decline in death rate was primarily the result of achievements in the economically advanced countries and unexpected low cost of applying modern medicine and replicating them in developing countries. The knowledge we acquired in curbing the spread of killer diseases & epidemics was transformed to the developing countries whose natural growth was near stagnant, which was the reflection of high mortality/high fertility. While the death rate falls drastically, fertility and reproduction maintained their high levels which resulted in unprecedented high levels of natural growth of the population.It was this concern of “excessive demographic increase” and its social, economical and geo-political ramifications impelled and triggered the international community to focus on slowing down population growth by implementing what was called “population control” or “FPP”.
As a preventive program, family planning is a first line of defense against many health concerns that we all share.We have strong evidence that family planning use reduces abortions – and this relationship may not be emphasized often enough. FP prevents maternal deaths and improves children’s health.And it is also linked to efforts to empower women and raise their status.FP can help prevent mother-to- child transmission of HIV by helping HIV + women avoid unintended pregnancies.And for all these benefits, family planning is cheap compared to other health interventions, because the methods are low cost and many can be delivered in non clinical settings.
In 1952, India was the first country in the world to launch a national programme, emphasizing family planning to the extent necessary for reducing birth rates “to stabilize the population level consistent with requirement of the national economy”Since then the national family planning programme has gone through several changes- at time it has been integrated with different programmes like minimum needs programme, MCH and Child survival& Safe motherhood (CSSM). However, the goal of FPP has been reducing the birth rate & the rate of population growth by the introduction (since1960’s) of method specific FP targets to achieve these goals.
It is hard to talk about population policies without mentioning the International Conference on Population and Development.It became very clear that population was no longer about numbers, figures, statistics but people and improving their quality of life.It was also agreed that no method specific targets imposed from above, no force, no coercion, no incentives, and disincentives are required, because both are either coercive or ultimately tend to be coercive and are infact counter productive. Coercion infringes upon human rights and inhibits human development.The ICPD (PoA) placed “individuals” in the center of development with a focus on building pillars of “Human Development, Human Rights, Gender equity and Equality”.
2. Used to be the fixation of most population programmes as well as they also served as indicators of success.
This definition focuses on right of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.
The DFW after an in-depth sectoral review, undertook many pilot activities to prepare for a total shift in the implementation of the FWP.Such a shift aimed at addressing the needs of women who are at risk of unwanted births, and assisted the country to accelerate fertility decline.India changed the strategy of NFWP to RCH in 1997 and in 9th fifth year plan (1997-02) a total change in implementation was recommended.
This has led to significant disparity in current population size and potential to influence population increase. There are wide inter state, male-female, rural-urban disparities in outcomes and inputs.. These differences largely stem from poverty, illiteracy, and inadequate to access to health and family welfare services, which co-exist and reinforce each other.
Population stabilization is not about number but it is about balanced development which should be looked in the context of wider, broader SED. How ever, the time has come to stop counting people and instead start counting on people. In short the moral of story is if we take care of people, population will take of itself.