India launched a nationwide family planning program in 1952 for
the first time in the world. It started with the establishment of a few clinics
and the distribution of educational material. Later the emphasis shifted from
the clinic approach to more vigorous extension education approach for
motivating the people to adopt small family norm. In 1966, a separate family
planning department was created in the Ministry of Health.
In 1976, India framed its first National Population Policy. It called for an increase in legal minimum age at marriage from 15 years to 18 years for females and from 18 years to 21 years for males. In 1977 the policy was revised and importance was given to the adoption of the small family norm but only on a voluntary basis and the name of the program was changed to the Family Welfare Programme. The policy endorsed the minimum age at marriage and birth rate target of 25 per 1000 population by 1984.
In 1983 the National Health Policy fixed the goals for replacement levels of Total Fertility Rate to be achieved by 2000 A.D. However, there was no spectacular decline in birth rate despite concerted efforts It was felt that if the annual increase of 15.5 million in population continued, India would overtake China by 2045 AD which will pose a great threat to conserving resource endowment and environment. The population of India was projected to be 1263.5 million by the year 2016.
The role of population stabilization for promoting sustainable development has been very well recognized. But this is possible only by making reproductive health care universally accessible and affordable besides empowering women and enhancing employment and communication facilities.
The National Population Policy 2000 (NPP 2000) affirms the commitment of the government towards voluntary and informed choice and consent of citizens while availing of reproductive care services, and continuation of Target Free Approach in administering family planning services It provides a framework for advancing goals and prioritizing strategies to achieve net replacement levels of Total Fertility Rate (TFR) by 2010. It also offers a comprehensive package of reproductive and child health services by government, industry, voluntary and non-government sectors working in partnership.
Ten strategic themes to achieve the socio-demographic goals and suggested ways of implementation were:
1.Decentralized Planning and Programme Implementation: This would be done through Panchayati Raj Institutions such as village panchayats. The panchayat committee will identify the area specific unmet needs of RCH and contraception and plan and provide services at the village level. As 33 percent of seats in panchayats are reserved for women the panchayats are expected to promote gender sensitive, multisectoral agenda for population stabilization.
2.The convergence of Service Delivery at Village Level: Village
Self Help Groups are existence through various schemes of Department of Women
and Child Development, Ministry of Rural Development, and Ministry of
Environment and Forests. Such groups would be utilized along with ICDS which is
poised to be universalized to organize and provide basic reproductive and child
health services at the village level. Regular meetings of these groups may
provide the forum for basic MCH care besides information about micro-credit and
3. Meeting Unmet Needs for Family Welfare Services: The health infrastructure at the village, sub-center, and primary health center needs to be energized, strengthened and made publicly accountable. Priority needs to be given to unmet needs for contraceptives, supplies, and equipment for integrated service delivery and mobility of service providers and patients for referral services.
4.Underserved Populations: Groups like the population in slums, tribal areas, adolescents are to be provided with comprehensive basic health and RCH services through better coordination with municipal bodies, NGOs and private sector organizations. Special focus would be on men in IEC campaigns for promoting their contribution in the adoption of the small family norm by promoting non-scalpel vasectomies. Emphasis is also to be given on enforcing the Child Marriage Act 1976 to avoid teenage pregnancies Adolescents would have access to health and nutrition services through ICDS.
5.Diverse Health Providers: Utilisation of private practitioners by assigning them to provide RCH services for satellite populations up to 5000 each may be explored. They 7 will be given compensation for services. The involvement of non-medical fraternity e.g. retired defence personnel and school teachers will be sought in counselling and advocacy. The concepts and strategies of RCH&NPP will be included in UG/PG curriculum.
6.Collaboration with NGOs and Private Sector: This would be sought for increasing clinic outlets, mobile clinics and encouraging self-help groups for efficient service delivery at the village level. Industry and corporate sectors may help to strengthen the management information system at PHC and sub-center level in the seven most deficient states by offering electronic data entry machines. Industries with 100 workers may provide preventive RCH care to their own employees. NGOS collaboration may be sought in IEC, advocacy and social marketing of contraception. 7.Mainstreaming Indian Systems of Medicine and Homeopathy: The indigenous systems of medicine have provided effective remedies for centuries. The feasibility of utilizing services of institutionally qualified practitioners of ISM & H after appropriate training in RCH needs to be explored. They may help to fill up the manpower gaps at village sub-center and PHC level. The ISM &H institutions, hospital, and dispensaries may be utilized for RCH Programme. 8.Contraceptive Technology and Research on RCH: This would be supported by the government by encouraging medical & social science research, demographic and behavioral science research in consultation with ICMR and the network of academic research and research institutions. A constant review and evaluation of community need assessment approach will be pursued. Newly emerging contraceptive technology will be reviewed with the aim of including in the program.
9.Provisions for Older Population: Promoting old age care and support for persons aged 60 years and above will reduce the incentive to have large families for this. Under National Policy on Older Persons, there is a plan to sensitize, train and equip rural and urban health institutions to provide geriatric care and encourage NGOs to design schemes to make elderly economically self-reliant. Tax benefits may be explored to encourage children to look after their aged parents.
10.Information, Education and Communication (IEC): Family welfare messages to be clear, focussed and disseminated everywhere including far-flung areas. Massive national campaign on population-related issues to be undertaken through mutually supportive strategy by both Department of Family Welfare and Education using folk media, public address system, public media, artists, popular film personalities, politicians, etc. Local bodies and NGOs may be supported for interactive and participatory IEC activities.