Evolution of National Family Planning Programme (NFPP) and National Population Policy 2000 (NPP) by dr.kumaravel

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.

1. Evolution of National Family Planning Program & the National Population Policy Kumaravel Ilangovan Second sem MPH student

2. 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

3. Outline 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. 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.

5. 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 I ndia Hospital post partum program, MTP act1971. 1974-79 during emergency Smt.Indira G andhi formulated a population policy, which permitted states to go for compulsory sterilization.

6. 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

7. 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”

8. 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.

9. 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”

10. 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 Policy 2002 – National Health Policy 2002-07 – Planning for RCH-II 2005 – RCH-II and NRHM 2007to12 – NRHM 2013 to 2017 – NRHM extended

11. 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.

12. India after ICPD 1994 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; Ch oice of contraceptive was limited; Involvement of males was poor; Quality of service was poor that lead to complications and generate distrust among users;

13. 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.

14. 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;

15. Objectives Short Term : fulfill unmet need for contraception, strengthening the health infrastructure, integrating the services for Reproductive and Child Health . Medium Term :e ffective 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

16. 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

17. 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

18. 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

19. 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

20. 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.

21. 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.

22. Conclusion