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Sh Bali Bhagat
Hon'ble Minister
Health & Medical Education


Ms Asiya Naqash
Hon'ble Minister of State
for Health & Medical Education


Dr. M.K. Bhandari
Secretary, Health & Medical Education Department

 

 

 

 

 


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Family Welfare

Family Welfare

PREAMBLE

India launched the National Family Welfare Programme in 1951 with the objective of reducing the birth rate to the extent necessary to stabilise the population at a level consistent with the requirement of the National economy.

"The Family Welfare Programme in India is recognised as a priority area, and is being implemented as a 100% Centrally sponsored programme. As per Constitution of India, Family Planning is in the Concurrent list. The approach under the programme during the First and Second Five Year Plans was mainly "Clinical" under which facilities for provision of services were created. However, on the basis of data brought out by the 1961 census, clinical approach adopted in the first two plans was replaced by "Extension and Education Approach" which envisaged expansion of services facilities along with spread of message of small family norms.

EVOLUTION OF FW PROGRAM (Programme)

4th FIVE YEAR PLAN
In the IV Plan (1969-74), high priority was accorded to the programme and it was proposed to reduce birth rate from 35 per thousand to 32 per thousand by the end of plan. 16.5 million couples, constituting about 16.5% of the couples in the reproductive age group, were protected against conception by the end of IVth Plan.

5th FIVE YEAR PLAN
The objective of the Five Year Plan (1974-79) was to bring down the birth rate to 30 per thousand by the end of 1978-79. The programme was included as a priority sector programme during the Five Year Plan with increasing integration of family planning services with those of Health, Maternal and Child Health (MCH) and nutrition, so that the programme became more readily acceptable. The years 1975-76 and 1976-77 recorded a phenomenal increase in performance of sterilisation. However, in view of rigidity in enforcement of targets by field functionaries and an element of coercion in the implementation of the programme in 1976-77 in some areas, the programme received a set-back during 1977-78. As a result, the Government made it clear that there was no place for force or coercion or compulsion or for pressure of any sort under the programme and the programme had to be implemented as an integral part of "Family Welfare" relying solely on mass education and motivation. The name of the programme also was changed to Family Welfare from Family Planning. The change was not merely in nomenclature but essentially in the content of its objectives.

6th FIVE YEAR PLAN

In the Sixth Five Year Plan (1980-85), certain long-term demographic goals of reaching net reproduction rate of unity were envisaged. The implications of this were to achieve the following by the year 2000 AD.

1. Reduction of average size of family from 4.4 children in 1975 to 2.3 children.

2.Reduction of birth rate to 21 from the level of 33 in 1978 and death rate from 14 to 9 and Infant Mortality Rate(IMR) from 127 to below 60.

3. Increasing the couple protection level from 22% to 60%.

 

 

Year-wise achievement during the 6th Year Plan period of the four Family Planning Methods was as below:

Year

Sterilisations

IUD
Insertions

C.C

Oral Pills

1980-81

2053

628

3718

91

1981-82

2792

751

4439

120

1982-83

3983

1097

5765

183

1983-84

4532

2134

7661

729

1984-85

4085

2562

8505

1290

 

 

7th FIVE YEAR PLAN
The Family Welfare Programme during VII five year plan (1985-90) was continued on a purely voluntary basis with emphasis on promoting spacing methods, securing maximum community participation and promoting maternal and child health care. In order to provide facilities/services nearer to the door steps of population, the following steps/initiatives were taken during the 7th Plan period.

1. It was envisaged to have one sub-centre for every 5000 population in plain areas and for 3000 population in hilly and tribal areas. At the end of 7th plan i.e.31.3.1990, 1.30 lakhs sub-centres were established in the country.

2.The Post Partum programme was progressively extended to the sub-district level hospitals. At the end of 7th plan, 1012 sub-district level hospitals and 870 Health Posts were established in the country.

3.The Universal Immunization Programme started in 30 Districts in 1985-86 was extended to cover all the districts in the country by the end of the 6th Year plan.

4.A project for improving Primary Health Care in urban slums in the cities of Bombay and Madras was taken up with assistance from World Bank.

5.  Area Development Projects were implemented in selected districts of 15 major States with assistance from various donor Agencies.

The achievements of the Family Welfare Programme at the end of the VII plan were

(i)   Reduction in crude birth rate from 41.7 (1951-61) to 30.2 (SRS:1990).

(ii)  Reduction in total fertility rate from 5.97 (1950-55) to 3.8 (SRS:1990).

(iii)     Reduction in infant mortality rate from 146 (1970-71) to 80 (SRS:1990).

(iv)    Increase in Couple Protection Rate from 10.4% (1970-71) to 43.3% (31.3.1990).

(v) Setting up of a large network of service delivery infrastructure, which was virtually non-existent at the inception of the programme.

(vi)   Over 118 million births were averted by the end of march, 1990.

The approach adopted during the Seventh Five Year Plan was continued during 1990-92. For effective community participation, Mahila Swasthya Sanghs at village level was constituted in 1990-91. MSS consists of 15 persons, 10 representing the varied social segments in the community and five functionaries involved in women's welfare activities at village level such as the Adult Education Instructor, Anganwari Worker, Primary School Teacher, Mahila Mukhya Sevika and the Dai. Auxiliary Nurse Midwife(ANM) is the Member-Convenor. A major new initiative undertaken during 1991-92 was the Child Survival and Safe Motherhood Project, an integration of Universal Immunization Programme with expanded/intensified MCH activities in high IMR States/Districts of the country.

VIII FIVE YEAR PLAN

To impart new dynamism to the Family Welfare Programme, several new initiatives were introduced and ongoing schemes were revamped in the Eighth Plan (1992-97). The broad features of these initiatives are as under:

World Bank assisted Area Projects which seek to upgrade infrastructure and development of trained manpower have been continued during the 8th Five Year Plan. Two new Area Projects namely India Population Project (IPP)-VIII and IX have been initiated during the 8th Plan. The IPP-VIII project aims at improving health & family welfare services in the urban slums in the cities of Delhi, Calcutta, Hyderabad and Bangalore. IPP-IX will operate in the States of Rajasthan, Assam and Karnataka.

An USAID assisted project named "Innovations in Family Planning Services" has been taken up in Uttar Pradesh with specific objective of reducing TFR from 5.4 to 4 and increasing CPR from 35% to 50% over the 10 years project period.

 

Recognising the fact that demographic and health profile of the country is not uniform, 90 districts which have CBR of over 39 per thousand (1991 census) were identified for differential programming. Enhanced allocation of financial resources, amounting to Rs.50 lakhs per year per district, was made for upgradation of health infrastructure in these districts from 1992-93 to 1995-96. This amount is being used for providing well equipped Operation Theatres, Labour Room, a six-bedded observation ward and residential quarters for paramedical workers in 5 PHCs of each district per year. All the block level PHCs of these 90 districts have been covered.

Realising that Government efforts alone in propagating and motivating the people for adaptation of small family norm would not be sufficient, greater stress has been laid on the involvement of NGOs to supplement and complement the Government efforts. Four new schemes for increasing the involvement of NGOs have been evolved by the Department of Family Welfare.

The Universal Immunisation Programme (UIP) was launched in 1985 to provide universal coverage of infants and pregnant women with immunisation against identified vaccine preventable diseases. From the year 1992-93, the UIP has been strengthened and expanded into the Child Survival and Safe Motherhood (CSSM) Project. It involves sustaining the high immunisation coverage level under UIP, and augmenting activities under Oral Rehydration Therapy, prophylaxis for control of blindness in children and control of acute respiratory infections. Under the Safe Motherhood component, training of traditional birth attendants, provision of aseptic delivery kits and strengthening of first referral units to deal with high risk and obstetric emergencies are being taken up.

The targets fixed for the 8th plan of a National level birth rate of 26 was achieved by all States except the States of Assam, Bihar, Haryana, Madhya Pradesh, Orissa, Rajasthan and Uttar Pradesh.

IX FIVE YEAR PLAN

Reduction in the population growth rate has been recognised as one of the priority objectives during the Ninth Plan period.

The objectives during the Ninth Plan are:

i) to meet all the felt-needs for contraception

ii) to reduce the infant and maternal morbidity and mortality so that there is a reduction in the desired level of fertility.

The strategies during the Ninth Plan will be:

i)  to assess the needs for reproductive and child health at PHC level and undertake area-specific micro planning.

ii) To provide need-based, demand-driven, high quality, integrated reproductive and child health care.

The expected levels of achievement by the terminal year of Ninth Plan (2002) are given below:

Indicator

If current trend continues

If acceleration envisaged in Approach Paper to the Ninth Five Year Plan is achieved.

CBR

24/1000

23/1000

IMR

56/1000

50/1000

TFR

2.9

2.6

CPR

51%

60%

NNMR

35/1000

 

MMR

3/1000

 
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