PRESENTATION

1. UNMET NEED FOR FAMILY PLANING

2. Unmet Need for Family Planning
 First explored in 1960s
 Surveys of contraceptive KAP showed a gap in women’s
reproductive intention and contraceptive behaviour
 KAP-gap or “Unmet need” (1977)
 1978, Charles Westoff published comparative estimates of unmet
need for limiting births
 Many women who are sexually active would prefer to avoid
becoming pregnant , but are not using any method of contraception
(including use by their partner)

3.  These women are considered to have an “unmet need for family
planning”.
 Concept is usually applied to married women
 Can apply to all sexually active women and even men, but its
measurement has been limited to married women.
 Powerful concept for family planning
 Challenge to family planning – to reach and serve the millions of
women whose reproductive attitude resembles that of the
contraceptive user, but for some reason/s are not using
contraceptives.
 The concept is usually applied to married woman women.

4.  Defined on the basis of women’s response to
survey questions
 NFHS-3, Unmet need is highest (27.1%) among
women <20yrs and is mostly for spacing births
than limiting births

5.  Also relatively high among 20-24 yrs (21.1%) with
75% of the need for spacing births
 Unmet need above 30 years is mostly for limiting
the births
 Higher in rural areas than urban areas
 Varies by women’s education (10-4-13.6%)
 Varies by religion (Hindu and Christian women
have a lower unmet need than Muslim women)

7.  NFHS-3 show that although current use of
contraception has increased and the extent of unmet
need has declined, that is a need for considerable
improvement in the coverage and quality of FP
services in UP, Bihar, MP and Rajasthan
 DLHS-3(2007-08), about 20.5% of currently married
women in India have an unmet need for family
planning.
 Unmet need for spacing births is 7.2%
 Unmet need for limiting births is 13.3%

8. Definition:
 Women with unmet need are those who are fecund
and sexually active but are not using any method
of contraception, and report not wanting any more
children or wanting to delay the next child. The
concept of unmet need points to the gap between
women's reproductive intentions and their
contraceptive behaviour.
 powerful concept for family planning.

10.  Unsatisfactory or inconvenient services
 Lack of information
 Fears about contraceptive side-effects
 Opposition from husband/relatives

11. Unmet need is especially high
among groups such as
 Adolescents
 Migrant
 Urban slum dwellers
 Refugees
 Women in the postpartum period

13.  Unmet need for family planning=
 Women of reproductive age (15 -49) who are
married or in a union and who have an unmet need
for family planning x 100
Total number of women of reproductive age
(15-49) who are married or in a union

14.  The standard definition of unmet need for family
planning includes in the numerator women who
are fecund and sexually active but are not using
any method of contraception, and report not
wanting any more children or wanting to delay the
birth of their next child for at least two years.

15. Extent of Unmet Needs
 Estimated 234 million women of reproductive age
group 15-49 years,about one in five have an unmet
need of family planing ,that is they are sexually
active and want to avoid pregnancy but are not
using contraception.
 The unmet need of contraception in india are as
high as 25% and it is one of the major reason of
population growth and high fertility.

16. Contraception in adolescents
 Puberty to Maturation
 Global adolescent birth rate 49/1000
 At risk pregnancies
 Unsafe abortions
 Barrier methods condoms
 Hormonal contraception
 IUD – Contraindicated
 Advocate abstinence

17. Sociology of Family Planning
 Sociologists and Economists have shown that it
will be difficult to raise the living standards of
people while population growth continues
unchecked.
 Attitude surveys have shown that awareness of FP
is very widespread and over 60% of people have
attitudes favorable to restricting or spacing births
 No organized opposition to FP

18.  Inspite of this, rate of contraceptive use by couples
in developing countries is very low – This is the
crux of the FP problem
 Studies have shown that the resons for this are
that there are complicated deep-rooted religious
and other beliefs, attitudes and practices favoring
larger families (e.g. strong preference for male
child)

19.  Common beliefs are
 Children are a gift of God
 Number of children are determined by God
 Children are a poor man’s wealth
 Children are an asset to which parents can look
forward to in periods of dependency caused by old
age, disease or misfortune
 Most of these beliefs stem from ignorance and lack of
communication

20.  The problem of FP is essentially the problem of SOCIAL
CHANGE
 What is most important is to stimulate socail changes affecting
fertility like
 Raising the age of marriage
 Increasing the status of women
 Education and employment opportunities
 Old age security
 Compulsory education of children
 Accelerating economic changes designed to increase the per
capita income

21.  Economic development is the best contraceptive
 The best motivation is economic, desire to
improve the standard of living
 Solution to the problem is MASS EDUCATION
and COMMUNICATION so that people under
stand the benefits of a small family.

22. NATIONAL FAMILY WELFARE
PROGRAMME
 Launched in 1952 – first country in the world to do so
 Early beginnings were only establishment of a few
clinics and distribution of educational material,
training and research
 3rd
Five Year Plan: FP was declared “The very center
of planned development”
 Emphasis was shifted from purely ‘clinic approach’ to
vigorous “extension education approach” for
motivating people to accept “small family norm”

23.  Lippes Loop was introduced in 1965 – major
reorganization of the programme – Led to creation
of separate Department of Family Planning in
1966 in MOH
 During 1966-69, family planning infrastructure
(e.g. PHCs, Sub centers, urban FP centers, district
and state bureaus) were formed
 4th
Five Year Plan – GOI gave TOP priority

24.  Program was made part of MCH activities of PHCs and sub
centers
 1970 – All India Post Partum Program
 1972- MTP Act
 5th
Five Year Plan – major changes
 1976 – National Population Policy
 1976 – forcible sterilzation campaign
 1977 – New population policy ruling out compulsion and
coercion
 Family planning renamed Family Welfare

25.  42nd
amendment of the constitution has made Population
Control and FP a concurrent subject - 1977
 Acceptance of the program purely voluntary
 1877 – Rural Health Scheme – involvement of the local
people (Health guides, trained Dais, Opinion leaders) in the
FW program at the grass root level
 Alma Ata Declaration was signed in 1978
 Acceptance of Primary Health Care approach to
achievement of HFA/2000AD
 National Health Policy in 1982

26.  Long term demographic goal of NRR=1 by year 2000
– for two child family norm – through attainment of
BR of 21 and DR of 9 per 1000 population
 6th
and 7th
plans set to achieve these goals
 UIP started in 1985-86
 ORS was started also
 During 1992 – all the programs aimed at improving
maternal and child health were integrated under
CSSM program

27.  1994- further integration of programs – International
Conference on Population and Development
recommended the implementation of RCH Program
 RCH program reduced cost of input due to
overlapping of expenditure will not occur
 9th
Five Year Plan integrates ALL the related programs
into RCH program – concept is the provide need
based, client oriented, demand driven, high quality
integrated services

28.  GOI evolved a comprehensive National Population
Policy in 2000 to promote family welfare
 Expenditure on the program has progressively
increased upto 11th
Plan

29. EVALUATION OF FAMILY
PLANNING
 Definition: process of making judgments about
selected objectives and events by comparing them
with specified value standards for the purposes of
deciding alternative course of action
 Improve the design and Delivery of FP servies
 Five types of Evaluation defined by WHO Expert
Committee 1975

30. Evaluation of Need
 Health, Demography and Socio-economic Needs
for FP e.g. Current status of Maternal Mortality
will be indicator of need for FP

31. Evaluation of Plans
 Assessment of Feasibility and adequacy of
Program Plans

32. Evaluation of Performance
 Services: Clinic services, mobile services, post
partum services, contraceptive distribution, follow
up services, education and motivation activities
 Response: number of new acceptors,
characteristics of acceptors
 Cost analysis
 Other activities: Administration, manpower, data
system etc

33. Evaluation of Effects
 Changes in knowledge, attitudes, motivation and
behaviour

34. Evaluation of Impact
 A ) Family Size (number of living children)
 B) Desired number of additional children
C) Birth interval
 D) Age of the mother at birth of first and last child
 E) Birth order
 F) Number of abortions
 G) Changes in birth rate
 H) Changes in growth rate

35.  Evaluation is a technical activity and requires
trained personnel, statistical facilities and adequate
flow of data and information

36. Refrences
 Park .k text book of preventive and social medicine, 23rd
edition,
bhanarsidas bhanot publishers. 2015:511-512
 Lal. Sundar, text book of preventive and social medicine, 4th
edition, CBS publishers.2014:136-137
 http://www.who.int/reproductivehealth/topics/family_planning/unmet_
 http://www.un.org/esa/population/publications/WCU2009/WCP_2009