family planning in india

1. Family Planning- Contd.
06-04-2023 DEPT. OF COMMUNITY MEDICINE 1
M O D E R ATO R S - D R . D E E P T H I . M . K A D E A N G A D I D R . FA R Z A N A B E G A U M
A S S O C I AT E P R O F E S S O R A S S I S TA N T P R O F E S S O R
D E P T. O F C O M M U N I T Y M E D I C I N E D E P T. O F O B S T E T R I C S & G Y N E C .
Presenter: Dr. Mohamed Aarif N

2. Unmet Need:
Women’s
reproductive
intension
Their
contraceptive
behaviour
KAP – Gap /
“unmet
need”
gap
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3.  Apply to sexually active fecund Women and Men – measurement limited to
married women
Poses challenge to family planning programme
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4. Reason
Inconvenient
services
Lack of
information
Fears about
side effects
Opposition
from
husband or
family
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5. Unmet need India
NFHS-5
Karnataka
NFHS-5
Belaum
NFHS-5
Total unmet need
for limiting birth
Urban- 8.4%
Rural- 9.9%
Total- 9.4%
NFHS 4 – 12.9%
7.3%
5.9%
6.5%
NFHS 4 – 10.4%
5.5%
10.3%
Unmet need for
spacing
4% 3.8% 2.1%
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6. High focus states
States
Unmet Need NFHS 5 NFHS 4
Total Spacing Total
Uttar Pradesh 12.9% 4.8% 18.1 %
Bihar 13.6% 6.1% 21.2%
Rajasthan 7.6% 3.7% 12.3%
Madhya Pradesh 7.7% 3.9% 12.1%
Chhattisgarh 8.3% 3.4% 11.1%
Jharkhand 11.5% 4.8% 18.4%
Assam 11% 4.1% 14.2
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7.  Higher in rural areas than urban areas.
Varies by women’s education and religion.
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8. Demand satisfied
Demand satisfied =
The need satisfied by
modern methods
Total demand of the
community
Includes the cohort using modern contraceptive and traditional method and having unmet need for contraception.
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11. Delivery system
At the centre
At the state
At the district
At the
community
health centre
centre
At the phc
At the village
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12. At the central level
Dept of family welfare
Special
secretary
Joint
secretaries
Advisor -
Additional
secretary
Secretary to GOI
in the MoHFW
National Institute of
Health and Family
Welfare
Education and
training services
Research Evaluation
Apex technical
institute
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13. Central Family Welfare
Council
• All the State
Health Ministers
• To review the
implementation
of the programme
Population Advisory
Council
• Union health
minister,
members of
Parliament and
persons from the
field
• Think tank – to
analyse and
advise
• Headed by PM of
India
• Periodic review of
the progress
Cabinet sub-committee
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14. At the State level
State government – administration and implementation
• Part of State Family Welfare
directorate.
• 25 Bureaus are functioning
State Family Welfare
Bureau
• Maintain liaison with state gov
and give technical assistance in
implementation
Regional Office for
Health and Family
Welfare
• To co-ordinate between state
and central gov.
Family Welfare Cell
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15. At the District level
District Family Welfare
Bureau
Administrative
division
- District Family
Welfare Officer
Mass Education and
Media division
-Mass Education and
Media Officer
Evaluation
division
- Statistical officer
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16. 1083 Urban Family Welfare
Centres
Type I
- Population between
10000-25000
Type II
- Population between
25000-50000
Type III
- Population above
50000
2 paramedical staff in type I & II
6 persons including medical officer in type III
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17. If >50000 – divided into sectors
Type A,B,C – Hospital for referral and supervisory services
Type D – Hospital for sterilization, MTP and referral
871 Urban Health
Post
Type A
- Population
<5000
Type B
- Population
between 5000 –
10000
Type C
- Population
between 10000
– 25000
Type D
-Population
between 25000 –
50000
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18. At Community Health Centre
Maintained by state gov
4 medical specialist and 21 paramedical staffs
• Surgeon, physician, gynaecologist and paediatrician
30 in-door beds, 1 OT, X-ray, labour room, laboratory – referral centre 4
PHCs
Full range of family planning services – laparoscopic and safe abortion services.
As of 2018 - 5624 CHCs functioning in the country.
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19. At PHC level
Rural Family Welfare centres – PHC with medical officer
As of 2018- 25743 PHCs supported by 1,58,417 subcentres
Provide “Essential health care including “ including family planning care
MO trained to provide MTP and sterilization services
IUDs insertion is intensified
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20. At the village level
The Village Health
Guides
• One for each village /
1000 population
• Provides supplies
Condom/OCPs
• 3.23 L guides in
position
Trained Dais
• 1 / 1000 population
• Conduct safe
deliveries in rural
• FP counsellors &
motivators.
ASHA
• 9.15 L so far
• Provided with drug
kits.
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21. Milestones Of Family Welfare Programme
- National Family
Planning Program
by GoI 1952
- First of its kind
- Extension
education approach
- Expansion of
facilities
- Small family norm
- Dept of FP IN MoH
- Introduction of
IUCDs & condom
1951-1956
1961 - 1966
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22. - FP services under
PHCs
- All India Hospital
Post Partum
Program
- MTP Act in 1971
- Campaign for male
sterilization
- Renaming to
Family Welfare
- Community
involvement
- Child marriage
restraint Act 1978
- National health
policy 1983
- Strengthening
MCH and Family
welfare
1969 - 1974
1974 - 1979
1980 - 1985
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23. - Various Programes
under MCH
- Child Survival And
Safe Motherhood
(CSSM)
- ICPD , Cairo, 1994
- Target free
approach
- Review of CSSM
- Reproductive Child
Health
- National
Population Policy
2000
1985 - 1990
1992 - 1997
1997 - 2002
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24. - RCH II with few
modification after
evaluating RCH I
- National Rural
Health Mission -
NRHM
- National Urban
Health Plan + NRHM
=National Health
Mission
- National Urban
Health Mission
2013 + NRHM
- RMNCH + A
- INAP 2014
- National health
policy 2017
2002 - 2007
2007 - 2012
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25. Key Strategies
Home Delivery of Contraceptives (HDC):
 ASHA to deliver contraceptives at the doorstep.
launched in 233 pilot districts of 17 States on 11 July 2011 - expanded to the
entire country from 17th December 2012.
 ASHA is charging a nominal amount from beneficiaries for her effort to deliver
contraceptives at doorstep
 i.e. Re. 1 for a pack of 3 condoms, Re. 1 for a cycle of OCPs and Rs. 2 for a pack of one
tablet of ECP.
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26. Ensuring Spacing at Birth (ESB)
- Services of ASHAs - counselling
◦ newly married couples to ensure spacing of 2 years after marriage
◦ couples with 1 child to have spacing of 3 years after the birth of 1st child.
◦ The scheme is operational in 18 States (EAG, North Eastern and Gujarat and
Haryana).
- ASHA would be paid following incentives under the scheme:
- Rs. 500/- to ASHA for delaying first child birth by 2 years after marriage;
- Rs. 500/- to ASHA for ensuring spacing of 3 years after the birth of 1st child
- Rs. 1000/- in case the couple opts for a permanent limiting method up to 2 children
only.
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27. Pregnancy Testing Kit
Nishchay: Home based Pregnancy Test Kits (PTKs) was
launched under NRHM in 2008 across the country
Anchored with the Family Planning Division on 24th
January, 2012.
The PTKs are being made available at subcenters and
to the ASHAs
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28. Mission Parivar Vikas (MPV)
Mission Parivar Vikas (MPV) - launched in 2016
 For increasing access to contraceptives and family planning services
 In 146 high fertility districts of seven high focus States (Uttar Pradesh, Bihar,
Rajasthan, Madhya Pradesh, Chhattisgarh, Jharkhand and Assam) having TFR of 3 and
above
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29. Key Strategic Initiatives have been undertaken in MPV Districts
Delivering assured
services
• Injectable
contraceptives
• Augmentation of
PPIUCD & PAIUCD
• Augmentation of
sterilization
• Condom boxes
Enhanced service delivery
• Building additional
capacity/HR
• Mobile out reach teams
Ensuring commodity
security
• Family planning logistics
management
information system [FP-
LMIS]
• Web /mobile based app
to manage supply chain
& to regulate the flow of
commodities to the end
user
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30. Promotional schemes
• New contraceptives
available at subcentre
level
• Nayi Pehal Kit : a family
planning kit to
newlywed couple
through ASHA.
• 2019-2020 – 4,26,632
• 2020-2021- 28,281
• Saas Bahu Sammelans
: communication btw
married women and
their mother in law
• To discuss freely about
FP & reproductive health
• 2020-2021: 15,611
conducted
• Sarthi : mobile van
offering information and
services at doorstep
• 2020-21: 1.26
beneficiaries, 19.57 L
condoms, 3.62 L oral pill
in MPV districts.
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31. Other Initiatives
More emphasis on spacing like IUCD
◦ - Training of state level trainers completed
◦ - Training service provider at sub centre level is under way
 New method of IUCD ( post partum IUCD 2010 and post abortion IUCD)
 2019-20: 25.45 L PPIUCD & 91,660 PAIUCD
 2020-21: 15.55 L PPIUCD & 43,138 PAIUCD
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32. Newer intervention to improve access
 Expansion of basket of choice
- Antara – injectable DMPA- INTRODUCED
- POP- Under piloting process
- Chhaya - Centchroman - under programming.
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33. Sterilization:
“FIXED DAY STATIC Services” (FDS) approach.
Frequency of services
- District hospital – twice a week
- Sub-district hospital – weekly
- CHC/BLOCK PHC – fortnightly
- 24x7 PHC / PHC - monthly
Objectives
• Shift from camp approach to
regular routine services
• To make health facilities self
sufficient
• Avail sterilization to client on any
date at their health facility
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35. Incentives – compensation scheme
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37. National family planning indemnity scheme
Payment of claims after sterilization in the event of death/ failure/complication/
indemnity cover to doctor/ health facility
Increments:
State gov employees – sterilization after 2 children : 2 increment; one after 3
children .
Central gov employee – one increment & special leave
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38. Family welfare linked health insurance scheme
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39. Public private partnership
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64
& 2020-21
2020-21
36

40. National
Population
Policy 2000
First formed in April 1976
“Target free approach in family planning services”
Provision of informed and voluntary choice to the people to
avail reproductive health care services.
Aims at TFR = replacement level.
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National population policy 2000

41. Components of NPP 2000
Women education and empowerment
Child survival and health
Unmet needs for family welfare services
Health care for under served population
Adolescent health & education
Increased participation of men in planned parenthood
Collaborations with NGOs
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42. SWOC Analysis - Strengths
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Affordable
Accessible
Client-
centered
care
Effective
communica
tion
Attained
replacement
level fertility
Community
need
assessment
approach
Technological
support
Integration
of
programmes

43. Weakness
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Lack of
Private
contribution
More unmet
needs in
Rural than
Urban
Lack of
Involvement
of male
Unmet need
for emergency
contraceptives
Social
challenges-
discrimination
in fair
distribution
Pregnancy among
Adolescent and
unmarried
women

44. Opportunities
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Man-
power and
resources
LMO at PHCs
Building
private
public
partnership
Involvement
of male
Adolescent and
unmarried
women -
emergency
contraceptives
Training of
staffs – IUCD &
Sterilization

45. Challenges
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Need for
emergency
contraceptives
Paternalistic
bias
Failure of
contraception
Social factors- religion, politics,
caste, belief and culture
*Gender preference
Private
public
partnership

46. Evaluation of family planning
Evaluation
of
impact
Need
Plans
perfor
mance
effects
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47. Reference
 Park’s Textbook of Preventive and Social Medicine, 26th Ed.
 Reference manual for oral contraceptive pills, Family planning division, MoHFW.pdf
 J. Kishore’s NATIONAL HEALTH PROGRAMS OF INDIA 13TH Edition.
 NFHS :http://rchiips.org/nfhs/
 HMIS: https://hmis.nhp.gov.in/
 Annual report 2020- 2021 -Department of Health & Family Welfare Ministry of Health & Family
Welfare Government of India Nirman Bhawan, New Delhi – 110011.
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48. Thank you
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