The document reviews India's family planning program, highlighting varied total fertility rates (TFR) across different states, with some achieving replacement levels while others lag significantly. It discusses the unmet need for family planning and the incidence of births occurring less than two years apart, emphasizing the importance of improving contraceptive use and delaying marriage to enhance maternal and infant health. Additionally, it outlines strategies and district-level action plans to bolster family planning initiatives and reduce higher-order births, aiming for overall population stabilization.

1. Review of Family Planning
Programme
Dr. Kiran Ambwani, DC (Family Planning)
10/10/24 1
NRHM Review Meeting, Bhopal

2. TFR in Different States(SRS 2008)
TFR 3.1 & above
1 Uttar Pradesh 3.9
3 Bihar 3.9
2 Meghalaya 3.8
4 Nagaland 3.74 (2005-06)
5 D&N Haveli 3.5 (1999)
6 Rajasthan 3.4
7 MP 3.4
8 Jharkhand 3.2
9 Chhattisgarh 3.1
TFR- 2.6 – 3.0
1 Arunachal 3.03 (2005-06)
2 Lakshadweep 2.8 (1999)
3 Manipur 2.8 (2005-06)
4 Assam 2.7
5 Gujarat 2.6
6 Haryana 2.6
7 Uttarkhand 2.6
TFR – 2.2 – 2.5
1 Daman & Diu 2.5 (1995)
2 Orissa 2.4
3 J&K 2.3
4 Tripura 2.22 (2005-06)
TFR – 2.1 & below
1 Chandigarh 2.1 (2000)
2 Karnataka 2.1
3 Sikkim 2.02 (2005-06)
4 Maharashtra 2
5 Punjab 2
6 Delhi 2
7 Andhra Pradesh 1.9
8 H.P. 1.9
9 West Bengal 1.9
10 A& N 1.9 (1999)
11 Goa 1.8 (2005-06)
12 Puducherry 1.8 (1999)
13 Tamil Nadu 1.6
14 Kerala 1.7
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3. Sl.No. States
TFR (SRS)
Average
Reduction
in TFR
(04-08)
2004 2005 2006 2007 2008
ALL INDIA 2.9 2.9 2.8 2.7 2.6 -0.075
1 Bihar 4.3 4.3 4.2 3.9 3.9 -0.10
2 Uttar Pradesh 4.4 4.2 4.2 3.9 3.8 -0.15
3 Rajasthan 3.7 3.7 3.5 3.4 3.3 -0.10
4 Madhya Pradesh 3.7 3.6 3.5 3.4 3.3 -0.10
5 Jharkhand 3.5 3.5 3.4 3.2 3.2 -0.08
6 Chhatisgarh 3.3 3.4 3.3 3.1 3.0 -0.08
7 Orissa 2.7 2.6 2.5 2.4 2.4 -0.08
AVERAGE PER ANNUM REDUCTION IN TFR IN LAST 4 YEARS -0.10
TFR - Declining Trend

4. While some states have achieved replacement
level fertility, others will take many more years
Source: Registrar General of India, 2006 (Population Projections for India and States 2001 – 2026
11th
FYP Goal
Total Fertility Rate
2.1 by year 2012
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NRHM Review Meeting, Bhopal

5. Source:DLHS-3 (2007-08)
Spacing
methods
8%
Limiting
method
13.5%
Total Unmet Need
Totalunmetneed
21.5%
Unmet Need
Current use of Family Planning
Methods
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NRHM Review Meeting, Bhopal

6. Trends in Modern Contraceptive
Prevalence-Overall
6
65.3
61.1 60.9
60.9
57.6 57.5 53.9
53.0 52.9
47.0
37.7 35.7
30.8 28.2 28.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
DLHS-III DLHS-II
10/10/24 NRHM Review Meeting, Bhopal

7. Unmet Need for Family Planning-Total
7
8.5
11.6
15.8
15.9 16.8
17.9
19.3
19.419.8
20.9
24.0
27.0
33.8 34.737.2
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
DLHS-III DLHS-II
Meeting unmet need of FP will avert nearly35,000 Maternal and
12 lakhs infant deaths.
10/10/24 NRHM Review Meeting, Bhopal

8. Source: DLHS – 3, 2007-08
In most states,
In most states,
approximately
approximately
1/3 of all births
1/3 of all births
are occurring
are occurring
less than two
less than two
years
years apart
apart
Spacing between Children
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NRHM Review Meeting, Bhopal

9. Source: DLHS-3 (2007-08), IIPS Mumbai
Delaying Age at Marriage reduces population momentum
Early Age at marriage – A Challenge in HF States
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NRHM Review Meeting, Bhopal

10. Source: DLHS-III
Percentage of teenage girls in India who are pregnant or already mothers
Teenage Pregnancies pose a higher risk of maternal and infant
mortality and morbidity.
Age at First Child birth
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NRHM Review Meeting, Bhopal

11. Gap between ELA & Performance in Sterilization
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NRHM Review Meeting, Bhopal

12. Name of the
State/UT
Estimated Couples
exposed to Higher Birth
Order of 3 & 3+ (in
000's)
Sterilisation per 10,000
unsterilised couples
exposed to higher order of
birth 3 & 3+
(March 2009- April 2010)
Bihar 6,632 469
Uttar Pradesh 14,822 319
Madhya Pradesh 3,165 1,296
Rajasthan 3,636 946
Jharkhand 2,054 551
Chhattisgarh 1,083 1,587
Orissa 1,600 728
Uttarakhand 416 586
Tamil Nadu 1,096 3,187
Andhra Pradesh 1,111 10,292
• Averting 50% of higher order births will bring down Birth Rate by
about 4 points.
• This will also help in reducing MMR and IMR.
Higher Order Births(3&3+) – 40% of total births in India
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13. Strategies
1. District level action plans to achieve ELA
(appoint nodal officer for FP for planning implementing,
monitoring, supervision and evaluating)
2. Fixed Day Static Services till PHC Level: (PRIORITIZE as per
DELIVERY LOAD)
 One Minilap/One NSV Provider at each PHC
 One trained IUCD provider at each Sub centre

3. Postpartum Centers at all facilities, where deliveries are
conducted (Counselor / Trained Minilap Service Provider)
4. Promote minilap over lap. sterilsiation as the preferred
mode
5. Encouraging Male Participation by concerted IEC for NSV
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14. Strategies Contd…
5. Accreditation of Private Providers: (to increase the
pool of service providers)
6. Promoting IUCD 380 A: as a safe, effective and long
term spacing method
7. Rational Training and Placement plan for Service
Providers
8. Demand generation
(IEC/BCC) activities: communication Strategy focusing
on specific issues like delaying age at marriage, age at
first child, spacing, male participation
9. Monthly Review of FP performance with CMOs
10. Rank and Reward districts
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15. World Population Day (11th
July) – 2010
• Slogan
• Population Stabilisation Week (11th
to 17th
July)
• Family Health Mela : 2 days’
– In each district/ each parliamentary constituency
– Inauguration by/Presence of local MPs/MLAs/other
elected representatives
– Stalls for Exhibition of FP methods, counseling etc.
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Chhota Parivar : Samagra Vikas
(small family: overall development)

16. State level activities
• Detailed instructions to District
Magistrates
• Allocate fund at approved rate to
districts/ blocks (from IEC head of RCH
flexipool)
• Broad implementation plan for state/
district level
• Instruction to district CMOs
• Orientation of district CMOs, DMOs, DPMs
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17. District level activities
• Mobilisation of eligible couples to participate in
the mela
• Identification of district/ block level centres for
services by name
• Deputation of service providers’ team by name
to designated centres for the whole week
• Communication of district/ block ELAs
• Enlisting of clients by ASHAs and ANMs
• District media plan (suited to local situation)
• Beat of mobile vans to reach every village
• Utilising the local NGOs, where available
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18. Thank you
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