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Popfocus 2010 January March English PFI |
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Volume XXIII; No.1 January–March 2010
THE POPULATION FOUNDATION OF INDIA NEWSLETTER
Regional Conference on Population, Health and Social Development
in the Eastern States: Bihar, Jharkhand, Orissa and West Bengal
Population Foundation of India,
always in the forefront of non-
government efforts to focus its activities
on Reproductive and Child Health,
Population, Health and Social
Development issues and to establish a
balance between resources, environ-
ment and population, has entered its
40th year of existence in 2010.
A series of events have been planned
to commemorate the 40th year, which
will reinforce PFI’s commitment and
vision to ‘promote, foster and
inspire sustainable and balanced
human development with a focus
on population stabilization through
an enabling environment for an
ascending quality of life with equity
and justice’. As part of the 40th
year celebrations, three regional
conferences (Eastern, Western and
Northern), followed by a national
conference in November 2010 at
New Delhi have been planned with
Mr. Prasanna Acharya, Hon’ble Minister for Health and Family Welfare, Government
of Orissa releasing the publication of PFI. Others are (from left): Mr. A. R. Nanda,
Executive Director, PFI; Mr. Hari Shankar Singhania, Chairperson, PFI Governing
Board; and Mr. B. G. Deshmukh, Vice-Chairman, PFI Governing Board
the aim of bringing out region specific
priorities and recommendations
related to population, health and
social development.
Regional Conference in progress
Inside
The 11th JRD Tata Memorial Oration:
‘Demographic Dividend or Debt’
... 4
KIRAN: A New Beginning
... 5
Youth Join in the 40th Year
Celebrations of PFI
... 6
Between Societal Aspiration and
Individual Choice: Contraceptive
Use in India
... 7
International Women’s Day Celebrated ... 9
Mainstreaming HIV/AIDS:
District Level Advocacy
... 9
History is created in Pindwara Tehsil
of District Sirohi, Rajasthan
... 10
Family Planning and Fertility
Regulation: Emerging Patterns and
Issues in India
... 11
PFI at the National Conference
Focusing on South India
... 12
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From the Executive Director’s desk...
The Population Foundation of India has recently
entered its 40th year. A series of events have been
planned to commemorate the 40th year, the first of which
is the recently concluded Regional Conference on
‘Population, Health and Social Development in the
Eastern States – Bihar, Jharkhand, Orissa and West
Bengal’ at Bhubaneshwar in February 2010. Two more
regional conferences (western and northern), followed
by a national conference in November 2010 have been
planned with the aim of bringing out national and region
specific priorities and recommendations related to
population, health and social development. A series of
other important meetings have also been taking place
in the recent past, including round tables on ICPD+15,
Community Action Group, Young people’s issues with
other civil society institutions. The common thread
emerging from all these voices is the increasing need to
focus on ‘Quality of Care’, not just in terms of provision,
but also acceptance. ‘Quality of care can be defined
by the way the clients are treated by the system, or
the actual process of care giving, and by the focus on
the client’s or user’s perspectives of the services’ (Hull,
1994). There is a deep connection between QoC and
contraception services and it is time that QoC indicators
must be included and monitored by the Government
especially for terminal methods. Going by our experience
of what has happened even with the states achieving
replacement level of fertility (e.g. Population Council’s
Tamil Nadu study and PFI’s Andhra Pradesh study), one
has to be careful. These can be taken care of through
QoC indicators, and monitoring them closely, which
have been discussed in detail in a later article. QoC has
many aspects and continuous improvement is required
in all quarters, including orientation of doctors and service
providers and monitoring by the community through
exit and follow-up surveys, as that brings credibility to
the efforts. PFI strongly believes that with reference to
contraception, ends do not justify the means. Numerous
studies across India have shown the suffering people
have gone through, due to lack of access to quality of
services and choice in family planning. The right way to
design and plan programmes on health and family
planning is to assess community’s needs for every village.
Quality of Care is the key to the success of contraception
programmes and attaining reproductive health for all,
while protecting reproductive rights. ‘Reproductive
Rights’ embrace certain human rights that are already
recognized in national laws and policies, international
human rights documents and other relevant UN
consensus documents. These rest on the recognition of
the basic right of all couples and individuals to decide
freely and responsibly the number, spacing and timing
of their children and to have the information and means
to do so, and the right to attain the highest standard of
sexual and reproductive health.
A. R. Nanda
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The first Regional Conference on ‘Population, Health
and Social Development in the Eastern States –
Bihar, Jharkhand, Orissa and West Bengal’ was
organized at Bhubaneshwar on February 16–17,
2010. Mr. Prasanna Acharya, Hon’ble Minister for
Health & Family Welfare, Govt. of Orissa,
inaugurated the conference as the Chief Guest.
In the conference, PFI brought together on one platform,
administrators, social scientists and scholars, national/
international institutions and NGOs concerned with these
issues from the Eastern Region for discussion on the
achievements, gaps and recommendations for the future.
Senior Government officials who participated in the
conference included Ms. Anu Garg, Commissioner cum
Secretary, Health and Family Welfare, Government of
Orissa; Mr. Ravi Parmar, Secretary, Health and Family
Welfare, Government of Bihar; Mr. K K Pathak, Principal
Secretary, Human Resource Development, Government
of Bihar; Ms. Bharti Ghosh, Joint Secretary, Panchayati
Raj and Rural Development, Government of West Bengal;
Dr. J.M. Chaki, Dy. Director, Department of Health
and Family Welfare, Government of West Bengal; and
Dr. Manju Kumari, Director, Department of Health and
Family Welfare, Government of Jharkhand.
The inaugural session was presided by Mr. Hari Shankar
Singhania, Chairperson, Governing Board, PFI.
Mr. B.G Deshmukh, Vice-Chairman of the Governing Board
of PFI, and other distinguished Governing Board Members
of PFI including Mr. B.G. Verghese, Mr. J.C. Pant,
Ms. Nina Puri, Mr. K.L. Chugh and Dr. Abid Hussain graced
the conference with their participation.
The objectives of the conference were to:
• Get a clear perspective of the demographic and health
transition process in Bihar, Jharkhand, Orissa and West
Bengal
• Draw attention to the reproductive health issues among
young people (10–24 years) and effective strategies to
address them
• Recapitulate initiatives by the State Governments on
population and health issues
• Draw out recommendations with policy implications at
the state, regional and national levels
Mr. A. R Nanda, Executive Director, PFI welcomed
the participants and mentioned that the prime objective
of this conference was to bring out region specific priorities,
issues and recommend strategies that would help in
improving the status of population, health and social
development in the region.
Mr. Hari Shankar Singhania, Chairperson,
Governing Board, PFI extended a warm welcome to
the audience. He described the efforts of PFI to work with
a focus on community needs, community participation and
ownership and building their capacities to take charge of
their own health.
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The inaugural address was given
by Mr. Prasanna Acharya,
Hon’ble Minister for Health and
Family Welfare, Govt. of Orissa.
Mr. Acharya congratulated PFI for 40
years of meaningful contribution
towards population stabilization in the
country. He also said that stabilization
of population leads to improved
quality of life. While there has been
some progress in the area of
population stabilization and key
health indicators in these states, a lot
more remains to be done to achieve
the universal goal of ‘Health for All’.
Speaking about health indicators, he
reflected that one of the major
contributors is early marriage (below
the age of 18 years), which affects
the health of a woman and impact
indicators such as MMR, IMR and
fertility. Orissa has a high level of both
maternal and infant mortality.
Ensuring that girls stay in school for
a longer duration, preventing early
marriages and informing the younger
generation on these issues are some
of the strategies that can be adopted.
The Minister also released four new
publications, including a Wall Chart
on ‘Population, Health and Social
Development in Bihar, Jharkhand,
Orissa and West Bengal’, the District
Profile for the States of Bihar,
Jharkhand, Orissa and West Bengal’,
Advocacy Papers on Population
Issues and a Module on RCH for
Corporate Sector.
Dr. Arundhati Mishra, Additional
Director, PFI made a presentation
on PFI’s journey across four
decades from 1970 to 2010. The
presentation traced the history of PFI
since its inception and highlighted
various landmarks and achievements
along the way.
Dr. Almas Ali, Senior Advisor,
PFI delivered the keynote address
‘Demographic and Health Transition
in the States of Bihar, Jharkhand,
Orissa and West Bengal’.
During the two day deliberations, the
different States’ health indicators and
its strategies to improve the same
were discussed in various sessions.
The first session focussing on
Demographic and Health Transition
in Bihar was chaired by Mr. B.G.
Young Artists performing classical dance
Verghese, Member, Governing
Board, PFI and included
presentations on Strategies to Meet
the Challenges of Demographic and
Health Transition in Bihar by
Mr. Lester Coutinho, Senior
Programme Advisor, Packard
Foundation, New Delhi; Policies and
Programme Initiatives of Bihar
Government on Population/RCH” by
Mr. Ravi Parmar, Secretary, Health,
Department of Health & Family
Welfare, Government of Bihar;
The Youth Perspective: Policy
Initiatives in Bihar by Ms. Sona
Sharma, Joint Director Advocacy and
Communication, PFI, New Delhi &
Mr. Matish Kumar, Coordinator, PFI,
Bihar; The Youth Perspective:
Initiatives by Civil Society by
Mr. Bishwajit Mukherjee, Team
Leader, Pathfinder International
Patna; and Promoting Access to Care
and Support for PLHAs in Bihar by
Dr. Mary Verghese, Project Director,
Global Fund Project, PFI, New Delhi
& Mr. Rajiv Singh, Assistant
Programme Coordinator, Global
Fund Project, PFI (U.P.)
The second session focussing on the
State of Jharkhand, was chaired by
Mr. K. L. Chugh, Member,
Governing Board, PFI, included
presentations on Strategies to meet
the Challenges of Demographic and
Health Transition in Jharkhand
by Mr. Subrato Mandal, PFI;
Presentation on Public Private
Partnership by Dr. H. Sudarshan,
Karuna Trust, Karnataka; Policies and
Programme Initiatives in Jharkhand
on Population/RCH by Dr. Manju
Sharma, Director, Department of
Health, Government of Jharkhand;
The Youth Perspective: Initiatives by
Civil Society by Mr. Ajay Kumar, CINI,
Jharkhand; and Corporate Initiatives
in Jharkhand by Col. S. Rath, Usha
Martin (KGVK).
The third session focussing on the
State of Orissa chaired by Dr. Abid
Hussain, Member, Governing
Board, PFI included presentations on
Strategies to Meet the Challenges of
Demographic and Health Transition
in Orissa by Prof. Bhagban Prakash;
Policies and Programme Initiatives in
Orissa on Population/RCH by
Ms. Anu Garg, Commissioner cum
Secretary, Health and Family Welfare,
Government of Orissa; The Youth
Perspective by Dr. Prafulla
Kumar Sahoo, Chairman, CYSD,
Bhubaneswar; and Promoting Access
to Care and Support for PLHAs in
Orissa by Mr. Deepak Ranjan Mishra,
PFI.
The fourth session focussing on the
State of West Bengal chaired
by Dr. Nina Puri, Member,
Governing Board, PFI included
presentations on Policies and
Programme Initiatives in West Bengal
on Population/RCH by Dr. J.M.
Chaki, Dy. Director, Dept. of Family
Welfare, Govt. of West Bengal; PRI
initiatives in Health (CHCMI) by
Ms. Bharati Ghosh, Joint Secretary,
Panchayat and Rural Development,
Govt. of West Bengal; Taking
Contd. on page 11
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The 11th JRD Tata Memorial Oration: ‘Demographic Dividend or Debt’
T he 11th JRD Tata Memorial
Oration ‘Demographic Dividend
or Debt’ was delivered by Dr. Nitin
Desai, Member, National Security
Advisory Board & The Prime
Minister’s Council on Climate Change,
Former Under Secretary of the United
Nations, on March 26, 2010 at
New Delhi. The Oration is part of a
lecture series that was started while
Mr. JRD Tata was the Chairperson,
as part of PFI’s advocacy programme.
A lecture series under the title
“Encounter with Population Crisis”
was instituted in 1990, inviting
important international and national
celebrities to deliver lectures on critical
issues related to population and to
carry the debate forward.
The welcome address was delivered
by Mr. A. R Nanda, Executive
Director, PFI followed by opening
remarks from Mr. Hari Shankar
Singhania, Chairperson, Governing
Board, PFI. He mentioned that this
Memorial Oration is an important
event in the PFI Calendar for three
reasons. The Oration provides an
opportunity for PFI to pay its tributes
to JRD Tata one of the co-founders
of the Foundation. The second and
equally important reason is that the
Oration is given by distinguished
speakers. The third reason is that that
this year the Population Foundation
of India has turned 40. This Oration
marks forty years of relentless efforts
to achieve our Founder Board
Chairperson Mr. JRD Tata’s vision of
population stabilization for growth
and development in the country.
While delivering the Oration,
Dr. Desai commented on the
A glimpse of the audience
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Dr Nitin Desai (2nd from left) addressing the gathering at the Oration
challenge of reform being acute in the
five Norther n States: Bihar,
Jharkhand, Rajasthan, Uttar Pradesh
and Madhya Pradesh, where the bulk
of this demographic dividend will be
realized over the next decades. If
these States continue to lag behind
the rest of the country then the
demographic dividend may well
become a demographic trap with a
large disaffected population of
unemployed youth turning to different
varieties of extremism and violence.
Hence, a summary prescription for
realizing the demographic dividend is
radical root and branch reform of the
public sector and rapid growth in the
Northern States as a central aim of
development policy.
The major challenge for realizing this
demographic dividend is to unleash
dynamism in the public sector,
providers of infrastructure and
services. We need the 1991 private
sector type of reform
for the management
and running of the
public sector in order
to realize the
demographic dividend
which requires an
order of magnitude
change in education
and
vocational
training. It also poses
huge challenges for
urban development.
Both of these are the
areas where the process of reform has
barely begun. The reform of public
sector management has to take place
in a political environment where
coalition compulsions have come to
dominate public policy. The politics
of patronage has acquired greater
importance and this has become a
barrier to the reforms that we need.
He concluded by saying that the
demographic dividend is a supply side
potential in that working people can
be an asset for growth and
development. But to realize this
potential, the economy must grow in
a manner that generates productive
work opportunities at the scale
required to absorb the growth in the
work force and the education and
vocational training system must
provide them with the skills required
to use these opportunities.
The vote of thanks was delivered by
Mr. B.G Deshmukh, Vice Chairman,
Governing Board, PFI.
The Oration was attended by
representatives of the Ministry of
Health & Family Welfare, NACO,
National Human Rights Commission,
and other Government Departments,
Non-Government Organizations,
International agencies including
UNFPA, USAID, World Bank, WHO,
MacArthur Foundation, Packard
Foundation, media representatives
and Corporate partners.
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KIRAN: A New Beginning
The inaugural ceremony of the
“KIRAN Project” was held on
February 25, 2010 in Yasin,
Meo Degree College, Nuh Block
of District Mewat, Haryana. The
programme started with lightning
of the lamp by Chief Guest,
Dr. Syeda Hameed, Member,
Planning Commission, Government
of India. Mr. A. R. Nanda, Executive
Director, PFI; Ms. Meera Satpathy
Chairperson, Sukarya; and Mr. Rao
Abhay Singh, Chairman, Zila
Parishad, Mewat & Gurgaon were
present at the ceremony. Other
stakeholders present during the
programme were: Ms. Aasha Kapoor
Mehta, Professor, IIPA, New Delhi;
Mr. Rashid Khan, Advisory, Finance
& Accounts, Mewat Development
Agency (MDA), Mewat; Ms. Chanchal
Dhalwal, DPO, ICDS, Mewat;
Ms. Mohammadi, MDA; Dr. Ranga,
Dy. Civil Surgeon, Nuh; Dr. Imtiyaz
Ali Khan, Principal, YMD College;
Mrs. Ritambhara Mehta, Consultant,
Planning Commission, GoI;
representatives of government and
non government organizations; PRI
members; and Aanganwadi workers
of the project villages.
The programme started with a
welcome song by the Community
Health Workers (CHWs) of the
KIRAN Project. This was followed by
Dr Syeda Hameed inaugurating the ceremony by lighting the lamp
sharing of the project brief by
Ms. Meera Satpathy. Addressing the
audience, she spoke about the project
and its objectives and shared that the
project focuses on improving
reproductive and child health status
in the predominantly Meo dominant
areas of Taoru and Nuh blocks of
Mewat through effective Behaviour
Change Communication (BCC) and
community processes along with
provisioning of quality reproductive
health services.
Mr. A. R. Nanda, while addressing the
audience, shared that the district
Mewat has marginalized population
in terms of various social
development indicators and shared
that over 50% of girls are getting
married before the age of 18 years,
institutional delivery is only 16%,
infant mortality rate is very high and
women do not receive much attention
during their maternal period. Thus
to improve the status, PFI in
collaboration with Sukarya is initiating
“KIRAN Pariyojna”. This is being
implemented across 29 villages (12
in Tauru block and 17 in Nuh block)
of Mewat district and will cover a
population of approx 70,000.
During his speech Mr Nanda said that
lots of myths and misconceptions
related to reproductive and child
health are prevalent among the
people of Mewat. ‘KIRAN Pariyojana’
aims to overcome many of them.
In view, CHWs have been recruited,
who would advocate for and ensure
health services are reached at the
community level and misconceptions
are eradicated. Dais will also be
trained. The activities of the project
will contribute towards improving the
health behavior of the target
Inaugural ceremony in progress
Contd. on page 8
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Youth Join in the 40th Year Celebrations of PFI
A s part of its 40th year
celebrations, PFI organized
poster, slogan and skit competitions
among adolescents/youth of urban
slums in four districts each of Orissa,
West Bengal, Bihar and Jharkhand
on the issues and concerns around
population and development.
The themes for the competitions
were: (a) role of youth in population
stabilization and development,
(b) reproductive and child health rights
of women and involvement of male
partner, and (c) development Vs
gender equity & women’s health.
The objective of the competitions was
to involve the community in
celebrating the completion of 40
years of PFI. The event provided an
opportunity to the youth to express
themselves on the identified issues by
providing them a platform to display
their creative and artistic skills. These
celebrations also provided an
opportunity to reunite with various
partners: NGOs, CBOs and
government functionaries across the
country, who have been PFI’s
partners and collaborators over the
years.
The Foundation has selected three
NGO partners: Multi Applied
System (MAS) for Orissa, Bihar
Voluntary Health Association
(BVHA) for Bihar, and Child In
Need Institute (CINI) for West
Bengal and Jharkhand to carry out
the activities in the four selected
districts each from the states:
Khurdha, Cuttack, Ganjam and
Keonjhar districts from Orissa; Patna,
Buxar, East Champaran and Nalanda
from Bihar; Hazaribag, Ranchi,
Latehar and Chatra from Jharkhand;
and South 24 Pargana, West
Midinapur, North 24 Pargana and
Kolkata from West Bengal.
In each district, 5-6 locations were
identified in coordination with the
partner agency, where non- school
going adolescents/youth were
mobilized from different wards/
villages, nearby districts and state
capital. Community meetings were
organized particularly with local youth
club members, councilors and
mothers to convince them about the
objectives of the event and allow their
children to participate in the event.
Key stakeholders including local
councilor, youth club secretaries,
other non-governmental organi-
zations and government officials were
invited to participate in the
programme.
It was the responsibility of the partner
NGOs to organize various
competitions: poster, slogan and skit
competitions in the selected four
districts each of Orissa, West Bengal
and Bihar and Jharkhand, which were
A scene from the State level skit
competitions in Patna
organized during January – February,
2010. More than 200 youths/
adolescents attended each event and
actively participated in various
competitions.
A committee was instituted consisting
5 to 6 jury members both at the
district and state levels for the
selection of the awardees at the
district and state levels. The jury
members were mainly from PRI,
education department, health
department and social development
organizations and for the skit
competitions at the state level,
eminent stage artists were involved
in the selection process.
For slogan writing and poster
competitions at the district level, cash
prizes each of Rs. 500/-, Rs. 300/-
and Rs. 200/- were given away to
the winners and at the state level
Rs. 1000/- and Rs. 500/- were
awarded for the best entry and the
2nd best entry respectively. For the skit
competitions at the state level,
Rs. 3,000 and Rs. 2,000 were
awarded to the first two winners.
All cash prizes were accompanied
with a certificate and a memento.
Certificate of Participation was
given to all participants to boost
their morale and to encourage
continuation of the learning process
on various issues of population
stabilization and family planning.
A scene from the district level poster competitions
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Contd. on page 8
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Between Societal Aspiration and Individual Choice:
Contraceptive Use in India
It is now fifteen years since the Cairo
Conference where the principle of
reproductive rights and the right to
informed choice in contraceptive use
received universal endorsement. Ten
years have also passed since India
reinforced its commitment to the
same principles through the National
Population Policy, and it is perhaps
an appropriate moment to review the
changes in family planning related
policy making and their consequences
in India.
There have been many positive
changes in this period. A quick review
of the results of the National Family
Health Survey between its first
round (1992-93) and its third round
(2005 -06) shows that there has been
a 15% increase in contraceptive
usage from 41 to 56%. If one looks
at the increase over existing status of
contraceptive usage in rural India
during the same period the increase
(37% to 53%) actually indicates an
increase of nearly one and half times.
Total fertility rates have declined
substantially and in a large number
of states it is below what is considered
replacement fertility or a TFR of 2.1.
If we take wanted fertility into account
this figure across the country is
actually 1.9, which means that the
average number of children a couple/
married woman wants is less than 2,
but she invariably ends up having
more children because the couple is
often unable to get the contraceptive
of their choice. This indicates a failure
of our family planning programme to
reach all couples, and this is as high
as one in five couples in states like
UP, Bihar and Jharkhand. On the
other hand in states like Himachal
Pradesh and West Bengal the
contraceptive prevalence is over 70%
of all couples.
It may thus be argued that even
without any centrally determined
targets the family programme did not
run around. However, the anxieties
have continued, and there has been
little attention paid to informed choice
Dr. Abhijit Das, Centre for Health and Social Justice, New Delhi
on the cornerstones of the rights
approach advocated by Cairo. Female
sterilisation continues to be the most
used method because it is the method
most easily available or promoted.
In states of northern India like UP and
Bihar where the anxieties are more,
camps continue to be the most
common method of service delivery.
Quality of care is easily compromised
in camps and this has been repeatedly
shown in studies. In addition,
acceptors are rarely informed about
alternatives or even about the side
effects of any method and how to deal
with them. Female sterilisation is not
suited to young women, however, in
Andhra Pradesh, a state well known
to have achieved fertility transition,
without attendant economic changes,
the median age of women undergoing
tubectomy is 23 years. This is not
considered an appropriate age for
tubectomy by any standards.
The overwhelming promotion and
use to tubectomy as the contraceptive
of choice for the relatively young
reproducing population in India needs
serious reconsideration. There is an
agreement among experts that the
age and marital profile of the Indian
population is changing. Thus, there
is need for contraceptives for young
people, who may choose to delay first
pregnancy and space the second.
Tubectomy has nothing to offer these
couples. There is also need to
reconsider the fact that marriage may
not be the exclusive domain of
relationship requiring contraceptives.
Even though there is a high
proportion of child marriage in
different parts of the country, age at
marriage is increasing both among
men and women. It is necessary
to recognise and address the
contraceptive needs of men and
women who are adults and in
consenting relationships. We need to
recognise that our parents and
grandparents had begun sexual
activity at an early age (probably in
their teens), and it is ridiculous to
restrict contraceptive access to our
children at a similar or even higher
age! One of the first steps that needs
to be taken in step with the march of
time is to rename the programme
from family planning to contraceptive
care.
We need to re-examine our anxiety
to find simple solutions to complex
situations. The continued dependence
on tubectomy and the current
emphasis on the long acting copper
T ( Cu 380A), is probably due to the
fact that they appear to provide a one-
time solution. However as has already
been pointed out contraceptive needs
differ not only at different points in
life but also according to the nature
of the relationship, the autonomy of
women and fertility intentions.
We also need to strengthen overall
contraceptive counselling and
inform all users of side-effects
and contraindications. While the
weakness of the service delivery
system has been one of the reasons
for the Supreme Court not allowing
the introduction of long acting
injectables like Depo Provera, the
same weak system plays havoc on
women who are undergoing
sterilisation at well before the
indicated age, without adequate
asepsis and in non-salutory surgical
conditions. Long term studies from
the US indicate that sterilisation is not
as safe as assumed and comparisons
with users of other methods shows
that women undergoing tubectomy
have much higher rates of
hysterectomy. This particular feature
is now being observed in southern
parts of India as well. Thus the focus
needs to shift from protecting women
through reducing their exposure to a
particular method to protecting
women through an overall
strengthening of service delivery
through comprehensive counselling
and quality service delivery.
However, the policy direction seems
to be much in the opposite direction.
As recently as September 2007, the
government increased sterilisation
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related incentives, worried about the
declining trend in sterilisation. Even
later, the Jan Sankhya Sthirta
Kosh, a Government promoted
organisation, has started a
competition among private providers
for sterilisation services in the state
of Bihar and Orissa under the
‘Santhusti’ Scheme. This may well
end up violating the Supreme Court
orders for maintaining quality during
sterilisation operations, in addition to
reintroducing provider incentives. The
lack of policy support to promoting
a basket of contraceptives, in the true
sense of the term, and anticipating
the contraceptive needs of the young
population of the country, has led to
the unbridled promotion of
emergency contraceptives by the
private sector. Another disturbing
policy trend in the international
arena, has been to link population to
climate change in some quarters.
While the Government of India, has
strictly stuck to the logic of per capita
carbon emissions, some influential
sources continue to link the two.
A review of contraception over
the last fifteen years, clearly highlights
the need to a re-articulation
of the problem, identifying
new programmatic priorities,
strengthening service delivery in new
ways and certainly increase the basket
of choices. However in addition to all
these changes, there needs to be a
fundamental shift in the way
contraceptive care is conceptualised,
and that is the way it views men.
In the heat of the campaign to prevent
HIV infections, there was an
aggressive promotion of condoms as
an infection prevention agent. It may
well have succeeded in slowing the
spread of the infection, however it has
removed condom and male
involvement from the domain of
contraception (and trusted sexual
relations) to the domain of risky sex
and infection prevention. We now
need to get men back into
contraceptive care, but they need to
be seen beyond targets of non-scalpel
vasectomy. The design and delivery
of contraceptive care programmes
need to focus on respect, care,
pleasure in addition to prevention of
pregnancy and men’s involvement
needs to be central to all of this.
Contd. from page 5
population. Emphasizing on male
participation, he said that any RCH
project cannot be successful if male
members are not involved. Therefore,
participation of men folk is important
for successful implementation of the
project. Speaking on the importance
of coordination, convergence and
leveraging he emphasized on
networking and liasioning with
government, health, education,
VHSC, PRI and ICDS departments,
NRHM and inter-departmental co-
operation. He also mentioned that to
compare the effectiveness and
efficiency of the project, we are in
the process of conducting a baseline
survey and at the end of the project,
an endline survey will be conducted
to disseminate the lessons learned
and outcome/ impact of the project
to the general public.
Speaking on the importance of the
KIRAN project, Mr Rao Abhay Singh
said that KIRAN project is a step
towards healthy and better society and
more such programs are required in
future. Subsequently, he emphasized
that awareness and education are very
important and he requested the key
stakeholders present during the
ceremony to come together to
achieve the desired goals of the
project.
Addressing the audience, Dr. Syeda
Hameed congratulated Sukarya and
PFI team for designing and launching
of the project. She added that we
need to work a lot for improving the
status of women and children.
Women need to be deeply involved
in such initiatives. She also said that
it is ironical that in spite of Gurgaon
being the adjacent district; illiteracy,
sanitation problems and other health
problems are highly prevalent in
Mewat. Citing one of the objectives
of the project of training of Dais, she
appreciated the initiative as our
indigenous knowledge and resources
could be complemented with
strengthened capacity.
Subsequently, CHWs of the project
shared their experiences and learnings
under KIRAN project so far in the last
two months. They also shared that
since joining, they have got lot of
opportunities to learn and work in new
areas towards improvement in the
health status of their own villages.
They expressed gratitude for the
opportunity and assured that with the
help of KIRAN project, they would
give new identity of their own villages.
At the end of the programme, the
guests and dignitaries visited the stalls
put up by Sukarya and Mewat
Development Agency.
Contd. from page 6
A series of events have been planned
to commemorate the 40th year of PFI,
out of which the first Regional
Conference on ‘Population, Health
and Social Development in the
Eastern States – Bihar, Jharkhand,
Orissa and West Bengal’ was recently
organized at Bhubaneshwar in
February 2010. During the
conference, the award winning
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posters, slogans and skits at the
district/state levels were displayed.
Two more regional conferences
(western and northern), followed by
a national conference in November ,
2010 have been planned with the
aim of bringing out national and
region specific priorities and
recommendations related to
population, health and social
development. The next regional
conference for western region is
planned in Pune in May 2010. Prior
to this, PFI will be organizing poster,
slogan and skit competitions among
adolescents/youth of urban slums in
four districts each of Pune,
Maharashtra, Gujarat and Rajasthan
on similar lines.
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1.9 Page 9 |
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International Women’s Day Celebrated
I nternational Women’s Day is
celebrated globally to mark the
economic, political and social
achievements of women. Population
Foundation of India, state unit
of Tamil Nadu observed the
International Women’s Day on 19th
March, 2010. The theme of the
Day was “Equal rights, Equal
opportunities: Progress for all”.
PFI collaborated with the ART and
Treatment Counseling Center (TCC)
of Madras Medical College (MMC) to
organize the event. Around 64
women and 7 men living with HIV
participated. The ART centre of
Madras Medical College has been
functioning since 2005.
The event highlighted the presence
of Women Living with HIV, who have
adhered to ART and have contributed
in tracing defaulters. Dr. Kalpana,
Medical Officer, ART Centre, Madras
Medical College applauded the
women’s contribution towards ART
adherence. She shared that around
1800 women living with HIV have
registered at the centre. Their
adherence levels have increased
significantly in the last one year.
Ms Noorie, President, South India
Positive Network (SIP+) highlighted
the importance of counseling about
HIV treatment. She also stated her
own example of living with HIV for
the last 22 years. Ms. Indhumathi,
Advocate, Legal Aid Clinic, Tamil
Nadu State AIDS Control Society
(TANSACS) gave examples of many
Indian women like Rani Laxmi Bai,
Ms. Indira Gandhi, Ms. Pratibha Patel
and Ms. Kalpana Chawla, who have
created history. She requested all
Women Living with HIV to come
forward and fight for their rights. She
explained the activities of the Legal
AIDS Clinic in Tamil Nadu.
Dr. Sekar, Sr. Medical Officer, ART
Centre awarded women living with
HIV, who have maintained adherence
and regular health check-ups.
Three positive networks namely,
A view of hand print campaign
Network for Chennai people living
with HIV/AIDS (NCP+), Positive
Friend’s Welfare Association
(PFWA+), Thiruvallur and Positive
Women Network (PWN+) were
awarded for effective outreach
activities. Women participated
wholeheartedly in the event. The day
ended with a hand print campaign.
This hand printed banner would
be displayed at the ART centre
of Madras Medical College.
A kit, containing an umbrella, lunch
box and biscuit packets, was given to
all participants.
Mainstreaming HIV/AIDS: District Level Advocacy
The Regional Coordination Unit,
Madhya Pradesh of Population
Foundation of India organized an
advocacy meeting on Mainstreaming
HIV/AIDS on March 18, 2010 in
Raipur district of Chhattisgarh. The
meeting was conducted in coordi-
nation with the State Mainstreaming
Unit of Chhattisgarh State AIDS
Control Society (CGSACS). The
Government officials from the
Departments of Women and Child
Advocacy meet on mainstreaming
HIV/AIDS in progress
Development, Health and Family
Welfare, Panchayati Raj Institutions
participated in the event.
Representatives from the civil society
organizations, partner organization:
Hindustan Latex Family Planning
Promotion Trust (HLFPPT) and local
NGOs also took part in the event.
Mr. Ajay Kumar Pandey, Project
Director, CGSACS and Special
Secretary (Health) chaired the
meeting. Mr Pandey said, “We expect
support from all the departments to
reach out to PLHIV of the district as
the current sentinel survey data shows
high prevalence in the district.”
Mr. Sarwat Hussain Naqvi, Programme
Officer of UNDP facilitated a session
on basics of HIV. Mr. Raza Ahmed,
Regional Coordinator of PFI sensitized
the participants about the need for inter-
sectoral coordination to minimize
stigma and discrimination related to
HIV and to reach the general
community. The government officials
from the Departments of Women and
Child Development, Health and Family
Welfare and Panchayati Raj Institutions
highly appreciated the advocacy
meeting. It was felt that the ICTC needs
to be established in all the Community
Health Centers. The officials from the
Department of Women and Child
Development committed to take up the
issue of HIV in Mitanin and Anganwadi
Workers’ meetings. Mitanins are
volunteers, who spread awareness
about community healthcare needs.
They also decided to include HIV in
the trainings of “Kishori Balika”
programme. The Department also
promised to counsel newlywed couples
under the Chief Minister Kanya
Dan Yojna for testing of HIV.
Representatives from the Panchayati
Raj Institutions decided to discuss the
issue of HIV in Gram Sabha and
Janpad (Block) Meetings.
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1.10 Page 10 |
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History is created in Pindwara Tehsil of District Sirohi, Rajasthan
The state of Rajasthan is one of
the most backward states known
for its poor health, social and
development indicators. Of the 32
districts in the state, district Sirohi,
located in the South-Western part of
the state, is one with the worst
indicators. It has been ranked 23rd on
the Human Development Index (HDI)
and 26th on Gender Related
Development Index in the State.
JK Laxmi Cements Ltd is located in
Pindwara tehsil of District Sirohi,
which is again one of the most
backward areas of the district. Here
the basic infrastructure required to
meet the primary needs of the people:
education, health, work opportunities
and transport facilities are either non-
existing or woefully inadequate. The
area is dominated by traditional ‘Bhil’
community, known for their skills at
archery and hunting. The community
also harbours unscientific beliefs,
several myths and misconceptions
about health and health seeking
behavior.
PFI, in partnership with the JK Laxmi
Cements Ltd launched ‘the Integrated
Health and Family Welfare Project:
Naya Savera’ about five and half years
back to bring about sustainable
improvement in their health status by
raising awareness on health and
population issues, dispelling myths
and misconceptions and bringing
about positive health seeking
behaviour.
Promoting small family norm and
motivating eligible couples to accept
modern methods of contraception
was a big challenge. The hilly terrain
and dispersed population made health
service delivery all the more difficult
and challenging. In the words of
Mr. Dinesh Pandya, Project Director,
“In the beginning, it was very difficult
to even talk to them. The poor tribals
would run into deep hill forests at our
first glimpse as they considered
people from the plains, aliens.”
Mr. Pandya recalls that initially
10
whenever the
Naya Savera
team broached
the topic of
contraception,
the community
would leave the
meeting in
anger.
However, the
Naya Savera
team continued
to pursue their
goal with deter-
mination and
perseverance.
They delivered Ms. Bheri Devi, a Bhil Woman with her baby
quality health services with a humane
touch at their door step through a
mobile health team; they were given
Over the years, the Naya Savera team
has been able to remove some of the
myths and misconceptions regarding
free medicines and diagnostic contraception. However, the
facilities. The women were given community continued to be averse to
antenatal care, support in delivery and sterilization due to unfounded fears,
post natal check-ups. Children were like stitches coming off if women
immunized against preventable
diseases. The friendly attitude of the
health team soon won them over and
they gradually started listening to
them on family planning and the need
for small family for development and
engage in heavy work, like picking
up heavy piles of cut wood, or death
of the woman resulting in heavy
economic burden on them as they
may have to pay a very heavy bride
price to their in-laws.
improvement in standards of living.
However, the resistance to modern
methods of family planning still
persisted. The team carried out
Ms. Bheri Devi, a 27 year old Bhil
woman with four children from Buta
phali of Valoria village, is associated
with the Naya Savera team as village
several rounds of intensive Behavior health worker for the last three years.
Change Communication (BCC) She was well aware of all methods of
activities. Emphasis was laid on one family planning and was on oral
to one counseling.
contraceptive pills (Mala D) for the last
one and a half years. However, both
Valoria, one of the project villages, Bheri Devi and her husband
having a population of about 6000, harboured a lurking fear of
spread over more than 12 phalis sterilization. The Naya Svera team
(settlements) is inhabited almost
entirely by Bhils and was a constant
challenge for the team. The literacy
constantly encouraged her and her
husband to accept a permanent
method of family planning.
levels here are abysmally low, and the
Bhil community is steeped into
superstitions and myths regarding
health and health seeking behaviour.
The prevailing system of bride price
The team saw a moment of glory and
achievement when Bheri Devi agreed
to undergo sterilization. History was
created when she became the first
woman from the village to have
also came in the way of adoption of undergone sterilization at the Primary
female sterilization.
Health Center, Rohida.
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2 Pages 11-20 |
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2.1 Page 11 |
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Family Planning and Fertility Regulation:
Emerging Patterns and Issues in India
According to the National Family
Health Survey (NFHS-III), 2005-
06, about 56.3 percent of currently
married women aged 15-49 are using
contraceptives in India. The
contraceptive prevalence rate varies
substantially across the states and
regions. Himachal Pradesh has the
highest percent of family planning
users (72.6 percent) followed by West
Bengal (71.2 percent). Among the
major states, Bihar has the lowest
contraceptive use (34.1 percent) in
India. The choice of contraceptive
methods shows wide variation across
the regions and states. In the
southern states: Andhra Pradesh,
Karnataka and Tamil Nadu, 90
percent or more of contraceptive
users have adopted female
sterilization. Condom use is higher
in the Northern states like Delhi,
Punjab and Uttaranchal. In Assam,
West Bengal and Tripura, the use of
traditional family planning methods
is quite high (21-30 percent).
Though, the use of family planning
method in India shows an increasing
trend, the fertility indicators show
only marginal reduction over a period
of time. In India, the Crude Birth Rate
(CBR) has declined from 28.7 to 24.8
between NFHS-1 and NFHS-2 which
is a decline of 14 percent points.
However, between NFHS-2 and
NFHS-3, the CBR shows only a
marginal reduction from 24.8 to
23.1, which is about 7 percent points.
The Total Fertility Rate (TFR) also
shows a similar pattern of decline.
The TFR has declined substantially
from 3.39 (NFHS-1) to 2.85 (NFHS-
2) whereas, the TFR has declined only
marginally from NFHS-2 to NFHS 3
(2.85 to 2.68).
The paper aims to discuss the trend
of family planning use and pattern of
contraceptive choices in India.
Also, the dynamics of the family
planning use in relation to fertility
regulation has been discussed. The
paper uses National Family Health
Survey (NFHS-1), 1992-93; NFHS-
2, 1997-98; and NFHS-3, 2005-06
data.
The NFHS data shows that in most
of the states the contraceptive
prevalence rate has increased over a
period of time. The fertility impact of
contraception depends not only on
its prevalence but also on the stage
of family building when it is used.
Couples are adopting contraception
to limit family size when they already
had the number of children they want.
Hence, the fertility level shows either
very low declining or almost stagnant
in most of the states. For example, in
West Bengal the use of family planning
methods shows an increasing trend
over a period of time (NFHS-1: 58
percent, NFHS-2: 67 percent, NFHS-
3:71 percent). Fertility level has
decreased 2.9 to 2.3 between NFHS-
1 and NFHS-2 in the state but
remained virtually unchanged in the
seven years between NFHS-2 and
NFHS-3 (2.3, 2.3). Programmers and
policymakers may need to advocate
the use of contraception at no or low
parity births. By popularizing the
concept of spacing of births and
contraception use at lower parities, the
health of the mother and children will
be enhanced and also lead to fertility
reduction.
An abstract of the paper presented at the
National Seminar on Population, Development
and Environment: Issues and Challenges,
February 18-20, 2010, Banaras Hindu
University (BHU), Varanasi by Ms. Shrabanti
Sen, Programme Manager, PFI and
Dr. Lalitendu Jagatdeb, Joint Director (M&E),
PFI. Ms. Shrabanti Sen represented PFI in the
conference and co-chaired a technical session
on “Demographic Scenario and Challenges”.
Contd. from page 3
Technology to Primary Health Care
by Prof. Sujoy K. Guha, IIT,
Kharagpur; The Youth Perspective by
Mr. Ranjan Panda, CINI, West
Bengal; and Promoting Access to
Care and Support for PLHAs in West
Bengal by Ms Pritha Biswas, CBCI,
West Bengal.
Various recommendations emerging
from the conference revolved around
preventing motherhood at immature
young ages by delaying age at
marriage, introducing and promoting
home based newborn care
interventions, focussing on adolescent
sexual and reproductive health;
nutritional needs of adolescent girls
and life skills education, focussing
on improving quality of care,
empowerment of PRIs especially
women leaders, to monitor health and
social development programs,
inclusion of tribal communities;
identify special needs and concerns
of tribal girls in all relevant programs
and looking at population stabilization
in the context of wider socio-
economic development and in a
holistic way, because Family Planning
programs cannot be addressed in
isolation.
The closing session “Conclusions and
The Way Forward” was chaired by
Mr. B.G. Deshmukh, Vice
Chairman, Governing Board,
PFI. The session started with a
presentation by Dr Arundhati Mishra,
Additional Director, PFI on Summary
of two days deliberations and
suggestions. The presentation briefly
touched upon the key points raised
by Mr. Hari Shankar Singhania,
Chairperson, Governing Board, PFI;
the Chief Guest Mr. Prasanna
Acharya, Hon’ble Minister for
Health and Family Welfare, Govt. of
Orissa in his inaugural address and
Dr. Almas Ali, Senior Advisor, PFI in
the keynote address. The important
suggestions from sessions for the four
states were also highlighted in the
presentation.
The key recommendations emerging
from this conference are being culled
out and will be printed as a report
that will be available for wider
dissemination shortly.
A cultural programme comprising a
rich milieu of traditional and classical
dance forms, performed by Guru
Gangadhar Pradhan Foundation, was
also organized for the participants of
the conference in the evening.
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2.2 Page 12 |
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PFI at the National Conference Focusing on South India
The International Institute for Population Sciences (IIPS),
Mumbai organized a National Conference on
Demographic Convergence, Demographic
Dividend, Population Ageing and Implications for
Health and Socio-Economic Transformations:
Special focus on South Indian States, which was
held in Chennai, Tamil Nadu, during March 25-27, 2010.
The conference was attended by senior policymakers and
academicians from the four south India states: Andhra
Pradesh, Karnataka, Kerala and Tamil Nadu, apart from
other nationally renowned demographers.
The conference highlighted the following major themes
with special reference to the four south Indian states:
• Second Demographic Transition, Lowest-low-Fertility
and the Demography of Declining Population
• Age-structural Transition and Demographic Dividend:
Past and Future Trends and Consequences
• Health and Epidemiological Transition and
Determinants, Morbidity, Mortality, Longevity and
Healthy Ageing
• Population Ageing, Health and Wellbeing, and Social
and Economic Consequences
• Long-term Social and Economic Outcomes and Health
and Demographic Inequalities
The discussions including the debates on “south Indian
state specific model of fertility control Vs. “quality of
population” and “missing opportunity of demographic
dividend” were worth mentioning.
Ms. Lopamudra Paul, Research Associate (Monitoring and
Evaluation), PFI along with other scholars contributed two
papers for the conference: (a) Late Marriage and Squeeze
in Reproductive Span: A Study on Contemporary Child
Bearing Pattern in Southern States, and (b) Analyzing
Timing, Pace and Determinants of Fertility in Southern
India. The paper on ‘Analyzing Timing, Pace and
Determinants of Fertility in Southern India was
received the best poster paper award in the
conference. Dr. Subrato Kumar Mondal, Sr. Manager-
Knowledge Management and Research of HUP/PFI
attended the conference.
As part of its 40th year celebrations, PFI partially sponsored
the conference, which was in tandem with PFI’s mandate
of advocacy on population stabilization.
We welcome...
Ms. Monica Sahni, who has joined the
Foundation as Manager (Finance and
Administration) for the project – Health of
Urban Poor (HUP)/USAID in January
2010. She is an Associate member of
Institute of Cost and Works Accounts of
India (AICWAI). Prior to this, she was
working with CARE India, New Delhi as
Assistant Manager – Finance.
Mr. Shahid Ansari, who has joined the
Foundation as Grants Manager for the
project- Health of Urban Poor (HUP)/
USAID in January 2010. Prior to this, he
was working with CARE India, New Delhi
as Budget Officer.
PFI Advisory
Council Meeting
The Advisory Council of Population Foundation of
India headed by Chairperson Prof. M S Swaminathan
contributes towards formulation of the Foundation’s
policies and programmes. The Advisory Council
meets every year to provide guidance and directions
to the activities of PFI. This year, the Advisory Council
met on March 11, 2010 at Hotel Qutub, New Delhi.
The members present at the meeting were:
Prof. M.S. Swaminathan, Mr. T. V. Antony, Ms. Rami
Chhabra, Dr. Usha R Krishna, Dr. K. Srinivasan,
Mr. Ajay S. Mehta, Dr Bobby John, Dr. Saroj
Pachauri, Dr. B.K. Joshi, Proj. G. P. Talwar, Ms.
Leela Visaria and Mr. A. R. Nanda.
Editorial Guidance
Mr A.R. Nanda
Ms Sona Sharma
Editor
Ms Chandni Malik
Editorial Assistance
Ms Jolly Jose
Editorial Committee
Ms Usha Rai
Dr Almas Ali
Dr Lalitendu Jagatdeb
Dr Sharmila G. Neogi
Published by
Population Foundation of India
B-28, Qutab Institutional Area
New Delhi-110016, India
Tel: 91-11-43894100
Fax: 91-11-43894199
e-mail: popfound@sify.com
website: www.popfound.org
Designed & Printed by Communication Consultants Tel: 91-11-24610176, 9811074665
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