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Population Stabilization and Sustainable Development - Advocacy Role of Elected Reprentatives PFI %28English%29 |
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Population Stabilization
and Sustainable Development
Need for Decentralized Planning
and Programme Interventions
Advocacy Role of Elected Representatives
Population Foundation of India
New Delhi
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Population Stabilization
and Sustainable Development
Need for Decentralized Planning
and Programme Interventions
Advocacy Role of Elected Representatives
Population Foundation of India
New Delhi
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© Population Foundation of India, 2010
(2nd Edition)
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List of Abbreviations and Acronyms
AIDS : Acquired Immuno Deficiency Syndrome
ANC : Ante Natal Care
CNA : Community Needs Assessment
CSR : Child Sex Ratio
ICPD : International Conference on Population and Development
IIPS : International Institute for Population Sciences
IMR : Infant Mortality Rate
ISM : Indian System of Medicine
MMR : Maternal Mortality Ratio
MoHFW : Ministry of Health and Family Welfare
NGO : Non Governmental Organization
NPP : National Population Policy
PoA : Programme of Action
RCH : Reproductive and Child Health
RTI : Reproductive Tract Infection
STD : Sexually Transmitted Diseases
STI
: Sexually Transmitted Infection
TFA : Target Free Approach
TFR : Total Fertility Rate
UNFPA : United Nations Population Fund
MCH : Maternal and Child Health
CSSM : Child Survival and Safe Motherhood
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Contents
I. Introduction
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II. The Context
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III. Advocacy Role of Elected Representatives
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IV. Population Growth Pattern:
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Myths of Population Explosion
V. Key Issues Related to Population Stabilization
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Age at Marriage
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Maternal Mortality Ratio
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Infant Mortality Rate
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Child Sex Ratio
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Adolescents
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Male Participation in Reproductive and Child Health
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Family Planning
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Quality of Care
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VI. Relevance of Integrated Approach
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VII. National Population Policy (NPP) 2000—Objectives,
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Goals and Strategic Themes
Empowerment Approach to Population Stabilization
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Population Stabilization and
Sustainable Development
Need for Decentralized Planning and Programme Interventions
Advocacy Role of Elected Representatives
I. Introduction:
Advocacy is the promotion of open dialogue, frank discussions and informed
public debate, and ultimately influencing of public opinion on a particular
issue in a sustained basis through various audiences and channels. To bring
about a change in the existing mind set and ultimately a desirable and
sustainable social change, advocacy is definitely a most appropriate approach
and an important strategic tool, for reaching out to key players who can act as
change agents. Advocacy is needed not just to change policies and laws but to
generate action where favourable policies exist but are not put in to action.
In the Indian context, elected representatives occupy an unique position
and are definitely an important and inescapable channel of communication
between government and people, who can play a meaningful role as “real
change agents”. The elected representatives at all levels have a crucial and
important role to play since they are in touch with people and are aware of their
actual needs, aspirations, attitudes and strengths. Therefore, their familiarity
with the issue of population stabilization and sustainable development in a
correct perspective assumes great importance.
In 1952, India was the first country in the world to launch a national
programme, emphasizing family planning to the extent necessary for reducing
birth rates “to stabilize the population level consistent with the requirement
of national economy.” Since then, the Indian family planning programme
has gone through several changes – at times it has integrated with different
programmes like Minimum Needs Programme(MNP), Maternal and Child
Health (MCH) and Child Survival and Safe Motherhood (CSSM). However,
the goal has been reducing the birth rates and the rate of population growth
by introduction (since mid 1960’s) of method-specific contraceptive targets
to achieve these goals. The International Conference on Population and
Development (ICPD) at Cairo in 1994 was a watershed in the history of
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thinking on population issues. It brought about a significant shift in frameworks
and strategies and approaches relating to population and public policy issues.
It involved a paradigm shift from the earlier emphasis on population control
to human centered sustainable development and recognition of the need for
comprehensive reproductive health care and reproductive rights. It redefined
population policies away from the Malthusian concerns, quick–fixing
approaches and numbers game principles. It repositioned population as an
element of a more harmonious “whole” acknowledging the inter linkages
between poverty, patterns of production and consumption, environment,
social equity, gender equality and sustainable human development. In fact, it
redefined population issues from an over all development perspective.
This change in thinking, concept and understanding naturally implied a
logical change in policies and strategies. Many countries had taken steps to
integrate population concerns with their development strategies. In 2000,
India announced its National Population Policy, which places quality of life
as the means to achieve population stabilization. The National Population
Policy(NPP) 2000 and Reproductive and Child Health (RCH) programme
of India reflect the paradigm shift with emphasis on gender, rights, and
development. In the Indian context NPP 2000 is in fact an affirmation and
an articulation of India’s commitment to the ICPD agenda. The NPP 2000
forms the blue print for population and development programmes in the
country. The NPP 2000 reflects a shift from earlier demographically driven
target oriented coercive policy to one that addresses the special concerns of
Reproductive and Child Health (RCH). NPP 2000 asserts the centrality of
human development, gender equality and equity, and adolescent reproductive
health and rights among other issues to stabilizing India’s population.
II. The Context:
India is a country of striking socio-economic and cultural diversity with
great variations among states, districts and social groups. Population and
development situation is a consequence of this diversity reflecting marked
variations in the demographic situations as well as programme performance.
Various studies have brought out the importance of decentralized planning
and programme intervention more specifically at the district level. With 73rd
and 74th amendment of Constitution district becomes the focus of planning
and programme interventions.
The National Population Policy recognizes decentralized planning and
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programme implementation as the first and most important strategic theme.
It envisages people’s participation in the planning, implementation and
monitoring of the programme. The NPP 2000 has recognized Community
Needs Assessment (CNA) to reflect the community’s perspective – indeed a
“bottom-up” approach.
III. Advocacy Role of Elected Representatives:
In this new approach which focuses on decentralization and people’s
participation, elected representatives at all levels have a crucial role to play.
The following are some of the key roles:
• Political will and public opinion are important pre-conditions for sustained
advocacy on issues related to population and development. Elected
representatives can provide leadership in acknowledging the existence of
the issues.
• Discussing the issues in meetings, formal and informal, including public
meetings, committee meetings, and party meetings. Utilising the feed
back received during such meetings in the process of policy formulation
and programme development.
• Sharing views and perceptions with other representatives to identify
common concerns as well as differences. Mentioning key issues in party
programmes and election manifestoes.
• Discussing these issues with international, national, and regional
organizations in order to convey people’s views and perceptions.
• Ensuring partnership and coordination among government and non-
government organizations in policy formulation and programme
implementation.
• Monitoring the progress of the programmes; while numerical achievements
are important, emphasis should be on qualitative aspects.
IV. Population Growth Pattern:
Myths of Population Explosion
It is a fact that in the last 5 decades India’s population has increased from 36
crores in 1951 to over 102 crores in 2001. As per the population projection
made by the Registrar General, India, currently (2010) the population of the
country is 118 crores. The growth in numbers of India’s population is often
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seen as an “uncontrolled explosion” and has been identified as a significant
hindrance for the country’s progress and development.
It has to be understood that population growth occurs naturally and has taken
place everywhere in all regions of the world and India is no exception. In order
to understand this in a correct perspective the theory of demographic transition
is presented below in terms of three stages of demographic evolution.
• First stage is High Birth Rate and High Death Rates (high balance);
• Second(intermediate) stage is High Birth Rate and Low Death Rate (high
rate of natural increase); and
• Third stage is Low Birth Rate and Low Death Rate (low balance).
India is no exception to this transition. In India around independence death
rates started declining rapidly while birth rates continued to be high. This led
to a rapid growth in population.
Population Growth of India at a Glance, 1901-2001
Years
Total
Population
(in crores)
Absolute
Increase
(in crores)
Decadal
Growth
Rate
Average
Annual
Exponential
Growth
Rate
Phase of De-
mographic
Transition
1901–1951 23—36
13
–
Near
–
stagnant
population
1951–1961 36—44
8
+21.6%
1.96
Rapid high
1961–1971 44—55
11
+24.8%
2.22
growth
1971–1981 55—68
13
1981–1991 68—84
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1991–2001 84—102
18
+24.6%
+23.9%
+21.3%
2.20
Rapid high
2.14
growth with
definite sign
1.93
of fertility
decline
The table shows that although there is absolute increase in population after
1981, the population growth rate (both decadal growth rate and average annual
exponential growth rate) has reduced considerably. In fact, the recent decadal
growth during 1991-2001 registered the sharpest decline since independence.
This means that in India, population growth rate has definitely been declining
steadily over the last two decades. Moreover Total Fertility Rate (TFR) (the
average number of births a woman would have in her life as she passes through
child bearing ages) which was high as 6 or more in 1951 has come down to
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2.6 in 2008. Despite the fact that couples now have fewer children than
earlier, the overall growth in numbers still appears high because of “Population
Momentum”. Past trends in fertility and mortality i.e. from 1951 to 1981 have
shaped the population structure in such a way that there is tremendous in-built
growth potential which has resulted in the ‘bulge’ in the proportion of people in
prime reproductive ages. In short, India has high proportion of women (about
55%) who are in reproductive age group. This tendency of growth is termed
as “Population Momentum” in demographic literature. Even if this group
produces fewer children per couple the quantum increase in numbers will be
high because the numbers of reproductive couples are high.
India with its large proportion of young persons will take some time before the
results of declining fertility start showing explicitly. Put simply, this decline
does not look very rapid and because India is like a fast moving express train
whose brakes have just been applied but since it is very heavy and moving
very fast, it will take some time before it actually stops. The important thing
to note is that the brakes have been applied.
Population growth in India continues to be high on account of following
factors:
• Large size of female population in the reproductive age group (estimated
contribution about 58 percent).
• High levels of unmet need for contraception, attributable to “unwanted
fertility ” i.e. unplanned and unwanted births to women who would like
to stop having more children. (estimated contribution 20 percent)
• High Infant Mortality Rate (IMR) leading to high wanted fertility
(estimated contribution about 20 percent). Repeated child births are seen
as an insurance against multiple infant (and child) death.
• Early age at marriage leading to early pregnancies. Over 50 percent of girls
marry below the age of 18, the minimum legal age of marriage.
A general misconception surrounding population stabilization has to do with
coercive approach. Some people believe that in order to bring down population
growth quickly we have to emulate China’s One Child Policy norm. While
it is true that China has brought down its population growth rate remarkably,
even more remarkable drops in the population growth rate occurred in Kerala
over the same period, that too without any coercion. (China’s TFR of 2.8 in
1979 dropped to 2.0 in 1991, while Kerala’s TFR of 3.0 in 1979 dropped to 1.8
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in1991). Another Indian state, Tamil Nadu had even faster fall, from TFR
3.5 in 1979 to 2.2 in 1991, again within the democratic set ups and without
any coercion.
Much of the population growth rate reduction in China took place between
1970 and 1979 before the introduction of the one child policy. The decline in
China’s population growth rate had its roots in increasing educational access,
improvement in the economy and improvement in the status of the women
which took place after the communist revolution and before the one child
policy was introduced. And so it is not clear how much of China’s fertility
decline can be actually attributed to the one child policy alone.
V. Key Issues related to Population Stabilization:
Age at Marriage:
Marriage is a universal phenomenon in India. Nationally 39% of women
aged 15–19 and 95% of women aged 25–29 are married. The mean age at
marriage for females has increased steadily overtime in India. Between 1961
to 2001 the mean age at marriage rose from 15.9 to 20.9 years for females.
Legislation, advocacy and socio-economic changes are possibly leading to this
positive trend. However in large parts of India, the female age at marriage is
low relative to the legal minimum age of 18 years. There are massive state and
district level variations.
According to the Child Marriage Restraint Act, 1978, the minimum legal
age at marriage in India is 18 years for women and 21 years for men. A large
majority of women are not aware of the legal minimum age at marriage and
child marriages continue to take place in large numbers.
Age at marriage, has far reaching consequences on fertility rates, child bearing,
and other health issues such as infant and maternal mortality. Menarche or
the onset of menstruation cycle constitutes the land mark for female entry
in to the institution of marriage. Women are pressurised to have children
soon after their marriage, in order to prove their fertility and worth. Hence
adolescent marriage becomes synonymous with adolescent child bearing. Early
marriages have adverse effect on the health of the mother and child. The high
rate of maternal, neo-natal infant and child death are positively associated
with early marriages. Ignorance of these critical issues may explain in some
part the failure of public in honouring the implementation of the minimum
age of marriage laws.
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For population stabilization one of the important factors is raising the age at
marriage/cohabitation especially for girls. The strongest impact of this can
come through increasing years of schooling for girls. At the national level the
age at marriage is likely to be achieved by a further rise in female education.
Population momentum can be curtailed in part by investing on adolescents
with emphasis on raising girl’s social and economic prospects and enhancing
their self-esteem.
Maternal Mortality Ratio:
Maternal Mortality Ratio (MMR) is defined as the number of maternal deaths
(during pregnancy, childbirths and purperial period) per 100,000 live births.
Like most developing countries, India does not have reliable data on maternal
mortality. Between the two rounds of National Family Health Surveys (NFHS-
I, 1992–1993 and NFHS-II, 1998–1999) there has been no significant change
in maternal mortality ratio i.e. NFHS–1–424 and NFHS–II–540.
The SRS estimated MMR of 408 in 1997 and 407 in 1998. Though, the
estimates vary with different methodology used but this does not change
in the stark fact. The stark fact is MMR in India is still very high. Even
if, we take the most conservative estimate of 400 per one lakh live births
(which is in the lower side), then also it can be stated that more than one lakh
women die every year in India due to causes related to pregnancy and child
birth. Currently, as per the SRS estimates, the MMR for India is 254.The
Empowered Action Group (EAG) states (Bihar, Jharkhand, Madhya Pradesh,
Chhattisgarh, Orissa, Rajasthan, Uttar Pradesh and Uttarakhand) and Assam
are having the MMR above the national average.
• Three mothers die for every 1000 live births each year in India. However,
there are vast regional and rural-urban differences.
• Every four minutes a woman dies as a result of a complication attributable
to pregnancy and child birth.
• It is estimated that for each woman who dies, as many as 30 other women
develop chronic debilitating conditions which seriously affect quality of
life.
In India, skilled personnel attend about 47% of deliveries. In some districts it
is as low as 5-10%. There are many districts where percent of safe delivery is
less than 30. Nearly 7 million induced abortions take place annually in India.
For each legal abortion, it is estimated that another 10 illegal abortions take
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place but go unrecorded. Nearly 12% of all maternal deaths are attributable
to abortion-related complications. Anaemia is the underlying cause for 20%,
toxemia for 13%, purperial sepsis for 13% and bleeding during pregnancy for
23% of maternal deaths.
Maternal mortality is high in those states, where fertility is high, simply
because women there are having more births. Maternal mortality is also high
in those states where children are born to very young women, to older women
and to women who have multiple, closely spaced pregnancies.
The lack of male participation results in poor utilization of pre/ante-natal,
natal, and post-natal services by pregnant women. Several reports indicate
that men do not give much importance to the health problems of women
especially during pregnancy and child births. Either they are unaware of the
importance in seeking preventive care or they are simply indifferent.
Women need support in obtaining access to essential obstetric care. Raising
awareness of the need for women to reach emergency obstetric care without
delay if complication arise during pregnancy is crucial. Studies have shown that
in 25% of maternal deaths family members were not aware of the seriousness
of women’s condition and took no action towards obtaining assistance.
Diet that provides sufficient calories and micronutrients essential for a
pregnancy to be successfully carried to term. Proper nutrition will reduce the
likelihood of a pregnant woman experiencing serious complications during
pregnancy and child birth.
Infant Mortality Rate:
Infant mortality is an important index of the level of socio-economic
development and quality of life. It is a sensitive indicator of the availability,
utilization and effectiveness of the health care particularly peri-natal care. It
is persistent undernourishment of women and girl child in particular that is
emerging as the critical factor responsible for infant mortality. Poor maternal
health results in low birth weight and premature babies. Infant and childhood
diarrhoeal diseases, acute respiratory infections and malnutrition contribute
to high infant mortality rates.
In the national level while IMR declined from 94.5 in 1988 to 53 in 2008 it
continues to be very high in many states. Despite the significant achievement
in bringing down the female IMR, there exist inter-state variations with the
highest female IMR of 70 in Orissa and Uttar Pradesh the lowest being 13 in
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Kerala in 2008. Access to family welfare services and contraceptive care is a
critical determinant of infant mortality and birth rate.
Child Sex Ratio:
While there is marginal improvement in overall sex ratio i.e from 927 in 1991
to 933 in the census 2001 what is most alarming is the decline of Child Sex
Ratio (CSR) i.e the sex ratio of children in the age group of 0–6 years. The
child sex ratio shows a negative trend and causes serious concern to population
scientists, policy makers and planners. The decline is not only from the
previous census, but also continuous from 1961. But what is matter of concern
is the points of decline in the last two decades.
Child Sex Ratio in India Since 1961
Year
Child Sex Ratio
1961
976
1971
964
1981
962
1991
945
2001
927
Census 2001 showed a decline of 18 points from 945 in 1991 to 927. The
decline of child sex ratio is so wide spread in the country that out of the 28
states and 7 union territories, only 4 states namely Kerala (5 points increase),
Tripura (8 points increase), Mizoram (2 points increase) and Sikkim (21 points
increase) and only one union territory, Lakshadweep (33 points increase) are
free from this socially harmful and degrading phenomenon.
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Child Sex Ratio in the States and Union Territories
States/UTs
Punjab
Haryana
Chandigarh
Himachal Pradesh
Delhi
Gujarat
Uttarakhand
D & N Haveli
Daman & Diu
Goa
Maharashtra
Arunachal Pradesh
Nagaland
Orissa
Bihar
Jharkhand
Manipur
Madhya Pradesh
Uttar Pradesh
Meghalaya
Assam
Andhra Pradesh
Karnataka
Chhattisgarh
Tamil Nadu
A & N Islands
Rajasthan
Puducherry
West Bengal
Lakshadweep
Sikkim
Tripura
Kerala
Mizoram
Jammu & Kashmir
India
1991
875
879
899
951
915
928
948
1013
958
964
946
982
993
967
953
979
974
941
927
986
975
975
960
984
948
973
916
963
967
941
965
967
958
969
NA
945
Year
2001
798
819
845
896
868
883
908
979
926
938
913
964
964
953
942
965
957
932
916
973
965
961
946
975
942
957
909
967
960
959
963
966
960
964
941
927
Absolute Change
–77
–60
–54
–55
–47
–45
–40
–34
–32
–26
–33
–18
–29
–14
–11
–14
–17
–9
–11
–13
–10
–14
–14
–9
–6
–16
–7
4
–7
18
–2
–1
2
–5
NA
–18
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The atates and union territories that have shown large declines in child sex
ratio are Punjab (–77), Haryana (–60), Himachal Pradesh (–55), Gujarat
(–45), Chandigarh (–54) and Delhi (–47) though they are economically quite
developed with high female literacy rates. There are 122 districts spread over
14 states having CSR less than 900. District level differences are alarming to
focus area specific interventions.
Several questions have been raised with regard to trends in child sex ratio
in the last two decades. The indications are that this alarming trend is due
to large scale practice of female foeticide. Female foeticide or sex selective
abortion is the elimination of the female foetus in the womb itself. The decline
in child sex ratio may be due to different factors such as neglect of female
children resulting in their higher mortality at younger ages, female infanticide
and female foeticide. Female foeticide refers to a practice where the female
foetuses are selectively eliminated after pre-natal sex determination thus
avoiding the birth of girls. High incidence of induced abortion and the sharp
decline in the child sex ratio in the last decade clearly proves the practice of
female foeticide.
Factors responsible for female foeticide:
• The obsession to have a son.
• The discrimination against the girl child.
• The socio-economic and physical insecurity of women.
• The evil of dowry prevalent in the society.
• The worry about getting girls married due to the stigma attached to being
an unmarried woman.
• Easily accessible and affordable procedure for sex determination during
pregnancy.
• Failure of medical ethics.
• The two child norm policy of certain state governments
The implications of declining sex ratio in the population:
• Decreasing number of females in the society likely to increase sex related
crimes against women.
• This will lead to increase in social problems like rape, abduction, bride
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selling, forced polyandry etc. Reports are already trickling in as to how
young men in Haryana find it difficult to get married. In the Dangs district
of Gujarat there was report of 8 brothers marrying one woman. This is not
only social problem but also unethical.
• There will be increase of prostitution, sexual exploitation and increase in
cases of STD and HIV/AIDS.
• Such an imbalance will not only lead to growth in crime against women
but will also cause various physical, physiological and psychological
disorders particularly among women.
• The health of the woman is affected as she is forced to go for repeated
pregnancies and abortions.
Adolescents:
Adolescents in the age group 10–19 constitute about 22% of India’s
population. Recognizing adolescents as a distinct group with their own
unique needs and concerns, issues related to them can not be ignored in
the policies and programmes of population stabilization. What happens in
the future depends to a large extent on the decisions taken by adolescents
as they enter the reproductive years. Reproductive health, in particular,
represents the most critical area given a situation where there is
strong son preference, incidence of early marriage and high rates of
maternal mortality.
The needs of adolescents, including improvement in health status, protection
from unwanted pregnancies and Sexually Transmitted Diseases (STD)
have not been sufficiently addressed in the past. Improvements in the
health status of adolescent girls have a significant intergenerational impact.
It reduces the risk of low birth weight and minimizes neo-natal mortality.
Their special requirements comprise information, counseling, population
education, accessible and affordable reproductive health services, food
supplements and nutritional services. Programmes should encourage delayed
marriage and child-bearing and education of adolescents about the risk of
unprotected sex.
Male Participation in Reproductive and Child Health:
In the past women were seen as the main party in procreation adding to
population. Thus almost all family planning strategies have hitherto focused
on women as targets of contraceptives. While couple protection rate has
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consistently increased over the years, the proportion of male sterilization
acceptors has progressively declined.
Men’s involvement is placed within the wider context of gender equity. The
active cooperation and participation of men is vital for programme acceptance.
Their involvement is not only limited to use of condom or vasectomy but also
called for in planning families, supporting contraceptive use, helping pregnant
women stay healthy, arranging skilled care during delivery, helping after the
baby is born and finally being a responsible father.
There is now a greater recognition that men make decisions that affect
women’s reproductive health as well as their own. Men are involved in
reproductive health through their multiple roles as sexual partners, husbands,
fathers family and household members, community members etc. The lack of
male participation results in poor utilization of pre-natal, natal, and post-natal
services by pregnant women.
Family Planning:
The evolution of population stabilization efforts in India by government goes
back to the onset of five year development plans in 1951–52. The Government
of India launched the world’s first ever and largest population “programme”
in the form of the National Family Planning Programme., which emphasized
“family planning” to the extent necessary for reducing birth rates to stabilize
the population at a level consistent with the requirement of national economy.
In 1950s it was largely an urban clinic-based programme, then it became in
the 1960s, rural in its focus and more community-oriented in its approach.
In 1966, several important developments concerning the Family Planning
Programme took place. A full fledged department of Family Planning was
established within the Ministry of Health. The programme was made “centrally-
sponsored”; financial incentives were introduced for sterilization acceptors; and
sterilization was made target-oriented. In 1976, the government announced a
National Population Policy Statement. The compulsory and coercive nature
of the programme during 1975 and 1976 made it highly unpopular. A damage
control exercise began by re-christening Family Planning as Family Welfare
with voluntary acceptance of contraceptive targets without any coercion as
the key strategy and again a policy statement was announced in June 1977.
The policy statements of both 1976 and 1977 were laid on the table of the
house of the Parliament, but never discussed or adopted. In 1996, a target free
regime started and Reproductive and Child Health Programme was launched
in 1998.
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The past two decades have seen a decline in Total Fertility Rate (TFR), with
TFR dropping from 4.0 in 1988 to 2.6 in 2008. Among major states (population
of 20 million and above), Bihar (3.9), Uttar Pradesh (3.8), Rajasthan (3.3)
and Madhya Pradesh (3.3), have very high TFR. Although knowledge about
one or more methods of contraception is almost universal (as high as 98% of
women and 99% of men, NFHS–III), it is seen that there is a gap between
knowledge and practice.
As per the NFHS–III, the contraceptive prevalence rate is 56 percent. Out
of the total users, majority (38.3 percent) have undergone sterilization. The
sex-wise break-up of sterilization shows that majority (37.3 percent) is female
sterilization and the rest 1 percent are male sterilizations. Among the modern
family planning methods, only 5.2 percent are using condoms followed by
3.1 percent using pill and 1.7 percent are using IUD. “Unmet need” suggests
the existence of a gap between the reproductive intentions and contraceptive
behaviours of men and women, resulting in a large number of individuals and
couples around the country being unable to plan their families as they would
like to. According to NFHS–III, the unmet need for contraception is 12.8
percent. The unmet need for limiting methods (6.6 percent) is almost the
same as that of spacing methods (6.2 percent).The challenge that India faces
therefore is to provide informed choice and quality of care to couples for a
better reproductive life.
Quality of Care:
Along with accessibility and availability of services, provision of “quality of
care” is recognized as a priority area in RCH programme. Good quality of care
creates demand from clients and ensures satisfied clients, who in turn come
back for services. Commonly accepted as quality services are those services that
meet the needs of clients. While the client perspective focuses on individuals,
the provider and managerial perspectives are equally important. Access to
quality reproductive health services should also be seen within the framework
of reproductive rights.
MoHFW with support of UNFPA has developed a nine-element framework
for “Quality of Care” which is used as a guideline for monitoring quality of
care. Five of these elements could be applied in a generic manner to any
reproductive health service. The remaining four elements are to be best applied
individually to each reproductive health service, such as, family planning,
maternal health and HIV/AIDS prevention. These are characterized as service
elements.
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Reproductive Health Programme Quality Framework
Generic Elements
Service-specific Elements
1. Service environment
1. Access to services
2. Client provider interaction 2. Equipment and supplies
3. Informed decision making 3. Professional standard and technical
competence
4. Integration of services
4. Continuity of care
5. Women’s participation in
management
VI. Relevance of Integrated Approach
Obviously India’s large population in itself is not the real reason for high levels
of poverty, low per capita income and slow economic growth. The stark reality
is that income levels and growth depend on how well the state invests in its
people in their education, in their health, and in their well-being to improve
their quality of life.
Curbing population growth can not be a goal in itself. It is only a means to
development. If development can help stabilizing population that is much
better and superior solution to one where population growth is curbed with the
hope that development will automatically follow. Therefore socio-economic
development and improvement in quality of life can be an end itself and will
also lead to population stabilization. The success of population stabilization
programme is dependent on various factors like improved literacy, socio-
economic status, women’s empowerment, better health care and other human
resource indicators. Therefore a broad social development policy with an
integrated approach to population stabilization is a necessity.
This has been accepted in principle in the National Population Policy
(NPP) 2000. The vision of NPP is “economic and social development and to
improve the quality of lives that people lead, to enhance their well-being
and to provide with opportunities and choices to become productive assets
in the society.”
Stabilizing population is an essential requirement for promoting sustainable
development with more equitable distribution. However it is as much a
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function of making reproductive health care accessible and affordable for
all, as of increasing the provision and outreach of primary and secondary
education, extending basic amenities, empowering women and enhancing their
employment opportunities, and providing transport and communication.
VII. National Population Policy (NPP) 2000:
Objectives, Goals and Strategic Themes
Objectives
• Immediate objective—To address the unmet needs for contraception,
health care infrastructure, and health personnel and to provide integrated
service delivery of basic reproductive and child health care.
• Medium term objective—To bring the TFR to replacement levels by 2010,
through vigorous implementation of inter-sectoral operational strategies.
• Long term objective—To achieve a stable population by 2045, at a level
consistent with the requirements of sustainable economic growth, social
development, and environmental protection.
National Socio-Demographic Goals for 2010
In pursuance of these objectives, NPP 2000 has formulated 14 National Socio-
Demographic Goals to be achieved in each case by 2010.
• Address the unmet needs for basic reproductive and child health services,
supplies and infrastructure.
• Make school education up to age14 free and compulsory for both boys
and girls, and reduce drop-outs at primary and secondary school levels to
below 20 percent.
• Reduce infant mortality to below 30 per 1000 live births.
• Reduce maternal mortality ratio to below 100 per 100,000 live births.
• Achieve universal immunization of children against all vaccine preventable
diseases.
• Promote delayed marriages for girls, not earlier than age18 and preferably
after 20 years of age.
• Achieve 80 percent institutional deliveries and 100 percent deliveries by
trained persons.
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• Achieve universal access to information/counseling, and services for
fertility regulation and contraception with a wide basket of choices.
• Achieve 100 percent registration of births, deaths, marriage, and pregnancy.
• Contain the spread of Acquired Immuno Deficiency Syndrom (AIDS) and
promote greater integration between the management of Reproductive
Tract Infections (RTI), and Sexually Transmitted Infections (STI)
• Prevent and control of communicable diseases.
• Integrate Indian Systems of Medicine (ISM) in the provision of re-
productive and child health services, and in reaching out to households.
• Promote vigorously the small family norm to achieve replacement level of
TFR.
• Bring about convergence in implementation of related social sector
programmes so that family welfare becomes a people centered programme.
Strategic Themes
The NPP 2000 has identified 12 strategic themes for successful implementation
of the policy. These are:
• Decentralized planning and programme implementation.
• Convergence of service delivery at village levels.
• Empowering women for improved health and nutrition.
• Child health and survival.
• Meeting the unmet needs for family welfare services.
• Under-served population groups- urban slums, adolescents, tribals,
displaced, and migrants.
• Diverse health care providers.
• Collaboration with and commitments from NGOs and private sector
• Mainstreaming Indian Systems of Medicine and Homeopathy.
• Contraceptive technology and research on reproductive and child health.
• Providing for older population.
• Information, education and eommunication
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Population Foundation of India
B-28, Qutab Institutional Area, New Delhi-110016
Tel.:+91-11-43894100, Fax: +91-11-43894199
E-mail: popfound@sify.com
Website: www.popfound.org