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Background

India was the first country in the world to have launched a National Programme for Family Planning in 1952. Over the decades, the programme has undergone transformation in terms of policy and actual programme implementation and currently being repositioned to not only achieve population stabilization goals but also promote reproductive health and reduce maternal, infant & child mortality and morbidity.

The objectives, strategies and activities of the Family Planning division are designed and operated towards achieving the family welfare goals and objectives stated in various policy documents (NPP: National Population Policy 2000, NHP: National Health Policy 2017, and NHM: National Rural Health Mission) and to honour the commitments of the Government of India (including ICPD: International Conference on Population and Development, MDG: Millennium Development Goals, SDG: Sustainable Development Goals, and others).

Factors that influence population growth:

Factors influencing population growth can be grouped into following 3 categories-

Unmet need of Family Planning: This includes the currently married women, who wish to stop child bearing or wait for next two or more years for the next child birth, but not using any contraceptive method. Total unmet need of Family Planning is 12.9 (NFHS-IV) in our country.

Age at Marriage and first childbirth: In India 26.8% (NFHS-IV)of the girls get married below the age of 18 years and out of the total deliveries 6.1% are among teenagers i.e. 15-19 years. The situation regarding age of girls at marriage is more alarming in few states like, Bihar (39.1%), Rajasthan (35.4%), Jharkhand (38%), UP (21.2%), and MP (30%). Delaying the age at marriage and first child birth could reduce the impact of Population Momentum on population growth.

Spacing between Births: Healthy spacing of 3 years improves the chances of survival of infants and also helps in reducing the impact of population momentum on population growth. SRS 2015 data shows that In India, spacing between two childbirths is less than the recommended period of 3 years in 59.4% of births.

Some positives:

Total Fertility Rate (TFR):

Total Fertility Rate (TFR) in the country has recorded a steady decline to the current levels of 2.3 (SRS 2015):

20052006200720082009201020112012201320142015
2.9 2.8 2.7 2.6 2.6 2.5 2.4 2.4 2.3 2.3 2.3

Survey Data (NFHS & DLHS):

Nationwide, the small family norm is widely accepted (the wanted fertility rate for India as a whole is 1.9: NFHS-3) and the general awareness of contraception is almost universal (98% among women and 98.6% among men: NFHS-3).

As per NFHS-IV TFR for India is 2.2. The NFHS-IV Survey shows 53.5% use of Contraceptives among married women (ased 15-49 years)and prevalence of mordern method 47.8%

Strategies under family planning programme in the country:

Policy LevelService Level
Target free approach More emphasis on spacing methods
Voluntary adoption of Family Planning Methods Assuring Quality of services
Based on felt need of the community Expanding Contraceptive choices
Children by choice and not chance  

Current family planning programme under public sector:

The public sector provides the following contraceptive methods at various levels of health system:

Spacing MethodsLimiting Methods
IUCD 380 A and Cu IUCD 375 Female Sterilization:
Injectable Contraceptive DMPA (Antara) Laparoscopic 
Combined Oral Contraceptive (Mala-N) Minilap 
Centchromen (Chhaya)  
Emergency Contraceptive Pill (Ezy Pill) Male Sterilization:
Progesterone-Only Pill (POP) No Scalpel Vasectomy
Condoms (Nirodh) Conventional Vasectomy 

Above services are provided at various levels of public sector facilities; following table provides details of the same:

Family Planning MethodService ProviderService Location
SPACING METHODS
IUCD 380 A, IUCD 375 Trained & certified ANMs, LHVs, SNs and doctors Sub centre & higher levels
Oral Contraceptive Pills (OCPs) Trained ASHAs, ANMs, LHVs, SNs and doctors Village level Sub centre & higher levels
Condoms Trained ASHAs, ANMs, LHVs, SNs and doctors Village level Sub centre & higher levels
EMERGENCY CONTRACEPTION
Emergency Contraceptive Pills (ECPs) Trained ASHAs, ANMs, LHVs, SNs and doctors Village level Sub centre & higher levels
LIMITING METHODS
Minilap Trained & certified MBBS doctors & Specialist Doctors PHC & higher levels
Laparoscopic Sterilization Trained & certified MBBS doctors & Specialist Doctors Usually CHC & higher levels
NSV: No Scalpel Vasectomy Trained & certified MBBS doctors & Specialist Doctors PHC & higher levels

Note: Contraceptives like OCPs, Condoms are also provided through Social Marketing Organizations.

Thrust areas under family planning programme:

Mission Parivar Vikas has been launched in 146 high fertility Districts of Bihar, Uttar Pradesh, Assam, Chhattisgarh, Madhya Pradesh, Rajasthan & Jharkhand, with an aim to unsure availability of contraceptive products to the clients at all the levels of Health Systems.

Emphasis on Spacing methods like IUCD

Revitalizing Postpartum Family Planning including PPIUCD in order to capitalise on the opportunity provided by increased institutional deliveries. Appointment of counsellors at high institutional delivery facilities is a key activity.

Strengthening community based distribution of contraceptives by involving ASHAs and Focussed IEC/ BCC efforts for enhancing demand and creating awareness on family planning

Availability of Fixed Day Static Services at all facilities.

Emphasis on minilap tubectomy services because of its logistical simplicity and requirement of only MBBS doctors and not post graduate gynaecologists/ surgeons.

A rational human resource development plan for IUCD, minilap and NSV be chalked up to empower the facilities (DH, CHC, PHC, SHC) with at least one provider each for each of the services and Sub Centres with ANMs trained in IUD insertion

Ensuring quality care in Family Planning services by establishing Quality Assurance Committees at state and district levels Plan for accreditation of more private/ NGO facilities to increase the provider base for family planning services under PPP.

Increasing male participation and promoting Non scalpel vasectomy

Demand generation activities in the form of display of posters, billboards and other audio and video materials in the various facilities be planned and budgeted

Strong Political Will and Advocacy at the highest level, especially in states with high fertility rates