Family Planning
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 promotereproductive 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:
1. 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 9.4% (NFHS-V) in our country.
2. Age at Marriage and First Childbirth
In India, 23.3% (NFHS-V) of the girls get married below the age of 18 years and out of the total deliveries 6.8% are among teenagers i.e. 15-19 years. The situation regarding age of girls at marriage is more alarming in a few states like:Bihar – 40.8%,Rajasthan – 25.4%,Jharkhand – 32.2%,Uttar Pradesh – 15.8%,Madhya Pradesh – 23.1%
Delaying the age at marriage and first childbirth could reduce the impact of Population Momentum on population growth.
3. 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. As per SRS 2020 data, spacing between two childbirths is less than the recommended period of 3 years in 47.6% of births in India.
Some Positives:
Total Fertility Rate (TFR)
Total Fertility Rate (TFR) in the country has recorded a steady decline to the current levels of 2.0 (SRS 2020):
| Year | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TFR | 2.9 | 2.8 | 2.7 | 2.6 | 2.6 | 2.5 | 2.4 | 2.4 | 2.3 | 2.3 | 2.3 | 2.3 | 2.2 | 2.2 | 2.1 | 2.0 |
Survey Data (NFHS):
Nationwide, the small family norm is widely accepted (wanted fertility rate: 1.6, NFHS-5) and the general awareness of contraception is almost universal (98.8% among women and men, NFHS-5).
As per NFHS-V, the Total Fertility Rate (TFR) for India is 2.0. The survey also shows 66.7% use of contraceptives among married women (aged 15-49 years) and prevalence of modern methods at 56.5%.
Strategies under Family Planning Programme in the country:
| Policy Level | Service 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 Methods | Limiting Methods |
|---|---|
| IUCD 380 A and Cu IUCD 375 | Female Sterilization: |
| Injectable Contraceptive MPA (Antara Programme) | Laparoscopic |
| Combined Oral Contraceptive (Mala-N) | Minilap |
| Centchroman (Chhaya) | Male Sterilization: |
| No Scalpel Vasectomy | |
| Condoms (Nirodh) | Conventional Vasectomy |
| Emergency Contraceptive Pills (Ezy pills) | |
| Emergency Contraceptive pills (Ezy pills) | |
Above services are provided at various levels of public sector facilities; following table provides details of the same:
| Family Planning Method | Service Provider | Service ******** |
|---|---|---|
| SPACING METHODS | ||
| IUCD 380 A, IUCD 375 | Trained & certified ANMs, LHVs, SNs and doctors | Sub centre & higher levels |
| Injectable Contraceptive MPA (Antara Programme) | Trained ANMs, 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 and Condoms are also provided through Social Marketing Organizations.
Thrust areas under Family Planning Programme:
Mission Parivar Vikas was initially for 146 high priority districts in the 7 high focus states (Bihar, Uttar Pradesh, Assam, Chhattisgarh, Madhya Pradesh, Rajasthan & Jharkhand), and has now been scaled up in all districts of the seven high focus states as well as six north-eastern states of the country with an aim to ensure availability of contraceptive products at all levels of the Health System.
Providing more choices through newly introduced contraceptives: Injectable Contraceptive MPA (Antara Programme) and Centchroman.
Emphasis on spacing methods like IUCD.
Revitalizing Postpartum Family Planning including PPIUCD, with appointment of counsellors at high institutional delivery facilities to capitalize on increased institutional deliveries.
Strengthening community-based distribution of contraceptives by involving ASHAs and focused 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 (not postgraduate gynaecologists/surgeons).
A rational human resource development plan for IUCD, minilap and NSV to empower 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 (NSV).
Demand generation activities such as display of posters, billboards and other audio-visual materials in facilities to be planned and budgeted.
Strong political will and advocacy at the highest level, especially in states with high fertility rates.