FAMILY PLANNING
PROGRAM IN INDIA
India’s Contribution to World Population
Delhi, 1.68 Cr. (1%)
J & K, 1.25 Cr. (1%)
Haryana; 2,54
Chhattisgarh, 2.55 Cr
Punjab, 2.77 Cr.
Uttarakhand, 1.01 Cr.
(1%)
Other states & UTs,
2.61Cr. (2%)
Uttar Pradesh
19.96 Cr. (16%)
Assam, 3.12 Cr. (3%)
Jharkhand, 3.30 Cr
Kerala 3.34 Cr. (3%)
Orissa
4.19 Cr. (3%)
Gujarat
6.04Cr. (5%)
Karnataka
6.11 Cr. (5%)
Populatio
n Share of
States
Bihar
10.38 Cr. (9%)
Rajasthan,
6.86 Cr. (6%)
Tamil Nadu
7.21 Cr. (6%)
Madhya Pradesh
7.26 Cr. (6%)
Maharashtra
11.24 Cr. ( 9%)
Andhra Pradesh
8.47 Cr. (7%)
West Bengal
9.13 Cr. (8%)
Source: Census 2011
National Population Policy - 2000 Objectives
IMMEDIATE
Address unmet need
MID-TERM
TFR to replacement level of 2.1 by 2010
LONG-TERM
Population stabilisation by 2045
Population & Growth Rate
548
439
361
319
279
251
238
0
252
0,56
400
200
1,25
1,64
0,03
1901 1911 1921 1931 1941 1951 1961 1971 1981 1991 2001 2011
2
1,5
1
0,5
0
• Steepest decline in Decadal Growth Rate between 2001 and 2011 from 21.54% to 17.64%
• Growth rate of populous states with high TFR has fallen sharply after decades of stagnation
Growth Rate
1,04
600
683
1,33
800
846
1000
1,97
1210
1,96
2,5
1029
Population (Million)
1200
2,20 2,22 2,14
Fertility trend in India (TFR)
TFR (NFHS)=2.2
TFR (SRS)= 2.3
6
55%
of country’s
population living in 24
States/UTs has already
achieved replacement level
fertility
Contraceptive Usage and Unmet Need
Modern Contraceptive Usage (NFHS IV)= 47.8%
(Track 20 estimates) = 54.4%
IUCD/PPIUCD,
1.5
Male
Sterilization, 0
.3
Condoms, 5.6
Pills, 4.1
Female
Sterilization, 3
6
TR
WB
AS
BH
JH
AP
TG
AR
DN
MG
MH
KN
OR
MN
MP
MZ
GJ
RJ
HR
NG
TN
CG
AN
DD
UP
PD
KL
GO
JK
UK
SK
HP
PJ
DL
CH
13,6
12,2
12
11,8
10,6
10,5
10,3
8,6
8,3
7,8
7,6
7,4
7,3
7,2
6,5
6,3
5,9
5,7
5
4,8
4,7
4,5
3,8
3,5
3
2,9
2,9
2,9
2,8
2,6
2,6
2,3
2,1
18,8
18,3
Teenage Fertility
India = 7.9%
Source: NFHS IV
Wanted and actual fertility rates
If unwanted fertility is averted
TFR will reach replacement level.
Source: NFHS-4
HIGH RISK BIRTHS
Too Close… Too Many… Too Early…
Too Close
48.1 % of births have birth interval of less than 36 months
Too Many
22.8% are 3rd or more order births
Too Early
7.9% of births are in the age group 15-19 years
Source: NFHS IV, SRS
Birth spacing >36 months
Source: SRS 2016
10/26/2021
12
Why Family Planning?
Fertility Contribution
52.5% of country’s
15-24 years women
fertility is contributed by
contribute
of
the maternal mortality
age group 15-24 years
46%
1.28 crore births every year
Source: SRS
Prevents one in every three maternal deaths
Prevents unintended
pregnancies and unsafe
abortions
Prevents high-risk pregnancies
For every woman who dies
of pregnancy and
childbirth complications,
at least 20 more suffer
long-term illness.
26/10/2021
Why FP?
15
Three times more risk of
child mortality if the interval
is less than 18 months
Prevents infant deaths
Benefits of achieving FP goals
Social Sector cost savings outweigh
Family Planning costs
Water,
Rs 6, 885 Cr
Total Savings: Rs 67,815 Cr
(2007-2015)
MH,
Rs 8, 640 Cr
Immunization
Rs 23, 985 Cr
Education
Rs 28, 305 Cr
Source: Calculation by Health Policy Initiative (USAID Project), Futures Group
Source: NFHS II, MDG analysis
Total Cost of FP, Rs 5,130 Cr
(2007-2015)
National Family Planning Program
Key highlights of FP programmes
India was the first country to launch National Family Planning Program
10/26/2021
Policy level
•Target free approach
•Voluntary adoption of Family Planning
Methods
•Based on felt need of the community
•Children by choice and not chance
Service level
•More emphasis on spacing methods
•Assuring Quality of services
•Expanding Contraceptive choices
18
Expansion of the
basket of FP
Choices
Augmenting the
demand through
ASHA Schemes for
Family Planning
Promoting quality
sterilization services
KEY FP INITIATIVES/SCHEMES
Addressing global
Commitments
(Family Planning
2020)
Generating demand
and awareness for
FP services
Promoting quality
IUCD services
Contraceptive Basket of Choice under National Family
Planning Program
Temporary Methods
•
Condoms (Nirodh)
•
Oral Contraceptive Pills• Combined Oral Contraceptives (Mala N)
• Centchroman (Chhaya)
• Emergency Contraceptive Pills (Ezy Pill)
•
IUCD-380A, 375
•
Injectable MPA
IUCD
380 A
Permanent Methods
•
Male Sterilization (Conventional Vasectomy/NSV)
•
Female Sterilization (Minilap/Laparoscopic)
10/26/2021
Family Planning Division, MoHFW
IUCD
375
Expansion of the basket of FP Choices
Introduction of new contraceptive choices Injectable Contraceptive (Antara Program)
 Centchroman (Chhaya)
 Progesterone only Pills- under pilot
Introduction of new device Cu IUCD 375 (effective for five years) was introduced in program in 2012-13.
Introduction of new method Post partum IUCD was introduced in the program in 2010-11 and has provided
post partum women an effective spacing option.
Augmenting the demand through ASHA
Schemes for Family Planning
• Home
Delivery of Contraceptives
• Ensuring Spacing at Birth
• Pregnancy Testing Kits• Pregnancy Testing
Kits are now a part of ASHA kits so as to
ensure early management of pregnancy
Promoting quality sterilization services
• Sterilization Compensation Scheme• The compensation package has been
enhanced in
2014 for 11 high focus high TFR states
• Higher package for post partum sterilization and
male sterilization
• Higher package for MPV districts
Sterilization Compensation Scheme
States
11 High focus states
(UP, BH, MP, RJ, CG, JH,
OD, UK, AS, HR, GJ)
Mission Parivar Vikas
Districts
Other High focus states
(NE states, J&K, HP)
Non High focus states
Acceptor
ASHA/ Health Worker Others
Total
VAS.
2000
300
400
2700
TUB.
1400
200
400
2000
TUB. (PPS)
2200
300
500
3000
VAS.
3000
400
600
4000
TUB.
2000
300
500
2800
TUB. (PPS)
3000
400
600
4000
VAS.
1100
200
200
1500
TUB.
600
150
250
1000
VAS.
1100
200
200
1500
600
150
250
1000
250
150
250
650
TUB.
(BPL + SC/ ST only)
TUB. (APL)
Clinical Outreach Teams
•
The scheme is applicable for 146 MPV districts in 7 high focus states
•
Special package for provision of sterilization services
10/26/2021
Female Sterilization
Male Sterilization
Client
2000
3000
Motivator
300
400
COT Cost
2200
1600
Total
4500
5000
25
Contd...Promoting quality sterilization services
National Family Planning Indemnity Scheme• Clients are indemnified in the unlikely events of deaths, complications and
failures following sterilization
• The providers/ accredited institutions are indemnified against litigations
• The scheme was revised in 2013 and is now being operated by the state
governments directly with NHM funding.
Claims arising out of Sterilization Operation
A
B
C
D
E
Death at hospital/ within seven days of discharge
Death following Sterilization (8th – 30th day from
discharge)
Expenses for treatment of Medical Complications
Failure of Sterilization
Doctors/facilities covered for litigations up to 4
cases per year including defense cost
Amount
(Rs.)
2,00,000
50,000
Additional as per
Hon’ble SC Directives
2,00,000
50,000
25,000
30,000
2,00,000
(per case)
25,000
30,000
Contd…Promoting quality sterilization services
• Mobile teams dedicated for FP services• Has been introduced in high focus states,
in 2014-15, to
provide sterilization services in areas where there is dearth of
service providers.
• Scheme for ensuring drop back services to sterilization clients• The scheme was launched in 2015 as per demand from the
states to provide drop back to sterilization clients.
Sterilization
Performance
Bihar
Chhattisgarh
HP
JK
Jharkhand
MP
Rajasthan
Mizoram
Haryana
Karnataka
Maharashtra
Telangana
Tamil Nadu
West Bengal
Puducherry
2014-15 2018-19
517,314
395560
48,153
65438
17,706
10878
13,015
10184
114,313
90943
373,584
305919
303,436
246065
1,545
1391
69,865
59480
322,145
278427
470,682
393443
156,729
76310
311,741
232690
197,101
173164
8,651
6639
% Decline
-23.5
35.9
-38.6
-21.8
-20.4
-18.1
-18.9
-10.0
-14.9
-13.6
-16.4
-51.3
-25.4
-12.1
-23.3
Promoting quality IUCD services
• Interval
• Can
IUCD:
be provided in all public health facilities by a trained provider in OPD
• PPIUCD
(Post partum IUCD):
• Inserted
within 48 hours after delivery in facilities conducting deliveries
• PAIUCD (Post abortion
• Inserted
IUCD):
within 12 days of abortion in PHC and above facilities
PPIUCD and PAIUCD incentive scheme :
• Trained/Skilled empanelled provider inserting PPIUCD/PAIUCD- Rs 150 per insertion.
• ASHA accompanying Client- Rs 150/insertion
• Beneficiary- Rs. 300
PPIUCD Acceptance
(% acceptance out of total public health
deliveries)
Contd… Promoting quality IUCD services
• Increasing provider’s base for providing IUCD services• Task shifting was introduced for utilizing the army of doctors
qualified in ISM (Ayurveda, Unani, Siddha and Homeopathy)
for the provision of IUCD services after undergoing a
structured training, at peripheral public health facilities.
Generating demand and awareness for FP
services
•
Improved counseling through RMNCH Counselors
•
Celebration of World Population Day & fortnight (July 11 – July 24)
•
Population stabilisation fortnight has helped to break the seasonal trend of sterilization services
in the northern states of India.
• It is being held in all blocks, districts and states of India since 2009 and the event is observed
over a month long period, split into:
•
June 27 to July 10: “Dampati Sampark Pakhwada” or “Mobilisation Fortnight”
•
July 11 to July 24: or “Jansankhya Sthirtha Pakhwada” or “Population Stabilisation
Fortnight”
•
Celebration of Vasectomy fortnight (21st November to 4th December)
•
The objective is to improve male participation in Family Planning
Quality Structures: Family Planning Indemnity
Subcommittee
Elements
State FP Indemnity
Subcommittee (SISC)
Members
5
Meeting frequency
As often as warranted/
minimum half yearly
Quorum
3 members
Functions
Redress, dispose and
disburse claims/ complaints
received through the DISC, to
the district health society as
per procedure and time frame
laid down in the manual
District FP Indemnity
Subcommittee (DISC)
5
As often as warranted/
minimum quarterly
3 members
Process claims received from
the clients and
complaints/claims lodged
against the surgeons and
accredited facilities, as per
procedure and time frame
laid down in the manual 33
Composition of SISC
•
•
•
Mission Director –NRHM (Vice
Chairperson)
Director Family Welfare/Director
Health Services/Director Public
Health/Equivalent (Convenor)
Additional/Joint Director
(FW)/Deputy Director
(FW)/Equivalent, designated by the
state government as the nodal
officer for the Quality Assurance
Cell (Member Secretary)
•
One Empanelled Gynaecologist
(from public institutions)
•
One Empanelled Surgeon (from
public institutions)
Composition of DISC
•
District Collector (Chairperson)
•
Chief Medical Officer/District
Health Officer (Convener)
•
District Family Welfare
Officer/RCHO/ ACMO/ equivalent
(Member secretary)
•
One empanelled gynaecologist
(from public institutions)
•
One empanelled surgeon(from
public institutions)
Hon’ble Supreme Court Directives
• Uploading following on state website: List of empaneled sterilization providers, Details
of S/DQAC member, Annual Report
• Availability and usage of Consent form, Medical record checklist and sterilization
certificate. The same to be translated in local language.
• Phase out camp approach for provision of sterilization services.
• Monitor at least 2 Public Health Facilities & 1 Accredited private/NGO Facility per month
• Document the minutes of meeting , Action Points and review in subsequent meeting
• Conduct client exit interviews during each visit (10% clients in each camp/fixed day
facilities)
• Strict adherence to the guidelines and standard operating procedures.
New Initiatives under Family Planning
• Mission
• Unified
Parivar Vikas
Software for FP logistics
• Expansion
of Contraceptive basket of choices
• New
Contraceptive Packaging
• New
FP media campaign
Mission Parivar Vikas
• Objective:
To accelerate access to high
quality Family Planning choices
based on information, reliable
services and supplies within the
rights framework.
• Timing/ Phasing:
To implement the mission in all
the 146 districts at one go and
not in phases.
Bihar- 37 districts; RJ- 14
districts; MP- 25 districts; CG2 districts; JH- 2 districts)
Delivering assured services
Dovetailing with new promotional
schemes
Ensuring commodity security
Building capacity (service
providers)
Creating enabling environment
Close monitoring and resolving
implementation bottlenecks
Unified Software for FP logistics
Aim:
To streamline FP logistics and
supply chain management
• Web based, App based and SMS
based application
• Instant access to stock
information from National level to
ASHA level
• Auto forecasting of contraceptives
• SMS alerts for key indicators
• Auto generated reports for
program review
New Communication Campaign
FP
Webpage
52 week
long radio
chat show
Toll free
helpline
number
Print ad
posters
Outdoor
Campaign
Celebrity
wats app
videos
Television
ads
Bihar
Overall Impact of Family Planning Services
Haryana
Chhattisgarh
Himachal Pradesh
Source: Track
20 Estimates
Overall Impact of Family Planning Services
Jharkhand
Jammu and Kashmir
Karnataka
Madhya Pradesh
Source: Track
20 Estimates
Overall Impact of Family Planning Services
Maharashtra
Mizoram
Puducherry
Rajasthan
Source: Track
20 Estimates
Overall Impact of Family Planning Services
Tamil Nadu
Telangana
Source: Track
20 Estimates
Its all about making the right
choice at the right time.
Responsible Us for a
Responsible Future!
Thank You…