FAMILY PLANNING PROGRAM

FAMILY PLANNING DIVISION

Ministry of Health & Family Welfare lf Government of India

POPULATION OF INDIA
1200 1000 800 600 400 252 200 0 0.56 0 56 9 279 31 9 36 61 4 439 5 548 686 -0.03 1029 846 1.04 1.33 1 33 1.25 2.20 1.96 2.22 2.5 2.14 2.0 1.93 1.5 1.0 10 0.5 0.0 -0.5

19 911-21 251

PO PULATIO N Source:- Registrar General India

GRO WTH RATE %

2

1991-2001*

19 901-11

19 921-31

19 931-41

19 941-51

19 951-61

19 961-71

19 971-81

19 981-91

DEMOGRAPHIC SCENARIO
1. India is the second most populous country in the world. 2. 2 India has 17 % of world s population and has less than worlds 3% of earths land area. 3. 3 While the global population has increased 3 times, pop lation times India has increased its population 5 times during the last century. 4. Indias population is expected to exceed that of China p p p before 2030 to become the most populous country in the world. world
3

PERFORMANCE OF STERILISATION
6 4.70 4.83 5.04 4.50 4 50 4.29

4 L LAKHS 3.73

3.54

3.69

3.67 3 67

3.67

3.34 2.86 3.00 3 00

3.17 2.88 0.96 1.20

2 1.12 1 0.74 0 '2002-03 3 '2003-04 4 2004-05 2005-06 2006-07 0.91 1.01 0.83 0.94 1.21 0.88

Bihar

MP

Orissa

Rajasthan

UP

PROJECTED POPULATION OF INDIA AS ON Ist MARCH (IN CRORES) 160 140 119.3 120 102.9 100
Crores s

126.9 111.2 111 2

134.0

140.0 140 0

80 60 40 20 0
2001 2006 2011 2016 2021 2026
5

WHAT IS TFR
The total fertility rate is the average number of children a woman would have if she were to pass through her reproductive years bearing children at the same rates as the women now in each age group. It is computed by summing the age specific fertility rates for all ages. It gives a magnitude of completed family size i it d f l t d f il i In simple terms TFR denotes

the average number of children borne per woman

6

TOTAL FE RTILITY RATE NFHS (2005-06) ,

4.0 3.5 3.0 2.5

T TFR

3.39 2.85 2.68

2.0 1.5 1.0 10 0.5 0.0

NFHS-I (1992-93) NFHS-II (1998-99) TOTAL FE RTILITY RATE
7

NFHS-III (2005-06)

Benefits of family planning Stabilises population St bili l ti Reduces maternal mortality

Reduces infant and child d f d h ld mortality
8

Slower rates of population growth benefit all aspects of development

Health Education Agriculture

Population
Economy Urbanisation
9

Environment

National Population Policy, 2000

IMMEDIATE OBJECTIVE Address the unmet needs of contraception, contraception Reproductive and Child Health care MEDIUM TERM OBJECTIVE Achieve Replacement Level Fertility by 2010 LONG TERM OBJECTIVE Bring b t B i about population stabilisation b 2045 l ti t bili ti by
10

Situation analysis
NPP 2000 and the present scenario:
1.

2.

3.

2010 Population replacement (put back now t 2021) to 2021) 2045 Population Stabilization (put back now to 2060 (1.53 billion in 2060). EAG states constitute 42% of th t t tit t f the population (TFR between 3.4 and 4.3) p p (TFR )
11

GOI POLICY (Servicing the unmet need)

Based on felt needs of the community TARGET FREE

Children by choice & not chance

Equal emphasis on both limiting and spacing methods ELA :Scientific and statistically significant way being formulated for calculating state wise performance level based on unmet need

Population stabilization is a priority area of the GOI

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MEETING UNMET NEEDS

1 2 3 Two third Indians want to use contraception There is no scope for coercion Ensure availability of quality RH services

4
5

Meet the felt needs of couple

Enable couple to achieve their RH goals
13

Programatic interventions in Family Planning (GOI)

1.

Addressing the unmet need in contraception g p through

Assured delivery of family planning services Developing skilled manpower for the same

2. 2 3. 4. 5.

Increasing male participation through intensive promotion of NSV Promotion of IUDs as a short & long term spacing method p g Promotion of Emergency Contraceptive Pills Increasing basket of choices

14

Promotional Interventions in Family Planning (GOI)

1. 2. 3. 4. 5.

Ensuring quality care in FP services Revised compensation scheme Family planning insurance scheme Promoting Public Private Partnerships g p Promoting contraception through increased advocacy

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Temporary (Spacing) Methods

IUD 380 A EC Pills OC Pills CC ( dual p p purpose condoms) )
16

Reduce unmet need in Spacing (advantages of IUD 380 A)

10 years duration & not 3 years years d ti t Can cover reproductive life span in 2 insertions only (25- 45 yrs.) (25Can potentially replace the sterilization procedures Can be inserted at subcentre level ANM/ MOs could be given refresher training t i i
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Promotion of EC Pills
2 tabs of 0 75mg or 1 tab of 1 5mg within 72 0.75mg 1.5mg hrs of intercourse in the following situations: Unprotected intercourse Unplanned intercourse Failed CC (Nirodh- torn) (NirodhAssault/ rape Levonorgesterol only No id ff N side effect One time activity to replace MTP y p Reduces Maternal Mortality by 10-15% 10-

18

Reducing unmet need in Terminal method th d

Assuring service provision through
Fixed day service round the year Periodic camps

Augmenting trained manpower in

NSV Minilap Lap. Ster. L St
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Male participation (Why N S l l Vasectomy(Wh No Scalpel Vasectomy- NSV ?) V t

1.

Attain population stabilization p p in a short period Shifting responsibility of family Shifti ibilit f f il planning from females to males
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2.

Why NSV ?
6 Ss:- (advantages) Ss:Scalpel less Stitch l Stit h less Safe Sound Simple p Short

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Tubectomy
(If client chooses it after all options have been explained) Offer minilap because No postgraduate surgeon/ gynaecologist required q No anesthetist required normally No pneumoperitoneum (inflating with gas) p p ( g g ) Less post operative distress If client still demands Laparoscopic Tubectomy Offer services routinely at DH, FRU, CHC, BLOCK y PHC (wherever OT is available)
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Camps in tubectomy
Should preferably start by 9 AM As the client is fasting since the previous evening Has travelled long distances to reach the camp site and Is dehydrated Has to have 4 hrs post operative observation before being discharged after being rehydrated
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Ensuring quality care in FP

The manual on Standards in sterilization has been updated, updated printed & uploaded on the website. website The manual on Quality assurance in sterilization has been updated, printed & uploaded on the website. Six Regional Dissemination Workshops on the revised Standards and QA manuals held countrywide in 06-07. 06-

24

Ensuring quality care in FP

All states reported to have set up the QACs at state and district levels as per affidavit filed by them in the supreme court Revised extended QAC as per the updated manuals are in place in most of the states. Most states have completed their orientation of the districts for QA
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COMPENSATION A.For Public (Govt.) facilities

Breakage of the Compensati on package

Acce ptor 1100 600

Motiva tor

Drugs and dressin g

Surgeo n charges

Anest hetist

Staff nurse

OT techni cian/h elper

Refresh ment

Camp managem ent

Total

High focus states Non High focus f states Non High focus states

VAS. VAS. (ALL) TUB. TUB. (ALL) VAS. VAS. (ALL) TUB (BPL SC/ST only))

200 150

50 100

100 75

25

15 15

15 15

10 10

10 10

1500 1000 1500 1000

1100
+

200

50

100

--

15

15

10

10

600

150

100

75

25

15

15

10

10

TUB (APL)

250

150

100

75

25

15

15

10

10

650
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COMPENSATION B For Private Facilities:

Category C t

Type of operation T f ti

Facility F ilit

Motivator Total M ti t T t l

High focus states t t

Vasectomy (ALL) Tubectomy T b t (ALL) Non High Vasectomy focus (ALL) states Tubectomy (BPL + SC/ST)

1300 1350

200 150

1500 1500

1300 1350

200 150

1500 1500

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Family Planning Insurance Scheme (limit of indemnity) t o de ty)

Claims arising out of Sterilization Operation
A B C D E Death at hospital/ within seven days of discharge Death due to sterilization (8th 30th day from the date of discharge ) Expenses for treatment of Medical Complications Failure of Sterilization Ste ili ation Doctors/ Facilities covered for litigations up to 4 cases per year including defence cost

Amount
Rs. 2,00,000/2,00,000/Rs. 50,000/50,000/Rs. 25,000/25,000/Rs. 30,000/ Rs 30 000/30,000/Rs. 2,00,000/2,00,000/-

Dissemination meetings co ducted for a state o c a s sse at o eet gs conducted o all officials Public institutions to display boards on the scheme

_________________________

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9. 9 Strengthening contraceptive supply

NSV instruments Revised Specifications prepared in 2006 (on website) States asked to procure as per their requirements through PIP Laparoscopes Revised Specifications prepared in 2006 (on website) States asked to procure as per their requirements from central funds as per approved specifications (can place indents with the TNMSC ) ECP supply Procurement has restarted recently Requirements from states received and being supplied

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10. Promotion of contraception through intensive advocacy i t i d

Advocacy kit on contraceptives Expert committee and core committee set up
All existing material reviewed and updated New materials developed for NSV, IUD380A, ECP, OCP All prototypes for p yp audio, video and print (leaflets, flip charts, posters) finalised and passed on to the IEC division for production and distribution to the states (Jan, 08)

Dissemination of FP capsule through regional workshops (WHO biennium 08-09) 08Approval obtained Funding awaited
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Family Planning
Components (Wh t the SFT should look for) (What th h ld l k f )
Contraception Conception (infertility management) Quality Assurance Accreditation of facilities Empanelment of providers p p Compensation Insurance I
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Responsibilities of the states/ districts p /

Increase number of services centres I b f i t Availability of services Accessibility of services Affordability of services (Upgradaiton DHs, FRUs, CHCs, (Upg adaiton of DHs FRUs CHCs PHCs & SCs under NRHM) Accreditation of private providers (PPP) p p ( )
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Responsibilities of the states/ districts p /

Regular fixed day services round the year
a) DH ) b) FRU/CHC c) PHC ) d) SC ) on demand (daily/ weekly) ( y/ y) weekly/fortnightly/monthly monthly/ bimonthly y/ y (Tubectomy only if OT available) IUD/ ECP ( demand) / (on ) Wednesday ( p y (optional) ) Saturday (optional)

Tubectomy: y Vasectomy:

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Responsibilities of the states/ districts p

1. Ensure at least One NSV One Tubectomy One IUD Surgeon per PHC Surgeon per PHC Provider per SC (ultimate aim) (ultimate aim) (ultimate aim)

2. Effect Manpower Rationalization Manpower Planning (based on ELA) Manpower Training Manpower Placement 3. Develop Comprehensive Training Plan for NSV Minilap LTT IUD ECP

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Action at State/Dist. level

Appoint Nodal officer for Family Planning A i t N d l ffi f F il Pl i
(for Planning, Implementing, Monitoring, Supervising & Evaluation)

Constitute QAC at state level (10 members) & notify Constitute DQAC at dist level (9 members) & notify dist. Accredit facilities (Public/Private/NGO) Empanel doctors (Public/Private/NGO) Conduct
Half yearly meetings of state QAC (to be minuted) Quarterly meetings of Dist QAC (to be minuted) Dist.
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Action at State/Dist. level /

Orientation of CMOs on
NFPIS (National Family Planning Insurance Scheme) Compensation Scheme (Revised) ELA di i wise for limiting & spacing methods (based on district i f li i i i h d (b d dist. Unmet Need) Manpower development (district action plan) NSV (MOs) Minilap/ LTT (MOs) IUD (MOs/ SNs/ LHVs/ ANMs) ECPs (MOs/ SNs/ LHVs/ ANMs/ ASHAs) Contraceptive updates District budget allocation and disbursement

Monthly Review of FP performance with CMOs 36

Action at State/Dist. level

Display prominently (facility wise)
Revised compensation scheme Family planning insurance scheme Service availability (district action plan) y( p ) Fixed day service calendar NSV Minilap/ LTT IUD Camp calendar for above IEC materials on NSV IUD ECPs ECP Budget may be provided accordingly

37

Action at State/Dist level State/Dist.

Lay down benchmarks (performance indicators) and Rank Districts Reward districts Reward CMOs (state award) R d CMO ( t t d) Recommend for national recognition
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