NATIONAL POPULATION POLICY 2000
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- Title
- NATIONAL POPULATION POLICY 2000
- extracted text
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First Meeting
of the
National Commission on Population
Address of Dr. S. Aruna,
Minister of Health, Medical & Family Welfare
Government of Andhra Pradesh
July 22nd, 2000
Hp
National Commission on Population
First meeting on July 22nd, 2000
Government of Andhra Pradesh
Department of Health, Medical & Family Welfare
First Meeting of the National Commission on Population
July 22nd, 2000
Address of Dr. S. Aruna,
Minister of Health, Medical & Family Welfare
Government of Andhra Pradesh
Hon’ble Prime Minister of India and Chairman of the National
Commission on Population, Sri Atal Behari Vajpayeeji, Hon’ble Minister for
Health, Dr. C P Thakurji, Hon’ble Minister of State for Health, Prof. Rita
Vermaji, distinguished members of the National Commission on Population,
members of the press and participants in this august gathering, it is my
pleasure and a privilege to participate in the first meeting of the National
Commission on Population. I congratulate Government of India for having
announced a National Population Policy and for having constituted this body
to address issues relating to population control, which is so crucial for the
development of our nation.
I am proud to state that Andhra Pradesh has been performing well on
the population control front, and that the Government of my State has given
this programme a central position in the developmental efforts of the State.
Since the inception of the Family Welfare Programme, there has been
a significant decline in the fertility rate. In the early 70s, 5 children were born
per family. In 1998, as per the NFHS survey, this had come down to 2.25
children per family. The birth rate has declined from 35 per 1000 population
in 1971 to 22.3 per 1000 population in 1998. Approximately 60% of couples
in the reproductive age are now protected by contraception. The Infant
Mortality Rate has also declined from 113 per 1000 live births in the early 70s
to 65.8 per 1000 live births in 1998. Sustained efforts for family planning and
effective delivery of Maternal and Child Health Services have helped Andhra
Speech of Minister of Health, Medical and Family Welfare
Page 1 of6
Government of Andhra Pradesh
Department of Health. Medical & Family Welfare
National Commission on Population
First meeting on July 22™', 2000
Pradesh overcome the handicap on account of low female literacy, relatively
high incidence of child labour and low age of females at the time of marriage.
Andhra Pradesh has the distinction of being the first State in the
country to announce a comprehensive Population Policy in 1997 with clearly
articulated demographic goals. Our goal is to reduce the Birth Rate to 13 per
1000 population, attain a Total Fertility Rate of 1.5, a Maternal Mortality Rate
of 0.5 per 1000 live births and an Infant Mortality Rate of 15 per 1000 live
births by 2020. The State Population Policy has been discussed on the Floor
of the House and an all-party consensus has been evolved in support of the
policy. The State Government has allocated Rs. 65 crores from its own funds
to implement policy initiatives and programmes. The key strategy of our
initiatives is decentralisation of planning and programme implementation,
making family welfare a people’s programme and a shift in approach from
Family Planning to Reproductive and Child Health.
In order to decentralise planning and implementation, we have
established District Population Stabilisation Societies; and PHC and Hospital
Advisory Committees have also been constituted to ensure the active
participation of elected representatives and beneficiaries in health care
delivery and family welfare. These Societies and Committees have been
given both administrative and financial powers for effective functioning. We
now propose to establish village level structures for enhancing the ownership
of the health and family welfare programmes.
Population control in Andhra Pradesh has indeed become a people-
centred programme. Family Welfare has been placed high on the agenda of
the Janmabhoomi programme. Under this programme, health teams have
visited each and every habitation in the State at least 12 times over the last 3
years, bringing about an improvement in service delivery and encouraging
health-seeking behaviour of the community. Issues relating to Family
Planning and Mother and Child Health are discussed in every gram sabha.
Speech of Minister of Health, Medical and Family Welfare
Page 2 of 6
Government of Andhra Pradesh
Department of Health, Medical & Family Welfare
National Commission on Population
First meeting on July 22nd, 2000
Active involvement of a large number of Self-Help Groups has further
contributed to widespread acceptance of the small family norm.
In order to improve the infrastructural facilities that have a bearing on
the quality of services, 160 First Referral Units have been newly built and
fully equipped. New buildings are under construction for 626 PHCs and
renovations are being carried out for 477 PHCs. Frequent recruitment of
Medical Officers and para-medical staff in the last three years has reduced
the vacancies to a minimum. Doubling of the budget for drugs and
streamlining their supply has improved the quality and availability of drugs.
Continuous clinical management and training programmes for Medical
Officers and para-medical staff seek to further improve the quality of services
being delivered to the people of my State.
Several specific interventions are designed to address unmet needs.
215 Round-the-clock PHCs have been established and specialist services of
Gynaecologist and Paediatrician have been provided at these PHCs and at
the First Referral Units. 286 surgeons across the State have been trained in
innovative techniques like Double Puncture Laparoscopy and Non Scalpel
Vasectomy. We have performed 107809 DPLs and 31454 NSVs during the
last year. A project for social marketing of contraceptives to meet spacing
needs is under implementation from this year. A massive house-to-house
survey has been completed in January 2000, which identifies the unmet need
for contraception in our State, and our programmes for the current year will
address these needs.
A new scheme - Arogya Raksha - was introduced in 1999 to cover
hospitalisation expenses of family planning acceptors and their children to
infuse confidence among them. The Government recognises the role of
institutional deliveries in reducing maternal and infant mortality. Such
deliveries are encouraged through a novel scheme - Sukhibhava - that
provides Rs. 300/- to every pregnant woman below-poverty-line, who has her
Speech of Minister of Health, Medical and Family Welfare
Page 3 of 6
National Commission on Population
First meeting on July 22nd, 2000
Government of Andhra Pradesh
Department of Health, Medical & Family Welfare
delivery at Government hospitals or PHCs. The appointment of 8500
Community Health Workers for every habitation in the tribal areas has
increased the outreach services for the tribal population.
Unserved
population in the urban slums is sought to be covered by establishing 192
Urban Health Centres in 74 municipalities. Each of these centres is entrusted
to an NGO. Our Government has also issued orders entrusting one remote
PHC in each district to an NGO - this is part of our strategy to forge a strong
relationship with NGOs in the State.
As a result of all these efforts, the percentage of women receiving
ante-natal care has risen from 86.6% in 1992 to 92.7% in 1998; the
percentage of safe deliveries has gone up from 49.3% to 65.2% and the
percentage of children with full immunisation has risen from 45% to 58.7%
during the same period. These are figures from the latest NFHS survey
conducted by the Government of India. The number of family planning
operations has registered a significant increase from 6.3 lakh during 1997-98
to 7.33 lakh in 1998-99 and a record 7.9 lakh operations in 1999-2000.
Mere availability of health
services
is not enough.
Women’s
empowerment is the key determinant of success in lowering fertility rates.
Demand generation for health care services is closely related to the
economic well-being and status of women in the society. Acknowledging this,
Andhra Pradesh has encouraged the establishment of women’s thrift and
credit groups. 3.25 lakh women’s groups with 50 lakh members and savings
of Rs. 600 crores which is having a significant impact on improving the status
of women.
Focused communication campaigns can influence attitudinal and
behavioural changes. State-wide communication campaigns lay stress on
eight key issues - Reproductive & Child Health, Age at Marriage, Spacing,
Institutional Delivery, Immunisation, Nutrition, Small Family Norm and Male
Responsibility - in Family Welfare. In fact, these issues have been discussed
Speech of Minister of Health, Medical and Family Welfare
Page 4 of 6
Government of Andhra Pradesh
Department of Health, Medical & Family Welfare
National Commission on Population
First meeting on July 22nd, 2000
in every Gram Panchayat during the World Population Day functions on July
11th and will again be discussed in each and every habitation during the
ensuing Janmabhoomi Programme from 1st to 7th August.
Exemplary leadership shown by the Chief Minister coupled with strong
political commitment and active participation by public representatives at all
levels has greatly contributed to the widespread acceptance of the family
welfare programmes. The Chief Minister in his interaction in the Gram
Sabhas, starts the discussions with the Population Control Programmes and
related issues, and we, his cabinet colleagues, do the same. Andhra Pradesh
has effected the necessary amendments to the Panchayat Raj, Municipalities
and Co-operative Societies Acts, debarring those who have more than two
children from contesting in the elections. My party has also passed a
resolution to the effect that party posts will be given only to those with 2
children.
In order to endorse the acceptance of small family norm, we propose
to give preference to those with 2 children or less for selection to Government
services with effect from 2001-02. We propose to increase the age at
marriage by having registers at Panchayat level to monitor adherence to the
legal norms on age at marriage. We also propose to give a thrust on spacing
by enhancing the acceptability, accessibility & affordability of contraceptives.
I would like to place before the commission certain issues which need
to be taken up by the Government of India. The commission my recommend a
step-up in the budgetary allocations for this programme by Government of
India to ensure smooth execution of all planned activities. In deciding
budgetary allocations, weightage must be given for good performance on the
population control front.
In order to bring about greater community
participation, the commission may recommend to Government of India to
earmark a certain percentage of funds in Rural Development programmes to
be awarded as incentives to those Gram Panchayats that perform well in
Speech of Minister of Health, Medical and Family Welfare
Page 5 of 6
Government of Andhra Pradesh
Department of Health, Medical & Family Welfare
National Commission on Population
First meeting on July 22nd, 2000
family welfare programmes. The national policy document speaks of care for
the aged. To encourage our tradition of caring for parents at home, benefits
may be announced for families that care for the elderly in their homes. We
also request that legislation may be enacted to ensure that population control
and related social messages can be aired free-of-cost through the electronic
media at prime time. The recent judgement of Supreme Court for payment of
compensation in the case of a failure of a family planning operation, has
given a set back to the family planning programme. It is internationally
accepted that there will be 1-2% incidence of tubal patency when initial
operative errors have been excluded. The Government of India needs to
immediately take up the issue with the Supreme Court.
The Government of Andhra Pradesh is determined to provide reliable
and high quality maternal and child health and contraceptive services to the
people of the State. At this first and historic meeting of this distinguished
body, my Government reiterates its commitment to meet the great challenges
that lie ahead to achieve the goal of population stabilisation. Let us today
reaffirm our resolve to participate fully in a programme, which is so crucial to
the progress and development of our States and the Nation.
Jai Hind!
Speech of Minister of Health, Medical and Family Welfare
Page 6 of 6
H P 5^
i
SPEECH'OF-SHRI V. HANGKHANLIAN HON'BLE MINISTER OF HEALTH
GOVERNMENT OF MANIPUR DELIVERED IN THE MEETING ON
NATIONAL COMMISSION ON POPULATION IN THE COMMETTEE ROOM,
PARLIAMENT HOUSE,ANNEXE NEW DELHI,22ND JULY,2000
India to-day faces a radically different demographic situation that posed
a problem - the Problem of Population Explosion with one billion on 11th May,2000.
As a result, developmental activities undertaken by the Government of India has been
plagued. The only answer that has been found by most of the population scientists is
stabilization. They recognised that stabilization of the population would make towards
achievement of sustainable development . Now, a National Population Policy,2000
with immediate, medium and long term objectives to achieve a stable population by
2045 at a level consistent with the requirements of sustainable economic growth,
social development and environment protection has been drawn up by the govern
ment of India which is now before us.
I, on behalf of the State of Manipur welcome the National Population Policy,2000
To-day, this August Assembly will confine to the immediate objective that
address the unmet needs for contraception, health care infrastructure and health
personnel and to provide integrated services delivery for basic reproductive and child
health care.
In persuance of these objectives, 14 sets of National Socio-Demographic Goals
to be achieved in each case by 2010 have been formulated with 12 identified stra
tegic themes like (a) Decentralised Planning and Programme implementation
(b) Convergence of services delivery at village level (c) Empowering women for
improved Health and Nutrition etc. which must be simultaneously pursued in
" Stand Alone" or inter sectorial programmes in order to achieve the national Socio
demographic goals for 2010.
However, the service proposed to be rendered or pursued do not reach the
villagers more particularly in the hills and accordingly vast numbers of people cannot
avail these services because of lack of infrastructure and service facilities. The
problem is more acute for a state like Manipur that presents a unique case in terms of
population characterised by hetrogeneity in respect of physical, economic, social and
cultural conditions.
I would like to take up some action points for the effective implementation of the
Population Policy in the State of Manipur.
1)
Priority will be given to the expansion of the integrated package of
essential services at village and house hold levels. Inadequacies in the exsisting
health infrastructure that led to unmet needs will be improved keeping in view of the
remoteness, inaccessibility, sparsely distributed population in the hills and
population components of the tribes. New institutions will be opened to cover the
left out areas if adequate funds are made available.
*
,
Uniaue features of Manipur demands flexibility in the yardsticks for provision of
Lhh cXXcLe “ order to solve unmet needs and extend coverage.
’Specific policy and support to prov^
3
particulary for North Eastern States
Population Policy.
reached the village in locally relevant acceptable dialects.
nutrition services.
6.
Registration of births, deathswill also be strengthened and registration of
marriage and pregnancies will also be attempted.
Involvement of media personnel, private sector. P^ayati raj
7.
people'ss participation in
be encouraged to the maximum for people
stabilize population.
JAI HIND
H p
First Meeting of the National Commission on Population
5"° ) /
/
New Delhi 22nd July 2000
<41^
Speech by Chief Minister of Madhya Pradesh
•
I am of the clear view that for stabilizing the population, we will
have to resort to certain practical measure along with reduction
in infant mortality rate, maternal mortality rate and total fertility
rate. Key to the success of any policy lies in people
participation. This is also a precondition for the success of
population policy of Madhya Pradesh and National Population
Policy as well.
Village level democratic institution have already emerged in
our state, these institutions are capable of ensuring peoples
participation in various programmes.
An important initiative which we intend to take is in terms of
stream lining our grass route health infrastructure. We believe
that the community control of village level functionaries like
male and female health workers is far more effective and
efficient. We have already gone far ahead in this direction.
Madhya Pradesh has the credit of initiating the implementation
of the Panchayati Raj Adhiniyam 1993. State has nearly 32000
PRIs with about 4.80 lacs elected representatives.
State govt, has passed an act in 1995, which will enable
District Planning Committees, popularly known as Zila Sarkar,
to prepare consolidated development plan for the entire district.
DPC have been made responsible for the implementation and
monitoring of the population stabilization efforts in the district.
• We have to bring about the gender equality and equity in
society by women empowerment. Madhya Pradesh in having
nearly 200,000 elected women representatives out of 4,80,000
total representatives. Women member of elected bodies have a
vital role to play in the process of achieving stabilized
population arid implementations of reproductive health services.
State government will launch systematic campaign to make
men realize their responsibility in empowering women.
3
State commission on women will be entrusted the
responsibility of identifying barriers of gender equity and
equality. Commission will also suggest measures to overcome
the problems.
More attention will be paid to encourage at least 30 percent
of girls in the age group 14-15 to complete elementary
education.
Total literacy campaign through Padhna-Badhna Samiti
covering the entire state is doing pioneering work to increase
literacy among men and women. Efforts will be intensified to
ensure 100 percent literacy amongst women aged 15-35 yrs.
Self-help groups will be created in each panchayat by the
year 2003. These groups will be assisted to achieve economic
independence.
• Certain regions in Madhya Pradesh are comparatively behind
other regions in term of infant mortality rate, maternal mortality
rate and total fertility rate, it will be our endeavor to specifically
and closely target these region and employ greater efforts to
ensure that this handicap is removed.
• The state is in the process of its latest human development
report, which will include working out human development
indices even at village level. We will make concerted efforts on
such pocket of villages, Community, and social groups, which
have high fertility rate.
• In urban areas special efforts will be made to tackle those
populations particularly slum areas, which have shown higher
IMR, MMR&TFR.
• The mission of the population policy of Madhya Pradesh is to
improve the quality of life of the people in the state by achieving
a balance between population, resources, and environment.
Rapid reductions in fertility and mortality rates will be achieve
for the population stabilization and improving the quality of life.
• In the state of Madhya Pradesh even the poorest of poor wants
to plan, his family, but our resources and services are falling
short in fulfilling this desire. I was deeply agonized to know that
23 percent of the total pregnancies taking place in Madhya
Pradesh are unwanted.
The health system will try to reach those families who are
willing to control their fertility, and the problem of unwanted
pregnancies has to be seriously heeded. A pilot project has
been started in the district Rajgarh to develop a framework to
identify the couple with unmet need and to convert their need
into acceptance through an effective service delivery system.
On the success of the framework, it would be replicated in the
other districts of the state.
• Private sector and the non-governmental organizations have
proven their ability in mobilizing the community support,
demand generation and awareness creation. NGOs can play
important role in providing health care services to the
population in the inaccessible and remote areas. NGOs
involvement in population stabilization efforts, providing
reproductive health care services and to impart skill base
training would be encouraged. For this purpose NGO
networks will be created through Mother NGOs.
Similarly, private sector potential will be harnessed to
provide quality reproductive health services. State govt, has
plan to provide soft loans to medical practitioners with
preference to lady medical practitioners for providing health
services in areas not effectively served by the public
institutions. Private sectors will also be utilized for promoting
social marketing of contraceptives.
• State has shown its firm determination towards the
implementation of the population policy. Constitution of the
State Population and Development Council under the
chairmanship of the Chief Minister is in process. Other
members of the council would include leader of opposition
party in the state, Ministers of the concern departments and
representatives
form
organized
sectors,
Women’s
organizations, trade unions and NGOs.
• State Population Resource Centre will be established. The
SPRC would provide technical support and suggest type of
measures to be taken from time to time to achieve the
desired goal of TFR 2.1. by the year 2011.
• Some of the initiatives taken by the state government:
Legal age at marriage has been made criteria for govt, jobs
and for sanctioning govt, loans and facilities.
Inclusion of Adolescent and Family life Education will be
made compulsory in all future NGO projects funded by the govt,
and the donor agencies.
Provision of safe drinking water.
An integrated Information, Education & Communication
strategy will also be formed to create awareness among
community.
Person having more than two children after 26 January 2001
would not be eligible for contesting elections for Panchayatas,
Local bodies, Mandis and Cooperatives. Govt, has also taken a
decision that person having more than two children after 26
January 2001 would not be eligible for govt, jobs and other
govt, benefits.
Awards will be given to Panchayati Raj Institutions and
Urban local bodies in the field of community support for
population stabilization.
Further the planned family has to be made a thing of pride
and for this people have to be involved in the programmes, to
provide new insight, new direction and modern thinking to the
society.
Madhya Pradesh Government has implemented its new
Population Policy with the hope that its success will contribute
in paving the way for the building of a modern Madhya
Pradesh.
Digvijay Singh
I.
Chief Minister Madhya Pradesh
H p s’-11
wy Jefer^b
I
Pa^ayyssilopom S
idaipphid gan^cj* *
f stTe^^alysi?
denc^Al inTe^
itions fNamada
Allen (1959:308.1^
ences
athematical Ecoiion.
edition.
(1982): Dynamic
heory. Academic
: ‘Strategic Analysis «
endence’. Journal a
Vol 84.
heoretic Approach t0
ary Confrontations’ j,
er, and G Schwodiaoa
e Theory, Institute fo,
Vienna.
momy of Internatioi^
<endence, MIT Pre^
spects
’ntemationi
ce’. E
mic Studiu
pp 165-80.
'itiul Games, John Wilq
k.
lels of Optimisation
ry of Economic Policj,
>ent of Economics, Iowa
nes, Iowa, US.
istence of an Optimal
Econometrica, Vol 37,
'olicies for Stabilisatn
istmcnt: A Global and
live’. Economic ari
>i 28. No 17, April 24,
of Development in dr
Global Economic
momic and Politick
25. June 22. pp I5»
Consensus Against the
nsus’. Economic
I 32. No 13. March 29.
id G J
uer (1984):
adratic. Closed-Loop,
i Game’. Journal l’l
ry and Applications,
51-60.
EPW from outside
subscription agents
India ihac ail foreign
irded to us and not
registered with us.
Manager
January 31, |99r
A0"
Population Programme in Ninth Plan
P H Reddy
rd
t» tko Ninth Five-Year Plan (1997-2002) has identified the three factors that contribute
lhe ^O^erow'th as- the large population in the reproductive age. higher fertility due to unmet need for
10
planning and high wanted fertility due to high infant mortality rate. How much do these factors 'ontnbu e
^nulation growth ? Although the paper recognises the need for promotion of male participation in family
,0,p PnS no strategy is spelled out. Other issues like the need to promote spacing methods incentives and
Pf enhves. family 'planning targets, demographic goals, etc. are not even mentioned in the Approach Paper.
£ preferred strategy to bring down the birth rate to be adopted is far from clear.
population programme. But the basic
INDIA is often cited as the first country in Sixth Plan, the health policy targeted a net question is whether there are enough
reproduction
rate
of
one
by
the
year
2000
he world to have started an official family
AD; a review, however, indicates that this resources to establish one PHC for every
fanning programme as far back as 1952.
5,000 population during the Ninth Plan
But the'family planning programme 1began goal would be reached only by the period
period. TTie Approach Paper makes no
2006-2011
”
[Planning
Commission
1985:
tobe implemented vigorously from the Third
mention of establishment of one PHC for
Five-Year Plan (1961 -66). In the Third Plan 2811. Thus, every time a demographic goal
5,000 population.
was
set.
it
was
either
revised
upwards
or
document, the planning patriarchs started
“Containing the growth rate of population”
deferred
to
be
achieved
in
a
later
year.
thinking in terms of “the objective of
is one of the nine priority objectives ol the
However,
it
may
be
mentioned
that
the
stabilising the growth of population over a
Ninth Plan and its serial number is five
reasonable period”. In pursuit of this achievement in CBR is likely to be close to [Planning Commission 1997:12]. How does
objective, policy-makers began to set family the target set for the Eighth Plan.
As can be seen from Table I, CBR was this compare with the population objective
planning method-specific targets for various
of the Eighth Plan? “Containment of
states and union territories and demographic stagnant at about 33 per 1.000 population population growth through active peoples'
iiom
1962
to
1985.
This
was
so
notwith
goals for the entire country. Much has been
participation and an effective scheme of
said about the ‘tyranny of targets'. But not standing considerable increase in the propor incentives and disincentives" was not only
tion
of
couples
effectively
protected
by
many people know the sad saga of
dilfrent family planning methods from less one of the six major objectives of the Eighth
demographic goals.
Plan, but also two in serial number, next only
Table I presents data on demographic than 5 percent in 1962 to 32 percent in 1985. to the objective of “Generation of adequate
This
anomalous
relationship
between
couple
goals set and actual achievement . It is clear
employment to achieve near full employment
that demographic goals were set as many as protection rate (CPR) and the CB R prompted level by the turn of the century" [Planning
some
social
scientists
to
analyse
the
situation
11 times between 1962 and 1992. The Third
Commission 1992.1:9]. We should not read
Plan set for the first time the demographic and conclude that India was in a demographic too much into the serial numbers of the
goal of reducing the crude birth rate (CBR) trap [Reddy 1989: 93-l02|.
populationobjectivcsinthe Eighlhand Ninth
to 25 per I .(XX) population by 1973. No one
Objectives
Plans. However, the objective in the Eighth
knows the criteria on the basis ot which (he
Plan was a little more detailed, while that
Since
the
reduction
in
the
CBR
achieved
demographic goal was set. In 1965. India
j.
r
—
r
*
Ninth Plan is brief. The Ninth Plan
far has not been satisfactory, people arc n
had a war with Pakistan and its economy so n'ting
eagerly to find out whether the Ninth Approach Paper docs not say anything about
.
suffered a temporary set-back. Instead of wai
•' j incentives and disincentives.
Fourth Five Year Plan immediately alter the Plan will chan out a new strategy m the
The Approach Paper has not only
implementation
of
the
family
welfare
Third Plan, there were three annual plans
identified the factors that contribute to high
programme.
The
direction
of
government
during 1966-69. The first annual plan
population growth, but also estimated the
(1966-67) set the demographic goal of thinking on the issue can be gleaned from percentage of their contribution [Planning
two
documents
the
document.
A
Common
reducing the CBR in lhe country to 25 per
Commission 1997: 59]. These are (1) the
1,000 population as expeditiously as possible. Approach to Major Policy Matteis and a
large sizcof the population in the reproductive
Minimum
Programme,
popularly
known
as
In 1968, a new demographic goal was set
age group and its estimated contribution to
the
Common
Minimum
Programme
(CMP),
to reduce the birth rate to 23 by 1978-79.
population growth is 60 per cent; (2) higher
Like this, demographic goals were set on released on June 5. 1996 by the 13-party
fertility due to unmet need for contraception
United
Front,
and
the
Approach
Paper
to
several occasions.
and
its estimated contribution to population
Mention must, however, be made of the Ninth Five-Year Plan. 1997-2002 [Planning growth is 20 percent; and. (3) high unwanted
Commission
1997].
The
CMP
document
fact that based on the recommendations of
fertility due to high infant mortality rate and
a Working Group on Population Policy contains a couple of small paragraphs under
its estimated contribution to population
[Planning Commission 1980], the National the sub-heading, ‘Drinking Water, Primary
growth is 20 percent [PlanningCommission
Health
Care
and
Housing
’
in
which
it
is
Health Policy [Ministry of Health and Family
1997:
59]. Let us examine briefly the three
Welfare 1983] set the goal of reducing the mentioned that the United Front government
factors in turn.
would
draw
up
special
plans
during
the
net reproduction rate (NRR) to one by 2000
AD by reducing the CBR to 21. crude death Ninth Plan period to ensure that, among
Large Size
tate to 9. infant mortality rate to less than otherthings, one primary healthcentre( PHC)
Table
2
presents
data on the number and
60 Per 1,000 live births and by increasing is established for a population of 5,000 (it
proportion
of
currently
married women
1‘ ................................................ ....................................... ^proportion of couples practising family is one PHC for30.000 population at present),
r’
Planning
to 60 per cent. But the Seventh Plan This is likely to make family planning
:-------services (CMW) in the reproductive age of 15-44
(1985-90) document said. “In the light of the more easily accessible to people. This is the years in 1961, 1971, 1981 and 1991. It is
immediately clear that there is a substantial
Progress made in the initial period of the closest lhe CMP document comes to
Gnomic and Political Weekly
January 31. 1998
239
increase in the number of CMW in the
reproductive age of 15-44 years between
1961 and 1991 .Even after making allowance
for the proportion of couples effectively
protected by different family planning
methods, the number of CMW in the
reproductive age would be more in 1991
than in 1961. The reason for the increase in
the number of CM W in the reproductive age
is not far to seek. Il is a direct result of high
fertility in the past. The result is sometimes
called ‘echo effect’.
Further analysis of data in Table 2 reveals
that the proportion of CMW in the age group
15-19 years in the total number of CMW in
the reproductive age has gradually declined
from a little over 15 per cent in 1961 to 9
per cent in 1991. The reason is obvious:
increase in age at marriage of girls. There
is also some decline’in the proportion of
CMW in the age group 20-24 years from
a little over 22 per cent in 1961 to a little
less than 21 per cent. As might be expected,
there is an increase in the proportion of
CMW in the older arc groups.
The proportion of couples with wives in
the child-bearing age in India effectively
practising some method of family planning
was about 22 per cent in April 1980. the
beginning of the Sixth Plan. 32 per cent in
April 1985 and about 40 percent in August
1988. But CBR was about 33 per 1,000
population in April 1980. in April 1985 and
in August 1988. Several scholars had
identified family planning programme factors
and community factors responsible for the
anomalous relationship between the CBR
and CPR JSrikantan and Balasubramanian
1988; Natrajan 1988;Pathak 1988;Gandotm
1988; Jolly 1988; Reddy 1988a; Reddy
1988b. Reddy 1988c; Gulati 1988]. One of
the community factors identified was an
increase in the proportion of females in the
age group 15-29 years between 1971 and
1988 and the consequent increase in the
CBR [Reddy 1988c: 1811]. As can be seen
from Table 2. this is no longer the case. On
the contrary, there is a decline in the pro
portion of CMW in the age groups 15-19
years and 20-24 years.
Another factor identified for lack of decline
in the CBR between 1980 and 1988 was
improvement in the health and nutritional
status and the resultant improvement in the
reproductive functions of women below 30
years of age and the consequent increase in
their marital fertility rates. There were also
increases in the total marital fertility rate and
general marital fertility rate during the period
[Reddy 1988c: 1811 ]. It would be important
to examine whether this factor continues to
contribute to an increase in the CBR. Table
3 presents data on age-specific marital fertility
rates, total marital fertility rates and general
marital fertility rates in India in 1988 and
1993. It may be noted that in none of the
240
six five-year age groups of CMW in the
reproductive age is there an increase in
fertility between 1988 and 1993. On the
contrary', there is a decline in the fertility of
all the six five-year age groups. There are
also declines in the total marital fertility rale
(TMFR) and general marital fertility rate
(GMFR) between 1988 and 1993. This does
not mean that there is no improvement in
the health and nutritional status of women.
The reason for decline in the age-specific
marital fertility rates. TMFR and GMFR is
undoubtedly increase in the proportion of
couples with wives in the child-bearing age
practising some method of family planning.
Thus, the Approach Paper, is in good
company when it said that the large size of
the population in the reproductive age group
was one of the factors for high population
growth rate in the country. But it is not clear
how its estimated contribution to population
growth is 60 per cent.
Unmet Need
Unmet need for contraception i=
as one of the three factors that contribute lo
high population growth in India and
contribution is estimated to be 20 per cent
Incidentally, what is meant by unmet need?
Table 3: Age-Specific Marital FERnurrY
Rates. Total Marital Fertility Rates and
General Marital Fertility Rates in India
Age Group (Years)
1988
1993
15-19
20-24
25-29
30-34
35-39
40-44
TMFR
GMFR
259.0
319.8
227.9
138.5
81.2
38.9
5.4
170.7
236.1
307.9
207.6
121.3
65.7
31.8
4.9
153.7
Notes: TMFR = Total marital fertility rate
GMFR = General marital fertility rate^B
Table I: Demographic Goals Set and Actual Achievement
Year
Specified Demographic
Objective (CBR)*
Year by Which the
Goal Was io Be
Achieved
Actual
Achievement
1962
1966
1968
1969
25
25
23
32
25
30
25
30
25
30
25
1973
as expeditiously
1978- 79
1974-75
1979- 81
1979
34.6
30
31
27
21
29.1
26.0
1982-83
1985
1990
2000
1990
1997
1974
April 1976
April ;977
January 1978
Cei.tral Council of Health
National Health Policy (1983)
Seventh Plan
Eighth Plan
1984
1978-79
1983-84
1978-79
1983-84
33.3
34.5
33.8
33.7
33.8
33.3
33.7
33.3
33.7
33.8
32.9
29.9
29.9
Note: * CBR = Crude birth rate.
Source: Planning Commission. Eighth Five-Year Plan. 1992-97. Vol 11. Government of India, Ne*
Delhi. 1992.
Table 2: Number and Proportion of Currently Married Women in the Reproductive Age in Ind»a
Age Group
(Years)
15-19
20-24
25-29
30-34
35-39
40-44
Total
I
1961
1971
1981
1991
12.024,245
(15.25)
17.557,341
(22.27)
16,997,625
(21.56)
13,581,216
(17.22)
10.320,406
(13.09)
8.366,885
(10.61)
78,847,718
(100.00)
12.325,666
(13.23)
13.079,599
(11.66)
23,933,293
(21.34)
23.559,607
(21.00)
19,730,736
(17.59)
17.675.654
(15.76)
14,192,716
(12.65)
112,171,605
(100.00)
12,983,391
(9.00)
30.236.237
(20.96)
32.599.649
(22.60)
27,103,296
(18.79)
23.454,214
(16.26)
17,871.167
(12.39)
144.248.054
(100.00)
19.122,792
(20.53)
19.447,045
(20.88)
16.801.352
(18.04)
14,309,752
(15.36)
11.137,240
(11.96)
93,143,847
(100.00)
Note: Numbers in parentheses are percentages to total.
The
met
in«u
repr
wan
any
spa<ofs
CM
they
havi
any
the i
neec
T
is ar
surv
has
that
chil<
atle
bef
this
corr
fire
repr
wan
are |
metl
to be
then
fam
info
mad
do r
not
that
fam
teas
law
but
fam
serv
surv
a sp
a te
chib
T
met
in th
a cl
que?
that
year
spar
que
rese
for,’
may
V.
the
the’
bee
that
Peo
the
Ec(
Economic and Political Weekly
January 31
■ so
g
1
MB f
>Ieed
iception is identify
irs that contribute^
h in India and k
d to be 20 per ce^
ant by unmet neej
Marital Fertujty
trtiuty Rates and
ltty Rates in India
988
1^93^
9.0
9.8
7.9
8.5
1.2
8.9
5.4
0.7
236.1
307.9
207.6
121.3
65.7
31.8
4.9
153.7
•Hal fertility rate
narital fertility rate
r
Actual
Achievement
34.6
33.3
34.5
33.8
33.7
33.8
33.3
33.7
33.3
33.7
33.8
32.9
29.9
29.9
ment of
a. New
jctive Age in India
1991
12,983,391
(9.00)
30,236,237
(20.96)
32.599,649
(22.60)
27,103,296
(18.79)
23.454.214
(16.26)
17,871,167
(12.39)
144.248,054
(100.00)
nuary 31, 199$
nniet need for terminal family planning
*s
on l^e ^as’s ot survey
rniation on the number of CMW in the
reductive age who say that they do not
any more children but are not practising
* terminal method; the unmet need for
^cing methods is estimated on the basis
[survey information on the number of
in the reproductive age who say that
. cy want to wait for at least two years before
living another child but are not practising
any temporary family planning method: and
Recombined estimate gives the total unmet
need [Robey, Piotrow and Saltern 1995: 6].
To my mind, the concept of unmet need
is an artifact of large-scale family planning
surveys. In India, family planning programme
has been propagating for the last 45 years
Rat a couple should have only two or three
children and that there should be a gap of
at least three years between two children. To
he fair to the family planning programme,
this message has reached every nook and
corner of India. So when survey interviewers
fire two questions at the CMW in the
reproductive age asking them whether they
want any more children and whether they
are practising any terminal family planning
method, some of them reply in the negative
to both the questions. The survey researchers
then estimate the unmet need for terminal
family planning methods on the basis of such
information. Three comments need to be
made here. The first is that the respondents
do not really mean what they say: they do
not want any more children. The second is
that they may not be practising a terminal
family planning method for a variety of
reasons such as unwillingness of mother-inlaw or husband, religious proscription, etc.
but not necessarily due to the failure of the
family planning programme to provide
services. The third comment is that many
surveys have revealed that some couples use
a spacing method like IUD in the place of
a terminal method to limit the number of
children.
To estimate the unmet need for spacing
methods, survey researchers ask the CMW
in the reproductive age whether they want
a child in the next two years. The other
question put to those respondents who say
that they do not want a child in the next two
years is whether they are practising any
spacing method. Some of them answer the
Question in the negative. Then survey
researchers rush to estimate the unmet need
for spacing methods. Here again all of them
^ay not be telling the truth.
Why do some of the respondents not tell
foe truth? They do not tell the truth because
diey want to please the interviewers and
ecause they want to create the impression
nat they are also well informed, modem
People. The respondents know very well that
be interviewers will not be around the next
Economic and Political Weekly
day to check the veracity of their responses.
A study of the causes of demographic
change in south India, employing micro
approaches, including participant
observation, found many discrepancies in
the responses of CMW in the reproductive
age in the initial surveys and in the later
informal discussions [Caldwell, Reddy and
Caldwell 1988]. The comment of a noted
anthropologist about the way large-scale
family planning surveys are conducted in
India and about the validity and reliability
of data generated by such surveys is worth
quoting: "The manner in which survey
workers elicited information was not always
conducive to providing useful data.
Commonly, for example, a village woman
finds herself suddenly confronted by a young
lady, carrying official-looking papers, who
fires a series of questions at her. The village
woman takes in the young lady’s austerely
elegant sari, her thin, expensive bangles, her
carefully tended hair, smooth complexion,
and her soft hand cleverly manipulating a
ball-point pen. She is likely to give the kind
of answers that she believes an educated
person would like to hear” [Mandelbaum
1974: 14]. Though this comment was made
more than 20 years ago. it is valid even
today. The point that I am trying to make
is that allowance has to be given for such
defects of surveys and that not all the unmet
need estimated by survey researchers is really
unmet need.
If the motivation of CMW in the
reproductive age or of couples with wives
in the reproductive age is really strong to
limit the number of children or postpone the
birth of the next child, they will go to a
primary health centre or any government
hospital, irrespective of its distance, and
adopt a suitable family planning method.
Alternatively, they can adopt traditional
methods like coitus interrnpfus or sate period
method. These traditional methods may be
unreliable at the individual level, but they
can reduce the aggregate birth rate
considerably. The major portion of the
Table 4: Number of Vasectomies and Tubectomies and Vasectomies as Percentage of Total
Sterilisations in India. 1956-57 to 1992-93
Year
I
1956- 57
1957- 58
1958- 59
1959- 60
1960- 61
1961- 62
1962- 63
1963- 64
1964- 65
1965- 66
1966- 67
1967- 68
1968- 69
1969- 70
1970- 71
1971- 72
1972- 73
1973- 74
1974- 75
1975- 76
1976- 77
1977- 78
1978- 79
1979- 80
1980- 81
1981- 82
1982- 83
1983- 84
1984- 85
1985- 86
1986- 87
1987- 88
1988- 89
1989- 90
1990- 91
1991- 92
1992- 93
Total
January' 31. 1998
Number of Sterilisations
Vasectomy
Tubectomy
2
3
2.834
5.411
I 1,300
22.624
44.167
75,999
1.12,923
1.36.259
2,95,030
4,32,457
7.85.378
16,48.152
13,83.053
10.55,860
8,78,800
16.20,076
26,13,263
4.03,107
6.11,960
14,38.337
61.99,158
1.87,609
3,90,922
4,72.687
4,38,909
5,73.469
5,85.489
6,61,041
5,49.703
6,39,477
8,09.605
7,54.086
6,17,331
3,41.581
2,54.905
1,74,201
1,50.496
2.73,77,659
5,965
11,178
18,137
25,187
30,232
41.972
48,099
58,816
74.850
70,660
1.01,990
1.91.659
2.81,764
3,66,258
4,51,114
5.67.260
5.08,593
5.39.295
7,41,899
12.30.417
20.62.015
7,61.160
10,92,985
13.05.237
16.13,861
22.18.905
33,97,700
38,71,181
35,34,880
42.62.132
42.33.580
41.85.670
40.60,846
38.46.582
38.70,650
39.15.838
41.35.922
5,77.34.444
Total
4
8,799
16,589
29.437
47,811
74.399
1.17,926
1.61.022
1.95,075
3,69,880
5.03.117
8.87.368
18.39.811
16.64,817
14,22.118
13,29.914
21.87,336
31,21,856
9.42.402
13,53,859
26,68.754
82.61.173
9,48.769
14,83.907
17,77,924
20.52.770
27.92.374
39.83,189
45,32.222
40.84,583
49,01,609
50,43,185
49.39.756
46,78.177
41,88.163
41,25,555
40.90.039
42.86.418
8,51,12.103
Percentage of
Vasectomies
to Total
5
32.21
32.62
38.39
47.32
59.37
64.45
70.12
69.85
79.76
85.96
88.50
89.60
83.10
74.20
66.10
74.10
83.70
42.80
45.20
53.90
75.00
19.80
26.30
26.60
21.40
20.50
14.70
14.60
13.50
13.00
16.10
15.30
13.20
8.20
6.20
4.30
3.50
32.17
241
European fertility decline in the 19lh and
early 20th centuries occurred long before the
widespread use of modem contraceptives
[Notestein and Stix 1940: 148). The French
birth rate dropped almost continuously from
the Napoleonic period onwards to 1930s
with the use of traditional methods [Beaver
1975: 6).
How did the Approach Paper arrive at the
estimate of 20 percent contribution of unmet
need to high population growth? It is perhaps
taken from the ‘findings’ of the National
Family Health Survey (NFHS) conducted in
1992-93 [International
Institute for
ruiu.miu.i
OUV..W, .
Population Sciences 1995: 188). But the
fmdinrofth^NFHS i/thal the CMW with
desire for as many children as possible,
objection from elders/spouse. personally
anamst family planning, family planning
acainst religion and no one to help at the
time of bed-rest after tubectomy or in the
event of complications arising from the
adoption of a family planning method (Reddy
and Gopal 1993: 91-92). Thus, the
assumption of the Approach Paperlhal only
three factors contribute to high population
growth is not correct.
Objectives and Strategies
The twin strategies proposed to be ad0^
ted arc (1) assessment of the needs fQr
reproductive and child health (RCH)
The/
primary health centre level and under
nrogf3’
toward
taking of area-specific micro-planning, and
the Pl
(2) provision of need-based, client-centre^
increas
and demand-driven high quality
jplanrservices [Planning Commissioh 1997: 59]
All these years, the emphasis was Ori
words'
that th
macro-planning and population-based
approach. The shift to area-specific micro,
on
planning and need-based approach is a
resp°f
grow1
welcome one.
The Approach Paper has declared that the
of the
a later
programmes will be directed towards filling
specu
the gaps in infrastructure and manpower,
Tat
providing additional resoures to poorly
vasec
performing districts, ensuring uninterrupted
jnies(
supply of drugs, vaccines and contraceptives,
and
and promoting» male participation in family
sterif
planning. These arc all important measures
inwt
which will go a long way in improving RCH
the fa
services. We will have occasion to say more
the I
about male participation.
The Approach Paper has also contemplated avail
first!
enhancement of coverage of family welfare
in th
services by involving private medical prac
32 p
titioners. practitioners of Indian Systems
peri
of Medicine and Homoeopathy, panchayat
1971
raj institutions, industries, agriculture
inep
workers and labour representatives [Plan
ovei
ning Commission 1997: 60). These could
cent
also be called strategies to improve family
toa<
welfare services. But the contemplation
ofv
should go beyond rhetoric and identify
of r
mechanisms through which the measures
T
would become effective.
mu,
On the basis of the three factors identified
and thel/estimated contributions to high
population growth, the Approach Paper has
set out to state the objectives of the population
unmet need for family planning accounted
for about 20 per cent. I do not think that the programme in the Ninth Plan and identified
finding of the NFHS that the need for family the strategies to achieve the objectives. But
planning of about 20 per cent of the CMW before that, the Approach Paper has said,
has not been met and the Approach Paper's “While the population growth contributed
estimate of 20 per cent contribution of unmet by the demographic factor of large population
need for family planning to high population in the reproductive age group will continue,
growth are the same. Incidentally, in the the other two factors need effective and
developing world as a whole also, about 20 prompt remedial action" [Planning Com
per cent of CMW in the reproductive age mission 1997:59). Thisis adefeatisl attitude.
have an unmet need for family planning While it is not possible to reduce the large
size of the population in the reproductive age
[Robey, Piotrow and Salter 1995: 6).
group, it should be certainly possible to
Infant Mortality
reduce its contribution of ’60 per cent’ to
The Approach Paper has rightly identified the high population growth.
The twin objectives arc. therefore, limited
high i n f ant mort a 1 i t y rate as one of t he f actors
contributing to high population growth. It to (1) meeting the unmet need for contra
is true that unless couples are reasonably ception, and (2) reducing the infant and
certain that the two or three children born maternal morbidity and mortality so that
to them will survive to adulthood, they will there is a reduction in the desired number of
not accept the idea and some method or the children [Planning Commission 1997: 59).
other of family planning.
A quick examination of the decline in
crude death rate and infant mortality rate
INDIA’S RELATIONS WITH
reveals that the former has declined by about
RUSSIA AND CHINA : A New Phase
42 per cent from about 16 per 1.000
population in 1975 to a little over nine in
M. Rasgotra and V.D. Chopra
1994, while the latter has declined by about
Foreword by: I.K. Gujral
48 per cent from 140 per 1,000 live births
The present volume covers a broad canvas of issues corl^er^lrJ^
in 1975 to 73 in 1994. Although infants have
India's relations with Russia and China after the end of the. Cold
benefited slightly more than adults from the
War.
Tiie main merit of this study is that it has attempted to
improvement in living conditions, infant
critically examine India's relations with Russia and China on the
mortality rale is so high that it cannot create
basis of concrete evidence as it emerged till the end of 1996.
confidence in the minds of couples to accept
The editors have divided this study into three sections, l.e. Indiaa family planning method, especially a
Russia: Friendly Relations. India-China: Open Door Policy, Indiaterminal method.
Russia-China. Economic Relations. Sixteen Chapters de ine_
The Approach Paper has estimated that
different aspects of political, economic and cultural relations ol
the contribution to high population growth
these countries. India's topmost academicians, scholars and
because of high desired level of fertility due
diplomats have contributed their articles for this study. Diplomats,
to high infant mortality rate is 20 per cent.
professors, Journalists and scholars have contributed their studies
How this contribution is estimated is not
clear.
for this work.
Rs. 450
23cm
Apart from the three factors identified by
251pp
1997
ISBN: 81-212-0559-X
the Approach Paper, there could be other
factors that contribute to high population
5. Ansari
Fax: 91-(011>3285914
growth. A large-scale survey conducted in
i
jgsx
•
E-Mail gyaribook®del2.vsnl.netm
Karnataka has revealed that the reasons
1
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for non-acceptance of family planning, as
cyan!
5. Ansari Road, New Delhi-1 W 002
.
given by CMW in the reproductive age,
L- I
included desire for son. desire for daughter.
Economic and Political Weekly
242
January 31, 199S
w:
per
19’
inc
du
no
J cc
19
thi
in
dt
F
ni
o
a
1
v
t
z
w
I
kJ
|||
aposed to be
of the needs
-s for
ealth(RCH)atl,
,evel and undJ
icro-planning,^*
sed, client-centnj
gh quality
nission 1997: 59?
mphasis was 2
5opulation-baS(J
ea-specific micro,
id approach js,
is declared that the
ted towards fli|jng
2 and manpower
so tires to poorly
-ing uninterrupted
nd contraceptives,
-‘ipation in family
iportant measures
1 improving RCH
asiont
'more
also contemplated
of family welfare
ate medical pracIndian Systems
lathy, panchayat
ics, agriculture
sentatives [Plan»0]. These could
improve family
: contemplation
ic and identify
:h the measures
e
nceni.
the Cold
npted to
a on the
1996.
e. Indlay, Indla5 define
itlons of
ars and
-plomats,
■ studies
Ks. 450
.iary 31, 1^
I
I
Male Participation
Approach Paper has rightly said that
will be directed, inter alia,
“promoting male participation in
^Jlanned parenthood movement and
^sing level of acceptance of vasectomy”
jJni ng Commission 1997: 60]. In other
thc Approach Paper has admitted
* the onus of family planning has been
^omen and that men have been avoiding
oO£onsibility in controlling population
wth- Has this been so since the inception
%e family planning programme? Or is it
°|ater phenomenon? In any case, it is worth
neculating about the reasons for it.
Table 4 presents data on the number of
vasectomies (male sterilisations), tubectomieslfemalesterilisations), total sterilisations
and vasectomies as percentage of total
sterilisations in India from 1956-57. the year
in which sterilisations were introduced into
the family planning programme, to 1992-93.
the latest year for which information is
available. It is immediately clear that in the
first four years, lhe proportion of vasectomies
in the total sterilisations ranged from about
32 per cent in 1956-57 to a little over 47
percent in 1959-60. Between 1960-61 and
1972-73, the proportion of vasectomies
increased enormously ranging from a little
over 59 per cent in 1960-61 to nearly 90 per
cent in 1967-68. A number of factors seemed
to account for this increase in the proportion
of vasectomies, one of which is organisation
of mass vasectomy camps.
The proportion suddently dropped to
much less than 50 per cent in 1973-74 and
1974-75 before increasing to about 54
percent in 1975-76 and 75 per cent in
1976-77, the two emergency years. The
increase in lhe proportion of vasectomies
during the two emergency years was not
normal: it was induced by compulsion and
coercion [Panandikar. Bishnoi and Sharma
1978]. Once the emergency was lifted and
the Janata Party came to power at the centre
in 1977, the proportion of vasectomies came
down to less than 20 per cent in 1977-78.
Prom then on. the proportion of vasectomies
never increased. In 1992-93, the proportion
°f vasectomies in the total sterilisations
accounted for as low as 3.5 percent. Between
1956-57 and 1992-93, the proportion of
Vasectomies accounted for less than onethird of the total sterilisations.
Reasons
. It is worth speculating on reasons, even
’ some of them are questionable, for the
. T decline in the proportion of vasectomies
n lhe total number of sterilisations. Every
Vasectomy acceptor should use condoms in
^ven or eight intercourses after vasectomy.
. Is,s necessary because there will besperms
be semen left in lhe seminal vesicle after
Gnomic and Political Weekly
vasectomy. In the beginning, condoms were
not given to all the vasectomy acceptors and
not all the vasectomy acceptors who were
given condoms used them. Further, in the
mass vasectomy camps, especially during
the emergency period, vasectomies were not
done properly. As a result, wives of many
vasectomy acceptors became pregnant. This
created a serious social problem. It is not
fortuitous that demand for vasectomies
declined sharply after the emergency. Also,
wives of vasectomy acceptors were subjected
to psychological trauma whenever their
menstruation was delayed by two or three
days. Therefore, women thought and still
think that it would be safer if they accept
tubectomy.
There is lhe belief, perhaps to a lesser
extent now than before, that vasectomy is
‘castration’ and that vasectomy acceptors
lose their virility. There is also the belief that
vasectomy is an ‘operation’ and that it is
likely to result in physical disability and that
it will not be possible for lhe vasectomy
acceptors to carry the same heavy loads
which they were carrying earlier and do the
same hard work which they were doing
earlier. There is the more serious
apprehension that the ‘operation’ may result
in death and should this occur to the
vasectomy acceptor, who is the main
breadwinner, it will spell disaster io the
family. All these raise the question of
effectiveness of information, education and
communication (IEC) programme in family
planning. Admittedly, IEC programme does
not seem to be effective in removing
misconceptions about different family
planning methods, including vasectomy.
One more factor that seems to be
contributing to a decline in the proportion
of vasectomies or to an increase in the
proportion of tubectomies is the differential
role played by the female and male health
workers. Female health workers are more
successful in motivating women for
tubectomy than male health workers in
motivating men for vasectomy. There are
two reasons for this. One is that female
health workers are more sincere and more
hard working than male health workers. It
is not an exaggeration to say that whatever
success the family planning programme has
achieved is mainly due to the efforts of
female health workers. The other reason is
that the nature of services (such as lhe
provision of ante-natal, intranatal and post
natal services) provided by female health
workers enables them to more easil y establish
rapport with married women in the
reproductive age and to motivate them for
tubectomy. The nature of services (such as
lhe provision of services for malaria,
tuberculosis, leprosy, etc), provided by male
health workers does not facilitate the
establishment of rapport with men whose
January 31. 1998
wives are in the child-bearing age and
motivate them for vasectomy, as all suffer
from the diseases.
Yet another reason is that when women
go to hospitals for delivery, they accept
tubectomy there. The post-partum tubectomy
is preferred by women for two reasons. For
one thing, post-partum tubectomy seems to
be easier than interval tubectomy. And
secondly, women need not stay in bed for
additional days because of tubectomy since
they will, any how. be in bed for post-partum
rest. This fact also contributes to a higher
pro portion of tubectomies in the total number
of sterilisations.
Thus, a combination of factors has
contributed to a virtual disappearance of
demand for vasectomy. Even in the adoption
of spacing methods, men lag behind women.
In India, in 1993, 8.3 per cent of the CMW
in the reproductive age were effectively
protected by spacing methods (6.3 per cent
by IUD and 2 per cent by oral pills), as
compared with 4.9 per cent of men with
wives in the child-bearing age who were
using condoms. Thus, family planning has
become the sole responsibility of women.
The situation should not be allowed to
continue any longer. The 1EC programme
should be improved, condoms provided
without interruption andolher measures taken
to generate adequate demand for vasectomy
and male spacing methods and make men
share in family planning responsibility.
Other Issues
There arc other issues which arc relevant
to the population programme but are not
raised by the Approach Paper. These arc
promotion of spacing methods, application
of incentives for family planning acceptors
and disincentives for non-acccptors. family
planning method-specific targets for all the
states and union territories, lhe number and
proportion of couples to be protected by
different family planning methods, and
demographic goal to be achieved by the end
of the Ninth Plan period.
Right from the inception of the family
planning programme, emphasis has been on
limiting the number of children and not so
much on spacing the children. As a result,
sterilisation has been promoted and spacing
methods neglected. Of all the family planning
acceptors, sterilisation acceptors account for
more than 80 per cent and acceptors of
spacing methods for less than 20 per cent.
Generally, couples accept sterilisation when
they are somewhat old and when they already
have more children than the number
propagated by the family planning
programme. The mean age of tubectomy
acceptors at the time of accepting tubectomy
was a little over 36 years in 1974-75 and
a little over 29 years in 1991 -92. The mean
number of children of women at the time
243
of accepting tubeclomy was 3.7 in 1980-81
anc 3.2 in 1991-92. Though there is
considerable decrease in the mean age of
tubectomy acceptors, the reduction tn the
mean number ol children is not much. The
mean age of vasectomy acceptors at the time
of accepting vasectomy was close to 33
years in 1974-75 and a little over 32 years
in 1991-92. The mean number of children
of men at the lime of accepting vasectomy
was 3.5 in both 1980-81 and 1991 -92. Thus,
there is little reduction in the mean age of
vasectomy acceptors and no reduction at all
in the mean number of their children. In
order to have significant reduction in
population growth, especially in a relatively
short period, it is absolutely necessary' to
promote the adoption of spacing methods by
young couples. But the Approach Paper is
silent about the importance of promoting
spacing methods.
The Eighth Plan made incentives and
disincentives as a strategy to promote family
planning. But no mention is made of
incenti ves and disi ncent i ves in t he Approach
Paperlo the Ninth Plan. Of course, the issue
of incentives and disincentives bristles with
controversies. Some argue that since Indian
family planning programme is a voluntary
one, no incentives should be given to lure
couples to accept family planning. Others
argue that the term ‘incentives’ is a misnomer
and that ’compensations’ should be given,
especial I y to the poor, for the wages foregone
during the post-sterilisation and post-1 UD
insertion rest period. The latter seems to be
a valid argument. But administration of
incentives only to the poor is difficult.
Therefore, incentives may be given to all the
sterilisation and lUDacccptors. Disincentives
to non-acceplors of family planning raise
many ethical issucs.Thcreforc.it is ad visable
not to apply disincentives to non-acccptors
or their children.
In the past, family planning method
specific targets were set for all the states and
union territories. But because of the ‘tyranny’
created by the targets for both family planning
workers and couples, these have been
discontinued from 1996-97. It is like throwing
away the baby with bath water. The
performance of family planning programme
in 1996-97 seems to have suffered a set-back
in many states because of the target-free
approach. It is necessary to have targets
which will serve as guide-posts towards
which action should be oriented. Of course,
care should be taken not to use coercion or
compulsion in achieving the targets.
In the previous five-year plans, the number
and proportion of couples to be protected
by different family planning methods and
the demographic goal of reducing the crude
birth rate to a particular level used to be
fixed. But the Approach Paper makes no
mention about them. Perhaps the final
244
document of the Ninth Five-Year Plan will
contain all the details about the family welfare
programme.
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Caldwell. John C . P H Reddy and Pat Caldwell
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Jolly. K G (1988): ‘Strengthening Demographic
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a paper presented al the National Workshop
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February 10-11.
Mandelbaum, David G (1974): Human Fertility
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February 10-11.
Notestein. Frank, W and Regine K Stix (|g.
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Sharma (1978): Family Planning under
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yadhya Praae*
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(Karnataka)’, Population Centre (mimeo),
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v V Bham
aluating
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Pranab Mi
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BJP's Real Ag
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Letters to Ed
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Patriarchal Hierarchy
—Rossana Barragan
Wrestling with the Connotation of Chinese ‘Minzu’
The Return of Keppetipola’s Cranium: Authenticity in
a New Nation
—Zhang Haiyang
econoh
I
264 Shahid E
Phones 2f
—Nira Wickramasingh'
Globalisation, Nationalism and Economic Policy Reform
—Baldev Raj Nayar
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Economic and Political Weekly
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Etftorial ct
January 31»
1
EMai
Hp ^-12-
Global Population Growth, Economic
Development and Environmental Impact
Case Study of India, 1991-2100
Mahinder Chaudhry
The nature ofenvironmental problems depends upon the level ofeconomic development, the nature ofindustrialisation
the degree ofurbanisation and the effectiveness ofpublic policies. This article examines the impact ofpopulation growth
and economic development separately, but with reference to the. conjectured global warming between 1991 and 2100
with special reference to India.
I
Introduction
BOTH developed and developing economies
face the challenge of sustained economic
development without environmental
damage. Although sustained economic
growth is a necessary condition for
eradication of poverty and wide-spread
increase in human welfare, it is by no
means a sufficient condition. Economic
progress has. in general, potential adverse
environmental effects. The evidence of it is
not lacking in the industrialised as well as
in the less developed countries. The
environmental damage that is global in
nature and irreversible over a very long
time underscores the truly international
nature of the problem. Since (he ‘external
diseconomies’ associated with environmental
damage are not a part of the private (Firms
and households) costs, the role for the
national public policy becomes imperative.
Also the environmental impacts which arc
global in nature necessitate policies at the
international level. The formulation of
economic development strategics with full
consideration for environmental concerns
must be based on accurate and clearer
understanding ol the problems involved.
The nature of environmental problems
depends upon the level of economic develop
ment (gross national product per capita), the
nature of industrialisation, the degree of
urbanisation, and the effectiveness of public
.
policies. In general, thedevcloping countries
experience immediate environmental
problems related to scarcity and safety of
drinking water: inadequate sanitation
facilities: air pollution in urban areas; soil
depletion and degradation: indoor smoke
from burning biomass (wood.coal, anddung);
and outdoor smoke from burning coal for
industrial production. In addition to the direct
negative effects on human and animal health,
the economic productivity is significantly
reduced. In contrast, the industrialised
socicticscncounteradillercnt set of problems
such as carbon dioxide emissions (CO.),
petrochemical smog, depletion of sphene
ozone, acid ram. and hazardous wastes. Ever
Econiiinic .Uhl polilical Weekly
expanding industrial production, agriculture,
and transportation systems are endangering
the sustainability of the healthy globe.
This paper examines the impact of
population growth and economic develop
nearly two-thirds of global warming. The
contribution oi deforestation to total carbon
emission is projected to decline from 12 per
cent in 1985 to less than 3 percent in 2100.
Following the World Bank classification’
ment separately, but with reference to the
conjectured global warming between 1991
and 2100. The exercise is primarily based
on the CO, emissions which account for
countries, the total world increases in CO,
emissions over the next century are assessed
within these groups of countries. India is
scheme of low, middle, and high income
Table I: Population Size Estimates and P
Projections, and Gross National Prodcct Per Capita
by the World Bank Classification of Group of Countries. 1991-21 (X)
Total
World
Population Size (millions)
1991
2(XX)
2025
2100
Economic development
GNP per capita (1991) USS
Notes:
5,350
6,111
8.247
12.036
Low Income Middle Income
Countries
Countries
(a)
(b)
3.127
3.686
5.184
7,784
1.401
1,561
2,140
3.285
High Income
Countries
(c)
India
822
866
1,017
1,365
1.635
864
922
966
(d)
4.010
350
2.480
21.050
(a) Low income countries arc those with a GNP per capita of U.S S 635
330
or less in 1991.
(b) Middlcincoinccounincsarefhosuwi(haGNPpcrcapitaofinorcihan$635 bullcss than
S 7.911 in 1991.
(c) High income economics are those with a GNP per capita of $ 7.911 or more tn 1991
(d) India is included in the low-income countries.
Sources: World Dcvrlopmeni Report I9V.I (June 1993). World Bank Working Paper Scries Number 601
(February 1991).
Table 2; Total and Pi r Capita Carbon Dioxide (CO.) Emission-*
_______________
by Group of Countries and Total
World. 1991 to 2KX)
Total
World
Low Income Middle Income High Income
Countries
Countncsb
Countries
India"
Total CO,
I Pgr (Petagrains.
i e. IO|$ grains) of CO. per year)
I99I'1
2(XX)U
2025
2100
6.79
8.13
2.03
2.73
12.45
2.10
2.45
5.24
30 09
12.30
3.63
9.94
1.27
0 65
0.74
1.01
1.58
CO, Increase (Petagrams)
‘1991
20(X)
2025
2100
1.33
1.51
2.50
1.50
1.57
1.70
3.03
2.66
2.95
3.58
7.85
0.53
0.75
1.38
2.58
3.24
3.42
3.88
8.13
0.65
0.74
1.01
1.58
Notes'.
(a) Including emissions from deforcsiaiion and cement production:
(h) For middle-income countries values obtained by residual method.
(c) India included in low income countries; data for'low income countries assumed for
India.
(d) For years 1991 and 2()()() linear interpolation between 1985 and 2025 values
Stmr< es: US Environmental Protection Agency. Poticv Opn.ms lor Siabilisu^ Global Climafe
Report to C ot^rcss. Washington. DC 1990; data adapted by Bongaarts (199'’)
December 9. 1995
3163
Chart 1: Population Without Safe Water and Country Income Levels; Global and India
Population without safe water
Per cent
i
—
.. j -. ...
0
100
Per capita income (dollars, log scale)
1 India GNP US $ 350 (Log10 = 2.544 in 1990)
2 India GNP US $ 985 (Loglo = 2.993 in 2025)
Notes: (a) Global: based on cross-country regression analysis (1980s data).
(b) India: gross national product US $ 350 in 1990.
Source: Adapted from World Bank data (1992).
Chart 2: Urban Population Without Adequate Sanitation and Country Income Levels.
Global and India
Percent
70 —
Urban population without adequate sanitation
60
40
■
•
20
0
I.OO.OOO
Per capita income (dollars, log scale)
1 India GNP US $ 350 (Log1(i = 2.544 in 1990)
2 India GNP US $ 985 (Log,,, = 2.993 in 2025)
Notes', (a) Global: based on cross-country regression analysis (1980s data).
(b) India: gross national product US’S 350 in 1990.
Source: Adapted from World Bank data (1992).
treated as a separate group by itself. The
basic data estimated by the US Environmental
Protection Agency (EPA) (1990) and by the
Intergovernmental Panel on Climate Change
(IPCC) (1991) are employed for analytical
purposes.
Section II outlines the scientific framework
of the climate change and projected global
warming. As an illustration of the economic
costs involved from the projected global
warming, the findings about the US economy
as estimated by Cline (1992) are highlighted.
Section III discusses the decomposition
process and presents the findings. The
period under study is divided into two sub
periods: between 1991 and 2025: and
between 2025 and 2100. Section IV examines
3164
environmental scenarios for India for a
medium-term period of 35 years (1991 -2025)
with respect to safe water supply, sanitation
facilities, urban concentration of particulate
matter, and urban concentration of urban
sulphur dioxide. The concluding remarks
follow in the next section.
II
Economics of Global Warming
The global warming or the greenhouse
effect is the process of heal trapping due to
rising atmospheric concentrations of CO,
and other gases emitted from deforestation,
the burning of fossil fuels, and other human
activity. These CO, gases arc transparent to
incoming shortwave solar radiation but
opaque to outgoing long-wave (infra-red)
radiation from earth. The scientists estimate
that the natural levels of these gases raise
the earth’s average temperature by some
33"C, from -18"C to +15"C.The General
Circulation Models (GMCS) prepared by
the international expert climatologists
estimate that “a doubling of carbondioxideequivalent above preindustrial concentrations
would increase global mean temperatures by
a best-guess estimate of 2.5"C, with typical
bounds of 1.5*’C and 4.5 ’C [Cline 1992]. It
is further projected that this doubling of
carbon dioxide-equivalent is expected to
arrive as soon as year 2025 under the
assumption ‘business as usual’. Further, if
allowance is made for ocean thermal lag. the
doubling year perhaps would be around 2050.
The IPCC estimates that the greenhouse
effect will cause significant global warming
by the middle of next century in the absence
of any policy intervention. Il may be noted
that while most European countries. Japan,
and Canada have set targets for reducing
emissions of carbon dioxide, thu policy
makers in the US have yet to do so. According
to the IPCC calculations, under the business
as usual scenario, the average global
warming would reach 5.7“C by the year
2100. Since this process of global warming
does not stop at the conventional bench
mark of a doubling of CO, concentration,
Cline (1992) estimates that global emissions
could increase from 6 billion tons of carbon
or 6 GtC (GtC = gigatons of carbon) today
to 20 GtC by the year 2100 and over 50 GtC
by late in the 23rd century. Then the
atmospheric concentrations of carbon could
multiply eight-fold and global temperatures
would ultimately rise by a central estimate
of IO“C and by IX"C for the upper bound.
In brief, this is the scientific framework for
the projected climate change.
As an illustration of possible economic
damage from the carbondioxidc-equivalcnt
doubling in the atmosphere (bench-mark
2.5‘C) some of the costs to the US economy
as estimated by Cline (1992) arc as follows.
These estimates are calibrated in absolute
dollars and are expressed as percentages of
the 1990 gross domestic product (GDP) of
six trillion dollars (O12): (a) The overall
economic damage suffered by the US would
be of the order of $ 60 billion, or 1 per cent
of GDP. (b) The agricultural losses from
heat stress and drought arc placed at $ 18
billion, (c) The sea-level rise due to thermal
expansion of sea water and melting of glacial
ice will cost $ 7 billion, (d) The increased
costs of air-conditioning (increased use of
electricity) would amount to $ 11 billion:
in contrast, the off-set for reduced healing
costs would be only about $ I billion,
(c) The costs of reduced water supply
amount to $ 7 billion due to lesser run-off
in the waler basins, (f) The increased urban
Economic and Political Weekly
December 9. 1995
■f
I
J
Chart 3: Urban Concentration of Particulate Matter and Country Income Levels,
Global and India
Micrograms per cubic metre of air
Urban concentrations of particulate matter
1,800 -----------------------------------------
'W
l-ZOO -
-V/ ■■
600 -
Ql—
‘\
*
•
'
■
1
:_______ • .
100
z
,
j
LOGO
10.000
Per capita income (dollars, log scale)
1.00,000
1 India GNP US $ 350 (Log,0 = 2.544 in 1990)
2 India GNP US $ 985 (Log|o = 2.993 in 2025)
Notes: (a) Global: based on cross-country regression analysis (1980s data).
(b) India: gross national product US $ 350 in 1990.
Source: Adapted from World Bank data (1992).
pollution (tropospheric ozone) associated
with warmer weather would i mpose an an nual
cost ot $ 4 billion, (g) An increased incidence
of mortality with heat stress would amount
to $ 6 billion when annual life losses are
conservatively valued at life-time earnings,
(h) The lumber value of forest loss would
be over $ 3 billion annually, (i) The ski
industry losses due to shortened ski-seasons
and relatively smaller quantities of snow
would amount to $ 1.5 billion annually,
(j) In additioifthere would be other tangible
costs on account of increased hurricane and
forest lire damage, (k) It other intangible
losses, particularly species loss and human
‘disamenity’. are included in the total
damage, the costs as proportion of national
GDP could be as high as 2 per cent. (1) With
upper-bound warming of 4.5"C from
doubling of carbon-dioxidc-equivalcnt. the
corresponding range of damage could be 2
to 4 per cent of GDP.
The above quantitative case study
demonstrates substantial damage costs in
the medium, long-term, and very long-term
future. The costs of delays in policy
formulation and implementation arc indeed
high in economic terms. The intellectual
demands fora proper policy formulation are
equally challenging.
III
Decomposition of
Carbon Dioxide Emissions
II the carbon dioxide emissions (CO,)
concentrations (oran equivalent combination
of several greenhouse gases) are doubled
fromiheprc-industriallevel.thcequiiibrium
temperature of the globe is predicted to
increase from l.9“C to 5.2"C. The ‘climate
sensitivity’ is conservatively assumed to be
2.5OC and the globe will be warmer by 4”C
Economic and Political Weekly
by 2100. The US Environmental Protection
Agency estimated a mean rise of 0.6"C above
the pre-industrial level and predicted a
temparature rise of l.5,,C by 2025 and of
4.4"C by 2100. The IPCC estimated a mean
rise of 0.9"C in 1985 and predicted a
temperature increase of 1.9°C by 2025 and
of 4.2,‘C by 2100. However, the actual
warming by 2100 could be as high as 9‘C,
in case the ‘climate sensitivity’ turns out to
be 5.2"C instead of the generally assumed
2.5*’C, or as low as 3.2"C at the lower end
of the range.
The determinants of annual CO2
emissions could be divided into two groups:
population growth and economic growth.
The latter group may be further subdivided
into energy intensity of gross national
product, carbon intensity of energy
consumption, and tropical deforestation.
The data estimated by the US EPA 2nd
IPCC form the basis of the decomposition
into two broad determinants. It is assumed
that the population growth is not an
endogenous variable in the model, and
further it as assumed that there is no
interaction term between these two
determinants, that is, the two determinants
are independent [Bongaarts 19921. For
analytical purposes the period under
study between 1991 and 2100 is divided
into two sub-periods of 1991-2025 and
2025-2100. Following the World Bank
classification scheme, countnes are grouped
as: low-income (GNP/capita in 7991 of
US $ 635 or less); middle-income countries
(GNP/capita in 1991 of more than US $ 635
but less than US $ 7,911); and high-income
Table 3: Average Annual Exponential Growth Rate of Population and Total (CO,)
Emission Increase. 1991-21 (X)
Total
World
Population (growth rate/year)
1991-2025
2025-21 (X)
1991-21(X)
CO, increase (growth rate/year)
1991-2025
2025-21(X)
1991-2100
Low Income Middle Income High Income
Countries
Countries
Countries
India
1.236
0.504
0.737
1.45
0.54
0.83
1.21
0.57
0.78
0.146
1.300
0.241
0.577
1.73
1.18
1.35
2.71
1.14
1.64
1.56
1.34
1.41
0.85
1.05
0.98
2.58
0.83
1.39
0.328
0.062
Sources and Noles: Tables I and 2.
Table 4. Estimates of Contribution of Population and Economic Development to the
Increase in CO, Emission. 1991-21(X)
Total
World
Total CO, (Petagrains per year)
1991-2025
2025-21 (X)
1991-2100
Contribution of population to
emission growth (per cent)
1991-2025
2025-2100
1991-2100
Conribution of ECO development
Low Income Middle Income High Income
Countries
Countries
Countnes
India
5.66
17.64
23.30
3.21
7.06
10.27
1.53
6.31
7.84
0.92
4.27
5.19
0.82
1.20
2.02
57.8
42.7
54.6
53.51
47.37
50.61
77.56
42.54
55.32
32.90
5.90
14.90
50.39
29.03
41.51
42.2
57.3
45.4
46.49
52.63
49.49
22.44
57.46
44.68
67.10
94.10
85.10
49.61
to emission growth (per cent)
1991-2025
2025-2100
1991-2100
70.97
58.49
Notes:
Decomposition is calculated as the proportional reduction in the average_ annual C() .emission
growth rate that would be if population size is kept constant. Furthenndependence between
population growth and GNP growth is assumed for simplification.
Sources: Tables I. 2 and 3.
nccembcr 9. 1995
.....................................................■'■■■'-
■
.
3165
sometime in the middle of the 22nd century
(Chart 7). During the first sub-period. India's
Urban conceniraiioiK <»l sulplim dioxide
population growth will contribute 50.39 per
Micrograms per cubic metre of air
cent share of the total emissions, but during
the second sub-period the share attributed
50
to population growth declines by about 40
per cent. In other words, the proportion
40
attributed to economic growth increases by
43 per cent during the second sub-period
(Table 4).
The estimates of CO, emissions by the US
EPA are based on the assumption of annual
20
growth in per capita income at the rate of
3 per cent for the developing countries and
10
2 per cent for the developed countries between
1985 and 2100. The global average GDP per
0
capita is projected to rise from US $ 3.000
10.000
100
1,000
toS 36.000 between 1985 and 2100 in terms
Per capita income (dollars, log scale)
of 1985 dollars. These assumed rates are
1 India GNP US $ 350 (LogI0 = 2.544 in 1990).
derived from the actual growth over the past
2 India GNP US $ 985 (Loglf) = 2.993 in 2025).
two decades. No doubt this assumption
Notes', (a) Global: based on cross-country regression analysis (1980s data).
remains very crucial in this exercise. India’s
(b) India: gross national product US S 350 in 1990.
average annual rate of growth rate of GDP
Source: Adapted from World Bank data (1992).
during 1970-80 was 3.4 per cent and during
1980-91 was 5.4 percent (World Bank 1993).
Chart 5: Municipal Waste Per Capita and Country Income Levels. Global and India
If the economic growth trends of the 1980s
continue and further improve in the future,
Municipal wastes per capita
Kilograms
our assumed rate of 3 percent growth in real
income over a long period may turn out to
be tin the low side.
The energy i ntensity is projected to decline
600
rapidly. For the developed economies (in
megajoules per dollar GDP) it declines from
• 20 in 1990 to 4. and for the developing
400
countries from 25 in 1990 to 4. However,
the pace of decline for the developing
countries is very slow. The carbon intensity
200
is measured as grams of carbon per
megajoule. Al present, the average carbon
intensity in developing countries is higher
than that of the developed economies. This
0
is so because the developing countries derive
1.00.000
100
1,000
10.000
a sizeable part of their energy from coal and
Per capita income (dollars, log scale)
use less energy from non-fossil fuels.
1 India GNP US $ 350 (Log,,, = 2.544 in 1990),
Deforestation produces about 0.7
2 India GNP US $ 985 (Log,,, = 2.993 in 2025).
petagrams of carbon per year. This annual
rate of emissions is to rise slowly to 1.1
Notes: (a) Global: based on cross-country regression analysis (1980s data),
(b) India: gross national product US S 350 in 1990.
pctagrams in 2075 and subsequently decline
Source: Adapted from World Bank data (1992).
to 0.8 petagrams in 2100. As noted earlier,
the proportion of total global emissions
in contrast, the high-income group includes attributed to deforestation in 2100 is only
countries (GNP/capila in 1991 ofUS$7.911
or more). Although India is included in the 22 countries with a weighted average per 3 per cent by the US EPA estimates. The
low-income group, it is treated as a separate capita GNP of US $ 21.050. accounting for estimated values of different factors used in
group by itself (GNP/capila in 1991 of only 15 per cent of the total population in these calculations are the product of a very
1991. During the first sub-period, the detailed assessment and complex computer
US $ 330).
The low-income economies (40 countries population growth will contribute one-third models.
with a wcighled average per capita income and economic development the remaining
IV
of US $ 350 in 1991) account for 58 per two-thirds. However, during the second sub
cent of global population. By the year 2100 period (2025-2100) the economic growth
Environmental Scenarios in India
the global population share is projected to will contribute almost the entire increase in
A recent World Bank study (1992) has
be 65 per cent (Table I). Over the 35 years the emission; only a 6 per cent share is
period. 1991-2025. the population growth attributed to population growth (Table 4). traced an ‘average’ relationship between the
India’s projected population growth is very level of economic development (GNP per
alone will contribute 54 per cent of the CO,
emissions, and during the following 75 years, sizeable indeed, almost doubling from the capita) andthe corresponding environmental
2025-2100. their contribution will decline present level of 866 million in 1991 to 1.635 damage/stress. India’s current position is
by 13 percent (Table 4). The total emissions million by 2100 (Table I). According to the identified on each ol these ‘average’ patterns
are shared almost equally by the two very long-term projections, India’s of economic development-environmental
population will stabilise al 1,862 million relationships for the current year( 1991 hand
detcrmiQanls.
Chart 4: Urban Concentration of Sulphur Dioxide and Country Income Levels.
Global and India
4|
li
i
3166
Economic and Political Weekly
December 9. 1995
/
y
s
r
g
d
3
Tonnes
i
16
Chart 6: Carbon Dioxide Emissions from Fossil Fuels Per Capita and Country Income Levels,
Globai. and India
Urban concentrations of sulphur dioxide (from fossil fuels)
j
12
I
f
i
8
4
i
r
of population without safe water supply will
decline from 75 per cent to 42 per cent
between 1990 and 2025; four out of every
10 households will be without safe water
supply (Chart 1). (b) Similarly, one out of
every four households will be without
adequate sanitation by 2025 (Chart 2).
(c) The level of urban concentrations of
particulate matter will drop by about 50 per
cent, from 1,6(X) to 8(X) micrograms per
cubic metre of air (Chart 3). (d) The urban
concentrations of sulphur dioxide will
increase by about 70 per cent over the same
35-year period in terms of micrograms per
cubic metre of air (Chart 4). (e) Municipal
)
0
100
1.000
10,000
1 ,()().()()()
Per capita income (dollars, log scale)
waste per capita is projected to double,
amounting to 200 kg in the year 2025 from
the present level of about 100 kg (Chart 5).
t
1 India GNP US $ 350 (Log11( = 2.544 in 1990).
2 India GNP US $ 985 (Log|n = 2.993 in 2025).
t
>
V
Concluding Remarks
Notes: (a) Global: based on cross-country regression analysis (1980s data),
(b) India: gross national product US $ 350 in 1990.
Source: Adapted from World Bank data (1992).
The future is uncertain, especially in
economic and social developments. These
long-term projections over the next century
must be interpreted as no more than broad
trends. As a member of the profession of
Chart 7: Long Tkhm Global and Popi cation Projections Under Different
Fertility Trends. 1985-2160
Billions of people
economic-demographers I must inject much
needed modesty in claiming the degree of
25 ---------------23.0
■
20
Slow decline in fertility1-
15
Base case*1
accuracy reflected in mathematical
manipulations and assumed relationships.
Nevertheless, it is clear that any rapid decline
in the population projection for India over
the next two decades will result in a
considerable environmental improvement in
the long run. The best environmental policy
will remain a rapid decline in population
12.5
growth in the country in general and Uttar
Pradesh in particular.
10.1
[The paper was presented at the XVII Conference
of the Indian Association for the Study of
Population, io be held at the University of
Annamalai. Annamalai Nagar. Tamil Nadu.
December 16-19.1993. in Session G: ■Population
Growth and Sustainable Development’, organised
by M K Prcini for the Volume of Contributions
(lor (he United Nations World Population
Conference. September. 1994).|
10 -
Rapid decline in fertility6
5
India
(W 2 006
() ---- -t-Z
1985
2010
Ol990
0.850 billion
I
!
1.348
—O ,
^2100
■©---------
—
2035
2060
©2000
2(M5
©2025
2110
1.862
2135
2160
©2160
References
1.006 billion
1.348 billion
1.862 billion
Notes: (a) Base Case. Countries with high and non-declining fertility levels begin the transition
toward lower fertility by the year 2005 and undergo a substantial decline by more than half
in many cases over the next 40 years. All countries reach replacement fertility levels by 2060.
(b) Rapid Decline: Countries not yet in transition towards lower fertility begin the transition
immediately; for countries already in transition, total fertility declines at twice the rate for
the base case.
(c) Slow Decline: Transition towards lower fertility (triggered when life expectancy reaches
53 years) begins after 2020 in most low income countries. For countries in transition,
declines are half the rate for the base case.
(d) India: Assumed year of reaching net reproductive rate of one (total fertility rate of
approximately 2.2) by year 2015. The projected ‘stationary’ population is 1.862 million
around 2150-2160
Source: Adapted from World Bank data 11992)
the likely change over the next 35 years
(1991-2025) is measured. India's per capita
GNP is projected to increase U' US $ 985
in terms of 1990 US dollars at 'he ax^.m-e
Economic and Political Weekly
annual rate of 3 percent. For calculating the
change over time the log values of GNP per
capita are used. The following general
observations can be made: (a) The proportion
uccember 9. 1995
Bongaarts. John (1992): 'Population Growth and
Global Warming’. Population and
Development Review /A1. Number 2. June.
1992. pp 299-319
Cline. William R (1992): TheEconomicsof Global
Warmini:. Institute of International
Economics. Washington. D C.
Intergovernmental Panel on Climate Change
(1991): Climate Change: The IPCCScientific
Assessment, edited by J Houghton. G Jenkins,
and J Ephraums. Cambridge University Press.
Cambridge.
U.S Environmental Protection Agency (1990).
Polic-v Options for Slahilisiii)’ Global (lunate:
Report to Congress. Washington. 1) C.
World Bank (1992): World Development Report
IW2. Oxford University Press.
- (199U: World Development Report /99.L
Oxford University Press.
3167
Hp
GOVERNMENT OF INDIA
j Department of women & child development)
5'°' '
)
w
//
/Z
NATIONAL POPULATION POLICY : WOMEN AND CHILD
PERSPECTIVE
The population projection up to the year 2016 made by Technical Group on
Population Projections set up by Planning Commission under the chairmanship of
Registrar-General of India provides a new vision to plan invest, and implement the
interventions in the Social Sector, especially programmes aimed at development and
empowerment of women and children. In addition, this is the right opportunity to look at
the issues related to women and children in the futuristic perspective and enrich/amend
the existing programmes aimed at women and children.
NPP : THE TASK AHEAD
2.
Our experience of about 50 years of economic progress, political developments
and social transformation have indicated that non-participation of women and children in
the developmental agenda is an impediment to success and achievement of desirable
results.
Despite major gains for children and women in terms of a sharp decline in
vaccine-preventable diseases, eradication of dracunculiasis, virtual elimination of Polio,
progress in the physical provisioning of primary school, progress in expanding food
supply, virtual elimination of famines and famine deaths, women’s empowerment
through legislation for sharing of property, reservations in local self-governance and
formation of more than 1 lakh self-help groups, a daunting task for development of
women and children still lies
ahead
of
us.
About 20
lakh
children still die
every year before completing one year and about 53 per cent of children under the age of
5 years remain moderately or severely mal-nourished with a high proportion remaining
stunted with life-long consequences. About 1,25,000 women die during pregnancy and
from pregnancy-related causes every year, and fflV/AIDS is beginning to spread to the
general population, greatly increasing the risk of vertical transmission of AIDS to new
born children.
•I
2
The regional disparities pose another challenge in implementation of the proposed
3.
population policy. There exist significant disparities across States, geographic locations,
caste and gender. Infant mortality rates, for instance, vary from 13 per 1000 live births in
Kerala to 94 in Madhya Pradesh. The infant mortality rate among Scheduled Castes is 24
per cent higher than the national average; and the literacy rate among Scheduled Tribe
population is almost 30 per cent lower than the national average. Child malnutrition rates
vary from 28 - 30 per cent in Keala, Manipur, Mizoram, and Nagaland to 63 per cent in
Bihar.
Whereas Kerala and Himachal Pradesh have both achieved almost universal
schooling for primary school children, only 50 per cent of children between 6-10 years
attend school in Bihar.
4.
Apart from this, the population pyramid as projected for the year 2016 provides a
new challenge for population, health, nutrition and gender planning
in a different
perspective. The last decade has been marked by wide social disturbances and natural
disasters across the country. Women and children are the first and worst sufferers of such
disturbances.
Inadequate provision of health, nutrition and educational interventions
further aggravate the situation of women and children in these areas.
5.
The situation of women in terms of their condition and position needs to be
understood
in the larger socio-economic, cultural
and political framework of the
country. Three main factors have contributed to the dis-empowerment of women, and
particularly of poor women: a) a culture built on patriarchy, discriminatory notions of
social hierarchy and division of labour that adversely affects women; b) an unequal
distribution and control over resources with women having very limited access when
compared with men; c) systemic baniers at various levels that restrict women’s access,
participation, and decision-making powers in economic, political and legal structures.
Efforts to promote women’s empowerment must, therefore, address all these three issues.
6.
Poverty in general, and extreme poverty in particular, has a significant gender
dimension.
Women are more sensitive than men to the extremes of poverty and its
consequences. Studies reveal that (i) the percentage of adult women below the poverty
line exceeds the percentage of adult men below the poverty line, both in rural and urban
areas; (ii) the percentage of children in the 0-4 age-group in poor households exceeds that
3
in non-poor households, with corresponding implications for the mobility of women and
for child-care services; and (iii) in both urban and rural areas, disadvantaged groups of
women from Scheduled Castes and Scheduled Tribes constitute a high proportion of the
poor.
7.
Maternal deaths in 1993 accounted for 1.3 per cent of total deaths in India, and for
15.1 per cent of all deaths of women of reproductive age.
These proportions have
increased from 0.8 per cent and 11.7 per cent of deaths respectively in 1989. These
figures imply that at present between 1,00,000 and 1,25,000 Indian women die from
pregnancy-related causes each year, accounting or nearly 25 per cent of all maternal
deaths every year in the world - many of which are preventable. Many maternal deaths
could be avoided through a range of relatively simple and low-cost interventions - early
treatment of anemia or, better, its prevention. The Medical Termination of Pregnancy
(MTP) Act has not achieved the desired results. These aspects of maternal health need to
be addressed very seriously.
PLAN OF ACTION IN NPP : KEY TO SUCCES
8.
The operational strategies under Action Plan for National Population Policy :
2000 begin with convergence of service delivery at village levels. The Department of
Women & Child Development has supported such a mechanism of convergence of
services at different fora, especially since the Anganwadi Centres under the ICDS
Scheme have a reach to the villages unparalleled by any other such intervention.
9.
However, the success of the Action Plan will depend on how the Anganwadi
Centres are equipped with adequate facilities and empowered personnel (Anganwadi
Workers and Helpers). At present, only 75 per cent of the blocks in the country are
covered under the ICDS programme.
Unless the ICDS Scheme is universalized and
Anganwadi Centres are available for every village/hamlet, the Action Plan under the
National Population Policy will not be successfully executed.
10.
In those blocks which have ICDS projects, the number of Anganwadi Centres are
sanctioned on the basis of old population figures. It has been estimated that not the
4
whole of the eligible population is being served by the ICDS Scheme. Unless these
Anganwadi Centres are opened, the question of providing services in convergent manner
in villages through Anganwadi Centres becomes difficult.
11.
The Integrated Child Development Services (ICDS) Scheme is a unique
intervention which has emerged as the biggest beneficiary programme for women also.
The programme at the grass-root level is being managed by over a million voluntary
women workers providing necessary services to over 50 lakh pregnant and nursing
women. However, the strong women force remains very inadequately remunerated. The
demand for a higher honorarium for these crucial grass-root workers has to be considered
before assigning them the gigantic task to implement the new Population Policy. Time
and again, the Department has raised the issue with the Ministry of Health and Family
Welfare to provide additional honorarium to Anganwadi Workers and Helpers to
compensate them for their invaluable contribution made for the implementation of
various health and family welfare schemes and programmes.
Without provision of
additional honorarium to these committed women workers, it will not be justified to load
them with additional work of implementation of the National Population Policy.
12.
The population projection in 2016 shows a massive increase of population in the
15-59 age-group from 519 million to 800 million which will constitute the core working
population of the country. In view of the fact that at least 50 per cent of our children are
mal-nourished today, it is quite logical that 50 per cent of our working population will be
under-nourished, diseased and will have dismal to low productivity by the time they
reach adulthood during 2011-16.
This will lead to huge loss to the nation.
The
Supplementary Nutrition provided under the ICDS Scheme is one of the most vital
components under Basic Minimum Services Programme aimed at eradication of the
menace of malnutrition of children and women. The success of the programme, however,
depends largely on adequate provisioning of funds to the States and UTs. We have
already requested the Planning Commission for adequate funds to be earmarked for this.
The Department is also finalizing an Action Plan for taking up nutrition as a project in
Mission Mode to cover infants, adolescent girls, pregnant women and lactating mothers,
the three critical links in the inter-generational cycle of malnutrition. The details of this
project would be shared as soon as finalized.
5
13.
Unless the women are empowered to be a part in decision-making in the family,
the community and the society, the overall goal of the Population Policy to improve the
quality of lives will remain unfulfilled.
Over the years, the Department has made
considerable efforts to empower the women in the country. The effort of the Department
on group formation amongst women has proved successful. Recently, Government’s
schemes for formation of women’s self-help groups like Indira Mahila Yojana (under
revision) attempt to provide a platform for their self-development. Apart from that, with
the feeling of ownership and management of their own resources and savings, poor
women have been able to choose their priorities and may be able to cover the cost of
additional nutrition and health gaps.
However, the Department is constrained in
implementing the women’s empowerment programmes due to paucity of funds.
* >Jc >jc *
File: NPC-WCD-Perspective/MyDoc
*
Hp
ir
Message of Smt Sumitra Mahajan, Minister of State for Human Resource
Development, Government of India.
When we discuss Population Policy, we must be very clear about the inter
linkages among different components of our developmental Policy. It is high time that
Population Policy should be linked to the developmental aspirations of the Indian people.
To my mind, following points come:
i)
The whole idea of popoulation control should be linked to a mechanism
whereby we give incentives to those individuals, groups, villages, districts and
ultimately to the States which perform well in meeting the popoulation control
measures. Here, I would like to make my point very clear that population
control would have to be free from the psyche which unfolds the whole
regime of targets and controls. The incentives may be in the form of higher
developmental assistance, when it comes to an area, and more increments
when it comes to individual officers. Similar incentives would have to be
thought of for organizations doing pioneering work in this field. At the same
time we would have to work out some disincentives also for those who do not
perform.
ii)
Population control or checking the population growth, if I may say so, has to
be linked to various other measures such as education of girl child, pre-marital
consultations for adolescent girls and a good health for feeding mothers. Until
and unless, we aim at addressing these issues we can not have a meaningful
population policy. However, one would have to consistently review the
synergies between the population and developmental policies.
iii)
A concerted effort is also required at the level of media. A committee should
be set up with the Chairperson of the Prime Minister, to strike the right
campaign, not only at the official electronic media, but also with private
channels. If in this process, we have to approach any major sponsors of
various popular programmes, we should not hesitate in the same. I am sure if
PM himself appeals to the private channels they would certainly respond and
they would also realize that they are part of the system. Private industry can
also be approached to plug the various gaps which adversely affect the growth
of developmental indicators. Similar efforts would have to be made by NGOs
on “Svamsavi Sangathans” as I call them.
H p ■S7' 15
Cc^'5 Zj-/ National Institute of Urban Affairs
'
National Population Policy: Agenda In the Urban Context
Urban Poverty and Population Perspectives
Urbanisation process has been speeding up in the country and imposing tremendous strain on
capacities of cities to respond to people's developmental needs. About 30 percent of the
country’s population are already urban. By the year 2031 it is expected that nearly half of
the country's population would be living in cities. Rural to urban migration has been the main
factor contributing to the growth of our cities. Large proportion of migrants who are
attracted to the city end up in the under-serviced/illegal settlements in the city, commonly
known as slums, in environmentally degraded conditions. Urbanisation of the nation is
therefore accompanied by an urbanisation of poverty, with nearly 30-50 percent people in
cities living in poor settlements. Cities seem to be growing more in the slums, both as an
outcome of migration of the rural poor into cities and the high natural growth rate in these
settlements. Urban poor have also spilled out of organised squatter settlements onto
streets/pavements, in the homes of the rich, on construction sites etc. Large proportions of
city population may not be poor by conventional definitions but vulnerable to economic
shocks that push them into poverty.
Large cities have nearly half their population living in these settlements. Enrolment rates in
these settlements are lower than the rest of the city and with a high drop out rate nearly
half the children belonging to the urban poor perhaps do not go to schools, particular among
them being girls. Most women from these communities work in the informal sector and leave
behind unattended or younger children in the care of older siblings, who have to miss school
in order to meet their child care /household responsibilities. Due to the high incidence of
sexual abuse in these communities, in the absence of any family safety nets girls are often
married off early and become young mothers with a long child bearing span. Gender biases
persist and most women do not have any choice over their reproduction.
Poverty Alleviation Programmes of the Ministry of Urban Development and
Poverty Alleviation
Ministry of Urban Development supports two major national programmes for urban poverty
alleviation and provision of basic services to the urban poor, the Swarna Jayanti Shahari
Rozgar Vojna (SJSRV) and the National Slum Development Programme (NSDP). While the
former aims at building capacities of individuals for improving incomes through self or wage
employment and opportunities to access loans, the latter assists the city governments to
provide minimum basic services in the poor settlements. Both programmes are founded on
the UBSP (Urban Basic Services for the Poor) strategy for community organisation.
Apart from these two programmes, several schemes have been started to address specific
issue in the urban context; i.e. Accelerated Urban Water Supply Programme (AUWSP), Low
Cost Sanitation (LCS) scheme, Scheme for the Integrated Development of Small and
Pi
Medium Towns (WSMT) etc. State schemes have also been initiated to brace the national
intervention programmes based on specific needs of the state.
Community building is an important strategy under the two urban poverty initiatives of the
Government of India, SJSRY and NSDP. Community organisation processes begin at the
neighbourhood level with a group of women from adjacent households coming together as a
neighbourhood group (NHG) with a chosen representative leader called the Resident
Community Volunteer (RCV), a community voice. Ten RCV leaders are associated into a
neighbourhood committee (NHC) and several NHC leaders are federated at the
community/ward/city level into a Community Development Society (CDS). CDS forms the
entry point for all programme interventions under the SJSRY and NSDP. Community
development plans developed by the CDS are integrated into larger city plans for poverty
alleviation and provision of basic services. CDS is also responsible for monitoring and
supervision of service delivery at the community level.
As part of programme interventions, CDS groups identify the poorest for capacity building
and subsidised loans for income generation activities (up to RsSOOOO) under the Urban Self
employment Programme (USER) of SJSRY. They are also recognised for contracts in smaller
towns, for development works under the wage employment programme (UWEP) of SJSRY.
CD Societies are encouraged to initiate thrift and credit groups under SJSRY that are
entitled to a matching grant under the programme, that is a revolving fund enabling the
group to meet costs of travel, meetings, child care activities etc. DWACUA (Development of
Women and Children in Urban Areas) groups are also supported with loan subsidies up to
Rsl.25lakh for setting up co-operative economic ventures. Women who are members of the
TAC/DWACUA groups are entitled to personal health insurance and for one additional
family member depending upon the level of her savings.
Under NSDP, ULBs are granted soft loans to provide basic infrastructure in poor
settlements based on needs and priorities determined by the CDS. CD Societies are
awarded contracts for executing physical development works. Services provided under the
programme include water, toilets, paved roads, drains, etc. at the community/household
level. Since both programmes, SJSRY and NSDP, use a common strategy and are
implemented by a single authority, there is synergy in its execution. Philosophy underlying
the urban poverty alleviation approach postulates convergent community action with the
objective of ensuring the rights of women and children in the communities. As such SJSRY
is implemented with flexibility, and in co-operation with other social sector departments in
several cities.
Decentralisation under the 74th Constitutional Amendment Act
Decentralisation under the 74th Constitutional Amendment Act has also resulted in elected
municipal bodies in 23 states with over 60,000 women representatives, creating a bridge
between the authorities and the planning systems. As part of their responsibilities, the
elected representatives are expected to represent the needs of the urban poor into city
level action plans, ensuring that city provides for the basic needs of the poor. Most of these
urban local bodies are therefore, both vibrant and actively involved in ensuring services in
their wards.
Agenda for Implementing the National Population Policy in the Context of
the Urban Poor
Urban poverty is not just the outcome of economic insuff iciency or inf restructure disparity
but also a social and ecological poverty. NPP in the urban context therefore must address a
range of interwoven issues that cut across different sectors for achieving the goals set out.
To address the challenges posed under the NPP in the urban sector, interventions would
need to be integrated with existing programmes of SJSRY and NSOP as well all state and
local initiatives, and their strategy of working with communities and community structures.
An interface with all other sectors to converge the programme components under different
programmes for achieving TFR replacement levels by 2010 would be essential.
The following strategic interventions will be pursued in the urban sector:
Establishment of City Task Forces
At present, no comprehensive plans exist at the city level that address holistically the
problems of urban poor and health care, including the population goals. It is therefore
planned that:
TUDA or the Town Urban Development Agency will form a City Level Task Force that
>
cuts across the social sectors of health and education to prepare a city wide, action plan
und^r the NPP. The Task Force would have a wide representation of all stakeholders
including the poor, the NGOs and civil society and the women elected representatives.
City
Level Task Force will also be responsible for monitoring inputs, training and capacity
>
building where jointly proposed, mobilising resources, gathering data etc.
Training of city administrators to develop city wide action plans including the health plan
>
will also be managed under the regular capacity building activities of SJSRY.
Involvement of Neighbourhood Groups and Community Development Societies
Neighbourhood groups form the fulcrum for community organisation processes under the
UPA programmes. Due to their proximity to each other and the sense of society that exists
in these groups, it is proposed that:
> NHGs will be made the focal point for advocacy of messages on population. The
integrated package of services will be delivered through the CDS, which will become the
axis in the urban poor settlements. CDS will be responsible for registration of
birth/deaths, provision of contraceptives, meeting needs of poor women with regard to
>
reproductive and child health information, facilitate routine immunisation programmes,
etc. They would be trained for maintenance of records through the urban/health
training networks, at the local level and in partnership with the MOHFW. They would
need to be in close contact with the health functionaries from the urban health centres.
NHG/CDS will become the platform for advocacy for all health messages, particularly
the small family norm, during their meetings.
3
61
/-
>
>
CbS groups w.ll form a health sub committee with c
community
level health functionaries
co-opted as members, that would debate all issues
of
-family
and child welfare and
P^PQre su'f°ble action plans for their settlements,
network and
Wts
proXe\
thr°U9h the hcalth
They would be responsive for creLfno a
QSS’StQnCe Ot the time
delivery,
births.
reQt,n9 Qwar’eness ™°ng women on their right to control
>
“fbUM„9 md
for the rest of the community NHG/ChS PUWEP to set examples
«•« l„ ,h. reprodj,™
"'’h '"'S"' f«“"“ "P »« 4/5 «nd
size may «l„ be encouraged ,hra„g°h X^ty‘WlXg’"'’''”*' ,0'“n,°r“Y “’‘"S
>
,h. smQll fmay
Department of H„,t“
P™^es/reproduetl,e rights etc. tvith the support .J
Identification of 'At Risk’ Families
Welfare programme.
P
flCQ,,y tar9et such families under the Family
Focus on Thrift and Credit Societies
in 'h' ”™'c9/ for
pover^ ollevtatioi
°f S™'"’ P- * en^eX ^2^
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fri,Y
be
Quantum of additional funds will deoend
Ju' 'eS thQt theY may W(sh t0 Pursuefamllies/women „h. hare adaptej "eZt P°"
"”'“r °t
also be acknowledged at CDS meetings at the
elected representatives In tha” a™
>
'”'d
be
i" T'’' 9roljp' Such groups will
“ P"™^ with the
” ’h^“ "'"P- »f
Support to DWACUA groups
DWAUA groups ore being organised and supported under th, STaov
operative economic ventures through venture capita,. cop„e„y buHd^Tm'aXtin’g
' hiXmped*' seUtX9Zi 'Sia
are Zoving
4
!
>
>
guidelines will be enlarged to include women with less number of children and the idea
up-scaled across the country. Kudumbashree model proposed by Kerala, under which the
State government proposes to eradicate poverty by year 2008 includes reduction in
family size as a primary objective. The ideas will be shared with other states at various
Seminars/Workshops. States will be encouraged to evolve similar models for their
states/districts/cities.
DWACUA groups with a larger proportion of members having small families/acceptors
will be prioritised for subsidies under IGA initiatives and assisted with marketing
linkages. An IGA activity for which they may be funded could be the ambulance service
from within the community to the nearest hospital.
DWACUA groups will be supported to set up partnerships with ICDS for setting up
child-care centres.
Formation of Youth Groups
Advocating messages of delayed marriage and parenthood and reproductive rights must
begin with the youth. It is therefore proposed to establish youth groups in partnership with
the Nehru Yuvak Kendra/Youth Welfare Departments:
> Adolescent groups of girls /boys will be formed using the CDS strategy with an
objective to create awareness. Child-to-adult approach will be used for communicating
messages to parents.
> Focus of these meetings will be to delay the age of marriage, protection of young girls
from sexual harassment/abuse and right of choice with regard to age of marriage and
parenthood.
> In order to delay marriages these girls/boys would be provided training under the
SJ5RY and assisted in obtaining loans and subsidies for IGA.
> Youth groups, especially adolescent girls will be encouraged to set up thrift and credit
societies.
> Young girls and boys who will delay marriages and have been part of the Savings group
will be provided health insurance.
Participation of Men in Planned Parenthood
Husbands of women leaders can become important advocates of messages in the community,
having been encouraged by the success of their wives. It is therefore proposed that:
> Husbands of CD5 members will be encouraged to come together and be actively involved
in planning families, creating awareness among community men about birth control and
ensuring reproductive rights of women.
> Acceptor male groups will be formed in the settlements to set examples and to advocate
messages.
Health' Insurance for Old Persons
Increasing older people due to better health care and increased longevity implies more old
people in communities. In urban poor areas the aged are often without care and support, as
they are lack income and family networks. It is therefore proposed that:
> Aged will form also be provided health insurance under the SJSRY programme. Those
who are still active will constitute a DWACUA/T&C group and be supported for IGA.
S'
i
.0
Involvement of Local Health Practitioners
Local private doctors are normally the first choice of urban poor because of their proximity
to the home and savings in terms of invisible health costs. Many of these doctors are RMP.
It is proposed to include them as part of the health delivery system in the urban poor
settlements.
> Private practitioners will be trained in collaboration with the MOHFW for RCH services
and equipped with contraceptives, supplies etc.
Private doctors/hospitals/nursing homes from adjoining better income neighbourhoods
will be encouraged to adopt poor communities for promoting better health and family
planning practices. Modalities of this can be planned with the private practitioners at
>
meetings called by the City Level Task Force.
Inclusion of the Private Sector
Private sector participation can be explored for urban poor settlements, as urban sector
has an advantage of a rich private sector network including for health.
> Participation of the private sector will be encouraged to mobilise resources and services
at the settlement level, particularly where legal issues constrain ULBs from reaching
>
the poor.
,
Private sector will also be encouraged to associate in the delivery of basic services
under the NSbP.
City Networks of NGOs /Civil Society
NGOs and the civil society are important agencies that can support successful practices at
the ground level.
> NGOs working in the areas of health, community development and education will be
brought together under a single umbrella network that would then be involved in meeting
>
>
the sectoral goals and over arching goals of the NPP.
In order to do so lists of NGOs will be prepared at the city level by combining the NGOs
that have been associated with programmes of different sectoral departments. City
lists will be combined at the national level into a master list to create a data bank of
successful NGOs/Civil society groups. Lists will also be drawn from other departments
who have successfully associated with NGOs such as CAP ART, RMK etc.
Lists developed would be dynamic in nature to enable new NGOs to be included. Under
the UPA programmes, NGO formation will be facilitated with the help of retired
professionals /resource persons from the social development field.
Linkages with NSDP
It is important to create a synergy between the basic services programme, the wage
employment activities and the IGA initiative under the two programmes, as together they
can help to alleviate poverty as well address the problems of population growth.
> Physical services of water, sanitation etc. for the settlements will be planned and
implemented in consultation with the CDS groups. Settlements that show reductions in
family sizes may be prioritised for relocation/resettlement, household facilities,
>
additional facilities etc.
Such CDS groups will also be prioritised for contracts under the UWEP programme for
physical works.
D
>
NSbP has provision for construction of community centre to develop a sense of
community in the settlements. These Community centres will be made nodal points for
family welfare activity. Centres will be used by CDS for family welfare activities apart
from other community programmes.
Linkages with Shelter Programmes
Urban poverty is closely associated with lack of affordable shelter. A large number of
people bvmg m squatter settlements are not income poor but continue to live in these areas
as inexpensive land/housing is not available to them. It is therefore important to converge
w.th shelter development programmes. Improvement in the habitats would mean better
health for the poor and reduction in health related expenses. SJSRV will make
Information Systems on Urban Poor and their Locations
It is important that at the city level an effective information system is developed that
data, Jvlth| re9ard to the urban ’poor cutting
across all —sectors
and that enables the
I II p.
-/ ---------------------------——■•V.
ui«v« ■ i IU I OIHJIMIC.3 I I C
ULBs to monitor the service delivery in the settlements
All cities will develop a Geographic Information System (GIS) relating to urban poor and
flag communities with high growth rates. Such communities will be prioritised for family
welfare interventions.
1
> Household level information on the poor will be included in the GIS. Community level GIS
including demographic and health status of each poor community will be linked to the
city GIS. The data on poor households and family sizes will be shared with the City Task
Force and the Department of Health for monitoring purposes.
> The GIS will be useful in developing local area monitoring systems,
> Training in the development of GIS will be provided by NIUA to the local bodies as part
of its training activities under the SJSRy.
i
Development and dissemination of IEC Material
Training and advocacy material is developed as part of the capacity building activities under
the SJSRy. Population messages will need to be integrated into the IEC material. It is
proposed to:
> Adapt IEC material available with the MOHFW to the urban
context and disseminate
these to the settlements through the CDS /NHG network.
> Additional material will be developed with the help of national agencies such as NIUA
HSAAI and disseminated.
> Urban Poverty Newsletter a publication of the MOUEAPA brought out by the NIUA
provides a platform for sharing experiences and ideas with city functionaries One page
of the newsletter will be devoted to NPP news/update/community experiences.
Establishment of Urban RCH centres
Urban areas do not have a wide reaching network of health services as in the case of rural
communities. As part of the Urban RCH programme being supported by the MOHFW in
selected cities, it is proposed that:
> C&5 will be involved in the identification of sites for urban RCH centres within /near
the community that would be able to provide specialised health services/services for
i
e
>
>
>
abortion and delivery, growth monitoring facilities etc. and improve access of the urban
poor to health services.
Timings of the urban RCH centres will need to be made more flexible in consultation
with the CDS groups to enable the working women in the urban slums to avail of its
services. Each settlement may have different timings and services depending upon
settlement needs.
Urban RCH centres would be established irrespective of the legal status of the
settlements in areas that are easily accessible to the community.
Urban RCH programme will need to be expanded to the rest of the cities in synergy with
the SJSRY community structures and the N5DP resources for community centres.
i
Convergence with the Education Sector
Education is an important thrust area that will ensure sustainable change in population
growth. It is important that all development programmes converge with education
intervention programmes in cities.
> Primary Education Enhancement programme being implemented through the active
partnership of NIUA, UNICEF and AUS AID with the Urban Local Bodies in Delhi is a
model whose technology will be transferred to other cities for developing similar
convergent efforts. The base of the present model will be widened to include health
inputs. Some efforts in this direction have already begun in cities such as Gwalior,
Jaipur, Surat.
>
NIUA will focus on the preparation of Master Trainers under the SJSRY to implement
such a model in other cities and to help develop partnerships between the local
governments, resource agencies for education and CDS groups.
Interface between Administrators and Community Members
Need for city managers to understand the problems of the community and enable them to
plan effective intervention strategies is essential to improve the governance of the NPP in
the urban sector.
> Borrowing from the Andhra Janambhoomi model, a vertical interface would be planned in
each city focussing on the issue of population where state administrators will be
responsible for visiting the settlements, meeting CDS groups and preparing action plans
under NPP.
> Meetings will be held once every quarter to ensure there is proper follow up of the
actions planned. This will enable the city managers to receive feedback and also report
back to the settlements.
Training of Elected Representatives
Elected representatives are an important part of decentralised governance. They need to
be involved in the promotion of the population policy objectives.
> Women elected representatives will be trained at the city level on NPP concerns, goals
and objectives. Constituencies /Wards that achieve targeted goals may be prioritised
for development works and honoured for exemplary performance.
> National training agencies such as NIUA and H5MI and regional training institutes will
organise training of master trainers to work with elected representatives on issues of
concern.
a
1^“^*11
v
u*:i Ikuaow. -». - -
. ., 4
n
>
Joint training programmes will be planned for Community Organisers under the SJSRY
programme and health functionaries at the city level to ensure synergy of inputs.
General Comments
Some general comments on the National Population Policy are:
> The Policy has a significant rural bias. In view of the fact that urban areas are growing
rapidly and constitute nearly thirty percent of the present population of the country, it
needs to be adjusted to focus more sharply on the urban sector as well. Issues,
strategies and interventions related to rural-urban migration and spatial distribution of
population need to be integrated with the National Population Policy.
> A large number of urban poor migrate from rural areas in search of economic
opportunities. NPP must be in synergy with the National Urban Policy and the National
Slum Policy being developed by the MOUD&PA that seeks to articulate an urban vision
and strategies for addressing the issue of migration.
> State Urban Commission on Population may be desirable or the existing Population
Commission proposed may ensure adequate representation from the urban sector.
> Cities may be rewarded for exemplary performance with additional grants under
development programmes.
> Partnership with ICDS in the urban areas is not possible, as ICDS cover in cities is
limited. ICbS will have to have a more specific urban agenda and target slums for child
care activities to promote immunisation and health care in settlements.
> All schemes such as the Balika Samridhi Vojna, Maternity Benefit Scheme should be
extended to the urban sector.
HP ^-16
o
o
Ministry of Health & Family Welfare
(Department of ISM & H)
Indian Systems of Medicine and Homoeopathy & Population
Stabilization
The Indian Systems of Medicine (Ayurveda, Siddha, Unani, Yoga &
Naturopathy) & Homoeopathy offer a range of safe, cost effective, preventive
and curative therapies which could be very useful in reaching the goal of
'Health for all’, in a cost effective manner. In the developed world, the
interest in alternative medicine has surged 60% since 1989 and the market is
growing as at the rate of 30% annually. Employers and insurers including
several major Managed Care Organizations have begun to respond to the
demand for adding alternative therapies to the insurance coverage.
iMternative Medicine practitioners are already working in the U.K., Germany
and USA and the herbal medicines and food supplements are gaining
popularity. WHO has estimated that the global market for medicinal herbs
and herbal products is today $62 billion and will grow to US $5 trillion by
2050. In India, the Central Government Health Scheme already extends
reimbursement to Government servants who opt to avail of treatment under
the Ayurveda, Siddha, Unani and Homoeopathy systems in recognized
centers. However, for quality drugs to be available there has to be an assured
supply of medicinal plants. Except for Yoga and Naturopathy which are
drugless therapies all the systems need plants for the preparation of
medicines.
Infrastructure
There is a huge infrastructure available in India and according to
information updated till 1998 there are 2,862 hospitals, 22,104 dispensaries
and 5.87 practitioners of Indian medicine and Homoeopathy in the country.
There are more than 300 colleges, conducting 5 ‘/z year degree courses and 45
Ayurvedic colleges imparting Postgraduate training apart form Gujarat
Ayurveda University, Jamnagar, Institute of Medical Sciences, Banaras Hindu
University and National Institute of Ayurveda, Jaipur which offer both
Postgraduate and Doctoral courses. PG colleges have been established under
the Unani, Siddha and Homoeopathy systems as well. These can be utilized
for improving health status of women and children counseling and achieving
community participation in RCH programme. There are 3 autonomous
Research Councils and their responsibility includes conducting clinical
research into health care, drug research covering survey and cultivation of
medicinal plants, pharmacognosy, phyto chemistry, pharmacology,
toxicology, drugs standardization, literacy research for revival of the ancient
classical literature and research into antenatal and postnatal care and the
development of contraceptive drugs. The Pharmacopoeia Committees are
working rapidly to see that formularies are prepared for all the drugs of
common usage under all the systems of Medicine. This will help standardize
the drugs. Ayurvedic and Unani drugs have been included in the drug kits for
distribution by ANH in selected states and cities.
Utilization of Indian Systems of Medicine and Homeopathy
(ISM & H) practitioners in RCH programme current status:
The approach seeks to concentrate on the known, documented, widely
used strategies and applications set out in the Ayurveda, Siddha, Unani &
Homoeopathy Systems of Medicine relating to the care of mother and child,
the whole cycle of conception, the growth of the foetus, antenatal care,
delivery, postnatal care, the growth of the infant and allied areas. It is widely
known that village people still depend very largely upon Traditional Systems
of medicine in looking after the needs of women and children. These
practices were documented in the ancient texts of Ayurveda, Siddha and
Unani which have been refined and are widely used in Ayurveda and Siddha
hospitals run both by the State Governments and the private sector in different
parts of the country. The public, both in rural and urban areas are accessing
these forms of preventive and promotive health care and can be seen in large
numbers frequenting the OPDs & IPDs of the Prasuti Tantra Departments of
Banaras Hindu University, the Poddar Ayurvedic Hospital, Worli, Mimbai,
the Government Ayurvedic College & Hospital in Bangalore, the Government
Ayurvedic college & Hospital in Thiruvananthapuram, the Arinagar Ann
Government Hospital of Indian Medicine in Chennai and the Government
Siddha Medical College & Hospital at Palaymkottai to name only a few
examples. People go of their own volition and the entire approach is based on
Ayurveda or Sidhha.
The fact that the Ayurvedic/Siddha/Unani system is recognized
officially by the Government, the practices are taught as part of the
curriculum of the B. AM.S. and P.G. courses according to standards set by the
Central Council of Indian Medicine (the counterpart of Medical Council of
India) set up by an Act of Parliament supported by University degrees
awarded for practice within the country. This brings about a piquant
situation where two systems which have been conferred equal status by the
Jaw of the land, supported by their own Professional Councils set up under
Acts of Parliament having hospitals, registered practitioners, therapies and
drug regimen for different applications, continue to remain polarized.
In China, consultation meetings have been held under the aegis of the
WHO to bring about harmony between the approach to traditional and
modem medicine in general. In the National Population Policy, 2000 of
India, the following strategies and actions points find place and have the
approval of the Government.
Mainstreaming Indian Systems of Medicine & Homoeopathy
visualised in NPP - 2000
“India’s community supported ancient but living traditions of
indigenous systems of medicine has sustained the population for centuries,
with effective cures and remedies for numerous conditions, including those
relating to women and children, with minimal side effects. Utilization of ISM
& H in basic Reproductive and Child Health Care will expand the pool of
effective health care providers, optimize utilization of locally based remedies
and cures, and promote low cost health care. Guidelines need to be evolved
to regulate and ensure the standardization, efficacy and safety of ISM & H
drugs, for wider entry into national markets.
Particular challenges include providing appropriate training, and raising
awareness and skill development in reproductive and child health care to the
institutionally qualified ISM & H medical practitioners. The feasibility of
utilizing their services to fill in gaps in manpower at village levels, and at
subcentres and primary health centres may be explored. ISM & H institutions,
hospitals and dispensaries may be utilized for Reproductive Child Health care
programmes. At village levels, the services of the ISM & H ‘barefoot
doctors’, after appropriate training, may be utilized for advocacy and
counseling, for distributing supplies and equipment, and as depot holders.
ISM & H practices may be applied at village maternity huts, and at household
levels, for antenatal and postnatal care and for nurture of the bom.”
Action Plans for Mainstreaming Indian Systems of Medicine &
Homoeopathy
1. Provide appropriate training and orientation in respect of the RCH
programme for the institutionally qualified ISM & H medical practitioners
(already educated in midwifery, obstetrics and gynecology over 5 l/2
years), and utilize their services to fill in gaps in manpower at appropriate
levels in the health infrastructure, and at subcentres and primary health
centres, as necessary.
2. Utilize the ISM & H institutions, dispensaries and hospitals for health and
population related programmes.
3. Disseminate the tried and tested concepts and practices of the indigenous
systems of medicine, together with ISM & H medication at village
maternity huts and at household levels for antenatal and postnatal care,
besides nurture of the newborn.
4. Utilize the services ISM & H ‘barefoot doctors’ after appropriate training
and orientation towards providing advocacy and counseling for
disseminating supplies and equipment, and as depot holders at village
levels.”
Implementation of the identified issues for mainstreaming of
Indian Systems of Medicine
To implement the above said four identified issues, there is need to
draw a clear cut implementation policy.
1. Although there is huge infrastructure of Government ISM & H
dispensaries and hospitals in 20 States yet their utilization in the RCH
programme as well as in the National Population Policy Programme
cannot be harnessed till there is suitable organizational set up i.e..
Directorate of ISM & H in the States and it is properly strengthened by
appointing Directors as well as supporting staff. 5 ‘/z years degree trained
doctors are competent to carry out various national programmes.
However, they need short re-orientation training also for various RCH
programmes. This requires a clear cut allocation of resources and targets.
2. The ISM institutions e.g., dispensaries and hospitals also need
strengthening in their infrastructure which require additional allocation of
financial resources. These institutions can be meaningfully utilized if they
are also designated as official institutions for various health programmes.
So far this has been done only in a couple of States like Himachal Pradesh,
Karnataka and Gujarat only.
3. There is need to propagate various health and RCH related concepts of
ISM & H among the masses in rural and urban areas. The villages
midwives and dais also need to reinforce their traditional knowledge
relating to RCH.
There is need of making linkage of dais with
Government ISM & H institutions. Specific targets and resources need to
be identified.
4. Over 6 lakh registered practitioners of ISM & H are covering all the
villages of the country. There is a need to specifically designate them to
carry out specific activities relating to RCH and other population control
programmes. Material resources could be distributed through them and
modest financial remuneration, also need to be made for this purpose.
5.
There is a professional rivalry in the allopathic doctors for the
practitioners of Indian systems of medicine. It is a known fact that
allopathic doctors are not available in majority of the rural areas. ANMs
are also not available in all the subcentres. Therefore, there is need to
have explicit policy decision to utilize 6 lakh practitioners of ISM & H,
institutions and medicines of these systems for RCH and National
Population Policy Programmes.
yaealt//
DEMOGRAPHIC DEFINITIONS
Crude Birth Rate: The number of births per 1,000 population in a given
year.
Crude Death Rate: The number of deaths per 1,000 population in a
given year.
Sex Ratio: The number of females per 1000 males, in the population.
Contraceptive Prevalence Rate: The percentage of married women of
child-bearing age (15-49 years) who are using or whose husbands are
using any form of contraception, whether modem or traditional.
Natural Population Growth Rate: The difference between birth rates
and death rates.
Infant Mortality Rate: The number of deaths to infants under one year
of age, per 1,000 live births in a given year.
Maternal Mortality Ratio: The number of deaths to women due to
pregnancy and childbirth complications per 100,000 live births in a given
year.
Total Fertility Rate: The average number of children a woman would
have in her life time, given current birth rates.
Replacement Level Fertility: This implies a Total Fertility Rate of 2.1
children per couple, which is enough to replace themselves.
Population Stabilisation is when population growth ceases and
population number remains unchanged.
Pl p SJ g1
I
of SARDAR PARKASH SINGH
BAD AL, CHIEF MINISTER, PUNJAB, AT
THE
FIRST MEETING OF THE
NATIONAL
COMMISSION
ON
POPULATION IN NEW DELHI ON JULY
22, 2000.
Hon’ble Prime Minister
Hon’ble
Members of the National Commission on
Population.
It gives me great pleasure to berpartieipating 7
in this first meeting of the National
Commission on Population and I take this
opportunity to heartily congratulate the Hon’ble
Prime Minister for having taken the initiative
for the formulation of the new National
Population Policy and for convening this
meeting today.
Punjab State has always had a place of
pride in providing accessible health care to its
people. This is evident from the fact that most
1
of the targets set for achievement by the year
2000 AD in family welfare programmes have
been achieved in Punjab. The death rate and
maternal mortality rate are already better than
the goals set to be achieved by 2010 AD. The
birth rate in Punjab is 22.4 perl 000 against the
target rate of 21 perl000 while the birth rate in
India is 26.5 perl000. The total fertility rate in
Punjab is 2.7 against the target of 2.1 while in
India it is 3.3. However, Punjab has always had
the inborn capacity to face every challenge and
I have no doubt that it shall achieve the goals
set for the year 2010AD much before that date.
I- AS REGARDS THE INITIATIVE TO
MEET THE UNMET NEEDSPunjab has identified the areas where a
certain amount of unmet need still persists. The
awareness
regarding
family
planning
programme is 100% but the practice of various
family planning methods by the eligible couples
is 66%/aftdHherertrs-am4mmet-nee<Uofmearly
1’0%. To meet this requirement, the
is determined to provide Family Planning
services to all the needy eligible couples by
improving the out reach of services with quality
care. It will also be ensured that supply of
various contraceptives is adequate. As regards
cent percent registration of ante-natal mothers
is concerned, there is an unmet need of nearly
25%. As far as achievement of atleast 80%
institutional deliveries is concerned, only 37%
antenatal mothers are availing institutional
services currently. Similarly, there is a gap of
28% in the achievement of full immunization of
Infants. The shortfall in these areas is largely
because of the dearth of ANMs and Nurses in
our Primary Health centres and I will, therefore,
urge the Government of India to provide more
funds for Punjab State for hiring them on
contractual basis.
II REGARDING ISSUES OF QUALITY
OF CARE
To ensure quality services to ante-natal
mothers, staff has been hired on contractual
basis. For the transportation of high risk
mothers and emergency cases, ambulances have
been made available by Punjab Health System
Corporation(PHSC) .
In order to improve the working skill of
medical and para-medical staff, short term
training courses have been organised.
Ill SYNERGY BETWEEN
DEPARTMENTS
DIFFERENT
The new approach to family welfare
programme envisages intersectoral coordination
and cooperation. The creation of Istri Sehat
Sabha has been done with an aim to get
coordination and cooperation from the
community.
Punjab is the only State in the country
where 26000 Istri Sehat Sabhas have been
formed, ensuring their presence in each and
I
- s’'-
every village and urban slums of the State.
These grassmot_level_-Sabhas—have- ex-offick)
members representing different departments.
MEDIA,
NON
IV.ROLE
OF
ORGANISATIONS,
GOVERNMENT
PRIVATE SECTORS & PANCHAYATI
RAJ INSTITUTIONS.
In Punjab the role of Information, Education
and Communication activities has always
occupied a prominent place in the
dissemination of information about activities of
the Health Department.
I would like to assure the Hon’ble Prime
Minister and all other members of the National
Commission that Punjab State will not lag
behind in implementing the National Population
Policy and would be amongst the first in the
country in achieving the targets set by it as it
has been doing in the past also** Here I would
like to inform the august audience that Punjab
had won National Awards in family planning
for four consecutive years( 1982-1986) in the
past too.
I would once again express my gratitude to
the Hon’ble Prime Minister for having given
me the opportunity to participate in today’s
meeting.
Jai Hind.
Pl p S’ J 8
_______J
■"yVealTA/
Dr. J. K. JAIN
PRESIDENT
■ ^4/
July 21, 2000
Hon’ble Shri K.C. Pant
Deputy Chairman
Planning Commission
Yojana Bhawan
Parliament Street
New Delhi - no ooi
Sub.: Some suggestions for “Population Stabilization”
Dear Shri Pantji,
1.
a) The “National Population Policy” is exceedingly ambitious. Only one developing
country with high fertility reached replacement fertility in 10 years. This was the
Peoples Republic of China. The socio political structure of our society is quite different
than of China.
b)
The Action Plan of the policy appears to be patterned after the successful
Indonesian experience. There are important differences between the Indian and
Indonesian political/bureaucratic structures. Indonesia, since independence until veiy
recently, was ruled by a single political party and ministers, including Ministers of
Health, were primarily retired Generals. Corruption existed only at the highest levels.
The press would not question Government policy. India is far more democratic with a
free press. Corruption at lower levels of the political and bureaucratic structure is well
known. The experience has shown that the free press can be destructive to introduction
of new contraceptives as happened to the introduction of Norplant in England and the
introduction of Quinacrine based non-surgical female sterilization in India. Norplant
and Quinacrine Sterilization are not used in India due to a hostile press and
misinformation distributed by some “feminist” actually urban elitist groups. Norplant
is widely used in Indonesia, and Indonesia has completed phase two trial of Quinacrine
Sterilization.
2.
i)
A rapid reduction in fertility though voluntary acceptance cannot be achieved
through incentives or disincentives schemes. The women belonging to the developed
world and rich societies have been refusing to bear children inspite of large incentives
being offered to them, while our poor women living in rural India keep falling in the
trap of unwanted pregnancies on account of lack of knowledge and availability of
contraceptive services, inspite of all the disincentives.
a
* • ■ TU '
JAIN INTERNET
E-CDmmERCE
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Corporate Office: Mohan Cooperative Industrial Estate. G-6. Block B-1. Mathura Road. New Delhi 110044.Tel; 011-6950911.6950912. Fax: 011-6950917. E-mail:dr.jain@jaintvcom
!
-2-
ii)
I am in favour of concentrating on women of the reproductive age as the target
ii)
of our primary attention. The focused campaigns should be planned for womens a
round development.
campaign especially in rural India.
iv)
The campaign should aim at creating a demand for contraceptive services Once
the people understand that fertility regulation services will be good for
quality of life, they will even come forward to buy these services instead of expecting
?o be^ree. Once the demand gets created, than only the supply be arrai?ge^o ensure
success. Even the social marketing of contraceptive services may be the part of the
campaign.
3-
Based on our field experience, May I suggest an innovative rural outreach
communication strategy for the purpose
We have identified a traditional institution which can become the focal point of
i)
our rural resurgence movement. For centuries, on certain days of the week, buireraJind
sellers in Rural India congregate together to trade and barter, buy'and selhatRural
Haats which serve as transient bazars to meet rural consumer s need. Melas a
anXr prominent feature of Indian rural and tribal life. These Melas are held
periodicaUy at different places to commemorate an event or to honour a
their marketing and religious significance, these Rural Haats and Melas have
social significance. We have been working in this sector for a number of years and our
conclusion is that these Rural Haats and Melas can be the corner ^one
°ur n^ral
outreach strategy through which our target audiences in remotest Huts and Hamlets
can be effectively reached while they visit these Rural Haats and Melas.
ii)
More than one rural media outfits are already working on this idea and the
entire detailed information is available and valuable data about theserural Haatsnand
Melas, is stored in the computers of these agencies. Thus, it is possible today to make
an immediate beginning in select hundred or more districts in States1 1ike■Utt
Pradesh Bihar, Rajasthan, Madhya Pradesh and Onssa where the challenge
population stabilization is immediate and more grave than the rest of the country.
iii)
A suitable dispensation of a multi-media mix consisting of Doordarshan
Satellite TV channels, Video on Wheels, local newspapers in vernacular languages and
the outdoor media like wall paintings, hoardings, banners etc. not excluding inter
personal communication based on folk media shall have
d^e^
WAVE in favour of development in general and family welfa
p
Y
organizing events at the rural Haats and Melas.
■
-3-
iv)
The messages of family welfare services should be packaged with health,
education, women’s empowerment, child development, drinking water, nutation, ,
environment protection and rural development.
infotammentand en^aimnent formats in Weal languages and dialects shall be
far more effective than centrally produced programmes.
vi)
The Government is not the best agency to undertake the implementation of such
campaigns. One or several private sector professional media companies or N.G.O.s
should be encouraged to be the implementing agency, which should further seek and
channelize the participation of(a)
(b)
(c)
(d)
(e)
private commercial sector interested in reaching rural markets;
Agencies of the State Government;
the Ministries of the Central Government like Ministry of Family
Welfare, Ministry of Rural Development, Ministry of Human Resource
Development, Ministry of Environment, Ministry of Rural Employment,
Ministry of Social Justice and Empowerment, Ministry of Women and
Child Development;
N.G.O.’s;
International development agencies;
vii) I propose that we should plan a set of three mobile vans in each of these chosen
hundred districts.
1)
2)
3)
A publicity van to disseminate the message.
A mobile clinic to deliver the family welfare services.
A mobile teleinfo centre which can be connected to the Internet through
a V-Sat network.
I believe that it is a doable idea and once we start implementing the scheme, the objectives of
.he Population Policy shall definitely appear achievable.
With kind regards,
Yours sincerely,
r
(DR. J.K. JAIN)
Hp
ADDRESS
BY
SHRI KC PANT,
DEPUTY CHAIRMAN, PLANNING COMMISSION
&
VICE CHAIRMAN, NATIONAL COMMISSION ON
POPULATION
AT
THE FIRST MEETING OF NATIONAL
COMMISSION OF POPULATION
ON
JULY 22nd, 2000
1 welcome you all to the first meeting of the National Commission on
Population. As you may know, India became the first country in the world to
initiate a National Family Planning Programme as far back as 1952. The
programme is Centrally Sponsored and 100% centrally funded.
As was brought out in the presentation - over the years, there has been a
rapid decline in death rate and a slower decline in birth rate and India’s
population has grown from 36 crores in 1951 to 100 crore in May 2000. If
the current trend continues the replacement level of fertility can be achieved
only by 2026 and population will stabilize in late 21st century. This would
have serious implications.
We see the consequences of population growth all around us. India has only
2.4% of global land but 16% of global population.
We have so far been
successful in meeting the food requirements of the growing population. How
will this be affected by a declining land-man ratio and further fragmentation of
land holdings? Urban basic services are struggling vainly to cope with the rapid
pace of urbanization. Per capita water availability has been declining all over
the country, with some areas facing the spectre of water scarcity. Many other illeffects of population growth can be cited. Suffice it to say that population
stabilization is necessary for sustainable development.
It is a sobering thought that experts do not expect India’s population to
stabilize before 2045 at a level of 150 to 160 crores. To reach that goal, the
National Population Policy 2000 seeks to achieve replacement level of fertility
by 2010 with a population of 111 crores. That this goal is attainable in our
democratic polity while respecting human freedom and dignity is supported by a
number of success stories in different parts of the country.
Kerala the first State to achieve replacement level of fertility, did so in
spite of relatively low per capita income, perhaps because of high female
literacy and low Infant Mortality Rate. The decline in Tamil Nadu, in spite of
higher IMR and lower female literacy rate than Kerala, was attributed to
political commitment, bureaucratic support and effective health infrastructure.
Andhra Pradesh is likely to achieve replacement level of fertility in the next
two years. The State has shown a steep decline in fertility in spite of relatively
lower age at marriage, low literacy and poorer outreach of health care
infrastructure. The reason, perhaps, is empowerment of women and
commitment at all levels. In the North-eastern States of Tripura, Manipur and
Mizoram, despite difficulty in accessing primary health care facilities, it has
been possible to achieve not only low fertility rates but low infant mortality,
suggesting thereby that a literate population with awareness can
overcome substantial difficulties and attain success.
During the presentation you saw that currently five states viz. Bihar, Uttar
Pradesh, Madhya Pradesh, Rajasthan and Orissa, constitute 45% of the total
I
population of India. The population in these states has poor access to health
services and poor health indices. It is estimated that unmet needs for
contraception are between 25-30% in these states. It is estimated that these
states will contribute 55% of the total increase in population of the country
during the period 1996-2016. Their performance would, therefore, determine
the size of the population and the year in which the country achieves population
stabilisation. I should point out that even in these States, there are districts with
health indices comparable to the national levels; these experiences have to be
studied and replicated so that there is rapid improvement.
All these states have excellent human, mineral and agricultural potential
which have not been fully utilized or realised. For this, they have to over come
poverty, illiteracy and poor development which co-exist and reinforce each
other. This calls for political commitment, good governance and planned
coordinated efforts from all sectors and all sections of the population.
In a vast and diverse country like India, we have to assess area-specific
needs and respond to them. It is important to ensure that all births and deaths are
registered and the data utilized for decentralized planning and monitoring.
In all states, a vast health care infrastructure has been created by
Departments of Health and Family Welfare, Municipalities and Zilla parishads.
However, much of it is functioning suboptimally; part of the problem lies in
lack of facilities like labour rooms and operation theatres or lack of drugs and
diagnostic facilities. Sufficient resources have to be provided by each State and
the Centre to meet these requirements. At the same time, the existing
infrastructure has to be restructured so that it functions effectively and provides
needed quality services to the population near the vicinity of their homes. PRIs
should be taking up increasing responsibility for
monitoring delivery of
primary health care services. It is of paramount importance that accountability
and governance improve so that the existing infrastructure and resources are
utilised appropriately.
Resources are important, but it is even more important to use them
efficiently. During the Ninth Plan every effort has been made to provide
additional funds to social sector programmes. The outlay for the Dept of Family
Welfare was increased form Rs 6,500 crores in the Eighth Plan to Rs 15,120
crores in the Ninth Plan. In 2000-2001, under the Prime Minister’s Gramodya
Yojana, funds have been provided for improving rural connectivity, health,
education and nutrition, all of which have a direct bearing on population
stabilisation. Planning Commission provided earmarked funds to meet the
arrears payable to the States every year. However the basic problem that leads
to the recurrent arrears payable to the States has to be tackled. The
recommendations of the Consultative Committee on restructuring of the Family
2
Welfare infrastructure and revision of norms have to be discussed with the
states and implemented.
To achieve the goals set in the Population Policy it is crucial that there is
widest participation of the civil society; NGOs, Voluntary organizations,
corporate sector and labour. The media will have to utilise their talent and reach
to create awareness of the benefits of small families, like better health of
mothers, and better education of children. Men will have to assume their
rightful role in promoting planned parenthood.
The education and empowerment of women is one of the critical factors
that determines and enables them to achieve their reproductive goals. There is a
need to give a special thrust to girls' education. Schemes for empowerment of
women such as DWCRA can play critical roles both in population stabilization
and human development. Programmes like Balika Samridhi Yojana, and
Maternity Benefit schemes can enable women to access facilities and services
to promote small healthy families. Synergies between various schemes aiming
at the same target group have to be promoted at the village level through active
involvement of peoples’ representatives and the people themselves.
To turn the programme for population stabilization into a peoples’
movement calls for partnership between various agencies and groups, like
village level functionaries of various Government Departments, members of
cooperative societies, self help groups, thrift and credit societies, joint forest
management groups, Mahila Swasth Sanghs, NSS Volunteers and Nehru Yuvak
Kendras
Planners, programme implemented and the people themselves have to
bring about synergy and accelerated convergence between ongoing
demographic, educational, technological and info tech transitions. With all
these efforts, and the active co-operation of the distinguished members of the
Commission, I am sure that the country will optimally utilize the demographic
opportunity window during the next two decades to achieve rapid population
stabilistion, sustainable human and social development and improvement in the
quality of life of the people of India.
3
Points to be made at the Population Commission Meeting
A
L(
— o xr
Z< S
\I vu
er. • J
? ° ' //b
s
*
1. Number versus people
Concern concerned about the general tenor in the larger discourse surrounding
population implying that the numbers are more important than anything else in the
population "problem": that is, if not for the one billion population, India would be
much more prosperous today. The facts are otherwise: Indians live longer, produce
more, eat more and are less poor than what they were fifty years ago. Painting a
Malthusian doomsday scenario may be counter-productive as it happened in 1976-77
when a popular and political backlash drastically slowed down the voluntary
contraception programme for about five years.
I like to call this the "we" vs "they" syndrome - "we", the educated/middle
class/affluent/urban, are aware and responsible so "we" have small families and
contribute to India's progress. Op the other hand, "they", the illiterate/poor/rural, are
ignorant and irresponsible, so "they" have large families and so "they" are a drag on
India's progress towards prosperity. Once again, the facts are otherwise: fertility is
falling even among "them" at a fairly rapid rate. What is needed within the health &
population sector are good quality and accessible contraception services for adults and
couples, especially in view of the fact that there is substantail unmet need for
contraception in all parts of India, as shown by the NFHS data. What is NOT needed
are Malthusian doomsday scenarios and arguments, because these will inevitably
bring a coercive element to the programme with all the undesirable consequences as it
happened in 1976-77. Further, both ICPD-1994 and the present National Population
Policy of the Govt of India are on humane and sustainable principles; therefore, let us
follow those policies and strategies. If we do that and with an annual GDP growth rate
of not less than six percent, per capita incomes will rise and poverty levels will
decline, eventually resulting in population stabilisation in India.
2. Unmet Need
Traditionally, the concept of unmet need originates from the field of family planning
where it has been extensively used to measure the proportion of women/couples who
want to limit and/or space their births but are not using any form of contraception.
Because family planning is now seen as an integral part of reproductive and sexual
health, this concept of unmet need must be redefined as programs make a paradigm
shift and begin to implement comprehensive sexual and reproductive health services.
The magnitude of unmet reproductive and sexual health needs in India is daunting.
The problems in this deprived region are many. Despite decline in fertility and
increase in contraceptive prevalence, infant mortality and maternal mortality rates in
India remain unacceptably high. Human deprivation is especially grim for women as
low status and poverty has resulted in tremendous increases in gender violence.
However, a changing policy environment presents an opportunity to make a
difference.
These unmet needs can be met by:
• Getting users perspectives on improving quality of care
• Meeting the needs of adolescents, a neglected group
• Reducing maternal mortality and morbidity which is a neglected tragedy
.
•
•
•
Reducing unsafe abortion that is fast becoming a pervasive problem
Diagnosis and treatment of the silent epidemic of reproductive tract infections
Looking at cancers of the reproductive system, till now an unaddressed problem,
and
Devising strategies to tackle the challenge of HIV/AIDS
3. Quality of Care
Over the past few decades, significant growth and expansion of the Indian family
planning program have been evident. Starting from virtually no infrastructure the
Indian program has grown to encompass over 150,000 primary health centres and
sub-centres employing more than 300,000 family planning personnel. This network
now extends to almost the entirety of India’s people, three-fourths of who reside in
600,000 often small and isolated communities. Apart from family planning the
program has gradually expanded the range of services it offers to include
immunisation, antenatal and delivery care, preventive and curative health care and
most recently reproductive health services. Child survival programs have been
implemented since the 1980s. Services for promoting safe motherhood have been put
in place more recently. Prevention of HIV/AIDs and STIs are also more recent
initiatives. These achievements notwithstanding, it is difficult to escape the fact that
the Indian family planning/welfare program remains characterised by considerable
unfulfilled potential and promise. Its modest progress stands in marked contrast to its
neighbours - most notably Bangladesh, Thailand, and Indonesia. Nowhere is this
disparity more apparent than in the most populous states - the Hindi belt- which home
more than 40% of India’s population. The reasons for the limited success of India s
program extend far beyond the service delivery system They encompass the social,
cultural and economic factors - including low status of women, low levels of literacy
among women and extreme poverty which influence the demand for fertility
limitation. In recent years though there has been a growing consensus among policy
makers, researchers, and experts that the program itself - as reflected in its priorities,
emphasis and implementation of services - must be accorded prime responsibility for
the limited success of family planning in India.
The challenge today therefore, is to strengthen all these services by expanding their
reach, improving their quality and effectively integrating additional reproductive
health services within ongoing programs. Although improved quality of care is
recognised as a priority to be addressed in programmes, there is still no clear working
definition of quality in the Indian context nor tools for monitoring it. Improving
quality of care requires a focus on the process of service delivery, including
communication and information sharing; establishing minimal standards for
procedures and examinations; and ensuring that clients receive the service appropriate
to their needs. Some countries, such as Sri Lanka, have make considerable progress,
beginning before the ICPD, to provide high-quality, client centred-integrated services.
Studies show that improvements in quality can be made at a reasonable cost; without
them, people will not come to or continue using the service. Using various tools ,
family planning providers and supervisors world-wide are being trained to improve
quality of care, thereby creating commitment to solve problems as they arise.
1 Ibid
Training in quality of care creates commitment to solve problems as they arise.
Principles include treating the client well, providing the client’s preferred method,
individualising care, aiming for dynamic interaction, avoiding information overload
and using and providing memory aids".
For reproductive and child health, UNFPA India has worked out a quality framework
of nine elements to be used for planning, implementation and assessment. They
reflect programme priorities in the Indian context. These elements are.
• Access to services
• Service environment
• Client provider interaction
• Informed decision making
• Equipment and supplies
• Professional standards and technical competence
• Continuity of care
• Integration of services
• Women’s participation in decision making
4. THE ROLE OF:
a-) Civil society Organizations (CSOs), Non Governmental Organisations (NGOs)
and Panchayati Raj Institutions (PRIs)
The emerging vision of civil society
The ICPD process has drawn renewed attention to the variety of and relationships
among civil society organisations and the public sector. Civil society takes different
forms, but it may be thought of as a range of associations, organisations and
institutions that bind people of similar interests together. It includes voluntary
membership groups, the private sector and its groups and associations, cultural
organisations and advocacy groups. Among its components are co-operatives, trade
unions, micro-enterprise and self-help groups, women’s groups, health and
development advocacy and service groups, business associations, charitable
organisations, religious bodies, trade unions, political parties, clans and other family
based systems, lobbying groups, social movements, political parties professional
associations, men’s groups, youth groups - in short, the whole range of ways people
get together to express their views and attain their ends other than through the formal
state3.
The State can be involved, to different degrees in different settings, with a range of
such groups (for example, as sponsor, partner, organiser, financier, manager, licenser
or regulator) but the special roles and responsibilities of the State are distinct. The
term non-governmental organisation (NGO) is often used to refer to groups that are
2 Murphy E M and C. Steele. 1997. “Client-Provider Interactions (CPI) In Family Planning Services.”
In Recommendations for Updating Selected Practices in Contraceptive Use vol. 1, by Technical
Guidelines/Competence Working Group, USAID. 1997. Chapel Hdl, North Caroline: INTRAH
1 UNFPA. 1998.Civil society and Population and Development. Background document for the Round
table on Partnership with Civil Society in Implementation of the ICPD Programme of action, Dhaka,
Bangladesh, 27-30 July 1998.
1
no part of the State apparatus but is generally understood to be less inclusive than
civil-society organisations (CSOs) as a whole .
In the years since the ICPD, the relationship between civil-society organisations and
governments has continued to mature. In many countries, including many developing
countries, NGOs have moved closer to involvement in decision-making. They are
often included in discussion of national population policy and in official delegations
to international and regional conferences. They are not only advocates for
reproductive health and rights and gender equity but are also active in programmes to
improve women’s status and rights and reproductive health services. The ICPD has
marked a turning point for recognition of NGOs as genuine partners of governments
in planning, implementing, monitoring and evaluating policies and programmes.
The 73rd and 74th Constitutional Amendments to the Constitution have brought
Panchayats and nagarpalikas into the centre of the development debate. These
Panchayati Raj institutions can emerge as de facto agents of the development. The
challenge facing the nation is how best to enhance the ability of local bodies to take
such responsibility.
The PRIs have opened up several opportunities. There is renewed optimism in many
areas, especially regarding the greater transparency of Government administration.
PRIs provide disadvantaged communities with a voice that can be heard all the way
up to the State and national level. A large number of women have been elected to the
Panchayats, some as sarpanches (Chiefs). Elected women representatives have been
drawn from a wide cross section of society, including many rural animators who had
the opportunity to work with NGOs in women’s empowerment programmes and in
campaigns like those for total literacy, the anti-alcohol movement, and
environmental protection.
Ways and means have to be identified to draw upon the widely differing experiences
of NGOs, Panchayats and nagarpalikas with a view to merging the initiatives
launched by voluntary organisations with the legitimacy and outreach provided by
local self-governing bodies.
As a national strategy, NGOs & PRIs in various parts of the country may be involved
in the programme in the following manner:
As partners:
For advocacy on the paradigm shift in population and development, reproductive
health, and gender.
For enhancing their capacity for reproductive health, with regard to human resources,
knowledge, and skills.
For improving the working environment of NGOs by providing more resources to
them, simplifying access to resources and approval procedures, and facilitating
intersectoral co-operation.
4 NGOs in one narrow sense refer to those organizations accredited by the State to endcr into contracts
and other formal associations with donors and/or State bodies. Organizations whose operations and
management overlap with the State and which operate as agents of the State, such as parastatal
enterprises, arc often excluded from the common understanding of NGOs.
As a Resource:
NGOs /PRIs in a consultative and planning role: nationally, for the total programme;
for district level programmes; and for specific national and regional projects.
NGOs/PRIs as a Recipients of Assistance:
For innovations in reproductive health service delivery; for promotion of gender
equality and equity; for programmes for adolescents and youth; and for programmes
in border areas designed for women, environment and other relevant population and
development issues.
CSOs, NGOs and PRIs should be involved as part of district-based programmes for
the provision of primary Health Care, including reproductive health initiatives.
Activities carried out in partnership with NGOs and PRIs could include:
Training and capacity building programmes for elected representatives (including
;
women), Government officials, and NGO partners
• Establishing a community controlled and managed revolving fund for purchasing J
necessary drugs and emergency care.
• Educating the community about available health services, using young men and
women in a process to identify key health problems and information on where to
go for various services.
• Training community members, both men and women, on how to access services ,
provided under different Government programmes and by private and charitable J
•
•
•
institutions.
Establishing support groups for female village-level health, education and other
development workers.
Creating for a at the district level where elected representatives, opinion leaders,
NGOs, and Government officials can come together to discuss local health
problems and to provide fund that could be utilised in programmes, interventions,
and campaigns planned by these groups.
b) Private Sector
The private sector has the potential to play several important roles in the
implementation of the policy.
• Businesses with direct interests in the provision of supplies, services and technical
know-how can work with governments to eliminate barriers to access to services
and informations and to development of markets for those able to pay.
• They can include family planning and reproductive health services are included in
the packages of benefits that are offered to their employees and in the regulatory
frameworks governing enterprises
• Provide workers with informations and education on family life and health issues
(e.g. Tata Corp of India)
• Business associations and community groups can use their networks to provide a
platform to promote greater awareness (e.g. Rotary International)
• Medical associations such as Commonwealth medical association and the
Federation of Gynaecologists and Obstetricians and their local affiliates have
advocated for expanding reproductive and child health services. They can define
national codes of conduct and standards of care that protect basic rights.
c) Communication and Education (Focus on communication rather than role of the
media - since media is and could very well be communication tool
Well-designed communication strengthens good programmes, but information
without services only produces dissatisfaction. Raising awareness about reproductive
health is not the same as increasing the use of the services. In many countries,
information campaigns are developed without the involvement of local providers,
communities and representatives from the target groups. Messages are usually
designed for adult women and ignore key target groups like men, adolescents,
newlyweds and opinion leaders.
Communication strategies are not always well linked with services: a campaign may
raise awareness of contraception but may not say where to find it; or motivate
potential clients before the services are available. Information, education and
communication (IEC) strategies about reproductive health must go well beyond
sensitisation to provide information about how to avoid reproductive tract infections,
unwanted pregnancies and obstetrical complications, for example-Hot lines and radio
call-in shows are good for providing accurate and confidential information.
Combining several media also reinforces messages'.
Information and education strategies about reproductive health and population and
development issues must advance beyond awareness raising. Policy makers and
programme beneficiaries alike need information that will help them to make decisions
and act on them. They need information about, for example, the risks of STDs, the
danger signs of a difficult pregnancy, and available methods of contraception. They
also need information on who can provide assistance, where services are to be found
and what kinds of treatment they can expect and have a right to demand.
This information must reach everyone who needs it. The mass media are useful for
giving practical information6, but traditional and local communication channels are
also needed. So are non-governmental organisations and community groups.
5. Linkages between social investment, demographic change and development:A
broader look at population issues
•
•
•
Population and development policies which establish broad goals should be
clearly linked with the resources to achieve them;
Institutional structures should be capable of adapting to changing policies;
There has to be a commitment to gender equity and equality, greater participation
of women in policy and decision making roles, partnership with men and action
to end gender-based violence;
5 McCauley, A. P., and C. Sailer. 1995. “Meeting the Needs of Young Adults.” Population Reports.
Series J No’ 41. Baltimore. Maryland: Population Information Program, Johns Hopkings University
6 An excellent source book of practical advice and case examples concerning health communications in
the area of reproductive health is: Piotrow, Phyllis Tilson, el al. 1997. Health Communication:
Lessons from Family Planning and Reproductive Health. Westport, Connecticut: Praegcr Press
(Published under the auspices of the Center for Communications Programs, Johns Hopkins School ol
Public health).
•
•
•
•
•
•
•
Need for a rapid movement towards reproductive health service integration and
better referral systems;
Need for more responsive services, better accountability to the people for whom
the services are designed, and intensified attention to staff training, retention and
management;
Determined action to halt the spread of AIDS;
A commitment to provide quality reproductive health sei vices and information to
young people including unmarried women,
More effective decentralisation;
Improvements in the quality and use of data;
Closer collaboration between government and civil society.
6. Investments in health and education lead to smaller, healthier families.
Important choices must be made regarding investments in education, particularly of
girls and women, and in health, including reproductive health and mortality reduction.
Decisions to invest in these areas can initiate dramatic changes in reproductive
behaviour, and will shape the demographic future.
Declines in fertility and mortality are mutually reinforcing. Fertility decline is often
associated with postponing the first birth, waiting longer intervals between births and
having fewer children late in reproductive life.
' proper• care for children includes
Women who have been to school understand' that
support for their education. The more education women have, the more education
their children are likely to have. Educated mothers are more likely to invest in the
health of their children and use information and services to protect their children’s
health.
One of the strongest and most consistent relationships in demography is between
mothers’ education and infant mortality - the children of women with more years of
schooling are much more likely to survive infancy7. More educated mothers have
better health care, marry later and are significantly more likely to use contraception to
space their children. They have better skills for obtaining and evaluating information
on health care, disease prevention and nutrition. They also have better access to
resources, through earning opportunities and marriage, and can manage them better.
They are more likely to recognise the advantages of educating their children.
Women of all levels of education and economic status take steps to choose the
number and spacing of their children. Their ability to do so is a function of not only
education, but also circumstance, resources and custom. Population programmes help
provide the means.
7 This relationship is regularly graphed in the World Education Report series. Sec, for example. United
Nations Educational, Social and Cultural Organization. 1997b. World Education Report 1997. Parts.
United Nations Educational, Social and Cultural Organization. See also: Cleland, J., and J. van
Ginnckcn 1988 “Maternal Education and Child Survival in Developing Countries: The Search lor
Pathways of influence.” Social Science and Medicine 27:1357-1368. An important early theoretical
discussion of the relationships can be found in: Cochrane, Susan H. 2979. Fertility and Education:
What Do We Really Know? Baltimore, Maryland: The Johns Hopkins University Press.
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From: Sharad Pawar, MP
ISSUES RELATING TO POPULATION STABILIZATION
The focus of the National Commission on Population for Population Stabilisation
should be on three broad areas:
1. Awareness
2. Technology
3. Infrastructure
1.
Awareness
Of these the most important is the spread of awareness amongst our people. It is
equally necessary to increase the level of awareness on all related issues because
population stabilization is a crucial factor of social and economic development. This can
only be done through IEC strategies by focusing at the girl child and women.
a)
I believe that if any developmental activity is to succeed the Government
should specifically earmark plan funds for capacity building in all social
sectors i.e. education, health, women and child development, water and
sanitation.
b)
There should be earmarked funds for training of elected women
representatives especially at the grass root level. Training should be
decentralized with a cluster approach to enable women to attend these
courses. Absenteeism by either trainer or trainees should result in
disqualification for the elected Zilla Parishad members, Panchayat Samiti
members, office bearers, Mayors, Muncipal Presidents, Sarpanch and
Dy. Sarpanch of Gram Panchayats. Population stabilization should be
the responsibility of Local Self Government bodies.
c)
Adequate funds for capacity building should be allocated by the Centre
and States under plan and non-plan expenditures. Utilisation of these
funds must be taken into consideration while formulating any scheme for
allocation of funds from Centre to State and from State to Local Self
Government bodies.
d)
At the village level responsibility for implementing the programme must
be with Gram Panchayats. Village Population Committee may be
formed consisting of 75% women including all women elected members
should be responsible for implementation of the programme.
Funds for this programme should be made available to Local Self
Government bodies directly at all three tiers as far as possible.
e)
NGO’s must be associated at all levels wherever possible. However, the
nature and magnitude of the problem is such that it is squarely the
responsibility of elected representatives and the government machinaries
at all levels to ensure its success. This should not be treated a welfare
programme. It is a national crisis and must be dealt with utmost care and
urgency.
f)
The potential of the print and the electronic media should be fully
utilized in this regard. No doubt the reach of electronic media makes it
an ideal vehicle for message transmission, however, it is not adequate
that a few spots and messages are put on the media. Most of the
programmes and advertisements depict women as vulnerable, helpless,
decorative and unempowered. Therefore, the role of the media and its
utilization should be analysed carefully.
There is an immediate need for a programme and advertisement code to be set in
place. A committee of media persons, NGOs, women in public service, women
working in management levels in bureaucracy and private sector headed by
senior persons from the media be set up to formulate such code. Such codes
exists even in free and developed societies like in U.K. The media should evolve
a code for self regulation in consultation with leaders and representatives of
various sections of our society and work out a commonly agreed code and abide
by it in a responsible and transparent manner. I have been the Chairman of the
Parliamentary Committee on Broadcasting Bill and I have observed that while
eveiy section of the industry cried itself hoarse against regulation and
“censorship”, not one of them offered to set up any machinery to look into this
situation themselves. The broadcasting & entertainment industry has money,
intelligence and human resources in abundance. I think the time has come for
them to display a sense of responsibility towards the country and society.
The key to population stabilization and socio-economic development of
our countiy lies in the empowerment of women
2. Technology
(a)
Concentration should be on spacing methods which are hassle
free.
(b)
Adequately trained counseling must be available at the village
level. I
would suggest a scheme where young married
women in villages be identified and trained as counselors to
advise on method of spacing, as well as on contraception
practice. This would include cooperating and alerting the
medical staff whenever necessary to specific problems.
(C)
There is a need to push for terminal methods of family
planning for men. I believe that persons in public life should
lead from the front. Political parties should make it a preferred
practice amongst younger party-men, who will become leaders
tomorrow. The two-child norm for elected posts should not be
applicable for women candidates till we are satisfied that
women truly have control over how many children they bear.
3. Infrastructure
It is necessary that physical infrastructure is available in the country to support the
massive programme of population stabilization.
(a)
There is need for creating a safe delivery room in every village.
This should be top priority for TRY funds. More emphasis on
training and equipping Traditional Birth Attended local women
is needed till we can ensure that at least 80-90% of all
deliveries are done in hospitals.
(b)
All weather roads must be built to primary health centers and
sub centers from the village - JRY and rural connectivity
programme must be allowed to take up other programmes after
this requirement is exhausted.
(c)
A village to be declared electrified only when health care
centre with delivery room has power supply for at least 6 hours
a day.
(d)
Safe and adequate housing for medical staff at all levels should
be the responsibility of the Local Self Government bodies.
Failure to provide this should carry heavy penalties.
(e)
75% jobs on the primary health sector should be for women
and their performance should be partly rated on their
contribution to population stabilization.
(f)
The Government must push through the 81st amendment with
immediate effect.
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National Population Commission: Some Points for Consideration
Rami Chhabra
he Prime Minister, addressing the Nation in October 99, has said:
new century
demands a new mind-set.” He also recalled the philosophy of Dandranarayan as a
guiding principle for his government and pledged for a rearrangement of
development priorities by re-deploying resources and strengthening institutions for
providing to all: safe drinking water, primary health services, primary education, rural
roads and housing to rural homeless.
The PM’s words are most relevant in the context of the population issue.
New Mind-Set: Not Disentitiement but Meeting Basic Human Entitlements
The implementation of the National Population Policy (NPP) demands a new mind set.
Notwithstanding, intermediate and long term demographic objectives and goals set out in
the NPP, a linear pursuit of the earlier "'numbers crunch” approach has to be clearly
forsaken, once and for all.
The nation, at all levels, must internalise the counter-productivity of any coercive or
manipulative policies that may be conceived in the cause ofpopulation stabilisation.
Conversely, there is need to unambiguously recognise the criticalityfor time-bound
improvement of the human condition of a large mass of citizens presently below or
around the poverty line.
The country carries the stigma of the largest concentration anywhere in the world of the
absolute poor; of illiterates; the malnourished and diseased from easily preventable or
curable infections - with women and girls disproportionately represented in these
deprived ranks.
It may well be argued that the level of economic development does not necessarily
correlate directly with the extent of fertility decline. But, a concerted effort to provide
minimum human entitlements, together with measures to energise the vast, latent
talent of the people, particularly women and youth, is the ethical imperative for 21st
century India. Indisputably, the synergistic environment that such a sincere
developmental effort would generate also makes it one of the soundest strategies for
achieving an early eventual equilibrium ofpopulation numbers.
Further, there is need to better appreciate that the strict imposition/canvassing of a two
childfamily norm is not the sole path to slowing rapid population growth.
Effective increase in the age at marriage beyond the teens and thefirst birth well into
the twenties -critical to the health and human development of the girl child - can bring
very dramatic demographic change, by extending the period between generations and
serving to empowerfuture generations of women to actualise their wishes for delayed/
smallerfamily formation.
Similarly, immediate servicing of the needs of high parity couples carries both
immediate andfuture dividends, as will be elaborated later. Therefore, the need is to
simultaneously encourage several alternate pathways towards population stabilisation
rather than project a monolithic 2-child pattern for everyone.
In particular, efforts that help women to avoid a pregnancy at lifecycle
points/situations that are harmful to her/her child - because the mother is too young,
too old or too exhaustedfrom repetitive childbearing have now basic public sympathy
and support Birth rates could tumblefairly rapidly and desiredfamily sizes shrink
with such humane, people-supportive, women-sensitive, health-focused initiatives
delivered with quality of care.
Fertility Decline Trend Not to Be Disturbed
Today, despite manifold problems, the country is well launched into a fertility decline
pattern - even in the difficult North Indian states, where the pace is much slower but very
evident. Care must now be exercised that this trend is not disturbed by any controversial
actions. A spirit of consensus-building and political commitment expressed in terms of
compassion and concern for the poor—not demographic outcomes - is capable of
yieldingfairly miraculous demographic changes.
Family planning awareness and information is reasonably widespread, there is a receptive
environment among the people and most women are willing, even eager, to adopt smaller
family norms. Bridging the gap between awareness and adoption will be fastest through
affirmative actions that provide progress towards fulfillment of citizens9 basic
entitlements to create a win-win situation.
Planning Commission a Fitting Nodal Point
The Government is to be congratulated for finally breaking many years of impasse in
policy formulation and particularly for locating the National Population Commission
within the Planning Commission. Population being the subject matter of all development,
it is fitting that the Planning Commission is the nodal point for the overseeing
mechanism. This serves to bring the issue central to the entire development process and
should facilitate the inter-sectoral coordination and convergence of social development
services essential to the success of the implementation of the NPP - which was an
understandably difficult task for a line Ministry.
Integration of Health <& Family Welfare
The Ministry of Health and Family Welfare (MOHFW) now needs to concentrate on
streamlining and improving the outreach and delivery of basic health services,
including RCH and FP- the crucial and critical, but not exclusive, elements needed for
- bringing about the required massive change in society. An integrated delivery of basic
health and RCH in thefield will also require integrated direction andfunctioning of
the Health & Family Welfare Depts at the Central level - as also of the National Aids
Control Organisation nowfunctioning as an independent entity within MOHFW- to
bring about policy cohesion and to conserve and maximise the utilsation of scarce
resources, human andflscaL
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Basic Minimum Needs Investment A Basic Minimum Backdrop for NPP
Alongside^ the Planning Commission must rearrange development priorities as
indicated by the PM and secure the investments required to fill the gaps in the priority
social service sectors as earlier identified by the Ninth Plan. In particular, a
functioning primary health care system within which reproductive and child health is
embedded, safe drinking water, basic sanitation, universalisation of elementary
education and nutrition security must be assured to all. These aspects serve the under
served and voiceless but can be ignored only to the entire nation's peril. They are a
minimum backdrop requirement for achieving the NPP objectives and goals.
Creation of A National Population and Social Development Fund
The National Population Commission needs to be supported by a Population and
Social Development Fund as envisaged in the Swaminathan Report so that the various
fragmented but large sums of moneys being spent under different ministries and
different project heads can be pooled to create maximum infrastructure and impact, as
also be effectively monitored and evaluated. In particular, external multilateral and
bilateralfunds should be encouraged to flow through such a central fund so that there
is a coherent overview on resources being expended. Further, private sector and
philanthropists can be encouraged to join in supporting the provision of basic amenities.
Amplification of NPP Socio-Pemographic Goals and Action Plans
At present 10 of the 14 Socio-demographic Goals and much of the concomitant Action
Plans are conceptualised as responsibilities mainly within the health sector or in terms of
support to the health sector. To reflect the broader perspective on population it is
necessary to further amplify the NPP list of 14 socio-demographic goals to include
other ^beyond health and RCH” parameters crucial to its outcome. For instance,
improvement of women’s economic and political participation.
The government has finalised (or is in the process of finalisation) Policy Statements on
Women, Youth, Older Persons, Aids Control. These need to be reviewed to ensure that
they provide a cohesive and complementary framework with NPP. Goals pertinent to
population stabilisation efforts need to be further incorporated into the NPP.
In the present document Socio-Demographic Goal 14 relating to convergence needs
stronger articulation to categorically assign responsibility to each social sector
Ministry/ agency to reach its particular programme to identified areas/communities in
tandem with the package so that the synergy of coordinated delivery of different social
services demonstrably improves the quality of lives within which family welfare
acceptance accelerates. Identifying and utilising opportunities to promote/ link served
groups with basic health care services, including family planning, must become a twoway responsibility.
For the NPC to function effectively a Steering Committee and Sub Committees as
suggested by the Independent Commission on Health need to be formed at the earliest
Meeting Unmet Needs:
Unmet needs for family planning are largely a result of poor, ineffective/inaccessible
service delivery. However, they are also in part the function of social factors that inhibit
the actualisation of inner wishes. Further, service delivery itself is hampered in remote
and social development deprived areas. Therefore, attention to the allied social aspects
will need to be simultaneous with the push to improve the reach of contraceptive
services, even within immediate priority plans.
Further, as a significant segment of unmet need (nearly half in the most vulnerable
states) relates to family limitation, attention to terminal methods and improvement in
the delivery of sterilisation services must remain a key priority. Unfortunately, currently
sterilisation appears downgraded in the system in the anxiety to create a basket of
contraceptive choices.
Terminal method adoption by those with higher parity cannot be viewed as
inconsequential to NPP goals. Besides fulfilling a critical need for the woman/couple in
that situation, it dents low birth weight; infant, child and maternal mortality and
morbidity, which is highest for higher parity births particularly when they occur to
exhausted, debilitated mothers.
In the vulnerable Northern states fourth order and above births, which are highly
dangerous to the mother and child, comprise a third of all births. Therefore, the direct
impact is not inconsiderable. It is also the most cost-effective contraceptive service. In
the states with low CPR quality sterilisation services could readily mop up pent up
demand and in turn become the most effective communication strategy to bring in
younger women at lower parity and age -if the older woman leaves as a satisfied
customer of the service given her.
Repopularising vasectomy is also a critical programme requirement But popularising
male sterilisation poses a major communication challenge to restructure male
perceptions of their masculinity and inculcate a sense of sexual responsibility.
Strategies to promote/reinforce sexual responsibility altogether need primacy in the
face of spiraling STD/HIV infections. These cannot be effectively tackled with the
current mechanistic usafe sex” approaches. The latter are not only creating a false sense
of security but are also leading to mounting expenditures on huge condom promotion and
distribution programmes, advocacy of dual contraception approaches etc. while
contributing to the breakdown of relational values. There is an urgent requirement to
critically examine and reformulate the Aids Prevention strategies which hold grave
potential of both destabilising societal norms and
Adolescents: A Most Critical Group
Adolescents are a very significant and neglected population group. With the largest ever
cohort of adolescents now maturing to adulthood, the challenges are immense. Closer
attention to the reproductive health and contrqcepiive n^eds of the large number of
married adolescents existing presently is a distinct programme requirementfor the
family welfare programme.
But the still larger challenge is in implementing the minimum legal age of marriage.
Further, in managing to extend the years between puberty and marriage without the
patterns of sexual exposure and indulgence that has marred so many adolescent lives
in the industrialised countries and led to an explosion of out of wedlock pregnancies
and other social problems.
Wq need to learn from the experience of China and other Asian countries like Indonesia
etc. who in similar circumstances were able to extract a good demographic bonus by
investing heavily in the training of the army of youths, involving them in national
construction and enhancing national productivity while actively ensuring disciplined
abstinence from the young. While there is need to develop specific schemes and
programmes (amongst others with NYKs, NSS ) to address skill building, vocational
training and activities that lead into informal and formal means of employment, the media
will need to be separately canvassed for its role and responsibility in this regard.
How we deal with tackling AIDS and how we help our adolescents to develop healthy
lifestyles to span the years till they are ready for marriage will determine to a great
degree whether we make a demographic transition that is a wholesome equation of
low-fertility-low-mortality- and high-social-well-being equilibrium or not The path is
as important to national well being as the ultimate goal ofpopulation stabilisation.
Legislation
There is need to debate whether a linear extension^ till 2026. of the 42^ Constitutional
Amendmentfreeze of Lok Sabha seats on the basis of 1971 Census population figures
is the best solution. There is considerable sentiment in the country that basic tenets of
democracy are being denied by both the unwieldy sizes of the constituencies and the
considerable differences in population sizes of different constituencies. Nor has the freeze
served its original purpose of deterring unbridled population growth in large parts of the
country. On the other hand, to defreeze is unfair to those states that have been responsive
to the national discipline imposed. At the same time the issue of women’s representation
hangs unresolved.
It is suggested that any legislation flowing out of the NPP should reflect the new
mindset tone and tenor of the new population policy framework-within which
fundamental human rights and gender equity need to have primacy. Therefore, this
legislation should be examined de novo in order to reflect the new thinking on
population issues and to bring about greaterjustice and equity in representation
without penalising those who performed well according to past criteria.
A freeze of number of constituencies at the state level; intra state delimitation to ensure
equitable electorate sizes andfinally to ensure the principle of dual membership - one
man, one woman - in every constituency could be one configuration that meets several
demands and creates an effective new instrument
We need imaginative new breakthroughs, not a linear extension of the past. The above
needs to be seriously examined.
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Department of Family Welfare
Ministry of Health and Family Welfare
Government of India
Speech
of
Dr.C.P.Thakur,
Hon'ble Minister of Health and
Family Welfare
at the
Meeting of
National Commission on Population
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22 July, 2000
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Respected Prime Minister ji. Learned Deputy Chairman, Hon'ble Chief
Ministers, Distinguished members of the Population Commission, Ladies
and Gentlemen.
I consider myself uniquely privileged to be in charge of the Ministry of
Health and Family Welfare at a time, when after years of deliberation, the
country has adopted a holistic and comprehensive Population Policy for
achieving "Commanding Heights" in human development, especially social
sector development.
I stand before you not to give a sermon on population or a big lecture.
Each one of you know more on population than me. I stand before you to
welcome you to this Meeting as well as to request you for total commitment
to the programme and action plan for population stabilization. The National
Population Policy, 2000 not only seeks to stabilise our population but is
also an approach to improve the total quality of life of the nation.
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Sir, this country starting from the First Plan has so far spent Rs. 19,516
crores on the Family Welfare programmes only to achieve a population of
one billion in 2000. You will agree with me that it is not the programme,
which has failed, it is we who have failed. The saying of William Shakespeare
is very much applicable in this situation " the fault, dear Brutus, lies in
ourselves and not in our stars". After 50 years of independence and after
9 Five Year Plans more than 400 women per one lakh life births die. Why
should a women die during delivery or delivery related problem? A serious
disease like Toxemia of pregnancy also has become preventable now. Our
women die of anaemia, malnutrition and due to inadequate obstetric care.
We must combine to reverse this trend. Why should a single infant or a
newborn child die? They die because they are born of mothers with
anaemia, malnutrition and have immunological system which is
underdeveloped because of the malnutrition of the
mother.
Our infant mortality rate revolves round 72. We can improve this by
providing better warming conditions for the newly born, preventing
infections and arranging for better nutrition. We are not able to cover all
the children with routine immunization in most of the States. But there are
States in this country like Kerala, whose demographic profile is approaching
that of Sweden. When one of the States of India can achieve such
demographic profile why not UP? Why not Bihar? Why not Rajasthan?
Why not Madhya Pradesh? Why not Orissa? You would agree with me that
what a man has done, another man can also do. What a State has achieved
1 am confident that other States can also achieve.
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Sir, now we have decided to converge ail the programmes of Department
of Health, Department of Family Welfare and Department of Indian Systems
of Medicine & Homeopathy in my Ministry and would approach the people
with a common and united effort to remove the drudgery of the weaker
sections. With concerted and coordinated effort involving all the
Departments like Human Resource Development, Rural Development,
Women and Child Development etc. and your support, we will turn the
table on the population boom.
Even with this inadequate investment, Government spending on health care
does not always targets the right priorities. Being a clinician myself, I know
as well as anybody else that the tertiary level health care facilities in this
country need both modernization and expansion. However, given our
resource constraints we recognize that our primary duty lies in improvement
of basic primary and secondary levels of health care; of the health status of
women and children and in controlling communicable diseases. We must
recall that during the early days of economic liberalization (early 90s) both
the Central Government and many State Governments had to resort to
cutbacks on expenditure on health care. One important consequence of
this cutback was the re-emergence of diseases (hat were considered extinct
like Malaria and Plague. Currently, alter the initial success ol the
immunization programme, we have been witnessing a decline in the
standards of routine immunization and in fact of other routine health
programmes. This is particularly evident again in the large North Indian
States. Countrywide, the decline in IMR has already been slowing down.
Maternal Mortality Ratio in the country is still unacceptably high. Pregnancy
is not a disease; there is no reason why women should die during or soon
after pregnancy. Women will not die, if we succeed in disseminating proper
health information and providing basic minimum services for essential and
obstetric care. We find, however that in many Indian States the standards
of these services have been steadily declining throughout the '90s. Bihar's
immunization record used to be much better in the early '90s. UP does not
present any significant difference, in the status of safe and institutional
deliveries between NFHS-I 1992-93 and NFHS-II 1998-99. The fact that
poor people are resorting to local and often unscientific methods of
contraception, demonstrates our inability to match the growing demand
for contraceptive services of reasonably good quality.
A recent landmark in the health sector has been a major consultation by
the Ministry with the professional associations in the medical sector - IMA,
FOGSI, IAP, Indian Association of Anesthetists, elc. It was heartening to see
that the long felt need for statutory bodies like Medical Council of India,
Nursing Council of India to ease the stringency of some of their norms for
making medical services of basic kind available to the poor people was
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also strongly voiced by the leaders of these associations. Absence of
anesthetists and gynecologists is one of the major reasons for our
continuing inability to set up a credible referral system and, in fact to
handle emergency conditions of any kind. I would, therefore, strongly urge
the medical professional bodies to take into account tire need of the country
in totality and to provide lor a certain degree ol liberalisation for rural
hospitals.
Another significant suggestion was made by FOGSI in this consultation
was that a special mid-wifery cadre needed to be developed everywhere
in the country and more clinical responsibilities entrusted to trained mid
wives. FOGSI had pointed out that in several countries obstetric care is
actually being provided by mid-wives. Even if it is not possible for the
Government to create a new cadre of Government employed mid-wives, it
would certainly be possible to train and equip mid-wives for working in a
private capacity in every village or in groups of villages. We should look at
the success of Sri Lanka and other South-East Asian countries, who have
wisely invested on building up a strong cadre of mid-wives as providers of
health care in rural areas.
Main streaming of the vast body ol Indian System of Medicine practitioners
in tlie health sector and using their services for certain essential public
health activities was another important recommendation ol the consultation
which the government intends to follow up vigorously. The Ministry has
already made an important beginning in this direction by including
Ayurvedic/unani drugs for basic health care needs for women and children,
in the drug kits supplied by the Family Welfare Department at the sub
centre level. The States too should supplement this effort vigorously through
their State specific schemes.
it is true that the current public sector expenditure on health at 1.2% of
GDP, is meager compared to that of other countries. I request the Prime
Minister, Finance Minister, Deputy Chairman of Planning Commission and
in fact ail the agencies of Government who have a role in deciding upon
financial allocations for government business, to accord higher priority to
investment in the Health, Family Welfare and population related sectors.
There is an urgent need to consider new and unorthodox solutions for
tackling this chronic problem. Did Mahatma Gandhi have enough resources
to start a war against slavery? Did Lord Rama had enough resources or an
organised army to win the war against the Ravana? The answer is NO. It
was their Will and Determination and the fighting spirit for a noble cause
that led to their victory. I request everyone present here to fight for the
noble cause of population stabilization. This time we are determined to
make good the shortcomings of the programme like shortage of condoms,
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pills, iron and folic acid but from our side. I would request the State
Governments to ensure the presence of Doctors at PHCs and Hospitals and
to make the services of Doctors and health workers available to the target
groups. State governments also need to frame imaginative and firm policies
for managing and motivating the work force in the health sector-doctors,
para medicals and all other categories of employees. The problem of
absenteeism and indiscipline can be tackled by firm and even handed
policies. Above all, the experience of many States has shown that in the
health sector, devolution of managerial and financial responsibilities to the
elected bodies at district and sub-district levels does pay in terms of
increased accountability and improved functioning. Where the arm of the
government does not reach, we must not fight shy of enlisting the support
of the NGOs. My Ministry would whole-heartedly compliment and support
your noble efforts.
This is a country where we worship Durga, we worship Kali and we worship
Saraswati. A very renowned poet of Hindi Shri Jay Shanker Prasad said
about women "Nari Tu Kewal Shradha". But this is a country where woman
is killed before she is born, just after the birth and even after marriage for
not bringing enough dowry. These are the heinous practices prevailing in
this country and can best be controlled by educating and empowering the
women.
We have targeted certain States, which are lagging behind and with your
help they can be brought at par with other States. The state of the health
care facilities in most of the urban slums and peri-urban areas is often
appallingly poor. We have been neglecting, far too long, the special needs
of our tribal population and vulnerable segments of our population like the
adolescents and the aged. With the increasing longevity of the average
Indian, chronic diseases cannot be neglected any longer. Nevertheless, the
fact remains that in large parts of the country the primary task is the effective
control of communicable diseases, diarrhoea, enteric diseases, vector borne
diseases like Malaria, Kala Azar, TB and HIV/AIDs. Control and treatment
of STls/RTls is an important strategy for not only improving maternal health,
but also for controlling HIV/AIDs in the community. The Family Health
Awareness Campaign now being conducted by the Ministry twice a year is
an excellent example of what can be achieved by converging the efforts of
various Departments.
There has already been too much delay in completing our basic tasks.
Time has now come to reorient our strategy and to take on the challenging
tasks set before us by the National Population Policy resolutely. With your
whole hearted cooperation and the support of Hon'ble Prime Minister and
the Planning Commission we will convert this war against population from
a possible victory to a certain victory.
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POPULATION SITUATION
AND
NATIONAL POPULATION
POLICY 2000
National Commission on
Population
22nd July, 2000
BIRTH & DEATH RATE IN INDIA 1901 to 2001
60
50
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1r°
10
0 ____
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Source:- Registrar General, India
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Population Projections
700
600
500
I
400
§
200
r
300
i:
100
0 LIB__
BIHAR,
M.P.
RAJASTHAN
O R IS S A ,
U.P.
MAHARASHTRA
KARNATAKA
KERALA
GUJRAT
ASSAM
WEST BENGAL
PUNJAB
HARYANA
OTHER STATES
T.N.
Region
^1996
o 2001
Source:- Registrar General India
E 2 0T6
lT2_0T1“
H 2016
5
6
3
NATIONAL
POPULATION
POLICY 2000
Requirements for rapid
Population Stabilisation
• Primary Health Care
• Reproductive Health care accessible
and affordable
• Coverage and outreach of education
• Empowering women
• Housing, safe drinking water and
sanitation
• Transportation and communication
10
5
Immediate Objectives
• Address the
unmet needs of
contraception, health infrastructure
and trained health care personnel
• Provide integrated service delivery
for basic reproductive and child
health care
11
Medium Term Objective
• Achieve Replacement Level Fertility
(TFR of 2.1) by 2010.
Long Term Objective
• To bring about population stabilisation
by 2045
12
6
Strategic Themes
• Decentralise planning & implementation
• Convergence of services
• Empower women
• Promote child health and survival
• Address unmet needs
• Utilise diverse health care providers
13
Strategic Themes (contd.)
• Target under-served groups
• Promote Indian Systems of Medicine
• Collaborate with NGOs & private
sector
• Promote R & D
• Provide for the older population
• Upscale IEC
14
7
STRATEGIES
FOR
CONSIDERATION
DECENTRALISATION, CONVERGENCE
AND PARTNERSHIPS
Population is not an issue of any one
sector - it is of concern to everyone
-Convergence of services
-Cluster services
-Partnerships
with
private/corporate sector
NGOs
&
-Strengthen Panchayati Raj Institutions
-Make Decentralisation
participation a reality
and
people’s
16
HEALTH - WHAT TO DO?
A healthy population is a pre-requisite
for better quality of life
• Reduce maternal and infant mortality
• Universal immunization
• Prevent & control diarrhea, ARI, malaria,
T.B., and AIDS
17
HEALTH - HOW TO DO?
• Ensure quality of care
• Increase out-reach
• Use Indian Systems of Medicine &
Homeopathy effectively
• Restructure health infrastructure
• Rationalize costs of health care
18
9
NUTRITION
• 20% of the world’s children, but over 40 % of
the under-nourished
• No decline in under nutrition in pregnant
women and 6-24 month children
• No change in birth weight.
• Though severe under nutrition reduced by
50%, reduction in mild under nutrition is
marginal
• To be tackled by convergence of
ICDS services
health &
19
WATER AND SANITATION
■ Households with-Drinking water
from pump pipe
B Household with Toilet facilities
• About 200 million
people do not have
120
access
to
safe
98.6
100
drinking water.
78.5
75.6
_________
74
3
80 18.2
• 1.5 million children
H
■
Z
)8.2
63.6
■
■
ffi
under
5
die
I________ ■
| 55.8 I
57-3 I
60
annually due to
40 .
water
borne
2.9
diseases
20 • 200 million person0 days of work lost
JS
E
■5
I
—
S
1 3
annually due to
E
1 E £
water-borne
20
diseases.
s
I it I I I I 1 11
1
re
^re
re
re
jC
R
10
WOMEN’S EMPOWERMENT
Fertility decline and quality of life
depend on status of women
• Increase female literacy
• Enhance political participation
• Promote women’s health in totality
• Facilitate income generation by women
• Eliminate violence against women
(foeticide, infanticide, dowry related
etc.)
21
Total Fertility Rate by Education
and Residence
1
1
1
High School and above
I
Middle School
Literate < Middle Complete
1
T
1
Illiterate
■ 2.15
I
is* .49
j___
rI
1
S*-03
3.67
Rural
|2.70|
Urban ■
0.0
05
1.0
1.5
2'0
2.5
3.0
3.5
4.0
4.5 I
__ I
22
Source-NFHS-l(1992-1993)
11
Met and Unmet Need
for Family Planning
a
5.T
89.
X
-------------
40.6/ /
^48.2/
\^NFHS-2_
g Unmet Need
□ Met Need
□ Desire for child
22
INFORMED CHOICE &
MEETING UNMET NEEDS
Two third Indians use or want to use
contraception. Coercion not required.
• Meet felt needs of families
• Enable them to achieve their RH goals
• Don’t push method specific targets
• Ensure availability and provide quality
services
• People will enable realisation of national
goals
24
12
ADDRESSING MEN
Reproduction and child care traditionally
seen as woman’s burden
• Educate, inform and counsel men to:
- Plan small families
- Use contraceptives (sp. NSV)
- Care for women’s health
- Be caring & responsible fathers
- Say no to sex determination tests & dowry
- Educate daughters
- Treat sons and daughters equally
25
ADOLESCENTS
The next two decades will witness the
largest ever increase in the number of
adolescents.
• Devise suitable strategies for meeting
health, economic and social needs
• Reduce teenage pregnancies
• Sensitize adolescents - break gender
stereotypes and respect women
26
BUILDING PUBLIC OPINION
Demonstration of support by political &
religious leaders
• Debate and discuss in print and audio
visual media
• Media to project the concepts of small
family, gender equality and discourage
objectification & stereotyping of women
• Promote innovative, participatory and
interactive IEC
27
"Th ^im I
o
@0
ooo
@ @
00000
14
JH p G -2?o
-
M'O* ? /
,00^
•D’
> -fr /_______________________________________ _ __________________
^?pej5'ch of Prime Minister, Shri Atal Bihari Vajpayee at Inaugural Meeting of
< rp.'^
National Commission on Population
New Delhi, 22nd July, 2000
My colleagues
Deputy Chairman of Planning Commission, Shri K.C. Pant,
Minister of Health, Dr. C.P. Thakur,
C 'hief Ministers,
Members of the National Commission on Population,
Ladies and Gentlemen:
1 am happy to be with you at the first meeting of the National Commission on Population.
Many of you have taken time off from your busy schedules to be here. This reflects emerging
universal concern over the problem of runaway population growth.
The solution to this problem lies in stabilising our population at a sustainable level.
Achieving this stabilisation is a challenge. But once we overcome the challenge, we can truly
develop our national human resource into a formidable force that will propel India towards allround prosperity.
It is expected of the state to look after the basic minimum needs of its people. But, as I had
pointed out the day we crossed the one billion mark, it is virtually impossible for any state to meet
the legitimate requirements of its people if its population continues to gallop from one high to
another. As a result, with the best of intentions, the state fails in its primary task: Ensuring a better
quality of life for the largest possible number of its people.
It is, therefore, the state’s responsibility to prevent its population from exploding to
unmanageable limits.
This was realised by India much before any other developing country faced with a similar
problem. Indeed, we were the first country to formulate and adopt a.National Family Planning
Programme way back in 1952. The objective of that programme was to "reduce birth rate to the
extent necessary to stabilise the population at a level consistent with requirement of national
economy".
Nobody can fault the intention behind that programme; indeed, it was a courageous step
forward, given the cultural, social and traditional realities of Indian society five decades ago.
But. a reality-check on how effective that programme and various policies framed
subsequently have been in preventing a runaway population growth, reveals rather disturbing facts.
Today, India is the second most populous country in the world. With only 2.5 per cent of global
land, it is home to nearly 17 per cent of the world’s population.
Every year, more than 15 million children are born here to an unsure future. For, India is
among those countries that have a high child mortality rate. As many as 100 of every 1,000 of our
children aged under five and more than 200 of every 1,000 of our children aged under 15, risk
dying a premature death.
No less disturbing are the facts that more than half our children aged under four are
undernourished; 30 per cent of our newborns are underweight; 60 per cent of our women are
anaemic. Forty per cent of the world’s malnourished children are to be found in our country.
It is indeed paradoxical that this dark reality is in sharp contrast to the progress made by us
in food production, disease control and overall socio-economic development. These harsh realities
persist in spite of numerous population-related programmes and despite huge sums ot money being
spent by Government.
Obviously there were flaws in these programmes as well as lapses in their implementation.
If I were to list the reasons why despite elaborate family welfare programmes and huge
years.
spending. India's population has shot up to one billion from 240 million in the last hundred years,
they would broadly be:
Lack of universal access to basic health care facilities;
High child mortality rate;
Low literacy rates, especially among women;
Persistence of high levels of rural and urban poverty;
Inadequate awareness of options and unmet needs for contraception services;
And. of course lack of political as well as popular will to squarely face the problem and
overcome the challenge.
Indeed, the success stories of countries like China, Bangladesh, Malaysia and Indonesia
show that given the political will, backed by adequate popular response, the apparently impossible
task of checking population growth can be achieved.
However, one need not necessarily look for examples outside India.
At home we have the examples of Kerala, Goa, Tamil Nadu and Andhra Pradesh. Each of
them has shown exemplary performance in containing the growth of their respective population.
The fertility and mortality rates of Kerala and Goa are nearly similar to those of developed
countries, fhese States are reaping the benefits of investing in literacy, especially womens
education, health care services and awareness campaigns.
At the other end of the spectrum are Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar
Pradesh. These States have very high mortality as well as fertility rates. They also lag behind in
providing adequate access to health care services, investing in education and empowering women - factors that ultimately play a decisive role in determining family size.
Ironically, there are pockets within these States where investing in health and education,
involving voluntary associations and encouraging community participation have yielded good
dividends. I would urge these State Governments to take a cue from the success stoiies of States
within the country as well as areas within their own territories.
The Central Government, on its part, is determined to ensure that flaws in programmes are
removed and lapses in implementation do not recur. As a first step, the Ninth Plan recognises the
need for a strategy to achieve rapid population stablisation by:
Reducing infant and maternal mortality;
Meeting felt needs for contraception.
The Ninth Plan also aims at investing more in the social sector and in synergising health,
literacy and women's empowerment programmes. To ensure that these objectives are fulfilled, and
to focus attention on the problem of runaway population growth, we took two subsequent
decisions.
The first was the adoption of the National Population Policy 2000 that provides the policy
framework for improving the quality and coverage, as well as for monitoring the delivery, of
family welfare programmes. The policy focuses both on society as a whole as well as the primary
building block of society, the family - it targets overall population stabilisation; it aims at
encouraging families to achieve sustainable reproductive goals.
Simultaneously, the policy promotes synergy among various social welfare and economic
development programmes. It rests on the wisdom that population stabilisation is the key to
sustainable development which is the key to improvement in the quality of life of the masses.
Our second move was to set up the National Commission on Population. This is a broad
based body that includes representatives of both Government and non-government organisations,
as well as individuals who can influence society.
Your mandate is to:
2
i
3
Review, monitor and give directions for the implementation of the National Population
Policy so that the goals that we have set for ourselves can he achieved;
Promote synergy between health, education and related development programmes so that
population stabilisation can be achieved by the year
Encourage inter-sectoral coordination in both planning and implementing programmes with
the help of different sectors and agencies of both the Union and the State Governments; and,
Build up a people's movement in support of this national effort.
The goals set by the National Population Policy are no doubt difficult, but by no means
impossible, to achieve. 1 am confident that with the help of the National Commission on
Population, and through you the people of India, Government will be able to achieve:
Universal access to quality family planning services so that the two-child norm becomes a
reality;
Total coverage of registration of births, deaths and marriages;
Full access to information on birth limitation methods and freedom of choice, especially to
women, for planning their families;
Reduction of Infant Mortality Rate to below 30 per thousand live births, incidence of low
birth weight and maternal mortality rate;
Immunisation against preventable diseases;
Elimination of incidence ofgirls being married below the age of 18;
Increase in the percentage of deliveries conducted by trained persons to lOOper cent,
C'ontain Sexually Transmitted Diseases, especially AIDS;
Universalisation of primary education and reduction in the dropout rates at primary and
secondary levels to below 20 per cent both for boys and girls.
.
To facilitate the attainment of these goals by the National Commission on Population, my
Government proposes to set up an Empowered Action Group and a National Population
StablIThe Empowered Action Group, attached to the Ministry of Health, will be charged with the
responsibility of preparing area-specific programmes, with special emphasis on States that have
been lagging behind in containing population growth to manageable limits and will account tor
nearly half the country's population in the next two decades.
>
The Group will also concentrate on involving voluntary associations, community
organisations and Panchayati Raj Institutions in this national effort. It will explore the possibility
of expanding the scope of 'social marketing' of contraceptives in a manner that makes them easily
accessible even while raising awareness levels.
The National Population Stabilisation Fund, which will provide a window for canalising
monies from national voluntary sources, is being set up to specifically aid projects designed to
contribute to population stabilisation. 1 appeal to the corporate sector, industry, trade organisations
and individuals to generously contribute to this fund, and thus contribute to this national effort.
To give it a kick-start, the Planning Commission may consider making a seed contribution
from resources available with it. We will associate non-government representatives in the
management of the National Population Stabilisation Fund.
Friends, I look forward to the National Commission on Population playing an active role,
not only by generating ideas but also helping in their implementation in the coming years.
I began by saying that India's runaway population growth is a challenge that stares the
nation in the face. I would like to conclude by saying that together we can overcome this
challenge.
Thank vou.
3
~c>r v
vA.
ou )
S
U2'^^Xirculated to the Members of the National Commission on Population
Some key isues brought to the attention of the Members of the Commission
at its first meeting on 22nd July 2000 for urgent action
1.
There is an urgent need for raising the budget allocation for all the social
sectors impinging on population stabilisation programmes envisaged in the
National Population Policy document. This will include raising budgetary
provisions for the Departments of Education, Family Welfare, Women and
Child Welfare, selected aspects of Rural Development including
empowerment of Panchayati Raj Institutions and Self-Help Groups for
women. The budget for the Department of Family Welfare, as a
percentage of Government budget should be immediately raised from 1.8
to 3.6 per cent.
2.
The budgetary provisions for primary education should be doubled
immediately from this year onwards in order to ensure universal education
for all children below the age of 14. The earlier promises made by the
Government to increase the provisions for education to 6 per cent of GDP
by 2000 (from 3.8 per cent in 1996-97) should be fulfilled at least by 2005.
3.
The infrastructure facilities for delivery of Primary Health Care should be
considerably expanded and improved, and the gaps in the availability of
sub-centres. Primary Health Centres and Community Health Centres
should be filled in immediately by necessary constructions, provision of
equipments and personnel.
4.
The Technology Mission contemplated in NPP 2000 for the six backward
States of Bihar, Madhya Pradesh, Rajasthan, Uttar Pradesh, Assam and
Orissa should be immediately set up under the leadership of a dynamic
management specialist with a group of experts drawn from different
disciplines of administration, reproductive health, primary health care and
monitoring and evaluation. The additional budget envisaged for these six
States should be made available to the Technology Mission for spending
on these States on directions listed in the National Population Policy 2000.
:^ii
5.
In order to have effective programme implementation in these States, it
will be useful to set up State-level Corporations which will oversee the
implementation of reproductive health, family planning and primary
education and Self-Help Groups (SHG)for women’s programmes in these
States.
6.
We have successful experiences of such Corporations in Uttar Pradesh.
Corporations such as U.P. Bridge Construction Corporation has made
good name and their work has been recognised in other States. If they can
do so in other States, why can’t they do in their own State?
7.
There should be close monitoring of the programmes of population
stabilisation implemented throughout the country. A separate cell under a
senior person should be set up in the Population Commission on the
progress of the programmes in different States of the country.
8.
The data on Couple Protection Rate estimated by the Department of
Family Welfare has come to be questioned in terms of its credibility and
usefulness. These data do not match with independent estimates obtained
from carefully conducted sample surveys such as the National Family
Health Survey. It is essential that a Committee is immediately set up to
revamp the estimation procedure of Couple Protection Rate calculated by
the Ministry and developing the data-base on which they have to be
computed.
9.
The extension of freeze on the number of seats to Parliament from each
State on the basis of 1971 census (42nd Constitution Amendment) until the
year 2026, approved by the Cabinet and included in para 37 of NPP 2000
is a laudable step. It should be brought up for legislation in the
forthcoming monsoon session of Parliament. This will serve as a powerful
motivational measure for the State Governments to fearlessly and
effectively pursue the cause of population stabilisation.
Dr K Srinivasan
Member, National Commission on Population
Executive Director, Population Foundation of India
2
I
Over one-third of Indian
population below poverty line
DH News Service
NEW DELHI, Junes
As per the latest information
available with the government,
320.37 million people, or 35.97 per
cent of the total population, are es
timated to have been living below
the poverty line in 1993-94. Of
these, 15.65 million people were
living below the poverty line in
Karnataka the same year, Minis
ter of State for Planning and Pro
gramme Implementation Ram
Naik informed the Lok Sabha in
written answers.
The minister said that from
time to time, the government had
reviewed the implementation of
the rural poverty alleviation and
employment generation
pro
grammes including the Integrated
Rural Development Programme
(IRDP), the Jawahar Razgar
Yojana (.TRY) and the Employment
Assurance Scheme (EAS) in the
Central Level Co-ordination Com
mittee (CLCC), State-Level Co-or
dination Committee (SLCC) and at
the district-level by the governing
body of the District Rural Devel
opment Agencies (DRDAs).
These programmes were also re
viewed through an intensive re
gime of field inspections by offic
ers of the Centre, state and imple-
mentation agencies. Periodic, re
view meetings with state secretar
ies the incharges of rural develop
ment and conferences of project
directors of DRDAs were also held
to review the progress of
implentation of these schemes.
Monitoring and vigilance commit
tees had been set up at the state,
district and block levels in which
elected representatives of the peo
ple had been associated to monitor
the implementation of these
schemes.
Besides, to assess the overall im
pact of various poverty alleviation
programmes, in relation to their
specific objectives, the Ministry of
Rural Areas and Employment
undertook periodic concurrent
evaluation of their major schemes
through independent recognised
organisations.
Some of the positive points list
ed among the main findings of the
latest concurrent evaluation re
port on IRDP (September 1992-August 1993) were: (a) while 15.96 per
cent of the families helped crossed
the poverty line of Rs 11,000 per
annum, the additional annual in
come of more than Rs 2,000 was
generated to a large percentage
(57.34 per cent) of families. The an
nual income from the assets was
more than Rs 6,000 in 29 per cent
of the cases; (b) 95 per cent of the
beneficiaries felt that the help
given to them was according to
their choice.
A large number of beneficiaries
found the assets to be of good qual
ity. On the other hand, the areas
of concern were (a) a very poor
linkage of the IRDP with the
Training of Rural Youth for SelfEmployment (TRYSEM) and De
velopment of Women and Children
in Rural Areas (DWCRA); and that
(b) in 45 per cent of the cases, the
settlement of claim preferred by
the beneficiaries for perished as
sets remained unsettled.
PM to call all-party
meet on poverty
NEW DELHI, June 3 (PTI)
Prime Minister Atal Behari
Vajpayee would be convening an
all-party meeting to elicit their
opinion on how they could play a
more effective role in proper
utilisation of funds for anti-pov
erty programmes.
Intervening during question
hour in Lok Sabha today, Mr
Vajpayee admitted that elected
representatives were unable to
participate effectively in such a
serious matter.
National Population Policy, 2000
I?
ACTION PLAN
Operational Strategies
Converge Service Delivery at Village Levels
1. Utilise village self help groups to organise and provide basic services for
reproductive and child health care, combined with the ongoing Intearated Child
Development Scheme (ICDS). Village self help groups are in existence throuah
centrally sponsored schemes of:
(a) Department of Women and Child
Development, Ministry of HRD, (b) Ministry of Rural’ Development, and (c)
Ministry of Environment and Forests. Organise neighbourhood acceptor groans
and provide them a revolving fund that may be accessed for income generation
activities. The groups may establish rules of eligibility, interest
rates, and
accountability for which capital may be advanced, usually to be repaid in
installments within two years. The repayments may be used to fund
•J another
acceptor group in a nearby community, who would exert pressure to ensure
timely repayments. Two trained birth attendants and the aanganwadi worker
(AWW) should be members of this group.
2. Implement at village levels a one-stop integrated and coordinated service
delivery package for basic health care, family planning, and maternal and child
health related services, provided by the community and for the community. Train
and motivate the village'self-help acceptor groups to become the primary contact
at household levels. Once every fortnight, these acceptor groups will meet and
provide at one place 6 different services for (i) registration of births, deaths
marriage and pregnancy; (ii) weighing of children under 5 years, and recordino
the weight on a standard growth chart; (iii) counseling and advocacy for
contraception, plus free supply of contraceptives; (iv) preventive care, with
availability of basic medicines for common ailments: antipyretics for fevers
antibiotic ointments for infections, ORT /ORS1 for childhood diarrhoeas, together
with standardised indigenous medication and homeopathic cures; (v) nutrition
supplements; and (vi)
advocacy and encouragement for the continued
enrolment of children in school up to age 14. One health staff, appointed by the
panchayat, will be suitably trained to provide guidance. Clustering services for
women and children at one place and time at village levels will promote positive
interactions in health benefits and reduces service delivery costs.
3. Wherever these village self-help groups have not developed for any reason
community midwives, practitioners of ISMH , retired school teachers and ex
defence personnel may be organised into neighbourhood groups to perform
similar functions.
Oral Rehydration Therapy /Oral Rehydration Salts
4. At village levels, the Aanganv/adi Centre may become the pivot of basic
health care activities, contraceptive counseling and supply, nutrition education
and supplementation, as well as pre-school activities. The aaganwadi centre
can also function as depots for ORS/basic medicines, and contraceptives.
5. A maternity hut should be established in each village to be used as the village
delivery room, with storage space for supplies and medicines. It should be
adequately equipped with kits for midwifery, ante-natal care, and delivery; basic
medication for obstetric emergency aid; contraceptives, drugs and medicines for
common ailments; and indigenous medicmes/supplies for maternal and new
born care. The panchayat may appoint a competent and mature mid-wife, to
look after this village maternity hut. She may be assisted by volunteers.
6. Trained birth attendants as well as the vast'pool of traditional dais should be
made familiar with emergency and referral procedures. This will greatly assist
the Auxiliary Nurse Midwife (ANM) at the subcentres to monitor and and respond
to maternal morbidity/emergencies at village levels.
7. Each village may maintain a list of community mid-wives, village health
guides, panchayat sewa sahayaks, trained birth attendants, practitioners of
indigenous systems of medicine, primary school teachers, and other relevant
persons, as well as the nearest institutional health care facilities that may be
accessed for integrated service delivery. These persons may also be helpful in
involving civil society in monitoring availability, quality and accessibility of
reproductive and child health services; in disseminating education and
communication on the benefits of smaller and healthier families, with emphasis
on education of the girl child; and female participation in the work force.
8. Provide a wider basket of choices in contraception, through innovative social
marketing schemes, to reach household levels.
Comment: Meaningful decentralisation will result only if the convergence of the
national family welfare programme with the ICDS programme is strengthened.
The focus of the ICDS programme on nutrition improvement at village levels
and on pre-school activities must be widened to include maternal and child
health care services. Convergence of several related activities at service
delivery levels with, in particular, the ICDS programme , is critical for extending
outreach and increasing access to- services. Intersectoral coordination with
appropriate training and sensitisation among field functionaries will facilitate
oissemination of integrated reproductive and child health services to village and
household levels. People will willingly cooperate in the registration of births,
deaths, marriages, and pregnancies if they perceive some benefit. At the village
level, this community meeting every fortpight, may become their most convenient
access tot basic health care, both for maternal and child health, as well as for
common ailments. Households may participate to receive integrated service
delivery, along with information about ongoing micro-credit and thrift schemes.
Government and nongovernment functionaries will be expected to function in
in
harmony to ensure integrated service delivery. The panchayat will promote this
coordination and exercise effective supervision.
(iii)
Empowering Women for improved Health and Nutrition
Create an enabling environment for women and children to benefit from
products and services disseminated under the reproductive and child health
programmes. Cluster services for women and children at the same place and
time. This promotes positive interactions in health benefits, and reduces service
delivery costs.
1.
2.
As a measure to empower women, open more child care centres in rural
areas, and in urban slums, where a woman worker may leave her children in
responsible hands. This will encourage female participation in paid employment
reduce school drop-out rates, particularly for the girl child, and promote school
enrolment as well. The aanganwadis provide a partial solution.
3.
To empower women, pursue programmes of social afforestation
to
facilitate access to fuelwood and fodder. Similarly, pursue drinking water
schemes for increasing access to potable water. This will reduce long absences
from home, and the need for large numbers of children to perform such tasks.
4.
In any reward scheme intended for household levels, priority may be given
to energy saving devices such as solar cookers, or provision of sanitation
facilities,, or extension of telephone lines. This will empower households, in
particular women.
5.
Improve district, sub-district, and panchayat level health management with
coordination and collaboration between district health officer, sub-district health
officer and the panchayat for planning and implementing activities. There is need
to:
• Strengthen the referral network between the district health office, district
hospital and the community health centres, the primary health centres, and the
subcentres in management of obstetric and neo-natal complications.
• Strengthen community health centres to provide comprehensive emergency
obstetric and neo-natal care. These may function as clinical training centres as
well. Strengthen primary health centres to provide essential obstetric and neo
natal care. Strengthen subcentres to provide a comprehensive range of
services, with delivery rooms, counseling for contraception, supplies of free
contraceptives, ORS, and basic medicines, together with facilities for
immunisation.
• Establish rigorous problem identification mechanisms through maternal and
peri-natal audit, from village levelupwards.
6.
Ensure adequate transportation" at village level, subcentre levels, zilla
parishads, primary health, and at community health centres. Identifying women at
risk is meaningful only if women with complications can reach emergency care in
time.
L '
'iriprove the accessibility and quality of maternal and child health services
through:
•
• Deployment of community mid-wives and additional health providers at
village levels, cluster services for women and children at the same place and
ime rom village level upwards, e.g. ante-natal and post-partum care, monitoring
imant
miant growth, availability of contraceptives and medicine kits; and routinised
immunisations at subcontrc lovals
Strengthen the capacity of primary health centres to provide
basic
emergency obstetric and neo-natal health care.
agencies in developing and disseminating traininq
modules for standard procedures in the management of obstetric and neo-natal
cases. The aim should be to routinise these procedures at all appropriate levels.
Improve supervision by developing guidance and supervision checklists.
8.
Monitor performance of maternal and child health services at each level bv
using e maternal and child health local area monitoring system; which includes
rnon|tonng he incidence and coverage of ante-natal visits, deliveries assisted by
C^re personnel' and post-natal visits, among other indicators. The
M at the subcentre should be responsible and accountable for registering
every pregnancy and child birth in her jurisdiction, and for providing universal
ante-natal and post-natal services.
Improve technical skills of maternal and child health care providers by;
Strengthening skills of health personnel and health providers through
pXmpT andT°w theJ°b tra'nin9 in the mana9ement of obstetric and neo-natal
C
mergencies This should include training of birth attendants and community
a oZa ani h ^H16761 h0SP't2lS 10 "fe SaW9 ski"S' Such as management of
asphyxia and hypothermia.
Training on integrated management of childhood illnesses for infants (1
week - 2 months).
9.
1°i h- S,UpPorl community activities such as dissemination of IEC material
including leaHe s and posters, and promotijn of folk jatras, songs and dances to
promote healthy mother and healthy baby messages,
along w'h good
dangerWil P
11.
'
CeS '° ensure saie m=lberhood. including early recognition jot
Programme development, comprising:
womeTand'rNHlly hSalth
nutrition- The aanganwadi worker will identify
micro-nutritional ripT ■ In .the. Vllla9es' who suffer from malnutrition and/or
Zide nXPnl?
'S1nC,eS 'nCludin9 ir°n' Vltamin A' and iodine deficiency
provide nutritional supplements; and monitor nutritional status.
onvergence, ^strengthening, and and universalisation of the
nutritional
programmes of the Department of Family Welfare and the ICDS
run by the
Department of Women and Child Development, ensuring training, and timely
-supply of food supplements and medicines.
Include STD/RTI and HIV/AIDS prevention, screening and management
m maternal and child health services.
Provide quality care in family planning, including information, increased
contraceptive choices .for both spacing and terminal methods, increased access
to good quality and affordable contraceptive supplies and services at diverse
oe ivcry points, counseling about the safety, efficacy and possible side effects of
each method, and appropriate follow-up.
'
12.
Develop a health package for adolescents.
13.
Expand the availability of safe abortion care. Abortion is legal, but there
are
strSt/giesr-remit,n9 WOmen'S access to safe'abortion services. Some operational
• Community level education campaigns should target women, household
deasion makers, and adolescents about the availability of safe abortion services
and the dangers of unsafe abortion.
• Make safe and legal abortion services more attractive to women and
affoXw itvderS/°n makefS by (i) increasin9 geographic spread; (ii) enhancing
affordability, (m) ensunng confidentiality; and (iv) providing compassionate
abortion care, including post abortion counseling.
Adopt updated and simple technologies that are ;safe
' and easy, e.g. manual
vacuum extraction not necessarily dependant upon anaesthesia
, or nonsurgical techniques which are non invasive.
KirnrOmOtJ collaboratlve arrangements with private sector health professionals
GOs, and the public sector, to increase the availability and coveraae of safe
a o ion services, including training of mid-level providers.
• Eliminate the current cumbersome procedures.for registration of abortion
clinics. Simpliry and facilitate the establishment of additional training centres for
sate abortions in the public, private, and NGO sectors. Train these health care
provioers in provision of clinical services for safe abortions.
Formulate and notify standards for abortion services. Strengthen enforcement
mecnanisms at district and sub-district levels, to ensure that these norms are
followed.
°
e
norms'based registration of service provision centres, and thereby
.switch the onus of meticulous observance of standards onto the provider
• Provide competent post-abortion care, including management of
complications and identification of other health needs of post-abortion patients
and linking with appropriate services. As part of post-abortion care, physicians
may be trained to provide family planning counseling and services such as
sterilisation, and reversible modem methods such as IUDs, as well as oral
contraceptives and condoms.
Modify syllabus and curricula for medical graduates
-------- as well as for continuing
education and in-'-house learning, to provide for practical training in the newer
procedures.
Y
• Ensure services for termination of pregnancy at primary health centres and at
community health centres.
14.
Develop maternity hospitals at sub-district levels and at community health
centres to function as
FRUs (FRUs) for complicated and life threatening
deliveries.
15. Formulate and enforce standards for clinical services in the public, private,
and NGO sectors.
16. Focus on distribution of non-clinical methods of contraception (condoms and
•oral contraceptive pills) through free supply, social marketing, as well as
commercial sales.
17. Create a national network consisting of public, private and NGO centres
identified by a common logo, delivering reproductive and child health services
free to any client. The provider will be compensated for the service provided, on
the basis of a coupon, duly counter-signed by the beneficiary, and paid for by a
system to be devised.-The compensation will be identical to providers, across all
sectors. The end-user will choose the provider of the service. A group of
management experts will devise checks and balances to prevent misuse.
(iv)
Child Health and Survival
1. Support community activities, from village level upwards to monitor early and
adequate ante-natal, natal, and post-natal care. Focus attention on neo-natal
health care and nutrition.
2. Set up a National Technical Committee on neo-natal care, to align
programme and project interventions w«th newly emerging technologies in
neo-natal and peri-natal care.
3. Pursue compulsory registration of births in coordination with the ICDS
Programme.
4. After the birth of a child, provide counseling and advocacy about
contraception, to encourage adoption of a reversible or a terminal method.
This will also contribute to the health and well-being of both mother and child.
5. Improve capacities at health centres in basic midwifery services, essential
neo-natal care, including the management of sick neo-nates outside the
hospital.
6. Sensitise and tram health personnel in the integrated management of
childhood illnesses. Standard case management of diarrhoea and acute
respiratory infections must be provided at subcentres and primary health
"
<■
centres, with rappropriate training, and adequate equipment. Besides, training
-in this sector rmay be imparted to health care providers at village levels
especially in indigenous systems.
7. Strengthen critical interventions aimed at bringing about reductions in
maternal malnutrition, morbidity and mortality, by ensuring availability of
supplies and equipment at village levels, and at sub-centres.
8. Pursue rigorously the pulse polio campaign, to eradicate polio
9.
Ensure 100 percent routine immunisation for all vaccine preventable
diseases, in particular tetanus and measles.
10.■ As a child survival
initiative, explore
explore promouonai
promotional ano
and motivational
motivational measures
vivqi nnuduve,
for couples below the poverty line who marry after the legal age of marriage,
to have the first child after the mother reaches the age of 21, and adopt a
terminal method of contraception, after the birth of the second-child.
11. Children form a vulnerable tgroup, and' certain sub-groups merit focussed
attention and intervention,. such- as
andi child labourers
-- street
------- children
---------- —
Encourage voluntary groups as well as NGOs to formulate and implement
special schemes for these groups of children.
12. Explore the feasibility of a national health insurance covering hospitalisation
costs for children below 5 years, whose parents have adopted the small
family norm, and opted for a terminal method of contraception after the birth
of the second child.
13. Expand the ICDS to include children between 6-9 years of age, specifically
to promote and ensure 100 percent school enrolment, particularly for girls.
Promote primary education with the help of aanganwadi workers, and
encourage retention in school till age 14. Education promotes awareness, late
marriages, small family size, and higher child survival rates.
14. Provide vocational training for girls. This will enhance perception of the
immediate utility of educating girls, and gradually raise the average age of
marriage. It will also increase enrolment and retention of girls at primary
school, and likely also at secondary school levels. Involve NGOs, the
voluntary sector and the private sector, as necessary, to target employment
. opportunities.
Y
(V)
Meeting the Unmet Needs for Family Welfare Services
1. Strengthen, energise and make publiclv ac
health infrastructure at the village,
ountable the cutting edge of
suocentre and primary health centre
2. Address on priority the different
unmet needs detailed at Appendix IV, in
particular, an increase in rrural inrra-structure, deployment of sanctionned
and appropriately trained health personnel,
and provisioning of essential
equipment and drugs.
3. Formulate and implement innovative social marketing schemes to orovide
bsidised products and services in areas where the existina coverage of the
'S
and covemge6'
°u
t0
4. 'r?,m3nehaC|^ieS for referral transportation at panchayat, zilla parishad
and
primary
subcentres - Provide ANMs ™th soft loans for
purchXehealth centre tlevels.
'eVelt At
A‘ Subcentres
anttnatl and nn.r'
,e^nce their mobility- This will increase coverage of
.
.
p st h21*3* check-ups, which, in turn, and will bring about
reductions in maternal and infant mortality.
5.
spX^hrn
entrep,reneurs at vil|age and block levels to start ambulance
transDortatinn9h SpeC'a Oan schemes, with appropriate vehicles to facilitate
attenknn
f persons rec?u'r'ng emergency as well as essential medical
aiienuon.
6. Sru ^eC'al 1030 schemes and make site allotments at village levels, to
medical2firsl
°f chem,st shoPs for basic medicines and provision for
111ckJiLzdI III^l 31g_
(vi)
Under Served Population Groups
(a) Urban Slums
1.
2.
Finalise a comprehensive urban health care strategy.
acihtate service delivery centres in urban slums
comprehensive basic health, reproductive^and' child health
an^rivate sector organisations: In^udi^coSr^o^s'
to
provide
NG°S'
Promote networks of retired government doctors.
XTa' z"r'doaors'and para-medicai and n°n'
non-XicarsZi^-- -- fUnCU°n “ heS'th C3re providers for clinical and
-J on remunerative terms,
4. Strengthen social marketing programmes for
non-clinical family planning
products and <services in urban slums.
5. Initiate especially targeted
information, education and communication
campaigns for the urban slums, on f
family planning, immunization, ante-natal,
natal and post-natal check-ups
and cmer reproductive. health
-------- 1 care services,
Integrate aggressive health
education programmes with health and medical
care
programmes , with emphasis
and hp^iihv hoK.-*
* -r ‘
3 on environmental health, personal hygiene
r>
. . y
1 S1 nu^r|t|On education and population education.
6. Promote inter-sectoral
coordination between departments / municipal bodies
dealing with water and sanitation, industry and pollution, housing, transport,
education and nutrition,, and women and child development, to deal with
unplanned and uncoordinated settlements.
7. -Streamline the referral
systems and linkages between the primary,
secondary and tertiary levels of health care in the urban areas.
8. Link the provision of continued facilities to urban slum dwellers with their
observance of the small family norm.
(b)
Tribal Communities, Hill Area Populations and Displaced and
Migrant Populations
1. Many tribal communities are dwindling in numbers, and may not need fertility
regulation. Instead they. mayx needi information and counseling in respect of
infertility.
2. The NGO sector may be encouraged to formulate and implement a system of
preventive and curative health care that responds to seasonal variations in
the availability of work, income and food for tribal and hill area communities,
and migrant and displaced populations. To begin with, mobile clinics may
provide some degree of regular coverage and outreach.
3. Many tribal communities are dependent upon indigenous systems of medicine
which necessitates a regular supply of local flora, fauna, and minerals, or of
standardised medication derived from- these. Husbandry of such local
resources and of preparation and distribution of standardised formulations
should be encouraged.
4. Health care providers in the public, private, and NGOs sectors should be
sensitised to adopt a “burden of disease" approach to meet the special needs
of tribal and hill area communities.
(c)
Adolescents
1.Ensure for adolescents access to information, counseling and services,
including reproductive health services, that are affordable and accessible.
Strengthen primary health centres and subcentres, to provide counseling, both
to adolescents, and also to newly weds (who may also be adolescents)
Emphasise proper spacing of children.
2. Provide for adolescents the nutntional package of services available under
the ICDS programme .
Comment: improvements
Improvements in healtn
health status of adolescent girls has an interkzUHimeni.
generational impact. It reduces the risk of low birth weight and minimizes neo
natal mortality. Malnutrition is a problem that seriously impairs the health of
adolescent and adult women and has its roots in early childhood. The causal
linkages between anaemia and Jow birth weight, prematurity, peri-natal
mortality,and maternal mortality has been extensively studied and established.
3. Enforce the Child Marriage Restraint Act. 1976, to reduce the incidence of
teenage pregnancies. Preventing the marriage of girls below the legally
permissible age of 18 should become a national concern.
Comment: It will promote higher retention of girls at schools, and likely also
encourage participation in the paid work force.
4. Provide integrated intervention in pockets with unmet needs in the urban
slums, remote rural areas, border districts and among tribal populations.
(d)
Increased Participation of Men in Planned Parenthood
Focus attention on men in the information--and education campaigns to
1.
promote the small family/ norm, and to raise Awareness by emphasising the
significant benefits of fewer children, better spacing, better health and nutrition,
and better education.
2. Currently, over 97 percent
of the sterilisations are tubectomies.
Repopularise vasectomies, in particular, the no-scalpel vasectomy as a safe,
simple, painless procedure, more convenient and acceptable to men.
In the continuing education and training at all levels, there is need to
ensure that the no-scalpel vasectomy, and all such emerging techniques
and skills are included in the syllabi, together with abundant practical
training. Medical graduates, and all those participating in "in-service
continuing education and training will be equipped to handle this
intervention.
3.
(vii)
Diverse Health Care Providers
1.
At district and sub-district levels, maintain block-wise, a data base of
private medical practitioners whose credentials may be certified by the Indian
Medical Association (IMA). Explore the possibility of accrediting these private
practitioners for a year at a time, and assign to each to a satellite population, not
exceeding 5000 (depending upon distances and spread), for whom they may
provide reproductive and child health services. The private practitioners would
be compensated for the services rendered, through designated agencies.
Renewal of contracts after one year may be guided by client satisfaction. This
will serve as an incentive to expand the coverage and outreach of high quality
health care. Appropriate checks and balances will safeguard misuse.
2.
Revive the earlier system of the licensed medical practitioners who, after
appropriate certification from the IMA, may participate in the provision of clinical
services.
3.
Involve the non-medical fraternity in counseling and advocacy so as to
demystify the national family welfare effort, such as retired defence personnel,
retired' school teachers, and other persons who are active and willing to get
involved.
Modify the under/post-graduate medical, nursing, and paramedical
4.
professional course syllabi and curricula, in consultation with the Medical
Council of India, the Councils of ISMH, and the Indian Nursing Council, in order
to reflect the concepts and implementation strategies of the reproductive and
child health programme and the national population policy. This will also be
applied to all in-service training and educational curricula as well.
5.
Ensure the efficient functioning of the First Referral Units i.e. 30 bed
hospitals at block levels which provide emergency obstetric and child health care,
to bring about reductions in Maternal Mortality7 Ratio/ Rate (MMR) and Infant
Mortality Rate (IMR). In many states, these FRUs are not operational on
account of an acute shortage of specialists i.e. gynaecologist / obstetrician,
anaesthetist, and pediatrician. Augment the availability of specialists in these
three disciplines, by increasing seats in medical institutions, and simultaneously
enable and facilitate the acquisition of in-service post-graduate qualifications
through the National Board of Medical Examination and open universities like
IGNOU in larger numbers. As an incentive, seats will be reserved for those in
service medical graduates who are willing to abide by a bond to serve for 5 years
at First referral Units after completion of the Course. States would need to
sanction posts of Specialists at the FRUs. Further, these specialists should be
provided with clear promotion channels.
(viii) (a)Collaboration with and Commitments from the Non
Government Sector
1. There remain innumerable hurdles that inhibit genuine long term
collaboration between the government and non-government sectors. A
forum of representatives from government, the non-government
organisations, and the private sector may identify these hurdles, and
prepare guidelines that will facilitate and promote collaborative
arrangements.
2. Collaboration with and commitments from NGOs to augment advocacy,
counseling and clinical services, to access village levels. This will require
increased clinic outlets as well as mobile clinics;
3. Collaboration between the voluntary sector and the NGOs will facilitate
dissemination of efficient service delivery to village levels. The guidelines
could articulate the role and responsibility of each sector;
4. Encourage the voluntary sector to motivate village level self help groups
to participate in community, activities;
5. Specific collaboration with the non-government sector in the social
marketing of contraceptives to reach village levels will be encouraged.
(viii) (b) Collaboration with and Commitments from Industry
i»—
*
1. The corporoie sector and industry could for instance, take on the
challenge of strengthening the management information systems in the
seven most deficient states, at primary health centre and subcentre levels
ele,ct([onic data entry machines to lighten the tedious work load
. s and he mu|ti-purpose workers at subcentres and the doctors at
e,primary health centres, while enabling wider coveraoe and outreach'
2. Collaborate with non-government sectors in running professionally sound
advertisement and marketing campaigns for products and services,
targeting all segments of the population, from village level upwards in
con^raceptivi Stren9then advocacy and IEC, including social marketing of
3. Provide markets to sustain the income generating activities from villaqe
evels upwards. In turn, this will ensure consistent motivation among the
community for pursuing health and education related community activities
4. Help promote.transportation to remote and inaccessible areas up to village
evels. This will greatly assist the coverage and outreach of social
marketing of products and services;
5. The social responsibility of the corporate sector in industry must, at the
very minimum, extend to providing preventive reproductive and child
ea care or its own employees (if >100 workers are engaged).
b. Create a national network consisting of voluntary, public, private and non
government health centres, identified by a common logo, delivering
reproductive and child health services, free to any client. The provider will
be compensated for the service provided, on the basis of a coupon
(SyS em'„duJy C°unter si9ned bV tha beneficiary and paid for by a system
that will be fully articulated. The compensation will be identical to
provi ers, across all sectors. The end user exercises choices in the
source of service delivery. A committee of management experts will be set
up to devise ways of ensuring that this system is not abused.
orm a consortium of the voluntary sector, the non-government sector and
e private corporate sector to aid government in the provision and
ou reacn o basic reproductive and child health care and basic education
to its 1 billion citizens.
8. In the area of basic education, set up privately run/managed primary
schools tor children up to age 14-15. Alternately, if the schools are set
up/managed by the panchayat, the pnvate corporate sector could provide
the m.d-day meals, the text -books and/or the uniforms
(ix) Mainstreaming
Indian Systems of Medicine and Homeopathy
(1) Provide appropriate training and orientation
forthe instit^onany qualifi^ISMH^Xady
;n°?n
ICS and 9ynaecoi°9y over 5-1/2 years),-and utilise their
*nf~ t
t " lrL 9393 'n manP°wer at appropriate levels in the health
astructure, and at subcentres and primary health centres, as necessarv.
(2) Utilise the ISMH institutions, dispensaries and hospitals for health and
population related programmes .
(3) Disseminate the tried and tested concepts and practices of the indigenous
systems of medicine, together with ISMH medication at village maternity huts
and at household levels for ante-natal and post-natal care, besides nurture of
the newborn.
(4) Utilise the services of the ISM and H ‘barefoot doctors' after appropriate
training and orientation towards providing advocacy and counseiino for
disseminating supplies and equipment, and as depot holders at villaoe levels.
(x) Contraceptive Technology and Research on RCH
(1 government will encourage, support and advance the pursuit of medical and
social science research on reproductive and child health, in consultation with
ICMR and the network of academic and research institutions.
(2)The International Institute of Population Sciences and the Population
Research Centres will continue to review programme and monitoring indicators
to ensure their continued relevance to strategic goals.
(3) Government will restructure the Population Research Centres , if necessary.
(4) Standards for clinical and non-clinical interventions will be regularly issued.
(5) A constant’ review and evaluation of the community needs assessment
approach will be pursued, to align programme delivery with good management
practices and with newly emerging technologies.
(6) A Committee of international and Indian experts, voluntary and non
government organisations and government may be set up to regularly review
and recommend specitic incorporation of the advances in contraceptive
technology and in particular, the newly emerging techniques, into program
development.
(xi) Providing for the Older Population
(1} Sensitize, train and equip rural and urban health centres and hospitals
towards providing
geriatric healtn care.
(2) Encourage NGOs and voluntary organizations to formulate and strengthen a
series of formal and informal avenues that make the elderly economically
self reliant.
(3) Tax benefits could be explored as an encouragement for children to look after
their aged parents.
(xii) Information Education and Communication
1. Converge JEC efforts across the social sectors. The two sectors of Family
-Welfare and Education have coordinated a mutually supportive IEC strategy.
The Zila Saksharta Samitis design and deliver joint IEC campaigns in the
local idiom, promoting the cause of literacy as well as family welfare. Optimal
use of folk media has served to successfully mobilize local populations. The
state of Tamil Nadu made exemplary use of the IEC strategy by spreading the
message through every possible media, including public transport, on mile
stones on national high-ways as well as through advertisement and hoardings
on roadsides, along city / rural roads, on billboards, and through processions,
films, school dramas, public meetings, local theatre and folk songs.
2. Involve departments of rural development, social welfare, transport,
cooperatives, education with special reference to schools, to improve clarity
and focus of the IEC effort, and to extend coverage and outreach. Health and
population education must be inculcated from the school levels.
3. Fund the nagarpalikas, panchayats, NGOs and community organizations for
interactive and participatory IEC activities.
4. Demonstration of support by elected leaders, opinion makers, and religious
leaders with close involvement in the reproductive and child health
programme greatly influences the behavior and response patterns of
individuals and communities. This serves to enthuse communities to be
attentive towards the quality and coverage of maternal and child health
services, including referral care. Public leaders and film stars could spread
widely the messages of the small family norm, female literacy, delayed
marriages for women, fewer babies, healthier babies, child immunization and
so on. The involvement and enthusiastic participation of elected leaders will
ensure dedicated involvement of administrators at district and sub-district
levels. Demonstration of strong support to the small family norm, as well as
personal example, by political, community, business, professional, and
religious leaders, media and film stars, sports personalities, and opinion
makers, will enhance its acceptance throughout society.
5. Utilise radio and television as the most powerful media for disseminating
relevant socio-demographic messages. Government could explore the
feasibility of appropriate regulations, and even legislation, if necessary to
mandate the broadcast of social messages during prime time.
6. Utilise dairy cooperatives, the public distribution systems, other established
networks like the LIC at district and sub-district levels for IEC and for
distribution of contraceptives and basic medicines to target infant / childhood
diarrhoeas, anaemia and malnutrition among adolescent girls and pregnant
mothers. This will widen outreach and coveraoe.
7. Sensitise the field level functionaries across diverse sectors ( education, rural
development, forest and environment, women and child development,
drinking water mission, cooperatives) to the strategies, goals and objectives
of the population stabilisation programs.
8. Involve civil society for disseminating information, counseling and spreading
education about the small family norm, the need for fewer but healthier
babies, higher female literacy and later marriages for women. Civil society
could also be of assistance in monitoring the availability of contraceptives
vaccines and drugs in rural areas and in urban slums.
- •. s'-
DEMOGRAPHIC PROFILE
India is foBcwing the demographic transition pattern of all developino
countlies from otia! levels of high birth rate - high death rate' to the current
intermediate transition stage of high birth rate - low death rate' which leads to
high rates of population growth, before graduating to levels of 'low birth rate low oeath rate'.
1. Age Composition
1. (i) i he age distribution of the population of India is projected to change by
20 16, and these changes should determine allocation of resources in policy
intervention. The population below 15 years of age (currently 35 percent) is
projecied to dedine to 28 percent by 2016. The population in the age group 15 59 years ( currenlliy 58 percent) is projected to increase to nearly 64 percent
by 2016. The age group of 60 plus years is projected to increase from the current
levels of 7 percent to nearly 9 percent by 2016.
Table 4 : Age Composition as Percentage of the Total Population2
Year
Below 5 years
1991
2001
2011
2016
12.80
10.70
10.10
9.7
Between
0-15
37.76
34 33
28,48
27.73
Between >15 59 years
55.58
58.70
63.38
- 63.33
+ 60 years
6.67
6.97
8,14
8.94
2. Inter State Differences
2. (i) India is a country of striking demographic diversity. Substantial differences
are visible between states in the achievement of basic demographic indices. This
Has led to significant disparity in current population size and the potential to
influence population increases during 1996-2016. There are wide ^nter-state0
male-remale and rural-urban disparities in outcomes and impacts. These
differences stem largely from poverty, illiteracy, and inadequate access to health
and family welfare -services, which coexist anc reinforce1 each. other.
In many
------ ..i
parts, the widespread health infrastructure is not responsive
2. (ii) Ai least 10 states and union territories in India have already achieved
of fertility,
fertility. These
replacement levels Oi
i hese are ranked in accordance with their total
' Technical Group on Population Projections. Planning Commission.
;(■>
ertility rates. Additionally, in each of the three tables below, the current
population of each state / union territory, the ratio of this population to the country
population, the infant mortality rate and the contraceptive prevalence rate of the
state / union territory is also indicated:
Table 4 : Population Profile of 10 States and Union Territories of India
State
Population.
Size (in
millions) as
on 1 March
1999*
INDIA
I
Percent of
Total
Population
981 ,3
|
Total
Fertility
Rate
1997
Infant
Mortality
Rate
1998
i
Contraceptive
Prevalence
Rate
1999
72
44 %
23
27.1
Goa
1.5
____ _______ 3^3
Group A (TFR =2.1)
0.2
1.0@
Nagaland
Delhi_____
Kerala
Pondichery
A&N
Islands
Tamil Nadu
Chandigarh
Mizoram
Source:
1.6
13.4
32.0
1.1
0.4
0.2
1,4
3.3
0.1
0.04
1.5@
1.6@
1.8
1.8@
T9@
NA
36
16
21
30
7,8
28.8
40.5
56.9
39.9
6.2
0.09
0.09
2.0
2,1@
NA
53
32
23
35,0
34.6
I
61.3.
0.9
0.9
|
|
50.4
Registrar General of India
@ Three year moving average TFR1995-97
Population Projections by Technical Group on Population Projections, 1995
2.(iii) There are 11 states and union territories that have a total fertility rate of
more than 2.1 but less than 3.0, ranked accordingly :
Table 5 . Population Profile of 11 States and Union Territories of India
State
Manipur
Daman & Diu
Karnataka
Andhra
Pradesh
Population
Percent of
Total
Infant
Size (in
Total
Fertility
Mortality
milhons) as Population
Rate
Rate
on 1 March
1997
1998
1999*
______ Group B (TFR = > 2.1 and< than 3.0)
2.21
0.1
51,4
74.6
I
I
,l
0.2
0.01
5.2
7.6
2.4@
- 2.5@
2.5
2.5
Contraceptive
Prevalence
Rate
1999
25
20.1
51,
58
66
30,2
55.4
50.3
•’ ■) -
!
i
0.7
6.5
Himachal
Pradesh
0.06
0.5
I Sikkim
T . 7.9
78.0
I
West Bengal
9.2
90.1
Maharashtra
2.4
23.3
Punjab
i
0.1
1.2
Arunachal
Pradesh
_______________
0.01
0.07
| Lakshadweep
I
Source:
Registrar General of India
48.2
64
2.5
I 2.5
I 2.6
i 2.7
I 2.7
2.8@
I
I
I
52
I
53
!
49
54
47
21.9
32.9
50.1
66.0
14.0
37
9.1
I 2.8@
.
I
JI
i
i
—I
!
@ Three year moving average TFR1995-97
’Population Projections by Technical Group on Population Projections.1996
2. (iv) However, there are at least 12 states and union territones that have a
total fertility rate of over 3.0. These have been listed below.
Table 6 : Population Profile of 11 States and Union Territories of India
State
Percent of
Total
Population
Populatio
n Size (in
millions)
as on 1
March
1999*
Total
Fertility
‘ Rate
1997
Group C(> 3.0)
I 3.0
3.6
I
I 3.0
4,8
T
I 3.2
2.6
I
I 3.4
2.0
3.5@
0.02
35.5
| Orissa
47.6
| Guierat______
25.6
Assam_______ [
19.5
Haryana______ I
0.2
Dadra & Nagar
Haveli _____
0.3
3.6
Tripura______
0.2
2.4
Meghalaya
8.0
78.3
Madhya
, Pradesh
5.4
52.6
Rajasthan
10.0
98.1
Bihar_______
17.0
166.4
Uttar Pradesh
1.0
9.7
&
Jammu
Kashmir________
Source:
Registrar General of India
I
T
T
3.9@
4.8@
4.0
I
I
Infant
Mortality
'Rate
1998
Contraceptive
Prevalence
Rate
1999
98
64
78
69
61
39
54.5
16.7
49.7
29.1
49
52
98
25.2
4.6
46.5
i
I 4.2
I 4.4
I 4.8
| NA
T
T
I
83
67
85
45
I
I
T
@ Three year moving average TFR1995-97
•Population Projections by Technical Group on Population Projections. 1996
2.(v) The five states of Bihar, Madhya Pradesh, Orissa, Rajasthan and Uttar
36.4
19.7
38.2
15.0
j
Pradesh that currently constitute nearly 44 percent of the total population of
India, are projected to comprise 48 percent of the total population in 2016. In
other words these states alone will contribute an anticipated 55 percent increase
during the period. 1996 -2016. Demographic outcomes in these states will
determine the timing and size of population at which India achieves population
stabilisation.
3. MATERNAL MORTALITY
3.(i) With 16% of the world’s population, India accounts for over 20% of the
world’s maternal deaths. The maternal mortality ratio, defined as the number of
maternal deaths per 100,000 live births, is incredibly high at 408 per 100,000 live
births for the country (1997), which is unacceptable when compared to current
indices elsewhere in Asia.
Table 5: Maternal Mortality Ratios in Asia 3
Sri
China
Thailand
Pakistan
Lanka
30
115
200
340
Indonesi
a
390
India
437
Bangladesh
850
Nepal
1500
3.(ii) Within India, the inter-state differentials are a matter of concern.
Table 6: Inter-State Differences within India in Maternal Mortality Ratios4
Kerala
Bihar
Madhya
Pradesh
Rajasthan
87 .
451
498
607
Uttar
Pradesh
707
Orissa
739
4. INFANT MORTALITY
3 UNFPA ” The Stare of World Population, 1999 - 6 Billion. A Time for Choices
Registrar General of India.
- i-i ••
TTirr*
’i-
—-
4. (i) It is estimated that about 7% new born infants perish within a year. 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. Additionally, in India, across the board
(rural or urban areas), there are more female deaths in the age group of 0-14
than elsewhere5. Although the Infant Mortality Rate (IMR) has decreased from
146 per 1000 births in 1951 to 72 per 1000 births (1997), and the sex differentials
are narrowing, again there are wide inter-state differences recorded in 1998, as
is clear from Table 2 on Page 3-4. In comparison, we note the infant mortality
rates in South Asia and elsewhere:
/
Table 1: Infant Mortality Rates in Asia 6
Sri Lanka
Thailand
China
Indoneisa
India
Pakistan
18
29
41
48
72
74
Bangladesh
79
Nepal
5. SEX RATIO
5. (i) India shares a distinctive feature of South Asian and Chinese populations
as regards the sex ratio, with a century’s old deficit of females12. The (female to
male) sex ratio has been steadily declining. From 1901 to 1991, the sex ratio has
declined from 972 to 927. This is largely attributed to the son preference,
discrimination against the girl child leading to lower female literacy, female
foeticide, higher fertility and higher mortality levels for females, in all age groups
up to 45.
5 UNICEF (1995) ’’The Progress of Indian States, 1995. India Country Office, New Delhi.
6 UNFPA "The State of the World Population, 1999, 6 Billion - A Time for Choices"
83
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_»
Reaching the Poorest and Disadvantaged Populations
WDBBTED1ESS ’ AND ILL HEALTH
A.
HOUSEHOLD
ILL HEALTH
PUBLIC SECTOR
MEDICAL/ HEALTH CARE
B.
POVERTY
CYCLE
INDEBTEDNESS
POVERTY
ALLEVIATING
EFFECT
NATIONAL / INTERNATIONAL DEBT
© Lowered Life Expectancy
© Debt Repayment 3-4 times health expenditure
(BMA, 2000)
Medicine Meets Millennium
Reaching the Poorest and Disadvantaged Populations
INDEBTEDN
c.
S - AND ILL HEALTH (Contd.)
NET RESOURCE TRANSFER
$ 2000 billion
From Poor to industrialized countries (unicef 1999)
D.
IMPACT OF SAPS
© unemployment
© Shift to informal sector without social security
© user charges
© Downsized Public social sector
© Reduced access to care
© Lowered nutrition status, nutrition insecurity
Medicine Meets Millennium
Reaching the Poorest and Disadvantaged Populations
-
••
•
■
■
______________________________
-
-
______________________________________________ Z
BRIDGING IMPLEMENTATION GAPS
IN PUBLIC POLICY
1. GOOD, HUMANE GOVERNANCE
with local governance systems
2. LEADERSHIP
at different levels
3. MANAGEMENT
of human and financial reserves, with
accountability, transparency
4. STRENGTHEN CAPACITIES, FOSTER
HUMANE ATTITUDES, RELATIONSHIPS
AT INTERFACE BETWEEN PEOPLE,
PATIENTS and PROVIDERS
5. INVOLVE WOMEN, NGOs, Stakeholders
Iy
Medicine Meets Millennium
_____
i
Reaching the Poorest and Disadvantaged Populations
INDIGENOUS SYSTEMS OF MEDICINE
AND HEALING TRADITIONS
MODERN
MEDICINE
INDIGENOUS
SYSTEMS
►► SCIENCE AND
TECHNOLOGY BASED
►► LOCAL HEALTH AND
CARING TRADITIONS
►► TRADITIONAL
KNOWLEDGE BASED
►► INDUSTRIAL AND
COMMERCIAL LINKS
►► SELF RELIANCE
►► LOCAL CONTROL
►► COMMUNITY RIGHTS
b
RECOGNITION
r ■
r
►► Involvement in Health Planning and Programmes
0* ►► Increased
Support
Budgetary,
Legal
and
Institutional
I ►► Openness to Different World views, Philosophies,
I
Approaches
1
Medicine Meets Millennium
.... ■
Reaching the Poorest and Disadvantaged Populations
COMMXEPJITY
IBJVOL.'VEMEM'T
COMMUNITY
AS HEALER
COMMUNITY
HEALTH
PROGRAMMES
►► Holding brokenness
►► Rapid Sustainable Gains
►► Restoring Wholeness
►► Low Cost
SOCIAL
MOVEMENTS
►► Livelihood, Water,
Environment
COMMUNnY
INVOLVEMENT
►► Women's Health, Workers
Health, Rational Therapeutics
►► Emerging Health Movement >
eg., PHA
/
►►To social control
FRAGMENTATION
BY COMMERCIAL
MARKET FORCES
MOVEMENTS
►► Professionals / Experts,
disempowerment
Medicine Meets Millennium
RESISTANCE TO
SUBJECT
PROFESSION AND
TECHNOLOGY
Reaching the Poorest and Disadvantaged Populations
THE
POVERTY
O
O
LINES
PEOPLE
PERSONS
FAMILIES
THE
SOCIAL MINORITY OR SOCIAL MAJORITY
20
30
40
80
70
60
DOES IT 'MAKE A DIFFERENCE'?
WHO DECIDES, ANYWAY?
Medicine Meets Millennium
Reaching the Poorest and Disadvantaged Poi
ations
INDUSTRY
INTERNATIONAL
AGENCIES/
PLAYERS
&
COMMERCE
MEDICAL
HEALTH
CAPITAL
PROFESSIONALS
KNOWLEDGE
INFORMATION
TECHNOLOGY
GOVERNMENT
ORGANIZATION
HEALTH POLICIES AND PROGRAMMES
CONTENT, DIRECTION, IMPLEMENTATION
WHICH WAY TO GO ?
CIVIL SOCIETY
GROUPS
ORGANISED
POOR
CONSUMERS
SOCIAL
MOVEMENTS
Medicine Meets Millennium
PATIENT
GROUPS
'
•
Reaching the Poorest and Disadvantaged Populations
REACHING THE POOR
MEDICAL CARE
DOCTORS
DIAGNOSTICS
DRUGS
HIGH TECH
HIGH COST
HEALTH CARE
PUBLIC HEALTH
COMMUNITY HEALTH, HEALTH
PROMOTION, PREVENTION, CURE &
REHABILITATION.
PRIMARY HEALTH CARE
DETERMINANTS OF HEALTH
NUTRITION
/a SAFE WATER
6 SANITATION
a CLEAN AIR
a HOUSING
//.
EMPLOYMENT/LIVELIHOOD
6 Which inputs have greater gain?
6 How do governments, international agencies and
donors prioritize?
6 How are resources distributed?
a Why did we abandon intersectoral coordination and the primary health
care approach?
Medicine Meets Millennium
Reaching the Poorest and Disadvantaged Populations
4
A PRESCRIPTION FOR ATTAINING THE HEALTH FOR
ALL GOAL
A MASS MOV€M€NT TO
REDUCE POVERTY, INEQUALITY AND SPREAD EDUCATION
ORGANISE THE POOR AND UNDERPRIVILEGED TO FIGHT
FOR THEIR BASIC RIGHTS.
PRODUCTIVE
MOVE
AWAY
FROM
COUNTER
CONSUMERIST WESTERN MODEL OF HEALTH CARE, AND
REPLACE IT BY AN ALTERNATIVE BASED IN THE
COMMUNITY.
BY |
Indian Council of Social Sciences Research (ICSSR), and
Indian Council of Medical Research (ICMR), 1981 E
Medicine Meets Millennium
-<
Reaching the Poorest and Disadvantaged Populations
GAINS
GAPS
T LONGEVITY
>
i MORTALITY
SMALLPOX ERADICATED
>
INFECTIOUS
DISEASE CONTROL
HEALTH DIVIDE
BETWEEN RICH & POOR
BETWEEN & WITHIN
COUNTRIES
EXPECTED OUTCOMES
AND ACTUALS
> IMPLEMENTATION GAPS
>
DISPARITIES IN CONTROL
OVER DECISION MAKING
Medicine Meets Millennium
Reaching the Poorest and Disadvantaged Populations
RE - VISIONED RELATIONSHIPS
S€LF
SOCIAL GROUP,
PRIVILCG6D,
PROFCSSION,
OTHER
WE
ARE
EQUITY
ONE
DCPRIVCD,
IMPOVCRISHCD,
MULTI-CULTURAL
DIFFERENT
KNOWLCDGC RRSC
KNOUULCDGC
Medicine Meets Millennium
Reaching the Poorest and Disadvantaged Populations
SHIFT
ATTENTION, ANALYSIS AND ACTION
FROM
REACHING THE POOR AND DISADVANTAGED THROUGH
CHARITY, WELFARE, AND EXTENSION OF EXISTING PARADIGMS.
TO
ADDRESSING POVERTY, INEQUALITY AND HEALTH,
SOCIETAL AND BEHAVIORAL PROCESSES.
Medicine Meets Millennium
Reaching the Poorest and Disadvantaged Populations
STRATEGIC APPROACHES TO IMPROVED
HEALTH FOR THE POOR
Promoting Indigenous systems of Medicine and Healing
Traditions
a
Fostering Community Involvement, using the Primary
Health Care Approach
Bridging Implementation Gaps
a
Addressing Political Process & Power
a
Preventing Distortions due to Privatization
66
Responding to Indebtedness and Ill-health.
Medicine Meets Millennium
Reaching the Poorest and Disadvantaged Populations
PREVENTING DISTORTIONS DUE TO PRIVATISATION
■I
POLICES PROMOTING PRIVRTC FOR PROFIT SCCTOR & PUBLIC - PRIVRTC MIX
•<- COST EFFECTIVENESS, QUALITY OF
PRIVATE MEDICAL CARE
ht PRIVATE SECTOR ROLE IN HEALTH
PROMOTION, PREVENTION,
REHABILITATION
er WILLINGNESS VS. ABILITY TO PAY
nr ECONOMIC CONSEQUENCES
nr ACCESS - GEOGRAPHICAL & ECONOMIC
wr EQUITY
nr EVIDENCE BASE AND ETHICS OF SUCH
POLICIES
WTO IMPACT - RISING COSTS OF DRUGS
AND MEDICAL CARE, NEW DEVELOPMENTS
OUT OF REACH OF POOR
REASSERTING ROLE OF THE STATE
RECOGNISING ROLE OF COMMUNITIES, CIVIL SOCIETY, NGOs, VOLUNTARY SECTOR
QUALITY ASSURANCE & ACCREDITATION OF PRIVATE SECTOR
Medicine Meets Millennium
State
State population to cross
5.33 crore by year-end
By Anupama GS
Bangalore, Oct 12: On Tues
day,
e World population
crosscu the six billion mark.
In Karnataka, the populat
ion is poised to cross 5.33
crore by the year-end, as com
pared to 5.22 crore in 1998.
And by the end of 2000, it is ex
pected to exceed 5.45 crore.
All this, because very few
people in the State believe in
practising birth control, acco
rding to a study. This is espe
cially true of backward distri
cts in the Hyderabad-Karnatak area.
As per the study, only
about 30 per cent of people of
the Hyderabad-Karnataka region use contraceptives tho
ugh the average rate of accept„ance of contraceptives in the
State is about 60 per cent. The
Hyderhad-Karnataka region
inch
Gulbarga, Bidar. Bij
apur, Kaichur, Koppal and Be
llary districts.
The survey titled The study
of Family Welfare Performance
in Karnataka was conducted
by the Population Research
Centre of the Institute for Soc
ial and Economic Change
(ISEC).
According to Prof P Bheem
arayappa of the Centre, the
low rate of acceptance of con
traceptives in the region was
in tune with development ind
icators. “Karnataka’s peculia
rity lies in its regional varia
tions and imbalances. In the
North-Karnataka region, pop1 ulation has continued to
rnnrnr rm
Projected district-wise population
•
.
DISTRICT
1999
2000
Bangalore
65,21,000 67,70,000
Bangalore(R) 18,80,000 19,08,000
Chitradurga 15,52,000 15,86,000
Davangere
18,88,000 19,35,000
Kolar
25,21,000 25,62,000
Shimoga
16,41,000 16,67,000
Tumkur
26,49,000 26,97,000
Belgaum
41,45,000 42,21,000
Bijapur
18,21,000 18.60,000
Bagalkote
16,52,000 16,87,000
Dharwad
15,92,000 16,22,000
Gadag
9,97,000 10,16,000
Haveri
14,77,000 15,04,000
Uttar Kannada 13,59,000 13,78,000
Bellary
20,51,000 21,07,000
Bidar
15,44,000 15,84,000
Gulbarga
31,16,000 31,90,000
Raichur
17,13,000 17,65,000
Koppal
12,03,000 12,38,000
Chikmagalur 11,15,000 11,28,000
DakshinKannada 18,50,000 18,81,000
Udupi
' 11,75,000 11,90,000
Hassan
17,89,000 18,19,000
Kodagu
5,09,000 5,11,000
Mandya
18,65,000 18,95,000
27,35.000 27,99,000
Mysore
Chamrajnagar 10,33,000 10,55,000
grow rapidly, people are resislant towards the use of cont
raceptives,
immunisation
and the age of a girl’s marri
age is still very low,” he said.
The performance of the rest
of the State including Bangal
ore, Chitradurga, Davanagere, Kolar, Shimoga, Tumkur, Belgaum, Bagalkot, Dharwad, Gadag, Haveri, Uttara
Kannada,
Chikmagalur,
Dakshina Kannada, Udupi,
Hassan, Kodagu, Mandya,
Mysore and Chamarajanagar
districts in practicing birth
control measures was satisfa
HI
ctory, Bheemarayappa said.
The professor also pointed
out that the study had revea
led a few startling facts. “Tho
ugh it is not a new trend, the
study found that participat
ion of men in birth control
measures is very low, as low
as one per cent. Women are
sterilised and are forced to fol
low spacing methods. There
is a need for an attitudinal
change to involve men in the
process”, he said.
The Family Planning Asso
ciation of India (FPAI) also
voiced a similar opinion.
“Something should be done to
involve men in practicing
birth control methods. In
rural areas, it is pathetic to
see women suffering for lack
of adequate health care”,
FPAI-Kamataka branch Dire
ctor Shanthi Baliga said.
The Director also wanted
the Government and the polit
ical parties to take up the
task of educating people on
family planning.
Bheemarayappa emphasised the need for the Governm
ent to concentrate on the dev
elopment of the HyderabadKarnataka region. “The Gov
ernment should concentrate
on all-round development.
Patchy development of a
State will result in regional
imbalances and Karnataka is
a perfect example of this”, he
said. The professor also sugge
sted that the Government pro
vide orientation to all the
members of the State Assem
bly on family welfare.
- Media
RF_HP_5_SUDHA.pdf
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