FAMILY PLANNING FAMILY PLANNING PROGRAMPROGRAM

FAMILY PLANNING FAMILY PLANNING DIVISIONDIVISION

Ministry of Health & Family Ministry of Health & Family WelfareWelfare

Government of IndiaGovernment of India

22

POPULATION OF INDIA

25125

2

279 31

9

361

439 10

29

548

686

846

1.25

1.96 1.932.14

0.56

-0.03

1.041.33

2.20 2.22

0

200

400

600

800

1000

1200

19

01

-11

19

11

-21

19

21

-31

19

31

-41

19

41

-51

19

51

-61

19

61

-71

19

71

-81

19

81

-91

19

91

-20

01

*

-0.5

0.0

0.5

1.0

1.5

2.0

2.5

PO PULATIO N GRO WTH RATE %

Source:- Registrar General India

33

DEMOGRAPHIC SCENARIO

1. India is the second most populous country in the world.

2. India has 17 % of world’s population and has less than 3% of earth’s land area.

3. While the global population has increased 3 times, India has increased its population 5 times during the last century.

4. India’s population is expected to exceed that of China before 2030 to become the most populous country in the world.

44

PERFORMANCE OF STERILISATION

0.88 0.96

3.73

0.91 1.010.83 0.94

2.86 3.003.34

3.172.88

4.70 4.835.04

4.504.29

1.201.211.12

3.673.673.693.54

0.74

0

1

2

3

4

5

6

'2002-03

'2003-04

2004-05

2005-06

2006-07

LA

KH

S

Bihar MP Orissa Rajasthan UP

55

PROJECTED POPULATION OF INDIA AS ON Ist MARCH (IN CRORES)

102.9111.2

119.3126.9

134.0140.0

0

20

40

60

80

100

120

140

160

2001 2006 2011 2016 2021 2026

Cro

res

66

WHAT IS TFRWHAT IS TFR The total fertility rate is the average number of The total fertility rate is the average number of

children a woman would have if she were to pass children a woman would have if she were to pass through her reproductive years bearing children at through her reproductive years bearing children at the same rates as the women now in each age group.the same rates as the women now in each age group.

It is computed by summing the age specific fertility It is computed by summing the age specific fertility rates for all ages.rates for all ages.

It gives a magnitude of It gives a magnitude of completed family sizecompleted family size

In simple terms TFR denotes In simple terms TFR denotes

the average number of children borne per the average number of children borne per womanwoman

77

TOTAL FERTILITY RATE, NFHS (2005-06)

3.39

2.85 2.68

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

NFHS-I (1992-93) NFHS-II (1998-99) NFHS-III (2005-06)

TOTAL FERTILITY RATE

TFR

88

Benefits of family Benefits of family planningplanning

Stabilises populationStabilises population

ReducesReduces maternal mortalitymaternal mortality

Reduces infant and child Reduces infant and child mortalitymortality

99

Slower rates of population growth Slower rates of population growth benefit all aspects of developmentbenefit all aspects of development

Population

Agriculture

Health

Education

Economy

Urbanisation

Environment

1010

National Population Policy, 2000National Population Policy, 2000

IMMEDIATE OBJECTIVEIMMEDIATE OBJECTIVE

Address the unmet needs of contraception, Address the unmet needs of contraception, Reproductive and Reproductive and Child Health careChild Health care

MEDIUM TERM OBJECTIVEMEDIUM TERM OBJECTIVE

Achieve Replacement Level Fertility by 2010Achieve Replacement Level Fertility by 2010

LONG TERM OBJECTIVELONG TERM OBJECTIVE

Bring about population stabilisation by 2045Bring about population stabilisation by 2045

1111

Situation analysisSituation analysis NPP 2000 and the present scenario:NPP 2000 and the present scenario:

1.1. 20102010 Population replacement (put Population replacement (put back now to back now to 20212021) )

2.2. 20452045 Population Stabilization (put Population Stabilization (put back now to back now to 20602060 (1.53 billion in (1.53 billion in 2060).2060).

3.3. EAG states constitute EAG states constitute 42%42% of the of the population (population (TFR between 3.4 and 4.3)TFR between 3.4 and 4.3)

1212

GOI POLICYGOI POLICY(Servicing the unmet need)(Servicing the unmet need)

Based on felt needs of the community Based on felt needs of the community TARGET FREE TARGET FREE Children by choice & not chanceChildren by choice & not chance Equal emphasisEqual emphasis on both limiting and on both limiting and

spacing methodsspacing methods ELAELA :Scientific and statistically significant :Scientific and statistically significant

way being formulated for calculating state way being formulated for calculating state wise performance level based on unmet wise performance level based on unmet needneed

Population stabilization is a Population stabilization is a priority area of the GOIpriority area of the GOI

1313

MEETING UNMET NEEDSMEETING UNMET NEEDS

11 Two third Indians want to use Two third Indians want to use contraceptioncontraception

22 There is no scope for coercionThere is no scope for coercion

33 Ensure availability of quality RH servicesEnsure availability of quality RH services

44 Meet the felt needs of coupleMeet the felt needs of couple

55 Enable couple to achieve their RH goalsEnable couple to achieve their RH goals

1414

Programatic interventions in Family Programatic interventions in Family Planning (GOI)Planning (GOI)

1.1. Addressing the unmet need in contraception Addressing the unmet need in contraception throughthrough

Assured deliveryAssured delivery of family planning of family planning servicesservices

Developing Developing skilled manpowerskilled manpower for the same for the same

2.2. Increasing Increasing male participationmale participation through through intensive promotion of NSVintensive promotion of NSV

3.3. Promotion of Promotion of IUDsIUDs as a short & long term as a short & long term spacing methodspacing method

4.4. Promotion of Promotion of Emergency Contraceptive Emergency Contraceptive PillsPills

5.5. Increasing basket of choicesIncreasing basket of choices

1515

Promotional Interventions in Family Promotional Interventions in Family Planning (GOI)Planning (GOI)

1.1. Ensuring quality care in FP servicesEnsuring quality care in FP services

2.2. Revised compensation schemeRevised compensation scheme

3.3. Family planning insurance schemeFamily planning insurance scheme

4.4. Promoting Public Private PartnershipsPromoting Public Private Partnerships

5.5. Promoting contraception through Promoting contraception through increased advocacyincreased advocacy

1616

Temporary (Spacing) Temporary (Spacing) MethodsMethods

IUD 380 A IUD 380 A

EC PillsEC Pills

OC PillsOC Pills

CC ( dual purpose condoms)CC ( dual purpose condoms)

1717

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

10 years10 years’ duration & not 3 years’ duration & not 3 years Can cover reproductive life span in Can cover reproductive life span in

2 insertions only (25- 45 yrs.)2 insertions only (25- 45 yrs.) Can potentially Can potentially replace the replace the

sterilizationsterilization procedures procedures Can be inserted at Can be inserted at subcentresubcentre level level ANM/ MOs could be given refresher ANM/ MOs could be given refresher

trainingtraining

1818

Promotion of EC Promotion of EC PillsPills

2 tabs of 0.75mg or 1 tab of 1.5mg within 72 2 tabs of 0.75mg or 1 tab of 1.5mg within 72 hrs of intercourse in the following situations:hrs of intercourse in the following situations:

Unprotected intercourseUnprotected intercourseUnplanned intercourseUnplanned intercourseFailed CC (Nirodh- torn)Failed CC (Nirodh- torn)Assault/ rapeAssault/ rape

Levonorgesterol onlyLevonorgesterol only No side effectNo side effect One time activity to replace MTP One time activity to replace MTP Reduces Maternal Mortality by 10-15%Reduces Maternal Mortality by 10-15%

1919

Reducing unmet need in Reducing unmet need in Terminal methodTerminal method

Assuring service provision throughAssuring service provision throughFixed day service round the yearFixed day service round the yearPeriodic campsPeriodic camps

Augmenting trained manpower inAugmenting trained manpower in NSVNSV MinilapMinilap Lap. Ster.Lap. Ster.

2020

Male participationMale participation(Why No Scalpel Vasectomy- NSV (Why No Scalpel Vasectomy- NSV

?)?)

1.1. Attain population Attain population stabilization in a short periodstabilization in a short period

2.2. Shifting responsibility of Shifting responsibility of family planning from females family planning from females to malesto males

2121

Why NSV ?Why NSV ?

6 Ss:- (advantages)6 Ss:- (advantages)Scalpel lessScalpel lessStitch less Stitch less SafeSafeSoundSoundSimpleSimpleShortShort

2222

TubectomyTubectomy(If client chooses it after all options have been (If client chooses it after all options have been

explained)explained) Offer minilap becauseOffer minilap because

No postgraduate surgeon/ gynaecologist No postgraduate surgeon/ gynaecologist requiredrequired

No anesthetistNo anesthetist required normally required normally No pneumoperitoneum (inflating with gas)No pneumoperitoneum (inflating with gas) Less post operative distressLess post operative distress

If client still demands Laparoscopic If client still demands Laparoscopic TubectomyTubectomyOffer services routinely at DH, FRU, CHC, Offer services routinely at DH, FRU, CHC,

BLOCK PHC (wherever OT is available)BLOCK PHC (wherever OT is available)

2323

Camps in tubectomyCamps in tubectomy Should preferably start by 9 AMShould preferably start by 9 AM As the client is fasting since the As the client is fasting since the

previous eveningprevious evening Has travelled long distances to reach Has travelled long distances to reach

the camp site andthe camp site and Is dehydratedIs dehydrated Has to have 4 hrs post operative Has to have 4 hrs post operative

observation before being discharged observation before being discharged after being rehydratedafter being rehydrated

2424

Ensuring quality care in FPEnsuring quality care in FP

The manual on The manual on StandardsStandards in sterilization has in sterilization has been updated, printed & uploaded on the website.been updated, printed & uploaded on the website.

The manual on The manual on Quality assuranceQuality assurance in sterilization in sterilization has been updated, printed & uploaded on the has been updated, printed & uploaded on the website.website.

Six Regional Six Regional Dissemination WorkshopsDissemination Workshops on the on the

revised Standards and QA manuals held revised Standards and QA manuals held countrywide in 06-07. countrywide in 06-07.

2525

Ensuring quality care in FPEnsuring quality care in FP All states reported to have set up the All states reported to have set up the QACsQACs

at state and district levels as per affidavit at state and district levels as per affidavit filed by them in the supreme courtfiled by them in the supreme court

Revised extended QACRevised extended QAC as per the as per the updated manuals are in place in most of the updated manuals are in place in most of the states.states.

Most states have completed their Most states have completed their orientation of the districts for QAorientation of the districts for QA

2626

COMPENSATIONA.For Public (Govt.) facilities

Breakage of Breakage of the the CompensatiCompensation packageon package

AcceAcceptorptor

MotivaMotivatortor

Drugs Drugs and and dressindressingg

SurgeoSurgeon n chargescharges

AnestAnesthetisthetist

Staff Staff nursenurse

OT OT technitechnician/hcian/helperelper

RefreshRefreshmentment

Camp Camp managemmanagementent

TotalTotal

High High focus focus statesstates

VAS.VAS.(ALL)(ALL)

TUB.TUB.(ALL)(ALL)

11001100

600600

200200

150150

5050

100100

100100

7575

--

2525

1515

1515

1515

1515

1010

1010

1010

1010

15001500

10001000

Non Non High High focus focus statesstates

VAS.VAS.(ALL) (ALL)

TUBTUB(BPL + (BPL + SC/ST SC/ST only))only))

11001100

600600

200200

150150

5050

100100

100100

7575

----

2525

1515

1515

1515

1515

1010

1010

1010

1010

15001500

10001000

Non Non High High focus focus statesstates

TUBTUB(APL)(APL) 250250 150150 100100 7575 2525 1515 1515 1010 1010

650650

2727

COMPENSATIONB For Private Facilities:

CategoryCategory Type of operationType of operation FacilityFacility MotivatorMotivator TotalTotal

High High focus focus statesstates

Vasectomy Vasectomy (ALL)(ALL)Tubectomy Tubectomy (ALL)(ALL)

1300130013501350

200200150150

1500150015001500

Non High Non High focus focus statesstates

Vasectomy Vasectomy (ALL)(ALL)Tubectomy (BPL Tubectomy (BPL + SC/ST)+ SC/ST)

1300130013501350

200200150150

1500150015001500

2828

Family Planning Insurance SchemeFamily Planning Insurance Scheme((limit of indemnity)limit of indemnity)

Claims arising out of Sterilization OperationClaims arising out of Sterilization Operation AmountAmount

AA DeathDeath at hospital/ within seven days of discharge at hospital/ within seven days of discharge Rs. Rs. 2,00,000/-2,00,000/-

BB DeathDeath due to sterilization (8 due to sterilization (8thth – 30 – 30thth day from the day from the date of discharge ) date of discharge ) Rs. 50,000/-Rs. 50,000/-

CC Expenses for treatment of Medical Expenses for treatment of Medical ComplicationsComplications Rs. 25,000/-Rs. 25,000/- DD Failure Failure of Sterilization of Sterilization Rs. 30,000/-Rs. 30,000/-

EE Doctors/ Facilities Doctors/ Facilities covered for litigations up tocovered for litigations up to4 cases per year including defence cost4 cases per year including defence cost Rs. 2,00,000/-Rs. 2,00,000/-

Dissemination meetings conducted for all state officialsDissemination meetings conducted for all state officials Public institutions to display boards on the schemePublic institutions to display boards on the scheme

_________________________

2929

9. Strengthening contraceptive 9. Strengthening contraceptive supplysupply

NSV instrumentsNSV instruments Revised Specifications prepared in 2006 (on website)Revised Specifications prepared in 2006 (on website)• States asked to procure as per their requirements through States asked to procure as per their requirements through

PIPPIP LaparoscopesLaparoscopes

Revised Specifications prepared in 2006 (on website)Revised Specifications prepared in 2006 (on website) States asked to procure as per their requirements from States asked to procure as per their requirements from

central funds as per approved specifications (can place central funds as per approved specifications (can place indents with the TNMSC )indents with the TNMSC )

ECP supplyECP supply Procurement has restarted recentlyProcurement has restarted recently Requirements from states received and being suppliedRequirements from states received and being supplied

3030

10. Promotion of contraception through 10. Promotion of contraception through intensive advocacyintensive advocacy

Advocacy kit on contraceptivesAdvocacy kit on contraceptives

Expert committee and core committee set upExpert committee and core committee set up All existing material reviewed and updatedAll existing material reviewed and updated New materials developed for NSV, IUD380A, ECP, OCPNew materials developed for NSV, IUD380A, ECP, OCP All prototypes for All prototypes for

audio, audio, video and video and print (leaflets, flip charts, posters)print (leaflets, flip charts, posters)finalised and passed on to the IEC division for production finalised and passed on to the IEC division for production

and distribution to the states (Jan, 08)and distribution to the states (Jan, 08)

Dissemination of FP capsule through regional Dissemination of FP capsule through regional workshops (WHO biennium 08-09)workshops (WHO biennium 08-09) Approval obtainedApproval obtained Funding awaitedFunding awaited

3131

Family PlanningFamily Planning Components Components (What the SFT should look (What the SFT should look

for)for)ContraceptionContraceptionConception (infertility management)Conception (infertility management)Quality Assurance Quality Assurance Accreditation of facilitiesAccreditation of facilitiesEmpanelment of providers Empanelment of providers CompensationCompensationInsuranceInsurance

3232

Responsibilities of the states/ Responsibilities of the states/ districtsdistricts

Increase number of services centresIncrease number of services centres Availability of services Availability of services Accessibility of services Accessibility of services Affordability of services Affordability of services

(Upgradaiton of DHs, FRUs, CHCs, PHCs & (Upgradaiton of DHs, FRUs, CHCs, PHCs & SCs under NRHM)SCs under NRHM)

Accreditation of private providers (PPP)Accreditation of private providers (PPP)

3333

Responsibilities of the states/ Responsibilities of the states/ districtsdistricts

Regular fixed day services round the Regular fixed day services round the yearyear

a) DHa) DH - on demand (daily/ weekly)- on demand (daily/ weekly)b) FRU/CHCb) FRU/CHC - weekly/fortnightly/monthly- weekly/fortnightly/monthlyc) PHCc) PHC - monthly/ bimonthly- monthly/ bimonthly

- (Tubectomy only if OT available)- (Tubectomy only if OT available)d) SCd) SC - IUD/ ECP (on demand)- IUD/ ECP (on demand)

Tubectomy:Tubectomy: Wednesday (optional)Wednesday (optional)Vasectomy:Vasectomy: Saturday (optional) Saturday (optional)

3434

Responsibilities of the states/ Responsibilities of the states/ districtsdistricts

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

(ultimate aim)(ultimate aim)

2.2. Effect Manpower Rationalization Effect Manpower Rationalization Manpower Planning (based on ELA)Manpower Planning (based on ELA) Manpower Training Manpower Training Manpower PlacementManpower Placement

3.3. Develop Comprehensive Training Plan for Develop Comprehensive Training Plan for NSV NSV MinilapMinilap LTTLTT IUDIUD ECPECP

3535

Action at State/Dist. Action at State/Dist. level level

Appoint Nodal officer for Family Planning Appoint Nodal officer for Family Planning (for Planning, Implementing, Monitoring, Supervising & Evaluation)(for Planning, Implementing, Monitoring, Supervising & Evaluation)

Constitute QAC at state level (10 members) & Constitute QAC at state level (10 members) & notifynotify

Constitute DQAC at dist. level (9 members) & Constitute DQAC at dist. level (9 members) & notifynotify

Accredit facilities (Public/Private/NGO)Accredit facilities (Public/Private/NGO) Empanel doctors (Public/Private/NGO)Empanel doctors (Public/Private/NGO) Conduct Conduct

Half yearly meetings of state QAC (to be minuted)Half yearly meetings of state QAC (to be minuted) Quarterly meetings of Dist. QAC (to be minuted)Quarterly meetings of Dist. QAC (to be minuted)

3636

Action at State/Dist. levelAction at State/Dist. levelOrientation of CMOs onOrientation of CMOs on

NFPIS (National Family Planning Insurance Scheme)NFPIS (National Family Planning Insurance Scheme) Compensation Scheme (Revised)Compensation Scheme (Revised) ELA district wise for limiting & spacing methods ELA district wise for limiting & spacing methods

(based on dist. Unmet Need)(based on dist. Unmet Need) Manpower development (district action plan) Manpower development (district action plan)

NSV NSV (MOs)(MOs) Minilap/ LTT Minilap/ LTT (MOs)(MOs) IUD IUD (MOs/ SNs/ LHVs/ ANMs)(MOs/ SNs/ LHVs/ ANMs) ECPs ECPs (MOs/ SNs/ LHVs/ ANMs/ ASHAs)(MOs/ SNs/ LHVs/ ANMs/ ASHAs)

Contraceptive updatesContraceptive updates District budget allocation and disbursement District budget allocation and disbursement

Monthly Review of FP performance with Monthly Review of FP performance with CMOsCMOs

3737

Action at State/Dist. levelAction at State/Dist. levelDisplay prominently (facility wise)Display prominently (facility wise)

Revised Revised compensationcompensation scheme scheme Family planning Family planning insuranceinsurance scheme scheme Service availability (district action plan)Service availability (district action plan)

Fixed day serviceFixed day service calendar calendar NSVNSV Minilap/ LTTMinilap/ LTT IUDIUD

Camp calendarCamp calendar for above for above IEC materialsIEC materials on on

NSVNSV IUDIUD ECPsECPs

Budget may be provided accordinglyBudget may be provided accordingly

3838

Action at State/Dist. Action at State/Dist. levellevel

Lay down benchmarks (performance Lay down benchmarks (performance indicators) andindicators) and

Rank DistrictsRank Districts Reward districtsReward districts Reward CMOs (state award)Reward CMOs (state award) Recommend for national Recommend for national

recognitionrecognition

3939