Long-term objective/goal: to achieve a stable population by 2045, at a level consistent with sustainable:
• Economic growth,
• Social development, and
• Environmental protection
Medium-term objective: to bring the TFR to replacement level (Meaning NRR=1) by 2010
Immediate objectives:
1. To address the unmet needs for
• Contraception
• Health care infrastructure and health personnel
2. To provide integrated service delivery for basic reproductive and child health care
NPP cites the following reasons for the population growth of India:
1) Large section of population is in the reproductive age group: As a result of high birth rates in past
• Due to this, momentum of population increase will continue for some more years
• If THIS age group adopts small-family norm, the rate of population increase may slow down
2) High unmet need for contraception (appx 20% of population increase)
‘Unmet need’ – for contraception refers to those couples who do not intend to have children but are still not using any contraception, due to any reason.
3) Families wanting to have higher number of children as an insurance against infant and child deaths
• Infant mortality rate (IMR) has been high in the country
• Hence high IMR counters the message for small family norm
4) Early age at marriage
A high percentage of girls are married off below the minimum legal age of 18 yrs.
• This results in starting reproduction too early
These families also tend to have a higher number of children with smaller intervals
5) Almost one-third of births occur at intervals smaller than 2 years
• This also results in having more children
The above discussion concludes that for population stabilization, we need to achieve certain level of basic health services (and not JUST FP measures )
Thus the ‘National Socio-Demographic Goals’ were formulated
• These ‘Socio-Demographic Goals’ were to be reached by 2010
(1) Address the unmet needs for basic reproductive and child health services and infrastructure. (U)
(2) Make school education up to age 14 free and compulsory (E)
• Reduce drop outs at primary and secondary school levels to below 20%
• For both boys and girls.
(3) Reduce infant mortality rate to below 30 per 1000 live births. (I)
(4) Reduce maternal mortality ratio to below 100 per 100,000 live births. (M)
(5) Achieve universal immunization of children against all vaccine preventable diseases. (I)
(6) Promote delayed marriage for girls (M)
• Not earlier than age 18
• Preferably after 20 years of age.
(7) Achieve 80% institutional deliveries and 100% deliveries by trained persons. (T)
(8) Achieve universal access to information +counseling and services for contraception with a wide basket of choices. (FP)
(9) Achieve 100% registration of births, deaths, marriage and pregnancy. (R)
(10) Contain the spread of Acquired Immunodeficiency Syndrome (AIDS), and
• Promote integration between the management of reproductive tract infections (RTI) and sexually transmitted infections (STI) and the National AIDS Control Organization. (A)
(11) Prevent and control communicable diseases. (C)
(12) Integrate Indian Systems of Medicine (ISM) in the provision of reproductive and child health services (as it will appeal to more households and increase coverage). (I)
(13) Keep promoting the ‘small family norm’ while striving to achieve the above. (S)
(14) Converge the related social sector programs making family welfare, a people centered program. (C)
• NPP anticipated that if fully implemented, the population by 2010 will be 1107 million only
o As against a projection of 1162 million.
• In actuality, the population (2011 census) was even higher than the projection, i.e. 1210 million.
STRATEGIC THEMES
1. Decentralized Planning and Program Implementation:
Delegating the planning and implementing NPP to village panchayats esp. its women members
• They can demand the calculated funds and resources
• Panchayats showing exemplary performance in civil registration (births, deaths, marriages etc.), universalizing the small family norm, increasing safe deliveries, reducing IMR and MMR, promoting education up to age 14, will be nationally recognized and honored.
2. Convergence of Service Delivery at Village Levels
• All services related to health (both govt. and pvt.) to be provided at one center.
• An equipped maternity hut in each village should be set up to serve as a delivery room with:
o midwifery kits,
o basic medication for essential obstetric aid, and indigenous medicines and
o supplies for maternal and new born care
3. Empowering Women for Improving their Health and Nutrition
• Low social and economic status of girls and women limits their access to education, good nutrition, as well as money to pay for health care and family planning services.
• Efforts will be made for education and empowerment of the girl child and women, thereby raising their social status and decision making power.
4. Child Health and Survival
Priority would be to intensify neo-natal care.
• The baby friendly hospital initiative (BFHI) to be extended to all hospitals/ clinics, up to sub-centre levels.
• Besides promoting breast-feeding and complementary feeds, the BFHI should include
o Updating the skills of trained birth attendants
o To improve new born care practices to reduce the risks of hypothermia and infection.
• Essential equipment for the new born must be provided at subcentre levels.
• Child survival interventions have helped to reduce infant and child mortality and morbidity.
o universal immunization,
o control of childhood diarrheas with oral rehydration therapies
o management of acute respiratory infections
o massive doses of Vitamin A and food supplements
• Need to improve the quality and coverage of routine immunization program.
5. Meeting the Unmet Needs for Family Welfare Services
• Focus on distribution of non-clinical methods of contraception (condoms and oral contraceptive pills) through free supply, social marketing as well as commercial sales.
• Expand the availability of safe abortion care.
o Abortion is legal, but barriers limit women's access to safe abortion services.
o Eliminate the cumbersome procedures for registration of abortion clinics.
• Simplify and facilitate setting up of training centers for safe abortion in public, pvt. & NGO sectors
• Ensure services for pregnancy termination at primary (PHC) and at community health centers
• Modify the curricula for medical graduates, as well as for continuing education, to provide for practical training in the newer procedures
6. Under-Served Population Groups
Urban Slums-
Little or no access to potable water, sanitation facilities, and health care services
• This contributes to high infant and child mortality
• Which in turn perpetuate high TFR and maternal mortality
Basic and primary health care, including reproductive and child health care, needs to be provided.
Coordination with municipal bodies for water, sanitation and waste disposal must be pursued
Tribal Communities, Hill Area Populations and Displaced and Migrant Populations-
Tribal populations often have high levels of morbidity arising from poor nutrition, low levels of literacy, coupled with high infant, child, and maternal mortality.
• These communities need attention for basic health, and reproductive and child health services.
• The special needs of tribal groups include the provision of mobile clinics
Adolescents:–
Adolescents represent about a fifth of India's population.
The needs of adolescents, including protection from unwanted pregnancies and sexually transmitted diseases (STD), have not been specifically addressed in the past.
Programs should encourage
• Delayed marriage and child-bearing, and
• Educating about the risks of unprotected sex.
• Reproductive health services for adolescent girls and boys are especially significant.
• Their special requirements comprise
• Information, counseling, population education, accessible and affordable contraceptive services
• Providing food supplements and nutritional services through the ICDS
• Enforcing the Child Marriage Restraint Act, 1976
7. Increased Participation of Men in Planned Parenthood
The active participation of men is vital in:
• Planning families and supporting contraceptive use,
• Helping pregnant women stay healthy,
• Arranging skilled care during delivery, avoiding delays in seeking care,
• Helping after the baby is born and finally
• Being a responsible father.
Currently, over 97% of sterilizations are tubectomies
• This is a manifestation of gender imbalance and needs to be corrected.
• The special needs of men include re-popularizing vasectomies
o in particular no scalpel vasectomy as a safe and simple procedure
8. Diverse Health Care Providers
• Accrediting private medical practitioners and assigning defined beneficiary groups to them
• Revival of the system of licensed medical practitioner who, after appropriate certification from the Indian Medical Association (IMA), could provide specified clinical service
9. Collaboration with Non-Government Organizations and the Private Sector
• A national effort to reach out to households cannot be sustained by government alone.
• Private sector currently accounts for nearly 75% of health care expenditures.
10. Mainstreaming Indian Systems of Medicine and Homeopathy
• This will expand the pool of effective health care providers
• Guidelines are needed to regulate and standardize efficacy and safety of ISMH drugs
11. Contraceptive Technology and Research on Reproductive and Child Health
Following have been set up to pursue applied research in population related matters and need to be strengthened further:
• The International Institute of Population Sciences and
• The population research centers
(Applied research includes monitoring of at the program and projects)
Demographic data for action is made available regularly through:
• The National Health and Family Welfare Survey provides data on key health and family welfare indicators every five years
• The district surveys cover 50% districts every year, so that every 2 years there is an update on every district in the country.
• The facility surveys ascertain the availability of infrastructure and services up to primary health centre level, covering one district per month.
12. Providing for the Older Population
Promoting old age health care will, over time, serve to reduce the incentive to have large families.
• Training and equipping health centers and hospitals for providing geriatric health care
• Encouraging NGOs to design schemes that make the elderly economically self-reliant
• Providing screening for cancer, osteoporosis, and cardiovascular conditions at peripheral levels.
• Tax incentives to encourage grown-up children to look after their aged parents
13. Information, Education, and Communication:
Family welfare messages disseminated in local language by local media
LEGISLATION
Lok and Rajya Sabha seats have been frozen (as per 1971 Census) via 42nd amendment till 2001, enabling state governments to fearlessly pursue population stabilization.
• This needs to be extended up to 2026.
PUBLIC SUPPORT
Demonstration of support to the small family norm, as well as personal example, by political, community, professional and religious leaders, film stars, sports personalities and opinion makers
Following NEW STRUCTURES are recommended:
1. National Commission on Population: presided over by the Prime Minister, with following members:
• Chief Ministers of all states and UTs,
• Central Minister in charge of the
• Department of Family Welfare
• Department of Woman and Child Development,
• Department of Education,
• Department of Social Justice and Empowerment in the Ministry of HRD,
• Ministry of Rural Development, NGOs etc.
2. State / UT Commissions on Population: Presided over by the Chief Minister
3. Coordination Cell in the Planning Commission: for inter-sectoral coordination
4. Technology Mission – Dept. of Family Welfare: technology support for RCH programs and IEC.
Other promotional and motivational measures for adoption of the small family norm
1. Panchayats and Zila-Parishads will be honored for exemplary performance in spreading small family norm and literacy and reductions in IMR and birth rate
2. Balika Samridhi Yojana will continue: Rs.500 at the birth of the girl child of birth order 1 or 2.
3. Maternity Benefit Scheme run by the Department of Rural Development will continue. Rs. 500 for mothers having first child after 19 years of age only for first or second child
.
4. A Family Welfare-linked Health Insurance Plan will be established.
Couples below the poverty line,
• Who undergo sterilization
• With not more than two living children,
Would be eligible for health insurance up to Rs. 5000, and an accident insurance for the spouse undergoing sterilization.
5. Reward for couples
• Below the poverty line,
• Who marry after the legal age of marriage,
• Register the marriage,
• Have their first child after the mother reaches the age of 21,
• Accept the small family norm, and
• Adopt a terminal method after the birth of the second child
6. A revolving fund will be set up for income-generating activities by village-level self-help groups
7. Crèches and child care centers will be opened in rural areas and urban slums for facilitating participation of women in paid employment.
8. A wider, affordable choice of contraceptives will be made accessible.
9. Facilities for safe abortion will be strengthened and expanded.
10. Contraceptive Products will be made affordable through social marketing schemes
11. Local entrepreneurs at village levels will be provided soft loans and encouraged to run ambulance services to supplement the existing arrangements for referral transportation
12. Vocational training for girls, leading to self-employment will be encouraged
13. Strict enforcement of
• Child Marriage Restraint Act, 1976 and
• Pre-Natal Diagnostic Techniques Act, 1994
15. Soft loans to ensure mobility of the ANMs will be increased.
16. The 42nd Constitutional Amendment freezing the no. of Lok Sabha representatives until 2001 for State Governments to fearlessly pursue population stabilization, needs to be extended until 2026.
References:
1. Population and Development Review. Vol. 1, No. 1 (Sep., 1975), pp. 147-161 (15 pages) Published By: Population Council
2. NPP document
What is a 'Population Policy'?: http://www.ihatepsm.com/blog/what-population-policy
National Population Policy, 2000: http://www.ihatepsm.com/blog/national-population-policy-2000
National Population Policy – 2000 Made Clear in Brief: http://www.ihatepsm.com/blog/national-population-policy-%E2%80%93-2000-m...