India’s population as per 2011 census was 1.21 billion, second only to China in the world. India accounts for 2.4% of the world’s surface area yet it supports more than 17.5% of the world’s population.
Population Stabilization has always been one of the priority agenda and Family Planning as one of the key intervention for the Government. In 1952, India was the first country in the world to launch a national programme, emphasizing family planning to the extent necessary for reducing birth rates “to stabilize the population at a level consistent with the requirement of national economy”. The program has come a long way and currently Family Planning Program is being repositioned to not only achieve population stabilization but also to reduce maternal mortality and infant and child mortality.
National Population Policy, 2000
The National Population Policy, 2000 (NPP 2000) provides a policy framework for advancing goals and prioritizing strategies to meet the reproductive and child health needs of the people of India, and to achieve net replacement levels of fertility (i.e. TFR 2.1) by 2010. National Socio-Demographic Goals formulated to achieve the objectives of NPP, envisaged to –
· Address the unmet needs for basic reproductive and child health services, supplies and infrastructure and to promote vigorously the small family norm to achieve replacement levels of TFR.
· Achieve 80 percent institutional deliveries and 100 percent deliveries by trained persons.
· Reduce infant mortality rate to below 30 per 1000 live births, maternal mortality ratio to below 100 per 100,000 live births, 100% registration of all births, deaths and pregnancies and achieve universal immunization of children against all vaccine preventable diseases.
· Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of age.
· Achieve universal access to information/counselling, and services for fertility regulation and contraception with a wide basket of choices.
· Bring about convergence in implementation of related social sector programs so that family welfare becomes a people centred programme.
Total Fertility Rate is still 2.6 at National level and scenario is diverse across states. Nine states are well above the replacement level fertility (TFR >3); twelve states/UTs are at threshold of achieving the replacement level of fertility (TFR – 2.1-3) while 11 state and 3 UTs have already achieved the replacement level of fertility i.e. <2.1.
The States also differ widely in terms of health indicators, nutritional status and socio-economic situation. Practice of Family planning is also low in the states where the other indicators are poor. Therefore, addressing population growth in the states with high fertility require a comprehensive approach to population stabilization based on social and economic development and improvements in the quality of life of people.
Currently the Government follows High-focus district approach (264 such districts have been selected) and support these districts (and states) for better implementation of Family Planning programmes (and other programmes as well).
The Government is committed to reduce the Maternal Mortality Ratio (MMR) to 100/100,000 live births, Infant Mortality Rate (IMR) to 30/1000 live births and to achieve the replacement level of fertility (Total Fertility Rate – 2.1) by 2012.
Strategic Options For Population Stabilization
States with TFR >3.0 (U.P. Bihar, M.P., Rajasthan, Jharkhand, Chhattisgarh, and Meghalaya): These States will account for almost 50% of the increase in India’s Population in coming years. In these States, the immediate concern is to address the unmet need and focus upon socio economic development to reduce the wanted fertility (desire for more than two children). At the same time the momentum for future population growth is to be checked by delaying age at marriage and ensuring adequate spacing between births.
States with TFR between 2.1 to <3 (Uttarakhand, Gujarat, Haryana, J&K, Orissa): The immediate concern in these states is to assist the couples to achieve their fertility goals by strengthening the family planning programme.
For States with TFR <2.1 (Delhi and Himachal Pradesh): The immediate concern in these States is to check the population momentum by delaying the age at marriage and ensuring adequate spacing between births.
Key Thrust Areas – 12th Five Year Plan : Family Planning
· Addressing the unmet need in contraception through introduction of newer contraceptives.
· Strengthening family planning service delivery, especially Post-Partum Sterilisation in high case load facilities.
· Enlisting private/NGO facilities to improve the provider base for family planning services.
· Community based distribution of contraceptives through ASHAs.
· Vigorous advocacy of family planning at all levels specially at the highest political level.
Strategies to Achieve Thrust Areas:
· Strengthening human resource structures (for programme management) at all levels (national, state and district).
· Introduction of a dedicated counsellor for family planning at district hospitals and high case load facilities.
· Marketing of contraceptives at households through ASHAs at nominal charges.
· Improving compensation package (both for providers and acceptors) for sterilisation services.
· Introducing Multi –load IUD (375) as a short term spacing method to improve IUD acceptance.
· Performance Linked Payment Plan to ASHAs for improving retention and usage of IUDs.
· Enlisting more number of private providers/ NGOs for provision of services.
· Ensuring vigorous advocacy.
*Inputs from the Ministry of Health & Family Welfare
**July 11 is celebrated as World Population Day