राष्ट्रीय स्वास्थ्य मिशन
National Health Mission
India was the first country in the world to have launched a National Programme for Family Planning in 1952. Over the decades, the programme has undergone transformation in terms of policy and actual programme implementation and currently being repositioned to not only achieve population stabilization goals but also promote reproductive health and reduce maternal, infant & child mortality and morbidity.
The objectives, strategies and activities of the Family Planning division are designed and operated towards achieving the family welfare goals and objectives stated in various policy documents (NPP: National Population Policy 2000, NHP: National Health Policy 2017, and NHM: National Rural Health Mission) and to honour the commitments of the Government of India (including ICPD: International Conference on Population and Development, MDG: Millennium Development Goals, SDG: Sustainable Development Goals, and others).
Factors influencing population growth can be grouped into following 3 categories-
Unmet need of Family Planning: This includes the currently married women, who wish to stop child bearing or wait for next two or more years for the next child birth, but not using any contraceptive method. Total unmet need of Family Planning is 9.4 (NFHS-V) in our country.
Age at Marriage and first childbirth: In India 23.3% (NFHS-V)of the girls get married below the age of 18 years and out of the total deliveries 6.8% are among teenagers i.e. 15-19 years. The situation regarding age of girls at marriage is more alarming in few states like, Bihar (40.8%), Rajasthan (25.4.%), Jharkhand (32.2%), UP (15.8%), and MP (23.1%). Delaying the age at marriage and first child birth could reduce the impact of Population Momentum on population growth.
Spacing between Births: Healthy spacing of 3 years improves the chances of survival of infants and also helps in reducing the impact of population momentum on population growth. SRS 2020 data shows that In India, spacing between two childbirths is less than the recommended period of 3 years in 47.6% of births.
Total Fertility Rate (TFR) in the country has recorded a steady decline to the current levels of 2.0 (SRS 2020):
| 2005 | 2006 | 2007 | 2008 | 2009 | 2010 | 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019 | 2020 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2.9 | 2.8 | 2.7 | 2.6 | 2.6 | 2.5 | 2.4 | 2.4 | 2.3 | 2.3 | 2.3 | 2.3 | 2.2 | 2.2 | 2.1 | 2.0 |
Nationwide, the small family norm is widely accepted (the wanted fertility rate for India as a whole is 1.6: NFHS-5) and the general awareness of contraception is almost universal (98.8% among women and men: NFHS-5).
As per NFHS-V TFR for India is 2.0. The NFHS-V Survey shows 66.7% use of Contraceptives among married women (ased 15-49 years)and prevalence of modern method 56.5%
| Policy Level | Service Level |
|---|---|
| Target free approach | More emphasis on spacing methods |
| Voluntary adoption of Family Planning Methods | Assuring Quality of services |
| Based on felt need of the community | Expanding Contraceptive choices |
| Children by choice and not chance |
The public sector provides the following contraceptive methods at various levels of health system:
| Spacing Methods | Limiting Methods |
|---|---|
| IUCD 380 A and Cu IUCD 375 | Female Sterilization: |
| Injectable Contraceptive MPA (Antara Programme) | Laparoscopic |
| Combined Oral Contraceptive (Mala-N) | Minilap |
| Centchroman (Chhaya) | Male Sterilization: |
| No Scalpel Vasectomy | |
| Condoms (Nirodh) | Conventional Vasectomy |
| EMERGENCY CONTRACEPTION | |
| Emergency Contraceptive pills (Ezy pills) | |
Above services are provided at various levels of public sector facilities; following table provides details of the same:
| Family Planning Method | Service Provider | Service Location |
|---|---|---|
| SPACING METHODS | ||
| IUCD 380 A, IUCD 375 | Trained & certified ANMs, LHVs, SNs and doctors | Sub centre & higher levels |
| Injectable Contraceptive MPA (Antara Programme) | Trained ANMs, SNs and doctors | Sub centre & higher levels |
| Oral Contraceptive Pills (OCPs) | Trained ASHAs, ANMs, LHVs, SNs and doctors | Village level Sub centre & higher levels |
| Condoms | Trained ASHAs, ANMs, LHVs, SNs and doctors | Village level Sub centre & higher levels |
| EMERGENCY CONTRACEPTION | ||
| Emergency Contraceptive Pills (ECPs) | Trained ASHAs, ANMs, LHVs, SNs and doctors | Village level Sub centre & higher levels |
| LIMITING METHODS | ||
| Minilap | Trained & certified MBBS doctors & Specialist Doctors | PHC & higher levels |
| Laparoscopic Sterilization | Trained & certified MBBS doctors & Specialist Doctors | Usually CHC & higher levels |
| NSV: No Scalpel Vasectomy | Trained & certified MBBS doctors & Specialist Doctors | PHC & higher levels |
Note: Contraceptives like OCPs, Condoms are also provided through Social Marketing Organizations.
Mission Parivar Vikas was initially for 146 high priority districts in the 7 high focus states (Bihar, Uttar Pradesh, Assam, Chhattisgarh, Madhya Pradesh, Rajasthan & Jharkhand), is scaled up in all districts of the seven high focus states as well as six north-estern states of the country with an aim to ensure availability of contraceptive products to the clients at all the levels of Health Systems.
Providing more choices through newly introduced contraceptives : Injectable Contraceptive MPA (Antara Programme) and Centchroman
Emphasis on Spacing methods like IUCD
Revitalizing Postpartum Family Planning including PPIUCD in order to capitalise on the opportunity provided by increased institutional deliveries. Appointment of counsellors at high institutional delivery facilities is a key activity.
Strengthening community based distribution of contraceptives by involving ASHAs and Focussed IEC/ BCC efforts for enhancing demand and creating awareness on family planning
Availability of Fixed Day Static Services at all facilities.
Emphasis on minilap tubectomy services because of its logistical simplicity and requirement of only MBBS doctors and not post graduate gynaecologists/ surgeons.
A rational human resource development plan for IUCD, minilap and NSV be chalked up to empower the facilities (DH, CHC, PHC, SHC) with at least one provider each for each of the services and Sub Centres with ANMs trained in IUD insertion
Ensuring quality care in Family Planning services by establishing Quality Assurance Committees at state and district levels Plan for accreditation of more private/ NGO facilities to increase the provider base for family planning services under PPP.
Increasing male participation and promoting Non scalpel vasectomy
Demand generation activities in the form of display of posters, billboards and other audio and video materials in the various facilities be planned and budgeted
Strong Political Will and Advocacy at the highest level, especially in states with high fertility rates
