that is adopted voluntarily, uponthe basis of knowledge, attitudes and responsible decisions by individuals and couples, in order to promote the health and welfare of the family group and thus contribute effectively to the social development of a country" It is an essential part of mch care Health aspects of family planning The principal health outcomes of family planning are Women's health Maternal mortality, morbidity of women of child- bearing age, nutritional status (weight changes, haemoglobin level, etc.) preventable complications of pregnancy and abortion. Foetal health Foetal mortality (early and late foetal death);abnormal development. Infant and child health Neonatal, infant and pre-school mortality,health of the infant at birth (birth weight), vulnerability to diseases. Target couples and eligible couples Eligible couples
An "eligible couple" refers to a currently married couple wherein the wife is in the reproductive age, which is generally assumed to lie between the ages of 15 and 45
Target couples
The term target couple was applied to couples who have had 2-3 living children, and family planning was largely directed to such couples Family planning programme History of national family programme
1. Started in 1952 2. Made primary aim in 3rd five year plan ( from purely clinical to extensive education ) 3. 4th five year plan ( made it an integral part of mch at phcs ) 4. 5th five year plan ( renamed as family welfare from family planning ) 5. In 1992 integrated with cssm 6. National population policy 2000 ( integral part ) 7. Subsequently a part of rch and rmnch+ a Elements of of a successful family planning programme
Element of success in family planning programme The main strategy of family planning programme is to offer to client easy access to a wide range of affordable contraceptive method through multiple service delivery channels in a good quality, reliable fashion. The key points are as follows : (1) Make services accessible (2) Make services affordable (3) Offer client-centered care (4) Rely on evidence-based technical guidance (5) Communicate effectively (6) Assure contraceptive security (7) Work for supportive policies Unmet need for family planning
1.Highest (22.2 per cent) among women between 15 to 24 years of age
1.1 .Almost entirely for spacing the births rather than for limiting the births. 2.The unmet need for contraception among women aged 30 years 2.1For limiting the births. 3.Higher in rural areas than in urban areas. 4.It also varies by women's education (within range of 11- 17 per cent) 5.Religion (hindu and christian women have a lower unmet need than muslim women). (According to the NFHS-4) Indicators of family planning
Couple protection rate (CPR). It is
defined as the per cent of eligible couples effectively protected against childbirth by one or the other approved methods of family planning, viz. 1. sterilization, 2. IUD, 3. condom 4. oral pills CPR > 60% leads to an NRR =1 Delivery system
1.Central level
2.State level
3.CHC level
4.PHC level
5.Village level CENTRAL LEVEL AND STATE LEVEL CENTRAL LEVEL
● Family welfare programme is a centrally sponsored scheme
● Aim = 2 child family ● Administration ○ Dept of family welfare ( secretary of MoHFW) Special secretary ○ Advisor of mass media
STATE LEVEL = State family welfare bureau
District level Set- up consists of a 1.District Family Welfare Bureau· consisting of 3 divisions - 1.1an administrative division headed by the District Family Welfare Officer; 1.2mass education and media division , in charge of District Mass Education and Media Officer. 1.3 an evaluation division , in charge of a Statistical Officer.
These are supported by 1,083 Urban Family welfare centres and 871 Urban Health Posts. . Urban Health Posts.
4 types of Urban Health Posts-
● Population norms = ○ Type A for areas with population less than 5,000 ○ Type B for areas with population between 5,000-10,000 ○ Type C for population between 10.000- 25,000 ○ Type D for areas with population between 25,000- 50,000. ● Functions ○ Type A, B and C Health Posts are attached to a hospital for providing referral and supervisory services. ○ Type D Health Post is attached to a hospital for sterilization, MTP and referral . Urban Family welfare centres
Presently there are three types of Urban Family Welfare Centres.
● Type I is for population between 10,000- 25,000,
● Type II is for population between 25,000- 50,000, ● Type III is for above 50,000 population .
Staff = 2 para-medical staff in type I and II centres and by 6 persons including
medical officer in type III centres.
Function =The Urban family welfare centres and health posts provide comprehensive integrated services of MCH and family planning. At chc phc and village level ● CHC = full range of family planning services including laproscopic services and safe abortion services. ● PHC = The medical officers are usually trained to provide MTP and sterilization services. The programme of insertion of copper- T IUDs ● At the village level: ○ {a) The Village Health Guides : Responsible for spreading knowledge and information to the eligible couples and providing them with supplies of Nirodh and oral pills. ○ (b) Trained dais : Act as family planning counsellors and motivators, supplementing the delivery system. ○ (c) ASHA : 9.15 lakh ASHAs have been selected so far and have been provided with drug kits Newer initiatives 1. Home Delivery of Contraceptives (HDC)(by asha = Rs. 1 for a pack of 3 condoms. Rs.1 for a cycle of OCPs and Rs. 2 for a pack of one tablet of ECP )
2. Ensuring spacing at birth (ESB) (By asha
- Rs. 500/- to ASHA for delaying first child birth by 2 years after marriage.
- Rs. 500/- to ASHA for ensuring spacing of 3 years after the birth of 1st child.
- Rs.1000/- in case the couple opts for a permanent limiting method upto 2 children only.
3. Pregnancy Testing Kits ( Nischay-Home based pregnancy test kits
(PTKs) )
4. Mission Parivar Vikas (MPV)
5. New contraceptive launch ( injectable MPA under "Antara programme"
and oral contraceptive pill centchroman "chhaya" ) Mission parivar vikas a. Delivering assured services; b. Building additional capacity/human resources development for enhanced service delivery; c. Ensuring commodity security; d. Implementing new promotional schemes; and e. Creating an enabling enviro nment Community needs assessment approach(CNAA) 1. Initially the top down approach was followed it had many drawbacks a. the user preference was not reflected in the targets. b. the quality of the services became secondary c. people may be tempted to resort to false reporting to claim fulfilment of the target. 2. CNAA a. The population goals remain the same as before. b. Health workers are expected to consult families and local community and set target for anm’s c. Later on it was found that due to complex calculations required the health workers were unable to fix the performance norms for themselves. Therefore, it was decided to modify and rename the target free manual as Community Needs Assessment Approach Manual Sociology of family planning
Awareness of family planning is very widespread . People are generally in favour of family planning, and there is no organized opposition to it. lnspite of this, the rate of contraceptive use by couples in the developing countries is very low. The common beliefs are (Most of these beliefs stem from ignorance and lack of communication.) ● That children are the gift of God; ● The number of children is determined by God; ● Children are a poor man's wealth; ● Children are an asset to which parents can look forward in periods of dependency caused by old age or misfortune, etc. Evaluation of family planning programme Five types of evaluation have been defined by a WHO Expert committee
1. Evaluation of need
2. Evaluation of plans
3. Evaluation of performance
4. Evaluation of effects
5. Evaluation of impact National Family Planning Indemnity Scheme (NFPIS)
it has been decided that States/UTs
would process and make payment of claims to acceptors of sterilization in the event of death/failures/ complications/indemnity cover to doctors/health facilities. Family welfare linked health insurance scheme 1. Operated by icici 2. Compensation in case of death within 7 days following sterilization ( upto rs 2 lakhs per case)
All India Hospital Postpartum Programme (AIHPP)
The programme is based on the following rationale : a. That women who have recently delivered are of proven fertility, and are at risk to become pregnant again rapidly b. At the time of delivery and during the lying-in period. they are generally more receptive to adopt one or the other family planning method. Incentives for family planning Voluntary agencies Some of the well-known voluntary agencies in India are
1.The Family Planning Association of India
2.The Family Planning Foundation
3.The Population Council of India.
4.Others include the Indian Red Cross, the Indian Medical
