Family Planning Program In India

1. Family Planning Program In India Dr. S.K Sikdar Deputy Commissioner, In-charge: Family Planning & Aspirational District Ministry of Health & Family welfare

2. India’s Contribution to World Population

3. Source: Census 2011

4. National Population Policy - 2000 Objectives IMMEDIATE Address unmet need MID-TERM TFR to replacement level of 2.1 by 2010 LONG-TERM Population stabilisation by 2045

5. Population & Growth Rate • Steepest decline in Decadal Growth Rate between 2001 and 2011 from 21.54% to 17.64% • Growth rate of populous states with high TFR has fallen sharply after decades of stagnation

6. Fertility trend in India (TFR) TFR (NFHS)=2.2 TFR (SRS)= 2.3

7. 55% of country’s population living in 24 States/UTs has already achieved replacement level fertility

8. Contraceptive Usage and Unmet Need Modern Contraceptive Usage (NFHS IV)= 47.8% (Track 20 estimates) = 54.4%

9. Teenage Fertility India = 7.9% Source: NFHS IV

10. Wanted and actual fertility rates If unwanted fertility is averted TFR will reach replacement level. Source: NFHS-4

11. HIGH RISK BIRTHSToo Close… Too Many… Too Early… Source: NFHS IV, SRS

12. Birth spacing >36 months Source: SRS 2016

13. Why Family Planning?

14. Fertility Contribution 52.5% of country’s fertility is contributed by age group 15-24 years 15-24 years women contribute 46% of the maternal mortality 1.28 crore births every year Source: SRS

15. Prevents one in every three maternal deaths Prevents unintended pregnancies and unsafe abortions Three times more risk of child mortality if the interval is less than 18 months Prevents high-risk pregnancies For every woman who dies of pregnancy and childbirth complications, at least 20 more suffer long-term illness. Prevents infant deaths Why FP?

16. Benefits of achieving FP goals Social Sector cost savings outweigh Family Planning costs Source: Calculation by Health Policy Initiative (USAID Project), Futures Group Source: NFHS II, MDG analysis

17. National Family Planning Program

18. Key highlights of FP programmes India was the first country to launch National Family Planning Program

19. Augmenting the demand through ASHA Schemes for Family Planning Expansion of the basket of FP Choices Promoting quality sterilization services Key FP Initiatives/Schemes Promoting quality IUCD services Generating demand and awareness for FP services Addressing global Commitments (Family Planning 2020)

20. Contraceptive Basket of Choice under National Family Planning Program Temporary Methods • Condoms (Nirodh) • Oral Contraceptive Pills- • Combined Oral Contraceptives (Mala N) • Centchroman (Chhaya) • Emergency Contraceptive Pills (Ezy Pill) • IUCD-380A, 375 • Injectable MPA Permanent Methods • Male Sterilization (Conventional Vasectomy/NSV) • Female Sterilization (Minilap/Laparoscopic) IUCD 380 A IUCD 375 Family Planning Division, MoHFW

21. Expansion of the basket of FP Choices Introduction of new contraceptive choices- • Injectable Contraceptive (Antara Program) • Centchroman (Chhaya) • Progesterone only Pills- under pilot Introduction of new device- • Cu IUCD 375 (effective for five years) was introduced in program in 2012-13. Introduction of new method- • Post partum IUCD was introduced in the program in 2010-11 and has provided post partum women an effective spacing option.

22. Augmenting the demand through ASHA Schemes for Family Planning • Home Delivery of Contraceptives • Ensuring Spacing at Birth • Pregnancy Testing Kits- • Pregnancy Testing Kits are now a part of ASHA kits so as to ensure early management of pregnancy

23. Promoting quality sterilization services • Sterilization Compensation Scheme- • The compensation package has been enhanced in 2014 for 11 high focus high TFR states • Higher package for post partum sterilization and male sterilization • Higher package for MPV districts

24. Sterilization Compensation Scheme

25. Clinical Outreach Teams • The scheme is applicable for 146 MPV districts in 7 high focus states • Special package for provision of sterilization services

26. Contd...Promoting quality sterilization services National Family Planning Indemnity Scheme- • Clients are indemnified in the unlikely events of deaths, complications and failures following sterilization • The providers/ accredited institutions are indemnified against litigations • The scheme was revised in 2013 and is now being operated by the state governments directly with NHM funding.

27. Contd…Promoting quality sterilization services • Mobile teams dedicated for FP services- • Has been introduced in high focus states, in 2014-15, to provide sterilization services in areas where there is dearth of service providers. • Scheme for ensuring drop back services to sterilization clients- • The scheme was launched in 2015 as per demand from the states to provide drop back to sterilization clients.

28. Sterilization Performance

29. Promoting quality IUCD services • Interval IUCD: • Can be provided in all public health facilities by a trained provider in OPD • PPIUCD (Post partum IUCD): • Inserted within 48 hours after delivery in facilities conducting deliveries • PAIUCD (Post abortion IUCD): • Inserted within 12 days of abortion in PHC and above facilities • PPIUCD and PAIUCD incentive scheme : • Trained/Skilled empanelled provider inserting PPIUCD/PAIUCD- Rs150 per insertion. • ASHA accompanying Client- Rs 150/insertion • Beneficiary- Rs. 300

30. PPIUCD Acceptance (% acceptance out of total public health deliveries)

31. Contd… Promoting quality IUCD services • Increasing provider’s base for providing IUCD services- • Task shifting was introduced for utilizing the army of doctors qualified in ISM (Ayurveda, Unani, Siddha and Homeopathy) for the provision of IUCD services after undergoing a structured training, at peripheral public health facilities.

32. Generating demand and awareness for FP services • Improved counseling through RMNCH Counselors • Celebration of World Population Day & fortnight (July 11 – July 24) • Population stabilisation fortnight has helped to break the seasonal trend of sterilization services in the northern states of India. • It is being held in all blocks, districts and states of India since 2009 and the event is observed over a month long period, split into: • June 27 to July 10: “Dampati Sampark Pakhwada” or “Mobilisation Fortnight” • July 11 to July 24: or “Jansankhya Sthirtha Pakhwada” or “Population Stabilisation Fortnight” • Celebration of Vasectomy fortnight (21st November to 4th December) • The objective is to improve male participation in Family Planning

33. Quality Structures: Family Planning Indemnity Subcommittee

34. Composition of DISC Composition of SISC • District Collector (Chairperson) • Chief Medical Officer/District Health Officer (Convener) • District Family Welfare Officer/RCHO/ ACMO/ equivalent (Member secretary) • One empanelled gynaecologist (from public institutions) • One empanelled surgeon(from public institutions) • Mission Director –NRHM (Vice Chairperson) • Director Family Welfare/Director Health Services/Director Public Health/Equivalent (Convenor) • Additional/Joint Director (FW)/Deputy Director (FW)/Equivalent, designated by the state government as the nodal officer for the Quality Assurance Cell (Member Secretary) • One Empanelled Gynaecologist (from public institutions) • One Empanelled Surgeon (from public institutions)

35. Hon’ble Supreme Court Directives • Uploading following on state website: List of empaneled sterilization providers, Details of S/DQAC member, Annual Report • Availability and usage of Consent form, Medical record checklist and sterilization certificate. The same to be translated in local language. • Phase out camp approach for provision of sterilization services. • Monitor at least 2 Public Health Facilities & 1 Accredited private/NGO Facility per month • Document the minutes of meeting , Action Points and review in subsequent meeting • Conduct client exit interviews during each visit (10% clients in each camp/fixed day facilities) • Strict adherence to the guidelines and standard operating procedures.

36. New Initiatives under Family Planning • Mission Parivar Vikas • Unified Software for FP logistics • Expansion of Contraceptive basket of choices • New Contraceptive Packaging • New FP media campaign

37. Mission ParivarVikas • Objective: To accelerate access to high quality Family Planning choices based on information, reliable services and supplies within the rights framework. • Timing/ Phasing: To implement the mission in all the 146 districts at one go and not in phases. Bihar- 37 districts; RJ- 14 districts;MP- 25 districts; CG- 2 districts; JH- 2 districts)

38. Unified Software for FP logistics Aim: To streamline FP logistics and supply chain management • Web based, App based and SMS based application • Instant access to stock information from National level to ASHA level • Auto forecasting of contraceptives • SMS alerts for key indicators • Auto generated reports for program review

39. New Communication Campaign

40. Overall Impact of Family Planning Services Chhattisgarh Bihar Haryana Himachal Pradesh Source: Track 20 Estimates

41. Overall Impact of Family Planning Services Jammu and Kashmir Jharkhand Karnataka Madhya Pradesh Source: Track 20 Estimates

42. Overall Impact of Family Planning Services Mizoram Maharashtra Puducherry Rajasthan Source: Track 20 Estimates

43. Overall Impact of Family Planning Services Tamil Nadu Telangana Source: Track 20 Estimates

44. Its all about making the right choice at the right time. Responsible Us for a Responsible Future! Thank You…