FEMALE FOETICIDE

FAMILY WELFARE PROGRAMMEFAMILY WELFARE PROGRAMMEIndia launched a nation wide Family Planning Programmed in 1952. India is the first country in the world to launch such a programme. A separate department of Family Planning was created in 1966 in the ministry of health. In 1977, the Janata Government formulated a new population policy ruling out compulsion. The acceptance of the programme was made purely voluntary. Also the Janata government named the FP dept. as Department of Family Welfare. The allocation for these programmes was just 0.1 crore in First Five year plan. It has increased to 3256 crores in the seventh plan.CONCEPT OF FWPIt is a Centrally sponsored programme. For this, the states receive 100 per cent assistance from Central Government. The current policy is to promote family planning on the basis of voluntary and informed acceptance with full community participation. The emphasis is on a 2 child family. Also, the emphasis is on spacing methods along with terminal methods. The services are taken to every doorstep in order to motivate families to accept the small family normAIMS OF FWPFamily welfare programme has laid down the following long term goals to be achieved by the year 2000 AD:Reduction of birth rate from 29 per 1000 (in 1992) to 21 by 2000 ADReduction of death rate from 10 (in 1992) to 9 per 1000. Raising couple protection rate from 43.3 (in 1990) to 60 per cent.Reduction in average family size from 4.2 (in 1990) to 2.3.Decrease in Infant mortality rate from 79 (in 1992) to less than 60 per 1000 live births.Reduction of Net Reproduction Rate from 1.48 (in 1981) to 1.Eligible couples, target couples and couple protection rateEligible couples: An eligible couple is a currently married couple, the wife being in the reproductive age group i.e. 15 to 45 year. It is estimated that there are 150 to 180 eligible couples per 1000 population in India. Presently, there are about 144 million eligible couples in India. These couples are in need of family planning services.Target couples: They are couples who have had 2 to 3 living children. Family planning was largely directed to such couples. The definition of target couple has been gradually enlarged to include families with one child or even newly married couple. The aim is to develop acceptance of the idea of family planning from the earliest possible stage.Couple protection rate (CPR):It is defined as the percentage of eligible couples effectively protected against child birth by one or other methods of family planning. CPR is an indicator of the prevalence of contraceptive practice in the community. The long term demographic goal is to achieve couple protection rate of 60 per cent by the year 2000 AD.

IMPORTANCE OF FWPIntegration with health services: Family welfare programme (FWP) has been integrated with other health services instead of being a separate service.Integration with maternity and child health: FWP has been integrated with maternity and child health (MCH). Public are motivated for post delivery sterilization, abortion and use of contraceptives.Concentration in rural areas: FWP are concentrated more in rural areas at the level of subentries and primary health centers. This is in addition to hospitals at district, state and central levels.Literacy: There is a direct correlation between illiteracy and fertility. So stress and priority is given for girl's education. Fertility rate among educated females is low.Breast feeding: Breast feeding is encouraged. It is estimated that about 5 million births per annum can be prevented through breast feeding.Raising the age for marriage: Under the child marriage restraint bill (1978), the age of marriage has been raised to 21 years for males and 18 years for females. This has some impact on fertility.Minimum needs programme: It was launched in the Fifth Five Year Plan with an aim to raise the economical standards. Fertility is low in higher income groups. So fertility rate can be lowered by increasing economical standards.Incentives: Monetary incentives have been given in family planning programmes, especially for poor classes. But these incentives have not been very effective. So the programme must be on voluntary basis.Mass media: Motivation through radio, television, cinemas, news papers, puppet shows and folk dances is an important aspect of this programme.

NATIONAL POPULATION POLICYWhat is a Policy?Set of Ideas or Plans that is used as a basis for decision making;Attitude and actions of an organization regarding a particular issue;General Statement of understanding which guide decision making.

NATIONAL POPULATION POLICYWhat is Population Policy?A deliberate effort by a national government to (Driver,1972). influence the demographic variables like fertility, mortality and migration. Influence the size, distribution or composition of human population

Four stages of Policy Process

Problem Identification and Issue RecognitionPolicy FormulationPolicy ImplementationPolicy Evaluation

objectivesto address the unmet needs for contraception.to provide integrated service infrastructure, and health personnel delivery for basic reproductive and child health care. is to achieve a stable population by 2045, at a level consistent with the requirements of sustainable economic growth, social development, and environmental protection Make school and child health services, supplies and infrastructure. education up to age 14, free and compulsory and reduce drop outs at primary and secondary school levels to below 20% for both girls and Reduce infant mortality rate to below 30 per 1000 live births boys Reduce maternal mortality ratio to below 100 per 100,000 live, Achieve universal immunization of children against all vaccine births. Promote delayed marriage for girls, not earlier preventable diseases. than age 18and preferably after 20 years of age.

National Population Policy -Milestones1946- Bhore Committee Report1952- Family Planning Programme1976- Statement of National Population Policy1977- Policy Statement of Family Welfare Programme

Cont1983- National Health Policy emphasized the need1991- National Development Council appointed a Committee1993- Dr. Swaminathan group prepared a Draft and discussed by cabinet and then Parliament

Cont..1991- Circulated and requested comments from Central and State Agencies1997- Promised to announce this policy in near future1999- Another Draft Policy was finished and finalized it on 19th Nov.

Programmes implemented to achieve immediate goal and medium term goalAims up to 2010IMR below 30/1,000 live birthsMMR below 100/1,00,000 live births80% institutional deliveries100% registration of vital eventsMedium Term Goal Total fertility Rate to replacement level18Cont..Themes to achieve these ObjectivesDecentralized planning and implementationEmpowering women and encouraging male involvement

ContMeeting the unmet need for family Welfare ServicesAddressing the needs of disadvantaged and under- served population groups Encouraging public- private partnershipMATERNAL AND CHILD HEALTH PROGRAMMaternal and child health refers to promotive, preventive and curative health care activities for mothers and children

Objectives of MCH To reduce maternal, infant and childhood mortality and morbidity.To promote reproductive healthTo promote physical and psychological development of children and adolescents

POLICY GUIDELINES FOR IMPLEMENTATION OF MCH PROGRAM:Effective use should be made of existing resources and infrastructures available in the community.The services should be delivered as close to the homes of beneficiaries as possible.Services for mothers and children should be delivered in an integrated manner.Child survival programs should serve as a sugar coating for delivery of the family planning programs which in general, are not popular.Voluntary agencies working in the area should be involved in providing MCH services.PACKAGE OF SERVICES RENDERED IN MCH PROGRAMSThe multipurpose health workers form the backbone of this program They are expected to:Record occurrence of pregnancy in their work area on the basis of history of missed periods andScreen women identified as pregnant for any of the under mentioned Risk factorsAge less than 145cm Weight less than 40 kg or more than 70kgHistory of stillbirths pregnancyHistory of stillbirthsHistory of cesarean section as indicated by scar in lower mid- abdomen.Identify women with moderate severe anemia Administer two doses of tetanus toxoidProvide iron and folic acid tablets to pregnant women for a period of 180 days.Antenatal CareThe package of antenatal care for all pregnant women consists of Screening for anemia, eclampsia and pre eclampsia and multiple pregnancies Hb estimation, blood pressure and fund height is measured.Advised to edt more food than general.Breast are examined to exclude retracted nipple.New born careRegarding spacing of further birth.

Intra natal careTrained birth attendant Use aseptic precautions during delivery of infant, severance of cord and subsequent care of the cord and infant.Education to mothers regardingBreast feeding (Exclusive breast feeding)Immunization Family planning and General health

Care of childrenMonitoring of growth of children to detect faltering of weight gain or malnutrition.Immunization against Vaccine Preventable diseasesTreat of common ailments as per the IMCI guidelinesReferral of cases to health institutions Implement national health programs.Impart health and nutrition education to community.Implementation of MCH ProgramsMedical officer of PHC is the leader of the health teamServices are delivered by staff members of the PHC and sub centres.INTEGRATED CHILD DEVELOPMENT SERVICES PROGRAM(ICDS)ICDS was launched in 1975 in 33 community development blocks and now spread to more than 4000 CD blocks.OBJECTIVES:To improve the nutritional and health status of children in the age group of 0 to 6 years.To lay sound foundation of Psychological , Physical and social development of child. To reduce morbidity, mortality, malnutrition and school drop - out rates.To impart nutrition and health education to mothers for making them more competent in looking after nutrition and health needs of children.PACKAGE OF SERVICES RENDERED IN ICDS PROGRAM:The scheme is focused for the benefit of preschool children and pregnant and lactating women in the reproductive age group (15-44 yrs).The Package of services provided by the ICDS scheme is given below.The expectant and lactating women are offered heath check-ups, immunization against tetanus, nutritional supplements, nutrition and health education.Recently health check-ups of adolescent girls have also been included in the program.Children below the age of 36 months, are given health check-up, immunization and nutrition supplements.

Children between 36 to 72 months also receive non formal preschool educationChildren are also administered a dose of 20000 international units of vitamin a every 6 months.Iron and folic acid provided to pregnant women and nursing mothers:Health checkup of children includes record of weight for identification of mal nourished children, who received special attention.Implementation of ICDS programICDS work is administered by child development project officer (CDPO), the anganwadi workers monthly report to CDPO.CHILD SURVIVAL AND SAFE MOTHER HOOD PROGRAMCSSM was initiated in 1992 the different components of the program are:Advice on Breast feeding Care of the newborn infant Resuscitation of the neonate Care of low birth weight infant and also services to pregnant women. Package of services the services under this program provided to Pregnant womenInfants and children under 5 years of age

Pregnant womenEssential care for all register by 12-16wks Antenatal checkup at least 2 timesImmunization with T.TGive IFA (1 tablet a day for 100 days)Treat those with clinical anemia (2 tablets a day for 100 days)Deworm with mebendazole (during 2nd/3rd trimester)Safe and clean delivery servicesPrepare women for exclusive breast feeding and timely weaning.

Early detection of complications:Clinical examination to detect Bleeding indication APH or PPHWeight gain more than 3kg in a monthSystolic BP of 140mm Hg or moreFever 39oC and above after delivery or after abortion.Prolonged or obstructed labor

Emergency care for those who need itEarly identification of obstetric emergenciesProvide initial management and refer to identified referral units.Use fastest available mode of transport women in the reproductive age group:Counseling onOptimal timing and spacing of birthSmall family normsUse and choice of contraceptives

Information on availability of:MTP servicesIUD and sterilization servicesProvide family planning services

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