Renewed focus on family planning in India

Division of Reproductive and Child Health INDIAN COUNCIL OF MEDICAL RESEARCH

NEW DELHI

CME 100th ICCR 20th April, 2012

Malabika Roy Scientist ‘F’ and Head

13.2% (NFHS 3) unmet need for contraception of which about 50% is for spacing methods

Introduction of any additional method in NFWP increases contraceptive use by 3.3% & would fulfill unmet need by 1.7%

Annually 78% conceptions are unplanned & 25% unwanted

8% maternal mortality related to abortion

Need for contraception

India in World Population India in World population

Source: Series – 1, India, Provisional Population Totals, Paper-1 of 2011 (http://www.censusindia.gov.in)

Population share of States- Census 2011

Source: Series – 1, India, Provisional Population Totals, Paper-1 of 2011 (http://www.censusindia.gov.in)

TFR: SRS 2010 Note: *-SRS 2007; ^-NFHS-3

TFR # of States

< 2.1 21

2.1-3.0 7

> 3.0 7

Total Fertility Rate: State-wise and India

Female Sterilization

34%

Male Sterilization 1%

Pill 4%

IUD 2%

Condom 6%

Any Traditional method

7%

Non user 46%

CURRENT USE OF FP METHODS

Source: DLHS-3 (2007-08), IIPS Mumbai

Utilization and quality of family planning services in rural areas of India: A

community based cross sectional study- An ICMR task force study

Indian J Med Sc, 57 (7); 303-10: 2003

B.S.

OBJECTIVE To obtain information from rural women regarding their contraceptive knowledge, practices and utilization of services and assess quality of services provided.

Number of women covered in the survey

Eligible women - 1,17,465 Current user of Family Planning - 14,276 Non user of Family Planning Method - 17,082

FIRST TIME USE OF ANY FAMILY PLANNING METHOD

Contraceptive use and desire for more children in rural districts of two States

in India - A cross sectional survey

Objective To study the association between met desire for children and contraceptive acceptance

TTAABBLLEE :: NNUUMMBBEERR OOFF WWOOMMEENN CCOOVVEERREEDD FFOORR VVAARRIIOOUUSS CCOOMMPPOONNEENNTT

State District Eligible women Uttar Pradesh

Barabanki Allahabad Kanpur Meerut Ghaziabad TOTAL

5276 3935 4036 4283 4814

22,344

Tamil Nadu

Chengai MGR N.Chengelpet Cuddalore Madurai Vellore Cheyyar HUD TOTAL

4139 5741 4805 5022 5368 4995

30,070

Total 52,414

Current age, Age at marriage and age of 1st conception

Per cent women expressing desire for one male and one female child by age

55.8

73.779.7

8.618.5

31.1

0

20

40

60

80

100

15-24 years 25-34 years 35-45 years

Perc

enta

ge

Age

Uttar Pradesh Tamil Nadu

Per cent women expressing desire for 3 or more child by age

COMPARATIVE DATA ON LIVING CHILDREN, DESIRED CHILDREN AND CONTRACEPTIVE USE

IN TWO STATES IN INDIA

Summary: Promote small family norm and make people aware of the benefits of FP

Community based survey on induced abortion and adoption of contraception

in 28 districts of India (AN ICMR TASK FORCE STUDY)

Indian J Med Sc, 56 (11); 478-84: 2004

Objective: To assess women's perceptions, knowledge, practices and utilization of

services for induced abortion.

REASONS FOR INDUCED ABORTION

PRECENTAGE OF WOMEN ACCEPTING POST-ABORTAL CONTRACEPTIVE

Contraceptive use mentioned (% ) Total acceptors………………………...48.9 IUD …..……………………21.9 OCP …..……………………15.3 Tubectomy (minilap)…….28.5 Tubectomy (laproscopy)..20.6 Others………………………13.7

REASON FOR NOT ACCEPTING POST-ABORTAL CONTRACEPTIVE

NON ACCEPTORS (%) (Multiple response) 51.1

Do not want 12.7 Husband objection 32.3

Private doctor do not offer 6.9 Family planning method also fail 3.7 Husband has vasectomy 1.3 Husband use condom 8.4 NR 20.7

1.9

1.6

2.1

0.8

0.5

0.9

0 1 2 3 4

Total

Urban

Rural

Wanted TFR Unwanted TFR

WANTED AND ACTUAL FERTILITY RATES

NFHS-3, India, 2005-06

If unwanted fertility is averted

TFR will reach replacement level.

RISING INSTITUTIONAL DELIVERY

7.39

31.58

73.29

90.37

100.78 106.97 108.70

0

20

40

60

80

100

120

2005-06 2006-07 2007-08 2008-09 2009-10 2010-11 2011-12

In la

khs

JSY BENEFICIERIES: 2005-06 to 2011-12

Post Partum Sterilization-Tubectomy (%) 2011-12

STATES

P E R C E N Tnt

0.00

0.

00

1.80

2.

15

2.74

2.

80

3.77

3.

90

4.31

4.

92

4.99

5.

31

5.35

5.

80

7.06

9.

41

10.2

8 11

.82

12.2

5 13

.06 20

.67

20.6

7 21

.14

21.7

4 21

.97 26.4

1 34.4

7 40.6

3 53

.73 62

.69

62.9

1 63

.49

76.5

0 78

.28 86

.90

97.4

4

0.00

20.00

40.00

60.00

80.00

100.00

120.00

DH

SK

JH

H

P C

G

BH

OR

AN

U

A PB

H

R

MP GJ

AS

AR

JK

UP

WB

NG

M

H

RJ

KN

DL

IND

IA

TR

DD

M

Z C

H

MN

M

G

AP

GO

KR

PD

TN

LD

Salient FACTs

If the current unmet need for family planning in India

could be fulfilled over the next 5 years, we can:

Avert 35,000 maternal deaths

Avert 12 lacs infant deaths

Save more than Rs.4450 crores

Saving of Rs.6500 crores if safe abortion services

are coupled with increased family planning services.

SOURCE: GoldieSJ, Sweet S, Carvalho N, Natchu UCM, Hu D (2010) Alternative Strategies to reduce maternal mortality in India: A cost-effective analysis, PLoS Med 7(4): e1000264. Doi:10.1371/journal.pmed.1000264

KEY POINTS in the census Positives Steepest fall in growth rate since independence:

17.64% decadal growth during 2001-2011 as compared to 21.54% during 1991-2001.

Annual growth rate declined sharply from 1.97% to 1.64%. Marked decline in fertility

3.08% decline in proportion of 0-6 child population Least population added compared to the previous decade:

18.15 crores added compared to 18.23 crores in previous decade

Concerns UP and Bihar together share 25.1% (one fourth)

of country’s population 8 EAG states have 45.87% of India’s population.

KEY Challenges

Acceptance of IUCDs have not improved significantly

Shortage of trained service providers. Lack of regular family planning services (fixed day)

at sub-district level. Increase in institutional deliveries through JSY is

not tapped fully for post-partum family planning. Services of private providers not brought into the

fold optimally. Lack of managerially skilled personnel for effective

monitoring of the programme. At Many areas in the country community is not

aware of benefits of the Family Planning (weak IEC).

THRUST areas – 12TH FIVE YEAR PLAN (2012-2017):

Strengthening Family Planning (FP) service delivery, especially post -partum FP in facilities with high case load

Promotion of spacing methods as a major initiative Introduction of newer contraceptives- to address

unmet need Community based distribution of contraceptives

through Accredited Social Health Activists (ASHAs) Involving private/NGO /CBO facilities to improve

the provider base for FP services Vigorous advocacy for family planning at all levels

specially at the highest political level

STRATEGIES –to address thrust areas

High focus approach ( 6 Northern states & 264 HFDs)

Operationalising ‘delivery points’ first , expand to other facilities.

Strengthening HR structures from national to the district level: Programme management structure

Counsellors at high delivery load facilities

Delivery of contraceptives to the door step by ASHA.

Roll out of ML 375 IUCD as a short term spacing method,

Ensuring vigorous advocacy Development of BCC tools (including IEC materials) for spacing between children

Development of IEC materials for IUCD

Enlisting more number of private providers/ NGOs /CBOs for provision of services (social franchising/ accreditation)

Initiatives in FP services Repositioning Family Planning for improvement in

maternal and child health along with population stabilisation. Popularising spacing methods (IUD 380-A) with

emphasis on training of providers for skilled insertion through ANM Establishment of QACs at state and district levels for

ensuring quality of family planning services Promoting Post Partum Family Planning

services Introducing revised compensation scheme for

FP services Introducing National Family Planning

Insurance Scheme Advocating population stabilisation through debate

in parliament and other national council meetings on population Research in newer contraceptive technologies to

expand the contraceptive choices.

Acknowledgements

SK Sikdar, Deputy Commissioner (FP), Ministry of Health and Family Welfare, Government of India

BS Dhillon, Scientist ‘E’ , RCH, ICMR Roopa Hariprasad, Scientist ‘C’, RCH, ICMR

Indian Council of Medical Research

Thank You