SEMINARON

NATIONAL POPULATION POLICY

Submitted to:

Dr. Navaneetha

Professor, Community Health NursingCON, PIMS

Submitted By :

T. Muthukumaran

1st Year M.Sc.(N)CON, PIMS `

S.NO CONTENT PAGE NO

1. Defining a policy and Population Policy

2. Need for population policy in India

3.Milestones in evolution of Population Policy of India

4.India’s demographic achievements till NPP-2000

5. Objectives of the NPP-2000

6. National socio-demographic goals for 2010

7. Major strategic themes in the NPP-2000

8. Legislation, public support and funding.

9.New structures for coordination of the activities

10. Action plan or operational strategies.

11. Promotional and motivational measures.

12. Conclusion

 Introduction

After independence the first objective of Indian government was economic and social development. In economic and social development government focus on to create the choices for the people to enhance the well being of the population. In 1952 India was first country in the world who launch the family planning program to decrease the birth rates in India. The time line of various committees for national population policies are given below.

1.  In 1946 Bhore Committee Report,

2. 1952   Launching of Family Planning  Programme

3. 1976   Statement of National Population Policy

4. 1977   Policy Statement on Family Welfare Programme

5. 1983   The National Health Policy of 1983  emphasized the need for “securing the  small family norm, through voluntary  efforts and moving towards the goal of population stabilization”.

6. 1991   ” a long term holistic view of development, population growth and, environmental protection”

DEFINITION OF 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.

POLICIES RELATED TO HEALTH SECTOR

National Health Policy

Nutrition Policy

Population Policy

WHAT IS POPULATION POLICY? Measures formulated by a range of social institutions including Government which may

influence the size, distribution or composition of human population (Driver,1972).

A deliberate effort by a national government to influence the demographic variables like

fertility, mortality and migration (Organski & Organski,1961)

A set of Coordinated laws aimed at reaching some demographic goal (Biurgeois-

Pichat,1974)

WHY THERE IS A NEED FOR POPULATION POLICY IN INDIA? NEED FOR POPULATION POLICY IN INDIA

On 11th May, 2000, India had 1 billion (100 crores) people, i.e., 16 percent of the

world’s population on 2.4 percent of the globe’s land area.

If current trends continue, India may overtake China by 2045, to become the most

populous country in the world.

Global population : ↑ 3 folds during this century (from 2 to 6 billion)

Population of India : ↑ nearly 5 times (from 238 million to 1 billion), during the same

period.

Stabilizing population is an essential requirement for promoting sustainable development

with more equitable distribution .

CAUSES OF HIGH POPULATION GROWTH

A large size of population in the reproductive age group (estimated contribution 58

percent).

Higher fertility due to unmet needs of contraception (estimated contribution 20 percent).

High desire for fertility due to high infant mortality rate (estimated contribution 20

percent) .

Approximately 50 percent of the girls marry below the age of 18 years, resulting in a

typical reproductive pattern of “too early, too frequent, too many.”

Preference for male child.

More children are preferred by poor parents as more workforce.

MILESTONES IN THE DEVELOPMENT OF THE NATIONAL POPULATION

POLICY

1940- The sub committee on Population , appointed by the National Planning

Committee, considered ‘ Family Planning and limitation of children’ essential for the

interest of social economy, family happiness and national planning.

1946- The Bhore Committee reported that control of disease and famine would cause

a serious problem of population growth.

1951- The Draft outline of the First Five Year Plan recognized ‘ population policy’ as

an ‘essential to planning’ and ‘family planning’ as a ‘step towards improvement in health

of mothers and children’.

1952- Launching of the first National Family Planning Programme in India.

1976- Statement of National Population Policy, by Shri K. Singh, Minister of Health

and Family planning, to deter population growth and events that contributed to it.

1977- A revised Population Policy Statement was tabled on Parliament. It emphasized

the voluntary nature of the family planning programme.

The term ‘Family Welfare’ replaced the term ‘Family Planning’.

1983- The National Health Policy emphasized “securing the small family norm,

through voluntary efforts and moving towards the goal of population stabilization”

1991- The National Development Council (NDC) appointed a committee with Shri K

Karunakaran as the chairperson.

The Karunakaran report endorsed by the NDC , in 1993 proposed the formulation of

a National Population Policy to take:

“a long term holistic view of development, population growth and environmental

protection”,

“to suggest policies and guidelines”

“ a monitoring mechanism with short, medium and long term goals”

1993 - An expert group headed by Dr. M.S. Swaminathan –asked to prepare draft

of a National Population Policy to be discussed.

1994 - Report on a ‘ National Population Policy’ by the expert group circulated among

members, and comments sought from the state and central agencies

1997 - On 50th anniversary of Indian independence , Prime Minister, Gujral

promised to announce a National Population Policy in near future.

- During 11/97 Cabinet approved draft, directed to be placed before the Parliament,

but could not be placed as both the Houses stood adjourned.

1999 - Another round of consultation in 1998, and another draft finalised and placed

before the Cabinet in March, 1999.

- Cabinet appointed a Group of Ministers (GOM) headed by Deputy Chairman,

Planning Commission, to examine the draft.

- The GOM then finalised a draft, placed before the Cabinet, discussed on 19th

November 1999.

BACKGROUND OF THE 1976 POPULATION POLICY

In 1976, with India’s population growing rapidly, the Emergency extended for

another year.

Minister of Health and Family Planning , Karan Singh, announced National

Population Policy, to deter population growth.

The policy hoped to reduce the nation’s hardships, established how incentives would

be allocated to those who participate in population management efforts, and sought

to reduce the nation’s birth rate from 35 to 25 per 1000 by 1984.

The policy also acknowledged that the country’s population growth concerns could

not wait for increased development and education to result in fertility drop.

The policy called for the Education Ministry to encourage and promote girls’

education.

The population policy stated that the central government did not wish to legislate

compulsory sterilization

But if a state legislature felt prepared to pass a policy making sterilization

compulsory, then it could do so.

The results of population policy 1976 , if measured by the number of sterilizations

would be a success ( although there were false reporting).

From a rights based perspective, when effectiveness is measured by deaths, violence

or rights compromised in an attempt to goals of the Population Policy, initiatives

were unsuccessful.

Failure was reflected by the lack of sustainability and being counter-protective to

improve the nation’s health.

For example, compensation for sterilization operations rose to 10 percent of the total

health budget.

It concentrated resources at one place, more of the health professionals were being

used to reach sterilization goals, rather than other services towards patient welfare.

DEMOGRAPHIC ACHIEVEMENTS OF INDIA BEFORE NPP-2000

Reduced Crude Birth Rate from 40.8 (1951) to 26.4 (1998)

Halved the Infant Mortality Rate from 146 per 1000 live births (1951) to 72 per 1000

live births (1998)

Quadrupled the Couple Protection Rate from 10.4 percent (1971) to 44 percent

(1999)

Reduced Crude Death Rate from 25 (1951) to 9.0 (1998)

Added 25 years to life-expectancy from 37 years to 62 years;

Achieved nearly universal awareness of the need for and methods of family

planning, and ;

Reduced Total Fertility Rate from 6.0 (1951) to 3.3 (1997)

India's population in 1991 and projections to 2016 are as follows:

Population Projections for India (million)3

March 1991 March 2001 March 2011 March 2016846.3 1012.4 1178.9 1263.5

NATIONAL POPULATION POLICY OF INDIA- 2000

OBJECTIVES OF THE NATIONAL POPULATION POLICY-2000

IMMEDIATE OBJECTIVE :

1. to address the unmet needs for contraception,

2. health care infrastructure and health personnel and

3. to provide integrated service delivery for basic reproductive and child health care.

MEDIUM TERM OBJECTIVE:

1. to bring the TFR to replacement level by 2010 through vigorous implementation

of intersectoral operational strategies.

LONG TERM OBJECTIVE:

1. achieve a stable population by 2045 at a level consistent with requirement of

sustainable economic growth, social development and environmental protection.

NATIONAL SOCIO-DEMOGRAPHIC GOALS FOR 2010

1. Address the unmet needs for basic RCH services, supplies and infrastructure.

2. Make school education up to age 14 years free and compulsory, and reduce drop outs

rate from primary and secondary school levels to below 20 percent for both boys and

girls.

3. Reduce IMR to 30/1000 live births

4. Reduce maternal mortality ratio (MMR) to less than 100 per 1000 live births

5. Achieve universal immunization of children against all Vaccine Preventable Disease

(VPD).

6. Promote delayed marriage for girls, at age not less than 18,and preferable after 20

years.

7. Achieve 80% institutional delivery and 100% by trained personnels

8. Achieve universal access to information/ counseling services for fertility regulation

and contraceptive with wide basket of choices

9. Achieve 100% registration of births, deaths, marriage, and pregnancy.

10. Containment of AIDS, and greater integration between the management of AIDS

and STD.

11. Prevention and control of communicable diseases.

12. Integration of Indian system of medicine in provision of RCH services, and in

reaching out to households.

13. Promote small family norm to achieve replacement level of Total Fertility Rate 2.1.

14. Bring about convergence in implementation of related social sector programmes so

that family welfare become people centered programme.

MAJOR STRATEGIC THEMES FOR THE NPP-2000

Strategic themes must be simultaneously pursued in “stand alone” or intersectoral

programmes in order to achieve the national socio-demographic goals for 2010. Following

strategic themes are presented in the policy:

1. Decentralized planning and programme implementation

The 73rd and 74th Constitutional Amendments Act, 1992, made health, family

welfare, and education a responsibility of village panchayats. The panchayati raj

institutions are an important means of furthering decentralised planning and programme

implementation in the context of the NPP 2000. However, in order to realize their

potential, they need strengthening by further delegation of administrative and financial

powers, including powers of resource mobilization.

Further, since 33 percent of elected panchayat seats are reserved for women,

representative committees of the panchayats (headed by an elected woman panchayat

member) should be formed to promote a gender sensitive, multi-sectoral agenda for

population stabilisation, that will "think, plan and act locally, and support nationally".

These committees may identify area- specific unmet needs for reproductive health

services, and prepare need-based, demand- driven, socio-demographic plans at the village

level, aimed at identifying and providing responsive, people-centred and integrated, basic

reproductive and child health care. Panchayats demonstrating exemplary performance in

the compulsory registration of births, deaths, marriages, and pregnancies, universalizing

the small family norm, increasing safe deliveries, bringing about reductions in infant and

maternal mortality, and promoting compulsory education up to age 14, will be nationally

recognized and honored.

2. Availability of services delivery at village levels

Efforts at population stabilisation will be effective only if we direct an integrated

package of essential services at village and household levels. Below district levels,

current health infrastructure includes 2,500 community health centres, 25,000 primary

health centres (each covering a population of 30,000), and 1.36 lakh subcentres (each

covering a population of 5,000 in the plains and 3,000 in hilly regions)4. Inadequacies in

the existing health infrastructure have led to an unmet need of 28 percent for

contraception services, and obvious gaps in coverage and outreach. Health care centres

are over-burdened and struggle to provide services with limited personnel and equipment.

Absence of supportive supervision, lack of training in inter-personal communication, and

lack of motivation to work in rural areas, together impede citizens' access to reproductive

and child health services, and contribute to poor quality of services and an apparent

insensitivity to client's needs.

Since the management, funding, and implementation of health and education

programmes has been decentralised to panchayats, in order to reach household levels, a

one-stop, integrated and coordinated service delivery should be provided at village levels,

for basic reproductive and child health services.

The panchayats should seek the help of community opinion makers to communicate

the benefits of smaller, healthier families, the significance of educating girls, and

promoting female participation in paid employment. They should also involve civil

society in monitoring the availability, accessibility and affordability of services and

supplies.

3. Empowering women for improved health and nutrition

4. Child survival and child health

5. Meeting the unmet needs for Family Welfare Services

6. Greater emphasis for underserved population group

• Urban Slums

• Tribal communities, Hill Area populations and displaced and migrant

populations

• Adolescents

• Increased participation of men in planned parenthood

7. Diverse health care providers

8. Collaboration with the commitments from private agencies and NGOs

9. Involvement of Indian system of medicine in delivery of RCH services

10. Contraceptive technology and research in RCH

11. Providing health care and support for the older population

12. Information, Education and Communication .

LEGISLATION:

The 42nd Constitutional amendment: Lok Sabha and Rajya Sabha seats are frozen on

the basis of 1971 census were valid up to 2001 that is further extended till 2026.

79th Amendment Bill of 1992 disqualify a person for being a member of either house

of legislature of a state, if he/she has more than 2 children.

PUBLIC SUPPORT:

Strong support of political, community, business, professional, religious leaders, media,

film stars, sports personalities, and opinion makers has been sought for small family norms.

FUNDING:

National Population Policy expressed that the programme, projects and schemes promised on the

goals and objectives of the policy 2000 will be adequately funded.

NEW STRUCTURES

The NPP-2000, is to be largely managed at the Panchayat and Nagar Palika levels, in

coordination with concerned State/ UTs.

For comprehensive and multi-sectoral coordination of planning and implementation

between health and family welfare on the one hand, along with schemes from

various other departments (like education, nutrition, and women and child

development,etc) the following structure has been proposed:

PROMOTIONAL AND MOTIVATIONAL MEASURES FOR ADOPTION OF THE

SMALL FAMILY NORM:

1. Panchayats and Zila Parishads will be rewarded and honoured for exemplary

performance.

2. Balilka Samridhi Yojana (Department of Women and Child Development) provide cash

incentive of Rs.500 at the birth of the girl child of birth order 1 or 2.

3. Maternity Benefit Scheme (Department of Rural Development) provide cash incentive to

mothers who have their first child after 19 years of age, for birth of the 1 and 2 child

only.

4. A Family Welfare linked Health Insurance plan will be established.

5. Couples below the poverty line will be rewarded for their active involvement in Family

Planning activities.

6. A revolving fund will be set up for income generating activities by Village- level self

help groups. 7. Creches and child care centers will be opened in rural and urban slums.

8. A wider and affordable choice of contraceptives will be made accessible.

9. Facilities for safe abortion will be strengthened.

10. Innovative social marketing schemes will be promoted.

11. Ambulance services at the villages level will be strengthened.

12. Increased vocational training schemes for girls, leading to self-employment will be

encouraged.

13. Strict enforcement of the Child Marriage Restraint Act, 1976.

14. Strict enforcement of the Pre-Natal Diagnostic Act, 1994.

15. Soft loans to ensure mobility of the ANMs will be increased.

OPERATIONAL STRATEGIES

Village self help groups to organize and provide basic services for RCH care ,

combined with the on going ICDS scheme.

Implement at village levels, a one-stop integrated and coordinated service delivery

package for basic health care, family planning and MCH care.

Where ever these village self help groups have not developed, community midwives,

retired school teachers may be organized to perform similar functions.

At village level, the Anganwadi centre may become the pivot of basic health care

activities, contraceptive counseling and supply, nutrition education and

supplementation and pre school activities.

Establishment of a maternity hut in every village with equipments, supplies and

medicines for safe delivery.

Trained birth attendants and traditional dais should be made familiar with emergency

and referral procedures.

Provide wider basket of choices in contraception through innovative social

marketing schemes to reach household levels.

Improve district, sub-district and panchayat level health management.

Strengthen Community Health Centres (CHC) and Primary Health Centres to

provide comprehensive essential and emergency obstetric and neo-natal care.

Strengthening skills of health personnels through various training activities.

Focus attention on men to promote the small family norm.

Sensitize train and equip rural and urban health centres and hospitals towards

providing geriatric health care

 Family Planning Efforts

First five year plan

The first five year plan focus on family planning program. The draft of first five year plan said,”

the increasing population on natural resources retards economic progress and limits seriously the

rate of extension of social services, so essential to civilized existence. It is very essential to plan

population policy. The main components of this plan were mortality, fertility and migration. For

the planning and research Rs. 15 lakh were earmarked. The objective of this plan were-

1. To get the factor which cause fast increase of population

2. To understand human fertility and methods to regulate it.

3. To plan effective methods to educate people.

4. To create family planning counseling in hospitals and health centers.

Second five year plan

This five year plan gave more emphasis on population assessment having four main components.

1. To educate the people for using contraceptive.

2. To provide sterilization facilities on rural and urban health centers.

3. Training of personal

4. Research

Third, fourth and fifth plan

These plans also focus on implementation of population policy through family planning

programs. The expenditure on population control also increased as the increase of time. In

second, third and fifth plan the expenditure was Rs. 2.16 carores, Rs. 284 carores and Rs. 497

carore respectively. The prominent features of these plans were voluntary adoption of small

family. People were convinced to take up small family norm. Now family planning renovate as a

family welfare. The government provided various facilities to control population on health

centers on free of cost. These facilities were sterilization, IUCD conventional contraceptive

(Nirodh). These facilities played significant role in controlling population. Government provided

financial incentives to the couples who accept family planning. The government employs get

increment in their salaries if they accept family planning. To implement effectively these

programs medical personnel and health workers were trained.

Sixth to ninth five year plan

Now the government gave more emphasis on overall development not only pupuplation control.

The priority was given to social restructuring. Small family norm was continued on voluntary

basis. Awareness was increase through effective communication strategies including multimedia

and inter personal communication. Facilities were provided at doorstep as possible. Population

education were given to all youth students and non students. Area specific approach was

followed for states like West Bengal, Uttar Pradesh, Bihar and Madhay Pradesh. Close

monitoring of these program were ensured with state government to enhance the machinery and

accountability of workers at field level.

Tenth five year plan

To control the trend of population growth the tenth five year plan (2002-2007) gives a

comprehensive outline of efforts in three areas. The first objective was meeting the unmet needs

for contraception. The second focus area was to reduce maternal and infant mortality and third to

enable families to get their reproductive goals.

Projection: Population in India

If the present trend will be continuing, in coming future our population will touch the sky.

Population control is necessary for the economic and social development of country. The

expected projection of population is given below.

1. March 1991                   846.3 million

2. March 2001                   1012.4 million

3. March 2011                   1178.9 million

4. March 2016                  1263.5 million

 Issue and challenges

Socio economic status

The socio economic status of households plays a substantial role in the success of

programs. In our country illiteracy, poverty, poor access to information, gender disparity. In India

women do not have right to take decision on family planning and there is lack of involvement of

male person leads to poor results of family planning program.

Resources and inadequate knowledge and awareness

Most of the time people do not have access to services in lack of resources. Government

is not able to reach in remote areas and sometimes lack of efficient medical personnel is also a

very big challenge. Most of the time trained health personnel were not available and if available,

they do not have training to work efficiently to meet the demand of population. There was lack

of proper IEC support and proper management in rural and urban areas. The information given to

men and women about contraceptive was inadequate.

Access to quality health services

Both urban and rural area people face this problem. People of slum areas and remote village

people do not have access to services in lack of infrastructure, inefficient staff and adequate

knowledge. People do not have contraceptive choices for the family planning in the program. At

present this is a very big challenge for the government to provide quality health services to

people