Wikipedia:SWASTHA/India Family planning

Family Planning in India

Introduction

Family planning is the practice of controlling the number of children one has and the intervals between their births, particularly by means of contraception or voluntary sterilization. [1] There are many services of family planning as listed below;


 * Contraceptive services
 * Pregnancy testing and counseling
 * Pregnancy–achieving services    including preconception health services
 * Basic infertility services
 * Sexually transmitted disease    services
 * Broader reproductive health    services, including patient education and counseling
 * Breast and pelvic examinations
 * Breast and cervical cancer    screening
 * Sexually transmitted infection    (STI) and human immunodeficiency virus (HIV) prevention education,     counseling, testing, and referral. [3]

Some of the key facts about family planning include;


 * 214 million women of reproductive    age in developing countries who want to avoid pregnancy are not using a     modern contraceptive method.
 * Some family planning methods, such    as condoms, help prevent the transmission of HIV and other sexually     transmitted infections. [6]
 * Family planning / contraception    reduces the need for abortion, especially unsafe abortion.
 * Family planning reinforces    people’s rights to determine the number and spacing of their children.
 * By preventing unintended    pregnancy, family planning /contraception prevents deaths of mothers and     children.

Family Planning in India

Family planning in India is based on efforts largely sponsored by the Indian government. From 1965–2009, contraceptive usage has more than tripled (from 13% of married women in 1970 to 48% in 2009) and the fertility rate has more than halved (from 5.7 in 1966 to 2.4 in 2012). However, the national fertility rate remains high, causing concern for long-term population growth. India adds up to 1,000,000 people to its population every 20 days.[1] Extensive family planning has become a priority in an effort to manage the projected population of two billion by the end of the twenty-first century. [2]

In 2015, the total fertility rate of India was 2.40 births per women and 15.6 million abortions performed, with an abortion rate of 47.0 abortions per 1000 women aged between 15–49 years. [3] With high abortions rates follows a high number of unintended pregnancies, with a rate of 70.1 unintended pregnancies per 1000 women aged 15 to 49 years.[3] Overall, the abortions occurring in India make up for one third of pregnancies and out of all pregnancies occurring, almost half were not planned.[4]

History of Family Planning Programs in India

In 1951, India created its first state-sponsored family planning program, the National Family Planning Program. [5] The program's primary objectives were to lower fertility rates and slow population growth as a means to propel economic development. [4] The program was based on five guiding principles:

1.    The community must be prepared to feel the need for the services in order that, when provided, these may be accepted

2.    Parents alone must decide the number of children they want and their obligations towards them

3.    People should be approached through the media they respect and their recognized and trusted leaders and without off-ending their religious and moral values and susceptibilities

4.    Services should be made available to the people as near to their doorsteps as possible

5.    Services have greater relevance and effectiveness if made an integral part of medical and public health services and especially of maternal and child health programs [5]

Over the course of the program, family planning in India resulted in a 19.9% decrease in birth rate where it has since stagnated at 35 births per 1000 persons. [5]

Family Planning Program in India

The Ministry of Health and Family Welfare is the government unit responsible for formulating and executing family planning in India. The objectives of the program are positioned towards achieving the goals stated in several policy documents. [6] While India is improving in fertility rates, there are still areas of India that maintain much higher fertility rates. [7] In 2017, Ministry of Health and Family Welfare launched Mission Pariwar Vikas, a central family planning initiative. The key strategic focus of this initiative is on improving access to contraceptives through delivering assured services, ensuring commodity security and accelerating access to high quality family planning services. Its overall goal is to reduce India's overall fertility rate to 2.1 by the year 2025. [7] Along with that two contraceptive pills, MPA (Medroxyprogesterone acetate) under Antara program and Chaya (earlier marketed as Saheli) will be made freely available to all government hospitals. [8]undefined

The Government of India’s goal is to expand availability and provide modern contraception to an additional 43 million women (36% of the global FP2020 goal) by 2020. Additionally, India has committed to the inclusion of family planning as a central element in its efforts to achieve universal health coverage, with a financial commitment of 2 billion USD for family planning during the years 2012-2020, and sustained coverage of 100 million women currently using contraceptives. India has also increased its condom supply to citizens.

Two Child Policy as a Family Planning Strategy in India

Multiple Indian states have adopted a limited two-child policy. The policies are implemented by prohibiting persons with more than two children from serving in government. [9] The most recent policy to be implemented was by Assam in 2017. [9] Some states have repealed policies; Chhattisgarh introduced a policy in 2001 and repealed it in 2005. [9] As of 2014, there were 11 Indian states that implemented the two-child policy, in hopes to reduce the number of children per family.[9] The policy was geared mainly towards politicians, future and aspiring, to limit their number of children to two or less. Those who held politicians have stricter policies in hopes that they will set an example for the community, if one were to exceed the limit of two children while employed, they would be terminated from the job. [9] Non-politicians may also receive consequences to exceed the two-child limit, the government begins to withhold health care, government rights, face jail and, fees.

India’s Modern Initiatives in Reproductive Health

Progress on reproductive health and family planning has been limited. As of 2016, India's infant mortality rate was 34.6 per 1000 livebirths, and as of 2015, maternal mortality was at 174 per 100,000 livebirths. [10] Leading causes of maternal mortality include hemorrhage, sepsis, complications of abortion, and hypertensive disorders, and infection, premature birth, birth asphyxia, pneumonia, and diarrhea for infants.[10] In 2005, the Government of India established the National Rural Health Mission (NRHM) in effort to address some of these issues amongst others. The objective of the NRHM includes the provision of effective healthcare to rural areas, especially to poor and vulnerable populations. Through the NRHM, special provisions have been made to address concerns for reproductive health, especially for adolescents who are more likely to participate in risky sexual behaviors and less likely to visit health facilities than adults. Ultimately, the NRHM aims to push India towards the Millennium Development Goal targets for reproductive health. [10]

References

1.    Rabindra Nath Pati (2003). Socio-cultural dimensions of reproductive child health. APH Publishing. p. 51. ISBN 978-81-7648-510-4.

2.    Marian Rengel (2000), Encyclopedia of birth control, Greenwood Publishing Group, ISBN 978-1-57356-255-3, "... In 1997, 36% of married women used modern contraceptives; in 1970, only 13% of married women had ..."

3.    India and Family Planning: An Overview (PDF), Department of Family and Community Health, World Health Organization, archived from the original (PDF) on 21 December 2009, retrieved 08 January 2020

4.    G.N. Ramu (2006), Brothers and sisters in India: a study of urban adult siblings, University of Toronto Press, ISBN 978-0-8020-9077-5

5.    Arjun Adlakha (April 1997), Population Trends: India (PDF), U.S. Department of Commerce, Economics and Statistics Administration, Bureau of the Census, archived from the original (PDF) on 08 January 2020

6.    "Population growth (annual %) | Data". data.worldbank.org. Retrieved 28 March 2018.

7.    Singh, Susheela; Shekhar, Chander; Acharya, Rajib; Moore, Ann M; Stillman, Melissa; Pradhan, Manas R; Frost, Jennifer J; Sahoo, Harihar; Alagarajan, Manoj (2018). "The incidence of abortion and unintended pregnancy in India, 2015". The Lancet Global Health. 6 (1): e111–e120. doi:10.1016/S2214-109X(17)30453-9. ISSN 2214-109X. PMC 5953198. PMID 29241602.

8.    Singh, Susheela; Shekhar, Chander; Acharya, Rajib; Moore, Ann M; Stillman, Melissa; Pradhan, Manas R; Frost, Jennifer J; Sahoo, Harihar; Alagarajan, Manoj (2018). "The incidence of abortion and unintended pregnancy in India, 2015". The Lancet Global Health. 6 (1): e111–e120. doi:10.1016/S2214-109X(17)30453-9. ISSN 2214-109X. PMC 5953198. PMID 29241602.

9.    "Trends in Demographic Transition in India - General Knowledge Today". www.gktoday.in. Archived from the original on 08 January 2020.

10.  Rao, Mohan(2004) from population control to reproductive health, Sage publications, ISBN 0-7619-3269-0