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Annual Report 2013-14 Chapter 9 FAMILY PLANNING 9.1 INTRODUCTION achievement is estimated for each State by the indicators
  111  Annual Report 2013-14 9.1INTRODUCTION With its historic initiation in 1952, the family planningprogramme has undergone transformation in terms of policy and actual programme implementation. Thereoccurred a gradual shift from clinical approach to thereproductive child health approach and this holistic andtarget free approach helped in reduction of fertility.The target free approach is now reflected in the Stateproject implementation plans based on communityneeds assessment. Presently the expected level of  Chapter 9 FAMILY PLANNING achievement is estimated for each State by the indicatorsreflecting the community needs like contraceptive usage,parity, unmet need and existing fertility.Over the years, the programme has been expanded to reachevery nook and corner of the country and has penetratedinto PHCs and SCs in rural areas, Urban Family WelfareCenters and Postpartum Centers in the urban areas.Technological advances, improved quality and coveragefor health care have resulted in a rapid fall in the CrudeBirth Rate (CBR) and growth rate (2011 Census showedthe steepest decline in the decadal growth rate.)The objectives, strategies and activities of the FamilyPlanning division are designed and operated towardsachieving the family welfare goals and objectives statedin various policy documents (NPP: National PopulationPolicy 2000, NHP: National Health Policy 2002, andNRHM: National Rural Health Mission) and to honourthe commitments of the Government of India (includingICPD: International Conference on Population andDevelopment, MDG: Millennium Development Goals,Family Planning (FP) 2020 Summit and others). Population (in Crores)Decadal Growth Rate 3.02.9 2.425.825.425.024.824.123.823.523.122.822.522.121.821. 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012TFRCBR  112  Annual Report 2013-14 1.Current Scenario of Population and Family Planning in IndiaExpected increase of population of 15.7%  ● From 1210 million in 2011 to 1400 million in 2026. in fifteen yearsDecline in TFR  ● Helps to stabilize India's population growth which in turnspurs the economic and social progress Greater investments in family planning  ● Helps to mitigate the impact of high population growth byhelping women achieve desired family size and avoidunintended and mistimed pregnancies ● Reduce maternal mortality by 35% ● Reduce infant mortality and abortions significantly Govt. of India's commitment by 2015  ● Maternal Mortality Ratio (MMR) to 100/100,000 ● Infant Mortality Rate (IMR) to 30/1000 live births ● Total Fertility Rate (TFR) to 2.1 2.Factors that Influence Population GrowthUnmet need of Family Planning  ● 21.3% as per DLHS-III (2007-08) Age at Marriage and first childbirth  ● 22.1% of the girls get married below the age of 18 years ● Out of the total deliveries 5.6% are among teenagers i.e.15-19 years ● Marriages below legal age is more alarming in few States like,Bihar (46.2%), Rajasthan (41%), Jharkhand (36%), UP (33%),and MP (29.2%) Spacing between Births:  ● Spacing between two childbirths is less than the recommendedperiod of 3 years in 57.4% of births (SRS 2012) ● 46% of women have spacing less than 30 months 15-24 age group (women)  ● 52.5% contribution in total fertility ● 46% contribution in maternal mortality 3.Current Demographic Scenario in the Country (Census 2011)2.4% of world's land mass  ● 17.5% of the world's population 1.21 billion  ● India's population as per Census-2011 200 million  ● Population of Uttar Pradesh - more than the population of Brazil Census YearPopulation (in crores)Decadal Growth (%)Average AnnualExponential Growth (%) 197154.8224.802.20198168.3324.662.22199184.6423.872.162001102.8721.541.972011121.0217.641.64  113  Annual Report 2013-14 Perceptible decline (in last 5 decades)  ● Crude birth rate - 40.8 per 1000 in 1951 to 21.6 in 2012. ● Infant mortality rate - from 146 in 1951 to 42 in 2012. ● Total Fertility rate - from 6.0 in 1951 to 2.4 in 2011 (Ref:Appendix -I). ● Steepest decline in growth rate between 2001 and 2011 from21.54% to 17.64%. ● Decline in 0-6 population by 3.08% compared to 2001. Population added  ● Lesser than the previous decade, 18.14 crores added during2001-2011 compared to 18.23 crores during 1991-2011. Significant decline  ● There is a 4.1 percentage point fall from 24.99% in 2001 to20.92% in 2011 in the growth rate of population in the EAGStates (UP, Bihar, Jharkhand, MP, Chhattisgarh, Rajasthan,Odisha and Uttaranchal) after decades of stagnation. 4.Progress in TFRTFR decline  ● From 2.9 in 2005 to 2.4 in 2012. ● Decline more significant in High Focus States. TFR of 2.1 or less  ● 23 States and Union Territories TFR 2.1-3.0  ● 10 States- Haryana - 2.3, Gujarat-2.3, Arunachal Pradesh-2.3,Assam-2.4, Chhattisgarh-2.7, Jharkhand-2.8, Rajasthan-2.9,Madhya Pradesh-2.9, Meghalaya-2.9 and Dadara & NagarHaveli-2.9 TFR above 3.0  ● 2 States - Bihar-3.5, Uttar Pradesh-3.3  Note:  refer Appendix - I for details. Impact of High Focus Approach of the Government of India-  Government of India has categorized States asper the TFR level as very high-focus (more than or equal to 3.0), high-focus (more than 2.1 and less than 3.0)and non-high focus (less than or equal to 2.1) ●  Decline in TFR  ● All the very high focus States have shown a decline of 0.1 points CategoryStateSRS 2010SRS 2011SRS 2012Point Change Very High Focus States forBihar3.73.63.5-0.1Family PlanningUttar Pradesh3.53.43.3-0.1Madhya Pradesh3.23.12.9-0.1Rajasthan3.13.02.9-0.1Jharkhand3.02.92.8-0.1High Focus States forChhattisgarh2.82.72.7 0.0Family PlanningAssam2.52.42.4 0.0Gujarat2.52.42.3-0.1Haryana2.32.32.3-0.1Odisha2.32.22.1-0.1  114  Annual Report 2013-14 9.2FAMILY PLANNING SCENARIO (NHFS,DLHS AND AHS) The last survey figures available are from NFHS-3(2005-06) and DLHS-3 (2007-08), which are beingused for describing current family planning situation inIndia. Nationwide, the small family norm is widelyaccepted (the wanted fertility rate for India as a wholeis 1.9 (NFHS-3) and the general awareness of contraception is almost universal (98% among womenand 98.6% among men: NFHS-3). Both NFHS andDLHS surveys showed that contraceptive use is generallyrising (see adjoining figure). Contraceptive use amongmarried women (aged 15-49 years) was 56.3% inNFHS-3 (an increase of 8.1 percentage points fromNFHS-2) while corresponding increase betweenDLHS-2 & 3 is relatively lesser (from 52.5% to 54.0%).The proximate determinants of fertility like, age atmarriage and age at first childbirth (which are societalpreferences) are also showing good improvement at thenational level. The adjoining figure indicates the currentposition of social determinants of fertility in the country.AHS survey has been conducted in 9 States (8 EAGStates + Assam) which indicates that: ● All the States except Uttarakhand has shown anincrease in use of modern contraceptives. 9.3CURRENT FAMILY PLANNINGEFFORTS Family planning have undergone a paradigm shift andemerged as one of the interventions to reduce maternaland infant mortalities and morbidities. It iswell-established that the States with high contraceptiveprevalence rate have lower maternal and infantmortalities.Greater investments in family planning can thus helpmitigate the impact of high population growth byhelping women achieve desired family size and avoidunintended and mistimed pregnancies. Further,contraceptive use can prevent recourse to inducedabortion and eliminate most of these deaths. Studiesshow that if the current unmet need for family planningcould be fulfilled over the next 5 years, we can avert35,000 maternal deaths, 1.2 million infant death, savemore than Rs. 4450 crores and save Rs. 6500 crores,if safe abortion services are coupled with increasedfamily planning services. This strategic direction is theguiding principle in implementation of family planningprogramme in future. 9.3.1Contraceptive services under the NationalFamily Welfare programme The methods available currently in India may be broadlydivided into two categories, spacing methods andpermanent methods. There is another method (emergencycontraceptive pill) to be used in cases of emergency. 9.3.1.aSpacing Methods-  These are the reversiblemethods of contraception to be used by couples whowish to have children in future. These include: A.Oral contraceptive pills ● These are hormonal pills which have to be takenby a woman, preferably at a fixed time, daily. Thestrip also contains additional placebo/iron pills tobe consumed during the hormonal pill free days.The method may be used by majority of womenafter screening by a trained provider.        4        8  .        2       4        2  .        8       5  .       4       5       1  .        8       5        6  .        3       4        8  .       5       7  .        8 4        3  .       7       5        2  .       5       4       5  .        2       7  .        2       4       7  .       5       5       4  .        0       4       7  .       1        6  .       7       4        6  .        0 0204060(%)NFHS-2(1998-99) NFHS-3(2005-06)DLHS-2(2002-04) DLHS-3(2007-08) Trends in Contraceptive Method Use:India Any method Any modern Any Traditional Not using anymethod method method Fig 5Age at Marriage &Age at First Birth: India 2005-06 By age 15By age 18By age 20 % 20-49 year women reporting marriage Source: NFHS-3 % of 25-49 year women reporting first birth
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