The National Commission on Population (NCP) convened a conference of State Population Commissions/Councils on 25th September 2002 in New Delhi under the Chairmanship of Shri K.C.Pant, Deputy Chairman, Planning Commission and Vice Chairman, NCP, in view of the scope for sharing of experience, strategies, successful models and discussing problems being encountered in implementing population policies. The conference was attended by the State Health & Family Welfare Ministers who are also generally the Vice Chairpersons of the State Population Commissions. The theme of the Conference included:-

• review of demographic scenario at National and State level
• making population stabilization a peoples' programme
• measures to promote population stabilization.

The proceedings started with observance of silence in memory of the victims of the terrorist attack at the Swami Narayan temple complex at Ahmedabad, Gujarat.

Welcoming the participants Smt. Krishna Singh, Member Secretary, NCP stated that as in the case of the NCP the State Population Commissions also have a wide mandate for overseeing the ongoing programmes relating to population stabilization for promoting synergy between programmes in sectors like Health, Family Welfare, Education etc. The NCP had mapped all the districts of the country on the basis of 12 key socio demographic indicators and have moved forward with the idea of getting district action plans prepared by several district magistrates, placing population as the central concern. In order to help the most backward districts to improve their infrastructure, the Vice Chairman NCP in his capacity as Deputy Chairman, Planning Commission had allocated additional central assistance during the last two years to benefit about 67 districts. However, for making the population stabilization programme a success, the support , cooperation and involvement of the Panchayati Raj Institutions, the NGOs, the Private Sector, Youth Organizations, Self Help Groups and the Community at large is necessary. She hoped that it would be possible through the framework of State Population Commissions to network with all the relevant stakeholders and agencies. At the National level the establishment of such a consortium would be of great importance for carrying forward the national task of achieving early population stabilization in the country.

Dr. Asim Kumar Das Gupta, Finance Minster, Vice Chairman, State Planning Board and Vice Chairman, State Population Commission, West Bengal appreciated the initiative taken by the NCP to convene this Conference of State Population Commissions. He was of the view that it would not be a correct approach to take a view that development alone would take care of the population problem. The critical issues in the formulation and implementation of the population policies were: (a) clear statement of objectives of population policy, (b) setting up of targets at the national and the state levels (and below) consistent with these objectives and (c) organizational matters for implementation of these targets. Whereas the main objective of the country was to achieve stabilization of population within a definite time frame, importance must be given to the quality of life with emphasis on reduction in infant mortality rate, maternal mortality rate, attainment of universal immunization of children, prevention and control of communicable diseases, universalisation of elementary education etc. Since these objectives are interrelated, and common people are the real beneficiaries, there is an essential need for convergence of these various programmes as well as involvement of common people in formulation as well as implementation of the schemes under these programmes. He stated that West Bengal was placed favourably as compared to the national average in demographic parameters like TFR, IMR and MMR. On the basis of the progress of Family Welfare Programmes in the State, by the end of the 10th Five Year Plan i.e. 2007, it may be possible to reach TFR 2, birth rate of 18 and IMR of 30 and these targets have been placed for consideration before the State Population Commission. In the case of MMR, the objective was to reach 100 maternal deaths in 1 lakh live births by 2010. Along with these specific targets, the State was also keen to follow the other targets and goals enunciated in the National Population Policy. The approach indicated for reaching the State level targets was one of decentralization. Targets were fixed at district, block and municipality with emphasis on the disadvantaged areas and districts. It was further emphasized that to achieve overall efficiency, cost effectiveness in the formulation and implementation of the State level objectives and targets, there would be an attempt to (a) ensure convergence of all the relevant schemes under health and family welfare, (b) interrelate the programme of health and family welfare with programmes of education and employment generation and (c) involve the common local people through the elected Panchayats and Municipalities. The NGOs could also play an important role in these programmes, in a coordinated manner with effective linkages through the Panchayats and Municipalities.

Discussing the organizational issues, Dr. Das Gupta referred to the innovative child education centres set up under the supervision of Panchayat samithis and the direct management of the village education committees. The teachers for these child education centres had been recruited on the basis of accountability and the performance of these centres in terms of accountability and cost effectiveness were reported to be note worthy. He also referred to the innovative health project launched in the municipalities around Kolkata where the main emphasis had been laid on all the preventive aspects of health care and coordination with the curative health care in hospitals run by the municipalities. All aspects of family welfare programmes had been made an integral part of this total health care approach. The doctors and the staff were appointed on the basis of social contract whose renewal depended on the performance and accountability to people. At the grass root level, there are lady health workers for every 200 families, and they were connected through supervisors to the doctors at the level of hospitals. The lady health workers are recruited from the locality, doctors and other staff are appointed on the basis of social contract. Renewal was made on the basis of performance and open accountability to people. This initiative based on accountability and cross subsidization had been extremely cost effective and had made a visible impact on birth rate, IMR, MMR and immunization coverage. This model was also replicable for the rural areas. For every 200 families in a village, health workers could be appointed. The management of block primary health centres and sub-centres could be given to the Panchayats. Dr. Das Gupta felt that there should be flow of funds from the national level to the implementing agencies through the State Governments. Periodic interaction between the NCP and State Population Commissions would also be very useful.

Girls in the age group of 13 to 21 years are registered and inducted in the scheme. The following incentives are made under the scheme :

Dr. Joginder Singh, Director, Health Services and Family Welfare, and Member Secretary, State Population Commission, Punjab appreciated that the NCP had convened this first Conference of State Population Commissions which would give an opportunity for indepth study of the issues involved and for knowing what other States were doing for achieving population stabilization. He stated that in the case of Punjab most of the parameters were better as compared to the national average. However, as the sex ratio especially in the case of 0-6 population was a matter of concern and the State Government had already taken strict remedial measures and they were confidant that by the next census the State would improve the sex ratio. As per SRS estimates, the TFR in Punjab in 1998 was 2.6. The Chief Minister and the Health Minister had directed that the performance of doctors and the paramedics at the village level would be closely monitored and the implementation of the Family Welfare programmes was going on very well in the State. As the couple proection rate stood at 60, sterilisation had exceeded one lakh level during the past three years and IUD insertions and other measures remained about 90% of the target. On a querry from the Vice Chairman (NCP), the Punjab representative stated that the State would reach TFR of 2.1 by 2010. Under the EPI programmes immunization had reached almost 100 % in most cases.

Shri S. Semmalai, Hon'ble Minister for Health, Tamil Nadu expressed his happiness that the NCP had convened this Conference at an appropriate time when most of the States were on the threshold of finalizing their population policies. The Tamil Nadu Population Policy was nearing tinalization and would be released shortly. The Hon'ble Chief Minister Dr. Puratchi Thalaivi has directed that the focus of the population policy should be: (a) meeting the unmet need for Family Welfare, (b) ensuring survival of children in general and new born in particular, (c) reducing the momentum of population growth, (d) integrating population programme with other developmental activities, (e) promoting community health activism and (f) empowering women in all spheres. For this purpose, the strategies included strengthening infrastructure through optimal utilization of operation theatres and hospitals, promoting private participation in the form of approving nursing homes for Family Welfare services and utilizing the services of ICDS and Self-Help Groups. Though there was a general tendency on the part of people to have a small family the desire for a male child and its consequences on the demographic scenario needed to be addressed through sustained IEC activities. The State Population Policy also intended to address the wider issues for bringing a real convergence of the various services and integrating them for attaining a stable population. Promoting Community Health activism at base level and ensuring involvement of elected representatives through decentralization of the Family Welfare activities would be given prime place in Tamil Nadu policy initiative. However, unless participatory approach was ensured through the formulation of district / panchayat level committees letting women have a decisive role in the State Population Policy thorugh empowerment, activating village self help groups, mobilizing public opinion in favour of gender equality, encouraging women in the reproductive age group to motivate husbands to adopt family planning practices, the Family Welfare programme would not succeed.

Mrs. Girija Vaidyanathan, Secretary Health and Family Welfare made a detailed presentation on the progress made by Tamil Nadu in implementing Family Welfare programmes and the different stages through which the policy evolved over the years. The earlier strategies based on targets involved various Departments and included incentives for motivators. This phase of the programme gave emphasis on camp approach, high participation by males and intensive monitoring. Later on the target free approach implemented only by the Health Department and was based on voluntary acceptance. This phase had been categorized by increased awareness and public demand and provision of services, poor monitoring and follow up services and a general sense of complacency among service providers. It had also resulted in negligible male participation, continued focus on tubectomy and inadequate attention to spacing methods. She indicated the following aspects as important elements of the future strategy:

Dr. Dinesh Kumar Sarangi, Hon'ble Minister for Health and Family Welfare, Government of Jharkhand made a detailed presentation about the demographic situation in the State and the measures being taken by the State Government for improving the health and Family Welfare facilities with a view to achieving population stabilization. Jharkhand is demographically backward as could be observed from the data on selected indicators given below:

The State had also been suffering from a serious shortfall of personnel such as doctors, lab technicians, nurses, pharmacists, multipurpose workers, etc. The contraceptive prevalence rate in the State was very low. As a significant proportion of currently married women had a desire to use modern family planning methods, meeting the unmet needs for contraception could go a long way to bring down the birth rates. The major problems faced by the State were low age marriage of girls, high proportion of 3 + births, low coverage of ante-natal care and high proportion of home deliveries, leading to high Infant Mortality Rate. He referred to the many initiatives taken by the State Government and the Constitution of the Jharkhand Population Commission under the Chief Minister. The objective of the State Population programme is to reach the replacement level fertility by 2010 and population stabilization by 2045. Other measures adopted by the State were to increase per capita allocation for health, upgradation of 14 hospitals at district level, establishment of five diagnostic centres and five trauma centres along National Highway, development of Ranchi Medical College into a super speciality hospital, upgradation of facilities at three medical colleges and improving the facilities in hospitals at various levels. The special measures initiated under the RCH programme were as below:

The Minister stated that Jharkhand also faced the problem of extinction of some tribal groups unless urgent measures were taken to save them. The State Government had identified seven such tribes and initiatives have been taken to bring them to the mainstream and to encourage them to increase their population. The government had also initiated innovative strategies to reach remote and inaccessible areas by introducing mobile clinics to serve the people in areas not having any health infrastructure.

Shri P. Shankaran, Hon'ble Minister for Health and Family Welfare, Govt. of Kerala stated that Kerala had achieved remarkable progress in bringing about population stabilization mainly due to the high level of literacy in the State. The prospects for population stabilization in a society depended on three critical factors, namely, the survival chances of new-borns, maternal health and reduction in birth rates. On all these fronts, Kerala had performed well. The IMR in the State is 13 and child mortality rate is 3. Though fertility decline still continued with TFR level at 1.96, a somewhat higher level TFR of 2.46 was found among Muslim population of the State. The median age of marriage for women was 20 years and for child birth was 22 years. 64% of married women were currently using some methods of contraception and the couple protection rate was estimated to be 64% (with Female sterilization accounting for 76%o of total contraceptive use). In Kerala more than 90%o pregnant women received one anti-natal check up and 85%o, 3 anti-natal check-ups, 95%o of the pregnant women receive iron and folic acid supplementation. 99%o of the deliveries were institutional.

The implementation of a Baby Friendly Hospital Initiative during the last decade had contributed to a substantial reduction in IMR and the control of infant diseases. 90% of the maternity hospitals promoted the norms laid down by UNICEF in breast-feeding procedures. Though 80% of the children aged 12 to 23 months were fully vaccinated against T.B., Diphtheria, Pertusis, tetanus, polio and measles, dropouts for series of DTP and polio vaccination continued to be of a concern. Similar was the case in so far as child nutrition was concerned as more than 44%o of the children aged 6 to 35 months are still anaemic. The Panchayati Raj Institutions had an important role in all development programmes including population stabilization with the village Panchayat being the grass-root unit of administration fully responsible for the registration of births, deaths and marriages, disbursement of cash awards under maternity benefit scheme, for institutional deliveries by the trained attendants and antenatal check-ups opening creches etc. The village Panchayat was responsible for identifying persons to be trained for the purpose and to maintain a list of eligible couples and beneficiaries of various schemes.

The Gram Sabhas comprising all registered voters of the area also helped in selecting the correct beneficiaries under the Family Welfare programmes. The Minister also stated that the State Population Policy was under formulation and a State Population Commission was to be set up soon with a view to consolidate the gains achieved by the State on the demographic front. He also drew the attention of the Deputy Chairman, Planning Commission and the Hon'ble Union Minister for Health and Family Welfare regarding the transfer of postpartum centres and the rural health and family training centres to the States involving additional expenditure burden on the States.

Shri Bala Bachchan, Hon'ble Minister, Health and Family Welfare, Government of Madhya Pradesh stated that as a matter of commitment to population stabilization the Madhya Pradesh Government has constituted the State Population Development Council under the chairmanship of the Chief Minister. In addition a State Population Policy Implementation Committee has been constituted under the chairmanship of the Chief Secretary. The Madhya Pradesh Population Policy had also been formulated. District Health Committees have been constituted to implement the population policy. The promotion of gender equity and empowerment of women for enabling them to control their own fertility were the cornerstones of the population and development programmes in the State. In order to offer broader ranged services, the community structures in the form of Village Health Committees had been created and a new scheme of Jan Swasthja Dakshak (Community Health Volunteer) introduced. These volunteers were matriculates belonging to the same village and trained in primary health care for six months and placed with the community to provide services as a health volunteer.

Further the government had also decided to train at least one trained birth attendant in every village by the end of this year and the village community structure was to have referral linkages to provide specialized health care in emergency situations. Self-Help Groups had been created in rural areas and Mahila Swasthja Sangh acted as the Women's Forum for discussing reproductive and child health issues and improvements of service delivery through linkages through health volunteers and Anganwadi Workers. As part of the implementation of Panchayati Raj system, Village Health Committees had been constituted and empowered by Gram Sabha to take local decisions regarding registration of birth and death, safe motherhood interventions, immunization, family planning and nutrition of pregnant mothers and children under six years. To facilitate a more holistic approach for total human development all inter sectoral Departments like Women & Child Development, Education, Social Welfare, Tribal Welfare and non-governmental organizations had been given a major role to play. He also stated that the State Government was taking action to fill up the human resource deficiencies in SHCs and improve the SHC infrastructure by construction of 200 SHCs buildings. For close targeting of eligible couples, pregnant mothers and infants, the camp approach was being adopted where the Health Worker is ensured 100% registration of beneficiaries, family cards in 20% SHCsHQ villagers, identification of missed out mothers and children for immunization and check up and counseling them for family planning methods. The high risk cases were identified and referred to RCH Camp at PHC level for specialized care.

Smt. Aruna Sharma, Secretary and Commissioner, Family Welfare, Government of Madhya Pradesh made a presentation about the demographic scenario in the State and explained the various elements of the population stabilization programme in the State. These included close targeting, VHC as active role players, each village to have trained Jan Swasthya Dakshak and TEA, AWW to work as Secretary of VHC, reward for best VHC based on parameters and involvement of SHGs, PRIs and NGOs. The major problem areas were meeting the unmet needs, underage marriages and low age child bearing, prevalence of strong son preference, ensuring safe delivery for the mother, anemia among pregnant women and immunization of women and infants. The major demographic objectives of the State Population Policy - 2000 were to bring down TFR to 2.1 by 2010 and to reduce IMR to 62/thousand live births and MMR to 220/ lakh live births. Under the modified RCH Camp programme, in the first phase 20%o (10,000) villages were to be covered for close targeting and intensive activity and child health, maternal health and other RCH services will be provided to all the beneficiaries. Functional integration of ISM practitioners for RCH interventions, establishment of male clinics in district hospitals for NSVT promotion, convergence of social sector programmes and focused IEC activities and MIS on web upto the SHC were other initiatives under implementation.

Dr. Shakil Ahmed, Hon'ble Minister Family Welfare and Medical Education, Government of Bihar stated that the backward states should be given special assistance from the Central Government for undertaking population stabilization programmes. The family planning programme which was derailed in 1977 had not so far come back on the rails. It was true that there was a renewed realization that population control was important for the development of the nation. The population growth rate in Bihar during the last decade had exceeded the national average. This could largely be attributed to the weak infrastructural facilities in the State as also the fact that the PHC and Sub-Centre level institutions functioning had deteriorated.

The project sanctioning system under the Empowered Committee sanctioned projects only in the last week of March as a result of which no progress could be made. However, the State Government had initiated remedial measures and had also set up the State Population Commission under the chairmanship of the Chief Minister with members representing different sections of the society. Though the Panchayat elections were held in Bihar after long delay, the elected Panchayat representatives had been made Chairmen of 37 District Boards and were also members of the State Population Commission. The State Government had given powers to these representatives to check the attendance of doctors and health workers and report to the Panchayat Samities.

The Minister also agreed with the views expressed by Kerala that with the sudden transfer of postpartum and rural family planning training centres to the States, no budgetary provision could be made by the State as the communication was received at the fag end of the financial year. As these setups are needed by the State, the uncertainty created regarding the personnel working for the last 12 to 15 years was not good. Regarding family planning he stated that the people should be mentally prepared for availing of family welfare measures and incentives should be given to those who are doing so. As people were generally shy to use contraceptives, the State Government had requested the Central Government for installation of 5,000 contraceptive vending machines in public places like toilets, cinema houses, bus stands, railway stations etc., where men and women could get contraceptives without any hesitation. However, no cooperation in this regard has forth come from the Central Government.

Another area was non availability of anaesthetists. The State Government had also requested the Union Health Minister to arrange short-term training programmes for doctors in anaesthesia but no action has so far been taken. The Hon'ble Minister also stated that selection of districts for implementing special programmes should be done on the basis of objective criteria rather than political considerations. In this connection, he referred to the categorization of 37 districts by the NCP on the basis of many yardsticks. The allocation of funds by the Central Government should be done to the backward States without any political discrimination. The demographic goals of Bihar as presented by the State Government is given below:

Shri K. Siva Prasada Rao, Hon'ble Minister for Health and Family Welfare, Govt. of Andhra Pradesh stated that Andhra Pradesh had adopted the State Population Policy as early as 1997 marking the beginning of an intensive effort to stabilize population. Ambitious goals were set on the basis of a pro-women and children RCH approach with focus on making available client driven services widely. The entire State machinery starting from the Chief Minister to the Sarpanch and all political parties were involved in the programme to generate a peoples' movement to promote the small family norm. In spite of the ban on all recruitments, Government continued to fill up vacancies of doctors and paramedical staff. New buildings were constructed for PHCs and supply of drugs and consumables streamlined and most of the PHCs became centres for all family planning services including sterilization operations. A large number of doctors had been trained in the new techniques of family planning operations.

The Arogyaraksha Scheme providing insurance for a period of five years from the time of the operation for the family planning acceptor and his or her two children had been introduced. Presently, the focus was on increasing the age of marriage, promoting spacing methods, institutional deliveries and immunization as also a campaign on the issue of increasing the age of marriage. The PHCs in rural, interior and backward areas were designated as round-the-clock women health centres, maternal and child care services are provided round the clock in these institutions.

The Sukhibhava Scheme to support poor women, opting for institutional deliveries had been introduced under which women below poverty line and residing in rural areas were paid Rs. 300 towards transport charges if they have delivery in Government institutions. Because of these measures the number of institutional deliveries had increased from 49% to 65% during the last four years. To strengthen the immunization programme, the skills of the ANM had been upgraded and she had been provided additional drugs as also given support from the Sarpanch and Self-Help Groups in the form of mother and child health care teams at the village level. Some of the ANMs were provided with mopeds and palmtops for data storage and retrieval.

The provision of spacing contraceptive was being done through an active social marketing programme. About 1.5 lakh Self-Help Groups members had been trained on spacing methods, 16,000 depots established and about 50 franchise clinics opened for providing these services. After having achieved a drastic fall in fertility during the last decade, Andhra Pradesh was now working towards improving the overall health and well-being of the families in the State.

Mrs. Nilam Sawhney, Commissioner, Health and Family Welfare, Govt. of Andhra Pradesh made a presentation highlighting the different aspects of the population stabilization programme in the State. A short audio-video presentation was also shown giving the reactions of the Chief Minister, the various functionaries and beneficiaries of the family planning programme in Andhra Pradesh. The key elements of the success behind the population stabilization programme were:

Dr. Tangor Tapak, Hon'ble Minister of State, Health and Family Welfare, Govt. of Arunachal Pradesh stated that during the last 40 years the population of Arunachal Pradesh had increased 3.26 rimes. The decadal growth and the annual exponential growth of the State had always been higher than the national average. Though the sex ratio as per 2001 census was 894, the sex ratio of the indigenous tribal population remained above parity showing that there was no discrimination against the girl child in the tribal communities. Some of the demographic indicators of Arunachal Pradesh were:

Though the population size of the State was small compared to the land area, there was a need for a vigorous population stabilization effort in the State especially as the actual per capita availability of usable land for agricultural purpose was limited. The issue of preserving the forest and bio-diversity of Arunachal Pradesh was critical not only for the people of Arunachal Pradesh itself but also for the neighbouring States, particularly those situated down below. Historically and traditionally the lifestyle of hill tribes was forest-based. Because of increasing population pressure the State of Arunachal Pradesh and its neighbouring States were suffering from recurrent floods, soil erosion, siltation of waterways and inundation of agricultural land. All these are due to massive deforestation occurring in the State which in turn is due to increase in population. Even though the population size of the State was small compared to the land area, the per-capita availability of usable land for agricultural purpose was limited and there was a need for preserving the forest and bio-diversity of Arunachal Pradesh in the national interest as also in State interest. Though historically and traditionally life-style of the hill tribes has been forest based, but due to increasing population pressure, deforestation, recurrent floods, soil erosion, siltation of waterways and inundation of agricultural land there is severe stress on the economy. Even though there was plenty of rain, rivers and streams were showing signs of water shortages and several water supply projects and micro hydel plants were on the verge of abandonment due to the drying up of catchment areas. Population being a major matter of concern, the State Government had constituted State Population Commission under the Chairmanship of the Chief Minister and a State Population Policy was being drawn up shortly. The Commission is a broad based body involving all the development sectors of governance.

There had been remarkable progress in the health indicators of the people after the starting of the national Family Welfare programme in the State in 1975-76. However, in order to achieve the goals of the National Population Policy within the given timeframe, there was a need to strengthen the Health and Family Welfare infrastructure in the State. Most of the interior areas of the State were yet to be properly served by Family Welfare services and many villages were yet to receive primary health care network as they are located in very inaccessible hilly areas. The cost of providing the services was very high in the remote regions and there was a need to relax the funding norms by the Central Government for States like Arunachal Pradesh. There was also a need for special programmes to take Family Welfare services to rural areas where the fertility was very high. The Minister also suggested that the PRIs, NGOs, Self-Help Groups etc should be involved in the population stabilization programme and there should be proper funding from the Central Government and decentralization of the funding system.

Shri Digvijay Khanvilkare, Hon'ble Minister for Public Health, Family Welfare and Education, Govt. of Maharashtra stated that the State Population Policy had been formulated in March, 2000. In order to demonstrate the total commitment towards population stabilization, the State had taken a conscious decision of enforcing the two child norm for all politicians right from the Panchayat, Zilla Parishad level, a measure that gave the right kind of message to the masses.

The Government had created a conducive environment to work towards population stabilization by making all the State Government Departments join hands to produce positive results. A sum of Rs. 7.5 crores had been sanctioned by the State Government for improving the health infrastructure including providing facilities in hospitals in the rural areas. Special needs of the urban slums, the rural and tribal pockets needed to be specially addressed. In many of the tribal areas, 45 % of the girls were being married below the legal age.

The District Magistrates had been advised to work in collaboration with NGO's with the objective of achieving the goal of population stabilization and a special campaign is being launched with around 3000 sonographers for booking people for illegal female foeticide practices at the village, district and State level.Concrete steps had been taken to promote girl child education by opening schools in rural areas and measures were being taken to reduce drop out rate in schools (presently 75 % ). The State Government proposed to bring down the present TFR level of 2.5 to 2.1 by 2004.

Shri G.C. Chaturvedi, Secretary, Health and Family Welfare, Government of Uttar Pradesh stated that the population growth in U.P. had been rapid after 1971. Most of the demographic indicators of U.P. were poor as compared to the national average :

The State Population Policy was formulated in July, 2000. According to this Policy, the population replacement level TFR 2.1 was to be reached by 2016. U.P. did not have individual incentives for promoting the small family norm. There was only one disincentive, i.e., those who marry before reaching the legal age of marriage were not eligible for government jobs. Though strong disincentives were advocated during the various meetings of the State Population Stabilization Committee, these proposals were not implemented because they went against the State and National Policies. The State Population and Development Commission had been constituted under the chairmanship of the Chief Minister. There was also a Population Stabilization Committee under the chairmanship of the Chief Secretary. Other highlights of the State Population Policy were decentralized planning and implementation, involvement of Panchayari Raj Institutions, public and private partnership, women empowerment, increased female literacy and inter-sectoral and inter-departmental coordination. The Population Stabilization Committee had suggested the following initiatives :

Shri R.S. Ronghang, Hon'ble Minister for Health, Government of Assam stated that as Assam had several problems like poverty, mal-nutrition, lack of education, etc. the infant mortality rate and maternal mortality rate were comparatively higher in the State. The State is ill-equipped in medical facilities like hospitals, paramedical facilities, availability of medicines and other health equipments and the stress felt is aggravated on account of the hilly topography of the State. Due to lack of awareness, IEC and poor coordination between the departments, the State Government has had to formulate a plan of action for improving the birth and death registration in the State which is only 24 % and 15 % respectively. As in other States ,the State Population Council has been set up under the Chief Minister and hopes to achieve the target of TFR of 2.1 by 2010. It was stated that as Assam is a backward State it requires funds and patronage from the Central Government to help to reach the desired goal.

Dr. B.S. Dahiya, Director, Health Services, Haryana stated that the Haryana State Commission on Population had been constituted on 14th July, 2000 under the chairmanship of the Hon'ble Chief Minister with more or less the same terms of reference as those of the NCR The first meeting of the Commission held on 15.4.2002 decided that the focus should be given on the following aspects to achieve population stabilization in the State:

Under the family planning programme, couples with two or more children were motivated to go for terminal methods. The rest of the couples are motivated to opt for other methods of their choice. In order to encourage male participation, the non-scalpel vasectomy programme had been introduced and training for this purpose had been given to the doctors in 17 districts. Haryana also had a scheme of incentives and disincentives for promoting the small family norm as indicated below:

Shri C.T. Wangdi, Joint Secretary, Health and Family Welfare, Govt. of Sikkim stated that the State Commission on Population had been constituted and its first meeting was likely to be held shortly. The policy of the State was to achieve a sustainable growth of population in the State keeping in line with the NPP 2000 and that the high decadal growth recorded in the last census was due to migration of skilled and unskilled workers to the State. The Tenth Plan strategy of the State was to achieve 100% deliveries at institutions or assisted by TBAs, 100% immunization and registration of births and deaths which was already more than 80%o now and as per the NFHS-II, the TFR was 2.75 in Sikkim. The State was committed to achieve the national target of 2.1 in order to bring down the growth of population to the desired level. The State Government was also running Planned Parenthood scheme under the Social Welfare Department and its aim was to delay the age of marriage, the birth of the first child and to space the second child. In order to make the scheme a success, women at the age of 50 years with one child were given Rs. 75000 and with two children Rs. 50,000.

Dr. I.S. Pal, Director General, Medical and Heath Service, Uttaranchal stated that Uttaranchal was mainly a mountainous State where the density of population was very low in the hilly regions and high in places like Haridwar and Dehradun. The population in the high ranges were scattered and living in 16,414 small villages, majority of which are not connected by pukka roads. Relatively speaking, the demographic indicators of Uttaranchal were better than its parent State UP. :

The State suffered from shortage of human resources in the health sector and the NGOs and private sectors seem to be concentrated in the plain areas. The health infrastructure in the State was weak with one sub-centre having to serve 10 villages. The average distance of a sub-centre from a village was 2 to 12 Kms. There was also a shortage of training institutions in the health sector. However, the State Government had taken many initiatives for helping population stabilization :

Thiru E. Valsaraj, Hon'ble Minister for Health, Law, Labour and Ports, Govt. of Pondicherry stated that the UT of Pondicherry had a population of over a million and had already reached the medium term replacement level TFR ( now estimated to be about 1.8) . The current objective of the Government is to address the needs of the people for contraception, health care infrastructure for integrated service delivery of basic reproductive and community health care. The UT had a well-established medical care infrastructure with 39 primary health centres, 4 community health centres, 75 sub-centres, 14 dispensaries and 8 hospitals. In the area of family planning the unmet need was estimated at 20%o and Sterilization had increased by 38%o, IUD by 10.5%o, OC users by 81%o, CC users by 44%o. Health care services such as antenatal checkup, immunization of children, AIDS awareness, safe deliveries were all assessed to be above 97%. The NCP had ranked the UT of Pondicherry as No. 1 in complete immunization of new born, school children and pregnant women. The UT had also been assessed as First on the basis of composite index of 13 vital indicators. UNICEF had ranked the UT of Pondicherry at top amongst all the States and UTs for ensuring 100%o awareness of polio and cent per cent coverage. The Hon'ble Minister stated that his Government would take all measures for implementing the National Population Policy and for tackling higher incidence of diseases associated with increased life expectancy and more deaths due to traffic accidents, suicide etc.

Shri Shatrughan Sinha, Union Minister for Health and Family Welfare

Shri Shatrughan Sinha, Hon'ble Union Minister for Health and Family Welfare stated that the year 2000 marked an important milestone for the Ministry as it was possible for it to place the National Population Policy before the nation. It very clearly laid down specific goals to be achieved within a specific rimeframe. But most significant of all was that the policy sought not only to reach a stable population, but also specified the approach to improve the quality of life. Such a comprehensive, holistic approach built over years of deliberation, when implemented in letter and spirit, was bound to go a long way in speeding up the development of the social sector in the country. According to all indications available now, India could become the most populous country in the world.

However, considering the fact that population policies in this country have to be implemented without coercion and in a spirit of consent and openness, it was remarkable that barring the States ofMadhya Pradesh, Uttar Pradesh, Bihar and Rajasthan, the rest of the country was likely to achieve the population replacement level TFR 2.1 by 2010. If we concentrated our efforts in the above four States, we would be able to achieve overall TFR 2.1 by 2015, if not earlier. Even a tradition bound country like Iran was able to bring down TFR from 5.5 to 2.4 within a decade. Therefore without being pessimistic or complacent, if we became resolute and determined in our actions there is no reason why we could not achieve the goals.

Since the experience in India and abroad had shown that population stabilization was greatly facilitated by low infant and maternal mortality, we should give highest priority for implementing the RCH policies and programmes, which should be effectively linked to contraception. There was no doubt that achieving a breakthrough on population stabilization in States like UP and Bihar was a complex problem due to the poverty, mal-nutrition, illiteracy, low status of women, unemployment, poor communication and transport facilities and the poor primary health infrastructure. In this connection, the mechanism of the Empowered Action Group established in 2001 could help in channelising more funds to the four demographically sensitive States. If these States were able to develop the capacity to implement programmes, more funds could be made available to them.

It had been decided that from the current year, the Government of India would be fully funding the sub-centres established for every 5000 population as per the 1991 census. This was an important policy initiative which would help the States to ensure that the services of a qualified ANM was available to the community. The Hon'ble Minister expressed concern about the unethical practice of female foeticide widely prevalent in several parts of the country. While stating that the Bill for introducing changes in the PNDT Act, 1994 had already been laid in Parliament, he requested the States to vigorously enforce the provisions relating to registration of all ultrasound clinics mandatory and determination/disclosure of sex of the foetus as a punishable offence.

The Minister also emphasized the importance of inter sectoral mobilization with the participation of NGOs for making population stabilization a success. In this connection, the NCP and the State Population Commissions had a pivotal role in facilitating such inter departmental coordination and could help increase access to services among the most needy sections. He concluded his address by appealing that population stabilization efforts should be given the highest priority for reaching the NPP goals.

Dr. Murii Manohar Joshi, Union Minister for Human Resource Development

Dr. Murii Manohar Joshi, Hon'ble Union Minister for HRD stated that in the area of population stabilization we should give special attention to the States which had lagged behind. If UP, Bihar, Madhya Pradesh, Rajasthan and Orissa took the programme of population stabilization seriously, we could achieve the targets within the stipulated time. The hard work achieved by some States had shown that the praiseworthy progress on the population front would be rendered useless if others did not improve their performance. For this purpose the importance of political will and administrative commitment could not be minimized. Dr. Joshi stated that wherever there was an improvement in the area of education especially of female children and improvement in the nutritional levels of the mother and child, IMR had come down leading to a reduction in birth rate.

The observance of punctuality by teachers and doctors could help us progress greatly. It would also be useful to incorporate the family education in the school syllabus and books according to the requirements of each State. The Hon'ble Minister felt that the time had come when we could think of incentives and disincentives to promote the two-child norm. Today people understood that their economic situation cannot be improved without a small family. Health and education were the two indices on which the development of the country depended and that uneducated and weak children would be a burden on us in future. The Anganwadi programme could be used more effectively because the Anganwadi Workers were normally available even when other functionaries were not. It had been noticed that fertility rates came down with the improvement in education and hence, it would be useful if the Health and Education Departments should sit together and consider the targets and areas where the services are required in a coordinated manner to achieve more success. He again referred to the necessity of the five Northern States for undertaking this work with speed and on the basis of targets. The last Census had shown that there was a reduction of about 3 crores in the absolute number of illiterates, but also felt that with more focused programmes, it would be possible to achieve better success on the literacy front which in turn would help reduce the population growth. He also emphasized on the need for bringing out credible and reliable statistics to help the planning process. He suggested that in order to make this discussion more purposeful, separate meetings should be held with Ministers and officials of such States that needed more attention. This would be more useful because there was a need to draw the attention of these States to the fact that it was due to them that the success of population stabilization programme is delayed. He concluded with a suggestion to NCP to organize such separate meetings wherever possible.

Shri K.C. Pant, Deputy Chairman, Planning Commission and Vice-Chairman, NCP

Shri K.C. Pant, Hon'ble Vice Chairman, NCP stated that the presentations made had shown the contrast between States like Kerala and Tamil Nadu at one end and U.R and Bihar at the other end of the spectrum in achieving progress in demographic stabilization. The purpose of convening this Conference was to get a clear picture of what was happening in the States and why in a given situation some States had made rapid progress. He requested the States which needed to move faster to draw upon the experience and lessons from more successful States to the extent they were relevant. The presentations and speeches made had shown that the country was concentrating on solving one of the major problems faced by it. The linkages between the survival of the child, the health of the mother and child, the education of the girl child, the age of marriage, etc. are well-understood as reflected in the goals relating to IMR, MMR and TFR set out in the National Population Policy. It was also worth noting that States had chalked out their own strategies to solve the population problem though many of the social and economic indicators were not favourable in some of them. The recent experience in States like West Bengal and Andhra Pradesh showed that even if some of the social and economic indicators were not what they ought to be, given the political will, the right administrative commitment and proper understanding of the inter-linkages between the various sectors, remarkable success could be achieved in population stabilization within a given time frame. In the present context, every family knew that it could give good education to its children and a better start in the life only if the family size was smaller. It is also true that women after a certain number of children would not like to have more children if they are certain about the survivability of their kids. It was also observed that sterilization was the most popular method of contraception chosen by women in India. If this is so, we ought to be able to provide this service to all the needy under hygienic conditions and under proper medical care.

Shri K.C. Pant emphasized the importance of focusing attention on a district wise basis. It was also necessary to look into the requirements of special groups like population in the tribal areas and slums. The Plan outlay for the Department of Family Welfare had been stepped up in recent years and it had increased from 2,489 crores in 1998-99 to 4,930 crores in 2002-03. Regarding the points raised by some of the States about the transfer of the postpartum centres and rural family welfare centres to the States, he stated that the Department of Family Welfare had now taken over the responsibility of funding all the ANMs on the basis of 1991 population and the postpartum centres and some of the rural family welfare centres funded by the Department could be transferred to the States. This arrangement had been done with a view to streamlining the programmes. The Vice-Chairman, NCP also referred to the large number of agencies working below the district level including NGOs. If the efforts of all these agencies could be coordinated and some degree of convergence achieved between the various Departments of the State and Central Government, faster progress could be achieved in the field of population stabilization as also other programmes. It was suggested that the Panchayari Raj Institutions should be used along with the NGOs, Youth Organizations, Self-Help Groups etc., as they were in touch with the ground realities almost on a village to village basis. If we could reduce compartmentalizarion and achieve integration of developmental programmes, it could be much easier for us to achieve the goals of the National Population Policy. If those States who had a large population did not achieve the replacement level fertility within a reasonable period the whole process of population stabilization for the country would be pushed further away. He, therefore, requested the States to make every effort to learn from the experience of other States which have moved forward on the population front. He agreed with the suggestion given by the HRD Minister Dr. Murii Manohar Joshi to have such meetings more frequently as also to have zonal and state level meetings.