• Achieve steep decline in CBR by meeting all unmet needs for contraception
• Achieve reduction in maternal mortality/morbidity due to women seeking illegal abortion for unwanted pregnancy

• In UP and Bihar there has been decline in performance even as compared to their past performance
• In MP the decline is marginal while in Rajasthan there has been an improvement in both permanent and temporary method use
• These four states have the largest proportion of unmet needs for family planning both for terminal and spacing methods
• These unmet needs have to be met by improving availability, access and quality of care

• Some districts in these states have birth rate and infant mortality rate well below the national average and substantially below the state level
• The states have to study and replicate these successful experiences within the state and also strive to meet all unmet needs in better performing districts

• Meet the felt needs of the family and enable them to achieve their reproductive goals
• The families will ensure that the national goals for population stabilization are achieved

• Demographic targets to focus on enabling couples to achieve their reproductive goals
• Method-specific contraceptive targets to meeting unmet needs for contraception to reduce unwanted pregnancies
• Numerous vertical programmes for family planning and maternal and child health to integrated reproductive and child health care
• Centrally defined targets to community need assessment and decentralized area-specific micro-planning and implementation of the Reproductive and Child Health (RCH) programme to reduce infant mortality and reduce high desired fertility
• Quantitative coverage to emphasis on quality and content of care
• Predominantly women-centred programme to meeting the couples’ needs with emphasis on involvement of men in Planned Parenthood
• Supply-driven service delivery to need and demand-driven service; improved logistics for ensuring adequate and timely supplies to meet the need
• Service provisions based on provider’s perception to addressing choices and conveniences of couples

During the 9th plan there has been decline in acceptors of all family planning methods except IUD-as compared to 1994-95. Sterilization is the most commonly used method of contraception in all states of the country

There had been a steep, persistent fall in number of vasectomies

Challenge

• Repopularize vasectomy by addressing concerns and conveniences of men and introducing newer techniques

Opportunity

This will result in :

• Improved involvement of men in planned parenthood
• Reduction in morbidity and mortality associated with sterilization

• In spite of uniform norms for funding of Family Welfare programmes, there are differences in expenditure incurred between states
• States like Kerala and Tamil Nadu have achieved low CBR and IMR at relatively low cost
• States like Punjab and Haryana have not achieved low CBR in spite of high expenditure
• States like Bihar with low expenditure have poor performance

• In spite of relatively high IMR, states like Tamil Nadu and Andhra Pradesh have achieved steep decline in fertility

• State/district-specific situation analysis and appropriate intervention is required for optimal benefits

• Hundred percent birth and death recording, collation and analysis at district level is essential for planning and monitoring impact of intervention

• 95% of maternal deaths occur in developing countries
• During the last four decades there has not been any substantial decline in maternal mortality in India
• Causes f maternal death have remained unaltered
• Maternal deaths represent the tip of the iceberg of maternal morbidity; for every maternal death, there are hundreds of mothers with serious illnesses requiring treatment
• There are differences between states and between urban and rural areas in the reported maternal mortality rates

Challenge

• To achieve 100% registration of births and death and utilization of data to initiate appropriate interventions
• Effective screening of all pregnant women and referral of at-risk individuals for appropriate care to achieve reduction in maternal morbidity and mortality

Opportunity

• RCH Care envisages improvement in content and quality of antenatal care
• Many States are investing in providing safe delivery services-institutional deliveries wherever possible

• There was sustained reduction in infant mortality in the seventies and eighties

• During the nineties the reduction has been very slow

• There has not been any substantial decline in stillbirth rate, neonatal and perinatal mortality rate

• Universal immunization against the six vaccine preventable diseases has not been achieved by 2000 AD

Challenge

• Improve content, quality and coverage of antenatal, intrapartum and neonatal services
• Improve referral services for high-risk cases
• Improve routine immunization coverage

Opportunity

• During the next two decades there will be a respite from the ever-increasing numbers
• With improved care:

• It is possible to achieve substantial reduction in mortality
• Achieve universal immunization and elimination of polio