Perspective Population stabilization and sustainable development are critical determinants of human development and improvement in quality of life. India, the second most populous country in the world, has no more than 2.5% of global land but is the home of 1/6th of the world's population. The prevailing high maternal, infant, childhood morbidity and mortality, low life expectancy and high fertility had been a source of concern for public health professionals right from the pre-independance period. The Bhore Committee Report (1946) which laid the foundation for health service planning in India, gave high priority improving nutritional and health status of women and children. This report which emphasized the importance of providing integrated preventive, promotive and curative primary health care services to all based on their needs preceded the Alma Ata declaration by over three decades. Under the Constitution of India elimination of poverty, ignorance and ill health are three important goals. In 1951, the infant republic took stock of the existing situation in the country and initiated the first Five Year Plan. Living in a resource poor country with high population density, planners recognised in the census figures of 1951, the potential threat posed by rapid population growth and the need to take steps to avert it. In 1952, India became the first country in the world to formulate a National Family Planning Programme, with the objective of "reducing birth rate to the extent necessary to stabilise the population at a level consistent with requirement of national economy". Thus, the key elements of health care to women and children and provision of contraceptive services have been the focus of Indias health services right from the time of Indias independence. Successive Five Year Plans have been providing the policy framework and funding for planned development of nationwide health care infrastructure and manpower. The Centrally Sponsored and 100% centrally funded Family Welfare Programme provides additional infrastructure, manpower and consumables needed for improving health status of children and and meet all the felt needs for fertility regulation. Over the last five decades the country has built up a massive healthcare infrastructure for delivery of FW services to the population, in the Govt, private and voluntary sectors.
The technological advances and improved quality and coverage of health care resulted in a rapid fall in Crude Death Rate (CDR) from 25.1 in 1951 to 9.8 in 1991. In contrast, the reduction in Crude Birth Rate (CBR) has been less steep, declining from 40.8 in 1951 to 29.5 in 1991. As a result, the annual exponential population growth rate has been over 2% between 1960-1990. Census 1991 showed that India was entering the phase when there will be progressive decline in population growth rate. (Figures 1 & 2). The rate of decline in birth rate and population growth is likely to be further accelerated in the next decade
Demographers refer to these changes from stable population with high fertility and mortality to a new stability in population due to low fertility and mortality as demographic transition. Demographic transition occurs in four phases; of these the first three phases are characterized by population growth. In the first phase there is fall in death rate and improvement in longevity; this leads to population growth. In the second phase there is a fall in birth rate but fall is less steep than fall in death rates and consequently there is population growth. In the third phase death rates plateau and replacement level of fertility is attained but the population growth continues because of the large size of population in reproductive age group. The fourth phase is characterized by fall in birth rate to below replacement level and reduction in the proportion of the population in reproductive age group; as a result of these changes population growth ceases and population stabilizes. India is currently in the second phase and is moving towards the third phase of demographic transition. The changes in the population growth rates in India have been relatively slow, but the change has been steady and sustained. As a result the country was able to achieve a relatively gradual change in the population numbers and age structure. The short and long term adverse consequences of too rapid decline in birth rates and change in age structure on the social and economic development were avoided and the country was able to adapt to these changes without massive disruption in development efforts.
In order to ensure that the country makes the best use of the opportunity window in the demographic transition, NDC in 1991 constituted a Sub committee on population. The committee made several recommendations not only to give a new thrust and dynamism to the ongoing Family Welfare Programme but also address the larger issue of population and development so that the country will speedily attain replacement level of fertility and simultaneously efforts will be made to improve the quality of life. Major recommendations pertaining to the Family Welfare programme include
These recommendations were endorsed by the NDC in 1993. International Conference on Population and Development (Cairo 1994) advocated a similar approach. Concordance between National (NDC Committee) and International (ICPD) recommendations enabled flow of national and international funding and accelerated the pace of implementation of the family welfare programme.
Dept of Family Welfare initiated several steps to implement the recommendations of the NDC sub Committee ; these include:
In spite of the uniform national norms set under the 100% Centrally Funded and Centrally Sponsored Scheme (CSS) of Family Welfare , there are substantial differences in fertility and mortality between States. At one end of the spectrum is Kerala with mortality and fertility rates nearly similar to those in some of the developed countries. At the other end, there are states such as Uttar Pradesh, Bihar, Madhya Pradesh Rajasthan and Orissa with high Infant Mortality Rate and Fertility Rates (Fig 7&8).
There are also substantial differences in availability and utilization of health care services and mortality and fertility rules not only between states but also between district in the same state; as a result there will be differences in type of intervention needed and also the time taken by them to achieve population stabilization. In view of these findings, the NDC Sub- Committee on Population recommended that efforts should be made to assess the needs for reproductive and child health at district level and undertake decentralized area-specific micro planning and implementation of appropriate interventions. In response to this recommendation Dept of Family Welfare has abolished the practice of fixing targets for individual contraceptives by the Central Government from April 1996 and had initiated decentralized district based, planning (based on community need assessment), implementation, monitoring and midcourse corrections of FW programme. The experience of states with district based planning, implementation and the impact are being closely monitored As the availability and utilisation of family welfare services is the critical determinant of performance in Family Welfare Programme, achievements in terms of reduction in IMR and CBR go hand in hand in most States. However, there are exceptions; both Punjab and Tamil Nadu have good primary health care infrastructure; IMR in both the States are identical and the age at marriage in these States is similar; TFR in Tamil Nadu is 2.1 and in Punjab it is 2.9. In Bihar, IMR is 72 and TFR is 4.6 but Assam with IMR of 75 has a TFR of 3.8. Efforts will have to be made to identify the factors responsible for poor achievements in terms of IMR and TFR and area specific remedial measures have to be planned and implemented in the States. District wise data on CBR and IMR computed on the basis of Census 1991 show that there are marked differences in these indices not only between States but also between districts in the same State. Census 1991 has confirmed that even in Kerala there are districts where IMR (Idikki) and CBR (Mallapuram) are higher than national levels. There are districts in UP with IMR (Almora) and CBR (Kanpur -Urban) lower than national levels. The Family Welfare Programme, therefore, has to be re-orient intervention to
Efforts are under way to improve the quality and coverage of FW services in all states. In each state, the success achieved by the better performing districts will have be replicated in poorly performing districts; in addition efforts will have to be made to achieve incremental improvement in performance in all districts so that the performance in the state improves. States like Kerala and Tamil Nadu have achieved low CBR and IMR at relatively low cost even when couple protection rates are far below to 0%.. On the other hand, States like Haryana and Punjab have not achieved any substantial reduction in CBR in spite of higher expenditure per eligible couple even high couple protection rates. In States like Bihar and Uttar Pradesh the expenditure is low and performance is poor. In between these extreme categories are States like Orissa and Andhra Pradesh with average or below average expenditure and average or below average performance in MCH or family planning. In some States like Orissa and West Bengal the performance in family planning is better than the performance in MCH or vice versa. Deptt. of Family Welfare is attempting to implement the recommendation of the NDC Committee on Population, that factors responsible for observed differences in utilisation of funds as well as impact of the programme are to be studied and existing lacunae rectified not only at the State but also at the district level.
There are major differences between states with regard to their current population size as well as their potential to contribute towards the increase in the population of the country during 1996-2016. The five states of Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan and Orissa, which constitute 44% of the total population of India in 1996, will constitute 48% of the total population of India in 2016. These states will contribute 55% of the total increase in population of the country during the period 1996-2016. The progresss in these states would determine the year and size of the population at which the country achieves population stabilisation. In all the states performance in the social and economic sector has been poor. The poor performance is the outcome of poverty, illiteracy and poor development which co-exist and reinforce each other. Urgent energetic steps are required to be initiated to assess and fully meet the unmet needs for maternal and child health (MCH) care and contraception through improvement in availability and access to family welfare services in the states of UP, MP, Rajasthan and Bihar in order to achieve a faster decline in their mortality and fertility rates. The performance of these states would determine the year and size of the population at which the country achieves population stabilisation.
The current high population growth rate is due to:
Unmet needs for health and contraceptive care exist in all regions and all segments of the population irrespective of religion, caste, education and income status. The objective of the Ninth Plan is to achieve rapid reduction in the population growth rate by:
The strategies for achieving these objectives will be:
The Family Welfare Programme will be directed towards:
Efforts are being made to provide adequate inputs to improve availability and access to services to improve performance so that the disparities between states will be narrowed. It is noteworthy that there are districts in these states where CBR and IMR are well below the national levels; steps may have to be initiated to study and replicate these success stories within each of these states so that the existing disparities between states are minimised.
One of the major recoomendations of the NDC Sub Committee on Population was that a National Population Policy should be drawn up so that it provides reliable and relevant policy frame work not only for improving Family Welfare Services but also for measuring and monitoring the delivery of family welfare services and demographic impact in the new millenium. The Dept of Family Welfare has drawn up the National Population Policy 2000 it provides reliable and relevant policy frame work for improving quality and coverage , measuring and monitoring the delivery of family welfare programme so as to enable the increasingly literate and aware families to achieve their reproductive goals, and the country to achieve rapid population stabilization; simultaneously the policy aims at promoting synergy with the ongoing educational, info-technology and socio-economic transition so that India can achieve not only rapid population stabilization, but also sustainable development, improvement in economic ,social and human development in the new millennium. One of the the major objective of the Policy is that the country should achieve replacement level of fertility by 2010. The countrys medium and long term efforts will be focussed on bringing about an accelerated convergence of ongoing demographic, socio-economic, educational and information technology transitions, enable the increasingly literate and aware families to achieve their reproductive goals, and the country to achieve rapid population stabilisation, sustainable development and improvement in quality of life.
India has reached one billion population on 11th May 2000. On that day the Prime Minister announced the formation of the National Population Commission with him as the Chairman and the Deputy Chairman Planning Commission as Vice Chairman. Chief Ministers of all states, Ministers of the related Central Ministries, secretaries of the concerned Departments, eminent physicians , demographers and the representatives of the civil society are Members of the Commission. The Commission has the mandate
The National Population Policy 200 0has set the following goals:
Based on the situation analysis the Ninth Plan has suugested that the States have to prioritise and utilise funds available for primary health care on the basis of the existing infrastructure and the performance indices as follows:
Analysis of 1991 Census data as well as the district surveys commissioned by the Department of Family Welfare have clearly shown that even in poorly performing states, many districts are doing well. Infant mortality rates in Almora and birth rate in Kanpur-urban district are lower than the national levels. These successes should be replicated in other districts; simultaneously all districts should strive for incremental improvement in performance so that the poor over all performance of the state improves. Central Government
State Government To assess the needs for reproductive and child health at PHC level and undertake area-specific micro planning. Enhance the quality and coverage of family welfare services through:
Panchayati Raj Institutions (PRIs) Involvement of Panchayati Raj Institutions in
Inter-sectoral Coordination
Education:
Women and Child Development
Rural Development:
Rural Water Supply and Sanitation
Others Coordination among village-level functionaries - namely Anganwadi workers, Mahila Swasthaya Sangh (MSS), Traditional Birth Attendant (TBA), Krishi Vigyan Kendra (KVK) Volunteers, School teachers to achieve optimal utilisation of available services. Conclusion Demographic transition is a global phenomenon; population growth is inevitable in the initial phases of the transition. For India the current phase of the demographic transition is both a challenge and an opportunity. In the next two decades the population growth will be mainly among the young adults who will be more literate, aware and utilise available facilities. The Family Welfare programme will be providing wider range of services; there will be an improvement in quality and coverage of services at affordable cost. The population can meet all their needs, achieve the desired family size and enable the country to achieve population stabilsation rapidly. Demographic transition does not occur in isolation. Simultaneously, there are ongoing economic transition, education transition, health transition and reproductive health transition The opportunity is to utilise available human resources to achieve rapid economic development and improvement in quality of life through a better sense of awareness throughout the Nation. |
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