1. Utilise village self help groups to organise and provide basic services for reproductive and child health care, combined with the ongoing Integrated Child Development Scheme (ICDS). Village self help groups are in existence through centrally sponsored schemes of: (a) Department of Women and Child Development, Ministry of HRD, (b) Ministry of Rural Development, and (c) Ministry of Environment and Forests. Organise neighbourhood acceptor groups, and provide them with a revolving fund that may be accessed for income generation activities. The groups may establish rules of eligibility, interest rates, and accountability for which capital may be advanced, usually to be repaid in installments within two years. The repayments may be used to fund another acceptor group in a nearby community, who would exert pressure to ensure timely repayments. Two trained birth attendants and the aanganwadi worker (AWW) should be members of this group.

2. Implement at village levels a one-stop integrated and coordinated service delivery package for basic health care, family planning and maternal and child health related services, provided by the community and for the community. Train and motivate the village self-help acceptor groups to become the primary contact at household levels. Once every fortnight, these acceptor groups will meet, and provide at one place 6 different services for (i) registration of births, deaths, marriage and pregnancy; (ii) weighing of children under 5 years, and recording the weight on a standard growth chart; (iii) counseling and advocacy for contraception, plus free supply of contraceptives; (iv) preventive care, with availability of basic medicines for common ailments: antipyretics for fevers, antibiotic ointments for infections, ORT /ORS1 for childhood diarrhoeas, together with standardised indigenous medication and homeopathic cures; (v) nutrition supplements; and (vi) advocacy and encouragement for the continued enrolment of children in school up to age 14. One health staff, appointed by the panchayat, will be suitably trained to provide guidance. Clustering services for women and children at one place and time at village levels will promote positive interactions in health benefits and reduce service delivery costs.

3. Wherever these village self-help groups have not developed for any reason, community midwives, practitioners of ISMH, retired school teachers and ex-defence personnel may be organised into neighbourhood groups to perform similar functions.

4. At village levels, the aanganwadi centre may become the pivot of basic health care activities, contraceptive counseling and supply, nutrition education and supplementation, as well as pre-school activities. The aanganwadi centres can also function as depots for ORS/basic medicines and contraceptives.

5. A maternity hut should be established in each village to be used as the village delivery room, with storage space for supplies and medicines. It should be adequately equipped with kits for midwifery, ante-natal care, and delivery; basic medication for obstetric emergency aid; contraceptives, drugs and medicines for common ailments; and indigenous medicines/supplies for maternal and new-born care. The panchayat may appoint a competent and mature midwife, to look after this village maternity hut. She may be assisted by volunteers.

6. Trained birth attendants as well as the vast pool of traditional dais should be made familiar with emergency and referral procedures. This will greatly assist the Auxiliary Nurse Midwife (ANM) at the subcentres to monitor and respond to maternal morbidity/emergencies at village levels.

7. Each village may maintain a list of community mid-wives, village health guides, panchayat sewa sahayaks, trained birth attendants, practitioners of indigenous systems of medicine, primary school teachers and other relevant persons, as well as the nearest institutional health care facilities that may be accessed for integrated service delivery. These persons may also be helpful in involving civil society in monitoring availability, quality and accessibility of reproductive and child health services; in disseminating education and communication on the benefits of smaller and healthier families, with emphasis on education of the girl child; and female participation in the work force.

8. Provide a wider basket of choices in contraception, through innovative social marketing schemes to reach household levels.

Comment : Meaningful decentralisation will result only if the convergence of the national family welfare programme with the ICDS programme is strengthened. The focus of the ICDS programme on nutrition improvement at village levels and on pre-school activities must be widened to include maternal and child health care services. Convergence of several related activities at service delivery levels with, in particular, the ICDS programme, is critical for extending outreach and increasing access to services. Intersectoral coordination with appropriate training and sensitisation among field functionaries will facilitate dissemination of integrated reproductive and child health services to village and household levels. People will willingly cooperate in the registration of births, deaths, marriages and pregnancies if they perceive some benefit. At the village level, this community meeting every fortnight, may become their most convenient access to basic health care, both for maternal and child health, as well as for common ailments. Households may participate to receive integrated service delivery, along with information about ongoing micro-credit and thrift schemes. Government and non-government functionaries will be expected to function in harmony to ensure integrated service delivery. The panchayat will promote this coordination and exercise effective supervision.

¹ Oral Rehydration Therapy /Oral Rehydration Salts

1. Create an enabling environment for women and children to benefit from products and services disseminated under the reproductive and child health programme. Cluster services for women and children at the same place and time. This promotes positive interactions in health benefits and reduces service delivery costs.

2. As a measure to empower women, open more child care centres in rural areas and in urban slums, where a woman worker may leave her children in responsible hands. This will encourage female participation in paid employment, reduce school drop-out rates, particularly for the girl child, and promote school enrolment as well. The aanganwadis provide a partial solution.

3. To empower women, pursue programmes of social afforestation to facilitate access to fuelwood and fodder. Similarly, pursue drinking water schemes for increasing access to potable water. This will reduce long absences from home, and the need for large numbers of children to perform such tasks.

4. In any reward scheme intended for household levels, priority may be given to energy saving devices such as solar cookers, or provision of sanitation facilities, or extension of telephone lines. This will empower households, in particular women.

5. Improve district, sub-district and panchayat-level health management with coordination and collaboration between district health officer, sub-district health officer and the panchayat for planning and implementation activities. There is need to:

• Strengthen the referral network between the district health office, district hospital and the community health centres, the primary health centres and the subcentres in management of obstetric and neo-natal complications.
• Strengthen community health centres to provide comprehensive emergency obstetric and neo-natal care. These may function as clinical training centres as well. Strengthen primary health centres to provide essential obstetric and neo-natal care. Strengthen subcentres to provide a comprehensive range of services, with delivery rooms, counseling for contraception, supplies of free contraceptives, ORS and basic medicines, together with facilities for immunisation.
• Establish rigorous problem identification mechanisms through maternal and peri-natal audit, from village level upwards.

6. Ensure adequate transportation at village level, subcentre levels, zila parishads, primary health centres and at community health centres. Identifying women at risk is meaningful only if women with complications can reach emergency care in time.

7. Improve the accessibility and quality of maternal and child health services through:

• Deployment of community mid-wives and additional health providers at village levels; cluster services for women and children at the same place and time, from village level upwards, e.g. ante-natal and post-partum care, monitoring infant growth, availability of contraceptives and medicine kits; and routinised immunisations at subcentre levels.
• Strengthen the capacity of primary health centres to provide basic emergency obstetric and neo-natal health care.
• Involve professional agencies in developing and disseminating training modules for standard procedures in the management of obstetric and neo-natal cases. The aim should be to routinise these procedures at all appropriate levels.
• Improve supervision by developing guidance and supervision checklists.

8. Monitor performance of maternal and child health services at each level by using the maternal and child health local area monitoring system, which includes monitoring the incidence and coverage of ante-natal visits, deliveries assisted by trained health care personnel and postnatal visits, among other indicators. The ANM at the subcentre should be responsible and accountable for registering every pregnancy and child birth in her jurisdiction, and for providing universal ante-natal and post-natal services.

9. Improve technical skills of maternal and child health care providers by:

Strengthening skills of health personnel and health providers through classroom and on-the-job training in the management of obstetric and neo-natal emergencies. This should include training of birth attendants and community midwives at district-level hospitals in life-saving skills, such as management of asphyxia and hypothermia.

Training on integrated management of childhood illnesses for infants (1week - 2 months).

10. Support community activities such as dissemination of IEC material, including leaflets and posters, and promotion of folk jatras, songs and dances to promote healthy mother and healthy baby messages, along with good management practices to ensure safe motherhood, including early recognition of danger signs.

11. Programme development, comprising:

Partnership in family health and nutrition. The aanganwadi worker will identify women and children in the villages who suffer from malnutrition and/or micro-nutritional deficiencies, including iron, vitamin A, and iodine deficiency; provide nutritional supplements and monitor nutritional status.

Convergence, strengthening, and universalisation of the nutritional programmes of the Department of Family Welfare and the ICDS run by the Department of Women and Child Development, ensuring training and timely supply of food supplements and medicines.

Include STD/RTI and HIV/AIDS prevention, screening and management, in maternal and child health services.

Provide quality care in family planning, including information, increased contraceptive choices for both spacing and terminal methods, increase access to good quality and affordable contraceptive supplies and services at diverse delivery points, counseling about the safety, efficacy and possible side effects of each method, and appropriate follow-up.

12. Develop a health package for adolescents.

13. Expand the availability of safe abortion care. Abortion is legal, but there are barriers limiting women's access to safe abortion services. Some operational strategies are:

Community-level education campaigns should target women, household decision makers and adolescents about the availability of safe abortion services and the dangers of unsafe abortion.

Make safe and legal abortion services more attractive to women and household decision makers by (i) increasing geographic spread; (ii) enhancing affordability; (iii) ensuring confidentiality and (iv) providing compassionate abortion care, including post-abortion counseling.

Adopt updated and simple technologies that are safe and easy, e.g. manual vacuum extraction not necessarily dependant upon anaesthesia, or non-surgical techniques which are non-invasive.

Promote collaborative arrangements with private sector health professionals, NGOs and the public sector, to increase the availability and coverage of safe abortion services, including training of mid-level providers.

Eliminate the current cumbersome procedures for registration of abortion clinics. Simplify and facilitate the establishment of additional training centres for safe abortions in the public, private, and NGO sectors. Train these health care providers in provision of clinical services for safe abortions.

Formulate and notify standards for abortion services. Strengthen enforcement mechanisms at district and sub-district levels to ensure that these norms are followed.

Follow norms-based registration of service provision centres, and thereby switch the onus of meticulous observance of standards onto the provider.

Provide competent post-abortion care, including management of complications and identification of other health needs of post-abortion patients, and linking with appropriate services. As part of post-abortion care, physicians may be trained to provide family planning counseling and services such as sterilisation, and reversible modern methods such as IUDs, as well as oral contraceptives and condoms.

Modify syllabus and curricula for medical graduates, as well as for continuing education and in-house learning, to provide for practical training in the newer procedures.

Ensure services for termination of pregnancy at primary health centres and at community health centres.

14. Develop maternity hospitals at sub-district levels and at community health centres to function as FRUs for complicated and life-threatening deliveries.

15. Formulate and enforce standards for clinical services in the public, private, and NGO sectors.

16. Focus on distribution of non-clinical methods of contraception (condoms and oral contraceptive pills) through free supply, social marketing as well as commercial sales.

17. Create a national network consisting of public, private and NGO centres, identified by a common logo, for delivering reproductive and child health services free to any client. The provider will be compensated for the service provided, on the basis of a coupon, duly counter-signed by the beneficiary, and paid for by a system to be devised. The compensation will be identical to providers across all sectors. The end-user will choose the provider of the service. A group of management experts will devise checks and balances to prevent misuse.

1. Support community activities, from village level upwards to monitor early and adequate antenatal, natal and post-natal care. Focus attention on neo-natal health care and nutrition.

2. Set up a National Technical Committee on neo-natal care, to align programme and project interventions with newly emerging technologies in neo-natal and peri-natal care.

3. Pursue compulsory registration of births in coordination with the ICDS Programme.

4. After the birth of a child, provide counseling and advocacy about contraception, to encourage adoption of a reversible or a terminal method. This will also contribute to the health and wellbeing of both mother and child.

5. Improve capacities at health centres in basic midwifery services, essential neo-natal care, including the management of sick neo-nates outside the hospital.

6. Sensitise and train health personnel in the integrated management of childhood illnesses. Standard case management of diarrhoea and acute respiratory infections must be provided at subcentres and primary health centres, with appropriate training, and adequate equipment. Besides, training in this sector may be imparted to health care providers at village levels, especially in indigenous systems.

7. Strengthen critical interventions aimed at bringing about reductions in maternal malnutrition, morbidity and mortality, by ensuring availability of supplies and equipment at village levels, and at sub centres.

8. Pursue rigorously the pulse polio campaign to eradicate polio.

9. Ensure 100 percent routine immunisation for all vaccine preventable diseases, in particular tetanus and measles.

10. As a child survival initiative, explore promotional and motivational measures for couples below the poverty line who marry after the legal age of marriage, to have the first child after the mother reaches the age of 21, and adopt a terminal method of contraception after the birth of the second child.

11. Children form a vulnerable group and certain sub-groups merit focused attention and intervention, such as street children and child labourers. Encourage voluntary groups as well as NGOs to formulate and implement special schemes for these groups of children.

12. Explore the feasibility of a national health insurance covering hospitalisation costs for children below 5 years, whose parents have adopted the small family norm, and opted for a terminal method of contraception after the birth of the second child.

13. Expand the ICDS to include children between 6-9 years of age, specifically to promote and ensure 100 percent school enrolment, particularly for girls. Promote primary education with the help of aanganwadi workers, and encourage retention in school till age 14. Education promotes awareness, late marriages, small family size and higher child survival rates.

14. Provide vocational training for girls. This will enhance perception of the immediate utility of educating girls, and gradually raise the average age of marriage. It will also increase enrolment and retention of girls at primary school, and likely also at secondary school levels. Involve NGOs, the voluntary sector and the private sector, as necessary, to target employment opportunities.

1. Strengthen, energise and make publicly accountable the cutting edge of health infrastructure at the village, subcentre and primary health centre levels.

2. Address on priority the different unmet needs detailed in Appendix IV, in particular, an increase in rural infrastructure, deployment of sanctioned and appropriately trained health personnel, and provisioning of essential equipment and drugs.

3. Formulate and implement innovative social marketing schemes to provide subsidised products and services in areas where the existing coverage of the public, private and NGO sectors is insufficient in order to increase outreach and coverage.

4. Improve facilities for referral transportation at panchayat, zilla parishad and primary health centre levels. At subcentres, provide ANMs with soft loans for purchase of mopeds, to enhance their mobility. This will increase coverage of ante-natal and post natal check-ups, which, in turn, and will bring about reductions in maternal and infant mortality.

5. Encourage local entrepreneurs at village and block levels to start ambulance services through special loan schemes, with appropriate vehicles to facilitate transportation of persons requiring emergency as well as essential medical attention.

6. Provide special loan schemes and make site allotments at village levels to facilitate the starting of chemist shops for basic medicines and provision for medical first aid.

(a) Urban Slums

1. Finalise a comprehensive urban health care strategy.

2. Facilitate service delivery centres in urban slums to provide comprehensive basic health, reproductive and child health services by NGOs and private sector organisations, including corporate houses.

3. Promote networks of retired government doctors and para-medical and non-medical personnel who may function as health care providers for clinical and non-clinical services on remunerative terms.

4. Strengthen social marketing programmes for non-clinical family planning products and services in urban slums.

5. Initiate specially targeted information, education and communication campaigns for urban slums on family planning, immunization, ante-natal, natal and post-natal check-ups and other reproductive health care services. Integrate aggressive health education programmes with health and medical care programmes , with emphasis on environmental health, personal hygiene and healthy habits, nutrition education and population education.

6. Promote inter-sectoral coordination between departments/municipal bodies dealing with water and sanitation, industry and pollution, housing, transport, education and nutrition, and women and child development, to deal with unplanned and uncoordinated settlements.

7. Streamline the referral systems and linkages between the primary, secondary and tertiary levels of health care in the urban areas.

8. Link the provision of continued facilities to urban slum dwellers with their observance of the small family norm.

(b) Tribal Communities, Hill Area Populations and Displaced and Migrant Populations

1. Many tribal communities are dwindling in numbers, and may not need fertility regulation. Instead, they may need information and counseling in respect of infertility.

2. The NGO sector may be encouraged to formulate and implement a system of preventive and curative health care that responds to seasonal variations in the availability of work, income and food for tribal and hill area communities and migrant and displaced populations. To begin with, mobile clinics may provide some degree of regular coverage and outreach.

3. Many tribal communities are dependent upon indigenous systems of medicine which necessitates a regular supply of local flora, fauna and minerals, or of standardised medication derived from these. Husbandry of such local resources and of preparation and distribution of standardised formulations should be encouraged.

4. Health care providers in the public, private and NGOs sectors should be sensitised to adopt a "burden of disease" approach to meet the special needs of tribal and hill area communities.

(c) Adolescents

1. Ensure for adolescents access to information, counseling and services, including reproductive health services, that are affordable and accessible. Strengthen primary health centres and subcentres, to provide counseling, both to adolescents and also to newly weds (who may also be adolescents). Emphasise proper spacing of children.

2. Provide for adolescents the package of nutritional services available under the ICDS programme. Comment: Improvements in health status of adolescent girls has an inter-generational impact. It reduces the risk of low birth weight and minimizes neo-natal mortality. Malnutrition is a problem that seriously impairs the health of adolescent and adult women and has its roots in early childhood. The causal linkages between anaemia and low birth weight, prematurity, perinatal mortality, and maternal mortality has been extensively studied and established.

3. Enforce the Child Marriage Restraint Act, 1976, to reduce the incidence of teenage pregnancies. Preventing the marriage of girls below the legally permissible age of 18 should become a national concern. Comment: It will promote higher retention of girls at schools, and is also likely to encourage their participation in the paid work force.

4. Provide integrated intervention in pockets with unmet needs in the urban slums, remote rural areas, border districts and among tribal populations.

(d) Increased Participation of Men in Planned Parenthood

1. Focus attention on men in the information and education campaigns to promote the small family norm, and to raise awareness by emphasising the significant benefits of fewer children, better spacing, better health and nutrition, and better education.

2. Currently, over 97 percent of the sterilisations are tubectomies. Repopularise vasectomies, in particular the no-scalpel vasectomy, as a safe, simple, painless procedure, more convenient and acceptable to men.

3. In the continuing education and training at all levels, there is need to ensure that the noscalpel vasectomy, and all such emerging techniques and skills are included in the syllabi, together with abundant practical training. Medical graduates, and all those participating in "inservice" continuing education and training, will be equipped to handle this intervention.

1. At district and sub-district levels, maintain block-wise data base of private medical practitioners whose credentials may be certified by the Indian Medical Association (IMA). Explore the possibility of accrediting these private practitioners for a year at a time, and assign to each a satellite population, not exceeding 5,000 (depending upon distances and spread), for whom they may provide reproductive and child health services. The private practitioners would be compensated for the services rendered through designated agencies. Renewal of contracts after one year may be guided by client satisfaction. This will serve as an incentive to expand the coverage and outreach of high quality health care. Appropriate checks and balances will safeguard misuse.

2. Revive the earlier system of the licensed medical practitioners who, after appropriate certification from the IMA, may participate in the provision of clinical services.

3. Involve the non-medical fraternity in counseling and advocacy so as to demystify the national family welfare effort, such as retired defence personnel, retired school teachers and other persons who are active and willing to get involved.

4. Modify the under/post-graduate medical, nursing, and paramedical professional course syllabi and curricula, in consultation with the Medical Council of India, the Councils of ISMH, and the Indian Nursing Council, in order to reflect the concepts and implementation strategies of the reproductive and child health programme and the national population policy. This will also be applied to all in-service training and educational curricula.

5. Ensure the efficient functioning of the First Referral Units i.e. 30 bed hospitals at block levels which provide emergency obstetric and child health care, to bring about reductions in Maternal Mortality Ratio (MMR) and Infant Mortality Rate (IMR). In many states, these FRUs are not operational on account of an acute shortage of specialists i.e. gynaecologist/obstetrician, anaesthetist and pediatrician. Augment the availability of specialists in these three disciplines, by increasing seats in medical institutions, and simultaneously enable and facilitate the acquisition of in-service post-graduate qualifications through the National Board of Medical Examination and open universities like IGNOU in larger numbers. As an incentive, seats will be reserved for those in-service medical graduates who are willing to abide by a bond to serve for 5 years at First Referral Units after completion of the course. States would need to sanction posts of Specialists at the FRUs. Further, these specialists should be provided with clear promotion channels.

1. There remain innumerable hurdles that inhibit genuine long-term collaboration between the government and non-government sectors. A forum of representatives from government, the non-government organisations and the private sector may identify these hurdles and prepare guidelines that will facilitate and promote collaborative arrangements.

2. Collaboration with and commitments from NGOs to augment advocacy, counseling and clinical services, while accessing village levels. This will require increased clinic outlets as well as mobile clinics.

3. Collaboration between the voluntary sector and the NGOs will facilitate dissemination of efficient service delivery to village levels. The guidelines could articulate the role and responsibility of each sector.

4. Encourage the voluntary sector to motivate village-level self-help groups to participate in community activitie.

5. Specific collaboration with the non-government sector in the social marketing of contraceptives to reach village levels will be encouraged.

1. The corporate sector and industry could, for instance, take on the challenge of strengthening the management information systems in the seven most deficient states, at primary health centre and subcentre levels. Introduce electronic data entry machines to lighten the tedious work load of ANMs and the multi-purpose workers at subcentres and the doctors at the primary health centres, while enabling wider coverage and outreach.

2. Collaborate with non-government sectors in running professionally sound advertisement and marketing campaigns for products and services, targeting all segments of the population, from village level upwards, in other words, strengthen advocacy and IEC, including social marketing of contraceptives.

3. Provide markets to sustain the income-generating activities from village levels upwards. In turn, this will ensure consistent motivation among the community for pursuing health and education-related community activities.

4. Help promote transportation to remote and inaccessible areas up to village levels. This will greatly assist the coverage and outreach of social marketing of products and services.

5. The social responsibility of the corporate sector in industry must, at the very minimum, extend to providing preventive reproductive and child health care for its own employees (if >100 workers are engaged).

6. Create a national network consisting of voluntary, public, private and non-government health centres, identified by a common logo, for delivering reproductive and child health services, free to any client. The provider will be compensated for the service provided, on the basis of a coupon system, duly counter-signed by the beneficiary and paid for by a system that will be fully articulated. The compensation will be identical to providers, across all sectors. The end user exercises choices in the source of service delivery. A committee of management experts will be set up to devise ways of ensuring that this system is not abused.

7. Form a consortium of the voluntary sector, the non-government sector and the private corporate sector to aid government in the provision and outreach of basic reproductive and child health care and basic education.

8. In the area of basic education, set up privately run/managed primary schools for children up to age 14-15. Alternately, if the schools are set up/managed by the panchayat, the private corporate sector could provide the mid-day meals, the text -books and/or the uniforms.

1. Provide appropriate training and orientation in respect of the RCH programme for the institutionally qualified ISMH medical practitioners (already educated in midwifery, obstetrics and gynaecology over 5-1/2 years), and utilise their services to fill in gaps in manpower at appropriate levels in the health infrastructure, and at subcentres and primary health centres, as necessary.

2. Utilise the ISMH institutions, dispensaries and hospitals for health and population related programmes.

3. Disseminate the tried and tested concepts and practices of the indigenous systems of medicine, together with ISMH medication at village maternity huts and at household levels for ante-natal and post-natal care, besides nurture of the newborn.

4. Utilise the services of ISMH 'barefoot doctors' after appropriate training and orientation towards providing advocacy and counseling for disseminating supplies and equipment, and as depot holders at village levels.

1. Government will encourage, support and advance the pursuit of medical and social science research on reproductive and child health, in consultation with ICMR and the network of academic and research institutions.

2. The International Institute of Population Sciences and the Population Research Centres will continue to review programme and monitoring indicators to ensure their continued relevance to strategic goals.

3. Government will restructure the Population Research Centres, if necessary.

4. Standards for clinical and non-clinical!ioterweotioos!will be issued and regularly reviewed.

5. A constant review and evaluation of the community needs assessment approach will be pursued to align programme delivery with good management practices and with newly emerging technologies.

6. A committee of international and Indian experts, voluntary and non-government organisations and government may be set up to regularly review and recommend specific incorporation of the advances in contraceptive technology and, in particular, the newly emerging techniques, into programme development.

1. Sensitize, train and equip rural and urban health centres and hospitals towards providing geriatric health care.

2. Encourage NGOs and voluntary organizations to formulate and strengthen a series of formal and informal avenues that make the elderly economically self-reliant.

3. Tax benefits could be explored as an encouragement for children to look after their aged parents.

1. Converge IEC efforts across the social sectors. The two sectors of Family Welfare and Education have coordinated a mutually supportive IEC strategy. The Zila Saksharta Samitis design and deliver joint IEC campaigns in the local idiom, promoting the cause of literacy as well as family welfare. Optimal use of folk media has served to successfully mobilize local populations. The state of Tamil Nadu made exemplary use of the IEC strategy by spreading the message through every possible media, including public transport, on mile stones on national high ways as well as through advertisement and hoardings on roadsides, along city/rural roads, on billboards, and through processions, films, school dramas, public meetings, local theatre and folk songs.

2. Involve departments of rural development, social welfare, transport, cooperatives, education with special reference to schools, to improve clarity and focus of the IEC effort, and to extend coverage and outreach. Health and population education must be inculcated from the school levels.

3. Fund the nagar palikas, panchayats, NGOs and community organizations for interactive and participatory IEC activities.

4. Demonstration of support by elected leaders, opinion makers, and religious leaders with close involvement in the reproductive and child health programme greatly influences the behaviour and response patterns of individuals and communities. This serves to enthuse communities to be attentive towards the quality and coverage of maternal and child health services, including referral care. Public leaders and film stars could spread widely the messages of the small family norm, female literacy, delayed marriages for women, fewer babies, healthier babies, child immunization and so on. The involvement and enthusiastic participation of elected leaders will ensure dedicated involvement of administrators at district and sub-district levels. Demonstration of strong support to the small family norm, as well as personal example, by political, community, business, professional, and religious leaders, media and film stars, sports personalities and opinion makers, will enhance its acceptance throughout society.

5. Utilise radio and television as the most powerful media for disseminating relevant sociodemographic messages. Government could explore the feasibility of appropriate regulations, and even legislation, if necessary, to mandate the broadcast of social messages during prime time.

6. Utilise dairy cooperatives, the public distribution systems, other established networks like the LIC at district and sub-district levels for IEC and for distribution of contraceptives and basic medicines to target infant/childhood diarrhoeas, anaemia and malnutrition among adolescent girls and pregnant mothers. This will widen outreach and coverage.

7. Sensitise the field level functionaries across diverse sectors (education, rural development, forest and environment, women and child development, drinking water mission, cooperatives) to the strategies, goals and objectives of the population stabilisation programmes.

8. Involve civil society for disseminating information, counseling and spreading education about the small family norm, the need for fewer but healthier babies, higher female literacy and later marriages for women. Civil society could also be of assistance in monitoring the availability of contraceptives, vaccines and drugs in rural areas and in urban slums.