TABLE OF CONTENTS
1.	Terms of Reference and Composition
2.	Report of the Sub-Group on Strategies for Empowerment of Women, Development of Children and Issues for Adolescents:
	• Background
	• Demographic Transition
	• Conceptual Issues
	• Status of Women's Health
	• The State of Indian Children
	• Issues of the Adolescents
	• Strategies for Intervention
	• National Socio Economic Goals
	• Operational Strategies
3.	Recommendations
4.	Annexure - I
	• Operational Strategies of NPP for Achieving the Goal of Empowering Women for Improved Health and Nutrition
5.	Operational Strategies of NPP for Achieving the Goal of Child Health and Survival

Report of the Sub-Group on Strategies for Empowerment of Women, Development of Children and Issues for Adolescents

1.1 The National Commission on Population which was set up to review, monitor and give directions for the implementation of the National Population Policy with a view to meeting the goals set out in the Policy constituted eight Working Groups on the following subjects related to population stabilization in the country :

1.2 Four Sub-Groups have been constituted under the first Working Group on Strategies to meet the following specific unmet needs:

1.3 The Sub-Group met twice under the Chairpersonship of Smt. Margaret Alva, Member of Parliament and Chairperson of Parliamentary Standing Committee on Empowerment of Women. During the course of the deliberations of the Sub Group, two important developments took place -first, the provisional results of Census 2001 were published and National Policy for Empowerment of Women was approved by the Government. The Sub Group considered both the developments and deliberated on various issues of empowerment of women and development of children and adolescents in the context of the National population Policy.

1.4 The Sub-Group felt that the 'unmet needs' of empowerment of women and development of children and adolescents cover a whole gamut of issues which cut through the terms of references of all the Sub Groups and of the Working Groups and, therefore, there is bound to be considerable degree of overlapping in the terms of reference and deliberations of this Sub-Group. The issue of empowerment of women and development of children and adolescents is not a side or peripheral but a core issue for stabilizing the population growth of the country.

2.1 The demographic transition of the country in the recent years has brought the issues of women and children into the forefront of the country's development strategy. From a "high birth rate-high death rate" country of the pre Independence era, which provided fodder for the theory of Malthus, India had reached the stage of " high birth rate -low death rate" in the early fifties, which contributed to the high rate of growth of population. This continued till the beginning of the eighties, with a decadal growth rising to 21.51% in the fifties, from 13.31% in the previous decade, followed by 24.80% in the sixties and 24.66% in the seventies, despite all the national efforts made to contain this growth. The transition to the phase of "low birth rate-low death rate" has started at a very slow pace, with population growth sliding to 23.85% in the eighties and 21.34% in the nineties. If the goal of National population Policy of bringing TFR to the replacement level has to be achieved by 2010, the growth rate of population has to be brought down to 10.7% during the current decade, which is a very tall order and can not be achieved unless the issues of women, adolescents and children are brought to the centre stage of our development planning.

2.2 The changing demographic profile of the country indicate a few important trends which will have significant bearing on the position of women and children of the country. First, although the percentage of child population below the age of 14 has declined from 37.76% in 1991 to 34.33% in 2001, the absolute numbers of children are still on the rise. The population of children in the age group of 0-6 has increased from 150.42 million in 1991 to 157.86 million in 2001. Likewise the population in the age group of 7-14 is projected to be 170.34 million today as compared to 161.94 million in 1991. Together they constitute 31.9% of the country's population - a huge 328.20 million out of 1.02 billion - the largest number of children in any country anywhere in the world. The adolescents in the age group of 15 to 19 constitute another nearly 10% of the population. Together they constitute the most important potential human resource and it is the health, nutrition, education and well being of these children and adolescents that will determine the future of the country.

2.3 The second trend in the country's demography is the declining sex ratio. The overall sex ratio has declined almost consistently over the years - from 972 females per 1000 males in 1901 to 933 in 2001 - although the numbers had improved marginally by 1 point in 1951, 3 points in 1981 and 6 points in 2001, but sliding by 5 points in 1961, 9 points in 1971 and 7 points in 1991. The decline of sex ratio have been particularly striking in the age group of 0 to 6 years in recent years. Census 2001 has registered this decline by 18 points - from 927 in 1991 to 945. This decline has been registered in all the States and Union Territories except Kerala, Mizoram, Sikkim, Tripura and Lakshadeep. The decline has been very sharp in prosperous States like Punjab, Haryana, Maharastra and Gujrat. In Punjab the gap in the sex ratio has widened to more than 200 per 1000 children. Unfortunately, the trend could not be arrested by rising female literacy during the decade. This is reflective of a deep seated prejudice against the girl child in the country. Countering this trend should be one of the priorities in the National Socio Economic Goals of the country.

2.4 While the female sex ratio among the children is declining, it is increasing among the aged, due to increased life expectancy among the females, leading to a strange gender asymmetry in the population pyramid of the country. With the gradual weakening of family based social security and absence of any strong alternate system, the care of the aged and particularly of the widows, is increasingly assuming the shape of a national problem to be reckoned with in the coming years.

2.5 The age pyramid of Indian population will swell in the centre in the years to come. At present 58% of Indians are in the age group of 15-59 years. This will increase to nearly 64% during the next ten years - from 596 million at present to 708 million by 2010, even if TFR reaches its replacement level. The implication of this transition in terms of additional needs of food, water, energy, health care, education and employment will be enormous. At the same time, the gradual increase in literacy particularly among the females on the one hand and the rise in the mean age of marriage of girls on the other, would mean that more and more girls will demand employment, particularly in the organized sector. New types of demands will be placed on the country's educational and training institutions for building capacity and skill of the workers and particularly of the female workers and of those who will be employed in the self employed and informal sectors.

2.6 The national demographic features often conceal substantial differences between States and between regions and sub regions within the same State in the achievement of basic demographic indices. These differences are conditioned by factors such as illiteracy, poverty, inadequate access to health and family welfare services etc, which often coexist and reinforce each other. At one end of the spectrum is Kerala with IMR and TFR comparable to many developed countries, but there are districts within the same State like ldukki and Malappuram where IMR and CBR are higher than the national average. At the other end are the States like Bihar and Uttar Pradesh (including newly created Uttaranchal an Jharkhand) which have the worst HDI indices in the world, but with districts like Almora and Ranchi with IMR and CBR much lower than the national level.

2.7 The co-relationship between various indices have also been conditioned by a complex web of 'other' factors which need to be studied in depth. Kerala and Tamil Nadu, for example, have achieved replacement level of fertility well before CPR of 60% was reached, whereas, inspite of a developed health infrastructure and CPR much above 60% Punjab is yet to reach that level. Inspite of low female literacy, Andhra Pradesh will be achieving replacement level of fertility much ahead of States with higher literacy rates. Maharastra, Haryana and Punjab have higher SDP than Kerala and Tamil Nadu, but are much behind the southern States in the rates of female literacy, infant mortality and fertility. These suggest that different strategic interventions are required in different States and in different regions and sub regions within the same States for reaching the desired goals of population stabilization.

2.8 The Sub Group felt that concerted attention should be paid on 5 BIMARU States (Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh) plus Orissa which account for nearly 44% of the total population of India and which are anticipated to contribute 55% of the population growth in the next decade. Here again district and sub-district specific strategies and action plan should be worked out.

Conceptual Issues

3.1 National Population Policy has rightly looked at the issue of population stabilization not as a technical issue that has a technical fix. Population stabilization cannot be achieved by mere physical provisioning of contraception mix or emergency obstetric care. It is critical to involve people - and enable women in particular - to have a say in decisions relating to reproduction and livelihood. This brings in the issues of reproductive rights of women and of the larger conceptual issues of gender equality and of empowerment of women within and outside the household.

3.2 The linking of the issue of reproductive health with women's empowerment recognizes that underlying the issue of good health and nutrition for women, we need to examine the issue of power and the nature of gender relations between men and women within the family and community. Here the following conceptual issues need to be highlighted.

3.3 While there have been intense debates attempting to distinguish "women's health" as a more holistic concept than "reproductive health", the issue perhaps is to clearly define what is meant, for our purposes, by women's health and to locate the discourse within a framework of rights. While decision making linked to reproduction and regulation of fertility is important, meeting health needs of women through a system that is sensitive to the differential needs of men and women and their differential access to health care also needs to be taken into account. There are some aspects regarding organizational issues of health delivery which need to be specifically addressed. The division of the health delivery system in terms of two structures - family welfare and health - is not very conducive to a holistic approach to women's health.

3.4 Linked to women's empowerment is the issue of raising awareness about rights - legal literacy, rights to education and health and enhancing information sharing about basic issues. Various studies have indicated that the knowledge of women and adolescent girls about their bodies, and reproductive functions is very limited. Substantial systematic efforts need to be made for enhancing women's and adolescent girls understanding and awareness about various issues.

3.5 It is essential to recognize the connection between women's health and food security and other economic and environmental conditions. For example, lack of access to water impacts on hygiene, heavy load bearing leads to occupational diseases, lack of nutrition impairs productivity and so on. Therefore the issue of access to safe contraception cannot be delinked from the larger issue of access to food, water, shelter and the issues of sustainable livelihood and a safe environment.

3.6 In view of the fact that we are laying emphasis on reproductive rights, informed choice and autonomy, it is important that attention is given to underlying social issues which relate to decision making and lack of choices at the level of the family. This involves the social conditioning of roles and responsibilities which one learns from one's 'culture'. It also means trying to address the structural/fundamental inequalities that exist and give rise to certain situations. For example, it is important that solution to anemia etc. is not viewed as a problem, which can be solved by distributing folic acid, but also as an issue of inadequate nutrition, which also has socio-cultural determinants.

3.7 For an empowerment approach to be well integrated into health programmes it is important that women's participation is incorporated at each stage of the programme and issues regarding power structures are also dealt with. The entire conceptual shift from targeted family planning to reproductive health, which is based on informed choice, is to allow women to voice their preference and needs. However, for women to be able to speak out within the family and community social factors have to be taken into account and conditions create for an enabling environment which would allow this to happen.

4.1 The experience of economic progress, political developments and social transformation of the last 50 years, indicate that although women of India have made major gains in terms of decline in maternal mortality and rise in life expectancy, increase in female literacy and employment, mobilization through self help groups and representation at the grassroots level democracy etc., large gender gaps still exist in almost every sphere of life, which do not empower women to have informed choices on their health and nutrition.

4.2 India accounts for nearly 25% of the world's maternal deaths. Every year about 1,25,000 Indian women die from pregnancy-related causes many of which are preventable. Poor maternal health results in low birth weight and premature babies. More than 7% of the new born babies perish every year. Nearly 2.3% of the babies who survive the first year perish before they complete five years. The number is more in case of female babies.

4.3 The mean age of marriage at the national level is 19.5 years, but about 17.4 percent of girls are married below the age of 18 years. Corresponding rates show marked rural (20.3%) and urban (7.4%) difference. 8.3% of fertility in India is contributed by mothers below 19 years of age and this is also linked with pregnancy wastages ranging form premature death, still birth, neonatal deaths, low birth weight babies and maternal morbidity.

4.4 Micro Studies have indicated that women do not get adequate nutrition during pregnancy and lactation. The dietary intake of women in the lower economic group is deficient by 500 to 600 calories. In the above 7 years age group there are gender differences in consumption of cereals, pulses, and milk products. In the above 18 years groups, gender difference is quite prominent in the intake of energy rich food. According to an assessment of underweight and stunted growth of children (1997), in the age group of 1-5 years, almost half (49.1 %) of the girls were underweight and 20.3 per cent were severely underweight. Stunting was observed in 56 % percent of girls. The Body Mass Index (BMI) indicates that more women (36.1 %) than male (28.6%) are affected by various stages of Chronic Energy Deficiency.

4.5 Research has provided enough information on women's morbidity linked with the environment like indoor air pollution, iodine deficiency of soil/water, flurosis and arsenic related disorder, use of fossil fuels etc. The spread of Tetanus, Pneumonia, Dysentery, Typhoid, Cholera, Plague do not need any further research to prove their relationship with environment and sanitation. The brunt of all these fall disproportionately on women.

4.6 Several domestic chores as also occupational work of many kinds affects the women and leads to an incurable state of health. This is true both at household level and at the work place specially in the unorganised industry sector where maximum number of women earn their livelihood.

4.7 Chronic Mental depression and neurosis in girls and adult females is quite wide spread, but the present health care delivery system and social attitude are ill equipped to tackle them especially in rural areas.

4.8 Studies have indicated that women are biologically and epidemiologically more vulnerable to AIDS. Male to female transmission of HIV is twice as efficient than female to male. Moreover, majority of Indian women being anemic, transfusion of blood during child birth is quite common making the women more susceptible to the contact. Besides social factors like lack of control over their own body, early marriage and repeated pregnancies, lack of information, poverty induced/forced prostitution, promiscuity of husbands etc. make them more vulnerable to this disease. The impact of HIV and Aids on women is also much more severe and critical. First, inter-generational transmission of the disease takes place through women. Secondly, the rejection and ostracisation of women and girls are much more than for males. Further, women and girls suffer disproportionately from the burden of the disease. The traditional gender role of women in caring for the sick make them more susceptible to the disease. Girls of AIDS affected families often have to leave the school to care for the sick.

4.9 Women are the victims of a whole plethora of violence committed against them - infanticide, torture, rape, molestation, battering, trafficking, prostitution, forced marriage, dowry death, custodial violence and so on. This is a reflection of the deep rooted 'gender ideology' of society. Often the crimes are committed by people who are close to the victims and are traditionally supposed to be their protectors. But the victims, especially the sexually abused girls and women, face the brunt of the act more than the abuser. Only a miniscule of the acts of violence committed against women are covered under legal provisions and the bulk of them go unreported. Complex and lengthy legal procedures, often involving substantial expenditure, poor rate of conviction and lack of support from relatives and community are the important reasons for under reporting of crimes against women. Even then the crimes committed against women in relation to the total crimes, has increased from 11% in 1996 to 13.5% in 1998.

4.10 Poverty in general, and extreme poverty in particular, has a s ignificant gender dimension. Studies has been revealed that (i) the percentage of adult women exceeds the percentage of adult men below the poverty line, both in rural and urban areas; (ii) the percentage of children in the 0-4 age group in poor households exceeds that of non-poor households, and (iii) in both urban and rural areas, disadvantaged groups of women from Scheduled Castes and Tribes constitute a high proportion of the poor. Incidence of poverty is positively co-related with IMR - a poor couple perceives an additional child to be an investment, both as security against probable mortality of the surviving child and as a potential wage earner.

4.11 Significant co-relation between spread of female literacy and decline of fertility has been observed throughout the country although there are regions where fertility has declined despite prevalence of illiteracy. A lot of gains have been made in the recent years in female illiteracy. For the first time the number of absolute illiterates has declined and rate of growth of female literacy has outpaced that of males. But still 45.84% of females in the age group of 6 to 50 are illiterates. The gap between male and female literacy is still as wide as 22 percentage points.

5.1 India is to home the largest number of children in the world. Nearly one third of its population -328.20 million in absolute terms - is children below the age of 15 years. About 45% of its population are minors i.e, below the age of 18 years. The country had formulated a National Policy for Children in 1974 and ratified the United Nations Convention on the Rights of the Child in 1992. A National Plan of Action for Children (NPAC) was also drawn up in 1992, which had set goals for various indicators to be achieved by the year 2000. But most of these goals have remained unfulfilled, although significant improvements have taken place in all the crucial indicators like infant and child mortality rates, school enrolment ratios, drop-out rates, levels of mal-nutrition etc.

5.2 Infant mortality has remained around 72 per 1000 live births with no significant improvement in the nineties unlike in the eighties. This is much below the average of 6 in developed countries, 64 in developing countries and the world average of 59. There are significant disparities across States, within the States and among castes, communities and other ethnic groups. Kerala for instance, has IMR of 13 per 1000 live births against 94 in Madhya Pradesh: The Infant mortality rate among Scheduled Castes is 24% higher than the national average. Like-wise, the rural and urban differentials also continue to be very high - 46 in urban areas as compared to 78 in rural areas. The underlying reasons of high infant mortality are early marriage and childbearing, lack of birth spacing, inadequate maternal nutrition, inadequate antenatal care, and large proportion of deliveries lacking supervision by trained birth attendants.

5.3 The Child Mortality Rate (CMR) of India is also very high 25 children out of every 1000 who survive the first year die before they complete 5 years. India ranks 49 out of 189 countries in CMR i.e, if the worst is ranked 1, India is 49th. This reflects the inability of families to look after their young children. Despite efforts being made under the Integrated Child Development Services programme, malnutrition continues to remain a principal underlying cause of morbidity and mortality in under-5 children. This is because intrauterine growth retardation caused by inadequate nutrition during pregnancy cannot be corrected later on. It is an alarming fact that one out of three children are born in India with low birth weight (<2500 g). Coupled with unsupervised delivery and delayed complementary feeding, unhygienic sanitary practices and lack of access to safe drinking water, the average child succumbs to acute respiratory infections and diarrhea.

5.4 Malnutrition constitutes a major threat to the development potential of young children. Although surveys conducted by the National Nutrition Monitoring Bureau, Hyderabad have confirmed that there has been a declining trend in severe and moderate degrees of malnutrition amongst children, the micro-nutrient deficiencies, viz. Vitamin A, iron and iodine have been affecting children in various degrees. The national data indicates that although the proportion of nutritional blindness has reduced drastically, yet the sub-clinical deficiency of vitamin A still continues.

5.5 Other health concerns of the children are vaccine preventable diseases, birth asphyxia, injury and disability, Mother to Child Transmission (MTCT) of HIV and iodine deficiency disorders. While India has achieved great success with the Pulse Polio Campaign, reports indicate that this has affected routine immunization under the Universal Immunization Programme where the coverage has slipped in recent times. Birth asphyxia is linked to lack of resuscitation facilities during delivery. Many cases of congenital birth defects and mental retardation are caused due to neglect at the time of birth, which are preventable.

5.6 A growing incidence of HIV positive mothers in the general population suggests that problem of HIV infected children may soon emerge as a serious problem to be reckoned with. The rate of transmission from a HIV positive mother to her child varies between 15 to 40% with increased risk if the child is breastfed. A child infected at birth, unlike in the case of adults with HIV has a short window period of 3-5 years before the infection overwhelms the developing immune system of the child.

5.7 Education is a right of every child. The Directive Principles of State Policy enshrined in the Constitution of India require the State to provide free and compulsory elementary education to all children up to the age of 14 years. Although there has been a substantial increase in the enrolment of children at all levels of schooling, yet 100 million children are estimated to be out of school. Most of these children are vulnerable to neglect. The NSS survey of 1977 has indicated that child labour in the country has increased to 17 million as compared to 13.6 million in 1981 and 11.3 million in 1991. As many as 4.15 lakh children live on the streets in the mega cities of Bangalore, Mumbai, Calcutta, Delhi, Hyderabad and Chennai and are exposed to all types of exploitation.

6.1 Adolescents comprise about a fifth of India's population, but they have so far not been recognized as a target of any strategy for development in the country. They are important human resource material, which can be effectively moulded and channelised for nation building. A bulk of population in this age group, particularly in the rural areas, are drop outs from schools and are vulnerable to exploitation of various sorts. The adolescent girls particularly are at high risk of anemia and mental and behavioral disorder. A three-fold strategy must be adopted for helping adolescents in the country. First, efforts should be made to retain them in the education system by progressively reducing the rate of dropouts from schools and colleges through improvement in educational facilities. Secondly, vocational training and skill development for the drop outs should be organized in various traditional and non traditional trades, depending on their aptitudes and job opportunities, to prepare them to become self sufficient economically and responsible citizens of the country. Thirdly, the nutritional requirement of the adolescents, particularly of the adolescent girls, should be a matter of special concern, since they are the potential mothers and any investment in their health and nutrition shall not only empower them to be better women, but also be an insurance against the underweight and under nourished children of the future. Improvement of health of the adolescent girl is a definite way of breaking the inter generational cycle of malnutrition in the population. The adolescent girls need also to be protected from unwanted pregnancies and sexually transmitted diseases. Reproductive health services for adolescent boys and girls is particularly needed in rural areas where adolescent marriages and pregnancies are widely prevalent.

7.1 The intervention strategy for empowering women to have informed and effective choices on their health and nutrition and for the development of children and adolescents has to be multi-pronged.

i) Convergence of service delivery at village levels

7.2 There are two main programmes in the Department of Women and Child Development, which aim at convergence of services delivery at the village level, namely, Integrated Child Development Scheme (ICDS) and Integrated Women.'s Empowennent Programme (IWEP). The ICDS network through Anganwadi Centres reaches 85% of the villages and hamlets in the country. The IWEP (erstwhile Indira Mahila Yojana) which extends to 650 blocks operates through the self help groups of women. Both these programmes can be effective vehicles for the implementation of the National Population Policy. It is therefore critical that both the schemes are universalized.

ii) Nutrition

7.3 The Supplementary Nutrition provided under the ICDS Scheme is one of the most vital components under Basic Minimum Service Programme aimed at eradication of the menace of malnutrition of children and women. The success of the programme however depends largely on adequate provision of funds to the States and UTs. An Action plan needs to be drawn up for taking up nutrition in a mission mode to cover infants, adolescent girls, pregnant and lactating mothers - the three critical links in the inter-generational cycle of malnutrition. One intervention that has successfully worked in improving nutrition levels as well as impacting favourably on retention of children in schools is the mid-day meal scheme. This has shown positive results in programmes like TINP and needs to be replicated widely.

iii) Formation of Self-Help Groups

7.4 The formation of self-help groups as a basis for the social and economic empowerment of deprived and disadvantaged women has been found to be a successful mechanism for the organization, mobilization and self development of women. This has been tested through the IMY and Swa Shakti projects of the Department of Women and Child Development and is being replicated in a number of programmes of other Departments. These groups can facilitate the process of economic empowerment through thrift and savings, training and skill upgradation and access to credit and other productive resources. They can also be instruments of social empowerment through awareness generation and convergence of delivery of schemes. With the feeling of ownership and management of their own resources and savings, poor women have been able to choose their priorities and have even been found to cover the cost of additional nutrition and health gaps. The success of this approach has resulted in universalization of this mode of organization in all the southern States. There is a need to replicate this mode throughout the country.

iv) Access to Resources

7.5 The issue of improved health and nutrition is intimately linked to access to and control over local, social, and economic structures. For women to be empowered we need to ensure

    a) equitable access and distribution of resources like land, credit etc.

    b) access to education.

This implies that resources should flow into these areas to bridge the gender gap and that systems be developed to plan, implement and monitor the 'bridging' of the gap. Various studies have shown that ownership of land tends to reduce fertility by providing an alternate means of security. Similarly education has its own impact on reproductive behaviour of both men and women. Improving the access of women/households in rural areas and urban slums to safe sources of drinking water will free them from the drudgery of fetching water and in decreasing the morbidity resulting from water-borne diseases such as diarrhoea and cholera. This will impact positively on the health and energy levels of women. Access to technologies which can reduce the drudgery of women on the various works performed by them both within and outside the household is also a very useful intervention for empowering the women.

7.6 While the Planning Commission has already incorporated the concept of Women's Component Plan in the 9th Five Year Plan whereby 30% of funds/ benefit on every women related sector actually flow to women, it is important that guidelines are finalized early so that this could be implemented effectively.

vi) Development of Gender Disaggregated Data System

7.7 One of the constraints in the preparation, implementation and monitoring of plans for the development of women is the absence of gender segregated data on various indices of development at the State, district and sub district levels. This lacunae in our statistical system should be addressed on a priority basis.

vii) Legislation

7.8 Laws should be gender sensitive and ensure equal provision and access to resources for men and women. Also there needs to be a much broader focus on implementation issues. Many of the existing statutes such as Indecent Representation of Women's Act, Minimum Wages Act, Equal Remuneration Act, and Pre-natal Diagnostic Act, Maternity Benefit Act, etc., are implemented more in their violation. A number of these Acts are under review in order to strengthen their provisions. The Maternity Benefit Act needs to be strictly implemented and expanded to cover women in the informal sector, along with provision of paid leave for a longer period.

viii) Freedom from Violence

7.9 Women and girls face violence in various forms at various stages of their life cycle. This takes the form of female foeticide and infanticide, rape, dowry death and more indirect forms such as desertion or abandonment of older women. This calls for a multipronged strategy of implementation of laws, awareness, community sanctions etc.

ix) Participation in Political Life

7.10 For empowerment, women need to have a voice in decision making and planning through adequate representation. Reservation of women in the rural and urban local bodies had enabled representation of nearly a million women at the grassroots who play a very important catalytic role in transforming the society. Similar representation in State Legislature and Parliament would further strengthen the process of empowerment of women.

x) Sustained Media Campaign

7.11 One of the most effective interventions that can take place to address the issues of attitude and mind sets of men and women, of the community and also of the functionaries of the government - the bureaucracy, police and judiciary is media campaigns. A sustained campaign through the print, electronic and folk media is necessary on various issues related to empowerment of women, health and nutrition, laws, value of the girl child, violence against women etc.

7.12 As the Sub Group was deliberating on the issue of empowerment of women, the National Policy for Empowerment of Women (NPEW) was approved by the Government. The Policy makes a series of prescriptions for the economic and social empowerment of women and for mainstreaming the gender perspective in the development process. The policy has also enjoined upon all Central and State Ministries to draw up time bound Action Plan for translating the Policy into a set of concrete actions and measurable goals to be achieved by 2010.

7.13 The Policy has also talked about identification and commitment of resources and responsibilities for implementation of the action plans and of development of suitable structures and mechanisms to ensure efficient monitoring, review and gender impact assessment of plans and policies.

National Socio Economic Goals

8.1 The objectives of National Population Policy have been conceptualised into three stages :

8.2 In pursuance of these objectives, the NPP has fixed a set of fourteen National Socio Demographic Goals to be achieved in each case by 2010. The NPEW has also urged that measurable goals to be achieved by 2010 have to be fixed in the Action Plan although these goals have not been stated in the Policy itself. Both the Action Plans of NPEW and of the medium term objectives of the NPP have taken the year 2010 as their time frame. There is urgent need therefore for operationalisation of the convergence of the two Policies through the Action Plans of the Governments at the national and State levels. In other words, the fourteen National Socio Demographic Goals should inform the preparation of the Action Plans under NPEW and to that extent guidelines should be issued by the Department of Women and Child Development to all the State Governments and Union Territories.

8.3 These fourteen National Socio Demographic Goals of NPP are:

8.4 It may be seen that out of these fourteen goals the first seven relate directly to the women and children and the remaining seven concern them indirectly, although vitally. The Sub Group deliberated on each of these goals. Judging by the pace of progress achieved in the social sectors in the last fifty years, the Sub group felt that implementation of these goals during the course of a decade may become extremely difficult and challenging unless there is commitment of adequate resources by the Central and State Governments on the social sector, particularly in the fields of health, education and nutrition and unless there is strong and effective convergence of services at the grassroot level involving all the stakeholders and the functionaries of all the related Government agencies.

8.5 Reduction of IMR to below 30 per 1000 and of MMR to below 100 per 100,000 live births from 72 and 408 at present would require identification of the blocks (i) where IMR has already reached below 30 level, (ii) where it has reached a threshold level, (iii) where it would reach the mark during the decade given the normal rate of progress already achieved, (iv) where it would need additional input and (v) where it would require substantially additional input of both child and maternal care services. At present no scientific system of continuous grading and monitoring of ICDS services, according to the level of achievements of IMR and MMR, exists at the national level. Uniform guidelines and criteria are applied to all the ICDS blocks throughout the country, irrespective of the levels of achievement. This must be replaced by a block specific flexible approach with additional anganwadi centers and additional supplementary nutrition wherever required. This should be put in place immediately in consultation with the State Governments and other stakeholders.

8.6 Although there are marked differences in the level of IMR/MMR between ICDS and non-ICDS blocks, such differences are very marginal in many blocks. In Uttar Pradesh, for example, average IMR in ICDS blocks is 86 per 1000 live births against 86.5 in non-ICDS blocks. This strongly suggests that the programme has not been properly implemented in certain States of the country. There is an urgent need for analyzing the causes of poor performance in some blocks and to take effective remedial steps for improving the level of performance in a time bound manner.

8.7 It is unfortunate that in the division of responsibilities between the Central and State Governments, Government of India have chosen the 'easy to manage' task of providing the cost administrative services and of medicines and learning materials, while entrusting the job of funding and arranging the nutrition items to the State Governments. Given the critical resource position of most of the State Governments, nutrition always remains a neglected priority for them. There are reports that the supplementary feeding programme in the States was not taken up for months together. Even the Additional Plan Assistance under Prime Minister's Gramodaya Yojana (PMGY) was not utilized for supplementary nutrition in many States. It is unfortunate that when the country is facing the problem of storage of surplus food grains procured by the Food Corporation of India, there are large number of infants and mothers who die every year due to lack of nutrition.

8.8 The country's achievement in food security must be converted into nutritional security by effectively distributing the surplus food grains at least to infants and mothers through the network of ICDS centers. This should be taken up in a mission mode, if the targets of IMR / MMR are to be achieved within the given time frame.

8.9 It is also unfortunate that the most backward areas of Bihar, Jharkhand and Uttar Pradesh, which have the highest incidence of infant and maternal mortality, have not yet been covered under the ICDS. These 450 blocks, which should have been the first charge on the programme, have been kept last in the priorities of the Government. The ICDS must immediately be extended to all the remaining blocks of the country and the unusual time lag between the sanctioning of the projects and the actual operationalisation must be reduced to a minimum. It is seen that the time lag is sometimes as high as two years, which cannot be justified by any means whatsoever.

8.10 The ICDS programme must also be effectively converged with the grassroot level programmes and infrastructure of Health and Family Welfare Departments, if the desired goals of IMR / MMR and of universal immunization of children against all vaccine preventable diseases are to be achieved. The States like Orissa and Gujrat, where such convergence has taken place, have done remarkably well, in a relatively short period of time. In most of the States the programmes suffer due to the lack of effective co ordination between the Department of Women and Child development and the Department of Health and Family Welfare. The village Panchayats and the community should also be involved more effectively with the functioning of the ICDS centers.

8.11 It is a matter of national shame that despite the Constitutional directive to the State to endeavour to provide within a period of ten years from the commencement of the Constitution, free and compulsory education for all children until they complete the age of fourteen years, more than 100 million Indian children either do not get admitted to schools or drop out. It is high time that the Directive Principle is converted into justifiable Fundamental Right of citizens and a comprehensive package of incentives and disincentives are built into our national education system to make it a reality. The Balika Samriddhi Yojana, which links payment of scholarship to girls to duration of school attendance should be implemented more vigorously and provided with adequate funds.

8.12 The average age of marriage at the national level has already reached 19.5 years and therefore achieving the target of 20 years by 2010 would seem to be an easily achievable task. But the average conceals significant regional differences. Child marriage is still a practice in many States. About 20.3% percent of girls in the rural areas are married before 18 years. 8.3% percent of fertility in India is contributed by mothers below 19 years of age and this is closely linked with pregnancy wastages ranging form pre-mature death, stillbirth, neonatal deaths, low birth weight and maternal morbidity. Therefore, region specific strategies and action plans need to be worked out to achieve this national goal.

Operational Strategies

9.1 The Action Plan under NPP 2000 has outlined operational strategies for (i) empowering women for health and nutrition, (ii) child health and survival and (iii) adolescents. (a summary is provided at Annexure I). The Sub Group considered these strategies, but while broadly agreeing with them felt that the overwhelming emphasis placed on maternity and childcare services can not be taken as 'stand alone strategies'. Rather these should be effectively integrated with the overall perspectives, strategies and programmes for empowerment of women and of development of children and adolescents, as outlined in this report.

3. Recommendations

10.1 The Sub Group makes the following recommendations for the consideration of the National Commission on Population :

Annexure-I