Though the officially family planning programme in India was launched in 1952, the birth control movement in the country is older than that. The first two birth control clinics anywhere in the world were established in Karnataka (Mysore) as far back in 1930. In those days, birth control was not talk about freely in the west as well as in India. Some people did practise it but they belong to the elite class. Some traditional method of contraception was used in India but there was no such thing as a government sponsored organised family planning programme. There was however a good deal of consciousness among the enlightened people of the country. The establishment of clinics in Karnataka is indicative of this. In December 1953, the Planning Commission recommended that a programme of family limitation and population control should (a) Obtain an accurate picture of factors which contribute to rapid increase of population. (b) Gain a fuller understanding of human fertility and the means of regulating it, (c) device speedier ways of educating the public and (d) make family planning advice and service an integral part of the services in hospitals and health centres.
Goals of the Programme:
Family welfare programme has laid down the following long term goals to be achieved by the year 2000 AD: 1. Reduction of birth rate from 29 per 1000 (in 1992) to 21 by 2000 AD 2. Reduction of death rate from 10 (in 1992) to 9 per 1000.
3. Raising couple protection rate from 43.3 (in 1990) to 60 per cent. 4. Reduction in average family size from 4.2 (in 1990) to 2.3. 5. Decrease in Infant mortality rate from 79 (in 1992) to less than 60 per 1000 live births. o. Reduction of Net Reproduction Rate from 1.48 (in 1981) to 1.
Eligible couples, target couples and couple protection rate: Family Welfare Programme can be successful only when it reaches those who are eligible and also those who are the targets. Eligible couples: An eligible couple is a currently married couple, the wife being in the reproductive age group i.e. 15 to 45 year. It is estimated that there are 150 to 180 eligible couples per 1000 population in India. Presently, there are about 144 million eligible couples in India. These couples are in need of family planning services. Eligible couples are approached by Health Workers by house to house visit in PHC area. Motivation is also done at dispensaries, clinics and hospitals. They are given contraceptives free of cost. Also sterilizations are done free of cost Target couples: They are couples who have had 2 to 3 living children. Family planning was largely directed to such couples. The definition of target couple has been gradually enlarged to include families with one child or even newly married couple. The aim is to develop acceptance of the idea of family planning from the earliest possible stage.
Couple protection rate (CPR)
It is defined as the percentage of eligible couples effectively protected against child birth by one or other methods of family planning. CPR is an indicator of the prevalence of contraceptive practice in the community. The long term demographic goal is to achieve couple protection rate of 60 per cent by the year 2000 AD.
The Renaming of “Family Planning Programme” as “Family Welfare Programme”:
The Government of India evinced greater interest in controlling population growth in 1976. During the emergency [1976-78] compulsory sterilisation was carried on at great speed through coercive measures in various places in North India. For example, in 1976, more than 76 lakh sterilisations were carried out against a target of 43 lakh. Coercive methods adopted for the implementation of the programme during this period resulted in people’s discontentment. Hence the Janata Government, which came to power soon after emergency, wanted to follow a soft policy.
It announced a comprehensive population policy in that year. Family planning programme was renamed as “Family Welfare Programme. This welfare programme has experienced several ups and downs in its performance over time.
Strategies of Family Welfare Programme (FWP)
1. Integration with health services: Family welfare programme (FWP) has been integrated with other health services instead of being a separate service. 2. Integration with maternity and child health: FWP has been integrated with maternity and child health (MCH). Public are motivated for post delivery sterilization, abortion and use of contraceptives. 3. Concentration in rural areas: FWP are concentrated more in rural areas at the level of subentries and primary health centers. This is in addition to hospitals at district, state and central levels. 4. Literacy: There is a direct correlation between illiteracy and fertility. So stress and priority is given for girl's education. Fertility rate among educated females is low. 5. Breast feeding: Breast feeding is encouraged. It is estimated that about 5 million births per annum can be prevented through breast feeding. 6. Rising the age for marriage: Under the child marriage restraint bill (1978), the age of marriage has been raised to 21 years for males and 18 years for females. This has some impact on fertility. 7. Minimum needs programme: It was launched in the Fifth Five Year Plan with an aim to raise the economical standards. Fertility is low in higher income groups. So fertility rate can be lowered by increasing economical standards. 8. Incentives: Monetary incentives have been given in family planning programmes, especially for poor classes. But these incentives have not been very effective. So the programme must be on voluntary basis. 9. Mass media: Motivation through radio, television, cinemas, news papers, puppet shows and folk dances is an important aspect of this programme.
Organisation at the centre and states that facilitate the programme.
In 1952, a Family Planning Cell was formed in the Directorate General of Health Services. A Family Planning Programme Research and Planning Committee were formed in 1953. This was replaced by the Central Family Planning Board in September, 1956 and the Central Family Planning Council in 1965. There are also three expert committees, namely the Demographic Advisory Committee, Expert Group on Scientific Aspects of Family Planning of the Indian Council of Medical research and the communication Action Research Advisory Committee. States have Family Planning Boards at the state level and committees at the district level. The State Governments have appointed special Family Planning Officers. The current pattern of financial assistance to local bodies and voluntary organisations provides for 100% assistance by the Government on all programmes of family planning, inclusive of contraceptives, sterilization facilities, education, research and training. Overall assistance to state Government is 90%.
Uneven Response of the States for the Family Welfare Programme
A state-wise break-up of the figures indicates that while some states notably Punjab, Gujarat, Maharashtra, Karnataka, Haryana and Tamil Nadu are forging ahead in the direction of family planning, some other states such as Bihar, Uttar Pradesh, Assam, Rajasthan, West Bengal, Jammu Kashmir, etc. are lagging behind.
Difficulties Involved in the Implementation of the Family Planning
Family planning had a limited success in India from account of multiple problems in implementing the programmes. The main problems are as follows: 1) Lack of suitable methods:
So far cheap, dependable and easily available means of family planning are not available in the country which the majority of the people can use. All the methods recommended are normally based on foreign medical science which are very costly for the people in general and more particularly to those people living in villages who are not able to purchase them. 2) Lack of public co-operation:
The family planning programme has failed to evoke satisfactory response from the public on account of illiteracy, ignorance, traditional outlook etc. People regard children as gift of God and they fight against those who try to interfere with the act of God. 3) Housing Problem:
Accommodation is not easily available to people in India and as a result it is difficult to employ chemical and mechanical device of family planning due to lack of privacy. 4) Resistance on social grounds:
Family welfare method are opposed to the ground that girls will lose their virginity by adopting contraceptives when they are easily allowed to have excess to the contraceptives. It is feared, it will lead to sexual relations, prostitutions etc. It is also feared that public places may become centre of fornication and purity of marriage will be destroyed. 5) Religious oppositions:
Family planning is opposed by many on the ground that it will disturb the ratio between Hindus and Non-Hindus as the family planning programme is not popular among the Muslims and the Christians. 6) Lack of publicity and official apathy:
In the country like India with large population and vast area, education, transport and communication are poorly developed. Consequently wide publicity is required to carry the message of family planning to the mass, so as to create public awareness. Even today in the rural areas people are ignorant about the need and importance and use of contraceptive. 7) Untrained and inefficient workers:
The family welfare programme suffered from the inefficiency, inexperience, ignorance etc. The officials by and large are not trained. The employees failed to convince and motivate the rural population to fulfil the target. The officials have restored to force sterilization which developed hostility towards the programme among the rural people. 8) Lack of finance:
To undertake the family planning programme on a massive scale requires adequate resources which are lacking in our country. Consequently, we are facing difficulty in spreading the family welfare programme and health services n a wider scale. Resources constraints also pose problems in conducting research and training in family welfare.
Although India was the first country in the world who launched the national family planning programme, over the years many other developing countries like China, Indonesia, Thailand have achieved a much degree of success in controlling population. With the National Health Policy adopted by the parliament in 1983, the latest figure indicates that, while efforts were made in providing better and more extensive health care, the death rate has come down but the birth rate is still very high. A sustainable effort is called for to achieve the goal of balanced population profile.
The Family Planning Programme in India is being promoted through voluntary basis as a people’s movement in keeping with the democratic tradition of the country. The two children norm is being promoted through independent choice of the family planning method. The programme is being implemented by the state government yet there is a very wide difference in the success rate, while it has considerable success in the certain state especially Kerala, Goa with the birth rate of about 19/ per thousand, it’s impact in the large Northern state like UP, Bihar, MP and Rajasthan has been limited, the birth rate in their states are still ranging from (33-37) per thousand. It is realised that people respond to the family planning programme more readily when they are assured of the survival of their children, in therefore family planning programme was for many years used Immunisation as a part of integrated programme of family welfare with special attention to the health and well being of the family, especially mothers and children.
Confronted with the serious prospect of population explosion and the inadequacy of the present statistics, radical and innovative strategies are requires to revive programme and bring about a more decline in the fertility. Population control and family welfare programme need to have a national consensus and address cultural differences. It needs to be transformed from a governmental programme to people’s movement. A different strategy is required especially for these four North Indian states like UP, Bihar, MP and Rajasthan to create immediate impact. The status of women and female literacy are given factors to achieve the programme as seen in the state of Kerala. The age of marriage is another factor.
Information, education and communication efforts are vital to the population control programme. Fortunately there has been increasing trend in the female literacy rate in the recent past years. Communication strategy should be also devised so as to be effective enough to bring about changes in their attitudes, ignorance and misconception about family planning and small family norm. All NGO’s, private sections, voluntary agencies, private medical practitioners, local bodies and Panchayats should be full involved in a massive effort for community participation. A package effective incentive should be formulated especially for younger couple in high spacing method of contraception. Thus, there is an urgent need to develop an integrated multi-sectoral strategy to handle the population problem in its entire dimension. With strong political backing, commitment of the people and vigorous implementation of new strategies, there is no reason why India should not be able to control its population within manageable limits and open the way for utilisation of its resources for improving the quality of life of its people. Strategies should be formed for different states as a common programme for the whole country will not bring uniform success.