1. NATIONAL POPULATION POLICY-2000

2. FRAMEWORK  Defining a policy and Population Policy  Need for population policy in India  Milestones in evolution of Population Policy of India  India’s demographic achievements till NPP-2000  Objectives of the NPP-2000  National socio-demographic goals for 2010  Major strategic themes in the NPP-2000  Legislation, public support and funding.  New structures for coordination of the activities  Action plan or operational strategies.  Promotional and motivational measures.  State population policies.  Conclusion.

3. WHAT IS A POLICY?  Set of Ideas or Plans that is used as a basis for decision making;  Attitude and actions of an organization regarding a particular issue;  General Statement of understanding which guide decision making.  It is more than mere statement of goals:  How the stated goals can be achieved?  Who will carry out the tasks?  In what manner? BASIS FOR A POLICY  Set of Values  Commitments  Assessment of current situation  Image of a desired future situation

4. STAGES OF POLICY PROCESS  Problem Identification and Issue Recognition  Policy Formulation  Policy Implementation  Policy Evaluation POLICIES RELATED TO HEALTH SECTOR  National Health Policy  Nutrition Policy  Population Policy

5. WHAT IS POPULATION POLICY?  Measures formulated by a range of social institutions including Government which may influence the size, distribution or composition of human population (Driver,1972).  A deliberate effort by a national government to influence the demographic variables like fertility, mortality and migration (Organski & Organski,1961)  A set of Coordinated laws aimed at reaching some demographic goal (Biurgeois-Pichat,1974)

6. WHY THERE IS A NEED FOR POPULATION POLICY IN INDIA?

7. NEED FOR POPULATION POLICY IN INDIA  On 11 th May, 2000, India had 1 billion (100 crores) people, i.e., 16 percent of the world’s population on 2.4 percent of the globe’s land area.  If current trends continue, India may overtake China by 2045, to become the most populous country in the world.  Global population : ↑ 3 folds during this century (from 2 to 6 billion)  Population of India : ↑ nearly 5 times (from 238 million to 1 billion), during the same period.  Stabilizing population is an essential requirement for promoting sustainable development with more equitable distribution.

8. TABLE: GROWTH OF POPULATION OF INDIA

9. FIGURE: GROWTH OF POPULATION OF INDIA

11. CAUSES OF HIGH POPULATION GROWTH  A large size of population in the reproductive age group (estimated contribution 58 percent).  Higher fertility due to unmet needs of contraception (estimated contribution 20 percent).  High desire for fertility due to high infant mortality rate (estimated contribution 20 percent).  Approximately 50 percent of the girls marry below the age of 18 years, resulting in a typical reproductive pattern of “too early, too frequent, too many.”  Preference for male child.  More children are preferred by poor parents as more workforce.

12. MILESTONES IN THE DEVELOPMENT OF THE NATIONAL POPULATION POLICY  1940- The sub committee on Population, appointed by the National Planning Committee, considered ‘ Family Planning and limitation of children’ essential for the interest of social economy, family happiness and national planning.  1946- The Bhore Committee reported that control of disease and famine would cause a serious problem of population growth.  1951- The Draft outline of the First Five Year Plan recognized ‘ population policy’ as an ‘essential to planning’ and ‘family planning’ as a ‘step towards improvement in health of mothers and children’.  1952- Launching of the first National Family Planning Programme in India.

13.  1976- Statement of National Population Policy, by Shri K. Singh, Minister of Health and Family planning, to deter population growth and events that contributed to it.  1977- A revised Population Policy Statement was tabled on Parliament. It emphasized the voluntary nature of the family planning programme. The term ‘Family Welfare’ replaced the term ‘Family Planning’.  1983- The National Health Policy emphasized “securing the small family norm, through voluntary efforts and moving towards the goal of population stabilization”

14.  1991- The National Development Council (NDC) appointed a committee with Shri K Karunakaran as the chairperson. The Karunakaran report endorsed by the NDC, in 1993 proposed the formulation of a National Population Policy to take:  “a long term holistic view of development, population growth and environmental protection”,  “to suggest policies and guidelines”  “ a monitoring mechanism with short, medium and long term goals”  1993 - An expert group headed by Dr. M.S. Swaminathan –asked to prepare draft of a National Population Policy to be discussed.  1994 - Report on a ‘ National Population Policy’ by the expert group circulated among members, and comments sought from the state and central agencies

15.  1997 - On 50 th anniversary of Indian independence, Prime Minister, Gujral promised to announce a National Population Policy in near future. - During 11/97 Cabinet approved draft, directed to be placed before the Parliament, but could not be placed as both the Houses stood adjourned.  1999 - Another round of consultation in 1998, and another draft finalised and placed before the Cabinet in March, 1999. - Cabinet appointed a Group of Ministers (GOM) headed by Deputy Chairman, Planning Commission, to examine the draft. - The GOM then finalised a draft, placed before the Cabinet, discussed on 19 th November 1999.

16. BACKGROUND OF THE 1976 POPULATION POLICY  In 1976, with India’s population growing rapidly, the Emergency extended for another year.  Minister of Health and Family Planning, Karan Singh, announced National Population Policy, to deter population growth.  The policy hoped to reduce the nation’s hardships, established how incentives would be allocated to those who participate in population management efforts, and sought to reduce the nation’s birth rate from 35 to 25 per 1000 by 1984.  The policy also acknowledged that the country’s population growth concerns could not wait for increased development and education to result in fertility drop.

17.  The policy called for the Education Ministry to encourage and promote girls’ education.  The population policy stated that the central government did not wish to legislate compulsory sterilization  But if a state legislature felt prepared to pass a policy making sterilization compulsory, then it could do so.  The results of population policy 1976, if measured by the number of sterilizations would be a success ( although there were false reporting).

18.  From a rights based perspective, when effectiveness is measured by deaths, violence or rights compromised in an attempt to goals of the Population Policy, initiatives were unsuccessful.  Failure was reflected by the lack of sustainability and being counter-protective to improve the nation’s health.  For example, compensation for sterilization operations rose to 10 percent of the total health budget.  It concentrated resources at one place, more of the health professionals were being used to reach sterilization goals, rather than other services towards patient welfare.

19. DEMOGRAPHIC ACHIEVEMENTS OF INDIA BEFORE NPP-2000  Reduced Crude Birth Rate from 40.8 (1951) to 26.4 (1998,SRS);  Halved the Infant Mortality Rate from 146 per 1000 live births (1951) to 72 per 1000 live births (1998, SRS);  Quadrupled the Couple Protection Rate from 10.4 percent (1971) to 44 percent (1999);  Reduced Crude Death Rate from 25 (1951) to 9.0 (1998, SRS);  Added 25 years to life-expectancy from 37 years to 62 years;  Achieved nearly universal awareness of the need for and methods of family planning, and ;  Reduced Total Fertility Rate from 6.0 (1951) to 3.3 (1997, SRS)

20. OBSERVATIONS ON THE NATIONAL POPULATION POLICY OF INDIA- 2000  3 Objectives  4 New Structures  12 Strategic Themes  14 National Socio-demographic Goals (2010)  16 Promotional and Motivational Measures  150 Interventions

21. OBJECTIVES OF THE NATIONAL POPULATION POLICY- 2000  IMMEDIATE OBJECTIVE :  to address the unmet needs for contraception,  health care infrastructure and health personnel and  to provide integrated service delivery for basic reproductive and child health care.  MEDIUM TERM OBJECTIVE:  to bring the TFR to replacement level by 2010 through vigorous implementation of intersectoral operational strategies.  LONG TERM OBJECTIVE:  achieve a stable population by 2045 at a level consistent with requirement of sustainable economic growth, social development and environmental protection.

22. NATIONAL SOCIO-DEMOGRAPHIC GOALS FOR 2010 1. Address the unmet needs for basic RCH services, supplies and infrastructure. 2. Make school education up to age 14 years free and compulsory, and reduce drop outs rate from primary and secondary school levels to below 20 percent for both boys and girls. 3. Reduce IMR to 30/1000 live births 4. Reduce maternal mortality ratio (MMR) to less than 100 per 1000 live births 5. Achieve universal immunization of children against all Vaccine Preventable Disease (VPD). 6. Promote delayed marriage for girls, at age not less than 18,and preferable after 20 years. 7. Achieve 80% institutional delivery and 100% by trained personnels

23. 8. Achieve universal access to information/ counseling services for fertility regulation and contraceptive with wide basket of choices 9.Achieve 100% registration of births, deaths, marriage, and pregnancy. 10.Containment of AIDS, and greater integration between the management of AIDS and STD. 11.Prevention and control of communicable diseases. 12.Integration of Indian system of medicine in provision of RCH services, and in reaching out to households. 13. Promote small family norm to achieve replacement level of Total Fertility Rate 2.1. 14.Bring about convergence in implementation of related social sector programmes so that family welfare become people centered programme.

24. MAJOR STRATEGIC THEMES FOR THE NPP-2000 Strategic themes must be simultaneously pursued in “stand alone” or intersectoral programmes in order to achieve the national socio-demographic goals for 2010. Following strategic themes are presented in the policy: 1.Decentralized planning and programme implementation 2.Availability of services delivery at village levels 3.Empowering women for improved health and nutrition 4.Child survival and child health 5.Meeting the unmet needs for Family Welfare Services

25. 6. Greater emphasis for underserved population group Urban Slums Tribal communities, Hill Area populations and displaced and migrant populations Adolescents Increased participation of men in planned parenthood 7. Diverse health care providers 8. Collaboration with the commitments from private agencies and NGOs 9. Involvement of Indian system of medicine in delivery of RCH services 10. Contraceptive technology and research in RCH 11. Providing health care and support for the older population 12. Information, Education and Communication.

26.  LEGISLATION:  The 42nd Constitutional amendment: Lok Sabha and Rajya Sabha seats are frozen on the basis of 1971 census were valid up to 2001 that is further extended till 2026.  79th Amendment Bill of 1992 disqualify a person for being a member of either house of legislature of a state, if he/she has more than 2 children.  PUBLIC SUPPORT: Strong support of political, community, business, professional, religious leaders, media, film stars, sports personalities, and opinion makers has been sought for small family norms.  FUNDING: National Population Policy expressed that the programme, projects and schemes promised on the goals and objectives of the policy 2000 will be adequately funded.

27. NEW STRUCTURES  The NPP-2000, is to be largely managed at the Panchayat and Nagar Palika levels, in coordination with concerned State/ UTs.  For comprehensive and multi-sectoral coordination of planning and implementation between health and family welfare on the one hand, along with schemes from various other departments (like education, nutrition, and women and child development,etc) the following structure has been proposed: 1. NATIONAL COMMISSION ON POPULATION; 2. STATE/ UT COMMISSIONS ON POPULATION; 3. COORDINATION CELL IN THE PLANNING COMMISSION; 4. TECHNOLOGY MISSION IN THE DEPARTMENT OF FAMILY WELFARE

28. PROMOTIONAL AND MOTIVATIONAL MEASURES FOR ADOPTION OF THE SMALL FAMILY NORM: Panchayats and Zila Parishads will be rewarded and honoured for exemplary performance. Balilka Samridhi Yojana (Department of Women and Child Development) provide cash incentive of Rs.500 at the birth of the girl child of birth order 1 or 2. Maternity Benefit Scheme (Department of Rural Development) provide cash incentive to mothers who have their first child after 19 years of age, for birth of the 1 and 2 child only. A Family Welfare linked Health Insurance plan will be established. Couples below the poverty line will be rewarded for their active involvement in Family Planning activities. Village- level self help groups will be set up.

29. Creches and child care centers will be opened in rural and urban slums. A wider and affordable choice of contraceptives will be made accessible. Facilities for safe abortion will be strengthened. Innovative social marketing schemes will be promoted. Ambulance services at the villages level will be strengthened. Increased vocational training schemes for girls, leading to self-employment will be encouraged. Strict enforcement of the Child Marriage Restraint Act, 1976. Strict enforcement of the Pre-Natal Diagnostic Act, 1994. Soft loans to ensure mobility of the ANMs will be increased.

30. OPERATIONAL STRATEGIES  Village self help groups to organize and provide basic services for RCH care, combined with the on going ICDS scheme.  Implement at village levels, a one-stop integrated and coordinated service delivery package for basic health care, family planning and MCH care.  Where ever these village self help groups have not developed, community midwives, practitioners of ISM, retired school teachers may be organized to perform similar functions.  At village level, the Anganwadi centre may become the pivot of basic health care activities, contraceptive counseling and supply, nutrition education and supplementation and pre school activities.  Establishment of a maternity hut in every village with equipments, supplies and medicines for safe delivery.

31.  Trained birth attendants and traditional dais should be made familiar with emergency and referral procedures.  Provide wider basket of choices in contraception through innovative social marketing schemes to reach household levels.  Improve district, sub-district and panchayat level health management.  Strengthen Community Health Centres (CHC) and Primary Health Centres to provide comprehensive essential and emergency obstetric and neo-natal care.  Strengthening skills of health personnels through various training activities.  Focus attention on men to promote the small family norm.  Sensitize train and equip rural and urban health centres and hospitals towards providing geriatric health care

32. STATE POPULATION POLICIES  Population Management falls in the concurrent list of activities envisaged in the constitutional framework of India – but state responsibility to a large extent.  Thus a new phenomena of policy formulation at state level has begun which may reintensify the efforts of Union Government.  In 1997 - land mark in the history of population policy in India, the State Government of Andhra Pradesh formulated a very well articulated Andhra Pradesh Population Policy, well before the NPP-2000.  Followed in quick succession by several other states.  Till date 17 states and UTs have formulated their state population policies.

33. TABLE: CHRONOLOGY OF THE FORMULATION OF STATE POPULATION POLICIES

34. MAHARASHTRA POPULATION POLICY  The population of Maharashtra as per census 2011 is 11.23 crores, which forms 9% of the total population of the country.  The population of Maharashtra doubled from 1901-1961.  Next double came from 1961-1991.  From 1991-2011,a decline, 22.73 to 15.99. DECADEDECADAL PERCENTAGE GROWTH OF POPULATION MAHARASHTRAINDIA 1961-197127.4524.80 1971-198124.5425.00 1981-199125.7323.85 1991-200122.7321.54

36. MAHARASHTRA POPULATION POLICY  OBJECTIVES OF THE POLICY:  1. To reduce Total Fertility Rate ( TFR) from 2.5 to 2.1 upto to 2004. 2. To reduce Infant Mortality & Maternal Mortality Significantly 3. To improve comprehensive health of family. 4. To provide special services to tribal area, small size villages ; and urban slum areas

37. GOALS DECIDED FOR VARIOUS INDICATORS INDICATORPRESENT STATUS (1998, SRS) GOALS TO ACHIEVE 20042010 Crude birth rate22.31815 Crude death rate7.66.45 Total fertility rate2.52.11.8 Infant mortality rate492515 Neonatal mortality rate 352010

38. PROPOSED ACTIVITIES AND INTERVENTIONS 1. Acceptance of small family norm Small family has been defined as one with “ two children”. 2. Compulsory acceptance of two child norm for individual benefits in government jobs. - For subsidies - Condition for government jobs- Govt. facilities will be extended to such families - Medical claims for these families only. 3. Performance of family welfare in their area to be part of officer’s assessment at various levels. 4. Improving accessibility of health services - 2 yrs compulsory post-PG rural service - Prompt implementation of service rules - Infrastructure development for NSV - “Matru Suraksha Wahini” for prompt referral in difficult areas

39. 5. Organization of FW camps with financial assistance from cooperative societies, sugar factories & other industrial establishments. 6. Strict implementation of existing acts and policies such as child marriage act, prenatal sex determination act, birth and death registration act. 7. Acceptance of small policy norm as a condition for qualifying for elections to various bodies such as Zilla Parishad, Panchayat Samiti, Cooperative societies etc. 8. Jagruk Grampanchayat Yojana 9. Improving quality of services – incentives 10. Strengthening ante, intra, post-natal services 11. Strengthening services in urban areas 12. MCH centers at village level

40. 13. Constituting Mahila Vikas Groups under the chairmanship of Hon. CM’s wife at state level and Guardian minister’s wife at district level. 14. Sudharit Savitribai Fule Kanya Kalyan Yojana - For BPL families - Sterilization on one daughter- Rs. 10,000 + 5,000 FD - Sterilization on two daughters- Rs. 5,000 + 5,000 FD

41. TABLE: 1. TARGETS SET BY NPP-2000 AND CURRENT SCENARIO

42. TABLE : TARGETS UNDER VARIOUS PLANS INDICATORTENTH PLAN GOALS (2002-2007) RCH-II GOALS (2005-2010) NPP-2000 GOALS (BY 2010) MILLENIUM DEVELOPMENT GOALS Infant Mortality Rate<45/1000<30/1000 - Under Five Mortality---Reduce by 2/3 from 1990 levels by 2015 Maternal Mortality Ratio 200/100000<100/100000 Reduce by ¾ from 1990 levels by 2015 Total Fertility Rate2.32.1 - Couple Protection Rate65% 100%-

43. CONCLUSION  In the new millennium nations are judged by the well being of their people- their level of health, education, nutrition, civil and political liberties, provisions for vulnerable and disadvantaged.  In India, vast majority of the population would become assets, if they are given means to lead a healthy and economically productive life.  Population stabilization is an inter-sectoral endeavour, and would be successful only if the action plan contained in the NPP-2000 is pursued as a national movement.

44.  REFERENCES:  National Health Policy Document, New Delhi, 2000. Govt. of India. Ministry of Health and Family Welfare.  Eleventh Five Year Plan 2007-2012. Planning Commission,Govt. of India, New Delhi.  Agarwal S. Public Health and Community Medicine Related Policies in India. Textbook of Public Health and Community Medicine, Dept of Community Medicine, AFMC, Pune in collaboration with WHO, India office, New Delhi; 1 st edition,2009.  Visaria P, Chari V. India’s Population Policy and Family Planning Programme: Yesterday, Today and Tomorrow. Do Population Policies Matter? Fertility and Politics in Egypt, India, Kenya and Mexico; The Population Council, 1998.  www.censusindia.gov.in/2011-common/CensusDataSummary.html www.censusindia.gov.in/2011-common/CensusDataSummary.html  www.populationcommission.nic.in www.populationcommission.nic.in  Khadija T. A Population Policy Transition: Human Rights and Population Politics in India during Emergency and at the present moment. Workshop “Population Politics and Reproductive Rights: State Intervention and Fertility Control.”  Dr. Reddy MR. Integrating Population into Development: Emergence of State Population Policies in India.  NRHM, Health and Population Policies. www.mohfw.nic.inwww.mohfw.nic.in  www.maha-arogya.co.in/policies www.maha-arogya.co.in/policies 