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Mini Varghese is a
Programme Officer in the Public Policy Division VHAI.
India was the first developing country to start a
population control programme way back in 1951. This
pioneering effort of adopting intervention strategies to
regulate the population growth as a national policy had a
very significant bearing on the national development
scene in the ensuing years. With the aim to achieve
control over the population explosion, the Government
from time to time reviewed its policies, adapted its
strategies and strengthened its activities in tune with
the changing demands consistent with the needs of
national development. But in spite of the family planning
programme in existence for nearly 50 years, the goal of
population stabilization still remains elusive. There can
be several reasons for this short-fall. One important
reason was that the family planning programme was started
purely a a demographic initiative, based on numerical
methods and target-oriented. There was lack of
consistency in the policies leading to variations in the
accessibility and viability in their implementation.
During the seventies there were rigid, coercive
implementation methods which caused a setback to the
entire programme. This was one issue which led to the
fall of a Government at the centre.
The subsequent Govt. renamed the family planning
programme as Family Welfare with a view to regain the
public support. But the emphasis on achieving targets
remained. During the 7th Five Year Plan (1984-89) the
family planning programme in the country was revamped by
incorporating some of the maternal and child health (MCH)
services with a focus on the health needs of women in the
reproductive age group and children under five years in
addition to providing contraceptive and spacing services
to the desirous people. The Universal Immunization
Programme (UIP) for reducing mortality and morbidity
among children under 5 years was started in 1985-86. The
objectives of the renamed MCH programmes were to improve
the health of women during pregnancy and to broaden their
contraceptive choices. The programme was vertical in its
approach and focused on fertility control. This programme
also did not fair well.
In the nineties (1992-93), during the Eighth Plan, an
integrated Child Survival and Safe Motherhood (CSSM)
programme was implemented in the country in a phased
manner. The CSSM programme included additional services
like management ofacute respiratory tract infections,
diarrhea care and emergency obstetric services. Over the
years this programme had contributed to women’s
health to an extent by broadening its scope from family
planning to maternal and child survival issues.
Even though transition had taken place in various forms,
the programme was not well integrated to meet the needs
of women. But it definitely helped reduce the mortality
and morbidity in children and women. Women’s groups,
both at national and international levels, voiced their
concern over the focus on women only during their
pregnancy and that too through medical interventions. A
technological approach to women’s health and a
family planning programme focusing more or less
exclusively on female sterilization did not take
women’s health in a proper perspective. This was not
acceptable to many. Some of the international meetings
like the International Conference on Population and
Development (ICPD) at Cairo in 1994 and Beijing
Conference in 1995 helped address some of these concerns
in the global context. The Cairo Conference, for example,
emphasized the vital linkage between population and
development focusing on meeting of individual needs of
men and women rather than the demographic targets. Key to
this approach was empowerment of women by providing them
with more choices and ensuring access to education,
health and resources through skill development and
employment as well as respect for their reproductive
rights.
The RCH programme draws its inspiration from the ICPD
guidelines. RCH is based on the principles that
"people have the ability to reproduce and regulate
their fertility; women are able to go through pregnancy
and childbirth safely, the outcome of pregnancies is
successful in terms of maternal and infant survival and
well-being, and couples are able to have sexual relations
free of fear of pregnancy and of contracting
disease". The concept of RCH was to provide to the
beneficiaries need-based, client-centred, demand-driven,
high quality and integrated health services leading to
population stabilisation. RCH aims at making available
contraceptive/terminal methods for desirous couples in
limiting their family size.
As a signatory to ICPD, the Government of India decided
to reorient the family welfare programme. The first step
towards implementing this programme was to remove the
obsession with contraceptive targets and incentives. The
new policy was known as the ‘Target Free Approach,
later renamed as community needs assessment approach. It
integrated the various programmes implemented under the
different family welfare schemes.
Some of the significant shifts in the new approach were
on decentralized planning and monitoring at the local
level identification of partnership and involvement of
community, intersectoral convergence specially with
panchayat and programme implementation with gender
sensitivity. Client satisfaction is the primary goal of
the programme and demographic impact is only secondary.
In October 1997 the new integrated package known as the
"Reproductive and Child Health" was launched
throughout the country. This was meant to provide an
integrated family welfare and health services for women
and children, with the objective of improving the
quality, coverage, effectiveness and access to these
services.The above
mentioned principles would be converted into action
through:
- improving the quality
of services for client satisfaction;
- decentralized
participatory planning;
- meeting the
individual and community needs;
- contraceptive choices
for both men and women with expanded choices for
male methods and responsibility;
- social marketing to
improve the availability and upgradation of the
level of services.
There is a wide gap
between the proposed RCH programme and the programme
originally visualized by the Government. Other than
slight modifications in the components, the programme has
not improved much in its content from the earlier CSSM.
The only additional services provided in the programme is
identification and management of Sexually Transmitted
Diseases (STDs) and Reproductive Tract Infections (RTIs).
Even though the programme loudly spoke about women in the
context of development it has not gone beyond trying to
find medical solutions to women’s health problems.
The proposed programme is silent on other crucial aspects
of women’s health like adolescent health, care of
menopaused and elderly, infertility, and strategies to
involve men for increasing male responsibility. The great
need for effective training programmes to develop skills
on planning, counselling as well as clinical management
for the successful implementation of the programme has
not been properly emphasized.
Voluntary organizations have a special role to play in
the RCH programme implementation by incoporating the
concerns which is not addressed in the RCH programme of
govt. With the advantage of their being close to the
community, they can ensure better accessibility of
services leading to greater client satisfaction. There
may be a need to upgrade clinical skills of these NGOs
through training. NGOs should visualize health in the
context of overall development, which involves their
effectively addressing the issues of female literacy,
nutrition as well as different forms of
violences/atrocities against women. This is to say that
in order to improve the status of women’s health in
India, simultaneous improvement in their socioeconomic
conditions is imperative. It is a well-proven fact that
educated women have fewer children and are in a better
position to take decisions regarding their health and
other family matters. The need of the hour is to empower
women, organize them and provide them with an atmosphere
conducive to their development. Apart from merely
providing mother and child care facilities, other health
problems of women should also be taken care of. Only in
such an event, RCH programme can make any substantive
contribution towards improving the overall women’s
health scenario of the country. What we need is not old
wine in the new bottle, but new wine in a new bottle.
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