The outreach of health programmes must be maximised to control population growth, says PP SINGH
Every year, July 11 is observed as World Population Day. India stands committed to the cause of population stabilisation. As of today, its population stands at 1.3 billion, which is a sixth of the world's total population. However, at this rate, India will, in no time, surpass China in head count.
Ever since independence, the country has made tremendous progress in reducing its overall population growth rate. However, there are many challenges in achieving the Net Replacement Ratio goal. India recognised the population issue early and is one of the pioneers to have introduced the national family planning programme in the 1950s.
Various programmes were carried out through voluntary acceptance. They were supplemented by strengthening the Maternity and Child Health and Universal Immunisation programmes. These were some of the key strategies that were implemented under the family planning exercise. However, this programme was considerably slow in making concrete impact and, thus, in 1976, a regressive approach was adopted which used permanent method of contraceptives such as tubectomy and vasectomies.
Unfortunately, during the years of the Emergency, forceful surgeries were made which made the birth control programme unpopular; and post-Emergency, this programme then experienced significant setbacks. Thereafter, family planning policies were reformed and, instead, family welfare was introduced with community need-based approach as its focus. later, during the Cairo summit in 1994, the family welfare programme was clubbed with the Reproductive and Child Health (RCH) programme.
Over the years, there has been a considerable improvement in the child birth rate and death rate. The other important indicator towards population stabilisation is the total fertility rate which too has gone down from 6.1 (1947) to 2.2 presently. Despite progress, there are challenges, especially in meeting universal primary health care targets — health for all, with greater emphasis on RCH and emergency obstetric care.
In addition to programmatic challenges, India being a multi-cultural and pluralistic country, faces issues related to uneven population growth rate within different ethnic communities. When a caste-based census causes country-wide unrest, interventions targeted at marginalised and unattended become futile. A topic which generates so much heat needs to be sensitively addressed by involving communities and their participation in welfare programmes.
A large percentage of population in India falls under the reproductive age group at present — close to 230 million. It is important that these eligible couples are educated about family planning. At the same time, easier, reliable and safe contraceptive methods need to be introduced to increase its acceptance amongst couples of all age groups. To achieve the Contraceptive Prevalence Rate of 60 per cent, one has to address the unmet need by adding more contraceptive methods, as a cafeteria approach, so that every women can choose her contraceptive method. Men should also be encouraged to take part in the overall family welfare under this holistic intervention.
Adolescents comprise a sizeable group, approximately 25 per cent of the total population. Teenage pregnancy and abortions at early ages is a serious issue which needs to be addressed with care. Although the national RCH programme encompasses adolescent health as one of the component, the effort on the ground is almost invisible. High school graduates, scoring above average in exams, are unaware about basic preventive or promotive health issue. Public health as a subject including topics such as immunisation, family welfare, sexually transmitted diseases, national health programmes, is not taught at the school level. Due to this, the youth is subjected to high risk, primarily due to ignorance.
Youths are the most vulnerable group and they need to be educated and guided to ensure a healthier India. For this, the Government must incorporate measures which specifically focus on the health care of the adolescent group — children under 10 to 19 years of age.
Public health should be mandated in the secondary school syllabus alonside subjects such as Make in India, Swachch Bharat or Skill India. Awareness generated through education will not only help improve the health of the youth, but will also impact the country's overall Human Development Index.
India can draw learnings from Indonesia which has formulated an innovative model to maximise outreach of its health programmes. Every month, under Posyandu (baby camps), the community comes together to ensure universal immunisation, child development, and family planning. Villagepradhans are made responsible to ensure that every member of the community participates in this exercise. Further, monthly meetings with block level grampradhans documents progress against key heath indicators such as antenatal and postnatal care, male-female ratio, birth and death rate, schooldrop outs etc.
A minimum high school degree is required for gram pradhans to contest elections in Indonesia; and before appointment, they receive a three months training on basic health, nutrition and sanitation. This Indonesian model of community participation in the public and reproductive health can be adopted in India to reduce population growth rates.
The following measures can be adopted under the National Health Mission: Appointing female volunteers from within the community for every 50 to 100 houses; collating information and developing a Management Information System which covers every household in the village, regular tracking of key performance indicators and documentation of progress through this MIS; attention must be given to absentees from the beneficiary group along with participating members.
(Sources of all statistical data is from the Health & Family Welfare Statistic of India, 2015. The writer is former medical superintendent, Hindu Rao Hospital)