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Family Planning and development :A scheme so essential, totally pushed under the carpet

Family Planning and development :A scheme so essential, totally pushed under the carpet

Today India has 1.30 billion mouths to eat and it is set to become the most populous country by 2028. All services and amenities created are falling short of expectations with the demands of such population pressure and need for control of population growth cannot be over-emphasized. Lengthening queues in the hospital corridors and inability to get admissions in the schools or choking of the roads are only a few of the visible side effects.  Success and failure of the birth control schemes are deeply linked to 1975-76 era of emergency days, when certain leaders pushed the agenda of family planning (FP) with iron hands. The objectives were noble, yet it boomeranged on the implementers due to coercive techniques. Since then it has been willfully forgotten by the successive governments to avoid adverse political fallouts. Also it is an emotive issue in India due to mixed culture, religious faiths, caste politics etc. Therefore, the challenge is to get the scheme accepted by all groups of people. The challenge can be met only by flexible approach in implementing the policies on all target-groups, since family planning is closely linked not only to healthcare of the people, but also overall development of the country. Most failures in healthcare and other sectors are due to excessive population. Limiting the numbers is essential to the development of the country. There is no place for coercion in democratic India, on the China style. As a part of comprehensive health care, promotion of family planning by doctors and health workers should reach religious leaders, opinion leaders, social activists and general population and moreover the couples in reproductive age.  Inclusion of mass media and political will is important to control the population of our country. The reasons for population explosion are poverty, ignorance, illiteracy and lack of utilization of health services due to local myths and taboos and vote bank politics. Poor facilities and poorly trained manpower are also the reasons why we cannot provide better health education and services. More focus should be given to improving the socio-economic status of villages and urban areas so that couples concentrate on better housing, nutrition and lifestyle, than having more children.

 

Sir Joseph Bhore ( 1946)  envisaged the delivery of health care services as close to the people as possible. Has it happened? No. It requires family planning and comprehensive reproductive health services that can enable couples to choose how many children they want, regulate their fertility, and understand the importance of two child norm and helping infertile couples to have a baby, safe birth for a healthy mother and child. Many women want to control pregnancies but they do not have the knowledge and means to do so. Unmet needs among rural women are more than urban women, more in Muslims, and other religions, in uneducated women, where there is no support from the family.

A healthy birth by trained personnel or institutional delivery is the first step towards newborn health. Prevention of childhood illnesses by proper nutrition of the child and training of health workers in order to detect them as early as possible and ensure timely medical cure shall prevent childhood deaths to
provide security to the parents. Proper care of the ill child through the concept of integrated management of neonatal and childhood illnesses shall reduce childhood mortality. When there is surety that the couples have a healthy child and they have knowledge and means to take care of their child and plan for proper nutrition and education, it will encourage them for proper spacing of births. This also entails reducing maternal deaths during childbirth. It is necessary to eradicate extreme poverty and hunger and educate couples that bearing more children will never bring them out of the vicious circle of poverty and malnutrition.

There are numerous methods of contraception such as oral contraceptive pills, condoms, Intra-uterine devices, foams, spermicidal creams, depot injectable contraceptives, female condoms, lactation, amenorrhea, sub-dermal implants, and research is going on about the contraceptive vaccines. Most promising is the vaccine against beta HCG. Breastfeeding should be promoted as a method of contraception. Exclusive breastfeeding must be encouraged for at least up to 6 months which will keep babies alive and healthy and would also provide natural contraception..

After completing 2 child births couples should be encouraged to adopt a method of sterilization. No scalpel vasectomy in men is a non-invasive method with lesser side-effects and if promoted instead of tubectomy in women will encourage male participation and promote the health of the mother. There are several myths about male sterilization and in a patriarchal society, males do not want to give up their potency and women also support this system. A lot needs to be done to bring about a change in this thought process and bring about a paradigm shift. Moreover, the obsession for a male child is bringing about multiple births. Therefore, empowerment of women is an extremely important measure in supporting small family norm. Condom vending machines and depots with the health centre and ASHA worker helps in meeting the demand of couples for contraception. IUD insertion is a good FP measure but should not be carried out in a population where there is a high prevalence of sexually transmitted infections. The medical officer should also be trained for emergency contraception and safe abortion through suction evacuation.

 

It is very necessary to control the population and promote family welfare with healthy people and develop human resources and enhance the physical quality of life, raise literacy levels, combat ignorance and improve the socio-economic status of poor and increase the utilization of health services with equitable access to both rural and urban population.

 

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