Iam||y |ann|ng In Ind|a

Current Status Iuture Strategy

ur Sushma uure[a
AssLL Commlssloner (l)
MCPlW CCl
opu|at|on of Ind|an states
Stat|st|cs
Program/
PoIicy
GoaIs
X Five
Year PIan
(by 2007)
NPP
(by 2010)
NRHM
(by 2012)
(by
2015)
Current Status
(Reference
Year)
Infant MortaIity
Rate
45 <30 30 27 50 (2009)
MaternaI
MortaIity Ratio
200 <100 100 100 212 (2009)
TotaI FertiIity
Rate
NA 2.1 2.1 NA 2.6 (2009)
erage nnua| Dec||ne |n
MMk IMk and 1Ik
Ind|cator
1arget
2012
Status
SkS
2000
Status
SkS
200S
Current
status
(SkS
2009)
erage dec||ne]
year requ|red
between 200S12
to ach|ee target
ctua| erage
dec||ne] year
20000S 200S09
lM8 30 68 38 30 400 200 300
1l8 21 32 29 26 011 006 0
MM8 100 327 301 212 2233 1300 4200
ro[ected opu|at|on of Ind|a
201116
ro[ec ted opu|at|on of Ind|a 20012026
S hare of add|t|ona| 371 m||||on
Der|ed by I S k
S ourc e Nat|ona| C omm|s s |on on opu|at|on MCnI W 2006
Internat|ona| Compar|son on
MMk and IMk
ge at Marr|age
I|rst 8|rth |n Ind|a
Iam||y |ann|ng Users Ind|a
Contracept|e Use
Share of
D|fferent Contracept|e Methods
Source: DLHS - 3
NSV as of 1ota| Ster|||zat|on
S as of 1ota| Ster|||sat|on
aparoscop|c |gat|on as of
1ota| Ster|||sat|on
oa|s
1o brlng down MM8 Lo 100 per
100000 llve blrLhs
1o brlng down lM8 Lo 30 per 1000 llve
blrLhs
1o brlng down 1l8 Lo 21
Cb[ect|es
1o bulld an accesslble equlLable affordable and
accounLable healLh sysLem
1o accord prlorlLy Lo removlng lnequlLles glven Lhe
wlde lnLer SLaLe and lnLra SLaLe dlsparlLles rural
urban dlvlde gender lmbalance and vulnerablllLy of
dlsadvanLaged and marglnallsed secLlons
1o adopL an lnLer secLoral approach Lo hollsLlc
healLh of women and chlldren deLermlned
1o lay emphasls on prevenLlve and promoLlve
healLh care Lhrough lncreased awareness vlgorous
lLC effecLlve 8CC promoLlon of healLhy llfe sLyles
Cb[ect|es (contd)
1o recognlse Lhe paramounL lmporLance of
communlLy ownershlp clvll socleLy engagemenL
and 8l leadershlp ln sLeerlng progress
1o forge approprlaLe parLnershlps wlLh Lhe prlvaLe
secLor Lo supplemenL Lhe publlc healLh sysLem
parLlcularly ln under / un served areas
1o encourage lnnovaLlve and conLexL speclflc
healLh acLlon and approaches
Iam||y |ann|ng
Method
Ser|ce ro|der Ser|ce ocat|on Ser|ce Strategy romot|ona|
Schemes
IMI1IN ML1nCDS
M|n||ap 1ralned cerLlfled M88S
docLors SpeclallsL uocLors
PC hlgher levels O llxed uay SLaLlc Approach
O 8evlsed CompensaLlon
Scheme
O naLlonal lamlly lannlng
lnsurance Scheme
aparoscop|c
Ster|||zat|on
1ralned cerLlfled SpeclallsL
uocLors (C8C Ceneral
Surgeons)
usually CPC hlgher
levels
No Sca|pe|
Vasectomy
1ralned cerLlfled M88S
docLors SpeclallsL uocLors
PC hlgher levels
SCIN ML1nCDS
IUD 380 1ralned cerLlfled AnMs
LPvs Sns and docLors
SubcenLre hlgher levels O Cn demand
O 8evlsed CompensaLlon
Scheme
Cra| Contracept|e
|||s (CCs)
1ralned ASPAs AnMs LPvs
Sns and docLors
vlllage level
SubcenLre hlgher levels
O Cn demand
O vPnus vlllage PealLh
nuLrlLlon uays
Condoms 1ralned ASPAs AnMs LPvs
Sns and docLors
vlllage level
SubcenLre hlgher levels
O Cn demand
O vPnus
LMLkLNC CCN1kCL1ICN
Lmergency
Contracept|e |||s
(LCs)
1ralned ASPAs AnMs LPvs
Sns and docLors
vlllage level
SubcenLre hlgher levels
O Cn demand
O vPnus
lamlly lannlng Servlces
Strategy
kepos|t|on|ng the Iam||y |ann|ng rogramme
noL [usL for achlevlng populaLlon sLablllzaLlon buL
also reduclng Lhe maLernal morLallLy lnfanL and
chlld morLallLy and morbldlLy
Lnsurlng Lhe f|xed day stat|c ser|ces round the
year for dellvery of famlly plannlng servlces
Lhrough lncreaslng Lhe servlce cenLres as well as
Lhe pool of Lralned provlders
8olllng ouL Lhe comprehens|e tra|n|ng p|an for
developmenL of Lralned human resources ln
famlly plannlng servlces whlch has been an area
of concern for a longLlme
Strategy (contd)
lncreaslng Lhe LhrusL on ostpartum Iam||y |ann|ng
servlces
Commun|ty 8ased D|str|but|on of Contracept|on
Lhrough ASPAs and vPnus
Crganlzlng state Iam||y |ann|ng d|ssem|nat|on
workshops counLrywlde wlLh focus on poor
performlng sLaLes
SLaLewlde d|ssem|nat|on of ILC]8CC and adocacy
mater|a|s
romoLlng Lmergency ConLracepLlon llls (LCs) for
prevenLlng concepLlon due Lo unplanned/
unproLecLed sex
Strategy (contd)
Poldlng SLerlllsaLlon Camps ln sLaLes where
lmplemenLaLlon of luS Lakes furLher Llme and unmeL
need for llmlLlng meLhods ls hlgh
8evlsed compensaLlon scheme for sLerlllzaLlon
accepLors and 'naLlonal lamlly lannlng lnsurance
Scheme' (nllS
CuallLy Assurance CommlLLees (CACs) have been
consLlLuLed ln all Lhe sLaLes and dlsLrlcLs Lo ensure
quallLy of sLerlllzaLlon servlces and empanelmenL of
provlders and accredlLaLlon of healLh faclllLles for
sLerlllzaLlon servlces
8eposlLlonlng luu as a shorL and long Lerm spaclng
meLhod
lemale SLerlllsaLlon
Condoms
lll
luCu
Male SLerlllsaLlon
IUCD Usage |n
Ind|a s Cther Methods
Seera| rob|ems w|th IUCD
CfLen Lhey are noL lnherenL problems of luu
oor moLlvaLlon of CllenL
oor SelecLlon of Cases
oor lnserLlon Lechnlque
oor lnfecLlon prevenLlon sLraLegles
oor posL procedural counsellng
rovlder dependenL problems
oor Lralnlng
erforaLlon
Lxpulslon
lallure
LcLoplc
Some of you may hae
a bad |mpress|on of Copper 1
uon'L condemn !
look aL Lhe evldence
0
3
10
13
20
23
30

1
C
u
3
8
0

A
M
l
n
l

l
l
l
C
o
m
b
l
n
e
d

l
l
l
M
a
l
e

C
o
n
d
o
m
u
l
a
p
h
r
a
m
l
e
m
a
l
e

C
o
n
d
o
m
S
p
e
r
m
l
c
l
d
e

e
r
c
e
n
t
a
g
e
Methods
kate of regnancy W|th 1yp|ca| Use
n|gh Ia||ure kate ?
lallure percenLage of dlfferenL meLhods wlLh Lyplcal use
Source ConLracepLlve 1echnology updaLe Serleslamlly PealLh lnLernaLlonal
0
1
2
3
4
3
6
7
n
o

M
e
L
h
o
d
u
l
a
p
h
r
a
m
C
o
n
d
o
m
l
e
m
a
l
e
S
L
e
r
l
l
l
z
a
L
l
o
n
C
C

1
C
u
3
8
0
A
k

1
L
ML1nCD
LS1IM1LD LC1CIC kLNNC ND
CCN1kCL1IVLS
ow Lctop|c regnanc|es
use of 1Cu 380 A has one of Lhe lowesL raLes of ecLoplc pregnancles
Source ConLracepLlve 1echnology updaLe Serleslamlly PealLh lnLernaLlonal
91 less chance of developlng
LcLoplc Lhan conLrol
Cont|nuat|on kate
luu has one of Lhe hlghesL conLlnuaLlon raLes aL flrsL year of use
80
72
70
67
63
38
43
0
10
20
30
40
30
60
70
80
90
l
u
u
C
o
m
b
l
n
a
L
l
o
n

p
l
l
l
u
e
p
o

r
o
v
e
r
a

e
r
l
o
d
l
c
a
b
s
L
l
n
e
n
c
e
M
a
l
e

c
o
n
d
o
m
u
l
a
p
h
r
a
g
m
S
p
e
r
m
l
c
l
d
e
s
Source.Caliornia Journal o lealth-System Pharmacy
oor pos|t|on|ng of Cu1
Iau|ty Insert|on 1echn|que
Why the Ia||ures?
n|gher Infect|on rates ?
oor lnfecLlon prevenLlon
sLraLegles
rovlders noL famlllar wlLh
no Louch 1echnlque"
1ra|ned ro|der |s a MUS1
numan|st|c tra|n|ng on
2CL Mode|s
Competency
8ased 1ra|n|ng
Copper 1 |s not touched
at any stage
IUDs C||ent Informat|on
and Instruct|ons
8eLurn Lo cllnlc |mmed|ate|y lf you
Lxperlence any of Lhe warnlng slgns
AlnS"
erlod relaLed
AAbdomlnal aln
llnfecLlon
nnoL feellng well
SSLrlng
1Cu w|th safe |oad de|ce
Copper 1 kegu|ar
Lff|cacy
Cne t|me
Not re|ated to co|tus
keers|b|e
ess menstrua| upset
We|| to|erated
Cost Lffect|e
Sem| permanent
Su|tab|e for resourcepoor sett|ngs
Medlcal AlLernaLlve
Lo SLerlllsaLlon
Immense 8enef|ts
Copper Copper
380A 380A
1he mosL effecLlve reverslble
meLhod of ConLracepLlon
Can we brlng back Lhe losL glory?
nea|thy 1|m|ng Spac|ng of
regnanc|es
Def|n|t|ons
8lrLh Lo pregnancy lnLerval
Llme perlod beLween a llve blrLh and Lhe sLarL of
Lhe nexL pregnancy
8lrLh Lo blrLh lnLerval
Llme perlod beLween a llve blrLh and Lhe nexL llve
blrLh
0
0.4
0.8
1.2
1.6
2
2.4
2.8
3.2
3.6
<6 6 to 11 12 to 17 18 to 23 24 to 29 30 to 35 36 to 47 48 to 59
Pregnancy nterval (months)
Risk (odds ratio)
Miscarriage
Low Birth Weight
MaternaI Death
Pre-term Birth
$ouroes. Corde-Agude|o 2005 ard 0avarzo el a| 200Z
8|rth to regnancy Intera|s and
ke|at|e k|sk of derse Materna| er|nata| and
regnancy Cutcomes
I|nd|ngs Materna| Cutcomes
ShorL blrLh Lo pregnancy (81) lnLervals 6 monLhs
are assoclaLed wlLh lncreased rlsk of
maLernal morLallLy
lnduced aborLlon
mlscarrlage
Long 81 lnLervals of 39 monLhs are assoclaLed
wlLh lncreased rlsk of
preeclampsla*
8ources: Corde-Agude|o, A, el a|, Ellecl ol o|rlr spac|rg or ralerra| rea|lr: A sysleral|c rev|eW, 2er|oan Journa| ol Dosrerr|os ano
Syneoo|oy, 200, 0avarzo, J, la|e L, Razzaque A, Rarrar V, Ellecls ol |rlerpregrarcy |rlerva| ard oulcore ol lre preced|rg pregrarcy or
pregrarcy oulcores |r Val|ao, 8arg|adesr, 3JDS. n lnrernar|ona| Journa| ol Dosrerr|os ano Synaeoo|oy, 200Z; Corde-Agude|o, A, 8e||zar,
JV, Valerra| roro|d|ly ard rorla||ly assoc|aled W|lr |rlerpregrarcy |rlerva|: cross secl|ora| sludy. 3r Veo J, 2000, 321(Z2Z1): 1255-9
I|nd|ngs ostabort|on]ost
M|scarr|age Cutcomes
lnduced aborLlon/mlscarrlagenexL pregnancy
lnLervals of less Lhan slx monLhs are assoclaLed
wlLh lncreased rlsk of
premaLure rupLure of membranes maLernal anemla
preLerm blrLh low blrLh welghL small for gesLaLlonal
age
$ource: Corde-Agude|o, A. el a|, 'Ellecl ol lre |rlerpregrarcy |rlerva| aller ar aoorl|or or ralerra| ard per|rala| rea|lr |r
Lal|r Arer|ca, lnrernar|ona| Journa| ol Syneoo|oy ano Dosrerr|os, vo|. 89, $upp|ererl No. 1, Apr|| 2005.
8|rth to regnancy Intera|s and
Infant and ost Neonata| Morta||ty
#ursre|n $D, 2008, Vaoro lnrernar|ona|
8lrLhLoregnancy
lnLerval of
24m and 60m
are assoclaLed wlLh
hlgher lnfanL and
posL neonaLal
morLallLy
8|rth to regnancy Intera|s and
Neonata| and Lar|y Neonata| Morta||ty
#ursre|n $D, 2008, Vaoro lnrernar|ona|
8lrLhLoregnancy
lnLerval of 24m
and 60m are
assoclaLed wlLh
hlgher neonaLal and
early neonaLal
morLallLy
nea|thy regnancy Spac|ng
keduced k|sk of Mu|t|p|e derse nea|th Cutcomes
#8K8 whEN P#ECNAN6Y 066U#8 H0NTh8 AFTE# A L'E
#Th, 60HPA#E0 T0 ThE #8K8 N #EFE#EN6E C#0UP
A0'E#8E 0UT60HE N6#EA8E0 #8K
3/uce/ Abort|o3 507
H|scarr|age 2307
Newbor3 0eath (<12 mo3ths} 2237
Hater3a| 0eath 1507
Preterm |rth 707
Low |rth we|ght 07
Rulsle|r $, 2008, Vacro lrlerral|ora|
keduc|ng Materna| and
Ch||d Morta||ty
MaLernal MorLallLy
CpLlmal use of lamlly lannlng could averL 32 of
maLernal deaLhs
ln Lhe year 2000 famlly plannlng nhave averLed
90 of aborLlon relaLed and
20 of obsLeLrlc relaLed morLallLy and morbldlLy"
Chlld MorLallLy
ConservaLlvely 1 mllllon of Lhe 11 mllllon deaLhs ln
chlldren 3 could be averLed by ellmlnaLlon of lnLerblrLh
lnLervals of less Lhan 2 years LffecLlve use of posLparLum
famlly plannlng ls Lhe mosL obvlous way ln whlch
progress should be achleved"
C|e|ard el a|. 200 Larcel$er|es, $exua| ard Reproducl|ve lea|lr
vo|ure 38, Nuroer 9549, 18 November 200
2006 WnC 1echn|ca|
Consu|tat|on kecommendat|ons
8ecommendaLlon for spaclng afLer a llve blrLh
1he recommended lnLerval before aLLempLlng Lhe
nexL pregnancy ls aL leasL 24 monLhs ln order Lo
reduce Lhe rlsk of adverse maLernal perlnaLal and
lnfanL ouLcomes
8ecommendaLlon for spaclng afLer mlscarrlage or
lnduced aborLlon
1he recommended mlnlmum lnLerval Lo nexL
pregnancy should be aL leasL slx monLhs ln order Lo
reduce rlsks of adverse maLernal and perlnaLal
ouLcomes
3ource: world health 0rganization, 2006 Report of a wh0 7echnical Consultation on 8irth 3pacing
2006 WnC 1echn|ca|
Consu|tat|on kecommendat|ons
8|rth Intera|s are Short
Cn average 37 of
blrLhs ln developlng
counLrles occur less
Lhan 36 monLhs afLer
Lhe precedlng blrLh
36
27
24
26
18
13
63
61 61
38
48
36
0
10
20
30
40
30
60
70

e
r
c
e
n
L

(

)
ercent of 8|rth Intera|s that are Short
Se|ect Dee|op|ng Countr|es
2436 monLhs 24 monLhs
$ouroe. Vosr reoenr 0l$.
arge ercentage of 8|rths hae
8|rth Intera|s that are 1oo Short
4,62J
307 of b|rths are space/ |ess tha3 24 mo3ths apart
47 of b|rths are space/ |ess tha3 3 mo3ths apart
8ource: 2005 NFh8
ostpartum ear 1 Method M|x
N= 313
8orda, M. et al. 2008. ACCE33-FP
6o3/oms 37
Per|o/|c Abst|3e3ce 327
Fema|e ster|||zat|o3 17
P||| 77
Uttar Pra/esh
nea|thy 1|m|ng and Spac|ng of
regnanc|es
Summary
8lrLh Lo pregnancy lnLervals of 24 monLhs are
assoclaLed wlLh
lncreased maLernal newborn chlld deaLhs
Plgher pregnancyrelaLed morbldlLy
CreaLer malnuLrlLlon among chlldren
WPC 8ecommends a blrLh Lo pregnancy lnLerval of aL
leasL 24 monLhs for besL ouLcome
osL parLum famlly plannlng and pregnancy spaclng
programs help women Lo achleve Lhose longer
lnLervals
lndla has hlgh unmeL need for l Lherefore efforLs
need Lo focus ln LhaL area
Wn1 NLk1 ??
!rolo: $ $uroWals|y, Jrp|ego
kat|ona|e for ct|on
LargesL generaLlon of adolescenLs ever Lhe maln l demand ln
29 age group ls for spaclng meLhods (!ansen 2003)
Plgh percenLages of blrLhs occur afLer Loo shorL lnLervals
(8uLsLeln 2003)
Lven hlgher percenLages of young women (ages 1329) reporL
shorL blrLh lnLervals buL wanL longer lnLervals
Cnly 33 of posLparLum women wanL anoLher chlld wlLhln Lwo
years (8oss and Wlnfrey 2001)
SlgnlflcanL servlce dellvery gaps (!ansen and Cobb 2004)
Inst|tut|ona| De||er|es ()
5nurcc: DLH5-3 (2007-08)
5pacIng
mcthnds
8%
LImItIng
mcthnd
13.5%
Tnta! Unmct Nccd
Tnta! unmct nccd
21.5%
Need for Iam||y |ann|ng
lncreased accepLance of l meLhods (reducLlon
ln unmeL need)
lncreased opporLunlLy for provldlng l
servlces
lncreased lnsLlLuLlonal dellverles
I CI o||cy
SLrengLhen osLparLum cenLers
lamlly lannlng Counselors
Mlnllap 1ubecLomy 1ralnlng Lo Medlcal
offlcers
luCu Lralnlng Lo be scaled up Lo all
faclllLles wlLh dellvery load and lncluded
ln pre servlce Lralnlng aL Medlcal
colleges
Lnsurlng osL naLal vlslLs by ASPA
IUCD CI o||cy
Cu1 380 A ls approved for ll
Counsellng of Lhe women ln AnLenaLal
perlod early labor or lmmedlaLe
posLparLum (noL durlng acLlve phase of
labor)
lnformed consenL by Lhe cllenL
1ralned servlce provlder
laclllLy wlLh dellvery servlces and
accepLable sLandards of lnfecLlon
prevenLlon
IUCD Strategy
lnlLlaLed 1C1s ln leb March 2010 ln Safdar[ung
PosplLal uelhl (wlLh Lechnlcal supporL from
!hplego)
CynaecologlsLs/ MCs/Sns from Medlcal Colleges
and uP from 20 sLaLes Lralned (3 days Lralnlng
course)
Scallng up of 1o1 ln more medlcal colleges and
dlsLrlcL hosplLals done ln 8lhar uelhl u 1amll
nadu kerala and 8a[asLhan
Scallng up of Lralnlng of provlders ln all Lhe sLaLes
Lhrough n8PM
Strategy
CrlenLaLlon workshops for Lhe faculLy and
sLaff of Medlcal colleges also done Lo
develop a Leam of counselors aL Lhe
faclllLy
aper presenLaLlons done by Medlcal
college faculLy on luCu lnserLlons durlng
AlCCC conferences
osL parLum cenLers of Medlcal colleges
were resLrucLured Lo provlde posL parLum
l servlces and follow up of Lhe accepLors
Strategy
uevelopmenL and dlssemlnaLlon of Lralnlng
Lools and lLC maLerlal/ [ob alds(Lechnlcal
supporL from !hplego)
SupporLlve supervlslon ls belng sLrengLhened
uocumenLaLlon and lollow up ls belng
sLressed upon Lo lmprove quallLy of servlces
1lll daLe more Lhan 1welve Lhousand lnserLlon
have been successfully done by Lralned personnel
States
1 uelhl
2 uLLar radesh
3 8lhar
4 Madhya radesh
3 Assam
6 1amll nadu
7 8a[asLhan
8 Andhra radesh
9 !harkhand
10 ChhaLLlsgarh
11 Cu[araL
12 MaharashLra
13 karnaLaka
14 Paryana
13 uLLarakhand
16 Crlssa
17 kerala
18 WesL 8engal
19 Slkklm
20 Manlpur
dantages
For the cIient:
Convenience: saves time & additional visit
(accessibility)
Safe, effective, reversible, long-term method
No risk of perforation (thick wall of uterus)
No increased risk of infection
Does not affect the quantity or quality of breast
milk
Reduced perception of initial S/E like bleeding,
cramps etc.
High Motivation- acceptability
Woman has an effective method of
contraception before she leaves the hospital
dantages
For Service provider/ Site:
Certainty that woman is not pregnant
Saves time
Evaluation and separate clinical procedure
not required
Minimal additional instruments/supplies
required
|m|tat|ons
SllghLly hlgher raLe of expulslon
8 14
(w|th good techn|que 4 S)
Mean|ng 8692 retent|on
8equlres speclal Lralnlng of provlders
CLher llmlLaLlons are slmllar Lo lnLerval
luCu
MLC and ostpartum IUCD
CaLegory 4
uerperal sepsls
unresolved posLparLum hemorrhage
CaLegory 3
8eLween 48 hours and 6 weeks
ChorloamnlonlLls
rolonged 8CM 18 hours (noL menLloned ln MLC)
CaLegory 2
no condlLlons
CaLegory 1
lmmedlaLe posL placenLal or lmmedlaLe posLparLum
48 hours lnLracaessarean
6 weeks
Lxpu|s|on Issues
1o reduce expulslon
use correcL Lechnlque
place all Lhe way aL fundus
sweep lnsLrumenL Lo Lhe slde
Lake care LhaL luCu does nC1
come ouL durlng wlLhdrawal
use correcL lnsLrumenL
kelly placenLal forceps (curved
longer) may be beLLer Lhan rlng
forceps
lnserL aL Lhe correcL Llme
posLplacenLal ls beLLer
Cha||enges ahead
Scallng up Lralnlngs Lo all faclllLles ln all
dlsLrlcLs where dellverles are conducLed
Assurlng quallLy and sLandards
lncreaslng follow ups
ulssemlnaLlon of maLerlals Lo all
faclllLles
MonlLorlng and LvaluaLlon
uocumenLaLlon
1hank ou