Population Policy at National and State Level (A case of India and Rajasthan) Shiv Chandra Mathur Professor and Head Preventive & Social Medicine Medical College, Kota Rajasthan, India

Why this presentation? India with a population of more than one billion scattered in 26 states and 8 union territories provide a unique ground for studying population programs management. There is a paradigm shift in population management from exclusive contraceptive delivery to concurrent dealing of all issues in the framework of reproductive health.The steps initiated under the influence of new philosophy at country and state level may give certain clues to many other countries, struggling for betterment of their population programs. Shiv Chandra,2001

Objectives This presentation aims at: 1. Illustrating the definition of policy; 2. Steps involved in policy cycle; 3. Defining the population policy; 4. Imparting knowledge on common elements of population policies. Shiv Chandra,2001

Objectives (cont.) 5. Document the Process of Formulating Population Policy at State level in a Federal Country; 6. Review the content of National Population Policy, India 2000; 7. Review the National v/s State Population Policy. Shiv Chandra,2001

What is a Policy? 4 Set of Ideas or Plans that is used as a basis for decision making; 4 Attitude and actions of an organization regarding a particular issue; 4 General Statement of understanding which guide decision making. Shiv Chandra,2001

What is a Policy 4 It is more than mere statement of goals: 4 How the stated goals can be achieved? 4 Who will carry out the tasks? 4 In what manner? Shiv Chandra,2001

Basis for Policy 4 Set of Values 4 Commitments 4 Assessment of current situation 4 Image of a desired future situation. Shiv Chandra,2001

Four stages of Policy Process 4 Problem Identification and Issue Recognition 4 Policy Formulation 4 Policy Implementation 4 Policy Evaluation Shiv Chandra,2001

Policies related to Health Sector 4 National Health Policy 4 Nutrition Policy 4 Women Policy 4 Training Policy 4 Population Policy Shiv Chandra,2001

What is Population Policy? 4 Measures formulated by a range of social institutions including Government which may influence the size, distribution or composition of human population (Driver,1972). 4 A deliberate effort by a national government to influence the demographic variables like fertility, mortality and migration (Organski & Organski,1961) 4 A set of Coordinated laws aimed at reaching some demographic goal (Biurgeois-Pichat,1974) Shiv Chandra,2001

Types of Population Policies 4 Explicit : Document by a national government announcing its intention to affect the population growth and composition 4 Implicit : Directives not necessarily issued to influence the population growth and composition but may have the effect of doing so. Shiv Chandra,2001

Elements common to Population Policies 4 Rationale : demographic analysis 4 Objectives and Goals 4 Targets : time bound level of fertility 4 Program Measures Shiv Chandra,2001

Process of Population Policymaking 4 Developing the Constituency in favor of Population Policy 4 Identifying the arguments favoring population policy 4 Addressing the issues to a right place 4 Visualizing the form a policy should take 4 Recognizing the most advantageous time Shiv Chandra,2001

Observations on National Population Policy(NPP)India Objectives 4 4New Structures 4 12Strategic Themes 4 14 National Socio-demographic Goals (2010) 4 16 Promotional and Motivational Measures Interventions Shiv Chandra,2001

National Population Policy-2000, India aims at 4 Short Term : fulfill unmet need for contraception, strengthening the health infrastructure, integrating the services for Reproductive and Child Health. 4 Medium Term :effective implementation of inter- sector strategies to substantially reduce the TFR by Long Term : to sustain the economic growth, social development and eco-conservation, stabilise the population by Shiv Chandra,2001

Demographic Targets of NPP India (2010) 4 Fulfilling the Unmet Need for RCH 4 Free and compulsory education for children under-fourteen 4 Reducing the school dropout between boys and girls to 20 percent 4 Bringing IMR < 30 4 Bringing MMR < Increasing Immunization against VPDs to 100 percent 4 Encouraging the increase in average age at marriage of girls 4 Increasing Institutional Deliveries to 80 percent 4 > delivery by trained hands to 100 percent 4 Making contraceptive of choice available to 100 percent population Shiv Chandra,2001

Demographic Targets of NPP India (2010) Cont. 4 Enhancing the IEC coverage for RTI/STI/AIDS to cent percent population 4 Integrating allopathy with ISM for betterment of RCH services 4 Encouraging the small family norm to substantially reduce TFR 4 Coordinating the activities of social sector development to make family welfare program public oriented Shiv Chandra,2001

Strategies for NPP-2000, India 4 Decentralise the Plan and Program Implementation 4 Convergence in services at delivery points 4 Women Empowerment to mitigate nutrition/health problems of females 4 Strengthening child survival 4 Meeting the unmet need for FW 4 Special services for slums 4 Attending Adolescents 4 Increasing Male Participation Shiv Chandra,2001

Structures to be created for NPP-2000,India 4 National Population Commission under the chair of Prime Minister 4 Population Commissions in each state under the chair of Chief Ministers 4 Coordination Cell in Planning Commission at country level 4 Creating Technology Mission at national level Shiv Chandra,2001

Population Program Promotional Measures 4 providing fertility regulating information/services 4 furnishing family life/sex education information 4 improving the status of women 4 improving health and nutritional status 4 providing incentives and disincentives 4 improving research and evaluation 4 carrying out specific legal reforms to influence internal and international migration Shiv Chandra,2001

Population Policy at State level 4 India is a federation of 26 states and 6 union territories with varying development status. While Kerala in south have exemplary demographic indicators, the situation in northern states is dismal. 4 Although Population Management falls in the concurrent list of activities envisaged in the constitutional framework of India but with other issues of social development like Health, Education and Women development being in the state list of activities, state governments own the responsibilities to a large extent. Thus a new phenomena of policy formulation at state level has begun which may reintensify the efforts of Union Government. 4 Since population growth and quantum influence the development of the country at large, union government has consistently interacted with states on this subject. Shiv Chandra,2001

Rajasthan-a large state of India 4 Rajasthan located in north-west India has a land area of 3.2 million sq km with a population of 54 million(2001). It is scattered in 200 urban agglomerations and more than inhabited villages. 4 The State has one of the highest decadal population growth rate and one of the lowest literacy rate (particularly female literacy) in the country. Sex Ratio is 913 females per 1000 males. 4 Its growth rate has consistently remained above the national average. It is 28.2 percent for the period between 1ast two census( ) 4 The average age at marriage is less then 18 although a law exists to not to marry girls before they attain adulthood. 4 The involvement of male in managing the fertility and reproductive phenomena is minimal. 4 The state has one of the highest infant mortality rate. Shiv Chandra, 2001

Trends in Population Growth of Rajasthan Shiv Chandra, With the existing TFR 4.4, CPR 40 %, IMR 86 and decadal Growth Rate of 28 %, the State’s population would reach to 98.8 million by 2041 A.D 4 State’s Population Policy aims to achieve TFR 2.1 by 2016 through raising CPR to >65%.

Policy Changes Proposed in the Sate of Rajasthan 4 From Medical to Social Engineering Behavioral Change Informed Choice Participation Sustainability 4 Specific Interventions: Girl Child Education/Female Literacy; Gender Equity; Family Life Education; Legislative Measures; Enhancing Age at Marriage; Male Participation, and Strengthening IEC. Shiv Chandra,2001

Policy Interventions In State’s Population Policy of Rajasthan From Quantity to Quality Upgradation of Skills Static Centres for Steriliz’ns Improved access to services Upgradation of facilities Operations Research 4 Integrated Services for Spacing Method Antenatal Care Deliveries Post-natal Care Immunization RTI Child Care Shiv Chandra,2001

Institutions to be created for Policy Implementation in Rajastahan-India 4 State Population Council 4 Pop’n Resource Centre 4 District Level Committee 4 Block Level Committee 4 Village Level Committee Shiv Chandra,2001

Summary 4 It has been a unique event in the history of Public Health in India that in the year 2000that the Population Policies have been released at the country and state level with the goal of stabilizing Population in a large subcontinent which currently constitutes one-sixth of world’s population. It is now for students of Health Management to see, how the proposed interventions work in the coming time. Shiv Chandra,2001