SEMINAR ON NATIONAL HEALTH AND FAMILY WELFARE PROGRAMMES RELATED TO MATERNAL AND CHILDHEALTH,NATIONAL RURAL HEALTH MISSION,ROLE OF NGOS

,HEALTH CARE DELIVERY SYSTEM.

INTRODUCTION: Reproductive & Child Health Reproductive and child health are a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity. It addresses the reproductive processes, functions and systems at all stages of life. Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide, if when, and how often to do so. This definition focus on right of men and women to be informed of and to have access to safe, effective, affordable, and acceptable methods of fertility regulation of their choice, and the right to access to appropriate health care services that will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant. DEFINITION OF REPRODUCTIVE HEALTH: To summarize the definition, we can say

People have the ability to reproduce and regulate their fertility. Women are able to go through pregnancy and child birth safely. The outcome of pregnancy is successful in terms of maternal and infant well being. Couples are able to have sexual relations free of fear of unwanted pregnancy and of contracting sexually transmitted diseases. After forty care. CONCEPT OF REPRODUCTIVE HEALTH: Reproductive health does not only mean that there is no illness or disability in all respects relating with fertility, functions and mechanism of it, but it means being fine entirely in terms of mentally and socially, as well. It means, people have

freedom in making decision in the matter of their satisfactory and secure sexual life, skills of fertility and whether they will use this skill or not, when and how often they will use it. Reproductive health services are defined as series of methods, techniques and services contributing to reproductive health and state of being fine by preventing the problems of reproductive health and solving them. However, these are also not only consultancy and services concerning fertility and diseases caught by sexual way, but these services involve sexual health whose aim is to enrich life and personal relationships. As the definitions have revealed, reproductive health is based on personal rights. It is striking that many people for some reasons have not attained reproductive health and can not use their rights of reproductive health. Reasons might be as follows: insufficient information, improper or unqualified reproductive health service, high-risk sexual behaviors, discriminatory social practices, discriminations toward girls and women, and the fact that many girls and women have confined influence on their sexual and reproductive life. The youth have serious problems about attaining reproductive health and using their rights of reproductive health. Reproductive health is a concept covering both men and women. However, for women it has a significance which affects their lives directly. Health issues related to pregnancy, birth and miscarriage, only affect women. They have high-risk of getting sexually transmitted diseases. Genital tract infections cause more serious late complications in women and transmission of the infections (HIV/AIDS) in mother to babies is in question. The motives indicated above should be taken into consideration in integrated approach devoted to the youth. Reproductive health should be treated as a whole covering sexuality as well and it should be regarded as a basic right of all individuals regardless of man-woman, the old-the young. REPRODUCTIVE RIGHTS AND SEXUAL RIGHTS: In the preparation process of this section, IPPF Reproductive Rights and Sexual Rights Report which was prepared by International Planned Parenthood Federation (IPPF), was utilized as a main resource. Right to life: Every individual has right to life. No womens life should be put at risk due to pregnancy. This right comes to prominence in preventable deaths primarily. Pregnancies and births at an early age are the results of the marriages done at an early age. The fact that fertility starts at very early age has a tragic cost because of the increased risk of death of mother and baby. Pregnancies in youth period are high-risk pregnancies. Prevention of these unwanted pregnancies in

this age will reduce the risk of death of mother and baby. In the case that governments do not take any active role to prevent sexually transmitted infections including HIV/AIDS, it can cause serious outcomes which can extend up to death, which affect the youth. The life of any young people should not remain under threat for they could not reach health services, sexual health or reproductive health services or information and consultancy. Right to Freedom: Every individual has right to freedom and security. In this sense, every individual has right to continue and control their sexual life provided that they respect the others rights. Young people have right to be protected from all medical interventions except for their full, free and conscious consent about reproductive and sexual health. All individuals, especially the young, have right to be protected from being imposed fear, shame, guilt complex and misbelief on them or from other psychological factors, which prevent their sexual desire and complicate their sexual lives. Right to Equality: Every single person is born as having free, honorable and equal rights. Women and young women should be equal to men in terms of laws, regulations, customs, practices, social and cultural behavior patterns. Young people have right not to be exposed to discriminations basing on traditional gender roles. In their sexual and reproductive lives and in their utilization of health care or health services, no one can be subjected to discrimination because of their race, their color, sex or sexual orientation, marital status, family status, age, language, religion, political or other views, national or social origin. All individuals have equal rights in reaching information and education concerning reproductive health, sexual health and their rights, which will secure their health and well-being and, no matter what their race, their color, sex or sexual orientation, marital status, family status, age, language, religion, political views etc. The age group the young are in should not create barriers in their reaching reproductive health right, on the contrary a facilitator environment should be prepared to get this rights. Every women and girls have right to proper nutrition and care during their lifetime. Because of the fact that another persons approval is required, no women can be deprived of education, information and/or services concerning growth, sexual health, reproductive health and their rights and which includes ordering of fertility services, as well. All individuals have right to be protected from all sort of violence. Nobody can be exposed to discrimination due to lack of mental and physical ability.

Right to Privacy: In all sexual health and reproductive health services including informing and consultancy, privacy and the confidentiality of personal information should be provided. All women have right to make choices about fertility including safe termination of pregnancy. Providing that they have respect for others rights, all individuals have right to express their sexual orientations for a secure and satisfying sexual life, regardless of the fear of being judged, being opposed to their freedom, being exposed to social intervention. Every sexual and reproductive health services which cover informing and consultancy, should be transmitted to individuals, couples, especially to the young by remaining true to all privacy. Friendly, respectful, nonjudgmental manner especially in approaches towards the young has come into prominence. Countries should remove the legal and social obstacles in proper places, which prevent the adolescent from getting the information and care about reproductive health. Right to Freedom of Thought: Every individual has right to freedom of thought and speech about their sexual and reproductive lives. In reaching education and information about sexual and reproductive health, allindividuals have right to be protected against any restrictions deriving from thought, conscience and belief. Professional health personnel has right to reject consciously the birth control and termination of pregnancy services only when he dispatches the one who applied to service, to another professional that wants to provide immediate service. There is no such a right in case of emergency. Right to Information and Education: Every single individual has right to get education and accurate information which are presented as gender-sensitive, away from prejudices, neutral and pluralist. All individuals have right to get enough education and information which will provide them to decide fully, freely and consciously about their sexual and reproductive lives. Everybody has right to complete information about all methods regularizing fertility, and about relative benefits, risks and effectiveness of prevention of unwanted pregnancies. That sexual education is given at schools causes early and increased sexual activity, which has no evidence. On the contrary, some investigations WHO (World Health Organization) has conducted show that with that education at schools the ones who have active sexual lives have revealed an increased more secure sexual attitudes. Some studies show that there is some detention in beginning of sexual activity as parallel with the education given at schools. It is quite obvious that education should start in family and continue at schools to provide the right to education.

Right to Marriage and Choice in Family Establishment Issues: All individuals have right to be protected from marriages except from their full, free and conscious approvals. Everybody, including the ones who are unproductive or whose fertility has disrupted because of sexually transmitted infections, has right to benefit from reproductive health services. Early marriage, generally described under 18 years of age, is an attack on personal rights of young girls because it has negative effects in terms of education, economic, autonomy, physical and psychological health. Another adverse effect of early marriage is prevention of girls education rights. Lack of education rights causes the restriction of health services utilization. That the young are not mature enough for birth physiologically causes serious problems, including increase in mother-baby deaths. Risks related to premature birth are bleeding, anemia, undernourishment, confinement to bed, increased possibility of given birth by cesarean, low birth weight babies. Right to Decide Whether or not to Have a Child: Every individual has right to decide freely and consciously the number of children they will have and the interval between their children and they have right to get information and education about these matters. All women have right to reach information, education and services, which is essential for protection of reproductive health, ensuring the safe motherhood and safe termination of pregnancy. All persons have right to reach the regulation methods of safe, efficient and acceptable fertility.

NATIONAL FAMILY WELFARE PROGRAMME:

INTRODUCTION: In India ,there is a feeling that every one should get married. If a boy or a girl is not married , the parents feel the burden. The community looks down upon the individual and the family if or any reason the marriage is delayed. Children are considered as a gift and their birth should not be obstructed. Also there is a need felt by several communities to have a son to light the funeral pyre of the father. This practice too adds to more births in a family. It is necessary to briefly look into the development of family planning programme in India. That will help the readers to know the background of this service and the existing programmes.

1877: Mrs. Annie Besant: Secretary of Malthusian league placed the question of uncontrolled population before the public. 1912-1923:Margaret Sanger, a public health nurse of U.S.A. headed the birth control campaign. In 1921, she formed a birth control league. In 1923,Dr.Stopes popularized the birth control movement in England. 1925:Prof.Karveof Bombay started propaganda on birth control. 1930: Mysore started the first government sponsored birth control clinic. 1935: Indian National Congress expressed itself in favour of family planning. 1940:Smt.Rama Rao formed the family planning association of India at Bombay. 1951: Planning Commission started to formulate comprehensive programmes to check rapid growth of population. 1953:India became the first country in the world to start a birth control programme by the National Government itself .147 family planning clinics were established by the government. 1956: A central Family planning Board was established with the Union Health Minister as its Chairman, Training centres ,demographic and research centres were established. 1962:Central Family Planning Institute was established during third five year plan. Emphasis was shifted from Clinic approach to Extension approach. This involves various local leaders and voluntary organizations in carrying family planning to the people. 1965:At the recommendations of Indian Council of Medical Research , the Lippes Loop was accepted as a safe and effective contraceptive. With the introduction of this new device it became necessary to employ a large number of women doctors. During the third five year plan , family planning bureaus were organized at state level and in 199 districts. 1966:A separate Department of Family planning was established in the Ministry of health, family planning and urban development . This consisted of Secreterial wing and Technical wing. India was divided into 6 regions with offices located in Ahmedabad, Bhopal, Banglore, Calcutta, Chandigarh and lucknow to give consultation to states. A director was in charge of each region. 1969:Rs.315 million was allocated for family planning during fourth five year plan. Programme is to motivate every couple not to have more than 2 or 3 children and to bring down the birth rate from39 per 1000 to 23 per 1000 by 1978.

1970:All India Hospital post partum programme was introduced to improve the health of the mother and children through MCH and family welfare programme. 1972:Medical termination of pregnancy. 1976:National population policy was framed for the first time by the country. 1986:The National population policy was revised. 1992:Integration of Universal immunization programme and Oral Rehydration Therapy, under Child Survival and Safe Motherhood (CSSM)PROGRAMME. 1994:International Conference on population and development in Cairo recommending implementation of Unified Reproductive and Child Health Programme (RCH). 2000:The government of India have evolved a more detailed and comprehensive national population policy to promote family welfare. India was the first country in the world to implement family welfare programme on national wide basis by the government itself. However, it was only during third five year plan that family welfare programme received more priority in the health schemes of the country. According to Indian Constitution, Family welfare programme is a state subject but for proper coordination it is a centrally sponsored item. The National Family Welfare Programme has four components. (1)Administration and organization which includes recruitment of staff, getting equipment and supplies. (2)Training Medical , paramedical and social workers in this field. (3)Social and health education. (4)Supplies and services. ORGANIZATION AND ADMINISTRATION OF FAMILY WELFARE PROGRAMME IN INDIA Centre provides 100% assistance to state governments for service and educational purposes towards family planning schemes. The central governments controls the planning and financial management of the programme, training

research and evaluation. A population advisory council headed by the union minister of health and members of parliament and persons related to the field of population was set up in 1982. During the second plan period, family planning bureaus were established in every state and its headquarters with an Additional Director of Health Services and Family Programme to direct the programme. One family welfare cell is set up for each state as a link between the state and central government. At the district level, since 1963, there are District family planning bureaus under the charge of district family welfare facilities for publicity services, sterilization and for the Intra uterine contraceptive application. The District Family Welfare staff consists of: District family welfare officer Medical officers Extension educator Information officer Statistician Administrative officer Clerk/auxiliary staff 1 2 2 1 1 1 1

Urban family welfare centres are being reorganized and have been established according to the population. The urban areas have been categorized into 4 types of health posts. At present there are 1499 urban family welfare centres in the country in the country. In rural areas , family planning programme has been integrated along with maternal and child health service programme of the existing health care infrastructure .i.e. primary health care. As mentioned in the earlier chapter, additional staff has been added to carry on family planning work in primary health centres.

CENTRAL CENTRAL MINISTER OF HEALTH AND FAMILY WELFARE

SECRETARY OF HEALTH AND FAMILY WELFARE

DEPARTMENT OF FAMILY WELFARE SPECIAL SECRETARY

SECRETARIAL WING

TECHNICAL WING

JOINT SECRETARY

COMISSIONER

Add.sec.

Add.sec.

Field MCH media and communication

Policy division plan budget Add.sec.aided

Program division Add. Sec Organizes operational media