18 Family Welfare

FAMILY FAMILY WELFAREWELFARE

..

INTRODUCTIONINTRODUCTION

India launched the national family welfare India launched the national family welfare programme in 1951programme in 1951 with the objective of with the objective of ""REDUCING THE BIRTH RATE TO THE EXTENT REDUCING THE BIRTH RATE TO THE EXTENT NECESSARY TO STABILISE THE POPULATION AT NECESSARY TO STABILISE THE POPULATION AT A LEVEL CONSISTENT WITH THE REQUIREMENT A LEVEL CONSISTENT WITH THE REQUIREMENT OF THE NATIONAL ECONOMY".OF THE NATIONAL ECONOMY".Tamil nadu is a Tamil nadu is a pioneer in the implementation of family welfare pioneer in the implementation of family welfare programme.it is viewed and implemented as a programme.it is viewed and implemented as a peoples programme involving the active co-peoples programme involving the active co-operation of many sectors and the participation operation of many sectors and the participation of the communityof the community

AIMSAIMS

At early stage it was to At early stage it was to REDUCE BIRTH BY FIXING REDUCE BIRTH BY FIXING CONTRACEPTIVE TARGETCONTRACEPTIVE TARGET

Now it has been changed to Now it has been changed to BRING DOWN BRING DOWN FERTILITY THROUGH IMPROVING MATERNAL AND FERTILITY THROUGH IMPROVING MATERNAL AND CHILD HEALTH CARECHILD HEALTH CARE

Assessment of the community needsAssessment of the community needs

DIRECTOR OF FAMILY WELFAREDIRECTOR OF FAMILY WELFARE

INCHARGE of implementation of family welfare INCHARGE of implementation of family welfare programme in the statesprogramme in the states

assisted by assisted by TWO JOINT DIRECTORSTWO JOINT DIRECTORS

TWO DEPUTY DIRECTORSTWO DEPUTY DIRECTORS

ONE CHIEF ACCOUNT OFFICER &ONE CHIEF ACCOUNT OFFICER &

ONE DEMOGRAPHERONE DEMOGRAPHER

V FIVE YEAR PLANV FIVE YEAR PLAN

The objective of the v plan (1974-79) was The objective of the v plan (1974-79) was to bring to bring down the birth ratedown the birth rate to 30 per thousand by the to 30 per thousand by the end of 1978-79. The programme was included as end of 1978-79. The programme was included as a priority sector programme during the v plan a priority sector programme during the v plan with increasing integration of family planning with increasing integration of family planning services with those of health, services with those of health, maternal and maternal and child health (MCHchild health (MCH) and nutrition, so that the ) and nutrition, so that the programme became more readily acceptable. programme became more readily acceptable.

CONTD…CONTD…

Government made it clear that there was no Government made it clear that there was no place for force or compulsion or for pressure of place for force or compulsion or for pressure of any sort under the programme and the any sort under the programme and the programme had to be implemented as an integral programme had to be implemented as an integral part of "part of "family welfarefamily welfare" relying solely on mass " relying solely on mass education and motivation. The name of the education and motivation. The name of the programme also was changed to family welfare programme also was changed to family welfare from family planning. from family planning.

VI FIVE YEAR PLANVI FIVE YEAR PLAN

In the VIplan (1980-85), certain long-term In the VIplan (1980-85), certain long-term demographic goalsdemographic goals of reaching net of reaching net reproduction rate of unity were envisaged. the reproduction rate of unity were envisaged. the implications of this were to achieve the following implications of this were to achieve the following by the year 2000 ad.by the year 2000 ad.

Reduction of average size of familyReduction of average size of family from 4.4 from 4.4 children in 1975 to 2.3 children. children in 1975 to 2.3 children.

Reduction of birth rateReduction of birth rate to 21 from the level of 33 to 21 from the level of 33 in 1978 and in 1978 and Death rateDeath rate from 14 to 9 and from 14 to 9 and Infant Infant mortality ratemortality rate from 127 to below 60. from 127 to below 60.

          Increasing the couple protectionIncreasing the couple protection level from 22% level from 22% to 60%. to 60%.

VII FIVE YEAR PLANVII FIVE YEAR PLAN

The family welfare programme during VII five The family welfare programme during VII five year plan (1985-90) was continued on a purely year plan (1985-90) was continued on a purely voluntary basis with emphasis on voluntary basis with emphasis on promoting promoting spacing methods, securing maximum community spacing methods, securing maximum community participation and promoting maternal and child participation and promoting maternal and child health carehealth care.. in order to provide facilities/services in order to provide facilities/services nearer to the door steps of population, the nearer to the door steps of population, the following steps/initiatives were taken during the following steps/initiatives were taken during the VII plan period.VII plan period.

CONTD…CONTD…

The achievements The achievements of the family welfare of the family welfare programme at the end of the VII plan wereprogramme at the end of the VII plan were

Reduction in crude birth rateReduction in crude birth rate from 41.7 (1951-61) from 41.7 (1951-61) to 30.2 (srs:1990). to 30.2 (srs:1990).

Reduction in total fertility rateReduction in total fertility rate from 5.97 (1950- from 5.97 (1950-55) to 3.8 (srs:1990). 55) to 3.8 (srs:1990).

Reduction in infant mortality rateReduction in infant mortality rate from 146 from 146 (1970-71) to 80 (srs:1990). (1970-71) to 80 (srs:1990).

   Increase in couple protection rateIncrease in couple protection rate from 10.4% from 10.4% (1970-71) to 43.3% (31.3.1990). (1970-71) to 43.3% (31.3.1990).

Setting up of a large network of service delivery Setting up of a large network of service delivery infrastructure,infrastructure,

which was virtually non-existent at the inception which was virtually non-existent at the inception of the programme. of the programme.

VIII FIVE YEAR PLANVIII FIVE YEAR PLAN

This seek to upgrade This seek to upgrade infrastructure and infrastructure and development of trained manpowerdevelopment of trained manpower have been have been continued during the 8th five year plan. Two new continued during the 8th five year plan. Two new area projects namely area projects namely India population project India population project (IPP)(IPP)-VIII-VIII and and IIX X have been initiated during the have been initiated during the 8th plan. 8th plan.

IX FIVE YEAR PLAN IX FIVE YEAR PLAN (1997-2002)(1997-2002)

Reduction in the population growth rateReduction in the population growth rate has been has been recognised as one of the priority objectives during recognised as one of the priority objectives during the ninth plan period. the ninth plan period.

  the the objectives objectives during the ninth plan are:during the ninth plan are:

i) i) to meet all the felt-needs for contraceptionto meet all the felt-needs for contraceptionii) ii) to reduce the infant and maternal morbidity and to reduce the infant and maternal morbidity and

mortalitymortality so that there is a reduction in the so that there is a reduction in the desired level of fertility.desired level of fertility.

CONTD…CONTD…

The The strategiesstrategies during the ninth plan will be: during the ninth plan will be:I) I) to assess the needs for reproductive and child to assess the needs for reproductive and child

health at PHC levelhealth at PHC level and undertake area-specific and undertake area-specific micro planning.micro planning.

II) II) to provide need-based, demand-driven, high to provide need-based, demand-driven, high quality, integrated reproductive and child health quality, integrated reproductive and child health care.care.

INFRASTRUCTURE INFRASTRUCTURE FACILITIESFACILITIES

Primary health centers - Primary health centers - 14091409

Health sub centers - Health sub centers - 8682 8682

Rural family welfare centers -Rural family welfare centers -382382

Post partum centers -Post partum centers -118118

Urban family welfare centers -Urban family welfare centers -6565

Urban health posts -Urban health posts -293293

Voluntary organization -Voluntary organization -6161

Private approved surgeries Private approved surgeries -847-847

HEALTH SUB CENTERSHEALTH SUB CENTERS

In rural area it is at the rate of one for every In rural area it is at the rate of one for every 50,000 population in plains 50,000 population in plains

One for every 30,000 population in hilly areasOne for every 30,000 population in hilly areas

These centers are looked after by-These centers are looked after by-

Trained health nursesTrained health nurses

Health inspectors Health inspectors

PRIMARY HEALTH CENTERSPRIMARY HEALTH CENTERS

There is one center for every 30,000 population in There is one center for every 30,000 population in rural areasrural areas

FunctionFunction

to provide family welfare , maternal & child to provide family welfare , maternal & child health serviceshealth services

RURAL FAMILY WELFARE RURAL FAMILY WELFARE CENTERSCENTERS

They provide family welfare servicesThey provide family welfare services

Facilities for Facilities for MTP & VasectomyMTP & Vasectomy

POST PARTUM CENTERSPOST PARTUM CENTERS

They cover 50,000 population in the urban areaThey cover 50,000 population in the urban area

Functions-Functions-

Provide an integrated package of maternal & Provide an integrated package of maternal & child health & family welfare serviceschild health & family welfare services

URBAN FAMILY WELFARE URBAN FAMILY WELFARE CENTERSCENTERS

It is functioning in medium & smaller townsIt is functioning in medium & smaller towns

It covers less than 50,000 populationIt covers less than 50,000 population

3 types are there-3 types are there-

type 1-covers population of 10,000 and lesstype 1-covers population of 10,000 and less

type 2- covers 25,00 to 50,000 of populationtype 2- covers 25,00 to 50,000 of population

type 3-covers 50,000 to 1 lakh of populationtype 3-covers 50,000 to 1 lakh of population

URBAN HEALTH POSTSURBAN HEALTH POSTS

Provides services to slum areasProvides services to slum areas

VOLUNTARY ORGANIZATIONVOLUNTARY ORGANIZATION

They receive grant from government They receive grant from government

They functions in towns except gandhigram They functions in towns except gandhigram institute institute

PRIVATE APPROVED PRIVATE APPROVED SURGERIESSURGERIES

Headed by district collector in various districtsHeaded by district collector in various districts

Facilities-Facilities-

O.TO.T

Qualified doctorsQualified doctors

Trained staffTrained staff

InstrumentsInstruments

COMMUNITY INVOLVED COMMUNITY INVOLVED PROJECTSPROJECTS

In order to foster community involvement in In order to foster community involvement in the family welfare programme, two new the family welfare programme, two new schemes have been started on pilot basis- schemes have been started on pilot basis-

FIRST SCHEMEFIRST SCHEME

Under one of these, one revenue village in Under one of these, one revenue village in every district, among villages with a every district, among villages with a population of 500 or more, will be given an population of 500 or more, will be given an award of RS.2 lakhs for achieving award of RS.2 lakhs for achieving lowering lowering of the crude birth rate, infant mortality rate of the crude birth rate, infant mortality rate and child mortality and child mortality

SECOND SCHEMESECOND SCHEME

The second scheme aims to integrate family The second scheme aims to integrate family welfare and health care into the ongoing welfare and health care into the ongoing National National Watershed Development Project For Rain Fed Watershed Development Project For Rain Fed AreasAreas (NWDPRA(NWDPRA)) of the ministry of agriculture. of the ministry of agriculture. Under this scheme, Under this scheme, the watershed level the watershed level community based management structures, community based management structures, known as the ‘Mitra Krishak Mandalknown as the ‘Mitra Krishak Mandal ( MKM)( MKM) will will conduct surveys and prepare watershed level conduct surveys and prepare watershed level family welfare and health care plansfamily welfare and health care plans.. An amount An amount of RS.5000/- will be given to each village in the of RS.5000/- will be given to each village in the watershed, for specified activities. watershed, for specified activities.

UNIVERSAL IMMUNIZATION UNIVERSAL IMMUNIZATION PROGRAMMEPROGRAMME

Universal Immunisation Programme Universal Immunisation Programme is being conducted in the country for is being conducted in the country for vaccine preventable diseases.vaccine preventable diseases.

Under this programme every year, Under this programme every year, about 25 million infants are to be about 25 million infants are to be vaccinated before they are one year vaccinated before they are one year old with old with three doses of DPT vaccinethree doses of DPT vaccine (diphtheria, pertussis and tetanus), (diphtheria, pertussis and tetanus), three doses of Polio vaccinethree doses of Polio vaccine and and one one dose each of the Measlesdose each of the Measles and and BCG BCG vaccines.vaccines.

About 27 million pregnant women About 27 million pregnant women were also to be administered were also to be administered two two doses of Tetanus Toxoid (TT) . doses of Tetanus Toxoid (TT) .

PRE-NATAL DIAGNOSTIC PRE-NATAL DIAGNOSTIC TECHNIQUESTECHNIQUES

The pre-natal diagnostic The pre-natal diagnostic techniques like amniocentesis techniques like amniocentesis and sonography are useful for and sonography are useful for the detection of genetic or the detection of genetic or chromosomal disorders or chromosomal disorders or congenital malformations or congenital malformations or sex linked disorders, etc. sex linked disorders, etc. This technology is misused on This technology is misused on a large scale for sex a large scale for sex determination of the foetus and determination of the foetus and mostly if the foetus is mostly if the foetus is pronounced as female, pronounced as female, This prompts termination of the This prompts termination of the pregnancy and brings to an end pregnancy and brings to an end the unborn child. This has led the unborn child. This has led to decline in child sex ratio.to decline in child sex ratio. According to Census 2001 According to Census 2001 reports child sex ratio in the reports child sex ratio in the age group 0-6 years has age group 0-6 years has declined from 945 in 1991 to declined from 945 in 1991 to 927 in 2001 927 in 2001

CONTD…CONTD…

In order to check female foeticide, the Pre-In order to check female foeticide, the Pre-natal Diagnostic Techniques (Regulation and natal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994, was enacted Prevention of Misuse) Act, 1994, was enacted and brought into operation from 1st January, and brought into operation from 1st January, 1996. 1996. Rules have also been framed under the Act. Rules have also been framed under the Act. The Act prohibits determination and disclosure The Act prohibits determination and disclosure of the sex of foetus .of the sex of foetus . It also prohibits any advertisements relating to It also prohibits any advertisements relating to pre-natal determination of sex and prescribes pre-natal determination of sex and prescribes punishment for its contravention. punishment for its contravention. The person who contravenes the provisions of The person who contravenes the provisions of this Act is punishable with imprisonment and this Act is punishable with imprisonment and fine.fine.

MTP PROGRAMMEMTP PROGRAMME

It is used to It is used to decrease maternal morbidity & decrease maternal morbidity & mortalitymortality

it is a it is a health care measurehealth care measure

it can also supplement family planning as large it can also supplement family planning as large percentage of women undergo MTP are willing to percentage of women undergo MTP are willing to accept accept sterilization sterilization or any or any contraception methodscontraception methods

INFORMATION EDUCATION INFORMATION EDUCATION AND COMMUNICATIONAND COMMUNICATION

Family Planning communication received a new Family Planning communication received a new impetus with the creation of the impetus with the creation of the Mass Education Mass Education Media (MEM)Media (MEM) division within the Department of division within the Department of Family Welfare during the Inter Plan period of Family Welfare during the Inter Plan period of 1966-69. Simultaneously, the media units of 1966-69. Simultaneously, the media units of Information and Broadcasting Ministry were Information and Broadcasting Ministry were strengthened for Family Planning communication. strengthened for Family Planning communication. The objective was to evolve a differential The objective was to evolve a differential communication strategycommunication strategy.. Simple messages with Simple messages with simple pictures were selected for wider simple pictures were selected for wider dissemination and through media which weredissemination and through media which were easily visible and audible easily visible and audible

TRAINING AND TRAINING AND DEVELOPMENTDEVELOPMENT

The Village Health Guide Scheme was initially The Village Health Guide Scheme was initially started as Community Health Workers’ Scheme started as Community Health Workers’ Scheme on 2nd October, 1977 in all the States except on 2nd October, 1977 in all the States except Arunachal Pradesh, J & K, Kerala and Tamil Nadu. Arunachal Pradesh, J & K, Kerala and Tamil Nadu. The Scheme was renamed as Village Health The Scheme was renamed as Village Health Guide Scheme in 1981 when it was made 100% Guide Scheme in 1981 when it was made 100% centrally sponsored scheme under Family Welfare centrally sponsored scheme under Family Welfare Programme. Programme. According to the scheme the village According to the scheme the village community selects a volunteer as Village Health community selects a volunteer as Village Health Guide who after training acts as a link between Guide who after training acts as a link between the community and the governmental health the community and the governmental health system. system.

HEALTH AND FAMILY HEALTH AND FAMILY WELFARE TRAINING WELFARE TRAINING CENTRES SCHEMECENTRES SCHEME

It have been established in the country with the It have been established in the country with the objective objective to improve the quality of services by to improve the quality of services by providing in-service orientationproviding in-service orientation

training to the medical and para- medical training to the medical and para- medical personnel engaged in the delivery of health and personnel engaged in the delivery of health and family welfare services. family welfare services.

MOTIVATIONMOTIVATION

It depends on It depends on voluntary voluntary acceptanceacceptance by the people by the people

co-operation and assistance co-operation and assistance of all official,non official of all official,non official agenciesagencies are also enlisted for are also enlisted for promotingpromoting the programmethe programme

RESEARCH & EVALUATIONRESEARCH & EVALUATION

It is contained in the field of demography & It is contained in the field of demography & communication action brought 16 demographic communication action brought 16 demographic and communication action research centers and communication action research centers situated in various statessituated in various states

FAMILY WELFARE METHODS FAMILY WELFARE METHODS FOR POSTPONING OR FOR POSTPONING OR PREVENTING BIRTHSPREVENTING BIRTHS

CONTRACEPTIONCONTRACEPTION

Two methods of contraception are there-Two methods of contraception are there-

Temporary contraceptionTemporary contraception

Permanent contraceptionPermanent contraception

METHODS OF TEMPORARY METHODS OF TEMPORARY CONTRACEPTIONCONTRACEPTION

For FemaleFor Female

--hormonalhormonal

-intra uterine devices-intra uterine devices

-barrier methods-barrier methods

-chemical methods-chemical methods

-rhythm or natural method-rhythm or natural method

For MaleFor Male

--barrier methodbarrier method

-withdrawal or coitus interrupts-withdrawal or coitus interrupts

-abstenance-abstenance

PERMANENT PERMANENT CONTRACEPTIONCONTRACEPTION

For femaleFor female

--Sterilization or tubectomySterilization or tubectomy

For maleFor male

--Male sterilization or vasectomyMale sterilization or vasectomy

ROLE OF COMMUNITY ROLE OF COMMUNITY HEALTH NURSEHEALTH NURSE

In generalIn generalIdentify people who desire to Identify people who desire to have childrenhave childrenProviding family planning Providing family planning informationinformationPlanning , participating and Planning , participating and evaluating family welfare evaluating family welfare servicesservicesSupervising and guiding other Supervising and guiding other female paramedical personnelfemale paramedical personnelInitiating and contributing Initiating and contributing towards researchtowards research

IN THE CLINICSIN THE CLINICS

Organise the physical set upOrganise the physical set up

Assist MO in conducting clinicsAssist MO in conducting clinics

Maintanence of register and Maintanence of register and recordsrecords

Teaching other concerned Teaching other concerned personnel in the clinicspersonnel in the clinics

EvaluationEvaluation

Referral services Referral services

HOME VISITSHOME VISITS

It is to supervise the field staffIt is to supervise the field staff

Classify couples in to high,medium or low parity Classify couples in to high,medium or low parity groupsgroups

Collect data of temporary and permanent used Collect data of temporary and permanent used MFPMFP

Supervise effective follow up of usersSupervise effective follow up of users

Refer when necessary to doctorRefer when necessary to doctor

Motivate the usersMotivate the users

Identify the women in need and Identify the women in need and refer them to hospital for refer them to hospital for following factors…following factors…

medicalmedical eugeniceugenic humanitarianhumanitarian socio-economicsocio-economic failure of contraceptive devicesfailure of contraceptive devices maitainence of registersmaitainence of registers

SUMMERIZATIONSUMMERIZATION

Introduction Introduction

AimsAims

Director of family welfareDirector of family welfare

Infrastructure facilitiesInfrastructure facilities

Community involved projectsCommunity involved projects

Universal immunization programmeUniversal immunization programme

Pre-natal diagnostic tecniquesPre-natal diagnostic tecniques

MTP programmeMTP programme

Information education & communicationInformation education & communication

Training and developmentTraining and development

Research & evaluationResearch & evaluation

Contraception Contraception

Role of community health nurse in family welfareRole of community health nurse in family welfare

BIBLIOGRAPHYBIBLIOGRAPHY

SWANKAR KUHAR ;COMMUNITY HEALTH SWANKAR KUHAR ;COMMUNITY HEALTH NURSING(2004);N R BROTHERS ; 2NURSING(2004);N R BROTHERS ; 2NDND EDITION ;PG EDITION ;PG 58-6458-64

PARK.K ; PREVENTIVE AND SOCIAL PARK.K ; PREVENTIVE AND SOCIAL MEDICINE(2005);18MEDICINE(2005);18THTH EDITION;PG 180-182 EDITION;PG 180-182

www.family welfare.ppt (1999-2003)www.family welfare.ppt (1999-2003)