CONTENTS

1. Executive Summary

2. Introduction

3. Hypothesis

4. Need for family planning

5. The reproductive revolution

6. Changing scenario of family planning in India

7. World at a glance

8. Methods of Family Planning

9. Programme Strategy

10. Participatory Monitoring

11. Participatory Planning

12. Quality of Care

13. Gender Sensitivity

14. Information, Education and Communication (IEC)

15. Suggestions

16. Conclusion

17. Bibliography

18. Annexures
 EXECUTIVE SUMMARY

The alarming population growth of India is creating increased pressure on

the infrastructure, economy, environment, and the availability of primary

health care and nutrition. In the coming years, the challenge is to introduce

innovative programmes that can help slow down the growth rate as well as

meet the basic health needs of the population, immunization family

planning and safe mother hood initiatives are some of these basic

requirements.

Many us of believe that a movement of social development such as family

planning should not and can’t remain the sole concern of the government

and it ought to be supported and supplemented by private voluntary

enterprises. There is a strong need for close co-operation and co-ordination

with official agencies and programmes for the success of family planning

work. By this effort family planning has tried to guide and influence the

national population policy and to serve as a catalytic agent to promote

programmes at different levels directed towards the ultimate goal of

population stabilisation participatory monitoring and evaluation (PM&E). It

is a different approach that involved local people, development agencies,

and policy makers deciding together how progress should be measured

and results acted upon.

Few development programs have made as significant a contribution

to reducing poverty as family planning. As a program whose benefits

touch all levels — individual, family, community, national, and global

— family planning enhances the quality of life by reducing infant

mortality, improving maternal health, and alleviating pressures on

governments to meet social and economic needs. In addition,

access to family planning can be seen as a human right and as a

means to enlarge women's life options.

In the developing world, the impact of the reproductive revolution

wrought by family planning over the past thirty years is

unmistakable: between 1960 and 1990, the average number of

children per woman declined by two-and-a-half, and fertility has

continued to decline. Nonetheless, the world's population is still

growing and will continue to do so for decades to come. The pace of

that growth could be moderated by commitment to two broad family

planning policies:

FOCUS ON UNMET NEEDS: Roughly one-fourth of married space

or limits their births but are not using any form of contraception.

These women, as potential contraceptors, represent an unmet need

for family planning.

ENHANCED PROGRAM EFFECTIVENESS: Based on extensive research

and field experience, family planning experts know the elements

needed to mount an effective program: high quality care, strategic

management, private-sector involvement, and communications.

INTRODUCTION

For over 30 years, the family planning programme in India has popularized

the small family norms. To assist couples in small families, the programme

has made available both spacing and permanent methods of contraception.

With only 2.4 percent of land area and 16 per cent of the world’s

population, India has the dubious distinction of being the second most

populated country in the world. The population has rapidly increased. Since

the time of independence. From 345 million at the time of independence; it

went up to 846m, in 1991. By year 2016, it is expected to reach 1,264

million, on an average, about 16 million people are added each year of

43,000 each day or 30 every minute.

There are a number of factors that contribute to population growth. Some

of the reasons for high fertility are high infant mortality rate, low age at

marriage and unmet need for contraceptives. A large proportion of the

population is in the reproductive age group and their reproductive decisions

contribute significantly to the population growth.

Other factors such as poor access to health facilities also impact population

growth. Since a large number of family planning acceptors are in the higher

age bracket, fertility has not reduced considerably. In other words, if people

already have several children before accepting family planning, this does

not lead to a reduction in population growth. The status of women also has

a profound impact on family planning acceptance. It has been observed

that a poor status of women and low female literacy contributes to high

fertility. Cultural factors such as son preference, the desire for old age

security and perceiving children as assets have also contributed to

population growth in India. Despite these challenges, the National Family

Planning Programme has been successful in generating almost universal

awareness of family planning. A vast infrastructure comprising health

workers and health facilities has been established to provide family

planning information and services to couples. As a result of family planning

measures, about 210 million births have been averted up to 1997. There

has been a decline in the Total Fertility Rate (TFR) or the average number

of children born to a woman. The TFR has dropped from 6 at the time of

independence about 3 in 1994. The TFR for the urban population was 2.8

in 1993. The Family Welfare Programme in India has experienced

significant growth and adaptation over the past half century since its

inception in 1951. During this period, financial investments in the

programme have substantially increased and service delivery points have

significantly expanded. Services administered through the programme

have been broadened to include immunisation, pregnancy, delivery and

postpartum care, and preventive and curative health care. The range of

Multiple stakeholders including the private sector and non-governmental

sector, have been engaged in providing contraceptive products delivered

through the programme has widened. Contraceptive services. Of late, the

programme has been integrated with the broader Reproductive and Child

Health Programme. The couple protection rate has quadrupled from 10 per
cent in 1971 to 44 per cent in 1999. Notwithstanding these achievements,

several issues continue to daunt the programme and many goals remain

under-achieved: a significant proportion of pregnancies continues to be

unplanned; the contraceptive needs of millions of women remain unmet.

Several sub-population groups including adolescents and men continue to

be neglected and under-served; and contraceptive choice remains

conspicuous by its absence, as is quality of care within the programme.

Recognition of the changes worldwide and the challenges that are faced by

the programme has led to the development of several new policies

initiatives. Recently, the programme focus has shifted away from vertical

family planning services towards the provision of comprehensive integrated

reproductive health care at all levels of the health sector . This report deals

with contraceptive use dynamics and the unmet need for contraception in

India. While discussing some of the barriers that hindered the success of

the programme, the report sheds light on new initiatives to address these

needs and assesses their impact if any.

 OBJECTIVE

To help in reducing the birth rate to the extent necessary to stabilise the

population at a level consistent with the requirement of the National

economy.

The estimates of population requiring various family planning services as

on 2001 are given below:

Total eligible couples (wife in the 177 millions

reproductive age group of 15-44)

Total no. of pregnant women 29.5 millions
Total no. of new borns 26.8 millions
Total no. of children 0-6 Years as 158 millions

per Census 2001

HYPOTHESIS
In India, gender inequalities favour men and they usually make sexual

and reproductive health decisions. Therefore, there is a growing

realisation that unless men are reached, the Reproductive and Child

Health Programme, including family welfare efforts will have limited

impact. Direct evidence on the use of male methods is scarce as men

have been excluded from most of the national surveys, and small-scale

studies exploring the contraceptive behaviour of men are limited. Data

from NFHS–2, based on the responses of currently married women,

show that one in ten currently married “couples” were using

male/couple-dependent contraceptive methods (condoms, vasectomy,

withdrawal and periodic abstinence) in 1998–99, which translates into 21

per cent of total current contraceptive prevalence. The use of

male/couple-dependent methods was as low as 2–3 per cent of currently

married couples in Mizoram, Bihar and Karnataka, and as high as 23–28

per cent of currently married couples in West Bengal, Delhi and Punjab.

Small-scale studies of women and men also reflect the limited use of

male/couple-dependent methods. For example, in a study of women in

the slums and villages in Maharashtra, male dependent methods

accounted for less than 10 per cent of total contraceptive prevalence.

However, another study of married men in Uttar Pradesh reports that

one in three current users were using either condoms or male

sterilisation.
Need for Family Planning

Family planning plays a crucial role in reducing poverty and

improving living conditions. Individuals and families benefit, and

communities and nations are strengthened.

 HUMAN RIGHTS. Family planning assists individuals to freely

choose the size of their families, a value-laden personal

decision that is widely recognized as a fundamental human

right.

 CHILD SURVIVAL. Family planning helps women delay having

their first child, lengthen the interval between births, and avoid

childbearing at advanced ages. These all increase the survival

chances of offspring.

 MATERNAL HEALTH. Pregnancy and childbirth remain a major

cause of deaths among women. By preventing pregnancy

among those likely to suffer medical complications in childbirth

— women who have already had several births, very young and

older women, and women with major health problems — family

planning saves lives. In addition, many deaths resulting from

unsafe abortions could be prevented by contraceptive use. For

example, up to 18 percent of deaths to women in Bangladesh

could be prevented if contraception replaced unsafe abortions.

 WOMEN'S LIFE OPTIONS. Having fewer children changes the

extent to which women's lives are punctuated by pregnancy,

childbearing, and childcare. For example, the average Thai

woman, who has slightly more than two children, can expect to

spend only 10 years of her life caring for a child under the age of

six, while her counterpart in Kenya, with employment

opportunities than women with large families. nearly seven

children to raise, spends 23 years — two-thirds of her

reproductive life — caring for at least one pre-school-age child.

Because women with lower fertility spend fewer years caring for

young children, they are better able to take advantage of

educational.

 REDUCED FERTILITY: Family planning also makes a major

contribution to reducing birth rates. Developing countries can

bring their birth rates and population growth in line with their

economic growth in a surer, faster, and more humane way

through voluntary family planning than through measures

sometimes practiced in traditional societies such as child neglect

and infanticide.
 THE REPRODUCTIVE REVOLUTION

Today, most industrialized countries and a handful of middle- and low-

income countries have completed a demographic transition, moving from

high to low birth and death rates. However, most developing nations are

still in the midst of this transition. Because of better hygiene and nutrition,

new technologies for disease control, and expanded medical care, death

rates in developing countries have dropped dramatically since 1950. Birth

rates have been slower to decline, resulting in record population increases.

Nevertheless, in each region of the developing world except Sub-Saharan

Africa, women are having at least one child fewer than they did 20 years

ago.

Whereas the transition from high fertility (six to eight children per

woman) to low fertility (around two children per woman) took 50 to

100 years in Western countries, experience over the past three

decades shows that organized family planning programs can cut this

time to 20 or 30 years. Furthermore, this rapid change is possible

entirely through voluntary means. Couples in the developing world

are now having roughly four children each, but if they were able to

exercise free choice and employ perfect fertility control, they would

have only three children on average. This number is still above the

number (2.1 children per woman) that would eventually lead to a

stationary population size, but most countries have found that fertility

continues to decline as couples become accustomed to controlling

their fertility. The cost of family planning programs is relatively

modest. More important, family planning investments actually save

money. Reduced maternal and child health care costs create short-

term savings that often amount to double the cost of the family

planning program; additional savings accrue as lower fertility eases

the demands on the education system.

Increased family planning expenditures are an effective, long-term

investment in human capital development and family welfare. Political

leaders and policy-makers should give family planning programs higher

priority, increase their funding, and pursue more supportive policies.

 Changing family planning scenario in India

An overview of recent evidence The Family planning Programme in India

was launched with the objective of reducing birth rates to the extent

necessary to stabilise population at a level consistent with the requirements

of the national economy. The programme has since evolved through a

number of stages, and has changed direction, emphasis and strategies.

During the first decade of its existence, family planning was considered

more a mechanism to improve the health of mothers and children than a

method of population control. Clinic-centered family planning service

deliveries, along with health education activities, were promoted during this

period. Over time however, the primary focus of the programme became

the achievement of demographic goals. With growing concerns about the

rate of population growth and its adverse effect on the pace of social and

economic development, the Third Five-year Plan period (1961–66) marked

a subtle shift in the emphasis of the programme from the welfare of women

and children to the macro objective of population stabilisation . At the same

time, an extension education approach replaced the original clinic-centered

approach, and the programme was integrated with health services. During

1965–75, the programme was further integrated with the maternal and child

health programme. This period also witnessed the introduction of time-

bound method-specific targets within the programme. As is well known, the

target-oriented approach became highly coercive during the Emergency

period (1975–77).1 The National Population Policy 1976 called for a “frontal

attack on the problems of population” and inspired state governments to

“pass suitable legislation to make family planning compulsory for citizens”

and to stop childbearing after three children, if the “state so desires”

(Srinivasan 1998). The backlash of the coercive approach compelled

subsequent governments to stress the voluntary nature of family planning

acceptance. The Population Policy 1977 clearly underscored that

“compulsion in the area of family welfare must be ruled out for all times to

come,” and emphasised the need for an educational and motivational

approach to make acceptance of family planning completely voluntary.

However, in the 1980s, the time-bound, target-oriented approach was

revived and efforts to encourage the use of reversible methods were

initiated.
 WORLD AT A GLANCE

HOW INTERNATIONAL FAMILY PLANNING PROGRAMS HAVE BEEN A

SUCCESS

THE NEED IS ACUTE

Over 120 million married women in developing nations have expressed the

desire to space their pregnancies apart or limit their childbearing, but don’t

have the means to achieve these goals. The facts associated with this lack

of family planning services are alarming:

 Every minute of every day, a woman dies from pregnancy-related

causes.

 Thirty thousand babies die every day during birth or soon after.

INTERNATIONAL FAMILY PLANNING PROGRAMS HAVE ACHIEVED

SUCCESS

According to the World Bank, “Few development programs have made as

significant a contribution to reducing poverty as family planning.” In

response to the global need and desire for international family planning,

programs have dramatically improved the quality of life around the world.

This has made the difference to millions of men, women and children in

many ways:
COUPLES ARE CHOOSING TO HAVE FEWER KIDS.

It took over 100 years for the size of the average U.S. family to fall from six

children to its current level of two. In many developing countries, a similar

shift has happened – in just a single generation!

WORLDWIDE CHANGE

With the exception of a few countries in Africa, couples almost everywhere

in the developing world are having far fewer kids than before.

EVIDENCE OF CHANGE

 KENYA: In the 1970s, the average family had 8 children. Now, the

average household has under 5 children.

 INDIA: During the 1960s, the average family included 6 children.

Thanks to access to family planning, an Indian woman today is more

likely to have between three and four children.

MORE WOMEN ARE USING MORE EFFECTIVE CONTRACEPTION

Better access to effective, modern contraception has played a critical role

in this revolution in reproductive behavior.

THE PAST

As recently as the 1960's, things were very different:

 Couples had few choices when it came to effective contraception.

 The oral contraceptive pill was just coming on the market.

 Only ten percent of women overseas used any method of family

planning.
THE PRESENT

Today, almost 500 million women in developing countries use modern

family planning methods.

 That translates to about one-half of the women of reproductive age

in the developing world.

 In many countries, the use of family planning methods has risen

dramatically.

EVIDENCE OF CHANGE

Bangladesh have cut its number of children per family nearly in half in just

four decades.

 Back in the 1960s, fewer than ten percent of women in Bangladesh

used a modern family planning method and families averaged over

six children.

 Today, 43 percent of women use a modern method, and couples are

having just above three kids on average.

THE CHALLENGE

Despite these advances, some 350 million women lack access to the full

range of contraceptive methods. And there are still about 120 married

million women who want to plan their families but are not using any

contraception at all.

POPULATION GROWTH IS SLOWING DOWN

The dramatic fall in birth rates has gradually begun to slow population

growth, which is critical for the health and well being of everyone and

everything living on this planet.

THE PAST

In the 1960s, annual population growth peaked at a little over two percent.

THE PRESENT

Population growth is now about 1.2 percent annually.

THE CHALLENGE

Even though the growth rate has slowed, we are still adding more people to

the planet than we did 30 years ago - about 77 million a year.

 Population growth is slowing in many countries, but many

populations will continue to grow.

 These positive trends can only be maintained if we continue to

support the desire of couples to have the number of children they

want.

WOMEN AND CHILDREN ARE HEALTHIER

As access to family planning has improved, women have been able to

reduce the risks related to pregnancy and childbirth. In addition, the health

and well being of children has improved dramatically in many countries.

THE PAST

In the 1960s, a child living in a developing country had a greater than 20

percent chance of dying before celebrating his or her fifth birthday.

THE PRESENT

Thankfully, the death rate has been cut in half.

THE CHALLENGE
The gains we have made in child health in some parts of the world are a

beacon to follow not the final goal.

 Too many children still continue to die from easily preventable and

treatable diseases.

 Unfortunately, the HIV/AIDS epidemic threatens to reverse the gains

made against childhood disease in some of the hardest-hit countries

in Africa.

ENVIRONMENTAL PRESSURES ARE EASING

We can reverse the damage to our natural environment, and family

planning plays a critical role in this process. Slower population growth has

helped head off and ease environmental crises in several countries.

BUT WE CAN'T FORGET

The pressure on our natural resources continues.

LIVING STANDARDS ARE IMPROVING IN MANY COUNTRIES

Though many countries are still mired in poverty, better access to family

planning has been linked to the success of many South and East Asian

countries.

A VITAL ROLE

Of course, other factors have contributed to all these improvements, but

international family planning programs have played a big part. Without the

services and information available through international family planning

programs, this profound shift in behavior may have taken much longer.
WE NEED MUCH MORE

Every day that we delay providing services to the 120 million women who

want access to family planning, thousands of women and children die

unnecessarily. The strain on our planet’s natural resources takes its toll.

WE CAN DO IT

While the problems the planet faces are huge, they are not beyond our

power to solve. The continuous support from international family planning

programs will bring us one step closer to a secure, healthy, and

environmentally balanced planet.

METHODS OF FAMILY PLANNING

The availability of family planning does more than enable women and men

to limit family size. It safeguards individual health and rights, preserves our

planet's resources, and improves the quality of life for individual women,

their partners, and their children. It provides basic information on a range of

contraceptive methods, including factors to consider when choosing a

method.

CONTRACEPTION

TEMPORARY METHODS

PERMANENT METHODS

EMERGENCY CONTRACEPTION

TEMPORARY CONTRACEPTION: These methods are for people who

wish to space out or delay pregnancies. The contraceptive action of these

methods is meant to last for a single act of sexual intercourse or for a

specific period of time (e.g., for several days, months or years, or for as

long as you continue to use the method).

1. CERVICAL CAP: A cervical cap is a soft, deep rubber cup (like a

thimble) with a firm, round rim that fits snugly over the cervix. The groove
along the inner rim improves the seal between the inner rim of the cap and

the surface of the cervix. The cervical cap comes in different sizes and

must be fit by a provider to ensure proper sizing; a fit that is too tight may

cause cervical irritation, whereas it can be dislodged if it is too loose.

Spermicide can be used to fill the dome one-third of the way before

insertion. The cap holds the spermicide against the cervix until the cap is

removed. The cervical cap that is commonly available is called the Prentif

Cavity Rim Cervical Cap.

2. MALE CONDOMS : A male condom is a thin sheath made of latex or

other materials. Latex condoms protect against pregnancy and sexually

transmitted infections (STIs), including HIV infection. Condoms that are

made of other materials may not protect against HIV infection and other

STIs.

3. FEMALE CONDOMS: A female condom is a thin, loose-fitting covering

made of polyurethane plastic that forms a pouch lining the vagina. It has

two flexible rings. The inner ring at the closed end of the condom eases

insertion into the vagina, covering the cervix and holding the condom in

place. The outer ring remains outside the vagina and covers the outer lips

of the vagina. The female condom is coated on the inside with a lubricant;

additional lubricant for the outside is provided in a small tube. This lubricant

is not spermicidal.
4. DIAPHRAGM : A diaphragm is a shallow rubber cup. You put a

contraceptive jelly (spermicide) into the diaphragm, and then put the

diaphragm into your vagina. The diaphragm covers the cervix (the opening

to the uterus).

5. Fertility awareness methods are ways to identify the days of the month

when the woman is most likely to get pregnant. You do not have sexual

intercourse on these days

6. INJECTABLES: Injectables are hormones delivered to the woman

through an injection in her arm or buttocks. Depo-Provera and Noristerat

are progestin-only injectables.

7. IUD : An IUD is a long-acting contraceptive method intended to be used

for several months or years. It is a small device that is usually made of

plastic or of plastic and copper. A doctor or trained health care worker

places the IUD in the woman's uterus. The most commonly used IUD, the

Copper T380-A, can be left in place for 10 years.

8. lam: By feeding a new baby only with breast milk, a new mother can

prevent pregnancy for up to six months if her period has not returned.

When used as a family planning method, this pattern of exclusive

breastfeeding is called the lactational amenorrhea method, or LAM.

9. PATCH : The contraceptive patch is a weekly hormonal contraceptive.

The small square, which contains estrogen and progestin, sticks to the

skin, enabling the hormones to be absorbed into the body.

10. NORPLANT IMPLANTS: Norplant implants are a long-acting

contraceptive method. They consist of six matchstick-sized plastic

capsules. A trained health care provider places Norplant implants under the

skin of your upper arm by making a very small cut. The capsules may

remain in your arm for up to five years. They have to be removed at the

end of five years, but they can be taken out at any given time before five

years.

11. COMBINED ORAL CONTRACEPTIVE PILLS (COCS): COCs are pills

made from a combination of hormones (estrogen and progestin) that

prevent pregnancy by stopping the ovaries from releasing eggs. You must

take one pill every day according to instructions.

12. PROGESTIN-ONLY PILLS (POPS): POPs are pills that use a progestin

to prevent pregnancy by stopping the ovaries from releasing eggs each

month. You must take one pill every day according to instructions.

13. SPERMICIDES: . Spermicides come as foams, jellies, creams, foaming

tablets, or vaginal suppositories. They are used to to kill the man's sperm to

prevent pregnancy.
14. VAGINAL RING : A contraceptive vaginal ring is a monthly hormonal

contraceptive. The slender, flexible, transparent ring, which is about 2

inches in diameter, provides continuous, low-dose infusions of estrogen

and a progestin that are absorbed into the body through the tissues of the

vagina.

15. WITHDRAWL : Withdrawal is a method in which the man takes his

penis out of the woman's vagina just before he ejaculates.

PERMANENT CONTRACEPTION

Surgical methods of contraception are for people who do not wish to have

any more children. The contraceptive action of these methods is meant to

be permanent; reversal of the operation may not be possible. People who

think they may want to have children in the future should consider using

temporary methods of contraception instead.

PERMANENT CONTRACEPTION FOR MEN

Permanent contraception for men is called "VASECTOMY." Traditional

vasectomy is performed via an incision in the scrotum. "No-scalpel"

vasectomy (NSV) is performed through a small puncture.

Vasectomy is a permanent method of birth control. It is a simple operation

in which the doctor ties or seals the tubes in the scrotum that carry sperm

to the penis. Vasectomy lets a man enjoy sex without causing a pregnancy.
PERMANENT CONTRACEPTION FOR WOMEN

Permanent contraception for women is called female STERILIZATION or

"tying the tubes."

Each month, one of a woman's ovaries releases an egg that moves down

one of her fallopian tubes to the uterus. If a man's sperm joins the egg, the

woman becomes pregnant. During female sterilization (a "tubal"), the tubes

are blocked so that the egg and sperm cannot meet. A tubal does not

remove any organs. It is not a hysterectomy. A tubal does not cause

menopause ("the change of life"). After a tubal, a woman's ovaries still

produce female hormones. She will continue to have monthly periods and

her sex drive and her ability to have sex will remain the same. The

operation will not change a woman's skin, breasts, or weight. The only

change is that she cannot become pregnant.

EMERGENCY CONTRACEPTION

Emergency contraception can prevent pregnancy when used shortly after

unprotected sex. While it is sometimes referred to as the "morning-after

pill," it can be provided in three different ways. The following methods of

emergency contraception are safe, simple, and increasingly available:

 COMBINED EMERGENCY CONTRACEPTIVE PILLS(ECPS) are

oral contraceptive pills containing ethinyl estradiol and

levonorgestrel that are taken for a short period of time in a higher

 dose than combined oral contraceptives, and must be started within

72 hours (three days) after unprotected sexual intercourse.

 PROGESTIN-ONLY EMERGENCY CONTRACEPTIVE PILLS

(ECPS) are oral contraceptive pills containing only levonorgestrel

that are used similarly as combined ECPs.

 COPPER-BEARING IUD can serve as emergency contraception

when inserted within approximately five to seven days after

unprotected sexual intercourse.

PROGRAMME STRATEGY
The Family Planning Programme so far had a singular objective of

reducing fertility as quickly as possible. In order to achieve this goal, the

programme employed a strategy based on contraceptive targets and cash

incentives to acceptors and providers. Data now clearly shows that this

approach has not been able to reduce fertility quickly enough.

The Family Planning Programme should address those problems by using

the following strategies:

 Community participation in planning for services and prioritizing

 Client –centered approach to service provision

 Upgraded facilities and improved training

 Emphasis on good quality care

 Absence of contraceptive targets and incentives

 Making services gender sensitive

 Multi-sectoral approach in implementing and monitoring services.

 PARTICIPATORY MONITORING

Why the interest in Participatory Monitoring in Family Planning Programme

Monitoring and evaluation (M&E) is vital if governments and aid

organisations are to judge whether development efforts have succeeded or

failed. Conventionally, it has involved outside experts coming in to measure

performance against pre-set indicators, using standardised procedures and

tools.

Participatory monitoring and evaluation (PM&E) has emerged because of a

recognition of the limitations of this conventional approach. It is attracting

interest from many quarters since it offers new ways of assessing and

learning from change that are more inclusive, and more in tune with the

views and aspirations of those most directly affected.

BEYOND THE CONVENTIONAL APPROACH

PM&E differs from conventional monitoring and evaluation approaches in

several important ways

CONVENTIONAL M&E PARTICIPATORY M&E

Who plans and Senior Managers, or Local people, project

manages the process outside experts staff, managers, &

other stakeholders,

often helped by a

facilitator.
Role of primary Provide information Design and adapt the

stakeholders’ (the only methodology, collect

intended beneficiaries): and analyse data,

share findings and link

them to action

How success is Externally defined, Internally –defined

measured: mainly quantitative indicators including

indicators more qualitative

judgements

Approach Predetermined Adaptive.

At the heart of PM&E however, are four broad principles:

 Participation

 Negotiation

 Learning

 Flexibility
 PARTICIPATORY PLANNING

People’s participation is the basis of the Family Planning Progamme as it

will depend upon the bottom-up planning approach instead of the top-down

approach that has been followed so far. The health worker will determine

her own workload on the basis of the felt needs of the community and

service needs, as determined by the number of pregnancies and births in

her area. The health workers’ action plan will make the foundation for all

action plans. Plans formulated at the Sub-Center and PHC level will be

integrated to form the District Action Plan. The State Action Plan will, in

turn, be an aggregation of the District Action Plans. The National Plan for

supplying material to the states will be based on the State Action Plans.

The key aspects of the participatory planning approach are:

 Bottom –up instead of top-down planning

 Involvement of the community in planning, implementing and monitoring

 Estimation of health care needs of the population to be served by health

workers

 Absence of pre-determined targets set at higher levels.

PREVIOUS APPROACH

National level Set targets

Accept targets
State level

Break down targets

District level
Distribute targets

Primary Health
centre

Sub centre
Implement targets

FEATURES

 Serlization targets

 Camp-oriented approach

 Cash incentives for sterilization cases

 Burden on health worker

 Neglect of quality

 Inflation of target statistics

NEW APPROACH

Strategies and
Computation

National
Level

State level Reports Results

Support and
District level monitor
implementation

Facilitate
Primary Health Implementation
Centre
Set goals
Sub-centre

Participate in goal-setting

FEATURES

 Needs-based Participatory planning

 Community involvement in planning, monitoring and surveillance

 Multisectoral participation in health services

 Self estimated goals by health workers

 Integrated package of services

 Good quality of care

 Educating community to adopt correct health practices

QUALITY OF CARE

Provision of good quality care is the crux of the family planning. Quality has

not been given adequate attention in Family Planning Programme. This is

one of the reasons why people have not availed family planning services to

the desired extent. Every individual desires good quality of care when

seeking family planning services. Good quality of care ensures satisfied

clients, who in turn come back for services if they are satisfied. Therefore,

provision of good quality care by health workers will determine the overall

success of the programme.

WHAT IS QUALITY OF CARE?

Quality of care is what we want for ourselves and our family. The manner in

which a client is treated determines quality of care. Even though quality

may seem like a minor thing in front of the mammoth task of services

provision, it’s the little things that make a big difference.

Factors that determine good quality of care:

 Promoting informed choice

 Needs-based service delivery

 Providing follow-up care

INTERPERSONAL COMMUNICATION

 Friendly and cooperative attitude of health workers.

 Spending time with the client

 Caring for client’s privacy and dignity

TECHNICAL FACTORS

 Technical competence of service providers

 Usage of good quality equipment and drugs

 Maintaining highest standards of hygiene

SOCIAL ASPECTS

 Gender sensitive service provision

 Encouraging male participation

 Increased role of women in the programme

It is important to care for quality

 Only if clients are satisfied with the quality of services will they return to

seek additional services.

 In the absence of targets, work will now be assessed using

achievement of indicators of quality.

 Quality of care is not a one-time effort, it’s an ongoing process. A

relationship of care has to be built with a client both inside and outside

the health centre. If health workers fully inform and motivate both men &

women to seek services during their field visits, they are more likely to

come to the health centre for services. On getting the services, they

have to be followed up regularly in their communities to rule out

complications and determine if additional services are required.

 GENDER SENSITIVITY

Gender sensitivity is an important consideration in the provision of good

quality care. Making the Family Planning Programme gender sensitive or

responsive to the needs of women must be an important concern for

everyone involved in planning and implementation. The following are some

strategies that are aimed at making the programme gender sensitive.

 Focussing on women’s participation

 Encouraging male participation in family planning

 Keeping clinics open at time suitable to women

 Training in gender sensitivity for service providers

 Getting men & women’s feedback in monitoring

 Encouraging involvement of panchatyats that now have thirty per cent

women members.

Under the new programme, special attention will be paid to Family

Planning. Family planning and service delivery will get priority. Health

services, in rural and urban areas will no longer be centre-based, outreach

services will also be introduced. Health workers will be allocated a defined

population around post-partum centres to which they will provide outreach

services. The workers will also be trained in participatory planning so that

they can actively involve community members and women’s groups in the
programme. Regular supply of contraceptive materials and equipments to

rural and urban health centres will be ensured.

INFORMATION EDUCATION COMMUNICATION

(IEC)

There is a wide gap between awareness about health and family planning

and acceptance of services. Even where services are available, people

often do not know about them. Even when awareness is high, attitudes do

not necessarily change or new behaviours practiced.

COMMUNICATIONS

Family planning, both public and private programs have to call the

attention of potential users to contraceptives — sometimes as a new

product they were not previously aware of, to make the product

attractive, and to show it to be safe. This effort is essentially

educational — it is aimed at producing satisfied and effective users

— but has to be accomplished with the skill and tact of modern

public relations and advertising, so that family planning messages

resonate in the public consciousness.

Communication activities have to reach not only potential married

users (both female and male) but also

 family members or others who could influence potential users;

 sexually active, unmarried people, including adolescents;

 current contraceptive users, to provide information about

effective use and encourage them to seek further advice;

  policymakers and opinion leaders; and

 the general public, to encourage people to see contraception

as a normal activity and limitation of family size as normative

behavior.

The importance of promoting services widely and providing

adequate information to clients has been demonstrated in

diverse settings. Mass media campaigns have been shown to

change attitudes and behavior. In addition, most people

support mass media coverage of family planning: at least two-

thirds of the respondents in national surveys in 22 developing

countries said they approved of family planning information

on radio and television.

However, to be effective, communication campaigns must

involve more than a few posters or advertisements; they must

be long-term, sustained efforts to change behavior and

maintain the new behavior. In addition, communication

campaigns need to be carefully designed, using quality

materials, so that they respond to the audience and the

environment and are coordinated across different media and

with provision of services.

COUNSELING, INFORMED CHOICE, INFORMED CONSENT,

AND THE RIGHTS OF THE CLIENT

WHAT IS COUNSELING?

Counseling is the process of helping clients confirm or make informed and

voluntary decisions about their individual care. It is a two-way exchange of

information that involves listening to clients and informing them of their

options. Counseling is always responsive to each client's individual needs

and values. All providers, regardless of their professional background and

educational credentials, need special training in counseling and informed

choice.

WHAT IS INFORMED CHOICE?

Informed choice is a voluntary, well-considered decision that an individual

makes on the basis of options, information, and understanding. The

decision making process should result in a free and informed decision by

the individual about whether or not he or she desires to obtain health

services and, if so, what method or procedure he or she will choose and

consent to receive.

WHAT IS INFORMED CONSENT?

Informed consent is the communication between client and provider that

confirms that the client has made an informed and voluntary choice to use

or receive a medical method or procedure. Informed consent can only be

obtained after the client has been given information about the nature of the

medical procedure, its associated risks and benefits, and other alternatives.

Voluntary consent cannot be obtained by means of special inducement,

force, fraud, deceit, duress, bias, or other forms of coercion or

misrepresentation.

Health care providers are often required by law or institutional policies to

obtain informed consent before administering certain medical procedures,

including experimental methods or procedures. Although informed consent

is often equated with a signed written form used to document an

individual's decision, written consent is neither inherently necessary nor

sufficient. Regardless of the presence or absence of written documentation,

informed consent requires providers to ensure that a client receiving a

method or treatment has knowingly and voluntarily agreed to be treated.

Whether informed consent is written or verbal, however, it cannot replace

the informed choice process, which is dependent on counseling and the

information exchange between providers and clients.

INFORMED CONSENT AND VOLUNTARY STERILIZATION

Informed and voluntary client consent is especially important before a

medical procedure that has a permanent or long-acting effect or that

requires the skills of a trained provider. In family planning, voluntary

sterilization is unique in that it involves a surgical procedure to end fertility

permanently. Therefore, many providers and funding agencies that support

sterilization services specify the elements for informed consent and require

written documentation of the client's consent. Although the purpose of

informed consent should be to ensure the client's right to make a voluntary

and informed decision, written consent is often required to provide

evidence of provider compliance with informed consent requirements and

to reinforce the importance of this client right.

WHAT ARE THE RIGHTS OF THE CLIENT?

Clients have the right to:

 Information

 Access to services

 Informed choice

 Safe services

 Privacy and confidentiality

 Dignity, comfort, and expression of opinion

 Continuity of care
COMMUNICATION SHOULD:

 Generate awareness of services

 Generate demand for better utilization of health services

 Motivate and support behavioural practices at home

 Act as a support to service provision

Under the family planning programme, planning for IEC will go hand-in-

hand with the decentralised planning approach.

 Combination and mix of media addressing different target audiences at

different levels.

 IEC activities should be planned at the Primary Health Centre level after

identifying service and communication needs in the area.

 Locally available communication channels should be identified and

utilised.

 Interpersonal counselling skills of health workers will be strengthened

so that they are able to effectively motivate clients to avail services.

IEC WILL PROMOTE:

AWARENESS

 Increasing age at marriage

 Birth spacing

 Male responsibility

SERVICES

 Reproductive health of adolescent girls

 Family life education for adolescents entering reproductive age

 Women’s education
 SUGGESTIONS

 There is need to upgrade the quality of contraceptives specially

condoms provided by government of India, there is a decline in

permanent, temporary methods such as oral pills, IUDs & condoms are

becoming popular.

 In preventing the population growth, the illiteracy factor is the most

important thing, as we know that adoption of family planning

programme is more successful in the states like Assam and Kerala

where the literacy rate is high, resulting in lower total fertility rate and

higher mean age at marriage.

Education encourages acceptance of family planning, there is an over

dependence on sterilization especially female sterilization. Choice

among different methods is not evenly distributed. All young girls and

boys should be educated about family life and reproductive health.

 So far the government has been the main source for obtaining

contraceptives, if non-government organisations contribute to this effort

and share the responsibility, it will lead to wider coverage of family

planning.

 Participatory management & its evaluation is necessary at grass root

level. Functionaries like representatives of NGOs, panchayat members,

primary school teachers, practitioners of idegenous system of

 medicines, anganwadi workers should all involve in participatory

planning process.

 Indian society is considered to be a male dominant society. In family

planning the males take most of the decisions so the participation of

males in this programme is extremely necessary.

 The family planning should be client-centered approach and the

importance of ensuring client satisfaction is necessary.

The sex education for young males and females is also a crucial part of

family planning education in India. It should be strictly implemented.

 CONCLUSION

The responsibility of making the family planning a success lies in the hands

of health managers, workers and the people. It offers an unusual

opportunity for decentralised planning that can be availed by everyone for

providing their valuable inputs to the programme. It is expected that the

programme will have wide acceptance and ownership not only because it

will be developed with people’s inputs but also because it will raise the

standards of quality. Ultimately, indicators of quality will determine the

effectiveness of this progarmme. It is now up to policy makers and

managers to utilize this opportunity and meet the challenge of making

family planning a people’s programme.

Family planning is an investment in the future and a fundamental

aspect of all human resource development programs. Political

leaders and development specialists at all levels can play a major

role in strengthening family planning programs by giving them

priority, increasing funding levels, and adopting supportive policies.

In addition, family planning programs can become more effective if

managers focus on four key points:

 Clients deserve quality services. With more choice of

methods, better information and counseling, services that

address urgent health needs, and a wider range of outlets,

family planning would spread even faster.

 Front-line staff should receive stronger support. These

staff are the key to program success, and they need more

supportive supervision and a logistic chain that provides

contraceptives reliably in a timely manner.

 Options for involving the private sector, both the

nonprofit and for-profit segments, should be expanded.

National programs need to be actively engaged in working

with the private sector and should seek to extend the most

promising forms of collaboration.

 Improved techniques for reaching potential clients

should be fully exploited. As programs focus on broader

populations, they will have to become more sophisticated in

using the media.

 BIBLIOGRAPHY

 Estrells, M. et.al, editors (Forth Coming). ‘Learning from Change;

‘Issues and Experience in Participatory Monitoring and Evaluation’.

London : IT Publication.

 IDS, Policy briefing (U.K.), Issue 12 November, 1998, Institute of

Development Studies, Sussex, (U.K.).

 National Family Welfare Programme Achievements & Strategies,

Booklet by Ministry of Health & Family Welfare, Government of India.

 Reproductive & Child Health Programme, booklet by UNICEF, India.

 State of India’s Population, Population Foundation of India, New Delhi.

POPULATION GROWTH

1951-2001
1200

1000
Population (in million)

800

600

400

200

0
1951 1961 1971 1981 1991 1996 2001
Year

Rapid population growth impacts various socio-economic aspects and the quality of life.

Source: Registrar General, India

TOTAL FERTILITY RATE

1951-1993
6

5
Total Fertility Rate

0
1951 1961 1971 1981 1991 1993
Year
Source: Registrar General, India

TOTAL FERTILITY RATE BY FEMALE LITERACY

1992-93
4.5
4
3.5
Total Fertility Rate

3
2.5
2
1.5
1
0.5
0
Illiterate Literate but < Middle Middle School High school & above
completed completed
Educational Level
Source: National Family Health Survey, 1992-93.

FEMALE AGE AT MARRIAGE

1951-1993
25

20
19.3 19.5 19.6
18.3
Mean Age

17.2
15
15.6 15.5

10

0
1951 1961 1971 1981 1991 1992 1993
Year
Source: Registrar General, India.
NEW ACCEPTORS OF FAMILY PLANNING

1996
18000
16000
14000
Acceptors (in Thousand)

12000
10000
8000
6000
4000
2000
0
Vasectomy Tubectomy IUD Condoms Oral Pills
Family Planning Methods

Source: Department of Family Welfare, Government of India.

SOURCES OF FAMILY PLANNING SERVICES

(Among Current Acceptors)

Government Sector
79%

Other Sources
6%
Private Medical
Sector
15%
Source : National Family Health Survey, 1992-93.

UNMET NEED FOR FAMILY PLANNING

Other Non-Users Current Users

39.90% 40.60%

Unmet Need
19.50%
Source : National Family Health Survey, 1992-93.

COUPLE PROTECTION RATE

1971-2000
70
60
Couple Protection Rate (%)

60
50
46.5
40 44.1

30
20 22.8

10
10.4
0
1971 1981 1991 1996 2000

Year
Source: Department of Family Welfare, Government of India.
ANNEXURE
 ADVOCACY STRATEGY BY UNESCO

Advocacy has been at two levels: policy advocacy and social mobilization

around youth and reproductive health issues.

1. National seminars

National seminars on Population Education and Adolescent Education

have created the necessary awareness and commitment among decision

makers for the acceptance of these programmes. The National Seminar on

Adolescence Education organized by the National Council of Educational

Research and Training (NCERT), in April 1993, recommended the

introduction of adolescence education in schools. As a follow-up to the

recommendations of this seminar and of ICPD Programme of Action,

adolescence education was made an integral part of the projects on

Population and Development Education in schools. The partner agencies

for this initiative are the Ministry of Health and Family Welfare, Human

Resource Development, NCERT, Central Board of Secondary Education

(CBSE), Kendriya Vidyalaya Sangathan (KVS), National Open School and

UNESCO.

The general objectives of adolescence education are:

(1) to provide authentic and accurate information about physical,

physiological, psychological, socio-cultural and interpersonal issues of

reproductive health to students in order to develop in them proper

understanding of the process of growing up and

(2) To inculcate in them a healthy attitude towards sex, respect for the

opposite gender and responsible sexual behaviour. The project includes a

variety of activities related to reproductive health issues, HIV/AIDS, STDs

and Family Life Education concerns.

For generating AIDS awareness among adolescents and adults, the

following content areas are covered:

 HIV/AIDS and its present scenario

 AIDS-causes, symptoms, and precautions

 Myths and misconceptions about AIDS

 AIDS-its effect on social life

 Question-answer sessions on vital issues that are critical areas of

concern for adolescents

A variety of materials are used in the transactional process. These include:

video cassettes, flash cards, flip charts, posters, booklets, films and

leaflets. They are used supplementary to lectures, discussions, debates

and group activities. The educational programmes are mainly transacted

through a series of workshops that take place in one to three days. The

contents have been developed under three major topics: Process of

Growing Up, HIV/AIDS and Drug Abuse.

UNFPA also organized, in 1998, an International Conference on Adolescent

issues. In November 2002, UNFPA organized an Experience Sharing

Meeting of project partners, with a focus on adolescents, during the Fifth

Country program (1997-2002).

2. Inter-country study visits

Inter-country study visits by decision makers and key personnel to

population education and IEC programmes in Asia have been a very

effective strategy in creating awareness about commitment to the

population education programme. These study visits were organized by the

UNESCO Regional Office in Bangkok with financial support of UNFPA.

3. Regional and national training courses

The regional training courses organized by the UNESCO Regional Office in

Bangkok for project personnel and decision makers have been very useful

in developing a sound knowledge base and generating interest and

commitment to the population education programme. Similarly, training

programmes organized at the national level by different projects have also

been very useful.

4. Environment Building

Advocacy efforts with school authorities, parents, opinion leaders are pre-

requisites for working with adolescents in and out of school, especially

when working with girls. Collectively organized social events such as melas

(fairs) have proved to be a good meeting point for advocacy.

1. In-school approach

The UNFPA-assisted population education programme in schools started in

April 1980. Since then, the programme has been implemented in three

phases. From a modest participation of ten states/union territories in 1980,

the programme is now implemented in 30 states and union territories. The

main objective of the programme is to institutionalize population education

at all levels of education from grades 1-12, as well as in teacher training

institutions.
In view of the needs of post-ICPD (1994) developments and the

experiences of previous phases of the implementation of NPEP, the

theoretical framework of Population Education has been re-conceptualized.

The new framework reflects six basic themes focusing on critical population

and developmental issues. These are: i) population and sustainable

development, ii) gender equality for empowerment of women, iii)

adolescent reproductive health (Adolescence Education), iv) family: socio-

economic factors and quality of life, v) health and education: key

determinants of population change and vi) population distribution,

urbanization and migration.

To facilitate the introduction of the sensitive topic of Adolescent

Reproductive Health into school education, it has been conceptualized as

Adolescence Education. The conceptual framework of Adolescent

Education covers three major components: i) process of growing up, ii)

HIV/AIDS, and iii) substance abuse. The frameworks are complementary to

each other and aim at attaining the population and development goals

envisaged in the Programme of Action of ICPD, 1994. The target groups

are students and teachers of primary to higher secondary, pupils and

teachers of elementary and secondary teacher education, all the

functionaries of the school education system and opinion leaders.

The following were the main achievements of the programme:

 Population and development education programme is being

implemented in 30 states and union territories .

  Population education elements have been integrated into the syllabi

and textbooks for all stages of school education.

 The number of schools covered is 5382.

 More than 550 titles on population education in 16 Indian languages,

and in English, have been published; audiovisuals have been

produced, disseminated and used in different kinds of project

activities.

 Nearly 3.1 million teachers and other educational functionaries have

been

trained/oriented in population education.

 Population education has been offered as a separate elective course

in B.Ed. and M.Ed. programmes in some universities.

2. Materials development

A variety of materials have been developed under different programmes implemented by

governmental agencies and NGOs. By and large, most of the IEC materials developed fall under

three categories

a. Materials that seek to motivate specific target

audiences to modify/influence their perceptions. These

materials may be called advocacy materials that are

generally in the form of leaflets, handbills and others,

and are aimed at policy makers, teachers and parents.

They take the form of supportive materials for

orientation and seminars to strengthen the programme.

b. Materials that tend to create awareness or carry
 messages of a general nature, such as posters,

newsletters, etc.
c. Materials that are developed in support of specific

activities, such as training of various categories of

teachers, field workers and students. These materials

are in the form of teacher’s guides, resource books,

supplementary reading materials, training modules,

students/learners’ manuals, etc. Some of these

materials have been produced in audio-visual form,

such as videocassettes, audiotapes and films. Various

NGOs have developed training materials and manuals.

Some of these include: CEDPA, CARE India, CHETNA,

CINI, and UNESCO. UNFPA and the UN Inter Agency

have also developed training materials on life skills.

3. Decentralised approach

The United Nations Population Fund (UNFPA) has supported district

reproductive health projects. This approach, called the Integrated

Population and Development project (IPD), is meant to improve the access

and quality of reproductive and child health services, make service

providers gender-sensitive and create supportive environment for women’s

empowerment as part of its Fifth Country Programme (1997-2002). Under

RH 27, districts spread across six states and five municipal areas of

Maharashtra were identified for district level projects.

The following were some of the accomplishments made in the IEC

area of the District Reproductive Health Programs (DRHP) during the

year 1998-1999:

 District IEC strategy (IEC plans and management plans) were

developed in four of the five DRHPs.

 Based on baseline data, the strategy was fine-tuned and IEC

indicators have been established.

 The IEC plans of DRHPs were focused on the behaviour change

process.

 Five DRHPs were shown to have influenced a behavioural change

of selected men in their respective districts.

 Three out of five DRHPs conducted IPC and counseling training for

capacity building of service providers.

 Four out of five DRHPs organized communication material

adoption/development workshops to procure suitable materials for

the IPC activities.

 The UNFPA-Technical Unit played a significant role in developing

and implementing RH-IEC strategy for the DRHPs. This strategy has
 proven successful enough for replication. It has been suggested that

UNFPA support the present IEC model as effective communication

on reproductive health issues which can be adopted by GOI, NGOs

and other donor agencies.

4. Telephone counselling

Telephone counseling services was one of the significant components of

the third phase of Population and Development Education in the Higher

Education Project. Telephone and personal counseling are significant and

effective means of communication for adolescents. Counseling services

were made available at all Population Education Resource Centres

(PERCs). The four major areas of focus for adolescents are adolescent

sexuality, HIV/AIDS, drug abuse and career-related questions. Services are

given free, confidential and done by experts/trained medical officers or peer

educators. The telephone counseling approach also has been found to be

very useful in providing correct information and guidance to students.

NGOs, such as TARSHI in Delhi, provide help-line services on sexuality

and reproductive health issues.

5. Outreach and extension approach

One of the approaches used under the Population and Development

Education in the Higher Education System Programme is to establish

linkages between the colleges and the community through the Department

of Adult, Continuing Education and Extension. The objective of the

programme is to create awareness among college students and, through

them, in the community regarding various population issues. The

programme is being implemented in 1,400 colleges through Population

Education Clubs (PECs). The messages include gender equality and

equity, adolescent reproductive health, population and development,

among others. This approach has been quite successful in creating

awareness among the college students and the community about

population issues.

6. Co-curricular approach

Co-curricular activities are undertaken by the National Population and

Development Education Programme of NCERT to strengthen classroom

learning and to enhance the process of institutionalization of the population

education programme in the school education sector. Not all the

components of population education can be integrated into the textbooks of

various subjects at all school stages because of the limitations of the

subjects concerned. Even those components, which are in the textbooks,

may be communicated much more effectively if reinforced through co-

curricular activities.

The Project Evaluation Study, conducted by the Indian Institute of

Population Studies (IIPS), Bombay, revealed that population education co-

curricular activities organized by the NCERT have generated a lot of

interest, not only among students and teachers, but also among the

parents and the community. NCERT has successfully organized a number

of population education co-curricular activities during the past few years.

Some examples include the All India Children’s Drawing/Painting

Competition, National Population Education Essay Competition and

National Population Education Quiz Competition. All three contests were

organized at all levels, beginning from the school level to district, state and

finally, the national level.

The Village Adoption Scheme, which sets up Population Education

Laboratories

in the schools, and conducts Observation of Population Education Week

every year throughout the country, has created awareness among students

about population issues. Another important activity, which has been

conducted for the last seven or eight years, is the National Component of

the International Poster Competition organized by UNFPA. These activities

have proved quite effective in bringing about awareness and attitudinal and

behavioural changes.

7. Youth camps

There is no single way of initiating an educational intervention for

adolescents. There can be many approaches ranging from intensive short-

duration interactions, such as residential camps of 5 to 8 days, or long-

duration training programmes of 1 or 2 months, or a year-long forum run

through a centre which meets for 2 hours every day. However, what is a

non-negotiable prerequisite for eliciting honest and ‘real’ responses from

adolescents is the overall friendly, gentle, and non-judgmental tone of the

dialogue. Adolescents require well-communicated assurance that they

matter, that they are cared for, and that they have a future. They also need

to be assured that their problems are real, common, and constitute the
normal complexities of life that are shared by other adolescents. The

texture of their concerns is best captured through sensitive and efficient

process documentation as an ongoing activity rather than as an exercise

coming at the end of the project.

The need for alternative schools and bridge courses has been highlighted

in a study on ‘Educating Adolescent Girls—Opening Windows’.

Interventions like bridge courses, summer schools, residential camps, and

remedial classes organized for out-of-school children, in both villages and

cities under the programme, have been effective in reaching out to

underprivileged communities.

The Society for Social Uplift through Rural Action (SUTRA), established in

1977 in the hilly region of Jagjit Nagar, Himachal Pradesh, regularly

undertakes training programmes and seminars/workshops and courses for

capacity building among various groups. These groups include mahila

mandals (women’s groups), panchayats (local governing councils) and

yuvati sangathans (adolescent girls’ groups). The organization operates in

five districts (Solan, Sirmaur, Mandi, Hamirpur and Kullu) and ten

development blocks of Himachal Pradesh. The staff works closely with 400

mahila mandals, 131 yuvati sangathans and 100 gram panchayats directly

through training and convening meetings or through sister organizations.

The activities are geared toward a wide understanding of reproductive

health. The encompassing issues are body care, menstruation,

reproductive tract infections, family planning, sexual relations, violence,

liquor and adolescent health. SUTRA started the Yuvati (adolescent girls)
Programme in 1991-1992. It consisted of a series of continuous activities

that has three main components:

 Yuvati shibirs (camps for adolescent girls)

 Yuvati sangathans (adolescent girls’ groups) including block-level

meetings and village-level meetings

 Yuva sathin (Adolescent Companion, a magazine by and for girls)

Unmarried adolescent girls, between 12 and 22 years, are the main target

of the camps, which have the following objectives:

 Provide a platform for adolescent girls to come together to discuss

and understand the situation of women from a feminist perspective

 Sensitize girls about the patriarchal value system inculcated within

them

 Enable girls to deal with the injustices resulting from an oppressive

value system which subjugates them

 Disseminate information about legal, health and other issues

pertaining to women

The residential camps for adolescent girls cover a period of five days.

SUTRA conducts four to six such camps per year. The average number of

participants at the camps is 20-25. The camps are usually conducted

during holidays when girls are free from school to participate. The profile of

participants includes in- and out-of-school, ongoing college students, and

unmarried girls between the age of 12 and 22 years from the different

districts of Himachal Pradesh. The programme strategy of adolescent girls’

camps, followed by the development of yuvati sangathans at the village

level, has helped increase outreach and information, making the

programme sustainable.

The youth camp approach is adopted by many NGOs as it is low cost,

intensive and reaches large numbers of adolescents.

8. Health and reproductive health education approach

MAMTA Health Institute for Mother and Child, New Delhi, an NGO, is

implementing an intervention model to Integrate Reproductive Health

Services for Adolescents in Bawal block, Rewari district, Haryana. The

objectives include:

 To develop an ARH model through the strengthening and

modification of existing health services;

 To enhance access to knowledge for adolescent groups;

 To enhance community awareness of and involvement in ARH

issues;

 To establish provision of ARH services at PHCs; and

 To increase utilization of ARH information and services by

adolescents in the community

The project covers about 20,000 adolescent boys and girls from 104

villages

Strategies include:

 Conducting a base-line study, through a survey, and supplementing

it with qualitative methods in order to understand the needs and

perceptions of adolescent boys and girls, as well as the outlook of

the service provider.

 Developing an enabling environment for adolescents’ reproductive

health needs through sensitization of, and knowledge sharing with,

parents and other gatekeepers, as well as the sensitization of health

service providers (mainly chief medical officers, medical officers, and

paramedical staff).

 Establishing a counseling centre at the CHC, Bawal.

 Promoting peer educators (PE) (14 boys and 9 girls) as change

agents in select villages in Bawal block. The PEs are selected on the

basis of the criteria of self-motivated adolescent boys and girls on

the issues, that is, those who have the potential to share

information, those who can easily become acquainted with their

peers, and those who can devote concerted attention to the issues.

Support through provision of information and the process of

sensitization were the significant motivating aspects in sustaining the

PEs in the community. Periodic meetings (once in a quarter) with the

PEs reinforce their status within the community and underline their

ability to play an effective role. They are given information/upgraded

knowledge and are equipped to address adolescent issues at the

community level; they also utilize the specialized services made

available by the existing institutions.

 Increasing the demand for requisite services along with the active

involvement of service providers at counseling centres.

  Seeking support from the district administration and panchayat

members to facilitate the process of project implementation in

Rewari district.g states.

9. Integrated approach

UNFPA, under its Gender support programme, is experimenting with

integrated approaches. One of its partners is Deepak Charitable Trust

(DCT), Vadodara, with CHETNA, Ahmedabad as a supporting NGO. The

project covers 1,000 adolescents, 17 self-help groups with a membership

of 270 adolescents; 600 trainees of vocational skills in 27 villages

surrounding the industrial village, Nandesari, 20 km. from urban Vadodara.

Strategies include:

 Economic objectives: Imparting livelihood skills to adolescents;

organizing adolescents into self-help groups; conducting trade-

related exposure visits

 Health objectives: Giving iron tablets daily to boys and girls; health

education; hemoglobin estimation before and after 6 months’

supplementation; increasing awareness of reproductive health

issues; developing cognitive, social, and negotiating skills for

responsible behaviour

 Social objectives: Increasing awareness of issues related to

patriarchy, gender, marriage, and family-life responsibilities;

involvement of men in shouldering family responsibilities; legal

literacy; and promoting the importance of education

  Innovative strategy: The livelihood component of the project is being

used as a strategy to provide training on reproductive health and

gender issues.

CEDPA is implementing the Better Life Options programs for girls and boys

through its partner agencies. The program is a holistic one combining

education, livelihood training, reproductive information and services. The

initiative tries to empower adolescents and sensitize the family and

community at the same time.

10. Building Networks

UNFPA is supporting an NGO network focusing on out-of-school youth in

Delhi. Titled KIDAVRI, the network focuses on the development of a

Comprehensive Adolescent Skills-Building Programme. The network

consists of 23 members comprising 12 NGOs and 12 individual members.

Organizations: Swaasthya, Prerana, Don Bosco Ashalayam, National

Spiritual Assembly of the Baha’is, Society for the Promotion of the Masses

(SPYM), Family Planning Association of India (FPAI), Action India, Lady

Irwin College, Urivi Vikram Charitable Trust (UVCT), Mobile Crèches,

Pratidhi, Association for Development (AFD), and Navjyoti Development

Society (NDS).

The objectives are to:

 To strengthen and operationalize the vision of networking among

NGOs and institutions working with out-of-school adolescent boys

and girls; and

  To build the capacity of member NGOs to improve their work related

to adolescent skills building.

Their strategies include:

 Envisioning and strategic planning workshops on participatory

research, Management Information System (MIS);

 Capacity building of member organizations through

seminars/workshops;

 Development of interfaces and linkages, viz. the newsletter KIDAVRI

Ki Awaaz;

 Collective ownership by the network as a whole rather than

ownership by one or a few select members; and

 Review of the existing resources of the organizations and sharing of

experiences.

11. Skill development approach

A few projects have used the edutainment approach to disseminate

information and to build the skills of adolescents

ADITHI (Agriculture, Animal Husbandry, Dairy Industry, Tree Plantation,

Handicrafts, Handlooms and Integration), a non-governmental

development organization, was established in Bihar in 1988 with the

purpose of empowering poor women through economic and social

development.

ADITHI’s primary strategy is to organize marginalized women into self-help

groups, develop their capabilities through awareness generation, education

and skills formation; and provide them with working capital for small
businesses. It was felt that these initiatives would make the women

economically self-reliant and would facilitate their control over resources

and the decision-making authority within their family and community.

ADITHI works with over 5,000 women in 277 villages. Its work is

concentrated in the six districts of Bihar, four in the North and two in the

East. ADITHI conducts literacy and livelihood initiatives for adolescent girls,

as well as awareness and self-development programmes. ADITHI’s

programmes, and those of its affiliates, have reached over 11,000 girls and

1,000 boys. Currently, ADITHI is working with 5,000 girls through its non-

formal education centres and the Balika Kishori Chetna Kendras

(unmarried girls’ awareness centres), and about 500 boys through its Balak

Vikas Kendras (boys’ learning centres).

In 1995, ADITHI, catalyzed by the findings of a study on female infanticide,

decided to start centres that would focus specifically on adolescent girls

between 11 and 18 years. ADITHI started the Balika Kishori Chetna

Kendras (awareness centres for young unmarried girls) with support from

UNICEF. The aim of the kendras is to build a community where women and

men have equal status and importance. In 1998, there were 18 kendras or

centres in 18 villages, with a total of 465 participants, of which 351

participated regularly. These kendras are now being run with support from

Action Aid. There are about 20-25 girls in each centre. Unlike the non-

formal education centres, which target girls who either have never attended

school, or who have dropped out, these centres are open to all, including

girls attending schools or non-formal education centres. The curriculum at

these centres includes legal literacy, health and sex education,

sensitization to the ways in which the patriarchal system undermines the

status of girls and women, and ways of dealing with sexual harassment

and abuse. The kendras go beyond literacy and provide life skills education

to teach girls several coping mechanisms. These kendras attempt to

broaden girls’ horizons and encourage them to think about and question

their position in society, the discrimination they face in their everyday lives

within and outside their homes, and the restrictions placed on them by

society. The primary focus is on helping girls understand the social system,

and to provide them with life skills that will help them resist oppression and

negotiate their way through life.

12. Community-based approach

Prerana, established as a non-governmental organization in September

1974, has been involved in implementing programmes in the areas of

Population, Reproductive Health Education and Community-based

Capacity Building. Prerana initiated adolescent programmes in 1987

following the realization that this special target group was being left out of

most development policies and programmes. In 1990, Prerana further

enhanced its initiatives by launching the Better Life Demonstration Project

for Girls and Young Women and a parallel programme of Better Life

Development Programme for Boys and Young Men in 1995. The objective

of each programme is to create an environment of dignity and opportunity

for adolescents, empowering and enabling them to achieve their full

potential of personal growth and ability to contribute to family, community

and societal development.

The programmes were implemented in six villages along the periphery of

Delhi as a development project. The programme targets individuals, their

peer groups, family and community. Learning modules include information,

education and services in the areas of personality development, education,

health, reproductive health, economic participation and life skills training.

Some of the achievements have been:

 Prerana has established itself as a resource center focusing on

capacity building, and materials development on youth issues for

other agencies

 42 self-sustained centres run by alumni girls trained as peer

educators/master trainers have been established in the project area.

Prerana has developed a scale up and sustainability model for

continuing the program.

 Government officials and news media persons have been reached

through sensitization workshops in Bihar, Rajasthan, Madhya

Pradesh and Uttar Pradesh. Prerana has also conducted advocacy

programs by organizing conferences on adolescent girls and sexual

exploitation, raising public opinion and influencing policy makers on

these issues.

 Programme Support Material in the form of a Multi-Media kit

comprising audio visual aids, posters and newsletters on adolescent

development have been produced.

13. Family life education

The ‘Shiksha’ project focuses on family life education and AIDS awareness.

The main beneficiaries of the programme are adolescent boys and girls

from lower economic strata of society. The target group comes from the

slum population and belongs to the age group of 15 to 25.

The objectives of Shiksha are:

 To equip young people to grow up into reasonable adulthood and

provide them with a healthy quality of life;

 To prepare them with knowledge and skills required to face the

challenges of every day life;

 To assist them to get acquainted with the major social institutions

and enable them to realize the significance of these for the well

being of society as a whole; and

 To enable them to know and appreciate the norms governing family

relations and family life

The main focus of the project is to provide education and awareness in the

areas of family life education, health concerns and improvement of quality

of life. It envisages educational intervention in a wider sense as a planned

effort to stimulate and help adolescents to acquire knowledge, skills and

behaviour patterns for responsible and confident adulthood.

14. Life skills approach

In some backward areas of Rajasthan, there are hardly any educated

women available to work as teachers in primary schools. The Shiksha

Karmi project identifies locally educated men and women to serve as para-

teachers or “Shiksha Karmis”. In some of the villages where there are no

educated women, a unique scheme has been initiated to enable those

identified as potential, or prospective, Shiksha Karmis to upgrade their

skills and pass the fifth class examination to become eligible for the

Shiksha Karmi training. The Shiksha Karmi Board and UNFPA have

initiated a pilot project to train the teachers of Mahila Prakishan Kendras

(MPKs), who are working with potential Shiksha Karmi women.

.
" A candle never loses any of its light by lighting another candle."

Lets join hands to enlighten the world that a small family is a

happy family