National Family Welfare Programme Research Articles

A Review of Sudanese Maternal Deaths

Background: The fifth Millennium Development Goal aims for a decrease in maternal mortality and universal access to high-quality reproductive health care. Every year, around a third of a million women die as a result of pregnancy-related complications. Three-quarters of these deaths might have been avoided. One of the most important markers of mother and child health care is the Maternal Mortality Ratio. One of the most significant aims of the national family welfare program is to reduce maternal fatalities are thought to be preventable. Objective: The study's focus is to document, investigate, and report the events and circumstances behind maternal fatalities, as well as to study maternal deaths in River Nile State in order to identify the maternal mortality rate and causes of death. Methodology: This is a hospital and community-based research that took place from January to December 2018 at River Nile State. Information on every maternal death was obtained using a questionnaire which was filled out and rechecked to completely cover State, and then analyzed using SPSS version 20. Results: The overall number of live births was 25988, with 29 incidents of maternal death. 112/100000 live births was the death rate. 27 of the patients (93%) died in a hospital, whereas two instances (7%) died at home. Obstetric hemorrhage was the leading cause of maternal death in seven cases (24.1%), followed by hypertensive disorders in seven cases (24.1%), sepsis in four cases (17.2%), indirect obstetric causes in three cases (10.3%), embolism (PE & AFE) in three cases (10.3%), unclassified causes in four cases (13.7%), and abortion in one case (3.4 %). The bulk of the cases were delayed at home (14 cases, 48.3%), with 10 cases (34.4%) having no delay and five (17.2%) being delayed in reaching hospitals. Unfortunately, 19 instances (65.5%) died as a result of preventable causes. Conclusion: In 2018, the maternal death rate in River Nile State was 112/100,000 live births, which was higher than in the previous report. Maternal fatalities were mostly caused by hemorrhage, hypertensive diseases, and sepsis. The bulk of deaths were postponed until they reached their final destination.

A study on knowledge of contraceptive usage and its determinants among married women in urban slum of Nalgonda district

Background: India was the first country in the world to launch National Family Welfare Programme in 1951.Modern contraceptive use remains an important public health intervention to reduce maternal mortality, avert unintended pregnancies, and to control population explosion especially in developing countries. To determine the extent of knowledge, awareness and practices of contraceptive use among married womenMethods: A descriptive cross-sectional study was done for a period of three months duration conducted among married women in reproductive age group of 15-49 years in urban slums of field practice area. Results: Among eligible couple, those who want to avoid pregnancy, though they have knowledge and awareness (93.5%), Out of them only 21% of participants were using temporary methods. Most of them (37.4%) were opting for tubectomy. The source of information is mostly from health personnel (46.8%), followed by friends and family members 42%. Partner (38.7%) and “in-laws” (14.8%) consent, fear of side effects (29.6%), illiterates (31.6%) and low socio-economic status (47%) playing major role as barriers of acceptance of birth control methods.Conclusions: The prevalence of contraceptive usage in our study was found to be 58.7%. In present study 41.2% women use no contraceptives which clearly indicate that awareness about contraceptives is not sufficient for its actual use in this community and extended efforts will be needed.

Insights from Client Experience with Injection Medroxyprogesterone Acetate (MPA) in India: Lessons from the Field.

The injectable contraceptives have been recently added to the contraceptive basket of Government of India under the National Family Welfare program with the aim to reduce the unmet need of contraception in the country. The present study has been conducted to analyse the continuation rates and concerns among the acceptors of injection MPA. The present study was an ambispective observational study conducted in the out-patient department of family welfare division at a tertiary care hospital in New Delhi over a period of 6months. The study enrolled 483 acceptors of injection MPA who were interviewed in person or telephonically, and a proforma was filled which included the demographic profile, obstetric history of the women, source of information about injection and its timing, number of doses received, side effects experienced and the compliance status. The data obtained was subjected to statistical analysis. The mean age of the studied population was 28.44 ± 4.73years and average parity was 2. It was found that injection MPA was initiated in the interval period in 304 women (63.3%), post-abortal in 124 (25.8%), and postnatal in 52 (10.8%). The source of information about the injection for most women was health workers (83.5%). Most women (74.3%) were pleased with the injection and showed their willingness to continue, and 67.7% were continuing with the injection at the time of interview. Menstrual irregularity was the most common side effect observed in 48.5% women. The present study showed a good continuation rate of injection MPA for the Indian population. The coverage for this excellent contraceptive modality can be enhanced further if more efforts to disseminate awareness about this method are made. Menstrual irregularity is the most common side effect causing discontinuation which can be mitigated to a significant extent with an effective pre-administration counseling.

Situation Analysis of Implementation of National Health Programmes in Primary Health Centres (Phcs) At Uttarakhand

Context: The Bhore Committee in 1946 gave the concept of PHC as comprehensive primary health care to the community and maintain an acceptable standard of quality of care. The study was conducted to assess the implementation of National Health Programmes at PHCs in Uttarakhand.
 Methodology: An observational cross-sectional study was conducted at two PHCs (Thano and Raiwala) from March 2019 to April 2019. Interviews of health functionaries and beneficiaries of national health programmes were done based on standard Indian Public Health Standards (IPHS) guidelines and check list, for both PHCs. Beneficiaries under each programme were also observed.
 Result: Various programmes such as Universal Immunization Programme, School Health Programme, and Pulse Polio Programme, National nutrition Programme, National family welfare Programme, NPCDCS and Jansankhya Niyantran Yojna were implemented successfully at both PHCs. Although knowledge among peripheral health workers was found to be little inadequate.
 Conclusion: The functioning and execution of some of the National Health Programs at PHCs Thano and Raiwala were found to be inclined with IPHS guidelines.

Assessment of family planning practices of women of reproductive age group in rural area of Jammu region

Background: Despite more than fifty years of implementation of National Family Planning and Welfare programme, unmet need for family Planning is still high which poses a big challenge for family planning programme. The aim is to reach all women whose reproductive behaviour requires one or the other forms of contraception but for various factors are not practicing them.Methods: A cross-sectional descriptive study was carried out amongst women of reproductive age group in the field practice area of Rural Health Training Centre of Dept. of Community Medicine of a Government Medical College, Jammu during the period of January to June 2018. Ethical clearance was obtained from the Institutional Ethics committee prior to the start of the study. Total of 541 eligible couples attending the family welfare section were interviewed by the trained staff using the pre-tested questionnaire. The information about various family planning methods adopted by couple was elicited. Data was analysed by using appropriate test whenever necessary.Results: A total of 541 eligible couples were interviewed. Maximum couples were in the age group of 30-34 years. 300 (55.4%) couples were using one or the other method of family planning. Condoms were most commonly used method by 148 (49.3%) couples followed by oral contraceptive pills (30.6%). Among permanent methods of family planning, tubectomy was adopted by 10 (3.3%) and vasectomy only by 4 (1.3%) couples. No one was practising any miscellaneous method of contraception. The percentage of family planning methods used by Hindus was maximum (65%). Difference was also observed in the context of socio-economic status.Conclusions: Nearly half of eligible couples were not practising any method of contraception. There is need to increase motivation among eligible couples to increase adoption of permanent methods of contraception especially vasectomy.

Healthy Mother & Child: Foundation of a Strong Nation.

Healthy Mother & Child: Foundation of a Strong Nation.

Challenges in Introducing New Contraceptive Methods: A Case Study of India.

Increasing choice and introducing new contraceptive methods in the National Family Welfare Program in India could play a significant role in increasing adoption of contraception and meeting the unmet need of a large proportion of couples. However, inclusion of any new contraceptive method in India has to face many challenges at different steps: from clinical trials, administrative processes, acceptance in the national program, and reaching the intended beneficiaries. Having a good product is necessary but not sufficient for widespread accessibility, acceptance, and use. This article reviews the challenges based on the available policy documents, literature review, and discussions with senior program managers of the Ministry of Health and Family Welfare and development organizations. It concludes that comprehensive strategic planning is needed to address all possible barriers to ensure new contraceptive access at an affordable price by the beneficiaries it is intended for.

A study about perceptions, attitude, and knowledge among men toward vasectomy in Bangalore rural population

Background: The National Family Welfare Program was launched in India in the year 1952. Although a range of contraceptive measures are provided by the Government at free of cost, women-oriented contraceptive measures only took the center stage and gained acceptance over the male contraceptive methods. Vasectomy (nonscalpel vasectomy) technique was introduced in India in 1992 to increase male participation in family planning. However, it has failed to get adequate momentum and to achieve its goal, despite being a simple and safe method. According to the National Family Health Survey (NFHS)-3, the current acceptance of nonscalpel vasectomy in India has decreased from 1.9% to 1% in NFHS-2. Objective: To understand the perceptions and attitude in the rural men population. Materials and Methods: This study is a community-based, cross-sectional study carried out in Nandagudi, where the Rural Health Training Center of MVJ Medical College and Research Hospital is located. The study was carried out from July 2014 to November 2014. The study population comprised all the men who were aged older than 20 years to 60 years. The study was done by interview technique using pretested and predesigned questionnaire. Data were collected and analyzed. Results: Totally, 215 men were included in our study. Half (52%) of the study population belonged to 31 to 40 years age group while majority were Hindu (62%)and from socioeconomic statuses II and III. Of the married men, only one man had undergone vasectomy although 82% had heard about vasectomy; 17% men were willing to accept vasectomy as a choice of contraception after repeated counseling sessions. The reasons for nonacceptance were very much similar to other studies done previously. Conclusion: The myths and the attitude of men toward vasectomy can only be changed by intensive IEC and health education. It should be enforced and reinforced.

Unit cost of providing and utilizing contraception services for newly married couples in Satara district of Maharashtra, India

Background: Since 2007, Satara district is implementing a pilot project named Second Honeymoon Package (SHP). SHP gives cash incentives to encourage postponement of first pregnancy in newly married couples. At the same time, contraception services are also provided under National family welfare program. There requires a significant amount of commitment and expenditure from the beneficiaries to avail the benefits of governmental programs, which is often overlooked by the system. The costs of these two reproductive health interventions are compared in this study. Objective: To calculate the cost of providing and utilizing contraception services for the newly-wed couples in Satara district from the perspective of the Government of Maharashtra and that of beneficiaries'. Materials and Methods: This was a cost-minimization study of two reproductive health interventions in rural part of Satara district. Information about expenditure incurred was calculated from 17th June 2010 to 16th June 2012. Cost analysis was conducted from the perspective of Government of Maharashtra and that of beneficiaries'. Costs of SHP were evaluated in comparison with those of routine family welfare program. Results: One thousand and ninety-five out of 1355 participants (80.8%) have used condoms, 125 participants (9.22%) have used oral pills while only 15 (1.1%) have used safe period method. The average distance of health facility from the homes of participants has been 4.24 km ± 6.54. Annual unit cost of implementation of SHP was Rs. 883 (16.35$/ year) during the study period while the opportunity cost of utilizing the contraception services was Rs. 383.40 (7.1$) per person per year. The annual unit cost of implementation of family planning program was Rs. 323.73 (6$). Conclusions: In districts like Satara that have a strong family planning infrastructure, reorienting the program to provide contraception services for newly married couples may be achieved with minimal additional inputs.

Trends in Average Living Children at the Time of Terminal Contraception: A Time Series Analysis Over 27 Years Using ARIMA (p, d, q) Nonseasonal Model.

Background:India's National Family Welfare Programme is dominated by sterilization, particularly tubectomy. Sterilization, being a terminal method of contraception, decides the final number of children for that couple. Many studies have shown the declining trend in the average number of living children at the time of sterilization over a short period of time. So this study was planned to do time series analysis of the average children at the time of terminal contraception, to do forecasting till 2020 for the same and to compare the rates of change in various subgroups of the population.Materials and Methods:Data was preprocessed in MS Access 2007 by creating and running SQL queries. After testing stationarity of every series with augmented Dickey-Fuller test, time series analysis and forecasting was done using best-fit Box-Jenkins ARIMA (p, d, q) nonseasonal model. To compare the rates of change of average children in various subgroups, at sterilization, analysis of covariance (ANCOVA) was applied.Results:Forecasting showed that the replacement level of 2.1 total fertility rate (TFR) will be achieved in 2018 for couples opting for sterilization. The same will be achieved in 2020, 2016, 2018, and 2019 for rural area, urban area, Hindu couples, and Buddhist couples, respectively. It will not be achieved till 2020 in Muslim couples.Conclusion:Every stratum of population showed the declining trend. The decline for male children and in rural area was significantly faster than the decline for female children and in urban area, respectively. The decline was not significantly different in Hindu, Muslim, and Buddhist couples.

Contraceptive practices adopted by women attending an urban health centre

India was the first country in world to launch - The National Family Welfare Programme in 1951 but even today the couple protection rate (CPR) is still not achieved as desired. To determine extent of awareness regarding contraception among married women. To estimate proportion of couples using contraceptive methods, identify reasons for their adoption & non adoption and to assess unmet needs for contraception. A cross sectional descriptive study of four months duration was conducted among married women in reproductive age group (15 - 49 years) attending general out-patient department in Urban Health Centre (UHC) employing universal sampling method. Participants not willing to respond and pregnant women were excluded. Total of 180 women were selected as study participants. Every woman was interviewed face to face with pre-tested questionnaire after taking informed consent. The data was analyzed by SPSS version 16. 94 (52.2%) were in age group of 20 - 24 years. 52.4% of women were aware about contraceptive practices, of which only 32.2% of subjects were using contraceptive methods. Out of these subjects, 89.66% used temporary methods and 10.34% used permanent methods. Cu-T (41.37%) was most preferred method. 93 subjects (51.6%) had unmet need for contraception. Religion, education status and age at marriage were significantly associated with contraceptive usage. The results suggest a significant Knowledge - Application Gap with regards to contraceptives knowledge and their actual usage in study participants. Almost fifty percent of the subjects had unmet need for contraception. This shows the need for more intense awareness campaigns for promoting contraceptive usage.

The disappearing girl child: Possible role of sterilizations as a method of family planning

The sex ratio in India has constantly been unfavorable to women. Although the 2001 census figures show it to be marginally better than the previous census figures yet there was a marked decline in child sex ratio (0-6 years) from 945 females per 1000 males in 1991 to 927 in 2001. The anti-female bias is not limited to poor-performing states but also to better-performing states. There are a number of important demographic factors (e.g. sex composition of the previous children birth order of children and sex differentials in mortality ect.) which are responsible for this declining sex ration. A little lesser talked about factor is the possible role of sterilizations performed under the National Family Welfare Programme. The present study was aimed at finding out possible relationship of sterilizations as a method of family welfare with the declining sex ratio. (excerpt)

Status of immunodiagnosis and immunocontraceptive vaccines in India.

The article focuses on the Indian initiative of making kits for diagnosis of various infectious and non-infectious diseases as well as reproductive hormones and hormones in various other endocrine disorders. Indigenous diagnostic kits for the detection of various infections such as filariasis, typhoid, amebiasis, Japanese encephalitis, hepatitis, HIV, dengue, leishmaniasis, malaria, rabies, toxoplasmosis, rotavirus, and group A streptococci have been developed. Agreements to transfer the know-how of some of these leads to industries have been signed. The know-how of enzyme-linked immunosorbent assay (ELISA) for detection of hepatitis C has been successfully transferred to industry and is being commercially produced. For detection of HIV-1 and HIV-2, indigenous diagnostic kits based on three different formats, namely ELISA, Western blot and rapid test have been developed and are being commercially produced by Indian industries. The factors influencing the successful transfer of laboratory-scale diagnostic assays from academia to industry and their commercial exploitation have been discussed. Indian scientists have made seminal contributions in exploring the possibility to develop an effective and safe contraceptive vaccine to control the increasing human population of India. Achieving contraception by means of vaccine is a novel approach, which entails generation of a specific antibody response against antigens critically involved in the process of mammalian reproduction. In India, three major programs on contraceptive vaccines based on the beta-subunit of human chorionic gonadotrophin ((beta)hCG) for women, ovine follicle stimulating hormone (oFSH) for men, and riboflavin carrier protein for both males and females have been initiated. The work at the National Institute of Immunology, New Delhi on contraceptive vaccine for women, based on (beta)hCG, has demonstrated, for the first time, that it is feasible to regulate fertility by such an approach. Basic research being carried out to achieve immunocontraception by interfering at sperm-oocyte interaction level has been briefly discussed. These developments are still at the research stage. In addition to advances in the area of contraceptive vaccines, a non-steroidal contraceptive oral pill has been developed by Central Drug Research Institute, Lucknow, commercially produced by two Indian pharmaceutical companies and has been incorporated in the National Family Welfare Program. Another interesting approach for fertility regulation in male has been developed in India, which involves vas occlusion with styrene maleic anhydride (SMA) and is currently undergoing clinical trials in human subjects.

Centchroman, a selective estrogen receptor modulator, as a contraceptive and for the management of hormone-related clinical disorders.

DL-Centchroman (67/20; INN: Ormeloxifene) synthesized at the Central Drug Research Institute, Lucknow, is a nonsteroidal once-a-week oral contraceptive. It was introduced in Delhi in July, 1991, marketed in India in 1992 as Saheli and Choice-7 (Hindustan Latex Ltd., Thiruvananthapuram) and Centron (Torrent Pharmaceuticals India Ltd., Ahmedabad), and included in the National Family Welfare Programme in 1995.5 According to post-marketing surveillance, approximately 100,000 women were using this pill and approximately 1100,000 menstrual cycles were covered until 1996. It is a unique need-oriented contraceptive being effective when taken immediately after coitus or routinely as a weekly pill and has the advantage of less frequent administration. Its contraceptive action is quickly reversible. It has long terminal serum halflife of 168 hr in women and exhibits duration of anti-implantation/estrogen antagonistic action of 120 hr, despite a short (24.1 hr) serum halflife, in the rat. In lactating women, it is excreted in milk in quantities considered unlikely to cause any deleterious effect on suckling babies. In phase II and III multicentric trials as a contraceptive, children born of method-and-user failure pregnancies showed normal milestones, without any congenital anomaly. Reports of its promising action in the management of certain hormone-related clinical disorders are available. It has an excellent therapeutic index and is considered safe for chronic administration.

COSMETIC SCAR AND SCOPE OF REVERSAL AFTER PUERPERAL STERILISATION

Female sterilisation is an important component of National Family Welfare Programme. The target group is best motivated during the puerperium for such a procedure. However laparoscopic sterilisation which has got some distinct advantages, is not technically feasible at this time. The authors have used a technique where the advantages of cosmetic appearance, reduced post operative morbidity and reversibility can be conferred on the puerperal women. After trying out the method individually in some cases, a formal case control study design has been made and an evaluation study has been performed in 122 cases. The technique has been found to be cosmetically more acceptable, both at clientele and peer evaluation levels (p<0.001). Though all the four parameters of post operative morbidity have shown better results for the technique evaluated as against the conventional technique, statistical significance has been achieved in two of the parameters (p<0.05).

A Turning Point In National Family Welfare Programme Moving To Target Free Reproductive &amp; Child Health Approach

A Turning Point In National Family Welfare Programme Moving To Target Free Reproductive &amp; Child Health Approach

Reproductive health in India.

While Indias National Family Welfare Programme has averted about 168 million births since its inception in 1951 Indias population has more than doubled since 1961. Simply meeting unmet demand for family planning (FP) will help India achieve its goal of replacement-level fertility however by increasing contraceptive prevalence from 41% to 60% of married women. In 1992 India began to incorporate a reproductive health perspective into its FP efforts. India must improve the accessibility and quality of FP and abortion services take steps to ensure safe deliveries and improve maternal health. Data on prevalence of reproductive tract infections and sexually transmitted diseases are scarce but knowledge about HIV/AIDS prevention has been shown to be poor. Reproductive health research in India has focused on continuation rates of various IUDs improving the counseling and technical skills of health staff at postpartum centers continuation rates of Norplant under field conditions and promoting the concept of informed choice of contraception. The government is implementing the following steps to improve reproductive health: 1) exploring a client-centered instead of target and incentive driven approach to FP 2) expanding the use of male methods and spacing methods and 3) adding other components of reproductive health into ongoing child survival and safe motherhood programs. Improving the National Family Welfare Program will require an increase in funding and enhanced collaborative research.

Small Family Norm and Uterine Cervical Cancer

Carcinoma of the cervix is known to have a multifactorial etiology and several factors are implicated in increasing the risk of eventual development of cervical malignancy in a woman. This communication attemps to highlight the small family norms in the prevention of uterine cervical cancer. Data on 117,411 cytologically screened women were considered in which 215 women were found to have cervical cancer. Age adjusted rates of malignancy per 100,000 women in three parity groups (0-2, 3-4 and 5+) were 91.1, 174.4 and 393.1 respectively. An increasing trend of malignancy was noticed with increasing parity in women who had their consummation of marriage before 18 years as well as after 18 years. It may be concluded that the small family norm (only two children) being advocated as a part of a national family welfare program would be another primary prevention measure against uterine cervical cancer.

Small Family Norm And Uterine Cervical Cancer

Carcinoma of the cervix is known to have a multifactorial etiology and several factors are implicated in increasing the risk of eventual development of cervical malignancy in a woman. This communication attempts to highlight the small family norms in the prevention of uterine cervical cancer. Data on 117,411 cytologically screened women were considered in which 215 women were found to have cervical cancer. Age adjusted rates of malignancy per 100,000 women in three parity groups (0-2, 3-4 and 5+) were 91.1, 174.4 and 393.1 respectively. An increasing trend of malignancy was noticed with increasing parity in women who had their consummation of marriage before 18 years as well as after 18 years. It may be concluded that the small family norm (only two children) being advocated as a part of a national family welfare program would be another primary prevention measure against uterine cervical cancer.