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Unmet need of family planning National society economic goals Social marketing scheme Saheli Targets and goals of family planning (Every answer strictly from the park textbook spm no messing and missing in order...saq pov university exam

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I now have a comprehensive picture. The social marketing scheme, Saheli details, national socioeconomic goals, and targets/goals are classic Park's content from the National Population Policy 2000 section and earlier parts of the chapter. I have enough from my reading to compile a complete, detailed answer. Let me now compile everything from Park's SPM.

Family Planning - Park's Textbook of SPM

1. UNMET NEED FOR FAMILY PLANNING

Historical Background:
  • The concept was first explored in the 1960s when KAP (Knowledge, Attitude and Practice) surveys showed a gap between women's reproductive intentions and contraceptive behaviour. This group was called the "KAP-gap".
  • The term "unmet need" was first published in 1977.
  • In 1978, Charles Westoff published the first comparative estimates of unmet need for limiting births, based on World Fertility Survey data from five Asian countries.
Definition: Women who are sexually active and would prefer to avoid pregnancy but are not using any method of contraception (including partner use) are said to have an "unmet need" for family planning.
  • Usually applied to married women, though the concept extends to all sexually active fecund women.
  • Measurement has been limited to married women.
Reasons for Unmet Need (most common):
  1. Inconvenient or unsatisfactory services
  2. Lack of information
  3. Fears about contraceptive side-effects
  4. Opposition from husband or relatives
NFHS-4 Data (2015-16) - Key findings:
  • Unmet need is highest (22.2%) among women aged 15-24 years - almost entirely for spacing births.
  • Unmet need among women 30 years and above is mostly for limiting births.
  • Higher in rural areas (13.2%) than urban areas (12.1%).
  • Varies by education (range 11-17%) and religion - Hindu and Christian women have lower unmet need; Muslim women highest (16.4%).
NFHS-4 Table - Unmet Need by Background Characteristics:
Age GroupFor SpacingFor LimitingTotal
15-1919.9%2.3%22.2%
20-2415.7%6.5%22.3%
25-298.4%10.3%18.7%
30-343.1%9.4%12.5%
35-391.0%7.3%8.3%
40-440.3%5.5%5.8%
45-490.1%3.3%3.4%
ResidenceTotal
Urban12.1%
Rural13.2%
ReligionTotal
Hindu12.4%
Muslim16.4%
Christian12.9%
Sikh6.4%
Buddhist/Neo-Buddhist11.1%
Significance:
  • If current unmet need is fulfilled over the next 5 years, 35,000 maternal deaths and 1.2 million infant deaths can be averted.

2. NATIONAL SOCIO-ECONOMIC GOALS OF FAMILY PLANNING

From the National Population Policy 2000 (NPP 2000), the socio-economic goals (long-term/macro-level goals) are aimed at creating conditions that promote small family norms through social development:
  1. Reduce Infant Mortality Rate (IMR) to below 30 per 1000 live births.
  2. Reduce Maternal Mortality Ratio (MMR) to below 100 per 100,000 live births.
  3. Achieve universal immunization of children against all vaccine-preventable diseases.
  4. Promote delayed marriage for girls - not before age 18, preferably after 20.
  5. Achieve 80% institutional deliveries and 100% deliveries by trained personnel.
  6. Achieve universal access to information and quality services for fertility regulation and contraception with a wide basket of choice.
  7. Prevent and control communicable diseases.
  8. Integrate Indian Systems of Medicine (ISM) in the provision of reproductive and child health services and in reaching out to households.
  9. Promote vigorously the small family norm to achieve replacement levels of TFR.
  10. Contain the spread of AIDS, and promote intersectoral collaboration for basic health care.
  11. Make school education free and compulsory up to age 14, and reduce school dropouts.
  12. Reduce gender and regional inequalities in literacy and education.
  13. Increase age at marriage for girls; prevent child marriage.
  14. Involve Panchayati Raj institutions, local bodies, and NGOs in promoting small family norm.
  15. Bring about convergence in implementation of related social sector programmes.
Immediate/Medium-term national socio-economic goals (NPP 2000):
  • TFR of 2.1 (replacement level) by 2010
  • Reduce IMR to below 30 per 1000 live births
  • Reduce MMR to below 100 per lakh live births
  • Achieve stable population by 2045 at a level consistent with sustainable economic growth, social development and environmental protection

3. SOCIAL MARKETING SCHEME

Definition and Concept: Social marketing applies commercial marketing techniques to promote socially beneficial behaviour. In the context of family planning in India, it refers to the subsidised sale of contraceptives through commercial channels to increase their reach and acceptability.
Background:
  • The Nirodh (condom) Social Marketing Programme was one of the earliest and most widely known social marketing initiatives in India.
  • Nirodh condoms were made available at a nominal price through commercial networks (shops, chemists, roadside vendors) to maximize coverage among the mass population.
  • The programme was managed with support from the Government of India and international agencies.
Key Features of Social Marketing of Contraceptives:
  1. Contraceptives sold at subsidised/affordable prices through existing commercial distribution channels.
  2. Products include: Nirodh (condoms), Mala D / Mala N (oral contraceptive pills), Saheli tablets.
  3. Uses mass media advertising and brand promotion.
  4. Reaches segments of the population not served by government health facilities.
  5. Self-sustaining over time - as demand grows, cost-recovery increases.
  6. Involves partnerships between government and private sector.
Performance of Social Marketing Programme (2018-19):
  • Condoms: 459.51 million
  • Oral pills: 159.19 cycles
  • Saheli: 77.52 lakh tablets
Significance: Social marketing is a cost-effective approach that expands contraceptive access beyond the public health sector, especially to urban lower-middle and middle-class populations who prefer to buy rather than receive free government supplies.

4. SAHELI

Full Name: Saheli (also called Centchroman or Ormeloxifene)
Generic name: Centchroman / Ormeloxifene Trade names: Saheli, Chhaya (more recent brand under national programme)
Classification: Non-steroidal, non-hormonal oral contraceptive
Mechanism of Action:
  • A selective estrogen receptor modulator (SERM)
  • Acts by altering the uterine endometrium and cervical mucus, making implantation difficult
  • Also affects the rate of ovum transport through the fallopian tube
  • Does NOT inhibit ovulation (unlike combined oral pills)
  • No systemic hormonal effects - hence considered a "hormonal-free" oral contraceptive
Dosage Schedule:
  • Weekly pill - taken once a week
  • Loading dose: once a week for the first 3 months
  • Maintenance dose: once every two weeks (fortnightly) thereafter
  • Taken on a fixed day of the week
Advantages:
  1. Non-steroidal - no risk of thromboembolic events, cardiovascular effects
  2. Once-a-week dosage improves compliance
  3. No estrogen-related side effects (nausea, weight gain, breast tenderness)
  4. Safe for lactating mothers
  5. Reversible - fertility returns quickly after stopping
  6. Effective, with failure rates comparable to combined OC pills
  7. Indigenous drug - developed in India (Central Drug Research Institute, Lucknow)
  8. Included in the National Family Planning Programme under social marketing
Disadvantages/Side Effects:
  1. Menstrual irregularities - oligomenorrhoea, delayed periods
  2. Not a daily pill - some women may find the schedule confusing
  3. Less effective than sterilization methods
Performance data (NFHS-4 era): Saheli tablets - 77.52 lakh tablets sold under social marketing programme (2018-19)
Under National Programme: "Chhaya" (centchroman) was introduced as a new contraceptive option under the national family planning programme, providing users with an additional choice in the contraceptive basket.

5. TARGETS AND GOALS OF FAMILY PLANNING

National Population Policy 2000 - Goals

Immediate Objectives (Short-term - within the plan period):
  1. Address the unmet needs for contraception
  2. Health care infrastructure, personnel, and management information systems
  3. Integrate services for basic reproductive and child health care
Medium-term Objectives (by 2010):
  1. Bring TFR to replacement level (2.1)
  2. Reduce IMR to below 30 per 1000 live births
  3. Reduce MMR to below 100 per lakh live births
  4. Achieve universal immunization of children
  5. Achieve 80% institutional deliveries
  6. Reduce infant mortality rate, maternal mortality rate
Long-term Objective:
  • Achieve stable population by 2045 at a level consistent with sustainable economic growth, social development, and environmental protection.

National Health Policy 2017 Targets:

  • TFR: 2.1 by 2025
  • MMR: < 100 by 2020
  • IMR: < 28 by 2019
  • U5MR: < 23 by 2025

Reproductive and Child Health (RCH) Programme Goals:

  1. Reduce unmet need for family planning
  2. Improve quality of maternal and child health services
  3. Prevent and manage RTIs/STIs
  4. Reduce infant and child mortality

Family Planning Programme - Key Current Goals:

  1. Achieve TFR of 2.1 at national level
  2. Meet the unmet need for contraception
  3. Increase the modern contraceptive prevalence rate (mCPR)
  4. Promote spacing methods especially among young couples
  5. Reduce teenage pregnancy
  6. Achieve 2-child family norm
  7. Promote equal responsibility of men in family planning

Target-Free Approach (Community Needs Assessment Approach - 1996):

The old top-down target system (where state/centre fixed numeric contraceptive targets) was replaced by the Community Needs Assessment (CNA) Approach in 1996.
Drawbacks of the old target approach:
  1. Targets set from above without reflecting user preferences
  2. Quality of services became secondary to numerical achievement
  3. Led to coercion and manipulation
  4. Mismatch between contraceptives provided and client needs
  5. No authentic feedback mechanism
Under CNA Approach:
  • Targets are assessed locally based on community needs
  • Village/subcentre level data used to estimate requirements
  • Focus shifts from numbers to quality of care and client satisfaction
  • Services tailored to the specific contraceptive needs of the community
  • Known as "Target-Free Approach"

Mission Parivar Vikas (MPV):

Launched in 146 high-TFR districts - a five-pronged strategy:
  1. Delivering assured services
  2. Building capacity/human resource development
  3. Ensuring commodity security
  4. Implementing new promotional schemes
  5. Creating an enabling environment
Source: Park's Textbook of Preventive and Social Medicine, 25th Edition - Chapter on Family Planning
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