National Family Welfare Programme (NFWP)

Overview

Historical Evolution by Five Year Plans

Phase 1: Clinic Approach (1952-1961)

• The First Five Year Plan (1951-56) allocated a modest Rs. 0.65 crore
• Emphasis was on establishing clinics and distributing educational material, training and research
• The "rhythm method" was the primary contraceptive approach

Phase 2: Extension Education Approach (1961-1969)

• Third Five Year Plan (1961-66): Family planning declared "the very centre of planned development"
• Shifted from the "clinic approach" to a more vigorous "extension education approach" to promote the small family norm
• The Lippes Loop (IUD) was introduced in 1965, requiring major structural reorganization
• A separate Department of Family Planning was created in 1966 within the Ministry of Health
• Rs. 27 crore in Third Plan; Rs. 82.9 crore in the Annual Plan (1966-69)

Phase 3: High-Intensity HITTS Approach (1969-1977)

• Fourth Five Year Plan (1969-74): Government gave "top priority" to the programme
• Programme integrated with MCH activities of PHCs and sub-centres
• 1970: All India Hospital Postpartum Programme launched
• 1972: Medical Termination of Pregnancy (MTP) Act introduced
• Fifth Five Year Plan (1975-80): Major changes occurred
• April 1976: India framed its first National Population Policy
• 1976-77: Disastrous forcible sterilization campaign during Emergency; led to Congress defeat in 1977 elections
• The HITTS model = Health department-operated, Incentive-based, Target-oriented, Time-bound, and Sterilization-focused

Phase 4: Voluntary Approach - Family Welfare (1977 onwards)

• June 1977: New Janata Government formulated a new population policy ruling out all compulsion and coercion
• Ministry of Family Planning renamed "Family Welfare"
• 42nd Amendment of the Constitution made "Population control and Family Planning" a concurrent subject (effective January 1977)
• 1977: Rural Health Scheme launched; community involvement (Health Guides, trained Dais) at grassroots
• 1978: India signed the Alma Ata Declaration
• 1982-83: National Health Policy formulated and approved by Parliament; set demographic goal of NRR=1 by year 2000 (birth rate 21, death rate 9 per 1000, couple protection rate 60%)

Phase 5: Integration Under MCH/RCH (1985 onwards)

• 1985-86: Universal Immunization Programme (UIP) started - to reduce infant/child mortality from vaccine-preventable diseases
• Oral rehydration therapy introduced (for diarrhoeal disease in children)
• 1992: Child Survival and Safe Motherhood (CSSM) Programme - integrated various MCH programmes
• 1994: International Conference on Population and Development (ICPD), Cairo - recommended Unified Reproductive and Child Health (RCH) Programme
• Ninth Five Year Plan: RCH Programme integrated all related programmes from the Eighth Plan

Phase 6: Modern Era (2000 onwards)

• 2000: National Population Policy 2000 (NPP 2000) - detailed, comprehensive policy to promote family welfare
• 2005: National Rural Health Mission (NRHM) launched (initially for 7 years, 2005-2012; extended to 2017)
• Later: National Urban Health Mission merged with NRHM to form National Health Mission (NHM)
• 2013: RMNCH+A (Reproductive, Maternal, Newborn, Child and Adolescent Health) strategy launched - based on a continuum of care approach with integrated service packages
• 2014: India Newborn Action Plan (INAP) - goal to attain single-digit neonatal mortality rate and stillbirth rate by 2030
• 2017: New National Health Policy launched

Financial Investment (Five Year Plans)

Key Components of the Programme

1. Family Planning Services - contraception, sterilization (tubectomy, vasectomy), IUDs, oral contraceptives, condoms
2. Maternal and Child Health (MCH) - antenatal care, safe delivery, postnatal care, child immunization
3. Universal Immunization Programme (UIP) - BCG, DPT, OPV, measles, Hepatitis B, etc.
4. Nutrition - supplementary nutrition, addressing anaemia and malnutrition
5. Medical Termination of Pregnancy (MTP) - legalized in 1972, integrated into programme
6. Postpartum Programme - contraception and health care after delivery
7. Information, Education and Communication (IEC) - promoting small family norm
8. Reproductive and Child Health (RCH) - integrated umbrella since 1997

Evaluation of Family Planning

1. Evaluation of need - assessing the extent of need for family planning
2. Evaluation of input - resources committed (manpower, money, material)
3. Process evaluation - how the programme is being implemented
4. Output evaluation - services provided (e.g., number of acceptors)
5. Outcome/Impact evaluation - effect on birth rates, fertility, and population

Achievements

• India has averted an estimated 168 million births since inception
• Birth rate declined significantly over decades
• Maternal and infant mortality rates have fallen
• Contraceptive prevalence has risen substantially
• The programme is cited as the world's first national family planning initiative

Key Policy Milestones at a Glance

• Park's Textbook of Preventive and Social Medicine, Chapter 10