and reproductive health in the urban setting: Sustainable Cities, - - PowerPoint PPT Presentation

By:

• Dr. S.K. Sikdar

Deputy Commissioner, In-charge, Family Planning Division Ministry of Health and Family Welfare Government of India

Creating greater understanding and addressing the relationship between poverty and reproductive health in the urban setting:

Sustainable Cities, Human Mobility and International Migration - Opportunities for South-South Cooperation and Intervention needs (Policy and Program)

Relationship between Poverty, Reproductive Health and Maternal Morbidity/Mortality

• Food/Nutrients
• Environment
• Water/Sanitation

POVERTY & INCOME MATERNAL MORBIDITY & MORTALITY Productivity Human Capital (Child Quality) Fertility (Child Quantity)

Sahn 2006

• Medical Care
• Reproductive Health/

Family Planning

Poor reproductive health is both a cause and consequence of poverty

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• Dr. SK Sikdar, MoHFW, Government of

India 2

Benefits of achieving FP goals

Total = 10433 mn USD

Water= 1059.2mn USD MH= 1329.2 mn USD Immunization = 3690mn USD Education= 4354.6mn USD

Social Sector cost savings outweigh Family Planning costs

Family Planning= 789.2 mn USD

Source: Calculation by Health Policy Initiative (USAID Project), Futures Group

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• Dr. SK Sikdar, MoHFW, Government of

India 3

Increasing growth rate in Urban Population

27.8 31.2

5 10 15 20 25 30 35

Decadal Growth Rate 2001 2011

44 56

Contribution in increasing urban growth rate National Increase Rural Urban Migration/reclassification of rural settlements Source: Census

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India 4

Urbanization Scenario in India

• 300 million Indians currently live in towns and cities.
• Within 20-25 years, another 300 million people will get

added to Indian towns and cities

• By 2030, more than 50 per cent of India’s population is

expected to live in urban areas (Source: UN Forecast 2008)

• By 2050 the percentage will increase to 70% (Source: UN Forecast

2008) 12-12-2017

• Dr. SK Sikdar, MoHFW, Government of

India 5

Some Evidences

• Meeting the unmet needs for family planning

raises the incomes of the poor by 10%-20% in cases of extreme poverty.

• A fall in the birth rate of 5 per thousand

people in 45 countries during the 1980s would have led to a one-third drop in the incidence

• f poverty

Source: Honduras and Colombia study in Latin America Source: http://www.sernina.org/our-stories-blog/more-than-just-girls-investing-in-global-change-10-reasons-why-we-must-prioritize-sexual-and-reproductive-health

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India 6

India Snapshot

India- Family Size and GDP per capita ($)

1000 2000 3000 4000 5000 6000 7000 8000 0.5 1 1.5 2 2.5 3 3.5 4 4.5 5

1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

GDP per capita ($) (PPP) Total Fertility Rate TFR GDP per capita ($) (PPP)

Source: SRS, Estimates by IMF

With almost 50% decline in TFR the GDP per capita has increased by 7 times

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India 8

Total Fertility Rate in Different Wealth Quantiles (India)

3.2 2.5 2.1 1.8 1.5

0.5 1 1.5 2 2.5 3 3.5

Lowest Second Middle Fourth Highest Total Fertility Rate

Source: NFHS IV

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India 9

Birth Numbers in Different Wealth Quantiles (India)

46.3 32.5 24.1 17.5 12.1

5 10 15 20 25 30 35 40 45 50

Lowest Second Middle Fourth Highest % of Births

Source: NFHS IV

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India 10

Education impacts fertility

• Pregnancy a major
• bstacle to school

attendance

– High levels of pregnancy in youth

3.7 2.8 2.6 2.3 2 ILLITERATE BELOW PRIMARY PRIMARY MIDDLE CLASS X Total Fertility Rate

Source: SRS 2015

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India 11

Addressing poverty and reproductive health

Building Institutions (political

commitment, financial investment, evidence based policies, strong leadership and implementation)

Safeguarding Rights- SRH

(Safe Sex, Safe Motherhood, FP); Right to health; Political and Civil Rights

Establishing Gender Norms-

Masculinity/femini ty; women’s participation in Workforce; Value

• f girls

Sexual and Reproductive Health Status Poverty Reduction

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India 12

M NCH A

Healthy timing of pregnancy & Birth spacing Improving Spacing between children Addressing Contraceptive Needs at Facility and Community Level Family Planning

R

India’s efforts to revitalise Reproductive Health

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India 13

Key schemes being implemented to improve Reproductive Health

Family Planning:

• 3 New Contraceptives introduced.
• Promoting Post Partum and Post Abortion FP services

(PPIUCD has become a global best practice)

• CHWs distributing contraceptives from house to house
• Introduced web based real time FP LMIS
• Enabling client to access service by compensating for

their wage loss.

• Special package in high fertility districts
• 360 degree holistic multimedia Communication

Campaign

Key schemes being implemented to improve Reproductive Health

Maternal Health:

• Janani Shishu Suraksha Karyakram (JSSK) Free and Zero

Expense for undergoing delivery in public health facilities.

• Janani Surksha Yojana- Cash assistance to eligible pregnant

women who give birth in a government health facility

• PMSMA (Every Ninth of the month – ‘I pledge for 9’ for
• bstetricans in public sector)
• Dedicated Maternal & Child Health Wings
• Obstetric ICUs/ High Dependency Units

Adolescent Health:

• Adolescent Friendly Health Clinics (AFHCs),
• Weekly Iron Folic Acid Supplementation (WIFS)
• Menstrual Hygiene Scheme (MHS)
• Peer Educator Programme

We realize that Improved Child survival also impacts reproductive health

• Newborn and Child Health Schemes:
• Essential newborn care at facility and SNCUs
• MAA (Mothers' absolute affection) :Promoting

nutritional care services and exclusive breast feeding.

• Screening and management of children with 4 Ds-

RBSK program

• Universal Immunization Program - Largest

immunization programme in the World (12 vaccines – free of cost)

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India 16

Our efforts are now resulting in improved Reproductive Health Outcomes

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India 17

Teenage Births and Teenage marriages have declined by half

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India 18

16 7.9

2005-06(NFHS III) 2015-16(NFHS IV) % of births to teenage mothers out of total births

Country has witnessed almost 50% decline in teenage births in last 10 years

47.4 26.8

2005-06(NFHS III) 2015-16(NFHS IV) % women of 20-24 years married before age of 18

Country has witnessed 43% decline in teenage marriages in last 10 years

55% of country’s

population living in 24 out of 36 States/UTs has already achieved replacement level fertility

India Total Fertility Rate = 2.2 (NFHS IV)

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• Dr. SK Sikdar, MoHFW, Government of

India 19

2.7 2.2 1.9 1.8 NFHS III NFHS IV

(wanted & actual fertility rate gap halved in India) Actual Fertility Wanted Fertility

137,000,000

Women are using a modern methods of contraception As a result of the contraceptive use:

39,000,000

Unintended pregnancies will be prevented

11,500,000

Unsafe abortions will be averted

43,000

Maternal deaths will be averted

16,500,000 total births will be averted

In 2017 we estimate in India

Strengthening Reproductive health is the key to sustainable development

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India 21

Thank You

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India 22