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Is Population an Issue?

India has progressed along the path of demographic transition as follows :-

Starting with a phase of high birth rate coupled with a high death rate in the early 20th century, India saw its population spurt in the 1960s and 1970s when the death rate plummeted but the birth rate remained high. During this period, India doubled its population from what it was in the 1950s. At that point, the focus was on motivating people to reduce the family size from six children to two per woman. Hence popular campaigns like "Hum Do, Hamare Do" (Two of Us, Two For Us) focused on the desirability of a small family.

The scenario has now changed. The average number of children per woman has come down, which means that couples are already opting for smaller families. So we rarely hear messages promoting a small family. The focus now is on providing quality reproductive and child care services to the people, increasing the age at marriage, reducing infant mortality and promoting spacing, or the gap between two consecutive pregnancies. These messages are now being communicated by health workers and Non-Government Organisations at the community level.

Sexual and Reproductive Rights.
Reproductive rights in essence flow from widely recognized and internationally accepted human rights. Yet, the concept of reproductive rights per se is relatively new, and their significance is less understood among many sections. Reproductive rights are not only ethically based but also impact the quality of life of people.

The important sexual and reproductive rights cover choices pertaining to sexuality, reproductive decision-making, which includes voluntary choice in marriage, and the determination of the number, timing and spacing of one's children. They also include the right to access information and the means needed to exercise such voluntary choice.

This empowers couples to plan their families by making informed choices regarding contraception, and so reduces the incidence of HIV/AIDS, unwanted pregnancies, teenage pregnancies, maternal morbidity and mortality - all of which impact on the health of the population.

Reproductive rights also include the capacity for men and women to make free and informed choices in all spheres of life, free from discrimination based on gender.

Reproductive and sexual health constitutes an integral component of overall health, throughout the life cycle, for both men and women. By adopting a life cycle approach, this right promotes sexual and reproductive health as a quality of life issue at all stages of life and is not limited to procreation alone.

Operational issues of Reproductive Rights
Reproductive rights came into operation through the Reproductive Child Health (RCH) programme.

Firstly, the programme replaced the top-down, pre-fixed targets approach with a process where the service providers are actively involved in setting the targets by assessing the needs of the community.

Secondly, it adopted a gender-sensitive approach to service delivery. The health needs of women were seen as going beyond pregnancy and childbirth. Thus, issues like status of the girl child, adolescent health and education, domestic violence, women's empowerment became integral to the programme. A whole range of services including infertility, reproductive tract infections and sexually transmitted diseases were covered under the RCH programme. There was also an attempt to make the service environment woman friendly. For the first time, men were also involved as equal partners in taking responsible decisions regarding family size and health of the mother and the child.

Additionally, there was a shift from mass media based information campaigns to communications support through counselling services that could enable couples to make informed choices regarding their reproductive behaviour.

Panchayats and the Population Programme
It is now more than a decade since local self Government institutions, or the Panchayat Raj Institutions (PRIs), were empowered in all matters of local governance by constitutional amendments that also reserved one third of PRI seats for women. As a result, there are close to one million elected women representatives while nearly three million women contested the elections.

The RCH programme introduced the community needs assessment approach where the service delivery goals are set at the local level. This is required to be done with the active participation of the panchayats, which are empowered to monitor the execution of the programmes.

Panchayats would be able to influence health service delivery effectively only when they are equipped with the skills of programme management. JSK is one organisation that seeks to do so.


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