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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