PROGRESS OF FAMILY WELFARE PROGRAMMES IN ANDHRA PRADESH

PROGRESS OF FAMILY WELFARE PROGRAMMES IN ANDHRA PRADESH T.Sankaraiah *, K.Rajasekhar** and T.Chandrasekarayya*** *Research Scholar, ** Associate Professor and *** Assistant Professor Dept. of Population Studies& Social Work, S.V.University, Tirupati. A.P-517502. ABSTRACT The Family Welfare Programme in India was launched with the objective of reducing birth rates to the extent necessary to stabilize population at a level consistent with the requirements of the national economy. Indeed much of the recent fertility decline in India (especially in the southern states) is attributed to increasing acceptance of sterilization, particularly female sterilization. The present study examines the examine the currently married women who used any contraceptive method by specific method in three phases of NFHS in Andhra Pradesh and to analysis Trends in couple protection rate in Andhra Pradesh based on secondary data. KEY WARDS Total Fertility Rate, Contraception, Couple Protection Rate, Currently Married Women, family planning and Family Welfare Programme. INTRODUCTION The family welfare programme is perhaps the most effective policy intervention to regulate fertility and stabilize population size. The direct impact of the programme relates to the spread of knowledge and the increase in the use of family planning methods. Hence, the impact of the programme can be accessed from the cumulative number of acceptors or from the current level of contraceptive prevalence. But the ultimate impact of the programme has to be assessed in terms of its impact on fertility. An additional source of evidence on ferti1ity decline is the inter-census growth rate and changes in the proportion of child population. The faster decline in birth rate and slow down in rate of decline in death rate reduced the gap between in birth and death rates (i.e. decline in natural growth) resulted in decline in rate of growth of population since 1990s. The fertility transition in the state owing high contraceptive prevalence rate, i.e. Couple Protection Rates (CPR) among the currently married women in reproductive age group and their higher exposure to family planning methods through media is a remarkable one. Uniqueness of the transition in the state is that it almost homogeneous across sub-population group s distinguished socioeconomic characteristics. The Sample Registration System (SRS) data indicate that the total fertility rate (TFR) in Andhra Pradesh remained more or less stable at around 5 per woman in reproductive age group 26

from 1961 to 1971. It took almost three decades for TFR to reach three children per woman but once this threshold level was reached, the further decline to two children took only about ten years. The pace of decline in fertility was slower till the first half of the 1980s but thereafter there has been a rapid decline in fertility, faster even as compared to other southern states particularly between 1987 and 1996. According to NFHS-3(2005-06), the Total Fertility Rate (TFR) for the state is below that of Kerala. The pace of fertility decline outstripped the decline in mortality rate in the second half of the 1980s and resulted in decline in the natural growth of population during 1990s. Using available data from the census, sample registration system and demographic sample surveys, this chapter examines the pace of population transition and contraceptive use in Andhra Pradesh. India set the goal of Population stabilization in its very first Five-Year Plan (1951-56) which was formulated soon after India attained independence in 1947. The Planning Commission clearly recognized the need for population control right at the beginning of the planning exercise. Bose, A. (1993) in his book opined that Family planning in India continues to be synonymous with sterilization, although government policies strive to promote reversible methods. K.S. James (1999) Fertility Decline in Andhra Pradesh: A Search for Alternative Hypotheses opined that The Southern states in India, on the whole, are undergoing a fertility transition. Santhya (2003), in his paper on Changing Family Planning Scenario in India: An Overview of Recent Evidence viewed that over the decades, there has been a substantial increase in contraceptive use in India. A Study by G.R. Varma and A. Rohini (2008) among Married Men and Women of a Rural Community in West Godavari District, Andhra Pradesh, opined that the fertility data indicate that there is a need to change to scenario of contraception use in India. Objectives The major objectives of the present study are: 1. To study the knowledge of different contraceptive methods among currently married women in three phases of NFHS in Andhra Pradesh. 2. To examine the currently married women who used any contraceptive method by specific method in three phases of NFHS in Andhra Pradesh and 3. To analysis Trends in couple protection rate in Andhra Pradesh. Methodology The present study is based on secondary data collected from the three phases of National Family Health Survey (NFHS-1, NFHS-2 and NFHS-3) and Health and Family Welfare reports. Results and Discussion Knowledge of contraceptive methods-women Table-1 shows knowledge of different contraceptive methods among currently married women age 15-49 (NFHS-1, NFHS-2 and NFHS-3). 27

Source NFHS-3 (2005-06) NFHS-2 (1998-99) NFHS-1 (1992-93) N.A=Not available Any Method Any Table-1 Knowledge of contraceptive methods (percentage) Modern Female Male Method sterilizat Steriliz ion ation Pill IUD Modern method Emerge Other Any Inject Condom Female ncy Modern traditional ables / Nirodh Condom contrace method method ption Traditional method Rhythm Withdr awal 99.1 99.1 99.0 89.1 62.8 46.0 31.7 98.2 9.9 4.6 0.0 14.9 9.7 4.3 0.6 Folk method 98.9 98.9 98.5 90.9 60.1 50.7 N.A. 48.3 N.A. N.A. 1.2 15.3 14.4 7.4 N.A. 96.7 96.9 95.7 89.7 53.7 43.7 12.8 41.9 N.A. N.A 3.5 14.6 11.3 2.9 N.A. The table-1 shows that almost not less than 96 per cent of women have knowledge on any method and even modern method. When compared to knowledge on male and female sterilization almost all of them known female sterilization than male sterilization i.e. around 90 per cent only have knowledge on vasectomy. It shows women are the compulsory resources for sterilization in Indian society. Regards to traditional methods knowledge on Rhythm method was somewhat better (fig.1). Knowledge of contraception is almost universal in Andhra Pradesh. Almost all women and men know about female sterilization. Knowledge of male sterilization is also very high (89 per cent of currently married women and 96 per cent of currently married men). Both men and women are less likely to know about temporary methods of contraception. The government family planning programme promotes three temporary methods: the pill, the IUD and the condoms. Of these three methods, currently married women are most likely to know about the pill (63 per cent), currently married men are most likely to know about condoms (88 per cent) knowledge of sterilization has been high in Andhra Pradesh since NFHS-1. Knowledge of temporary contraceptive methods has not increased such since NFHS-1. Fig.1: Knowledge of contraceptive methods-women (percent) 28

For example, only 46 per cent of currently married women in Andhra Pradesh know about the IUD, which is even lower than in NFHS-2 (51 per cent) and only slightly higher than NFHS-1 (44 per cent). Knowledge of condoms increased from 42 per cent in NFHS-1 to 48 per cent in NFHS-2, but remained at 48 per cent in NFHS-3. Among currently married women, 63 per cent now know about the pill (NFHS-3), compared with 54 per cent in NFHS-1 and 60 per cent in NFHS-2. Contraceptive Use Table-2 contains data on percentage of currently married women who used any contraceptive method by specific method, according to A.P state, NFHS-1, NFHS-2 and NFHS-3. Table-2 Currently married women used in contraceptive methods (percentage) Source Any Method Any Modern Method Female sterilizat ion Male Sterilization Pill IUD Injec tables Condom / Nirodh Female Condom Emerge ncy contrace ption Other Modern method Any tradition al method Rhythm Not currently using Urban NFHS-3 67.7 67.2 61.5 3.0 0.6 0.9 0.1 1.1 0.0 0.5 0.3 0.2 0.0 32.3 NFHS-2 63.4 62.3 52.4 5.0 1.4 1.6-1.8-1.0 1.0 0.0-36.6 NFHS-1 56.6 55.6 44.1 7.2 1.1 1.0-2.1-1.0 0.8-0.2 43.6 Rural NFHS-3 67.6 67.0 63.6 2.8 0.1 0.2 0.0 0.1 0.0 0.6 0.3 0.1 0.1 32.4 NFHS-2 58.3 57.8 52.8 4.1 0.3 0.3-0.3-0.3 0.2 0.1-41.7 NFHS-1 43.6 43.3 36.0 6.6 0.2 0.4-0.2-0.3 0.1-0.2 56.4 Total NFHS-3 67.6 67.0 62.9 2.9 0.3 0.5 0.1 0.5 0.0 0.6 0.3 0.1 0.1 32.4 NFHS-2 59.6 58.9 52.7 4.3 0.5 0.6-0.7-0.5 0.4 0.1-40.4 NFHS-1 47.0 46.5 38.1 6.6 0.5 0.6-0.7-0.5 0.3-0.2 53.0 The data in table-2 clearly indicates the contraceptive methods used by currently married women in Andhra Pradesh in three successive NFHSs. As per data, in NFHS-1, 53 per cent of currently married women were not used any method of contraception, but 68 per cent of the currently married women were undergone any one method of contraception in NFHS-3 period, it is a very good improvement in Andhra Pradesh. One of the probable reasons is government efforts during 1994-2004, in this period nearly 9 per cent of berths were averted due to family welfare programmes in Andhra Pradesh. When compared to rural and urban data, the similar trends were prevailing. The figure.2 shows the trends in currently married women used contraception by area wise. 29

Fig.2: Currently used in contraception (percentage) The contraceptive prevalence rate among currently married women age 15-49 is 68 per cent, up from 60 per cent at the time of NFHS-2. Female sterilization accounts for 93 per cent of all contraceptive use, up from 88 per cent at the time of NFHS-2. Contraceptive use is higher among women age 30-39 years than among younger or older women. Muslim women are somewhat less likely to use contraception (62 per cent) than Hindu women (68 per cent) or Christian women (69 per cent). Contraceptive use increases steadily with an increase in the household wealth index. Contraceptive use is particularly high among the wealthiest women (74 per cent). Women belonging to scheduled tribes and scheduled castes are less likely to use methods of family planning methods than other women, but the differences are quite small. However, women with no education or less than 5 years of education are more likely to use contraception then women with more education. The figure 5.3 clearly explains the differences between the use of any method and any modern method in three NFHSs in Andhra Pradesh. Fig.3: Using any method or any modern method of contraception (percentage) Consistent with son preference, women in Andhra Pradesh are more likely to use contraception if they already have a son. For example, among women with two living children, 90 per cent of women with two sons use a contraceptive method, compare with 88 per cent of women with one son and 79 per cent of women with two daughters but no sons. The use of every spacing method is very low (less than 1 per cent 30

of currently married women use each of the modern and traditional spacing methods). Fig.4: Contraception methods used by women in A.P Contraceptive use at the time of last sex as reported by men (59 per cent) is somewhat lower than women s reports of current contraceptive use (68 per cent). Men are more likely than women to report current use of condoms, however, seventy-eight per cent of sterilized women had the operation n a government facility, usually in a government of municipal hospital, whereas 85 per cent of IUD users and pill users used the private medical sector as the source of their method. Condoms were most frequently procured from the private medical sector (51per cent); only 16 percent got their supply from the public medical sector. More than one-quarter of women (26 per cent) said their husband obtained the condoms and they did not know the source. Although use of temporary spacing methods is low, discontinuation of these methods within 12 months of adoption is substantial. Four in 10 women who adopted a spacing method discontinued use of the method within one year. Table-3 Trends in current use of contraception by methods, Andhra Pradesh (percentage) Method 1992-93 1998-99 2005-06 Male sterilization 7 1 4.3 2 9 Female sterilization 38.1 52.7 62.9 Spacing methods 1.8 1.8 1.4 Any modern method 47 58.8 67.2 Any method 47 58.8 67.2 Source: National Family Health Survey 1992-93; 1998-99; 2005-06. Male sterilization continues to lose its popularity in the state as the prevalence of male sterilization has declined from 7.1 per cent in 1992 to just 3.0 per cent in 2005-06.These information available from the National Family Health Survey as well as from the programme service statistics suggests that female sterilization continues to dominate the contraceptive method-mix in Andhra Pradesh and there is a gradual erosion of the popularity of spacing methods over time. The below figure.5 explores the District-wise contraceptive adoption in Andhra Pradesh. 31

Fig. 5:District-wise contraceptive use in Andhra Pradesh (percentage) Source: Ministry of Health and Family Welfare, Government of India, 2007-08 As per above figure.5 data, more than 75 per cent of Couple Protection Rates(CPR) were in Godhavari districts(east and West) and Krishna district of coastal Andhra. These districts are called Rice Bowl of Andhra Pradesh and literacy is also high, power house with agriculture and Information Technology (IT) being the major contributor to the state s economy. So, these positive indicators head to higher performance of contraception in these three districts. Whereas one Rayalaseema district (Cuddapah) and four Telangana districts, viz. Adilabad, Nizambad, Medak and Mahabubnagar have less than 60 per cent Couple Protection Rates (CPR). Interestingly, in the capital city of the state, Hyderabad have 65 to 70 per cent of eligible couple were undergone contraception/couple protection. 32

Table-4 Trends in couple protection rate in Andhra Pradesh, 1980-2011(percentage) Year CPR Year CPR Year CPR 1980 28.2 1993 46.1 2004 61.0 1983 28-4 1994 48.8 2005 62.4 1984 30.0 1995 51.2 2006 63.3 1985 32.2 1996 1996 2007 63.9 1986 34 7 1997 49.8 2008 66.3 1987 36.0 1998 50.5 2009 64.6 1988 59 9 1999 51.8 2010 63.9 1989 41.8 2000 53 5 2011 61.5 1990 44.2 2001 56.6 1991 44 3 2002 58.2 1992 45.1 2003 60.5 Source: Commissioner, Family Welfare, Government of Andhra Pradesh. The performance of the family welfare programme is usually assessed from the current prevalence of family planning by method. The proportion of couples in the reproductive ages currently and effectively protected against conception, termed as couple protection rate (CPR) is currently being used by the Department of Family Welfare for assessing the performance of family welfare programme. Table-5 Trends in acceptors of sterilization in Andhra Pradesh, 1990-91 to 2004-05 Year No. of Sterilizations Percentage of Tubectomy Vasectomy Tubectomy Total of the Total Sterilizations 1990-91 25146 431837 456983 94.5 1991-92 29183 454349 483532 94.0 1992-93 33645 490748 524393 93.6 1993-94 41957 561952 603909 93.1 1994-95 28914 546814 575728 95.0 1995-96 23654 496898 520552 95.5 1996-97 26328 487398 513726 94.9 1997-98 33436 595595 629031 94.7 1998-99 65666 667731 733391 91.0 1999-00 52537 739571 792108 93.4 2000-01 63377 750958 814335 92.2 2001-02 44486 763577 808063 94.5 2002-03 42406 791538 833944 94.9 2003-04 31804 799008 830812 96.2 2004-05 28808 707609 736417 96.1 Source: Commissioner. Family Welfare, Government of Andhra Pradesh. The CPR in Andhra Pradesh had increased from 28.2 per cent in 1980 to 19.0 per cent in 1988. A 33

dramatic increase of +631.7 percentage points in the CPR was, however, recorded by 8 years. This large spurt in the value of CPR was due to coercive measures adopted during the Emergency. Following the Emergency period, the family welfare programme suffered a set-back and the CPR declined to 41 per cent in 1989. Later on with minute fluctuations the CPR increased 66.3 per cent in 2008 and ever since decreased to 61.5 per cent in 2011.The overwhelming importance of sterilization, particularly female sterilization in the family welfare programme in the state is apparent from the data presented in Table- 5. The number of annual acceptors of female sterilization increased steadily from 0.43 million in 1990-91 to 0.56 million in 1993-94. Between 1993-94 and 1996-97, there was a decline in the annual acceptors of female sterilization but after 1996-97, annual number of acceptors of female sterilization increased rapidly. It is remarkable to note that between 0.7-0.8 million female sterilizations were done annually for 5 years from 1999 through 2004. It is laudable to note that Andhra Pradesh has been the leading state in terms of performance in sterilization; especially female sterilization. The National Family Health Survey -3 carried out in Andhra Pradesh in 2005-06 has revealed that 67 per cent of currently married women in the reproductive age group were using modern methods of contraception. The terminal methods accounted for almost 66 per cent, while temporary spacing methods accounted for about 1 per cent. Sterilization (mainly female sterilization) dominates the contraceptive use in the state, accounting for 97 per cent of the current contraceptive prevalence (International Institute for Population Sciences and Macro International, 2007). Table-6 Methods used before sterilization-nfhs-1, NFHS-2 and NFHS-3 (percentage) Method used None Pill UID Injectable Condom / Nirodh Source Female condom Rhythm NFHS-3 95.1.6 1.4 0.1 1.9 0.0 0.3 0.1 NFHS-2 94.4.9 2.0 N.A 1.5 N.A. 0.5 0.2 NFHS-1 93.0.3 2.0 0.3 2.1 N.A. 1.1 0.2 With -drawal The table-6 shows that before sterilization pill, UID and condom were dominant. But from NFHS- 1 to NFHS3, number of people who did not use increased from 93 per cent in NFHS-1 to 95.1 in NFHS-3 showing increasing use of one method or the other. But the usage of Pill, UID, and Rhythm decreased whereas the usage of Nirodh increased showing health consciousness of the people in safe side against decreased. CONCLUSION The family welfare programme is perhaps the most effective policy intervention to regulate fertility and stabilize population size. The direct impact of the programme relates to the spread of knowledge and the increase in the use of family planning methods. Women are the compulsory resources for sterilization in Indian society. Regards to traditional methods knowledge on Rhythm method was somewhat better. The government family planning programme promotes three temporary methods: the pill, the IUD and the condoms. Of these three methods, currently married women are most likely to know about the pill (63 per cent), currently married men are most likely to know about condoms (88 per cent). Although use of temporary spacing methods is low, discontinuation of these methods within 12 months of adoption is substantial. The female sterilization continues to dominate the contraceptive method-mix in Andhra Pradesh and there is a gradual erosion of the popularity of spacing methods over time. The terminal methods accounted for almost 66 per cent, while temporary spacing methods accounted for about 1 per cent. Sterilization (mainly female sterilization) dominates the contraceptive use in the state, 34

accounting for 97 per cent of the current contraceptive prevalence. The annual compound growth rate for Andhra Pradesh was 1.37 per cent, which was much lower rate than the all-india average of 1.93 per cent. The RGI projections indicate that although the size of the population would increase further over the period 2026, the rate of growth in population would be very low and it would be declining further. According to Sample Registration System annual estimations, the fertility rate in the state declined to 1.8 in 2008, below replacement level (i.e.2) from its highest at 5.5 in 1961. The fertility transition in terms of declined fertility rate below the replacement level is the main contributing factor in demographic transition in Andhra Pradesh. Many studies based on NFHS-I,II and III data shows that exposure to mass media and contraceptive use, have had a relatively strong influence on fertility decline. Hence, in Andhra Pradesh fertility mortality and increasing contraception/couple protection rate(cpr) are the major contributing factors for the observed demographic transition in the state. References 1. Bose, A. (1993) India and the Asian Population Perspective, Delhi: BR Publishing. 2. International Institute for Population Sciences and Macro International.(2007) National Family Health Survey (NFHS-3) 2005-06. Mumbai, International Institute for Population Sciences. 3. James, K.S.(1999) Fertility Decline in Andhra Pradesh: A Search for Alternative Hypotheses. Economic and Political Weekly of India. 34(8), p.491-499. 4. Santhya, K.G.(2003) Changing Family Planning Scenario in India: An Overview of Recent Evidence, Reagional Working Papers, No.17, 2003, Editor: Deepika Ganju, Population Council, New Delhi, India. 5. G.R.Varma and A.Rohini.(2008) Attitude of Spouse towards Family Planning: A Study among Married Men and Women of a Rural Community in West Godavari District, Andhra Pradesh, Anthropologist, 10(1): 71-75. ***** 35