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

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) By: Dr. S.K. Sikdar Deputy Commissioner, In-charge, Family Planning Division Ministry of Health and Family Welfare Government of India

Relationship between Poverty, Reproductive Health and Maternal Morbidity/Mortality - Medical Care - Reproductive Health/ Family Planning - Food/Nutrients - Environment - Water/Sanitation MATERNAL POVERTY MORBIDITY & & MORTALITY INCOME Productivity Human Capital (Child Quality) Poor reproductive health is both a cause and consequence of poverty Fertility (Child Dr. SK Sikdar, MoHFW, Government of Quantity) Sahn 2006 12-12-2017 2 India

Benefits of achieving FP goals Social Sector cost savings outweigh Family Planning costs Education= 4354.6mn USD Immunization = 3690mn USD Total = 10433 mn USD MH= 1329.2 mn USD Water= 1059.2mn USD Family Planning= 789.2 mn USD Dr. SK Sikdar, MoHFW, Government of 12-12-2017 3 Source: Calculation by Health Policy Initiative (USAID Project), Futures Group India

Increasing growth rate in Urban Population 35 31.2 27.8 30 25 20 2001 15 2011 Contribution in increasing urban 10 growth rate 5 0 Decadal Growth Rate 44 National Increase 56 Rural Urban Migration/reclassification of Source: Census rural settlements Dr. SK Sikdar, MoHFW, Government of 12-12-2017 4 India

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) Dr. SK Sikdar, MoHFW, Government of 12-12-2017 5 India

Some Evidences • Meeting the unmet needs for family planning raises the incomes of the poor by 10%-20% in cases of extreme poverty. • Source: Honduras and Colombia study in Latin America • 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 of poverty 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 Dr. SK Sikdar, MoHFW, Government of 12-12-2017 6 India

India Snapshot

India- Family Size and GDP per capita ($) 5 8000 TFR GDP per capita ($) (PPP) 4.5 7000 GDP per capita ($) (PPP) 4 6000 Total Fertility Rate 3.5 5000 3 2.5 4000 2 3000 1.5 2000 1 1000 0.5 0 0 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 With almost 50% decline in TFR the GDP per capita has increased by 7 times Source: SRS, Estimates by IMF Dr. SK Sikdar, MoHFW, Government of 12-12-2017 8 India

Total Fertility Rate in Different Wealth Quantiles (India) 3.5 3.2 3 2.5 Total Fertility Rate 2.5 2.1 2 1.8 1.5 1.5 1 0.5 0 Lowest Second Middle Fourth Highest Source: NFHS IV Dr. SK Sikdar, MoHFW, Government of 12-12-2017 9 India

Birth Numbers in Different Wealth Quantiles (India) 50 46.3 45 40 32.5 35 % of Births 30 24.1 25 17.5 20 15 12.1 10 5 0 Lowest Second Middle Fourth Highest Source: NFHS IV Dr. SK Sikdar, MoHFW, Government of 12-12-2017 10 India

Education impacts fertility 3.7 • Pregnancy a major Total Fertility Rate obstacle to school 2.8 2.6 2.3 attendance 2 – High levels of pregnancy in youth ILLITERATE PRIMARY PRIMARY MIDDLE CLASS X BELOW Source: SRS 2015 Dr. SK Sikdar, MoHFW, Government of 12-12-2017 11 India

Addressing poverty and reproductive health Building Institutions (political commitment, financial investment, evidence based policies, strong leadership and implementation) Establishing Safeguarding Gender Norms - Rights - SRH Masculinity/femini ty ; women’s (Safe Sex, Safe Motherhood, FP); participation in Right to health; Workforce; Value Political and Civil of girls Rights Poverty Sexual and Reproductive Health Status Reduction Dr. SK Sikdar, MoHFW, Government of 12-12-2017 12 India

India’s efforts to revitalise Reproductive Health R Family Planning Healthy timing of pregnancy M & Birth spacing Improving Spacing between NCH children Addressing Contraceptive A Needs at Facility and Community Level Dr. SK Sikdar, MoHFW, Government of 12-12-2017 13 India

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 obstetricans 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) Dr. SK Sikdar, MoHFW, Government of 12-12-2017 16 India

Our efforts are now resulting in improved Reproductive Health Outcomes Dr. SK Sikdar, MoHFW, Government of 12-12-2017 17 India

Teenage Births and Teenage marriages have declined by half Country has witnessed almost 50% Country has witnessed 43% decline decline in teenage births in last 10 in teenage marriages in last 10 years years mothers out of total births % women of 20-24 years married before age of 18 % of births to teenage 47.4 16 26.8 7.9 2005-06(NFHS 2015-16(NFHS 2005-06(NFHS 2015-16(NFHS III) IV) III) IV) Dr. SK Sikdar, MoHFW, Government of 12-12-2017 18 India

India Total Fertility Rate = 2.2 (NFHS IV) 55% of country’s population living in 24 out of 36 States/ UTs has already achieved replacement level fertility (wanted & actual fertility rate gap halved in India) 2.7 2.2 1.9 1.8 NFHS III NFHS IV Actual Fertility Wanted Fertility Dr. SK Sikdar, MoHFW, Government of 12-12-2017 19 India

In 2017 we estimate in India 137,000,000 Women are using a modern methods of contraception As a result of the contraceptive use: 11,500,000 39,000,000 Unsafe abortions will be averted Unintended pregnancies will be 43,000 prevented Maternal deaths will be averted 16,500,000 total births will be averted

Strengthening Reproductive health is the key to sustainable development Dr. SK Sikdar, MoHFW, Government of 12-12-2017 21 India

Thank You Dr. SK Sikdar, MoHFW, Government of 12-12-2017 22 India