Welcome Speech of Smt. Krishna Singh Member Secretary, NCP

Respected Vice Chairman, NCP and Deputy Chairman, Planning Commission, Hon'ble Minister for HRD, Dr. Murii Manohar Joshiji, Hon'ble Minister for Health and Family Welfare, Shri Shatrughan Sinha Ji, who would be joining us a little later, Member, Health and Education, Planning Commission, Hon'ble Ministers from State Governments who are present here in their other capacity as Vice Chairmen of their State Population Commissions, Members of State Population Commission, Members of the National Commission on Population, Secretaries to the Government of India, Pr. Advisers, Advisers of the Planning Commission, Health Secretaries of State Governments, representatives of NGOs and heads of the important academic/ Research Institutions, representatives of the media and friends.

The National Commission of Population is privileged to hold the first Conference of the State Population Councils/Commissions. Present amidst us are the Hon'ble Health and Welfare Ministers in their capacity as Vice Chairmen of the State Population Commissions. We have also representatives of those State Governments who have no Population Commissions in place and those State Governments who are in the process of constituting a framework. The purpose of the meeting is to provide an opportunity for interaction, for understanding, collectively wherever country stands on the demographic front and whether the strategies that are being pursued are adequate to reach the demographic goals as envisaged in NPP 2000. Like the National Commission on Population the State Population Commissions also have a wide mandate that aims at overseeing the on-going programmes relating to population stabilization to promote synergy between health, education, etc.

To enable us to move in a decentralized way we have not only mapped all the districts of the country as per 12 key socio-demographic indicators, but have also moved forward with the idea of the preparation of the District Action Plans placing population as the central concern through the efforts of the field agencies like the District Magistrates. Apart from other initiatives, Vice Chairman, NCP in his capacity as Deputy Chairman, Planning Commission has very generously allocated Additional Central Assistance to over 60 to 70 districts that have large infrastructure gap especially in the high fertility areas. Emphasis on area specific planning, support and cooperation of all the concerned agencies the communities at large, NGOs, private sectors and the Panchayats could be made possible to the help of State Population Commission framework. After listening to the view of the Hon'ble Vice Chairman, NCP we look forward to hearing the views of Hon'ble Minister for HRD, Hon'ble Minister for Health and the Ministers from State Governments who have taken the trouble to be present on the occasion. Though Health and Family Planning remains at the centre of concerns for population stabilization, concerns like nutritional security, safe drinking water, literacy, etc. have all had a different bearing in reaching the demographic goals in different States. We would be making a presentation that brings out the need to focus our attention especially on some States and would try to learn from the experience and success stories of other States in the course of the presentation brought out by the State Governments.

Dr. Asini Kumar Dasgupta Hon'ble Finance Minister, Vice Chairman, State Planning Board & Vice- Chairman, State Population Commission Government of West Bengal

We appreciate the convening of this conference of Vice-Chairpersons of State Population Commissions. It gives us an opportunity to exchange our views with National Commission on Population and other State Population Commissions on issues which are of critical importance in the formulation and implementation of population policy in a federal structure such as ours. These critical issues relate to (a) clear statement of objectives of population policy, (b) setting up of targets at the national and the state levels (and below) consistent with these objectives and (c) organisational matters for implementation of these targets. I shall make pithy observations on each of these three issues.

The main objective of population policy in the present context of our country should be to achieve stabilisation of population within a definite time frame, and, at the same time, achieve quality of life for the population in terms of reduction in infant mortality rate, maternal mortality rate, and attainment of universal immunization of children, prevention and control of communicable diseases, universalisation of elementary education etc. Since these objectives are interrelated, and common people are the real beneficiaries, there is an essential need for convergence of these various programmes as well as involvement of common people in formulation as well as implementation of the schemes under these programmes.

2.1 Given these objectives, the targets for each of them need to be specified with a timeframe for the country as well as for each state (and levels below). With the basic objective of stabilisation of population, we should set the target for achieving for the country the total fertility rate of 2.0 by 2010, with crude birth rate reduced to 21.0, infant mortality rate to 30 and maternal mortality ratio to below 100 per 1,00,000 live births by 2010. Along with these targets, the other targets relating to universal immunization of children and universalisation of elementary education with dropout rates falling below 20, as well as supporting targets on delayed marriage for girls, institutional deliveries, registration of births, deaths, marriasge, pregnancy, prevention and control of communicable diseases should also be reasonably quantified for national level to be achieved by 2010.

2.2 Given the national targets and the demographic trends in West Bengal, the targets for the critical parameters of population policy can be set for the State in a manner which are feasible to achieve.

2.3 With the background of progress of Family Welfare Programme in the State, it is possible to set the target of stabilisation of population of West Bengal by the end of Tenth Five Year Plan, i.e. by the year 2007 which may be ahead of the national level target. It may be noted that the total fertility rate has already come down in the State to 2.3 in 1998-99 as against 3.3 for the country. With a coordinated course of actions, it is indeed feasible to reduce the total fertility rate to 2.0 in West Bengal by 2007. This target has been proposed in the meeting of State Population Commission which has been duly constituted in West Bangal.

2.4 Regarding the birth rate, the all-India target has been set at 21.0 to be achieved by 2010. For West Bengal, the birth rate has already come down to 20.6 in 2000. Among the major States, the position of West Bengal is third in lowering the overall birth rate and first in lowering the urban birth rate (14.3). Keeping this trend in mind, it is possible to set the target of reduction of birth rate for West Bengal as a whole to 18.0 by 2007.

2.5 The infant mortality rate in West Bengal has been 51 in 2000. This rate is much below the national average of 68 and is the third-lowest among the major States. In some of the urban areas of West Bengal, the infant mortality rate has now come down to a level below 30. Keeping this trend in view, the target of reducing this rate to 30 by 2007 may be set for the State as a whole. Every effort will also be made to achieve the reduction of maternal mortality ratio to 100 by 2010. Along with these specific targets, we also accept all other targets enunciated in the National Population Policy.

2.6 In the sphere of educaiton, the target of universalisarion of primary education by 2007 was adopted in West Bengal about three years back. This had required the setting up of additional 20 thousands of primary educational institutions over and above the pre-existing number of about 52 thousands of such institutions. Keeping this target in view, 1778 additional conventional primary schools and 11,077 child education centres have already been set up. The remaining number of additional institutions will be started within the next three years. These child education centres have been set up in an innovative manner under the supervision of Panchayat Samitis and direct management of village education committees where teachers have been recruited on the basis accountability. The performance of these child education centres in upholding the norms of accountability and cost-effectiveness has been noteworthy.

2.7 It has also been decided in the State Planning Commission that all the targets of population policy for West Bengal should be broken down to the level of each district, and within each district, to the level of each block and municipality. This decentralisation in the specification of targets is specially important for uplifting the performance of relatively disadvantaged districts, and disadvantaged areas within each district, and make the over-all performance indicators more meaningful by narrowing down the dispersion and variations in performance.

3.1 In the formulation and implementation of these objectives and targets of population policy, it is essential, in the interests of overall efficiency, cost-effectiveness and meaningful achievement, to (a) ensure convergence of all the relevant schemes under health and family welfare, (b) interrelate the programme of health and family welfare with programmes of education and employment generation and (c) involve the common local people through the elected Panchayats and Municipalities, in a coordinated manner with effective linkage through the Panchayats and Municipalities.

3.2 It is with these organisational objectives in view, an innovative health project was launched in the municipalities around Kolkata (KMDA Municipalities) under IPP-VIII, preceded by a similar project under CUDP-III. In this project, main emphasis has been laid on all the preventive aspects of health care and coordinating that with decenteralised curative health care in hospitals run by the municipalities, and all aspects of family welfare programme have been made an integral part of this total health care approach. At the ground level, there are lady health workers for every 200 families, and they are connected through supervisors to the doctors at the level of hospitals. The lady health workers are recruited from the locality, and doctors and all the staff are appointed on the basis of social contract, and renewalis made on the basis of performance and open accountability to people. The results reflected in terms of behavior crude birth rate, infant mortality rate and maternal mortality rate are note worthy. The birth rate infant mortality rate and maternal mortality rate in all these municipalities have fallen from 16.1, 55.3 and 3.4 in 1994-95 to 14.2, 22.4 and 0.3 respectively in 2001-2002 and the immunization coverage on the whole, has also crossed 95%. Moreover, the entire exercise, based on accountability and cross subsidisation, has also been extremely cost-effective.

3.3 Since the beneficiaries covered under the health project are also beneficiaries (actual or potential) under self-employment programmes, particularly, through self-help groups as well as literacy programme and universalisation of primary education, attempts have also been made to achieve integration of all these programmes in a decentralised manner through the municipalities and by involving the local people. NGOs have also played an important role in these programmes, particularly in areas related to training.

3.4 It is indeed possible to replicate this innovative, converging and participatory exercise in all the municipalities and in all the rural areas of the districts. In rural areas, for every 200 families in a village, lady health workers need to be appointed and there should be a coordination with decentralised curative health care at the block level, with management of block primary health centres and subcentres given to the respective Panchayats. Not only should all the family welfare schemes be a part of the total health care approach, but again a coordination can be forged between the programmes on education and self-help group based employment programmes through the Panchayats. NGOs can again play an important role in the overall -matrix of activities.

3.5 The entire exercise can again be made cost-effective, and if funds are made to flow from the national level through the State Government to the implementing agencies, with regular monitoring of activities of all the agencies, auditing of expenditure by CAG and accountability to people in terms of open mass meetings, then it will indeed be possible achieve the targets.

3.6 It will also be useful to have a periodic joint Centre-State review meetings at the national level in terms of interaction between the National Commission on Population and State Population Commissions.

3.7 Finally, the beneficiaries of all these programmes will be common people. When they will be involved in an active manner in the implementation of the programmes of population policy, there may be opposition from local vested interests. The success of the programmes will, threfore, depend on the organised struggle of the people in overcoming these obstacles. The success of implementation of population policy will thus have to take the form of peoples movement.

Shri S. Semmalai Hon'ble Minister of Health Government of Tamil Nadu

Hon'ble Shri K.C. Pant, Deputy Chairman, Planning Commission and Vice-Chairman, National Commission on Population, Hon'ble Shri Shatrughan Sinha, Union Minister of Health and Family Welfare, Secretaries of Health and Family Welfare, Govt. of India, State Ministers of Health, other dignitaries and friends!

I am happy to say that the National Commission on Population has convened this Conference at the most appropriate time, when most of the States are on the threshold of finalising Population Policy. So far as Tamilnadu is concerned, the State Population Policy is nearing finalization, which will soon be put on board. Tamilnadu with a population profile of 6.2 crores, accounting for 6 percent of the Country's population has a decadal growth of 11.19 percent. A declining birth rate from 31.4 in 1971 to 19.2 in 2000 is the best tribute to the sustained political will and administrative commitment of the Government of Tamilnadu. What we have achieved over the years in terms of crude birth rate, Infant Mortality Rate, Couple Protection Rate, Crude Death Rate, Life Expectancy, Total Fertility Rate, and Maternal Mortality Rate are by no means less significance when compared to All India level. We feel that, still "we have miles to go" to achieve desirable demographic features.

Despite the ubiquitous phenomenon of poor health seeking behaviour of individuals and under funding of health sector, the State Population Policy will aim at achieving,

It is our endeavour to ensure that these goals stand achieved by 2007.

Our Hon'ble Chief Minister Dr. Puratchi Thalaivi, while assessing the various dimensions of the Population Profile, directed us to lay greater focus on (a) Meeting the unmet need for family welfare, (b) Ensuring survival of children in general and new born in particular, (c) Reducing the momentum of population growth, (d) Integrating Population Programme with other developmental activities, (e) Promoting Community Health Activism and (f) Empowering women in all spheres. On the above thrust areas, we intend to delineate Policy contours, in tune with the National Population Policy. Improving the quality of life of the people, by achieving a balance between population, resources and environment would naturally constitute the mission of our policy.

According to the findings of the National Family Health Survey, Tamilnadu 1998-99,13 percent of currently married women have unmet need for Family Planning. The unmet need for spacing methods is 7 percent and for limiting birth is 6 percent. It is our endeavour that this unmet need has to be sufficiently and carefully met through enhancing the services for use of contraceptives, which would result in the increase of Couple Protection Rate from 52 percent to 65 percent. Adoption of appropriate strategies like strengthening infrastructure through optimal utilization of Operation Theatres in Hospitals, promoting private participation in the form of approving Nursing homes for Family Welfare Services and utilizing the services of Integrated Child Development Scheme and self-help groups shall constitute the Board spectrum of activities. Next to Kerala, Tamilnadu has been able to reduce the fertility level considerably. The Total Fertility Rate has come down to 2 from 3.9 in 1971. However, as per National Family Health Survey (India) findings, the wanted Fertility Rate in Tamilnadu is 1.71. The tendency of the people to have less number of children on one side, but actually begetting children till the couple gets a child of their own choice - male or female will be addressed in a more effective way through sustained and need based I.E.C. activities. We will be working out a Plan of Action whereby, the Higher Birth Order will be brought down from the current level of 24.2 to 10 by 2007.

Our Hon'ble Chief Mmister Dr. Puratchi Thalaivi, has time and again emphasized the need for ensuring child survival through reducing the Infant Mortality Rate from the present level of 51 to 30 per 1000 live births by improving the Institutional deliveries and providing Anti-natal and Post-natal care and raising the age at marriage for females. Intervention programmes, including enhancing the quality of life of adolescent girls through provision of IFA Tablets, strengthening Primary Health Centres with hi-tech diagnostic facilities and reaching the un-reached through Mobile Health Services are some of the measures initiated by the Government of Tamilnadu.

Resolutely and strongly committing ourselves to bring down the aggregate growth in population and to regulate the population density, we are embarking upon a programme of increasing the practice of birth spacing method, safe abortion services, sustaining low fertility rate, reducing the number of women entering child bearing age and also increasing age at marriage. Through these measures, we hope to achieve a reduced population momentum for sustainable development.

Time and again, our Hon'ble Chief Minister Dr. Puratchi Thalaivi has drawn the attention of Policy makers and programme implementers on the nexus between poverty and poor health. Enhancing the quality of life of the people through appropriate health intervention strategies and integrating them with developmental programmes of other sectors would alone lead to a healthy populous State. Towards this end in view, the State Population Policy will address the wider issue of bringing a real convergence of various services and integrating them for attaining a stable Population level. Much has been said about it in various fora, but little has been done. The State Population Policy would take up the issue in right earnest and evolve a comprehensive approach.

Promoting Community Health acrivism at base level and ensuring involvement of elected representatives through decentralizing the Family Welfare activities will be given prime place in our policy initiative. Unless, participatory approach is ensured, the policy will not succeed. Formation of District/Panchayat Level Committees, allowing the opinion makers to have greater say in implementation process are envisaged in the State Population Policy.

Decisive role of women in ensuring 'Child by choice and not by Chance' will be emphasized in the State Population Policy. This could be possible only by empowering women. Activating self-help groups, women's fora and mobilizing opinion on gender equity will be the core areas of our Policy. Encouraging child-bearing women to morivate their husbands to go in for contraceptives, though appear to be a very hard choice, shall form the focus of action.

In fine, I would like to state that the State Population Policy contours spelt out above are reflective of the framework provided by our Hon'ble Chief Minister Dr. Puratchi Thalaivi. It is our hope that through a target-free approach, motivating the eligible couple to adopt small family norms, discouraging higher order births and ensuring Maternal, Child Health will result in stable population over the decades.

Shri P. Sankaran Hon'ble Minister of Health Government of Kerala

Hon'ble Dy. Chairman, Planning Commission and Vice Chairman National Commission on Population Shri K. C. Pant, Vice-Chairperson and Member Secretaries of State Population Commissions senior officials of the Central and State Govt.

I deem it a great privilege to attend this conference which is providing us a forum to share our experience in and interact with other states on Population Stabilization actions.

Now, let me give a brief account of the activities which led to population stabilization in our State.

The prospects of Population Stabilization in a society depend on three critically interdependent factors. They are the survival chances of New borns, Maternal Health and reduction in Birth rates. The experience of Kerala show that there is need to lay greater emphasis on some of these factors that have hitherto recorded relatively less attention in the policy on population control. Kerala has achieved spectacular success in reduction of Population growth during the past three decades.

The State of Kerala accounts for 3.1% of India's population in 2001 and 1.18% of its land area. Kerala is predominantly an agricultural State with 73% of population living in rural area. As per the estimates given by the Planning Commission for 93-94, 25% of the population were below the poverty line, lower than the country as a whole (36%) - Central Statistical Organization 1999.

Kerala had a population of 31.8 million at the time of 2001 census. The total population of the State was 21 million in 1971, 25 million 1981, and 29 million in 1991. According to 91 census 10% of the population of Kerala belong to Scheduled Caste and 1% belong to Scheduled Tribe. By contrast in India as a whole 17% of the population belong to Scheduled Caste and 8% Scheduled Tribe. In the State 55% of the house hold heads are Hindu, 26% Muslims and 19% Christian.

Kerala is the most literate State in India with a literacy rate of 91%. By contrast the corresponding literacy rate of India as a whole is 65%.

Unlike most States of India very early marriage is not common in Kerala. The median age at marriage for women in the age group of 25-49 is 20 years. Only 14% of women in the age group of 15-19 are already married. On an average, women are about 6 years younger than the men they marry. IMR is 13 deaths per thousand live birth at age 0-11 month. The child mortality rate is 3 death per thousand children at the age 1-4 years. The IMR and CMRwere lowest among the Indian States. For example the IMR in India is 68 death per thousand live birth, five rimes as high as IMR in Kerala.

Fertility continues to decline in Kerala. The fertility level of women is 1.96 children each through out their child bearing years, one of the lowest levels in India. It had already reached the replacement level of just over 2 children per woman. Higher replacement level fertility is found in Kerala only among Muslim Population, which has a fertility rate of 2.46 children. The median age at child birth is 22 years for women in the age group of 25-49, and women in the age group of 15-19 account for 10% of total fertility. 64% of married women are currently using some method of Contraception. Female Sterilization alone account for 76% of total Contraceptive use. Women tend to adopt Family Planning only after they have achieved their desired family size. As a result contraceptive use can be expected to rise steadily with age and number of living children. Family Welfare Programmes focusing on women in the age group could improve Maternal and Child Health in the State. Efforts to expand the use of temporary contraceptive method for delaying and spacing births would help in further reducing Infant Mortality rate.

Promotion of Maternal and Child health is one of the most important component of Reproductive Child Health Programme. The goal is for each pregnant women to receive at least three Ante-natal check ups plus two TT injection and a full course of Iron and Folic Acid supplementation. In Kerala, more than 90% pregnant women received one Ante-natal check ups. 95% of the pregnant women received Iron & Folic Acid Supplementation.

99% of the pregnant women deliver in hospitals. The FW Programme encourages women to deliver in a medical fecility.

The Government of India recommends that breast feeding should begin immediately after child birth and that infant shoud be exclusively breast fed for about the first 6 months of life. Kerala's successful implementation during the past decade of Baby Friendly Hospital Initiative have contributed to substantial reduction in the Infant Mortality rate and control infant diseases. Now the State as a whole has come to be recognized for its Child-friendly policies, it is due to the fact over 90% of the maternity hospitals promote the norms laid down by the UNICEF in breast feeding procedures. Kerala is the first State in India even in Asian Continent to declare as Baby Friendly State.

Based on International Standard 27% of children under age 3 years are under weight, 22% are stunted, Child nutrition status has not improved much in Kerala. Under nutrition is much higher in rural area than in Urban area. Anaemia is of great concern in young children in Kerala. More than two fifth (44%) of children age 6-35 months are anaemic.

Child immunization is an important component of child survival programme with effort focusing six serious but preventable diseases - TB, Diphtheria, Pertusis, Tetanus, Polio and Measles. In Kerala 80% of children age 12-23 months are fully vaccinated. Another 18% have received some and 2% have not at all vaccinated. Dropouts for series of DTP and Polio Vaccination continue to be of some concern. 96% received first DTP, but 88% received all three doses. Similarly 97% received first Polio Vaccination, 88% received all three doses.

The Couple Protection Rate (percentage of couple effectively protected against pregnancy by various methods of contraception) in Kerala increase steadily from 15% in 1971 to 55% in 1988 and now it is 64% Between 1971 & 1977 Fertility declined sharply in the State. The Researchers suggested that female literacy may be the single most important factor explaining the Demographic transition in Kerala.

The Panchayati Raj Institutions have been involving in the State for stabilization of population programme to a certain extent. The nation's population has crossed the one billion mark on May 11th 2000. It is a matter of serious concern to act upon - how to tackle the problems relating to growing population.

Though health is a State subject, the 11th Sechedule of the Constitution has listed health and sanitation, including hospitals, primary health centers and family welfare to be assigned to Panchayats.

Kerala has taken lead in devolving more powers to Panchayats and the results are encouraging. The Village Panchayat, being the grass root unit of administration is responsible for the registration of births, deaths and marriages, disbursement of cash awards under maternity benefit scheme, institutional delivery by trained attendants, Ante-natal check up, opening creche etc. The Village Panchayat will identify persons

Experience shows that Family Planning Programmes are most effective when they directly involve and accommodate local committees. NGOs are many types Viz. Voluntary, Private, Religions, Social, Professional, Academic and Philanthropic. Government is certainly a pre-eminent actor in health care and development particularly in Population Stabilization. Yet, Voluntary Organizations, are vigorously active as an indispensable partner in population development activities. NGOs have rich experience in working at grass root Community level and possess high credibility in general. Therefore, they can facilitate lowest level contact, elicit community participation and facilitate social action. All these are vital inputs for area specific and need based population development activities.

Many NGOs have undertaken innovative community based health development projects which are specifically targeted to the poor and deprived people. These programmes have successfully demonstrated significnt improvement in health status of these people which in turn lead to population control activities and thereby population stabilization.

NGOs can best serve as advocacy and catalytic partners in population development activities.

NGOs should motivate people for health development and help them to get organized for the purpose. They should link their work with that of Panchayati Raj Institutions and Government. They should serve as a path finder ; develop new strategies, alternatives, innovations etc. for Family Welfare and Health promotion. They should explore and pioneer in new ventures and modernistic endeavor in the field of population development and related matters to influence human behavior conducive for health friendly life style. They can develop, promote and take leadership in social actions and public issues like population control measures.

I take this opportunity to express my gratitude to the organisers of this conference for having invited me.

Jai Hind

Shri Bala Bachchan Hon'ble Minister of Health & R W. Governnient of Madhya Pradesh

The state is heading towards demographic transition, most of the state's populace faces new set of challenges. The hopes and aspirations of the people have risen by leaps and bounds due to maturing of democracy and ever-increasing number of informed masses. It has become our bounded duty to find quick solution to their basic problems so as to smoothen the transition phase and ensure a good quality of life of our people.

In the state low per capita income and social inequalities continue to remain high and the incidence of absolute poverty is wide spread. Majority of people live in rural areas and practice agriculture and allied occupation. Socio-economic status of the people determines life expectancy at birth, access to food, education career opportunities, health care housing and even basic amenities such as safe drinking water and sanitation. Our state is committed to provide good quality health care services to the people despite limited resources.

Our commitment to population and development programme is evident in the steps initiated in formulating the population policy of the state. Constitution of State Population Development Council under the Chairmanship of Hon'ble Chief minister of the state for giving directions to Social and economic development and formulate policies to meet the goals of Reprodutive health. The State Population Policy Implementation Committee is functioning under the chairmanship of the Chief Secretary Govt. of Madhya Pradesh for monitoring the population stabilization efforts of various development department.

Massive implication of rapid population growth have already diluted much of benefits of our substantial economic growth since independence. Due to whirlwind changes taking place in our Political and Social set-up, role of civic society earns more prominence. I firmly believe that holistic civilization is one where human beings have full implementation of Health Programmes so as to help in creation of a happy and peaceful community.

Human beings are the center of concerns for sustainable development. I consider that people are the most important and valuable resource of our nation. Consequently right to development must be fulfilled so as to meet equitably the population, development and environmental needs of present and future generation.

I believe the advancement in gender equity and empowerment of women for ensuring their ability to control their own fertility are corner stones of population and development programmes. The objective of facilitation of smooth demographic transition can be consistently achieved by involving the civil society and individuals as health activists rather than playing the passive role of receiver of health commodity.

The state has formulated its own population policy with mission and vision of improving the quality of life of our people by achieving a balance petween population, resources and environment. We are addressing rapid reduction in fertilit and mortality to achieve population stabilization. The family planning efforts are more effective when coupled with comprehensive reproductive and child health services, universal education, & women's empowerment.

The key policy initiatives under population stabilization efforts are creating an environment conducive to planned family and creating demand for family planning and reproductive health services. Increasing collaboration with Panchayati Raj institutions, private and NGO sector in community mobilisation and programme implementation. Improving the management of family welfare programme to achieve excellence in meeting client needs and developing appropriate implementing structure.

Poor road transport distant villages due to low density, inadequate clinical, and interpersonal communication skills along with lack of motivation for health workers to work in rural areas, all impede access to services, contribute to poor quality of care and created an apparent insensirivity to client needs.

To offer a broader ranger of services we have created community structures in form of Village Health committee. The state has implemented innovative scheme of Jan Swasthya Rakshak This Community Health Volunteer is a matriculate person of the same village trained in primary health care for six months and placed with the community to provide services as a Health Volunteer.

We have taken a decision to train adeast one Trained Birth Attendant in every village by the end of this year. We are ensuring capacity building of local community structures at that level so that the local health needs are addressed.

The community structure will have referral linkages to provide specialised health care in emergency situation. This ensure equitable distruburion of health care delivery in rural areas and will help people to exercise their rights and motivate them to change the health seeking and fertility behavior. It will also provide opportunities for community based distribution system of commodities like ORS, Condoms, Oral pills and many other essential items.

The self help groups have been created in rural areas and Mahila Swasthya Sangh are successfully acting as a women's forum of discussing Reproductive and Child health issues and help in improving service delivery through linkages with Health workers and Anganwadi workers.

Madhya Pradesh was the first state to implement Panchayari Raj institution. Democratizing development denotes participation of common people/community in planning, implementation and monitoring of developmental activities in an integrated manner. The state has taken an endeavor to implement "Gram Swaraj". Village health committees have been constituted and have been empowered by Gramsabha to take local decisions.

As a result of this major reform the resultant unleashing of creative energy of people providing and enabling context for a sharper focus towards human goals on the one hand and the changeover to a participatory model of delivery on the other hand is evident. Education, Health livelihood security were a people's agenda and now Village Health Committee and Gram Sabha provided a forum for their articulation and improving systems for delivery. The challenge before us has been to seize this opportunity and reorder structures of governance in a manner that accommodate and channelize new energies for health care delivery and proper implementation of determinants of health in the "Swasthya Jeevan Sewa Guarantee scheme".

The community award scheme has been introduced in the name of "Healthy Village" award scheme. The village health committee have been given the responsibilities to registration of birth & death, safe motherhood interventions, immunisation, Family planning and nutrition of pregnant mothes and children under 6 years. Emphasis has been made on PRI's to act as coordinator between different stakeholders. Govt. have further tried decentralization of powers in the form of district planning committees. The powers of state governments have been decentralized to district planning committees at every destrict under the leadership of in charge Minister of the district.

To facilitate a more holistic approach for total human development all inter sectoral departments like Women & Child Development Department, Education, Social Welfare, non governmental organization, Cooperatives, food and civil supply department and other stakeholders have been given major roles to play in achieving the goals of population stabilization.

We are trying to establish Public Private NGO partnership and involve the corporate sector in health Programme. It is important to realize that focus on fertility reduction alone without convergence of social sectors schemes will not yield fruitful results.

We are focusing our efforts to reduce IMR, MMR & TFR to tolerable limits. The Manpower deficiency in SHCs have been taken care of and within 2-3 months all the parts of ANM in SHCs will be filled up. We are also improving SHC infrastructure by contrucfion of 2000 SHC buildings from state resources. I appreciate the Govt. of India is also supporting infrastructure development through RCH Programme and provision of Addl. ANM in over populated SHCs. We are also improving manpower position in FRUs to operationalise them.

For close targeting of Eligible couples, Pregnant mothers and Infants we are using modified RCH camp approach in which the Health worker is ensuring 100% registration of beneficiaries, Family cards in 20% SHC HQ villages, identification of missed out mothers and children for immunisation and checkup and counseling them for Family planning methods. The high risk cases are identified and referred to RCH camp at PHC level for specialized care.

In urban areas Swasthya and Parivar Kalyan Melas have been held in 5 cities with similar efforts to cover all the slum areas and referrals were tackled in mega camps organized with all diagnostic and curative facilities. Both the schemes have shown tremendous response and Gol support for RCH camps will further potentiate our efforts. Our state is a developing state and we believe that with the concentrated effort under the leadership of our Chief Minister Mr. Digvijay Singh the state will achieve its population stabilization goals. Thank you

Dr. K. Prasada Rao Hon'ble Minister of Health Deptt. of Medical, Health & Family Welfare Government of Andhra Pradesh, Hyderabad

In order to harness the benefits of economic development and maximise its impact on the lives of individuals, it is essential that the population base of the State be limited. Population stabilisation therfore assumes great significance in this context. AP adopted the State Population Policy in early 1997 and it marked the beginning of an intensive effort to stabilize the population. Ambitious goals were set and Reproductive and Child Health approach was adopted to achieve population stabilisation. This approach, besides being pro-women and children, also highlights the necessity of making quality focused, client driven services widely available to achieve the population goals.

The initiatives of the Government have already yielded results and it is reflected in the Census of 2001, which highlights some of the important achievements of AP. AP recorded an amazing fall in the decadal population growth rate. While the all-India decadal population growth rate fell from 23.86% in 1991 to 21.34% in 2001, AP registered the steepest fall in the country from 24.2% in 1991 to 13.86% in 2001. Further there has been a remarkable decline in the Total Fertility Rate from 4 per woman in 1981 to 2.25 in 1998.

To translate the challenging goals into activities we put the entire State machinery into action. The involvement of all political representatives from the CM to the Sarpanch, irrespective of party affiliations ensured that a people's movement is generated. Step-by-step, gaining in strength with each day, awareness of the small family norm permeated into every household in Andhra Pradesh. Simultaneously, improving the women's status economically and politically was given a very high priority. As a result, women became conscious of concerns related to health, education and nutrition of their families and took decisions about their family size.

Another factor for the success was the effort made by the district administration and the health staff to make the family planning services widely available all over the State, even in the remote areas. The Government which had banned all recruitment, continued to fill-up vacancies of doctors and paramedical staff. New buildings were constructed for Public Health Centers and supply of drugs and consumables enhanced and streamlined. Most of the PHCs became centres for all family planning services, including sterilization operations. A large number of doctors were trained in the new techniques for family planning operations. A key role has also been played by the ANM at the field level. She has been in the forefront in providing services for children, pregnant women and in counselling eligible couples.

All these efforts have combined to gain wide acceptance of the small family norm across the State, taking our family planning operations from 5.14 lakhs in 1996-97 to more than eight lakhs per year since 2000-01. To reinforce the acceptance of small family norm and ensure child survival, we introduced the Aarogyaraksha Scheme, which provides insurance for a period of 5 years from the time of operatin for the family planning acceptor and his or her 2 children.

Besides providing family planning services, we have also concentrated on improving the reproductive and child health of couples and children in the State. The focus is now on age at marriage, spacing, institutioani delivery and immunisation. There is now a campaign running on age at marriage. Trainings are being conducted for women, adolescent girls and opinion leaders on the issue of age at marriage.

A high priority is now accorded to improve institutional deliveries. The facilities provided by the referral hospitals were improved and PHCs in rural, interior and backward areas were designated as Round the Clock Women Health Centres. Maternal & child care services are being provided round the clock in these institutions. The ANMs are on turn duty in 3 shifts to attend deliveries 24 hours. Specialist services of Gynecologist and Pediatrician are being provided in these institutions weekly once. Additional facilities like phone and jeep are also allotted to improve communication and referral system for emergency cases. I am glad to mention that the number of institutional deliveries has increased drastically in the PHCs from 64227 in 2000-01 to 121153 in 2001-02. The reported institutional deliveries have shown a jump from 49% in 98-99 to 65% in 2001-02.

Sukhibhava scheme to support poor women to opt for institutional deliveries has been introduced consciously. Under this scheme, women below poverty line residing in rural area are paid Rs. 300/- towards transport charges and incidental expenses if they have delivery in any Govt. institution. Rs. 10 Crores is the budget for 2001-2002.

To strengthen the children's immunisation, we have had a serious look at the Programme implementation. Besides introducing the Hepatitis B vaccine and expanding safe injection practices, gaps in drugs, consumables & logistics related to immunization are being identified & filled. We are consolidating the institution of ANM, by upgrading her skills and providing her additional drugs. We intend to position additional ANMs. To ensure improved outreach services by the ANMs we are giving our support from the Sarpanch and self-help groups in the form of mother & child health care team at the village level. Further few ANMs are provided with mopeds and provision of palm tops of the ANMs for mechanized data storage and retrieval is being piloted.

As the usage of spacing methods in AP is one of the lowest in the country and probably contributing to the maternal and child deaths, we are implementing a contraceptive social marketing programme. Under this programme, over 1.5 lakh SHG members have been trained on spacing methods, 16000 depots have been established and around 50 franchisee clinics that provide family planning services are to be established by December, 2002.

192 Urban Health Centres that provide mother and child health care services to the urban poor have been established. These centres are established in collaboration with the local NGOs. There are also backward area projects operational in Mahabubnagar and RR districts. We have also improved coverage in tribal areas by positioning 8500 Commumity Health Workers who assist on both areas of health & family welfare.

To sum up, the wide acceptance of Planned Parenthood has given the Government the impetus to concentrate on improving various other mother and child health services. Having achieved a significant drop in the decadal growth rate, we are now working towards improving the overall health and well being of the families in the State.

Mkñ 'kdhy vgen] ekuuh; fpfdRlk f'k{kk] ifjokj dY;k.k ,oa ns'kh fpfdRlk foHkkx] fcgkj ljdkj

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v/;{k egksn;] eSa vk'kk djrk gw¡ fd oSls jkT;ksa ds fy, fo'ks"k dk;ZØe pyk;sa tk;saxs vkSj fo'ks"k lgk;rk fn;k tk,xk tgka bldh t:jr gS vkSj blesa fdlh çdkj dk HksnHkko ugha cjrk tk;sxkA

eq>s cqykus ds fy,] vius fopkj j[kus ds fy, eSa vkidk vkHkkjh gw¡A

/kU;okn

t; fgUn!

Dr. K. Prasada Rao Hon’ble Minister of Health Deptt. of Medical, Health & Family Welfare Government of Andhra Pradesh, Hyderabad

In order to harness the benefits of economic development and maximise its impact on the lives of individuals, it is essential that the population base of the State be limited. Population stabilisation therfore assumes great significance in this context. AP adopted the State Population Policy in early 1997 and it marked the beginning of an intensive effort to stabilize the population. Ambitious goals were set and Reproductive and Child Health approach was adopted to achieve population stabilisation. This approach, besides being pro-women and children, also highlights the necessity of making quality focused, client driven services widely available to achieve the population goals.

The initiatives of the Government have already yielded results and it is reflected in the Census of 2001, which highlights some of the important achievements of AP. AP recorded an amazing fall in the decadal population growth rate. While the all-India decadal populaiton growth rate fell from 23.86% in 1991 to 21.34% in 2001, AP registered the steepest fall in the country from 24.2% in 1991 to 13.86% in 2001. Further there has been a remarkable decline in the Total Fertility Rate from 4 per woman in 1981 to 2.25 in 1998

To translate the challenging goals into activities we put the entire State machinery into action. The involvement of all political representatives from the CM to the Sarpanch, irrespective of party affiliations ensured that a people's movement is generated. Step-by-step, gaining in strength with each day, awareness of the small family norm permeated into every household in Andhra Pradesh. Simultaneously, improving the women's status economically and politically was given a very high priority. As a result, women became conscious of concerns related to health, education and nutrition of their families and took decisions about their family size.

Another factor for the success was the effort made by the district administration and the health staff to make the family planning services widely available all over the State, even in the remote areas. The Government which had banned all recruitment, continued to fill-up vacancies of doctors and paramedical staff. New buildings were constructed for Public Health Centers and supply of drugs and consumables enhanced and streamlined. Most of the PHCs became centres for all family planning services, including sterilization operations. A large number of doctors were trained in the new techniques for family planning operations. A key role has also been played by the ANM at the field level. She has been in the forefront in providing services for children, pregnant women and in counselling eligible couples.

All these efforts have combined to gain wide acceptance of the small family norm across the State, taking our family planning operations from 5.14 lakhs in 1996-97 to more than eight lakhs per year since 2000-01. To reinforce the acceptance of small family norm and ensure child survival, we introduced the Aarogyaraksha Scheme, which provides insurance for a period of 5 years from the time of operatin for the family planning acceptor and his or her 2 children.

Besides providing family planning services, we have also concentrated on improving the reproductive and child health of couples and children in the State. The focus is now on age at marriage, spacing, institutioanl delivery and immunisation. There is now a campaign running on age at marriage. Trainings are being conducted for women, adolescent girls and opinion leaders on the issue of age at marriage.

A high priority is now accorded to improve institutional deliveries. The facilities provided by the referral hospitals were improved and PHCs in rural, interior and backward areas were designated as Round the Clock Women Health Centres. Maternal & child care services are being provided round the clock in these institutions. The ANMs are on turn duty in 3 shifts to attend deliveries 24 hours. Specialist services of Gynecologist and Pediatrician are being provided in these institutions weekly once. Additional facilities like phone and jeep are also allotted to improve communication and referral system for emergency cases. I am glad to mention that the number of institutional deliveries has increased drastically in the PHCs from 64227 in 2000-01 to 121153 in 2001-02. The reported institutional deliveries have shown a jump from 49% in 98-99 to 65% in 2001-02

Sukhibhava scheme to support poor women to opt for institutional deliveries has been introduced consciously. Under this scheme, women below poverty line residing in rural area are paid Rs. 300/- towards transport charges and incidental expenses if they have delivery in any Govt. institution. Rs. 10 Crores is the budget for 2001-2002.

To strengthen the children's immunisation, we have had a serious look at the Programme implementation. Besides introducing the Hepatitis B vaccine and expanding safe injection practices, gaps in drugs, consumables & logistics related to immunization are being identified & filled. We are consolidating the institution of ANM, by upgrading her skills and providing her additional drugs. We intend to position additional ANMs. To ensure improved outreach services by the ANMs we are giving our support from the Sarpanch and self-help groups in the form of mother & child health care team at the village level. Further few ANMs are provided with mopeds and provision of palm tops of the ANMs for mechanized data storage and retrieval is being piloted.

As the usage of spacing methods in AP is one of the lowest in the country and probably contributing to the maternal and child deaths, we are implementing a contraceptive social marketing programme. Under this programme, over 1.5 lakh SHG members have been trained on spacing methods, 16000 depots have been established and around 50 franchisee clinics that provide family planning services are to be established by December, 2002.

192 Urban Health Centres that provide mother and child health care services to the urban poor have been established. These centres are established in collaboration with the local NGOs. There are also backward area projects operational in Mahabubnagar and RR districts. We have also improved coverage in tribal areas by positioning 8500 Commumity Health Workers who assist on both areas of health & family welfare.

To sum up, the wide acceptance of Planned Parenthood has given the Government the impetus to concentrate on improving various other mother and child health services. Having achieved a significant drop in the decadal growth rate, we are now working towards improving the overall health and well being of the families in the State.

Jai Hind!

Dr. Tangor Tapak Hon'ble Minister of State Health & Family Welfare Government of Arunachal Pradesh

Demographic Scenario of Arunachal Pradesh

The systematic census operation was started in Arunachal Pradesh in 1961 There have been census operations during the British times and in independent India but they were partial in geographical coverage and mainly limited to the foothills belt.

The following table presents population of the state as reported by the various census data since 1961.

During the last 40 years, the population of Arunachal Pradesh has increased by 3.26 times. The decadal population growth and also the annual exponential growth are also consistently higher than the national average. This can be seen from the following table.

The total census population indicates adverse sex ratio (number of females per 1000 males) showing less number of females per 1000 males.

But the sex ratio of the indigenous tribal population is favourable towards the female population. The adverse sex ratio based on the total census population reflects the total situation taking tribal and non-tribal population together. The sex ratio of local ST population is shown below.

There is a considerable size of in-migrant population in Arunachal Pradesh who are engaged in various occupations in both public and private sectors. Many of them excluding the government employees live in the state without families. The favourable sex ratio in the ST population of the state confirms the absence of discrimination against the girl child in tribal communities.

Health and Demographic Scenario of Arunachal Population

As compared to national average the health and demographic indicators of Arunchal Pradesh present a mixed picture. This can be seen from the following data

The progress or otherwise of the state of Arunachal Pradesh vis-a-vis the country in certain health and demographic indicators is shown in the following table on the basis of findings of the National Family Health Survey 1 and 2

Population size of Arunachal Pradesh is small in relation to its total land area. The state has the lowest density of population in the country. Because of these facts there is an impression among the political leadership and even in general Public that there is no population growth problem in Arunachal Pradesh. Central government funding for development programmes based on population norms tends to reinforce such opinion. Such notions acts as disincentive for populatin stabilization programme. During the last four decades, Arunachal Pradesh has recorded higher population growth rates than the national average. There are various other socio-economic factors Contributing to the high population growth rate. But there cannot be a second opinion on the requirement of a vigorous population stabilization efforts for Arunachal Pradesh. Actual availability of usable land for agriculture purposes per capita is very limited in the hilly terrain. The issue of preserving the forest and bio-diversity of Arunachal Pradesh is critical not only for the people of Arunachal Pradesh itself but also for the neighbouring states, particularly those situated down below. Historically and traditionally the lifestyle of hill tribes is forest-based. Because of increasing populatin pressure the state of Arunachal Pradesh and its neighbouring states are suffering from recurrent floods, soil erosion, siltarion of waterways and inundation of agricultural land. All these are due to massive deforestation occurring in the state which in turn is due to increase in population numbers. Amidst plenty of rain, rivers, and streams people are already facing water shortages in the towns because of deforestation. Many water supply projects and micro hydel plants are on the verge of abandonment due to drying up of water catchments areas due to deforestation.

Therefore the state government of Arunachal Pradesh has constituted a State Population Commission under the chairmanship of the state Chief Minister. Population issue is basically a development issue and encompasses various socio-economic development sectors. The State Population Commission has therfore a broad-based memberships involving all the development sectors of governance. The state government will draw up a population policy very shortly.

Infrastructure for Population Programmes

The National Family Welfare Programme was started in the 1975-76 in Arunachal Pradesh. Since then there has been some remarkable progress in the health indicators of the people. But to achieve the national population policy goals within the given timeframe there is a need to strengthen the health and family welfare programme infrastructure in the state along with infrastructural inputs in other related development sectors. Most of the interior areas of the state are yet to be properly served by family welfare services for want of health and family welfare service facilities. The cost of building infrestructure is highly capital intensive in the hilly state. The available resources are not adequate. Many interior villages are yet to be reached by primary health care networks as they are located very dispersely in the inaccessible hilly terrain. This calls for further relaxation for funding norms by the Central Government. Even the family welfare programme management structure at the state headquarter and districts need expansion and strengthening. There is also a need for special outreach programme to take family welfare services to the rural areas where fertility is very high yet there are unmet needs for family planning services.

Shri Digvijay Khanvilkare Hon'ble Minister for Public Health Government of Maharashtra

The highlights of the speech made by the Hon. Minister for Public Health, Government of Maharashtra during the Conference of Vice Chairpersons and Member Secretaries of State Population Commissions/Councils on 25th September, 2002.

Hon. Minister had mentioned that Maharashtra is the second largest in area and population. The State has taken pioneer steps towards population stabilization and is one of the premier States in the country which has declared the Population Policy in 2000. A significant point of this policy is that it does not discreminate against the children and mothers at all and they have not denied any of the benefits which accrue to this section of the population. The Population Policy of the State has been universally accepted by all sections of the society of the State and has adopted the two child norm for election to the local bodies.

The State has made earnest efforts to stabilize the population through sterilization, spacing methods and has achieved significant results. The population growth during the last decade was substantially lower in comparison with the previous decade. While the State is endeavouring its most towards this direction, significant steps have also been taken to bring down infant, child and maternal mortality and we are certain that the goals declared on these counts would definitely be met.

The State Matrutva Anudan Yojana Provides help by way of medicines and cash to the tribal expectant mothers and this is at the rate of Rs. 800 per expectant mother. Not only this, the State also gives Rs. 10,000 if the family resorts to terminal method of Family Planning after the birth of two girl children.

Special efforts have been made by the State to reduce the Infant Mortality and Child Mortality Rates in the Tribal areas by providing additional staff to take care of the health of the tribal people in these areas during the monsoon season.

Special attention has been paid by the State to Registration of Births and Deaths and Committees have been constituted to oversee the Registration of Births and Deaths at the District, Panchayat and Village levels with the local representatives and NGOs as Members.

Hon. Minister however mentioned that in order to tackle infant and Child Mortality, it would be necessary that there is proper co-ordination amongst various Departments of the Government.

The Hon. Minister thanked the Hon. Vice Chairman of the National Population Commission for convening this meeting and assured that Mahrashtra State would leave no stone unturned in making the Population Policy a success.

Shri R. S. Ranghang Hon'ble State Minister for Health & Family Welfare Government of Assam

Most respected Deputy chairman, Planning Commission & Vice Chairman National Commission on Poularion & Members of the Commission, dignitaries present and high offcials of Government of India as well as of different states.

It gives me pleasure to offer my heartiest thanks for organising this conferece for giving us the opportunity to place our views and policies which has immense importance to the national interest.

Repected gentlemen as you all know that Assam is situated in the North East of India. Its geographical area is 78438 sq.km. having density of 323 per sq. km with its 2.66 cores of population as per 2001 census. The projected population was 2.7 cores before the census.

The mighty Brahmaputra river passes through it covering about 800 Kms from Sadia in East to Dhubri in the Western side. It has created some reverine areas gener-ally known as CHAR areas. The majuli is the biggest such area within the river in the world. The Barak river passes through the southern districts. Besides these it has two hill districts namely Karbi Anglong and N.C. Hills. As such the state comprises many areas having geographical barriers like Char area, Tea Gardens, Hill areas and forest villages bordering to neighboring states and Bhutan. More attention has to be made to reach the national goals towards these areas.

Natural calamities like flood waves, swept out the entire Assam every year dislodging all types of communication every year.

The state has agricultural based economy. It lacks proper and required industrial growth though a few such industries are these: Oil, Coal, Tea are a few to name of such industries.

The per capita income is about Rs. 6000/- per annum.

The mortality and morbidity pattern of the state is higher than the national level. The health & family welfare activities are going on in the state with a special objective to lower the mortality and morbidity pattern but still it needs to go further.

Emergency obstetric care services in the rural char areas as well as hilly areas needs to be enhanced.

Respected gentleman, poverty, lack of education, low social status, mal-nutri-rion, infection high fertility and lack of access to health care are some major factors of maternal and child mortality. It can not be denied that social status & literacy status of women & awareness activities to adolescent health will have to be done with an enhanced manner.

Respected dignitaries, considering all the above factors as I stated, the state has framed a draft state Population Policy constituting a State Commission with the Chief Minister as its Chairman.

The demographic scenario has been submitted by our official. I hope Govt. of India as well as the National Commission will give due attention to this backward state of Eastern front so that the state can rise to the level of other developed state of the country.

Tiru E. Valsaraj Hon'ble State Minister of Health, Law, Labour & Port Government of Pondicherry

Hon'ble Vice Chairman, Member Secretary, Members of National Population Commission, Secretaries of the Central & State Governments,

I am happy to be present amidst this August body to share experiences and strategies in implementing the population policies. The U.T. of Pondicherry a one time French colony has a population of over a million in four interspersed regions Pondicherry, Karaikal, Mahe and Yanam in the eastern and western coast of South India.

The percentage increase in population growth has been successfully decreased to 20.51 in contrast to the decadal increases of 27 to 34 during the preceding three decades.

The mid-term objective of the National Population policy is to bring the Total Fertility Rate down to replacement levels by 2010. The U.T. of Pondicherry has al-ready achieved this goal of 2010 and the total fertility rate for the three years average of 1995-1997 is 1.8.

The current objectives of the Government is to address the needs of the population on contraception, health care infrastructure for integrated service deliv-ery for basic reproductive and community health care. The U.T. has established easily accessible medical care for its citizens in a radius of less then 1.18 kms through 39 Primary Health Centres, 4 Community Health Centres, 75 Sub Centres, 14 ESI Dis-pensaries and 8 Hospitals.

The salient findings of the rapid household survey indicate 100% awareness of the family planning methods and estimated the unmet needs for contraception at 20% for limiting the family at 14% and for spacing at 6%. In the recent years sterilization operations has been increased by 35%, IUD by 10.5%, oral contraceptive users have increased by 81% and CC users by 44%. The Non-Governmental Organizations have been actively participating in the promotion of small family norms. The private sector hospitals were involved in medical termination of pregnancies.

Health care services of Ante-natal check up, Immunization of children, AIDS awareness, safe deliveries are all assessed above 97%. One of the creditable health care services is that there has been no Maternal death or Infant death due to Tetanus.

I am very happy to submit this forum that the National Population Commission has ranked the U.T. of Pondicherry as number one in complete immunization of new born, pre-school children, school children and pregnant women. Again the U.T. is assessed as the first based on the composite index of 13 vital indicators and has the highest composite index. The per capita Health care expenditure which was at Rs. 538 in 1997-98 has been increased to Rs. 830 in 2001-2002.

The U.T. has been achieving 100% of the targets set for the Immunization against 6 killer diseases. The low coverage against Measles, DT, DPT has been effec-tively increased during the last two years of the IX Plan. During the past 3 years there was no Polio cases in any of the 4 regions of U.T. even though the other adjoining states have confirmed Polio cases till last year.

The UNICEF has ranked the U.T. of Pondicherry at the top amonst all the States and U.Ts. for ensuring 100% awareness of Polio and cent percent coverage.

The increased life expectancy of the population would necessarily increase the incidence of cancers, heart diseases, diabetes, etc. The changing socio economic sce-nario in the U.T. would also result in increase in the number of deaths due to traffic accidents and accidental/suicidal poisons. Further progress in the reduction of Crude Birth Rate, Crude Death Rate, Infant Mortality Rate would essentially require thrusts in the implementation of various health care programmes and also immediate treat-ment of road traffic accidents by improving and effective supervision of preventive and curative health care in the U.T. in the X Five Year Plan, it is proposed to give necessary thrust in these areas.

I am very happy to register in this forum that the U.T. of Pondicherry is one among the State and U.T. of the country which have achieved ahead the goals set for 2010 in many aspects of health care delivery and with a declining population growth rate.

I assure that our Government would take all measures for implementing the national population policies and surge forward in its development.

Jai Hind!

Shri Shatrughan Sinha,Hon'ble Minister of Health & Family Welfare Government of India

Respected Shri K.C. Pant Ji, Respected Dr. Murii Manohar Joshi Ji, Dr. Venkatasubramanian, Mrs. Krishna Singh Ji, Hon'ble Ministers and the Vice Chairpersons of the State Population Commissions, distinguished members of the National Commission on Population, Ladies and Gentlemen,

It is indeed a great pleasure for me to attend this Conference of Vice-Chairpersons and Member Secretaries of State Population Commissions. For me, it is a unique privilege to be here amidst all of you as I have only recently taken charge of the Ministry of Heath and Family Welfare.

2. The year 2000 was indeed a defining moment for us in the ministry as we were able to place before the nation, the National Population Policy. The uniqueness of this policy was that it was built on consensus and reflected a high political commitment. Besides, it very clearly laid down specific goals to be ahieved within a specific time frame. But most significant of all is that the policy seeks to not only stabilize our population but also lays down an approach to improve the quality of life of our people. Such a comprehensive, holistic approach built over years of deliberations, when implemented in letter & spirit, is bound to go a long way in speeding up the development of the social sector in the country.

3. Today India has crossed a billion mark and all estimations go to show that we may shortly become the most populous country in the world. Even so, I would not say that we have failed. Instead, considering the fact that population policies in this country have had to be implemented without coercion and in a spirit of consent and openness, it is quite remarkable that barring the States of Madhya Pradesh, Uttar Pradesh, Bihar and Rajasthan, the rest will be able to ahieve the net replacement level ofTFR by 2010. This is definitely an encouraging position. But for the population to stabilize we have to keep our efforts sustained. Further, if we are able to concentrate and focus our energy on four States of Madhya Pradesh, Uttar Pradesh, Bihar and Rajasthan and in particular Uttar Pradesh and Bihar, we should in all probability to able to achieve a Total Fertility Rate of 2.1 by 2015, if not earlier.

4. I have no doubt in my mind that the goal is achievable. If a tradition bound country like Iran was able to bring down the TFR from 5.5 to 2.4 within a decade, so can we. What matters is to be resolute, much depends on what action we take today since population containment cannot be achieved in short time frames. There is, therefore, neither room for complacency nor needless pessimism. We simply need determination.

5. I do not believe that population stabilization goals can be achieved with the narrow pursuit of Family Planning. What we need is the building up of an enabling environment in which mothers feel secure that they and their children can have neatly long lives. Families and women must be made to demand and aspire for a better quality of life. This has been the experience of all countries, which have been able to achieve breakthroughs in reduced infant mortality and maternal mortality. It is, therefore, not a matter of chance or coincidence that countries that have stabilized their population also have low infant and maternal mortality. In our own country, Kerala, Tamil Nadu and Andhra Pradesh have demonstrated the same similarity in experience. Therefore, the highest priority needs to be given to implementing the reproductive and child health policies and programmes but effectively linked to contraception.

6. I am aware that achieving population stabilization or substantially improving health status in Bihar or U.R is very complex due to the prevailing socio-economic conditions. Poverty, mal-nutrition, illiteracy, low status of women, unemployment, poor communication and transport facilities, and above all the poor condition of the primary health infrastructure all have a very direct bearing on the poeple, particularly the poor, being able to access health services. To provide focused attention to the needs of these low performing States the mechanism of Empowered Action Group was established in 2001. Because of such an approach, flow of funds to these States has also been steadily increasing. From Rs. 109 crores that were released for taking up several initiatives in these States during 2001-02, the amount proposed to be released during the remaining part of the current 2002-2003 is estimated to be Rs. 325 crores which is in addition to Rs. 172 crores already available with them making a total of Rs. 498 crores to be spent by them by March, 2003. In fact, we are willing to provide more funds for the EAG States and look forward to State Governments developing the required capacity so that they can absorb these additional resources.

7. From the current year, Government of India will be fully funding the sub centres established for every 5000 population as per 1991 Census. In exchange, the Rural Family Welfare Centres and the postpartum centres for which we were giving financial support are now handed over to the State Governments to manage. This is an important policy initiative as it is now possible for the States to ensure that for every 5,000 population, the services of a qualified ANM is available to the communities. In handing over the RFWCs and PP centres, States have now an opportunity to rationalize staff and enhance the utilization of these centres appropriately. But what is required is that under each intervention, ensuring quality, close monitoring and fixing of responsibilities for effective supervision need to be worked out in detail. Rationalizing of the recording of target families, registration of births and deaths and extending communication through use of electronic system is yet another area to be given priority along with implementation of Family Welfare programmes in coordination with the Gram Panchayats and peoples' representatives.

8. Another important area of concern which I am deliberately making a special mention of today is the unethical practice of female foeticide. The rapid increase in the number of female foetuses aborted in several parts of the country is extremely disturbing. The child sex ratio in the age group 0-6 years of some of the States/UTs is a matter of concern for all of us. Inordinately low sex ratio of below 850 are recorded in all 17 districts of Punjab, 17 out of 19 Districts of Haryana. Certain amendments to the PNDP Act, 1994 have been approved by the Cabinet to incorporate certain emerging technologies like selection of sex prior to conception as well as those in current use which are being misused for pre-natal determination of sex of the foetus. A Bill to this effect has already been laid in the Parliament in the last session clearly making the registration of all ultra-sound clinics a mandatory requirement and determination/disclosure of the sex of the foetus a punishable offence. I request you to rigorously enforce provisions of this Act. One or two examples of severe action by you would send the right kind of signals to all concerned that such unethical practices would not be tolerated.

9. Finally, utmost importance is the consolidation of the efforts through intersectoral mobilization with the participation of NGOs. I am given to understand that the Ministry of Education, Women and Child Development, Rural Development and Youth Affairs have indicated their readiness to work towards a convergence of programmes. Specific programmes have also been indentitied. Though my Ministry is the nodal Ministry for population stabilization, yet the NPP goals need the support and involvement of other related sectors and civil society. The National Commission on Population and the State Population Commissions indeed have an important and a pivotal role in facilitating such inter-departmental coordination which will no doubt help enhance access to services among the most needy sections. Human and material resources need to be mobilized and peoples' participation ensured.

10. In conclusion, I would like to thank the Deputy Chairman, Planning Commission for having invited me today for this meeting and allowing me to share some of my concerns. I would like to close with a request to all of you to accord population stabilization efforts your highest priority so that the goals of National Population Policy are realized.

MkW- eqjyh euksgj tks'kh ekuuh; ekuo lalk/ku fodkl ea=h] Hkkjr ljdkj

;kstuk vk;ksx ds lEekuuh; mik/;{k Jh ds- lh- iar th] esjs lg;ksxh LokLF; ea=h Jh 'k=q?u flUgk th] ;kstuk vk;ksx ds lEekuuh; lnL; Jh ds- osadVklqczeU;u th] lnL; lfpo] jk"Vªh; tula[;k vk;ksx vkSj vkt bl lEesyu esa i/kkjs gq, fofHkUu jkT;ksa ds lEekuuh; ea=hx.k] vf/kdkjhx.k] fo'ks"kK fe=A

;g dk;ZØe ftl dh leh{kk ge yksx ;gk¡ dj jgs gSa esjh n`f"V esa ns'k ds lcls egÙoiw.kZ dk;ZØeksa esa ls ,d gS] cfYd dqN ekeyksa esa rks lcls vf/kd egÙoiw.kZ gSA ns'k esa fdu&fdu jkT;ksa dh D;k fLFkfr gS] bldk C;kSjk vkids lkeus vk x;k gSA dksbZ fVIi.kh djus dk esjk mís'; ugha gSA ysfdu gesa bl ckjs esa t:j /;ku nsuk gksxk fd ns'k ds tks jkT; bl {ks= esa lcls fiNM+s gq, gS mUgsa D;k djuk pkfg,A

mÙkj izns'k tula[;k dh n`f"V ls lcls cM+k jkT; gS] vkSj bl lkjh ifjppkZ esa geus ns[kk fd cgqr dqN ekeyksa esa tula[;k ds foLrkj esa mldk gkFk gSA mÙkj izns'k] fcgkj] e/; izns'k] jktLFkku vkSj mM+hlk ;g lc jkT; vxj bl dk;ZØe dks iwjh izkFkfedrk ds lkFk ysa rks ge vius y{; fu/kkZfjr le; esa vo'; iwj djsaxsA vxj bu jkT;ksa us rsth ugha fn[kkbZ rks mudk ifjJe Hkh fujFkZd gks tk,xk ftu jkT;ksa us cgqr ljkguh; dke fd, gSaA eSa mu lHkh jkT;ksa ds izfrfuf/k;ksa ls ;g vuqjks/k d:axk fd bl ekeys esa vius jkT; esa ,d etcwr bPNk'kfDr dk izn'kZu djsaA There is no substitute for policitcal will. ;g cgqr t:jh gS vkSj vxj jkT; esa n`<+ bPNk'kfDr] ogk¡ ds ea=h ifj"kn~ esa] ogk¡ ds vf/kdkfj;ksa esa ugha gqbZ rks ;g dk;ZØe iwjs rkSj ij lQy gksaxs] blesa lansg gks tk,xkA bl lkjs izn'kZu esa lcls egÙoiw.kZ ckr ;g ns[kh xbZ gS fd tgk¡ f'k{kk] og Hkh ckfydkvksa dh f'k{kk c<+h gS] ogka tula[;k dh nj ?kVh gSaaA tgk¡ ekrkvksa dk iks"k.k Bhd gS] ogk¡ f'k'kq e`R;q ?kVh gSA tgk¡ f'k{kk Bhd gS vkSj fookg dh vk;q dk ikyu Bhd ls gks jgk gS] ogk¡ Hkh tula[;k dh nj ?kVh gSA eSaus ;g ns[kk gS fd f'k{kk vkSj iks"k.k oxSjg ds vfrfjDr bl lkjs ekeys dks gy djus dh ;g nks egÙoiw.kZ dqft;ka Hkh gSA geus ns[kk gS fd bu leL;kvksa dks gy djus ds fy, tSlk fd vkU/kz izns'k ds eq[;ea=h us dgk fd lsYQ gSYi xzqi vkSj vkaxuokMh dk;ZØe gSa ;s lc dk;ZØe bl fn'kk esa enn djrs gSa] cgqr egÙoiw.kZ dke djrs gSaA geus ns[kk gS ftu xkaoksa esa] ftu fodkl [k.Mksa esa] Cykdksa esa efgykvksa dh f'k{kk ij T;knk /;ku fn;k x;k vkSj efgykvksa dh f'k{kk c<+h ogk¡ nksuksa ckrksa esa gedksa lQyrk feyh gS] tula[;k dks fu;a=.k djus ds fy, Hkh vkSj vkfFkZd fodkl ds fy, HkhA eSa ,d ckr dh rjQ vkSj /;ku fnykuk pkgw¡xk fd f'k{kk ds {ks= esa vxj v/;kid Bhd le; ij fo|ky;ksa esa igq¡prs gS vkSj fpfdRlky;ksa esa MkWDVj vkSj muds deZpkjh miyC/k gksrs gSa rks Hkh cgqr dqN dke gks ldrk gSA T;knkrj esjs ns[kus esa vk;k gS fd lHkh jkT;ksa esa dgh de ;k dgha T+;knk ;g f'kdk;r feyh gS fd fpfdRld xkao esa de miyC/k gSA cgqr ls LFkkuksa ij tkrs gh ugha gSa vkSj vxj tkrs Hkh gSa rks cgqr de #drs gSaA f'k{kd vf/kdka'k LFkkuksa ij Bhd le; ls ugha igq¡prs vkSj efgykvksa dh f'k{kk ds ekeys esa rks vkSj FkksM+h T;knk <+kbZ Bhd ls dh tk,] iqLrdksa esa mlds ckjs esa mYys[k fd;k tk, eSaus mldh flQkfj'k dh gSA eSa vki lc yksxksa ls vuqjks/k d:axk fd vius&vius f'k{kk foHkkxksa ls bl ckjs esa fopkj djsa vkSj vius jkT;ksa ds vuq:i whatever suits their states, whatever is reliable for their states, mUgsa lykg nsa fd vki bl rjg ds ikB;Øe vkSj iqLrdsa rS;kj djsa D;ksafd bl ekeys esa f'k{kk ds ek/;e ls tcjnLr awareness iSnk dh tk ldrh gSA vxj vkidh rjQ ls] tks tula[;k ds ckjs esa] vPNs ifjokj ds ckjs esa ikB ns ldrs gSa] suggest dj ldrs gSa rks t:j nsaA ;g gesa dsUnzh; Lrj ij fdlh jkT; dh rjQ ls vk,axs rks mls ikB;iqLrdksa esa 'kkfey djus dh iwjh dksf'k'k djsaxsA D;ksafd ;g egÙoiw.kZ dk;ZØe gS ftl ij esjk cgqr lkyksa ls vkxzg jgk gS ;g gesa t:j djuk pkfg,A

bl ekeys esa eq>s ;g Hkh yxrk gS fd vc le; vk x;k gS fd incentives and disincentives dh rjQ Hkh /;ku nsus dh t:jr gSA cgqr lh lqfo/kk,a bl ckr ls tksM+h tk ldrh gS fd ge nks cPpksa ds ifjokj ds ukWeZ dk ikyu djrs gSa fd ughaA blesa tSls&tSls jktuSfrd bPNk'kfDr dk ge izn'kZu djsaxs] oSls&oSls gesa lQyrk feysxhA FkksM+k lk vc bl rjQ /;ku fn;k tk ldrk gS D;ksafd og le; pyk x;k tc vkt ls 20&25 lky igys tks ?kVuk,a gqbZ Fkh] vkt yksx le>rs gSa fd fcuk NksVs ifjokj ds vkfFkZd fLFkfr lq/kjuk eqf'dy gSA vc bl ckr dks le>k;k tk ldrk gS fd blds fy, ;g lqfo/kk gS vkSj og lqfo/kk gSA cPPkksa dh i<+kbZ ds ekeys esa lqfo/kk,a nh tk ldrh gSaA vf'kf{kr vkSj detksj ckyd vkxs pydj gekjs fy, cgqr cM+k cks> cusaxsA larku T;knk vkSj detksj gS rks mldh 30] 40] 50 lky tks Hkh mldh ftanxh gS mldk cks> lekt dks <+ksuk iM+rk gSA og cgqr cM+k [kpkZ gksxk cfuLir blds fd tks ge vkt [kpZ djsaA geus fglkc yxk;k Fkk fd vxj vkt ,d :i;k [kpZ fd;k tk jgk gS] og [kpZ u djsa rks vkxs pydj mlh leL;k ds fuokj.k ds fy, 40 :i;s rd [kpZ djus iM+ ldrs gSA blfy, eSa vuqjks/k d:axk fd bl rjQ iwjk /;ku fn;k tkuk pkfg,A gekjs tks vkaxuokM+h ds dk;ZØe gSa blesa cgqr enn dj ldrs gSa] dj Hkh jgsa gSaA geus muds fy, fo'ks"k O;oLFkk djus dk Hkh lkspk gS] flQkfj'k dh gS fd mudk tks ekuns; gS mlesa o`f¼ dh tk, vkSj og bl rjQ Hkh /;ku nsa ;fn mUgsa iwjs rkSj ij f'k{kk vkSj LokLF; ds fy, yxk;k tk, rks cgqr tYnh ;s lkjs dke gks ldrs gSaA cgqr ls dke muls fy, tkrs gSa ftudks ysus dh dksbZ t:jr ugha gSA tc Hkh eSa xkaoksa esa tkrk gw¡] eq>s vDlj ;g feyrk gS fd vf/kdkjh feys u feys ysfdu vkaxuokM+h dk;ZdrkZ viuh txg t:j dke djrh fn[kkbZ nsxhA mudk bl 'kfDr dh n`f"V ls iwjk mi;ksx fd;k tkuk pkfg, vkSj gj jkT; esa muds vkfFkZd lk/ku c<+k, tkus pkfg,A dqN jkT;ksa us c<+k, gSa] dqN vkSj c<+ ldrs gSa rks mUgsa c<+k;k tk, vkSj bl dke esa mudks yxk;k tk,A

bl ckr ij Hkh fopkj fd;k tkuk pkfg, fd 'kknh dh mez esa dqN vkSj o`f¼ dh tk ldrh gS ;k ugha\ D;ksafd ;g ns[kk x;k gS fd tgk¡ f'k{kk gkbZ Ldwy ls vf/kd gks xbZ gS ogk¡ vius vki bl ekeys esa deh vkbZ] IMR esa Hkh deh vkbZ gS] ekr`Ro e`R;qnj esa Hkh deh vkbZ vkSj tula[;k foLrkj esa Hkh deh vkbZ gS] TFR Hkh de gqvk gSA ;g ,d egRoiw.kZ pht+ gSA xkoksa esa Hkh tgka yM+fd;ksa dh f'k{kk gkbZ Ldwy ls Hkh Åij xbZ gS] ogk¡ bl ekeys esa cgqr lqfo/kk feyh gSA eSa vuqjks/k d:axk fd ;s nksuksa dke lkFk pyus pkfg, yM+fd;ksa dh f'k{kk] ckfydkvksa dh f'k{kk fo'ks"kdj vkSj ;g LokLF; lacaf/kr dk;ZØeA vxj budks ,d Qksdl djds fd;k tk, ;kfu nksuksa ea=ky; feydj ;g fopkj djsa fd ;g VkjxsV ,fj;k gS] ;g CykWDl gSa] ;g lkekftd {ks= gSa ftuesa dke djus dh t:jr gS rks lQyrk T+;knk fey ldrh gS vkSj tYnh fey ldrh gSA ysfdu lcls t:jh ;g gS ftls eSa fQj ls nksgjkuk pkgw¡xk fd ;g tks 4&5 jkT; gSa buesa dke cgqr n`<+rk ds lkFk] rsth ds lkFk vkSj y{; cuk dj fd;k tkuk pkfg,A gekjk vuqHko gSa fd tgka geus ,slk fd;k gS] ogka fiNys tux.kuk ds vk¡dM+s ;g crkrs gSa fd vkT+kknh ds ckn absolute number of illiterates esa rhu djksM+ dh deh gqbZA rks eSa ;g le>rk gw¡ fd Qksdl dk;ZØe fd, tk, rks bl ekeys esa ges tYnh lQyrk fey ldrh gSA ;g T+k:jh blfy, Hkh gS fd ftl j¶rkj ls gekjh tula[;k c<+ jgh gS vxj mldks Bhd le; ij geus stabilize ugha fd;k rks vU; dfBukbZ;ksa ds tky gekjs lkeus [kM+s gks tk,axsA eSa le>rk gw¡ fd tks dqN izxfr vkt eSaus ns[kh gS mlls bruk rks t:j irk pyrk gS fd dkQh dqN izxfr gqbZ gS vkSj dqN jkT;ksa us cgqr esgur dh] eSa mu lc jkT;ksa dks c/kkbZ nsuk pkgrk g¡wA ysfdu dqN ,sls jkT; Hkh gSa ftuesa cgqr T+;knk djus dh t:jr gSA tula[;k ds ekeys esa ,d ckr vkSj Hkh /;ku nsus dh jgrh gS fd dbZ ckj dke djrs&djrs ftl j¶rkj dks ge pkgrs gSa og ugha fey ikrhA blesa dqN QSDVj ,sls vk tkrs gS tks dHkh&dHkh gekjs y{;ksa dh j¶rkj esa fnDdrsa iSnk dj nsrs gSa] D;ksafd blesa ekuoh; fØ;k,a gSA ;kaf=d fØ;k ugha gS] esdsfudy fØ;k,a ugha gSA blesa lkbDyksth cgqr tcjnLr dke djrh gS] rks bl rjQ /;ku nsus dh t:jr gSA vkSj vxj dgh Hkh FkksM+k cgqr mrkj&p<+ko gksrk gS rks mlls fpafrr gksus dh t:jr ugha gS] exj ml oDr mu dkj.kksa dh feeka'kk t:j djuh iM+sxhA ftlls ge mu lkjh dfBukbZ;ksa dks nwj dj lds tks bl jkLrs esa vkrh gSA ,d ckr dh rjQ vkSj eq>s /;ku nsuk gS vkSj oks gS vkadM+sA bl ckjs esa lrdZrk dh t:jr gSA gekjk statistics cgqr reliable gksuk pkfg,A mldh iwjh credibility gksuh pkfg, statistics Bhd ugha gqvk] vk¡dMs Bhd ugha gq, rks tks dqN Hkh ge djus tk jgs gSa mldk ge Bhd ls fu;kstu ugha dj ldsaxsA eSaus ns[kk Fkk vius f'k{kk foHkkx esa] foHkkx ds vkadM+ksa esa bldk cgqr vHkko jgrk gS vkSj dbZ ckj tgk¡ ls vk¡dM+s Nu dj vkrs gSa] vxj Bhd ls monitoring ugha gS] Bhd ls checking ugha gS rks vk¡dM+s dbZ ckj gesa xQyr esa Mky ldrs gSaA blfy, eSa ;g Hkh vuqjks/k d#axk] D;ksafd ;g cgqr gh egÙoiw.kZ vkSj laonsu'khy ekeyk gS] blds vk¡dM+s cgqr lko/kkuh ds lkFk vkSj cgqr gh accuracy ds lkFk bdV~Bk djus pkfg, rHkh planning djus esa lqfo/kk gksxh] rHkh gesa viuh ;kstukvksa dks vkxs ys tkus esa lqfo/kk gksxhA

eSa Jh iar th dk vkHkkj izdV djrk gw¡ fd mUgksaus bl mís';iw.kZ dkaÝsal dk vk;kstu fd;k vkSj eq>s Hkh ;g le>us dk volj fn;k fd fdu jkT;ksa esa D;k dke gks jgk gS vkSj vHkh dgka deh gSA ,sls vk;kstu vxj FkksM+s varjky esa gks rks T+;knk ykHkdkjh gksaxs vkSj eSa ;g Hkh fuosnu d#axk vxj ctk, iwjs ns'k dks bdV~Bk djus ds dqN tksu cukdj djsa] [kklrkSj ij ftu jkT;ksa esa vHkh cgqr deh gS] ftUgsa dkQh dke djuk gS] muds ea=h ds lkFk] vf/kdkfj;ksa ds lkFk vkSj fo'ks"kKksa ds lkFk vyx ls cSBd gks rks T+;knk dkjxj gksxh] T+;knk effective gksxhA D;ksafd mudk vxj /;ku fnykuk gS fd mudh otg ls bl dk;ZØe dh lQyrk esa nsj yxsxh rks eSa ;g fuosnu d:axk fd tc Hkh dHkh vk;ksx ds ikl le; gks rks ;g Hkh ,d dk;ZØe fd;k tk ldrk gS ftldk ykHk gesa feysxkA

cgqr&cgqr /kU;oknA ueLdkj

Shri K. C. Pant Hon’ble Vice-Chairman, NCP & Deputy Chairman, Planning Commission

Joshi ji, Shatrughan Sinha ji, Dr. Venkatasubramanian, Smt. Krishna Singh, State Ministers, Members of National Commission on Population, other experts, ladies and gentlemen,

I would like to thank all those States whose representatives have spoken here and who have made presentations. I would very much like to give time to everybody who has come here but as you know in these meetings it is not always possible, in particular, I would like to apologize to the Minister from Pondicherry whom we could not accommodate in this list. But I am prepared to even now sit down and let you speak. The suggestions which Dr. Joshi made that there should be more frequent meetings and perhaps we may have some zonal meetings of those States which have a bigger problem and that something we would take on board and we will see that with the full cooperation of the Health Ministry as to how we can help in this process. We have seen this presentation from the National Commission on Population. Some of you may ask why is that only northern and southern States have been shown there. The reason is that contrast brought out is not so much on northern and southern states as a contrast between Kerala on the one hand, Tamil Nadu not being very far behind and UP and Bihar is the other angle of the spectrum and it brings it out rather graphically and I think it is necessary for all of us to understand that many States have made a great deal of success in the realization of the targets which have been set by the population policy and the population policy itself has taken note of the demographic diversities in the country and that is why today we have this meeting and we hear all the States, we get a very clear picture of not only what is happening in the States but perhaps what is not happening there.

I leave it to the States who come here to understand this basic point that in the given situation, some of the States have made rapid progress. In the given situation some states have to go faster as they are not going faster now. And I request them not to look round for reasons as to why it is not happening but to look round for what needs to be done to make it happen. And that is the essence of the lesson we have to draw from today's meeting. Today's meeting is meant for us because we share experience with each other and we learn with each other's both successes and mistakes. Now the State Population Commissions have been set up in large number of States, i.e., 20 States have set them up and four States are in the way of setting them up. And I saw in one State, I forget now, perhaps it was in Jharkhand, I forget, they have put up another organization under the Chief Minister. So I think it would be better to have a pattern all over the country so that if there are Population Commissions to be set up in the States, why have yet another population Control Committee or Commission at the State level. The Chief Minister could be the Chairman of the State Population Commission as is there in some States. This is one point which the States might like to take into account. The other is I don't want to go into all the details but you have seen that the goals which are set by National Population Policy are very clear in respect of the IMR and the MMR as well as the TFR and State after State put before you, the picture of their progress on these three accounts because they are inter-related and the linkage between survival of the child, the health of the child, the health of the mother, the education of the girl child, the health of the child, the health of the mother, the education of the girl child and the marriage age are all well-understood and well-known by all of you. So therefore, the level of awareness and the level of focused attention and the feature of the presentation that was made here and the speeches that were made here, gives one reason to believe that we are on the right track and that country as a whole is concentrating on one of its major problems. Now what also came out very clearly is the fact that States which have done well have followed their own strategies and they have done well in differing conditions. Kerala has excellent social indicators but its economic indicators are not that good and yet it has done well. Tamil Nadu as came out there in the presentation did well, even though some of the social indicators at that stage were not that good and yet it managed to do well. The State which did not come here, Tripura, Manipur and mizoram, I saw the figures that they have done well. And in that case it is education, the education of the girl child, in particular, which is much better than in many other States, which have led to low infant mortality and also to some kind of population stablization. So, again it is different reasons that operate in those States and now you have two examples of West Bengal and Andhra Pradesh which you have just seen. I would not say the socioeconomic indicators are as good as in some of the other States. And in the case of West Bengal you saw how the clear strategy, with good administration with involvement of the private doctors, nursing homes and so on with decentralization and an attempt to involve the people in the programme, a lot has been achieved and, in fact, I say in the case of Andhra Pradesh also, it is Self-Help Groups and their involvement which have given a fillip to the programme. And you saw a remarkable improvement effected in Andhra Pradesh in comparison with all the States in the last decade it was moved much faster.

So the point really comes out is even while it is desirable to improve all the indicators, social indicators, economic indicators, education and all the rest of it but even if all the them are not what they ought to be given the political will, given the right administration, given the proper understanding of the interlinkages between all these sectors, I feel the State can and the people of that State can achieve remarkable success in population stabilization. And in the root of that are two factors; one that every family knows today that it wants to give good education to the children and so on and so forth and a smaller family give them better room within their income to do so. And everybody is conscious of the importance of education. The Second thing is the women after the certain number of children, most women would not like to have more children provided they were certain of the survivability of the children they have. So if these two factors have been taken into account, then you can understand the success of these States which have achieved success and you will have noticed that sterilization is by far the most popular method of contraceptives and, in fact, when I first saw these figures, I was little surprised but then I was told that no, this is so because it is the choice of the women themselves in most cases. Coercion today is a thing of the past. There is no coercion and there should not be any coersion. But if these methods are wanted by the people if they want certain kinds of contraceptives then they sould be among the unmet needs that we have to provide. And in this aspect one important area is the number of child deliveries in hygienic conditions and under proper medical care and this is something in which I think some of the states are very far behind the others and we have to see our best to move out in that area. The other thing is to focus on districts and not just States and you would have seen, I think Madhya Pradesh has divided it among various districts, which are the districts where TFR is above 3, I think one TFR is above 6. So once you look at district wise and perhaps areawise, perhaps group wise then it will be easier to focus on the needs of the tribal population as mentioned. It has its own particular problem, the slum areas have their own problems. So we have to understand these problems and to see how best to approach them. Dr. Joshi was telling to me, how you can also use the schools, the curricula and so on in a constructive way to put this message across. As far as the plan outlay is concerned, they have been stepped up. In 1998-99, the plan outlay was Rs. 2,489 crores and nearly doubled to Rs. 4,930 crores in 2002-03. Now I don't want to go into the two specific issues that were raised in relation to two of the schemes that is the postpartum schemes and the rural family welfare centres but since you have raised them I think I will spend just half minute on that. The position is that there are 1.37 lakh ANMs in the sub centres, of which 97,000 were funded by the Department of Family Welfare of the Centre and 40,000 were funded by the States. Now, from April, 2002, all the 1.37 lakh ANMs will be paid by the Department of Family Welfare of the Centre, So the Centre is taking over that liability. On the other hand, in 5,200 of rural family welfare centres, staff of these 5,200 centres was being paid by the Department of Family Welfare and 22,500 by the States. So the idea was if the Centre would take over the liability of the States with respect to the ANMs the states would take over the liability with respect to rural family welfare centres. This is the idea behind this particular scheme. It is not as though it is a one sided thing on both sides so that there is greater, let's say, streamlining and an arrangement as far as the salary of personnel is concerned. You can go into that. It is not something which we can dicuss here. I am corresponding with some of the States, but in order to avoid your getting a wrong impression, that this is something which we have done which is at the cost of the State, I would like to tell you that the Centre is taking on some liabilities, which it did not have and the attempt is to smoothen this whole process and to divide it in a smooth manner.

The only other point since all the points that can be made and have already been made, the only other point which I would like to make is that there are so many agencies working below the district level and there are also NGOs and others, is it not possible that all of them should coordinate their efforts and that there should be convergence and if you do nothing else, this one single fact that we utilize all the agencies and lying departments of the State Governments and some of even Central Government, if all of them could get together, I have no doubt, that this programme along with other programmes could move much faster. Then they would be also able to call upon the Panchayati Raj Institutions, they would be able to use the NGOs and the voluntay organizations and they would be in touch with ground realities almost on a village-to-village basis. The whole question of registration of births and deaths would be musch easier to tackle. So how to do that? Unfortunately, the compartmentalization is such it comes up vertically, horizontal integration is getting weaker in the administration. So my request to you would be to consider to what extent that kind of integration can be brought about in which case it would be much easier for us to move faster and since we are committed to ahieving the goals set by the National Population Policy, this one step should enable us to move in that direction and achieve the desired goals. Unfortunately, all the States are not likely to achieve the goals set by the National Population policy, TFR 2.1 by 2010. Let us accept that fact but at the same time, since all the other States which have already achieved the figure, overall national figure will be ahiveved and we have to have the determination to achieve but that is not enough because some of the States which have not achieved it i.e. States with very large population and if they would not also achieve this within a reasonable period of time, then our whole process of stabilizing population would be pushed further away. So may request to you, particularly to high fertility States, to see that they make every effort to learn from those States which have moved ahead so fast and we had a wealth of information today that we can all draw upon.

And I thank you very much for the pains that you have taken and for the extremely informative and, in fact, in some cases, illuminative morning you have spent here.

Thank you.