Health Policy Issues and Health Programmes in ... - Amazon S3

Arogya Raksha: Health Insurance Scheme for Family Welfare Acceptors in Andhra Pradeshlabour is high in Andhra Pradesh, ranging from 14%–19% for children aged 5-14 years. Eventhough mortality rates are falling, infant and child mortality is still high, which may reinforce thedecision by couples to have larger families.The dependency ratio (measured as the ratio of population below age 15 and above age 49) isapproximately 75%, which is very high. Socio-cultural factors of Andhra Pradesh reveal thatcouples have a tendency to begin their reproductive activity at an early age and complete theirdesired family size also at an early age. The mean age of acceptance of sterilization is 27.4years in Andhra Pradesh, compared to 30 years for India overall. According to the 1992National Family Health Survey (NFHS) in Andhra Pradesh, the total fertility rate (TFR) ofchildren born per woman is slightly higher (2.6) than the desired TFR (2.1). The survey alsoreported that the percentage of unmet demand for spacing methods is 5.5. Adolescentfertility, lower birth intervals, and the use of terminal methods at younger ages indicate thatsupply constraints, not the demand for family planning services, contribute to the currentlevel of fertility in Andhra Pradesh.The demographics indicate an adverse sex ratio, high dependency ratio, low female literacy, lowage at marriage for females, low level of acceptance of temporary family planning methods, andhigher incidence of adolescent fertility. These are all problems to be tackled at the state level inorder to contain the population growth rate.In Andhra Pradesh, population stabilization policy is formulated basically to reducepopulation growth by improving reproductive and child health (RCH) services. AndhraPradesh was the first state in India to formulate a comprehensive policy to cover health, familywelfare, women and child development, and nutrition. However, the Department of FamilyWelfare (DoFW) cannot alone assume all the responsibility of reducing population growth orbirth rates. The issues concerned are greatly associated with many other socio-economicfactors, such as female age at marriage, female literacy, child labour practices, and so forth. Atmost, the DoFW can help diminish fertility to a desired family size; however, what is needed isa change in desired family size itself to two children per family at the community level. Thus,an integrated approach among various departments is essential, which is envisaged under theState Population Policy (SPP).Objectives of the PolicyA significant increase in female age at marriage, coupled with simple, effective, accessible, andaffordable basic health and family welfare services, as well as a substantial reduction in childand maternal mortality, are essential. Improvement in the perception by couples of theenhanced chances of survival of their children is also necessary to improve the quality of servicetowards realizing state demographic goals.The ultimate objective of the state policy on population and reproductive health is that peoplemust accept the programmes and policies as in their best interest. Institutional support, such asservices and equipment, must consciously and constantly uphold this belief. Synergistic effortsshould be made through strong political commitment, favourable social consciousness, and117