NATIONAL FAMILY WELFARE

PROGRAMME
 NATIONAL FAMILY WELFARE
PROGRAMME
INTRODUCTION : -
The National Family Welfare Programme
was lanced in 1952 as National Family
Planning Program . India was the first one
to do so. It is 100% centrally sponsored
program. The ministry of health and family
welfare is responsible for this program.

In 1977 the
government of India redesignated the
“National Family Planning Program” as the
“National Family Welfare Program”.
History :-
EARLY DEVELOPMENT : -
 The second 5 year plan (1956 to 1961)
the “clinic approach” was adopted . Large
no of family planning clinic were opened
 In 1960 the NFWP entered a New
technological era with introduction of
the Lippi's loop later replaced by copper
T.
Cont…
Later Development:-
 IUD insertion at the rate of 20/1000
urban and 10/1000 rural.
 Integration with maternal and child
welfare , immunization , nutrition and non
formal education.
Medical termination of Pregnancy Act
OBJECTIVE :-
To stabilize the population by the year 2050
through small family norms.

AIM :-
To achieve a higher end that is to
improve the quality of the life of the
people.
CONCEPT :-
The term “family welfare”
is in much broader in
scope then “family
Planning” . The concept of
welfare is basically related
to “quality of life”. It
includes –
 EDUCATION
EMPLOYMENT
SAFE DRINKING
WATER

WOMEN ‘S
WELFARE
CONCEPT CLIENT CENTERD
OF FW APPROACH

FAMILY PLANNING
PREVENTION &
MCH & RCH TREATMENT OF
SERVICES MAJOR DISEASES
COMPONENTS OF NATIONAL FAMILY WELFARE
PROGRAMME
1. Administration and Organization :-
This includes appointing the employee and arranging the
resources.
2. Training :-
Training the medical, nursing and paramedical staff.
3. Social and health education :-
4. Supplies and Services :-
a. The scope of activities carried out under family welfare
programme.
b. mother and child health
c. small family norm
d. school health
REPRODUCTIVE & CHILD HEALTH
RCH :-
Introduction :-
The reproductive and child health
program was formally launched by
Gov. of India on 15th Oct 1997. As per
recommendation of International
Conference on Population and
development held in 1994.
DEFINITION :-
 “A state in which people have the ability to
reproduce and regulate their fertility are able to
go through pregnancy and child birth, the
outcome of pregnancy is successful in terms of
maternal and infant survival and well-being ,and
couples are able to have sexual relation free of
the fear of pregnancy and of contracting
diseases.”
OBJECTIVE :-
1. To promote the health of the mothers
and children to ensure safe motherhood
and child survival.

2. The intermediate objective is to

reduce IMR & MMR.

3. The ultimate objective is population

stabilization , through responsible
reproductive behavior.
INTERVENTION/CONCEPT OF
RCH
 Prevention and management of
unwanted pregnancies
Maternal care (safe motherhood)
Child survival
Prevention and management of
RTIS/STD
Prevention of HIV/AIDS
COMPONENT OF RCH
 COMPONENTS OF
FollowingRCH
services are included in the
reproductive health area as proposed by Gov. of
India.
MAIN COMPONENTS:-
1. Family planning
2. Child survival and safe motherhood
program
3. Prevention /management of RTI/STD AND
AIDS
4. Client approach to health care.
OTHER ACTIVITIES

• Providing counseling , information and

communication services on health ,
sexuality and gender difference.

• Referral services for all above

intervention.

• Growth monitoring ,nutrition

education ,reproductive health services
for adolescents etc.
RCH PACKAGE FOR VARIOUS SERVICES
1. For maternal services (safe
motherhood) :-
The service components are obstetric care ,
infection control and nutrition promotion.

2. For child services ( child survival ):-

The essential care of the newborn, including care
of the at risk newborn by prompt referral service.
-Infection control measures.
-Nutritional Promotions.
Cont……

3. Reproductive Health :-
- Fertility control
- MTP services ( for prevention and
management of unwanted Pregnancies.
- Adolescent
- HIV/ AIDS
RCH PROGRAMME PHASE 1
Under the RCH Programme Phase 1 , various
provision were made to improve the status of
maternal and child health. These include :-
- Provision of essential & emergency care.
- Provision of equipment and drug kits to selected PHCs
and selected FRUs in all districts.
- Provision for additional ANM , Staff nurse, and
Laboratory technicians for selected districts.
- Provision for 24 hours delivery services at PHCs and
CHCs.
CONTI….

 Referral transport in case of obstetric complication

 Immunization and oral rehydration therapy.
 Prevention and control of vitamin A deficiency in
children.
 Integrated management of childhood illness.(IMCI).
 District surveys for focused intervention to reduce
IMR and MMR.
 New initiative undertaken during phase 1
of RCH are :
 setting up of blood storage units at FRUs
 Training of MBBS doctors in anesthetic skills for
emergency obstetric care at FRU.
LACUNAE OF RCH 1
 The outreach services were not available to the
vulnerable and needy population.
 The management of financial resources were
inadequate .
 The human resources such as doctors , nurse , health
worker , etc were deficient.
 The management information and evaluation system was
lacking.
 The effective network of first referral units was lacking .
 Quality of services in PHCs and CHCs was poor.
 Lack of community participation.
RCH 2
RCH 2 was started from 1st April 2005 up to
2009. The RCH 2 vision articulates, “
improving access , use and quality of RCH
services , especially for the poor and
underserved population .”

AIM OF RCH 2
To reduce infant mortality rate , maternal
mortality rate, total fertility rate, and
immunization coverage specially in rural
areas.
OBJECTIVES OF RCH 2
 To improve the management performance.
 To develop human resources intensively.
 To expand RCH services to tribal areas also.
 To monitor and evaluate the services.
 To improve the quality, coverage and
effectiveness of the existing family welfare
services
COMPONENTS OF RCH 2
1) Population stabilization
2) Maternal health
3) Newborn care
4) Child health
5) Adolescent health
6) Control of RTI/STIS
7) Urban health
8) Tribal health
9) Monitoring and evaluation
10) Other priority areas
1) POPULATION STABILIZATION
 By increasing the number of trained personnel like
medial officer of PHCs and female health worker of
sub centers.
 By covering the services at grass roots level by
having linkage with ICDS
 Involving panchayati raj institutions urban local
bodies and NGOs
 By training one couple from each village to provide
nonclinical family planning method services.
 By involving district urban development authorities
(DUDA)cooperative societies and industrial workers
in providing family planning services
 By identifying NGOs to provide financial technical
and managerial support
2:MATERNAL HEALTH/REPRODUCTIVE
HEALTH
The strategies to improve and strengthen the
quality of maternal services are
(a) Essential obstetric care
(b) Emergency obstetric care

(a) ESSENTIAL OBSTETRIC CARE:-

• Three or more antenatal checkups
• Two doses of tetanus toxoid
• One pack of Iron folic acid tablets during the
last trimester
• Counseling on promoting of institutional delivery.


 (B) EMERGENCY OBSTRETRIC CARE :-
This consists of operationalizing the first referral
units to be fully functional round the clock (24
hours).
First referral unit(FRU):
 It is an upgraded PHC/CHC into a 30 bedded
hospital, having a well furnished and equipped
operation theater with a newborn care corner, a
labor room , blood bank and laboratory to provide
the services of obstetric emergencies such as
cesarean section and adequate supply of drugs to
the patients , care of sick children ,family welfare
services.
NEWER SCHEME :-
1.Janani Suraksha Yojana (JYS)
Scheme.

2. Training of traditional birth

attendants.
3. Training of MOs in the skill of
obstetric management.
 3) NEWBORN CARE & CHILD
HEALTH
The effective health interventions for the newborn starting
from the antenatal period ,intarpartum and immediate
newborn care , early newborn care ,late neonatal care.
 Navjaat shishu suraksha karyakarm (NSSK):-The main
aspect of NSSK are prevention of hypothermia ,
prevention of infection , early initiation of breast feeding.
 Facility based IMNCI :- It focuses on providing appropriate
inpatient management of the major cause of neonatal
and childhood mortality .

 Sick
newborn care (SNCU).
Home based care (HBNC).
4 ) ADOLESCENT HEALTH
 This is implemented on pilot basis in those
districts where more than 60% girls marry
before age of 18 years.
 The adolescent health services are provided
by counseling once in a week in the PHC &
CHC.
 The services are Management of menstrual
disorder , nutrition counseling , counseling for
sexual problem.
5 )URBAN HEALTH :-

-This is improved by providing quality

primary health care to the urban poor by
establishing urban health centers (UHC)
ratio is 1: 50,000 population .

-Where 1 MO, 3-4 ANM, ! Lab assistant, 1

Public health nurse, 1 clerk , 1 Peon and 1
Chowkidar.
 6 ) TRIBAL HEALTH (VULNERABLE
POPULATION )
 These are the people who are underserved due
to problems of geographical access and those
who suffer social and economical
disadvantages such as SC/ST and the urban
poor .
 7.MONITORING AND EVALUTION

Management Information and Evaluation System

(MIES)
This is done by following measures :
 Planning is done at various levels of Sub center,
PHC, CHC, District & State.
 Monitoring is done by establishing Consumer Need
Assessment Approach cell at district and state level
with an officer incharge.
 Evaluation is done through District Surveys,
National Family Health Survey, Focus studies and
Census report
 -Validation is by supervision and surveys.
 8. OTHER PRIORITY AREAS :-
The services provided under RCH-2 are :-
 Health education
 TB control programme
 Store and distribution of anti-malaria drugs,
 ANC service
 contraceptive distribution and
 referral for terminal methods.
 FAMILY
PLANNING
DEFINITION :-
DEFINITION
WHO “ a way of thinking & living that is
adopted voluntary upon the basis of
knowledge , attitudes & responsible
decisions by individuals and couples , in
order to promote the health & welfare of
the family group & contribute effectively
to the social development of a country”.
AIMS & OBJECTIVE :-
-To bring down population growth.
- To reduce the maternal & child
mortality rate.
- To control the unwanted birth.
- To prevent from abortion.
- To bring out wanted birth.
- To bring interval between pregnancies.
 GOALS OF FAMILY PLANNING
1. Operational goals
2. Demographic goals

1. Operational Goals :-
- To promote the voluntary acceptance of small family
norms .
 Family planning has two main goals :-
- To promote the people to use of spacing between
children's.
- Child survival.
- Poverty eradication & socio – economic growth.
2 ) DEMOGRAPHIC GOALS -:
-Stabilizing the population by the year 2045.
Reduce the infant mortality rate to level below 30/1000
live childbirth.
Reduce the maternal mortality rate to the level below of
100/100,000 live child birth.

SCOPE OF FAMILY PLANNING :-

-Proper spacing between birth.
- Limited number of child birth.
- Sex education
- Nutritional education.
- Pregnancy test.
- Diagnosis of reproductive tract infection.
- Preparing for first birth.

 sssss
 CONTRACEPTION
It means prevention against pregnancy .It can also be
termed as Fertility Regulation.
- Now a days many kinds of contraception are widely used
for family planning purpose.
 The method or device used for the contraception or
prevent pregnancy is called Contraception Device.
CHARACTERISTICS :-
 It should be effective for prevent pregnancy.
 It should not be harmful for the health.
 It should have long life and in expensive
 It should be simple & could be used without any
consultation or supervision of doctor/medical personal
FAMILY PLANNING
METHOD
FAMILY PLANNING METHOD
1. Natural Method
2. Mechanical Method
3. Hormonal Method
4. Surgical Method
1. Natural Method
a. Calendar Method
b. Basal Body Temperature
c. Cervical Mucosa
d. Sympto thermal Method
e. Ovulation awareness
f. Lactional Amenorrhea
g. Withdrawal Method
 2. MECHANICAL METHOD :-
a. Female condom
b. Male Condom
c. Diaphragm
d. Spermicidal
e. Intra uterine device

3. Hormonal Method :-
f. Pill’s (combined pills)
g. Vaginal ring
h. Injection
i. Implant
4. SURGICAL METHOD :-
a. Vasectomy
b. Tubectomy
.
C.LACTATIONAL AMENORRHEA METHOD;-
 This method can be used by a women who is
breastfeeding her baby day and night .It
provide natural protection against pregnancy
for up to 6months .Breastfeeding suppresses
ovulation .
 The failure rate is 1 to 2%
2. MECHANICAL METHOD
A. MALE CONDOM;-
It is a sheath or covering which is made of
thin latex rubber.
ADVANTAGES :-
Cheaper & easy to carry.
 No side effect .
Protection against STD & AIDS.
Reduce the incidence of tubal
fertility & Ectopic pregency .

DISADVANTAGES :-
Inadequate sexual pleasure .
To discard after one coital act.
B. INTRAUTERINE CONTRACEPTIVE DEVICE

 An IUD is known as Coil is a small plastic and copper

device .
 Usually shaped like ‘T’ which is fitted into uterus by a
doctor using a simple procedure and provide protection
against pregnancy .
 In IUD can stay in place 5 to 10 year .
 TYPES OF IUDs:-
(a)LIPPE’S LOOP
(b)COPPER T

COPPER T :- Copper reduces the fertility of woman so

that it is used for contraceptive.
Advantages :-
 Inexpensive , easy to use and can be inserted in minimal
time.
 Effective contraceptive.
 Fertility can be restored removal of copper T.
 Disadvantages
 Pain and bleeding.
 Ectopic pregency.
HORMONAL METHOD
Hormonal contraceptives are the effective means
of maintaining interval between births. It
includes :-
1. ORAL PILLS
2. Mixed Pills
3. Mini Pills ( Progesterone only pills)
4. Post Coital Pills
5. Non Steroidal weekly oral pills
6. Long acting /Once a month pills
7. Emergency Contraceptive pills ( E – Pills )
 MIXED PILLS
 It include both Oestron & progestron .
 This pills is to be taken from 5th day of
menstrual cycle upto 21st days continually .
 Department of Family Welfare has made
available the pills named Mala – N & Mala –D.
Their contents are –

Mala - N
●
Norethisterone acetate
●
+
●
Ethynyl oestradiol

Mala - D
●
Noregestrol
●
+
●
Ethynyloestradial
MINI PILLS :-PROGESTERONE ONLY
PILLS (POP)
This contains only Progesterone .These
are to be taken through out the
menstrual cycle .
 These are not used much due to poor
control on menstrual cycle & the higher
rate of failure.
POST COITAL PILLS
 This pills should be taken within 48 h of
the unsafe coitus.
 This pills should be taken in case of
emergency only like rape , Failure of
contraceptive & unsafe sexual intercourse.
NON STEROIDAL WEEKLY ORAL
PILLS :-

-Central drug research institute Luknow has develop a

pill named “ CENTCHRAMAN .
-This is a weekly pill that is to be taken orally.
-This pill is known by the brand name SAHELI.
LONG ACTING /ONCE A MONTH PILLS :-
-Long acting estrogen & short acting Progesterone are
mixed in this tablet.
 This pill is taken only once a month.
 Its harmful effect only rate of failure is very high .

 Advantages :-
 Prevents pregencey
 Shortness period.
 Prevents ovarian and uterine cancer.
 Disadvantages :-
 Headache
 Malaise
 Leg cramps
 Weight gain.
 Sleep disturbance.
 Hypertension
EMERGENCY CONTRACEPTIVE
PILLS ( ECPS OR E – PILLS )
 ECPs are used to prevent pregenency
following an unprotected sexual
intercourse .If taken within 72 hours ECPs
are safe for all women.
 It comes in pack of two pills.
 The first pills should be taken as soon as
possible but certainlly before 72 h.
 The 2nd pill should be taken 12 h after
the first pill is taken.
 SURGICAL METHOD :-

VESECTOMY :-
 It is simple operation performed under local
anaesthsia .
 In this method both of the vas-difference are cut
1cm each & clamped or their heads are tied in a
manner that they can not unite again .
 These days more attention in being paid to
microvesectomy to avoid cuts & stiches.
 ADVANTAGES
Permanent ,
safe , inexpensive Can be
technique . conducted
any where
Does not effect ( Sub center ,
normal working PHC etc.)
after the
operation .

Does not
interfere with
sexual pleasure. Hospitalization
not required .
DISADVANTAGES :-

Pain ,hematoma in scrotum

Impotency

Local infection
TUBECTOMY :-
1. Traditional method
This method is known as the abdominal
tubectomy in which under General
anesthesia.

2. Mini lap :-
This is minor from abdominal tubectomy
in which under local anesthesia .
3. Laparoscopy :-
In this technique using a laparoscope
through the abdomen .
ADVANTAGES
 This method is almost 100% safe against
pregencey .
 Minimal complication .
 Comparatively less expensive .

DISADVANTAGES
 Local infection.
 Some women complain of bleeding.
 Irregulatingr of cycle.
ROLE OF NURSE IN FAMILY WELFARE
PROGRAMME

 Motivation of eligible couple on family welfare

methods.
 Follow up of IUD & Oral Pills users.
 Organizing special camping .Domiciliary services for
perinatal care.
 Educational activities.
 Records maintainces.
 Maintaining adequate supplies .
Evaluation of programme.
ANY DOUBT ???
BIBLIOGRAPHY
1. Park K. , ‘Parks essential of community health &
nursing” , 6th edition , M/S Banarsidas Bhanot
Publishers , 2012 , Pp : 390 – 391

2. Park K. , “ Parks textbook of Preventive &

social medicine 22nd edition , M/S Banarsidas
Bhanot Publishers , 2013 , Pp :371– 318

3. Rao sridhar B. ‘community health Nursing” 2nd

edition Aitbs Publishers Pp : 213

4. Suryakanta AH , community Medicine with

recent advantages 3rd edition Jaypee brothers
medical publishers P (Ltd) Pp :859 -869