Integrating Social Support for Reproductive and Child Health Rights (Phase-II)

RCH Network Rajasthan

“Reproductive health addresses reproductive processes, functions, and systems at all stages of life. Reproductive health therefore implies that people are able to have responsible, satisfying and safe sex lives, and that they have the capability to reproduce and the freedom to decide if, when, and how often to do so. Implicit in this last condition are the rights of men and women to be informed of and to have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice, and the right of access to appropriate health care services. This will enable women to go safely through pregnancy and childbirth and provide couples with the best chance of having a healthy infant.” (WHO)
Changing Global Perspectives and Resolutions
	The International Conference on Population and Development (ICPD), held in Cairo in 1994, declared that the population control Programme was ignoring the health of women. Programme should not address only specific targets, but instead aim at empowering women in terms of their control over all aspects of reproductive health through proactive involvement of the community, provision of quality services and male participation. The Fourth World Conference on Women (Beijing, 1995) confirmed the results from ICPD, but worked out its goals within a broader context of gender equity
Needless to say, these UN conferences have proposed a comprehensive solution to the problem which includes: empowering women to access quality services relating to all aspects of their health, availability of a holistic health care system which providing affordable, comprehensive, and integrated RCH services especially in relation to women’s health needs. Most importantly, Programmes dealing with women’s health should take care of concerns of gender equity. Thus, the new agenda on Population identified five main themes: Women’s empowerment, Reproductive Health, Sexual Health, Reproductive rights and Sexual rights. As was stated in a Ford Foundation report (1997), reproductive health is a question of women’s health, rights and empowerment, rather than a medical question of RTIs, UTIs and STDs. A key underlying factor that influences women’s reproductive health status is the complex web of gender relations and power structures that bars women from participating in crucial decisions that affect their reproductive lives as well as beings.
Shift in National Policies on RCH and Limitations
	In tune with this emerging global concern on population and RCH, the Government of India (GOI) has re-oriented its Health and Family Welfare Policy to make it more comprehensive and holistic in relation to Reproductive and Child Health (RCH). At the institutional level, the new Population Policy of India, 2000 has proposed for the creation of specialized facilities including properly trained and gender sensitive health staff. The inclusion of men, adolescent girls and boys as well as elderly women within the purview of RCH clearly shows a paradigm shift as it highlights the need for the adoption of life cycle approach. However, the experiences of field workers show that the paradigm shift has not become a reality at the state and district levels. For instance, targets have been removed in the official pronouncements, yet target based functioning of the family planning Programme is very much in practice and the Programme still remains targeted mainly at women.
Local Scenario in Rajasthan: Issues and Concerns
Rajasthan is predominately a rural state consisting of 32 districts, which are sub - divided into 237 blocks and 39,810 villages. Out of a population of 56.5 million (2001 census), ¾ of the total population is residing in villages including a substantial share of nomadic population, which migrates over long distances during summer for in the search of water. The SC & ST populations, who have low levels of literacy and low economic status, are 12% and 17% respectively.
According to the Human Development Index (HDI), Rajasthan’s rank is in the lowest quartile of Indian states. Rajasthan’s HDI is 0.356, in comparison to an all-India level of 0.603 (Human Development Report, Rajasthan, 1999). A special problem of Rajasthan is that it receives an extremely low and irregular rainfall, causing serious drought conditions in 40 of the past 50 years, affecting 215.07 lakhs of people in 1997-’98 (Relief Department - Government of Rajasthan).
According to an Economic Survey, carried out by the Directorate of Economics & Statistics in Rajasthan (1998-’99), the State holds rank 15 in percentage of male literacy and 16 in female literacy, in comparison with 17 major states of India.
Further, the status of women is also not satisfactory on account of many retrogressive customs and practices such as child marriage and female infanticide. Deprivation of girls from education results in low female literacy rate - lowest in the country. The health indicators reveal high IMR 86, MMR 670 and a high morbidity rate. The high crude birth rate of 33.6 has also added to the already alarming population growth. Both chronic and acute “under nutrition” levels are high. Major burden of disease is borne by children and women in rural areas. The presence of abysmally low level of health infrastructure force people to seek magic cures and faith healing even for problems pertaining to infertility, children’s diseases, sexual problems and other RH plights. The most common problems are RTIs and menstrual disorders among women. 45 % of women are reported having symptoms of RTIs (NFHS II).
On the demand side, eligible women and adolescent girls and boys are found being anxious about their health problems but are reluctant to seek help due to socio-cultural barriers. Health and family welfare services in the state are provided through a network of Sub-centers, PHCs, CHCs, Postpartum Centers, Referral Hospitals and other private facilities. Yet, it is a fact that health personnel staffing these institutions are less than adequate, apart from being generally insensitive towards the shy and diffident rural masses, especially women.
The TFR has been slowly declining and is 3.78% (NHS II) at present. It has been reported that there are 2.6 living children per woman, consisting of 1.4 boys and 1.3 girls. Yet, the women have been found desiring an additional number of children. On an average they demand for 0.7 male and 0.5 female additional children (HDR). Hence the preference is for 4 children generally. In 10 districts the preference is for 5 children e.g. Alwar, Bharatpur, Jaipur (Concurrent Evolution of spacing methods & MCH services 1996-97, GOR).
In addition to this, child malnutrition has actually increased by 9% between 1992-’93 and 1998-’99. Thus, the state of Rajasthan has achieved the worst performance of India’s 14 major states. It also has the highest proportion of low birth weight babies and the lowest child sex ratio (which declined even further between 1991 and 2001) amongst these 14 states.
At present, 5.5% of the GDP is spent on the health sector. The expenditure per person rose from Rs. 0.91 in 1955-’56 to Rs. 157.59 in 1997-’98. Yet, large areas of Rajasthan remain untouched by health services. Of the 38,800 villages in Rajasthan, 26,000 villages lack presence of medical services (excluding Hospitals, CHCs, PHCs and Sub centres). In other words, about 26 million populations have no access to health services. Illustrative are the following facts:
There is only one doctor per 8568 people and one hospital bed per 1397 people While the population is 26% urban and 76% rural, only 25% of medical services are available in rural areas. Coverage:        · Complete immunization: 30%        · Institutional deliveries: 17%        · Number of hospitals: 219 Expenditure on equipment and medicines has reduced in the past five years from 6.62% to 4.3%. Of the 90 districts in India with high IMR, 27 are of Rajasthan.
Sida Supported Intervention through a Network of NGOs
Looking for an effective answer to the present status of RCH in rural Rajasthan, a NGO Network reviewed the quality of its Programme implementation during 2000-2003 and suggested for an overhaul in the focus, direction and strategy of Programme planning. The Programme started with 20 villages and extended to 100 villages with 6 partners. In the second phase it is being extended to 180 villages with the addition of new partners.
Overall Goal of the project:
Sustained and gender equitable improvement in Reproductive and Child Health status in rural areas.
Main Objectives of the project:
Strengthened community groups (At village and Panchayat level) generate demands and ensure RCH services to target groups as their right. Sustainable institutional linkages formed between community groups, PRI, W&CD and Pvt. Health agencies/ medical practitioners for addressing RCH needs. Advocacy at all levels for improved behaviour regarding RCH and better utilization of services. Strengthened network in terms of structure, functioning and its capacity to influence policy environment on RCH issues.
Special features of the project:
Empowering of the Panchayat Members fort sustainability of the work started. Implementation of RH should go beyond MCH with incorporation of other issues including HIV/AIDS Special interventions for adolescent population and male involvement in RCH Socio cultural interventions as well as co ordination and capacity building both for the collaborating partners and local community. Adoption of the life cycle approach for ensuring involvement of every individual. Working closely with the Government and related departments to supplement the work of NRHM Research, Documentation, Training & Advocacy Establishment of Formal partnerships with the PHC and the PRIs for sustainability Gram Panchayat to be the unit of programme management Community based & managed Monitoring system to be developed. Streamlining of HMIS with capacity building of the NGO on HMIS through the use of Management tools for Monitoring including Health Mapping and village microplanning to assess changes. Development of an effective training strategy needs to be developed with gender mainstreaming within the programme Interlinkages between the concept of Health, RH& Rights, gender and other sectors like environment, sanitation, water and education
Kumarappa Institute of Gram Swaraj is one of the partners in Sida supported RCH project. It is working in 12 villages in the Niwai block of Tonk district. The demographic details of the project area is as follows:

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