REPRODUCTIVE RIGHTS, REPRODUCTIVE HEALTH AND REPRODUCTIVE HEALTH PROGRAMME IN INDIA

A HISTORICAL PERSPECTIVE

DR Amrit Krishna Bora

HOD, O&G District Hospital Kamrup

People’s has the right to enjoy a safe and satistifying sexual and reproductive life with couple freedom
to decide the number and timing of their children and the information and knowledge about the
different provision available for both fertility enhancing and limiting services . It encompasses

A) A satistifying and safe sex life free from fear, coercion, disease and violence.
B) Capability to reproduce and the freedom to decide when and how often to do so, that is access
to both Infertility and contraceptive service.
C) Reproductive choice for women and men has the right to be informed and have access to safe
effective, affordable and acceptable method of family planning.
D) Access to safe and affordable abortion service.
E) Access to appropriate health care service that will enable women to go safely through
pregnancy and child bearing.
F) Access to services for the prevention and care of reproductive health problems in a culturally
sensitive setup to reduce the reproductive Morbidity.

All this rights has been recognized and endorsed by the different international treaties of Human Right
and Health like

International Conference of Human right 1968

International Conference on Civil and Political rights

International conference on Economic, social and Cultural right

Convention of all form of Discrimination against women

International Conference of Population

International Conference of Population and Development 1994 also called Cairo Declaration.

All the rights has been endorsed by participating countries including India and stressed upon the
attainment of a quality reproductive life which should be free from Disease, coercion, discrimination and
violence and to fulfill the cherished dream of women-hood and to execute the vested responsibility
towards their Children and society.

The Reproductive Rights and ethical issues have been converted to different National and International
Laws according to prevailed socio cultural and political ecosystem of different countries. So we have
seen much minor modification of different laws and ordinance pertaining to women’s Health and rights.
Again the issues have been incorporated in different health planning and Programme in a sensitive way
to achieve the preset Goal. To do so, every country initiated different action plane as the issue are
controversial land sensitive in nature and sometimes base upon abstract ideology. The strategies to
improve the implementation are strengthening of International monitoring Mechnism, IEC activity
regarding Reproductive right , formation of support group, and formation of local health and social
policy which endorsed the reproductive rights.

Now, the Reproductive Health defines as a “State of complete Physical, Mental and Social wellbeing and
not merely absence of Disease or infirmity in all matters relating to Reproductive system and its
FUNCTIONS and PROCESS.” United Nations, 1994. This definition itself elaborate a broader outlook of
Reproductive Health with different Domains which involves different sectors of social science like
Health, Education, sociology, Health Planning, anthropology, women Empowerment and women Right,
Cultural issues etc.

Domain of Reproductive Health

A) Safe Motherhood: - It is a right to every women and every nation try to improve the Maternal
health service system to reduce the MMR which is still alarmingly high in South eastern and Sub
Saharan Countries. A comprehensive, multi sectoral approach is required to implement an
affordable, easily accessible, Client Friendly and Culturally sensible safe Motherhood
Programme.
B) Family Planning: - Population explosion cannot be contained by stipulating target to female
sterilization only. Long Acting Reversible contraceptive ( LARCS) and Male sterilization should
come forefront and the programm should be affordable, effective, and socially acceptable need
based approach with Community Participation, Cultural land Psycho-social Conceptualization,
Voluntary male participation should be mainstay.
C) Services for Reproductive Morbidity :- Prevention and care of different Reproductive Morbidity
is essential for overall improvement of Reproductive Health of the community. Screening and
early treatment of Carcinoma Cervix and Breast, Nutritional supplement to adolescent girls,
Menstrual Health management, Syndromic approach of STI-RTI, Genital prolapsed, discomfort
associated with menopause, treatment of Infertility should be part of Reproductive Health
package.
D) Abortion and Post abortion Service:-It is one of the major domain in reproductive health to
provide safe, affordable, acceptable abortion service and post abortion care at the doorstep. It is
the prerequisite to prevent unsafe abortion practice by village quacks or back alley unhygienic
service that leads to major health consequences or even death. Same time appropriate legal and
saturatory health policy should be in place along with mass awareness generation.
E) STI-RTI/HIV-AIDS:- One of the major concern is the Socio Cultural attitude towards Sexually
Transmitted Diseases and raising incidence of HIV-AIDS in Antenatal cases. A multidimensional
adverse socioeconomic impact has been observed as a result of increase burden of AIDS
patient ,HIV-AIDS affected Children and orphan of AIDS patient.
F) Adolescent Health :- Priority should be entrusted upon the Adolescent Health in terms of
nutritional supplements, Preventing School dropout, Raising age of Marriage ,Sexual and STI
counseling, Reproductive hygiene, sex education, child sexual abuse etc. The aim of the
 intervention should be to prevent the ignorant Girl to become the Victim of the reproductive
Health problems and adloscent pregnancy and also to aware and educate them for future role
of empowered women of the society.
G) Domestic Violence-Sex abuse -women trafficking: - It is also a part of the reproductive Health
system as the atrocity upon the women-- usually child or Adolescent result upon the serious
future reproductive health problem in terms of STI/RTI, HIV/AIDS, PID, Sexual Dysfunction,
Infertility etc.
H) Male Participation: - In most of the Developing countries decision making capacity usually rested
upon the Male counterpart, The Psycho- Social attitude of Male toward the Reproductive Health
Service usually guide the outcome of a specific RH programme . So, women Right and
Reproductive issue should be addressed toward the Male Partner.
I) Women Empowerment :- An educated, socially and economically empowered omen can oly
improve the reproductive Health situation in the community which should be free from any
type of suppression , Coercion and Violence and have the ethical ad constitutional right to
attain a free and informed choice of Reproductive function and it service hen required.

Reproductive Health Policy According to prevail socioeconomic and Political situation, different
RH packages has been started in different Countries but not a single policy is succeeding in
fullest. Sporadic improvement of different aspect of Reproductive Health has been noticed in
different part of the world like Cuba, Sree Lanka or Kerala State of India. It is due to Change of
Socio Cultural and Eco Political Attitude of common People toward the reproductive Health,
Empowerment and Education of Female which is the Keystone to achieve the target.
Historically, India is the first country in the world to start officially Reproductive Health
programe to improve Maternal and child Health condition in 1995, though record shows that
birth control Clinics were functioning since 1930.
1) Maternal & Child Health Programme (MCH ):- This programmestartedin1961 envisage by
Planning Commission in 1962 to reduce Morbidity and Mortality rate of Mother and Child ,
Promotion of Reproductive health by Incorporating Universal Immunization Programme
(UIP) it FamilyPlanning Programme. Main focus was better coverage of Antenatal care,
Immunization up to children of five year and Pregnant Mother, Vit A Prophylaxis and
sterilization after completion of Family.
2) Child survival and safe Motherhood Programme ( CSSM) :-Started in August 1992, this
programme is aimed to reduce Infant Mortality from 60 to 10 per thousand child population
and MMR below 200 per lakh live Birth by the year 2000. Ith the previous UIP , Vit A
prophylaxis ORT and Acute Respiratory Infection Programme for under Five child has been
started .To improve maternal ealth , Capacity building of skilled Birth Attendants ,
Formulation of Emergency Obstetric Care with f BMOC and EMOC training to Peripheral
Doctors and creating First referral unit ( FRU )at Community.

3 )Reproductive and Child Health Programme( RCH) :- In 1994 ,International Conference of

Population and Development at Cairo stressed upon the more strengthening of Safe motherhood
programme in developing countries . A the previous p rogrames are not successful to reduce the MMR
and IMR to a desired level so a new approach has been adopted to addressed the [Link] phase I
and II in continuum started in 1997 based upon a Client Orientated, Need based, High quality ,Integrated
Maternal Health service through Participatory Planning with different stakeholder like Community
NGO ,Donor agencies, CSO, and professional Organization like IMA,IPA FOGSI etc ,Media and Academic
and Management Institute.

Salient feature

A) Target free, Community Need Based Approach (CNBA):-

Previous Health Programs are monitored according to fulfillment of preset Goal. But in this
approach, the grassroots workers study their own requirement and accordingly plan the action
plan to provide all the comprehensive services to the community .This yearly vision has been
implemented by the service provider with the help of Logistic and Manpower support from
immediate upper level.
B) Participatory Planning (PP) :-
The village level Health worker act as a resource & skilled person in all health related activities
and the prime source of Information- Communication –Education activities. This is done with
active consultation and Participation of all the member of the community .Here emphasis is
given upon Women’s group, Panchyat members, Youth club, NGO, Village leader, Religious
Clerics, to execute the responsibilities to the communities in different Health related matters.
C) Quality Care (QC):-
To provide a good quality service at door step, all the health professional were provided
reorientation training including sill based integrated course with special focus on Interpersonal
Communication, Counseling and Logistic and management service skill.
D) Sensitization Programme :-
All field functionary’s from different departments like health, Family welfare, Socia welfare,
Education, Rural development, PRI, Community groups Mohila Sangha was sensitized about
different social component of reproductive health and the role entrusted.

National Institute of health and Family Welfare as the Nodal implementing Institute with
technical guidance from Health Management Institute, IIM different official and quasi official
organizations relating to Reproductive Health. Later on all this components are merging with
Flagship programme, NRHM, now NHM with massive allocation Central fund, with a structured
HR policy, innovative ground force like ASHA and digitization. Time will say whether all this
endeavourer will help us to achieve the SDG Goal on 2030 and thus creating a just and right
Society in terms of Reproductive Health and Rights.