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Family planning methods

Family planning is the set of spacing and limiting methods, and the counselling around them, by which a couple decides the number of children they have and the interval between them. It matters because birth spacing of at least three years is one of the cheapest ways to cut maternal, newborn and child deaths, and because India runs the oldest national family planning programme in the world and expects every staff nurse to counsel on the whole basket of choice rather than one favourite method.

India launched the world's first national family planning programme in 1952; the current basket of choice under the National Family Planning Programme and Mission Parivar Vikas includes condoms, combined oral pills, emergency contraceptive pills, the copper intrauterine device including the postpartum device, the injectable Antara, the non-hormonal weekly pill Chhaya, and male and female sterilisation.
Copper intrauterine devices: Cu-T 380A is effective for 10 years and Cu-T 375 for 5 years; insertion is safe within 12 days of the start of a period, within 48 hours of delivery (post-placental insertion within 10 minutes of the placenta), or immediately after an uncomplicated abortion, and failure is under 1 per 100 women-years.
Antara is injectable medroxyprogesterone acetate 150 mg intramuscularly every three months with a grace period of two weeks on either side, and it is safe in breastfeeding; Chhaya is centchroman (ormeloxifene) 30 mg taken twice a week for the first three months and then once a week, is non-hormonal and does not suppress lactation.
Combined oral pills are started on day 1 to 5 of the cycle, one tablet daily, and are avoided in a woman breastfeeding a baby under 6 months, a smoker over 35, and in migraine with aura, uncontrolled hypertension, past venous thrombosis or breast cancer; a missed pill is taken as soon as remembered with a backup method for 7 days.
Emergency contraception is levonorgestrel 1.5 mg as a single dose taken as early as possible and within 72 hours of unprotected sex, or a copper intrauterine device inserted within 5 days, which is the most effective emergency method and continues as ongoing contraception.
The lactational amenorrhoea method is about 98 per cent effective only while all three conditions hold together: the baby is under 6 months, is exclusively or nearly exclusively breastfed including at night, and the mother's periods have not returned; the method fails the day any one of the three fails.
Sterilisation is permanent: minilaparotomy or laparoscopic tubal occlusion for women and no-scalpel vasectomy for men, done after written informed consent that can be withdrawn at any time, with the woman aged between 22 and 49 years and having at least one child over one year old; vasectomy is not effective immediately and another method is used until azoospermia is confirmed, usually after about three months or twenty ejaculations.
An eligible couple is a currently married couple in which the wife is of reproductive age, and there are roughly 150 to 180 such couples per 1,000 population, all listed in the eligible couple register kept by the auxiliary nurse midwife and the ASHA; the couple protection rate is the percentage of eligible couples effectively protected by a modern method, and NFHS-5 records a total fertility rate of 2.0 with female sterilisation still the most used method in India.

ASHA worker roles

The Accredited Social Health Activist is the honorary, incentive-paid village woman created by the National Rural Health Mission in 2005 to be the first port of call for any health need in her hamlet and the bridge between the community and the public health system. She is an activist and mobiliser rather than a service provider: she counsels, escorts, follows up and reports, and almost every national programme now reaches the household through her.

The norm is one ASHA for about 1,000 rural people, relaxed to habitation-based selection in tribal, hilly and desert areas, and roughly one for every 1,000 to 2,500 people in urban slum clusters under the National Urban Health Mission; she is a resident woman of the village, usually between twenty-five and forty-five years of age, preferably schooled to class eight, selected by the community and accountable to the Gram Sabha and the Village Health, Sanitation and Nutrition Committee.
She is trained through the induction module and modules one to five, with modules six and seven adding home-based newborn care and the community-based non-communicable disease role, and she is supported by an ASHA facilitator for about every twenty ASHAs and by the block community mobiliser.
Her drug kit lets her treat and refer, not prescribe: oral rehydration salts and zinc, paracetamol, iron and folic acid tablets, oral and emergency contraceptive pills, condoms, pregnancy test kits, and in malarious areas a bivalent rapid diagnostic test with the first dose of an antimalarial.
Home-based newborn care now runs under the Samagra Shishu Bal Swasthya Karyakram (SSBSK, 2026), which merged HBNC and HBYC: four home visits for a healthy newborn on days 3, 7, 14 and 42, five after a home delivery because day 1 is added, and nine for an at-risk newborn on days 1, 3, 5, 7, 10, 14, 21, 28 and 42, the at-risk baby's day-3 and day-7 visits being made jointly with the ANM and the Community Health Officer (the Medical Officer in urban wards); at each visit she weighs the baby, takes the temperature, watches a breastfeed, examines the cord, uses the danger-sign checklist and records the visit on the Shaishav mobile app, and she is paid incentives for the scheduled visits, with extra for identifying and following up an at-risk baby.
SSBSK then continues the former Home-Based Care for the Young Child with eight visits at three, six, nine, twelve, eighteen, twenty-four, thirty and thirty-six months of age for growth, feeding, immunisation, oral rehydration and zinc, and early childhood development.
Across the programmes she registers pregnancies and escorts women for institutional delivery under JSY, mobilises children for immunisation sessions, supports treatment and reports in Nikshay under NTEP, collects and transports sputum, assists in mass drug administration for filariasis, distributes iron and folic acid tablets, gives the biannual vitamin A and deworming rounds with the ANM, counsels on family planning and follows up acceptors, and fills the Community Based Assessment Checklist for every adult over thirty for non-communicable disease screening.
She is paid performance-based incentives together with a routine recurring incentive rather than a salary, and there are limits to her role that the paper tests: she does not conduct deliveries, does not prescribe beyond her kit and does not replace the ANM — her work is to bring the case to the system and the system to the case.
She keeps the village health register and the SSBSK home-visit cards, sits on the Village Health, Sanitation and Nutrition Committee, runs the monthly Village Health, Sanitation and Nutrition Day with the ANM and the Anganwadi worker, and reports through the ANM into the health management information system.

CHC — population coverage

The Community Health Centre is the block-level referral hospital of the rural public health system, a thirty-bedded unit with specialists that receives what the sub-centres and primary health centres cannot handle. It is the designated First Referral Unit for obstetric and newborn emergencies, and the population it must cover, the beds it must have and the staff it must employ are laid down in the Indian Public Health Standards.

One Community Health Centre serves 1,20,000 people in the plains and 80,000 in hilly, tribal and desert areas; it covers a block and takes referrals from about four primary health centres.
It is a thirty-bedded facility with an operation theatre, a labour room, a laboratory, X-ray and a blood storage unit, and it is assessed for quality under the National Quality Assurance Standards and Kayakalp.
Under the Indian Public Health Standards of 2022 a CHC working as a First Referral Unit has five essential specialists — a physician, a surgeon, an obstetrician-gynaecologist, a paediatrician and an anaesthetist (a non-FRU CHC needs only a physician; the older norm counted four, without the anaesthetist) — with a dental surgeon, staff nurses, a laboratory technician, a pharmacist and a radiographer; the Indian Public Health Standards of 2022 restyle the centre as a block public health unit and add public health and programme management posts to that list.
A facility is a First Referral Unit only if it does three things round the clock: comprehensive emergency obstetric care including caesarean section, care of the sick newborn, and blood storage; a unit missing any one of the three is not an FRU whatever its signboard says.
Its services are emergency and outpatient care, inpatient care, comprehensive emergency obstetric and newborn care, sterilisation and IUCD services, national programme clinics for tuberculosis, non-communicable disease and others, and referral transport through the 102 and 108 ambulance services.
The whole rural ladder is what the paper actually asks: an Ayushman Arogya Mandir at sub-centre level for 5,000 people in the plains and 3,000 in hilly and tribal areas, staffed by a Community Health Officer with a female and a male health worker; a primary health centre for 30,000 and 20,000; a community health centre for 1,20,000 and 80,000; then the sub-divisional hospital and the district hospital, whose bed strength is fixed by the population of the district.
Health and Wellness Centres were renamed Ayushman Arogya Mandir in 2023, and the sub-centre and PHC level of the ladder now delivers the twelve packages of comprehensive primary health care, which is why a question may name the same facility by either title.

PHC — population coverage

The Primary Health Centre is the first point at which a village community meets a qualified medical officer, and it is the institution the Bhore Committee proposed in 1946 as the base of the rural health service. One PHC covers 30,000 people in the plains and 20,000 in hilly, tribal and desert areas, supervises about six sub-centres and is where the formal referral chain and the reporting chain both begin.

The population norm is one PHC for 30,000 in the plains and 20,000 in hilly, tribal and desert areas, and each PHC supervises six sub-centres, each of which serves 5,000 in the plains and 3,000 in hilly and tribal areas.
A PHC has four to six beds and is staffed by a medical officer with a staff nurse, a pharmacist, a laboratory technician, health assistants male and female, and support staff; a PHC designated 24x7 has additional medical officers and staff nurses and provides round-the-clock normal delivery and emergency services as the first delivery point below the First Referral Unit.
Its functions are medical care, maternal and child health including family planning, safe water and basic sanitation, prevention and control of locally endemic diseases, collection and reporting of vital statistics, health education, delivery of the national programmes and referral; it is the reporting unit for the health management information system and for the medical officer's presumptive form under IDSP.
The historical anchors examiners use are the Bhore Committee of 1946, which recommended the primary health unit and the three-tier structure; the opening of PHCs from 1952 under the Community Development Programme; the Mudaliar Committee of 1962, which found the existing centres overloaded and recommended that a PHC should not serve more than 40,000 people while the district hospital should be strengthened; and the later reorganisation of rural health services that fixed the present norm of 30,000.
Under Ayushman Bharat the PHC and its sub-centres have been converted into Ayushman Arogya Mandirs, renamed from Health and Wellness Centres in 2023, and deliver twelve packages of comprehensive primary health care covering pregnancy and childbirth, newborn and child health, adolescent health, family planning, communicable diseases, common acute illness, non-communicable disease screening and management, mental health, eye and ENT care, oral health, care of the elderly and palliative care, and emergency and trauma care.
Below the PHC, the sub-centre is led by a Community Health Officer with the female health worker or ANM and the male health worker, and one female health assistant, the lady health visitor, supervises about six ANMs; above it, the community health centre takes the referrals for 1,20,000 people.
Free drugs from the essential drug list, free diagnostics, quality certification under the National Quality Assurance Standards and Kayakalp, and the untied funds of the Rogi Kalyan Samiti and the Village Health, Sanitation and Nutrition Committee are what the PHC actually runs on, and the nurse is expected to know which fund pays for what.

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