Shifting to a reproductive health approach in India means designing a cost-effective package of good quality services that can be made available and accessible to all, especially the poor, says Dr. Pachauri. Planners need to expand interventions without compromising the quality and effectiveness of existing services. Essential services must be integrated horizontally within the existing health care system, a daunting task since the capacity of the delivery system varies widely among regions, states, and even within states. When method-specific targets were removed nationwide, their sudden and abrupt removal was a dramatic change that shook the system, Dr. Pachauri reports. However, they also report that this trend has since been reversed.
Birth rates show a continued decline, even in states with persistent high fertility.
In the state of Tamil Nadu, Leela Visaria and Pravin Visaria found a significant increase over the last 7-8 years in immunization services, antenatal visits by health workers, and mothers' meetings at the village level. In addition, workers there enjoyed a better status as health care providers than they did when they provided only family planning services. Nirmala Murthy examines the issue of decentralized planning and monitoring and concludes that it has brought about several qualitative changes. Almost all states have begun to report on improvements in prenatal care and to focus their attention on providing safe delivery services. The acceptance of reversible methods by younger couples has increased, and health workers are better able to identify contraceptive side effects.