Upholding the freedom of couples to use a method of their choice

A recent review of the Philippine Population Program's 5-year plan, ended in December 1982, showed that in 1980, natural family planning (NFP) users were only about 12.5% of couples practicing family planning. This figure doubled by 1982. Based on these responses the decision was made to intensify the NFP program as early as 1982. The 1st step was to put more money into the NFP program. The program includes the modern scientific techniques such as cervical mucus, basal body temperature, and sympto-thermal. The program also will fund the training of doctors and other clinic personnel and the production and distribution of appropriate training and information material. Other family planning methods, such as sterilization, oral contraception (OC) and the condom, also will be promoted. Promotion of NFP will depend on the choice of the family planning practitioners themselves. The program's community based services are being intensified. NFP, together with the other family planning methods such as sterilization and OC, will always be made available to couples in the community based services. All agencies in the population and family planning program will be promoting NFP. Knights of Columbus doctors have been invited to assist the program and share their own training modules for the training of trainers. An agreement has been entered into with the Gabriel M. Reyes Memorial Foundation based in Aklan. The goal is for trainers who need further knowledge and skills in NFP to learn from the foundation's wealth of organized orientation and training techniques in NFP. NFP is emphasized at this time because it is acceptable to a great number of couples.     

NFP promotion in the Philippines: all program components covered

At least 50 of the 105 agencies in the Philippines listed in the "Directory of Agencies with Population Activities" are actively participating in the promotion of natural family planning (NFP). Of these, 40 offer instruction on its use, 22 provide training to clinic personnel or field workers, 19 conduct information/education/communication (IEC) activities, and 6 undertake research. The Population Center Foundation's (PCF's) Information Support to Population Projects (ISP) has prepared a preliminary inventory of programs and projects on NFP, covering some of those that were done in recent years, are being implemented, or have been proposed. Some projects described in the inventory are reviewed. Recent research or research proposals are showhow related, all leading to how the method can be effectively promoted and how couples can be taught its proper use. Instruction on NFP appears in all training activities of Popcom's regional offices, particularly in their refresher courses. Program managers are being trained in managing and monitoring activities to promote the method. In 1980 outreach workers, doctors, nurses, and midwives were trained by Popcom to motivate couples to practice the method and to teach them how to use it correctly. That same year, Popcom's office in the Ilocos region introduced the rhythm dial calendar, a simplified version of the rhythm slide rule. The Ministry of Health National Family Planning Office incorporates natural family planning instruction in its training seminars for the Ministry's health personnel in the regions. As in training, all regional offices of Popcom promote NFP along with other methods that they make available to prospective acceptors. This is in keeping with the program's "cafeteria approach" to family planning. In 1982 Popcom began intensifying the provision of services in NFP, allocating around 4 million pesos to preparations for its effective promotion. In support of service delivery efforts are IEC activities such as the development, production, and distribution of brochures and other reading material on NFP, schoolroom instruction, and lectures. The intensification of IEC efforts in the private sector to promote the modern and scientific techniques of NFP is most clearly evident in a fairly recent seminar sponsored by the Communication Foundation for Asia. Program agencies with activities in natural family planning are listed.     

NFP update: researcher cites need to improve instruction

In the Philippines more and more couples are practicing natural family planning (NFP), but there is a need to improve instruction on this method to increase its effectiveness. Calendar rhythm has been the most popular technique of NFP, but failure rates have been high. This could be changed by improved calendar rythm instruction and the introduction of newer, more effective natural techniques like the basal body temperature, cervical mucus, and symptothermal methods. Dr. John E. Laing, in a paper entitled "research on Natural Family Planning in the Philippines," examines the trends in NFP and summarizes major findings of past research related to NFP and the status of current research. It also discusses the implications of such findings for the National Population Program and the needs for current research. Cting World Fertility Survey (WFS) data on 19 developing countries, Laing states that the Philippines is second only to Peru in current and past use of the rhythm method. He also indicates that since the start of the National Population Program in 1971, rhythm has been offered as an official program method. Yet, in the early years of the program rhythm was not promoted as actively as the other family planning methods. In the last few years, program, officials have become more interested in NFP. 1976 National Acceptor Survey (NAS) data showed that rhythm reduced fertility by 78% compared to the condom's 79%, oral contraceptive's 94%, and the IUD's 98%. A comparison of data from the 1972, 1974, and 1976 NAS indicated a decline in continuation rates and an increase in overall pregnancy rates for all methods except rhythm. The overall pregnancy rate of rhythm declined, but there was no significant change in continuation rate. Laing suggests that probably, while the national population program was increasingly recruiting less motivated couples to try other methods, the rhythm acceptors, who were largely self initiated, mantained earlier levels of motivaton. Evidence points to the widespread use of crude formulas that do not take into account individual variations in cycle length. Many users do not even fully understand the mechanism by which rhythm affects fertility. There is also little knowledge among acceptors of the new and more reliable techniques of NFP for identifying the safe and unsafe periods. Despite problems, a considerable number of acceptors still prefer rhythm to other methods. The commission on population has embarked on a solution to some of the problems by committing itself to the training of volunteers of community-based organizations, particlarly lay leaders. 3 large scale projects are planned for this purpose.     

The participation of non-governmental organizations in the Philippine population program

In 1957 the National Council of Churches in the Philippines (NCCP) established the Family Welfare Center, offering an educational program in family planning; it was subsequently expanded and reorganized into the Planned Parenthood Movement of the Philippines. Since its creation in 1970 the Philippine Population Program has brought together government, private, and religious activities. Under the 1987-92 development plan nongovernmental organizations (NGOs) will be taking a more active role in the implementation of the population program by contributing to the maternal and child health/family planning and the information, education, and communication (IEC) components. There are more than 50 private organizations engaged in such population activities. These include national women's organizations and development NGOs with a mass base. The Family Planning Organization of the Philippines is carrying out a 3-year comparative study of the effectiveness of community volunteers in the acceptance of natural family planning. The Reproductive Health Philippines has completed a follow-up of Depo Provera defaulters in a previous clinical study of Depo Provera acceptors conducted in 1985-87. IEC support from various medical and social organizations also helped advance family planning and population awareness of the program. The Mary Johnston Hospital and Iglesia ni Kristo have been front-runners in sterilization through their mobile teams and regular clinics. On the negative side, funding constraints are threatening the very existence of some NGOs. Even those that do not face such constraints face problems related to cost effectiveness, priority setting, capability building, and staff development. A survey of the Population Center Foundation identified some urgent concerns: sharing experience in self-reliance, enhancement of the managerial skills of staff, and funding problems. NGOs complement the family planning services of the government as well as focus on the smooth flow of IEC activities.     

The Population Program's Medium-Term Plan: a blueprint for welfare

The Population Program in the Philippines initially was preoccupied with the problem of fertility reduction. From 1981-85, the program will be carrying out a 5-year population plan which aims at the reduction of fertility as well as the broader goal of enhancing the well-being of the family and of society. Called the Medium Term Plan, this population plan began to evolve in January 1978 when President Marcos called for a comprehensive review of the population program in the context of the country's overall development plans. The Special Committee to Review the Philippine Population Program, worked from February to June 1978 and focused attention on the policy, program, and research components of the population program. They assessed the achievements of the program, analyzed its limitations, and recommended future policy and program thrusts. In performing its task, the committee observed the following guidelines: 1) the program must be evaluated by taking into account the overall development goals that are directly related to the population problem, 2) the program must be evaluated in its totality, 3) the concept of family planning must be redefined as family planning and welfare, 4) research must be recognized as a vital instrument for program formulation, and 5) the population program must be evaluated with an awareness of the role of financial and institutional support in its implementation. The committee's findings stressed the need to link family planning efforts with the rest of socioeconomic issues outlined in the government's 5-year development plan for 1978-82. The broad objective of the National Population Program is to reduce the population growth rate to levels that promote national welfare and individual well-being. Under the Medium Term Plan the population growth rate should be reduced from an estimated 2.3% to an estimated 2.0% in 1985. To achieve this objective, the program aims to raise the number and quality of protected couples, promote delayed marriage, promote internalization of the small family size norm, and study other development factors. 14 strategies and their objectives are outlined along with action steps.     

Asian and Pacific population targets

2 population targets for the Asian and Pacific regions were established in 1981-82: 1) by the Asian Conference of Parliamentarians on Population and Development at Beijing, China to attain 1% population growth rate for the Asian region by the year 2000, and 2) by the 3rd Asian and Pacific Population Conference at Colombo, Sri Lanka, to attain replacement level of fertility by the year 2000. In an attempt to ascertain whether these targets can be achieved and/or related, the Population Division of the UN's Economic and Social Commission for Asia and the Pacific (ESCAP) prepared population projections in which the 2 targets are achieved. These projections were prepared by aggregating the total population of member countries. When net reproduction rate (NRR) equals 1 (replacement level fertility) it will lead to a stable population with a growth rate of zero. In the short-term a population with replacement level fertility will continue to increase if it has a young age structure due to previous higher levels of fertility. Some projections for the period 1980-2005 are: 1) population growth rate will decrease from 1.78% to 1.05%, 2) total fertility rate will decrease from 3.63-2.11, 3) male life expectancy will increase from 59.8-67.3, and 4) infant mortality rate will decrease from 67.3-34.5. For the ESCAP region, a target of NRR of 1 would be easier to achieve than a growth rate of 1%. The UN projects the total population of the region to be 3,382,000,000 in the year 2000. If the NRR can be lowered to 1 by then, however, the total population would be 3,342,000,000 and if the growth rate can be reduced to 1% by the end of the century the resulting population would be 3,300,000,000. Major demographic benefits will be attained in terms of the age structure of the population if a 1% growth rate is achieved; the proportion under age 15 was 37.1% in 1980 but will be 27.2% in 2000 with a dependency ratio of 48.8 compared to 70.8 for 1980.     

A second look at natural family planning

There is renewed interest in natural family planning (NFP) as the Philippine Population Program enters the 1980s. Much of this interest is due to the realization that, properly practiced, NFP can be a highly effective means of birth spacing. In 1978 the Special Committee to Review the Philippine Population Program recommended that more efforts be made to promote NFP. The different methods of NFP are reviewed. Sex without intercourse, coitus interruptus, and prolonged nursing are not officially recognized as NFP methods by the Program. The rhythm method was first described independently by Drs. Hermann Knaus of Austria and Kyusaku Ogino of Japan in the 1930s. Ogino's method of calculating a woman's fertile period is based on the lengths of the last 12 menstrual cycles which she recorded on a calendar. The advantages of rhythm are that it is inexpensive, it requires only the cost of charts which may be homemade, there are no physical side effects, control is in the woman's hands, and it is acceptable to people who consider it their duty to follow religious teachings. Disadvantages include: keeping constant, accurate records of cycles for long periods of time; the need for perseverance and correct interpretation of the chart; the possible need for medical advice and help; and the fear that something might upset a woman's cycle and change the time of ovulation. The continuation rates of rhythm acceptors in the Philippines are unimpressive. A study of 142 women revealed a high pregnancy/failure rate--25% for a 12-month period compared to 0 with oral contraception (OC) and the IUD's 2%. The basal body temperature method helps determine the unsafe period with some accuracy. Its premise is that there are slight but detectable changes in a woman's body temperature during her cycle. These changes herald ovulation. A special thermometer must record temperature changes of 0.1 degree Farenheit. This instrument and the charts are the only expenses involved. The reviewers of the Philippine Population Program noted that since the end of the unsafe period can be indicated only by the temperature, the total period of abstinence becomes long, although the basal body temperature method gives more or less 10 successive days for intercourse. The cervical mucus method, also known as the Billings method, takes into account the cervical secretions during the menstrual cycle. Appearance of this mucus is an indication of fertility. All that is required of a practitioner is to learn to distinguish the different sensations of wetness and dryness. The disadvantage is that the method becomes ineffective in areas where there is cervicitis or infection of the cervix. The symptom thermal method is the basal body temperature method combined with other NFP techniques and is widely used. With this method an accurate record of the 6 immediately preceding menstrual cycles is established. The start of the fertile period is set by substracting 20 days plus 1. The woman watches for symptoms like pelvic heaviness, breast softness, and mucus discharge.     

Republic of Korea. Country feature

The Government of Korea's 5th 5-Year Economic and Social Development Plan (1982-86) seeks to reduce the population growth rate from its 1982 level of 1.58% to 1.49% by 1986; it is assumed that the population replacement level of fertility (total fertility rate, 2.1) will be attained in 1988. The task of achieving these demographic targets is expected to be made more difficult by factors such as the impact of the 1950s baby boom and widespread son preference. New population control policy measures announced in 1981 call for improvements in the current family planning program management system; a new social and institutional support system to inculcate the small family size norm; strengthened information, education, and communication activities for family planning; and establishment of coordination among the government organizations involved in population-related activities. Numerous social support measures have already been put into effect, including income tax exemptions for up to 2 children, inclusion of population education in the school curriculum, priority in alloting public housing to sterilization acceptors with 2 or fewer children, and provision of IUD services through the medical insurance system. The number of contraceptive acceptors in the government program increased 78.3% from 1981-83, from 614,000 to 1,094,600. Sterilization and menstrual regulation services have shown particularly sharp increases. Program achievement for 1983 was equivalent to 19% of eligible women ages 15-44 years. The total fertility rate stood at 2.7 in 1982. Major efforts now must be directed toward eradicating the strong parental son preference and ensuring better family planning program efficiency and effectiveness.     

Decentralizing population education research

Population education research will now be conducted at the regional, division, and local levels. It is expected that this decentralization will solve problems faced by population education teachers and supervisors in the field and help to formulate curricula suitable to local needs. It will also mean changes in the implementation of the research activities of the Department of Education and Culture-Population Education Program. Since its creation in 1972 the Population Education Program of the Research Unit has been conducting research studies on a centralized basis, seeking out research leads, conducting studies to determine the content and methodology of program curriculum, and assessing the effectiveness of training programs. During the past 3 years the Research Unit has also made significant progress in monitoring the program's activities - determining problems and needs, making recommendations on the basis of findings, and initiating action on such recommendations. 1 recommendation is to establish regional centers for research activities. If approved by the Commission on Population, the proposal will bring about major changes in the research program, the most significant of which will be the establishment of research centers in 12 teacher-training institutions all over the country. Additionally, these institutions will offer consultative services to researchers in the field. The reorganization of the research program, as well as the eventual restructuring of the Training and Curriculum Units, anticipates the withdrawal of foreign financial assistance by 1977. In the decentralized setup, basic results gathered by regional research centers can be immediately consumed by the training or curriculum staff based in these institutions. With decentralization and the related activities, the Population Education Program shows itself capable of responding to emerging research needs.     

Fertility and eugenics: Singapore's population policies

Singapore, after serving for two decades as a model for Third World birth control and economic development programs, is now abandoning its earlier population policies in favor of encouraging dramatic population growth. The initial eugenics-based program introduced in 1984 sought increased fertility for university-educated women and provided major subsidies for the voluntary sterilization of poor and uneducated parents. These much publicized and internationally discussed programs have now been abandoned in favor of new population programs seeking to encourage fertility in lower as well as better educated groups. A forty percent population increase is being set as a goal. To accomplish this the effective Singapore Family Planning and Population Board has been abolished and Housing Development Board policies are in the process of being reversed to encourage rather than discourage fertility.The research reported here was partially funded by the Rockefeller Foundation and by a grant from the Population Council's International Research Awards Program on the Determinants of Fertility in Developing Countries, a program funded by the U.S. Agency for International Development.     

The Philippine population program: a stocktaking

Summarizes findings of the Special Committee to Review the Philippine Population Program, created by the Commission on Population to evaluate population related programs and recommend program directions for the future. The Committee conducted a 2 part study: an indepth review and analysis of existing policies and programs, evaluation of their effectiveness, and identification of organizational, statistical and policy or program related gaps and bottlenecks; and recommendations on policy and program thrusts for the next 5 years. Along with specific recommendations on program operations, service delivery, and research, the Committee made a number of important policy recommendations. Chief among these were a call for the development of a broader popultion policy, not focused only on growth but encompassing demographic, manpower, and welfare components; recognition of the need for the program to advocate an ideal family size and a desirable age for marriage; and redesign of the program on a broad scale to integrate it fully with national development plans.     

The Philippines: country statement prepared for the International Conference on Population,Mexico City,August 1984

This statement, prepared for the 1984 International Conference on Population, summarizes the demographic situation in the Philippines, the Philippine position regarding implementation of the World Population Plan of Action, and current population policies. In 1980, the population of the Philippines stood at 48.1 million. The country's current population growth rate reflects the interplay between decreasing mortality and still high but declining fertility. The 1984-87 Philippine Development Plan aims to achieve sustainable economic growth, equitable distribution of the gains of development, and personal development. A net reproduction rate of unity by the year 2000 is sought, and preschool-age children, youth, premarriage-age groups, and married couples of reproductive age have been targeted for special outreach efforts. The national population program will concentrate on developing a network of public and private community-based organizations, strengthening the capacity of local government and community organizations to plan and manage the population program, developing community capacity to finance family planning services, upgrading the quality of natural family planning practice, continuing the promotion of effective contraceptive methods, developing a population data bank, and upgrading the technical and management capabilities of population program personnel. Increasing attention is being paid to regional development and spatial distribution. The average annual population growth rate is expected to decline from 2.8% in 1970-75 to 2.2% by 1987. The crude birth rate is expected to drop from 34/1000 in 1980 to 31/1000 in 1987. To help achieve this goal, the contraceptive prevalence rate should increase from 34% in 1983 to 41% in 1987 and 50% by 1993. In addition, attempts will be made to reduce the proportion of women marrying below the age of 20 years and to improve women's access to educational and employment opportunities.     

Sterilization in the Philippines: the score after half a decade

Since the initial use of sterilization in the Philippines in 1973 as a family planning method, it has become more and more widespread. A bar graph, giving yearly percentages of acceptors for 5 family planning methods, for the years 1974 -- 1977, shows sterilization increasing steadily in popularity, from 3% in 1974, to 12.7% in 1977. Objections to sterilization generally stem from sociocultural and religious considerations as well as misconceptions and fear. People have feared that sterilization is a form of mutilation and castration. Due perhaps to the male fears of castration, female sterilization acceptors account for 90.6% of sterilizations in the Philippines. In 1974, the Philippine government's Commission on Population set guidelines for the training of physicians and the setting up of sterilization centers. The guidelines also stipulated that the procedure would be undertaken on a voluntary basis, would not include abortion, and that clients would be informed of all medical implications, particularly the irreversibility of sterilization. Programs for sterilization in the Philippines have different requirements for acceptors; most stipulate parity of 2 to 4. Difficulties have also arisen from the uneven distribution of sterilization providers throughout the country as well as a lack of physicians trained in both male and female sterilization methods. The need to create effective linkages among the various agencies engaged in sterilization work is noted.     

Backing seen of population policy in AID

Congress is almost certain to agree to use of U.S. funds to motivate reduced population growth in developing countries but funding for sterilization abroad emerged as a political issue in the House. In the proposed U.S. AID budget, which in the past has been about 10% funded for direct population programs, a total concern with literacy for women, higher educational levels, and other developmental programs which increase motivation for family planning has been proposed. Zero Population Growth has sent telegrams to Congress supporting this basic development policy. The controversy over sterilization is the result of India's compulsory sterilization legislation. An amendment refusing to allow any U.S. funds to be used for sterilization programs was rejected, but in rejecting it, the members of the House of Representatives expressed their concern that any and all sterilization programs be completely voluntary. In a letter, AID Deputy Administrator Robert Nooter assured Congress that AID has no goals to sterilize any certain number of women around the world and it is not the main purpose of the AID program to to emphasize sterilization as a method of family planning.     

Pakistan: re-organization at the top

New measures for population program planning have been introduced in Pakistan. 3 wings were added in the Population Planning Council: administration, coordination, and planning; operation; and technical. New elements in the program include: 1) setting up of new directorates; 2) opening of more family welfare clinics, model clinics, and sterilization centers; and 3) expansion of training facilities for medical and paramedical personnel. 2 national training institutions have been established: the Population Training Centre at Lahore, and the National Institute of Advanced Training at Hyderabad. 16 centers have training courses for doctors performing sterilization. There has been a restructuring of the information, education, and communication aspects of the program. The commercial distribution of contraceptives has become an important element. There are efforts to relate the program to other development programs.     

Contraceptive sterilization in Puerto Rico

For twenty years Puerto Rico has had the world’s highest prevalence of sterilization. From the 1982 Puerto Rico Fertility and Family Planning Assessment we examine whether the probability of obtaining sterilization is changing and what impact sterilization has on fertility, finding that the use of contraceptive sterilization has not declined and will probably continue to increase in Puerto Rico. Nonuse rather than temporary methods of contraception is the second most likely circumstance after sterilization. We also find that sterilization has reduced the total marital fertility rate by over 33 percent, thus having a significant effect on reducing the rate of natural increase; by all indications, it will have a greater effect in the future.     

Depo-Provera: clarifying the issues

In this interview, deputy executive director Ester B. Sy-Quimsiam of the Commission on Population talks on Depo-Provera, the latest method officially accepted by the Philippine Population Program. Medically, Depo has been proven to be safe, effective, long-acting, and reversible. A single dose of this drug can prevent a woman from pregnancy for 3 months. In clinics where the nurse or the midwife is trained in comprehensive family planning technology the drug will be introduced. Clinics in areas where prevalence of the more effective method is low must be targeted. Managers, supervisors, trainers of service providers, and fieldworkers will be trained to implement the information and education campaign and generate demand among married couples of reproductive age who are most eligible for Depo. Family planning services will continue to be subsidized by the program, but the cost of contraceptive supplies will be shared by the user. But there will still be subsidized supplies for those who cannot afford them. Service providers must be well informed; they must not only at the contraceptive, they must also consider a prospective client as a total person.     

Redefining family planning programs

The Population Council's issue paper entitled Reconsidering the Rationale, Scope, and Quality of Family Planning Programs calls on family planning programs to focus only on reducing unwanted fertility by helping people meet their own reproductive goals safely and ethically. Many family planning programs have been wrongly handed the extra responsibility of reducing wanted fertility. They have therefore used inappropriate means (e.g., incentives, quotas, and coercion) to boost contraceptive prevalence. If programs do focus on reducing unwanted fertility, they will foster reductions in overall fertility and population growth as well as improvements in clients' health and well-being. A new framework has emerged from this shift in rationale. It sets the stage for expanding the scope, improving the quality, and assessing the impact of family planning programs in terms of client choice, health, and well-being. A program needs to determine the range and quality of family planning services it provides at the local level. Local program managers, policymakers, and consumer interest groups should establish minimum or achievable standards of service based on the local health care capacity. Program items that should be assessed include choice of methods, information for clients, technical competence, interpersonal relations, mechanisms to encourage continuity of care, and appropriate constellation of services. The Population Council has conducted rapid appraisals of the quality of care of family planning services to help local program managers to evaluate the strengths and weaknesses of their programs. The HARI (Helping Individuals Achieve their Reproductive Intentions) Index measures a program's success in helping clients safely prevent unwanted or unplanned pregnancy. Program managers can conduct a self-assessment that revolves around answering four questions. Family planning services are an important social investment and are essential to development.     

The marketing of the condom

The Commercial Contraceptive Marketing Program was developed by the Population Center Foundation in the Philippines to increase participatio n of private commercial firms in promotion and distribution of nonclinical contraceptives. The program was started to eliminate ignorance concerning contraceptive methods, to increase contraceptive acceptance, and to decrease dropouts from the program. It is hoped that all 200,000 sari-sari stores in the Philippines will eventually become involved in marketing contraceptives. This will free government personnel for the work of extending family planning services to the rural areas. The history of the development of a plan for commercial marketing of condoms in the Philippines is discussed.     

India: New family planning program direction outlined

The focus of the current Family Welfare Program in India is education and active community involvement rather than coercion and compulsion. The government is totally committed to the program and has indicated that it will spare no efforts to motivate people to voluntarily accept family planning. However, there is a need for family planning efforts to include all aspects of family welfare, particularly those designed to promote the health of mothers and children. All family planning methods will be made available, and the family will be free to choose the method they prefer. As part of the program, employees of the Union government, State governments, autonomous and local bodies are expected to set an example and adopt the small family norm. The policy statement made by Mr. Raj Narain, Minister of Health and Family Welfare, revealed the government's decision not to legislate, either at the national or the State level, for compulsory sterilization. Sterilization services will be available free of charge to those who voluntarily choose this method. A plan for training indigenous midwives will be implemented as part of the program in order that maternity services may be available to all expectant mothers. Additionally, in recognition of the direct correlation between illiteracy and fertility and between infant/maternal mortality and age at marriage, the government will introduce legislation to raise the minimum age at marriage to 18 years for girls and to 21 years for boys. The plan is for trade unions, Chambers of Commerce, cooperative societies, women's organizations, teachers' federation, district councils, and other voluntary institutions to be associated intimately with the educational campaign launching the Family Welfare Program.