Felrrr,y Pr,*NNrnc UNDER rua EuencsNcy

FAMILY PLANNING
UNDER THE EMERGENCY
Policy Implications of Incentives anl Disincentives

VA PAI PANANDIKER
R N BISHNOI O P SHARMA

under the auspices
Centre

of

for Policy

Resear ch

.

and Family Planning Foundation

RADIANT PUBLISHERS

n

Copyrtght A) ff78 by Cente P lanning Foundation

for Policy

Research and Familv

be reproduced or transmitted in any

All rights reserved. No part of this book may form or

by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without permission in writing from the Publishers.
First Published 1978 by Radiant Publishers E-155 Kalkaji, New Delhi-I10019

Printed in India

Dhawan Printing orks 26-4 Mayapuri, New Delhi-I10064

by l

i

Contents

List of Appendices

List of Tables List of Abbreviatio!s
Preface

vll ix xi

xiii
I

A Perspective 2 Our Research Problem 3 The New Policy Measures 4 Organization and Administration 5 The People-Their Atiitudes and Reactions

I

t5
24
50 87

6

Overview and Policy Implications Appendices Index

144

152
175

I,ist of Appendices

List of Selected Units 2 Guide Points for Discussion with Officials 3 Selection of Acceptors and Non-Acceptors-Sampling
Design

I

152
153

163

4

Incentives Formulated by State Governments for Promoting FamilY Planning

166
168

5, Disincentives Formulated

by State Governments for
170

6 7 8 9

Promoting FamilY Planning Composition of StateJevel Committees

Distribution of Respondents by Religion Distribution of Respondents by Age Group Distribution of Respondent Cultivators by the Size of their Land Holdings

r72
l'13 174

List of Tables

1.1 Percentage Distribution of Population of Developing Countries by Official Population Policies and
Programme, 1971

1.2 Selected Demographic Indicators
1970-75

by

Country'

l4

3.1 Classification of New Policy Measures by the Nature of Their ImPact 3.2 Break-up of Compensation Money for Sterilization in Madhya Pradesh 5.1 Sample of Persons Selected 5.2 Distribution of Respondents by Level of Education 5.3 Percentage Distribution of Acceptors and Non5.4 .5.5 Distribution of Respondents by Their Economic
Status AccePtors bY LrteracY GrouPs Distribution of Respondents by Occupation

lo
43 88

90
91

92

94 95 96
99
102

5.6 Percentage Distribution of Acceptors and .NonAccePtors bY Income GrouP 5.7 Distribution of Respondents by the Number of Living Children 5.8 Distribution of Acceptors by Their Awareness of Family Planning Methods 5.9 Distribution of Non-Accepto$ by Their Awareness of Family Planning Methods

Family Planning in India

5.10 Distribution of Respondents by Their primary Source of Awareness 5. i I Distribution of Acceptors by Methods of Family
Planning Adopted

103 107 109

5.12 Distribution of Acceptors by Reasons of Adoption

of Family Planning 5.13 Distribution of Acceptors by Their Primary Source of Motivation 5.14 Distribution of Non-Acceptors by Reasons of Nonadoption of Family Planning 5.15 Distribution of Acceptors by Their Knowledge of New Measures Being Taken by the Government for Promoting Family Plannin g 5.16 Distribution of Non-Acceptors by Their Knowledge of New Measures Being Taken by the Governmenr for Promoting Family Planning 5.17 Distribution of Respondents by Their Opinion on Higher Monetary Compensation for Sterilization 5.18 Distribution of Respondents by Their Opinion on the Raising of the Age of Marriage

112

il6
122

130 136
138

List of Abbreviations

A.N. A.N.M. C.M.O. F.P. LU.D. K.A.P. L.H.V. M.C. M.C.H. M.P. M.T.P. P.H. P.H.C. P.H.P. Ste. T.A. T.B. U.P.

Auxiliary Nurse Auxiliary Nurse l\{idwife Chief Medical Officer
FamilY Planning

Intra-uterine Device
Knowledge Attitude and Practice

Lady Health Visitor Medical Care Maternity and Child Health Madhya Pradesh Medical Termination of Pregnancy Public Health Primary Health Centre Pregnancy Health Programme Sterilization Travelling A,llowance
Tuberculosis

Uttar Pradesh Vol. Orgns. Voluntary Organisations

Preface

It is a rare research experience specially in social sciences
happened

where within the short span of a few months that the study is
completed, its findings become dated' This is p' ecisely what has

present study. When the Family Planning Foundation suggested a study of the policy implications of the incentives and disincentives of the New Population Policy in April 1976, it looked too premature to undertake the study. At the time we moved to do the field work, the States were still in the process of gearing themselves for the implementation of the new policy package. We conducted our field studies in the

to our

summer months of June-August 1976. By thb time we completed the first draft of the study in early March 1977 , just before the 1977 Lok Sabha Elections, the

political events had already overtaken the new population policy. The virtual rejection of the new policy package and the
decision of the new Government to convert the Family Planning into Family Welfare Programme and put the entire population programme on a voluntary basis, made our conclusions a matter

of history. This was iirdeed an unusual experience and indicates the extent to which the family planning programme had become We tried to undertake this study in only four States. These four States were critical both politically and in terms of the
a political issue.

programme. When we

political developments in India. We selected Uttar Pradesh, Bihar, Madhya Pradesh and Punjab' In our classification the

four States we had not quite realised how important these States rvould be to the future
bele-cted the

xrv

Family planning in India

first three States were relatively backward and the last State relatively progressive in the field of family planning. Our field visits were conducted during the months of June, July and August 1976. Nature posed many a handicap to our researchers who had to weather difficult and scorchins temDerature in the plains ol northern lndia. Besides, *h.r, our .tudy proceeded into Punjab we ran into heavy weather, almost

literally. The floods virtually flooded out our study in the
Amritsar District.

in the country at that time, particularly with regard to fainily planning. This made many a respondent try to avoid meeting us,
them iu some further complications. It was some task to get them round to talk to us and even then many of them did not talk with us freely. The fear psychosis was so widespread that it even made many ofthe officers talk evasively and cautiously. We also noticed that most of the records on family planning were not maintained properly.
inaccurate. The non.acceptors among them feared that we might haul them up for sterilization. The acceptors felt that we might involve

We faced several difficulties in the conduct of the study. There was an intense fear of the Government orevailine

incomplete, sometimes grossly incomplete, and

In

many cases they

were
cases

in

some

planning to male investigators.

to our problems, the women in the rural areas, in Punjab, were generally reluctant to talk to us. Those in Bihar considered it taboo to talk on a subject like family
To add
except

The occurrence of heavy floods in Amritsar district of Punjab made it impossible for us to reach the villages in that district inspite of successive attempts to reach there in August and September 1976. Even in Amritsar city many localities were flooded and it was with considerable difficultv that we could get some respondents. As we look back, the study might provide a useful documentation of the policy measures which were jmplemented in the family planning field during 1976. lt is unlikely that such policy measures will ever be undertaken again. From that point of view this documentation wi.ll provide us some clues to

the kinds of issues which emerged in the implementation of

Preface

family planning programme. We did not, admittedly, visit the
States when the heat of the family planning programme was at its 19'76. Even so: we were able to peak later in the winter gather the mood of the people by the time we made our field visits. There are obviously many limitations of a study which was rushed through the way we did. Besides, as stated earlier, the nation did not have enough experience with this policy to make a very thorough assessment. Some of the limitations which are in the study, apart from those of the authors', were inherent in

of

the situation. We are very grateful to the Family Planning Foundation for their generous grant which made this study possible. In particular, we are grateful to Prof J.C. Kavoori for his initiative and support given to us for carrying out this study. We would also like to express our deep gratitude to all the State Govemments who provided us full cooperation and every assistance we demanded of them. We record our appreciation of Sarvashri Y.L. Nangia, Kamal Jit Kumar, Trimbak Rao and P.K. Yegneswaran who provided a great deal of staffsupport at various stages in the completion of this studY. Centre for Policy Research New Delhi

VA Pai Panandiker RN Bishnoi
OP Sharma

July

1978

Cseprrn I

A Perspective.
Never before in the history of the world has the population increase been at such a high rate as in tle present half of the twentieth century. There is a wide consensus of opinion that the current level ofgrowth cannot be sustained for long without serious detriment to the welfare ofthe people. The growth of the world population which, on an average, had been 0.5 per cent per annum in the nineteenth century increased to 0.8 per cent in the first half of this century and further rose to an alarming 1.9 per cent per annum during the period l95l to 1975. As of mid-year 1975, the world population stood at about 4 billion and at the current rate of growth is expected to rise to about 6.5 billion by the turn of the century. This has, for good reasons, caused considerable alarm and more so in many of the developing countries where the bulk of the world population is located and the growth of the economy is relatively inadequate to support such population growth.

There has, therefore, been a growing realization in these countries that econonic development cannot make much headway unless the population is more effectively planned. For a long time, however, it was believed that not much could be done to stem a high growth of population in these countries even if it was desirable to do so. Many people felt that a high degree of economic and social development must be awaited which will automatically lead to a fall in the birth rate. In the last few years, since after 1971 generally, there has been a marked change in this attitude. A growing body of public opinion has been arguing that for economic, social and

Family Planning in India

environmental reasons, governments must not regard the population question as outside their concern and that they must adopt a population policy. Several factors have bean responsible for bringing about this change ofperspective. First of all, there is the realization that parents, especially the mothers who have to bear the brunt of rearing children, want small

families. Secondly, there has been an advancement in cheap, effective and acceptable contraceptive technology. And last, but not the least, the easy and ready availability of various birth control methods, including facilities for legalised abortion in several countries, have created an atmosphere conducive to family planning and birth control. Nevertheless, the governments of all the developing countries have not yet adopted a national population policy. While a large number of them have launched a full-fledged national programme for curbing the growth of population as a part of their national policy, there are some which are still vacillating on the issue. A third group has adopted a middle course. They have accepted the need to curi-r the growth of population but prefer to do so by encouraging and assisting privateiy sponsored programmes. Even where population control has been adopted as a national policy, it has not ushered in a revolutionary change or brought about a radical departure from the previous position. Such a decision has generally been a culmination of a long-drawn process during which family planning evolved from a small to a large programme with the support of the government. The adoption of a national population policy or the absence of it, therefore, represents essentially the degree of emphasis in the realization of the problem of a high growth rate of population. Measures have generally been taken to resolve the problem in accordance with the degree of this realization. Developing countries can be divided into three categories on the .basis of the status population policy and family planning obtain there. These categories are as follows:
a) Countries which have adopted a national population policy :.rid an official family planning programme. b) Cor.rntries which. have not adopted such a policy but in which the government gives material and technical assistance

A Perspective
to privately sponsored family planning programme. c) Countries which do not have official population policy and do not give support to fanily planning activities,

More often than not the population policy adopted by a developing country was an antinatalist policy rather than a comprehensive population policy covering ai1 aspects ofhuman life. This was because the more direct and immediate concern of these countries was to reduce the erolvth rate of their population and relieve its pressure on ih.i, economies. The argumetrt seems to be that if this could be achieved, ihe resultant higher growth rate of the econorry and per capita income will in due course lead to a better standard of living of the people and improve their quality of life. By 1971, 72 per cent of the population of developing countries lived in countries which had adopted an antinatalist policy and were running an official family planning programme, 9 per cent in countries which had not adopted any policy but supported privately organised family planning activities, and 19 percentin countries which had neither adopted a policy nor lent any worthwhile support to family planning. The table on page 4 shows the position region-wise. A comprehensive population policy is virtually the core of
social policy of a country and covers tbe whole gamut of government actions pertaining to human life. The areas to which it relates range from the birth of children, their upbringing, education, employment, marriage, social security, etc., to industrialisation, urbannisation, migration and even the distribution of national income and wealth. Obviously, it is beyondthe pale ofcompetence of any developing country to coordinate and corelate action on such a rvide front in order to bring about the desired demographic results. Therefore, they have to opt for a narrolver policy of regulating the birth of children. Strictly speaking, this is only an antinatalist or low fertility policy. However, this is what most of the developing countries have generally adopted and seems to constitute their population policy. Even in that sense there is nothing like a universal population policy applicable to tJl countries or even to all the developing countries. It varies from country to cowttry and

Family Planning in India

Tlst,r
Prncrurlcp DtsrntsufloN

1.1

oF PoPULATIoN op DpvrroplNc CouNrRIEs nv Orprclel Popur-lrrox Potrclrs lNo

Pnocne urs.

1971
Rest

Positiott

All devecounlries

IoPing

Africa Lati,t East America Asia

of

Asia

Official antinatalist policy and family planning programme

No official policy
activities

72.O 4t.0

4.0 96.0

86.0

but

support to privately organised farnily planning

No official policy and little or no support to family planning activities

9.0 i4.0 33.0 0.1
19.0 45.0 63.0 4.O

1.0

13.0

Source: Gavin Jolaes, Populqtion Grotth and Educational Planni S in Dew' loping NationE (New York, N.Y., 1975), p. 14.

to be in corformity with the economic and social situation obtaining in a country. There are, however, certain measures which have, by experience, proved to be effective in curbing the growth ofpopulation in many developing countries. These are
has
as foilows: 1) Spread of education among the populalion. gainful employment outside 2) Participation of women

in

the home.
3)

Abolition of or reduction in the economic value of
child labour.

4) Reduction in infant mortality.

5) Restraint on early marriage.
6) Decline

in

traditionai religious beliefs which support

high fertility norms. 7) Attenuation of the extended family.
8) Adoption of social security measures like

old age

pension,

unemployment reiief, etc.

A Perspective

.

9) Provisicn of different possible.

birth contror methods as alternanative choices and as close to the homes ofthe people as

l0) Increase in the per capita income of the econcmically
weaker sections of societY. This is by no means an erhaustive list' There are a number of other measures which have been taken by the different countries to meet the exigencies of their situation. But the above, in our opinion, represent the largest common denominator- However, not all the developing countries have adopted all these measures. These have been adopted in varying numbers by the different countries. There is also no evidence to suggest that these measures have been adopted only as an integral part of its population policy by any country. Almost invariably, only some of these form part of the population policy, while some other are being pursued as independent policy measures Besides, a varying degree of emphasis is being placed on the di{ferent measures by the different countries. Nevertheless, each ofthese measures has stood the test of time by proving its efficacy and earned a world-wide recognition as a restraining influence on the growth of poPulation. The most common form of the population policy adopted by the developing countries in general and those in Asia in particular is the formulation of a time-bound plan for the reduction of the growth rate ofthe population. Quantitative targets are set and are sought to be achieved through the operation c'f a national family planning programme. The programme is organised and run wholly or largely by the government. The people are sought to be motivated mainly through the process of extension education and in some cases also by the offer of certain incentives to those who accept the programme and disincentives to those who do not. The larger social good and welfare ofthe people are kept iri view both while formulating

the plan and implementing the programme but are

seldom concrete schemes ilcorporated in the plan in the form. of direct,

programmes other than family planning. This is the form and the setting in which the population policy is conceived and operated by most developing countries aod in which our own policy should be viewed.

or action

Family Planning in India

Whether such a policy will achieve the desired goal is a matter of continuous debate among the social scientists and the

policy makers. While the family planning programme is designed mainly to give immediate results, it is the broader social policy which will go a long way in shaping the future of the generations to come. Therefore, side by side with the family planning programme, whatever the constraints of time and resources, efforts should be made to evolve a longterm policy in which there should be a proper synthesis of the desired pattern of growth of the population and the social and economic development. Thus, a population policy, in a broad

perspective, must include both a solution to the immediate problem and a plan for the realization of the ultimate objective, i.e., the creation of a reasonable physical quality of life for every citizen. As shown in the table given above in this chapter, an overwhelming majority of the people of Asia reside in countries

which have adopted an official population policy and are

operating a national family planning progr:)mme. 96 per cent of the population ofEast Asian countries, in which India has also been categorized, and 86 per cent of therestof Asia falls inthis category. is, therefore, worthwhile to discuss the course of

It

action being followed by some of these countries. account of their activities is given below.
INpoNnste

A

brief

Indonesia has adopted an official population policy. The main aims of the policy are as follows:
1) To raise the standard of

living ofthe people by decreasing the birth-rate to a level where the increase in population does not exceed their ability to step up the gross national
product.

2) To improve the health and general welfare

ofthe motler,

the child, the family and the nation.

of family planning. The government runs an official family planning programme and provides the necessary funds,

The policy is sought to be implemented through the practice

A Perspeclive

for it' The accommodation, equipment and manpower techniques use of pr.tt*t*" f , propuguttd by the -extension of the irnportance of iu"t u, tr-r. creation of an as'areness people' i"*irt- pr""ti"g for welfare of the family among the in the in their own.and familv planning ;;;ril;;;iopt use of the interest, ,.pu.,'o! of instructions on the nation's planning and provision of the nurior, -"tflods of famil-y No compuln...r.ury facilities for practising family planning' used in implementing the .i* or-.o.r"ion of any kintl is
programme.

Mlr-eYsll Malaysiahasformulatedapopulationpolicy.lviththeprincipal of ;tr;i;; of reducing tn" tititt rate through the practicethe rate of f"tltfiv pf^i"*g. Tie aim is to reduce the growth 3 per cent per annum prevailing in ;;;i",";;;;"; about 1965 to 2 Per cent Per annum bY 1985' fne family planning programme has been made an integral part of the planning process since the introduction ofthe very t.riri"" Y""i rtuo Jfttautuy'iacovering the periodit1966-70' is being Orr" of the salient features of the programme is that with large metropolitan areas *.ri.a-oot in phases, beginning ; il; t and graduaily extending it to rural areas.in phases of li, ill anC lV, with areas of high density the population being programme isthe ieature of taken first. Another notable thc oral pill as a contraceptive high degree of acceptance of the mainstay of the rnirt"al In fact' oral pill has beenper cent of the total about 92 Julv 1970 ;;;;;;;-.. upto had accepted oral pills and only 4. per cent iOOiOOO acceptors device' had taken to sterilization, Z p" cent to intrauterine contraceptrves' and 2 per cent to conventional

lt carries out the programme throughout the country'the as well as ,aa"iua, large annual grants from the government government clinics and health centres for facility to use as the famiiy planning programme' The Federation "p..Jl"g constituent units follow closely the government's tilt u, lts policy and instructions on family planning'

The Federation of Family Planning Associations

of

Malaysia

Family Planning in India

Parrsr.rN

"f rJuiiprouirion theimportance of famirypranning, made u ro, it plan covering the perioJ in the First Five_year
family planning a national poiicy and d."id"J;o;;;;chO."lar.d a com_ prehensive family planning programme throughout the country. Late r, the progralnme was integiated with tfr"-S..onj f,l*-V*, Plan ( 1960.65) and the Government undertook to make it an official activity. The aim ofthe national policy was to regulate and control the growth of population through voluntu.v iurrl"ip.liion of the people in famity planning. The basic id";*;, ih;;;e people should voluntarily limit the size of their famities anJ space ttre birth of children. The programme was administered through the existing health services by making f"ritt;;;;;a normal function of the government hospitals, airp.ninri"r'-""d rural health clinics. Reatizing that flmity ph;;i;; ';;r'viral to achieve economic viability, the Governme ni'asrigned u high priority to the programmeand also incorporated it uiu r.prror" secticn in the Third Five-year ptan, tgdS_70. The programme has since gathered momentum. It aims at making planned, limited fani.lies a way of tife. Consequentty, great emphasis is laid on educational and motivational particularly arnong the younger and lower-parity work, women. Ef:i1s a:leing made to popularize conv."tiooui.oni.uceprives
_

began with some publicity and educarionat "linics work,-mainly in the urban areas, with a view to propagate the idea ofand the need for family planning. The Governmeot p"tiriuo itso .eutizing

. lu*1tY planning activitr'es were started in pakistan rn 1953 by the Family planning Association p"tirt.r," voluntary organization. The Association initially op.nud "f " ,orn. and

ever, very little work was done during the early -vears Plan. It was only in 1959.60 ttrut tt" -Cou..nnient

isjj_oo. Ho*_ of the

and the IUD among them. One ofthe metfrods teing used is to supply conventiona.l contraceptives at the very Aoor-'step of tne people and to provide facirities lbr other forms oi at all clinics. "ont."""pfion

PgrLrpprlrs The Philippines has an offcial population poJicy. Its princi_

A

Perspective

9

pal objective is to strike a balance between the famiry size and the social and economic goals of the governnent. part of the policy is being implemented through tlre operation of the national family planning programme which aims at reducing the growth rate ofthe population. Thisis sought to be achieved by educating and motivating people on the desirability of a small family and by the advocacy of voluntary control of conception. The programme does not set any norms and even allows the couptres to have the desired number of children but expects them to exercise restraint on having any more children. A voluntary organisation called the Responsible Parenthood Council plays an important part in promoting family planning. It utilizes the services of Christian missionaries and barrio school teachers for visiting all eligible families in the provinces, cities and municipalities and propagating the cult of family planning among them. The rnethod jt advocates generally is the rhythm
method. In addition to voluntarism, the Government of philippines is thinking in tenns ofintroducing a scheme of incentives and disincentives for promoting family planning. In fact, the population policy itselfl makes it possible to evolve such a schenre by providing for an examination of the legal and adrrinistrative policies and measures of the government with a v.iew to bring about a harmonious balance between the size of the family and the social and economic goals set for the country. SrNceponp

Family planning was initiated

in

Singapore in 1949 by the

a voluntary organisation. The Association used to offer all the recognised methods of contraception, with a choice to the client to accepl any. C)ne of the salient features of the Association's programme was that it was not free but operated on a fee-for-service basis. Nevertheless, it was quite popular. In August 1965, Singapore dissolved its affiliation rvith
Malaysia and became an independent nation. Soon after, the new Government announced a five-year national programme of family planning. It also constituted a body called the Singapoie Family Planning and Population Board. The Board was given

Singapore Family Planning Association,

l0
full

FamilY Planning in India

responsibility for implementing the five-year programme well as the responsibility for directing and coordinating all as family planning work in the country. In November 1968, the functions of the Singapore Family Planning Association as a voluntary family planning organisation were taken over by the Family Planning and Population Board. Since then the Board has been the sole body responsible for running the family
planning programme in SingaPore. The programme aims at reaching all the people
ductive age-group. Inter-personal communication

in

the repromost

is the

important method being flollowed in propagating the programme and motivating the people. Special attention is given to women attending the matemity and child health clinics and to mothers Iying in bed in maternity hospitals. Family planning wolkers contact expectant mothers both in the hospitals and at home and give them direct personal advice on tbe need for family planning and the availability of the service. Such advice is also given in post-partum visits to individual homes. A public address system

regularly explains the benefits of family planning and as to where the necessary information and services could be obtained. Men's clinics and individual consultation facilities are also
available. Of all the developing countries, Singapore is one where the national family planning proglamme has been the most successful. The programme owes its success to a number of factors such as an efficient administrative structure, high standards of maternal and child health care programmes, a competent extension and communication system and the responsiveness ofthe people. In addition, certain changes in the social policy have given an impetus to the programme. These include the cance'llation of matemity leave and defraying of hospital charges for the fourth and subsequent pregnancies and no discrimination against married couples without children in the allocation of public housing. Unlike other developing countries the question before the government of Singapore is not whether the target set for reducing the growth rate of population will be achieved or not,

but what would follow after the programme is

successfully

completed.

A Perspectirc
TAIWAN

ll

A modest beginning was made in family planning in Taiwan Family Planning Association of China. The main activities of the Association were publicity and education on family planning and popularising the use of traditional methods of contraception. In 1959, family planning programme was rnade an integral part ofthe matemal and child health servjces of the Government. Later on, the programme was designated as the 'Pregnancy Health Programme' (PHP). PHP clinics were set up in all the Government general and maternity hospitals and PHP workers appointed at township health stations. The main functions of the PHP clinics were to render advice and
in
1954 by the

guidance on family planning and provide the necessary services. The PHP workers would make home visits and conduct group meetings to educate and motivate women towards family plan-

ning. The family planning services being provided, however, only related to the distribution of conventional contraceptives and later on, from 1964 onwards, also included the insertion of
the Lippe's loop. Inspite of its moral support to and participation in the programme, the Government of Taiwan, horvever, did not declare a formal policy on population or family planning until 1969. It was only on l lth May 1969 that the Government announced its

population policy. The policy envisaged the limiting of the growth of population through the practice of family planning and for the first time legalised sterilization and therapeutic abortion under certain medical conditions. It also provided for the introduction of population studies in the curriculum of schools and colleges. Consequartly, population dynamics and family planning are being taught in medical, nursing, health and allied institutions in Taiwan. An important factor operating in favour of the policy is the high level of literacy prevalent in the country. E7.l per cent of themales and 64.4 per cent of the females above 1 5 years of age are literate. This has helped in spreading consciousness about the problem facing the country and the significance of family planning in meeting the challenge.
TIIIILANo

Until

1959 Thailand's official stance on population was pre-

12

Familr Planning in India

dominantly pro-natalist. It was in 1959 that on the basis of a World Bank Report/the attention of the Thai Government was drawn to the high growth rate of its populatio!. However, until 1962 no serious notice was taken ofthis issue. Serious thought about population contlol appears to have begun in Thailand with the holding of a National Population Seminar in Bangkok in March 1963. The high growth rate of the population ofthe country which was about 3 per cent per annum and its implications were examined at length. Opinion was divided among the participants of the Seminar on the desirability of introducing family planning in Thailand. Nevertheless, the majority agreed that a family planning pilot project should be started to investigate the response of the people to family plannitg services. As a first step to the project a survey was conducted to obtain information useful to an action programme.
The main findings of the survey were as follows:

l) The size ofthe family
3.8 children.

considered ideal by

the people was

2) About 72

per cent of women wanted to have no more children but did not know how to prevent pregnancy. 3) Not even I per cent of the women had the vaguest idea of birth control, but over'70 per cent wanted to learn the use of contraceptive methods and practise family planning.

Towards the end of 1964 the pilot project was set up in Potharam district. It met with a very favourable response from the people. Starting from almost no contraceptive practice in the

district, the proportion of eligible women who adopted birth control methods in the very first year of the project grew to about 20 per cent. Being encouraged by this response, the programme was further strengthened in the district and gradually extended to other parts ofthe country. The main features of the programme were that it was entirely voluntary. No notms we re laid down with regard to the number of children. Each couple could decide for itself at what stage they wanted to commence practising family planning. A number of methods were offered simultaneously as alternative choices, such as the loop, the pill, the condom and the foam tablet.

A Perspective

TJ

It was not until March 7970 that the Government adopted a national policy on population control. The policy aims at reducing the birth rate through the propagation of family planning among the people. Targets have been laid down but it is left to the choice ofeach individual couple whether to adopt family
planning ornot and what tnethod to use and at what stage. The Government supplies all the information on the subject and makes the necessary services available to the people. The Maternal and Child Health Division of the Departnrent of Public Health runs the programrne.

organisations ofstanding. The reduction in the growth rate is sought to be achieved by voluntary participation of the people in family planning and no coercion or compulsion of any kind is used. Consequently, education and publicity are the principal means for propagating the programme and the provision of a number of contraceptive methods simultaneously as alternative choices the most common practice in making family planing services available in these countries. By and large, this is the pattern which obtains throughout the region, including lndiasome temporary aberral ions notwithstanding. Selected demographic indicators in respect ofthe above couutries for the quinquennium 1970-75, except for Taiwan for which the corresponding data is not available, are given in the following table. Government of India's estimates for the quioquennium l97l-76 are also given below the table.

The above account indicates that most ofthe developing countries in South and South East Asia, in order to cope up with the problem ofa large growth ofpopulation, have adopted a policy to reduce the growth rate through family planning. The programme of family planning is the mainstay of these policies and is run largely or wholly by the governments themselves or with a large support from the government by voluntary

l4

Family Planning in India

Tlsrn

1.2

Srrnctno DEuocnapslc INntcarons
Name
the

lv

CouNrnv,
Death
t 970-7

1970-7 5

of

Populqtiotl Grottlh

Crude

Country

(Mid-year Rate 1975) 1970-',7 5

Crucle Life Expec-

Birth
Rate
1970-75

Rate
5

tancy 197075 (years)

(Percentage)

(per
Indonesia Malaysia Pakistan Philippines Singapore
13,60,44,000 1,20,91,000 7,05,60,000 2.60 2.89 3.09 3.34
1.6

1000)

(per

1000)

4,M,37,000
22,48,000 4,20,93,000 61,32,17,000

r

42.9 3 8.7 47.4 43.8 21.2
43.4 39.9

16.9

qq

47.5
59.4

Thailand India

3.27
2.43

16.5 10.5 5.1 10.8 15.7

49.8 58.4
69.5

58.0
49.5

Soarce.' Population Bulletin of the United Nations,
Sheet.

No' 8,

1976, Data

GovERr.rltBNr oF INDIA
Population* as

Estlu,lrrs
Growth Rate+
r-76

on

1.3.1976

10C0

60,62,03,000

Crude Birth Rate+
1971-76 1971-76

per

Crude Death Rate+

-

36.6
15.2

(Percentage) Life Expectancy+ 197i-75 (Years) -

197

2.L4
49.5

per i000

*Fanrily Welfare Programme Year Book, 1975-76' p. l7+Draft Five-Year Plan 1978-83, Vol. lI, Page 34. The Draft Flan esti' mates birth rate in 1978 at 33 per thousand and death rate at 13.3' giving a growth rate ot 1'971'.

Cgeprsn

Il

Our Research Problem

At the time of independence in 1947,India had a population of 345 million people. At the end of 1977 Ihe population was
estimated at 629 million. This marks an increase or'284 million or a rise over 82 per cent in the population in 30 years. Never in the history India has there been such a large increase as during the post-independence period. From a growth rate of 13.3 per cent in the decade 1941-50, it had risen to 21.6 per cent in 1951-60 and further to 24.8 per cent in l96l-70. This steep rise in the growth rale has not only added large

a

of

numbers to our population but built a growth potential which even with a declining rate of growth has the capacity to generate
a large population increase. Thus, even

which is stated to have been reached now, as many as 12 million people are being added to the population per year. The mechanism of the growth of population is such that percentages do not always present a correct picture. For instance, with a growth rate of2 48 per cent per annum in the last decade, 196l-70, the average increase in the population was of the order of 11 million persons per year, whereas a growth rute of 2.2 psr cent per annum in the last quinquennium, l97l76, has been adding 12 million people to our population per year. A decline in the growth rate does not necessarily mean a fall in the net addition to the population. It is, therefore, more appropriate to take into account the absolute numbers rather

2 per cent pet annum,

with a growth rate of

than percentage points
problem.

in

an analysis of the population

16
Judgecl

Family Planning in India

in the light of this interpretation, the growth of our

18

Fwnily Planning in lndia

74 at 1972-7 3 prices. The share ofthese 30 per cent, or 173 rnillion people, in the total priva.te consumption in 19j3-74 was estimated to have been 13.46 per cent, i.e., even less tban half of their legitimate sirare in the national consumption expendi-

tufe.
economic development been low but the gains of this development, however small, have been very unevenly spread. For the Iowest 40 per cent of the population in the urban areas, poverty

The above analysis shows that not only

has the pace

of

hasin fact deepened and for their counterparts in the rural areas it has largely been stationary. A large proportion of the population has to go without even the most essential necessities of life because the income in their case is too small relative to their needs. There are three main causes of poverty in India-(i) mderdevelopment of the economy, (ii) inequality in the distribution of national income and wealth, and (iii) a large growth of the population. Our efforts to neutralize these causes have so far been indadequate and to a certain extent unimaginative. Inspite of the measures taken in the successive five-year plans to accelerate the growth of the economy, the tempo of development has been slow and halting, land reforms and fiscal measures have failed to make any major impact on the reduction of inequality in income and wealth and the family planning programme has not been able to check the high growth of the
population. The combined effect has been to create a kind of a syndrome of poverty and large population growth: Experience has shown that it is rather difficult to eradicate this malaise. Consequently, public policies have been under review from tjme to time with a view to reorient them in the light of the emerging situation and impart a measure of new dynamism to their implementation for the purpose of breaking this vicious combination of factors making for poverty. One such review which was recently undertaken was that of the population policy. The population problem of India is essentially that ofthe physical quality of life-how to make the people lead a better, fuller and richer life, a life that will enable them to have reasonable economic comforts, a certain measure of social security and sufficient leisure and means for the pursuit of cultural values.

Our Research Problem

l9

The central theme and objective of planning have also been the same but the low margin between the grorvth rate of the economy and that ofthe population has thwarted the nation from realising that objective. Instead, the nation has been poncentrating on survival and has just been able to keep its head above water. On 17 April 1976 the Union Minister of Health and Family Planning announced a new population policy for India to the Parliament. The main features of this policy were (1) the decision to raise the minimum legal age of marriage from I 5 to 18 years for girls and from 18 to 2l years for boys, (2) increasing the amount of monetary compensation for sterilization to a

substantial amount both for male and female acceptors, (3) freezing of people's representation in the Lok Sabha and the

allocation of Central assistance to State Plans. devolution of taxes and duties and sanction of grants-in-aid on the basis of population figures of l97l till the year 2001, (5) 8 per cent of the Central assistance to State Plans to be specifically earmarked against performance in family planning, and (6) the introincentive and disincentive to family planning to be left to the choice of State Governments. lt was also envisaged in the new policy that it would be the responsibility of all the Ministries and Departments of the Government of India as well as of the State Governments to take up as an integral part oftheir normal programme and budgets the motivation of the citizens towards responsible reproductive behaviour. give a boost to

State Legislatures on the basis of the 1971 census until 2001, (4)

duction

of

compulsory sterilization and specific measures of

The principal thrust of the new population policy was to the family planning programme and thereby bring down the birth rate from an estimated 35 per thousand at the beginning of the Fifth Five Year Plan in 1974 to 25 pet thousand at the end ofthe Sixth in 1984. It is also anticipated that if thjs can be brought about, the growth rate of population will come down from the present about 2 per cent per annum
1.4 per cent by 1984, We considered it worthwhile to study the policy implications of the various measures incorporated in the new package and to assess the nature of the effect they are likely to produce on the different classes of people. With this aim in view it was

to

20 decided

Family Planning in India

to undertake a study ofthe new population policy, Thd specific obiectives of the study were as follows:

l) To examine
see how far

the contents of the new policy with a view to serves as a viable population policy for the country, and more specifically the policy implications of the scheme of incentives and disincentives incorporated in the new package.

it

2) To explore

Governments towards
3) To
assess

the thinking and motivation of the State the new policy, including the

their own initiative. the administration, including the family planning infrastructure, for putting the new measures through effectively. 4) To find out the understanding and attitude of the different classes of people towards the family planning programme in general and the new measures in particular and to assess the nature of the effect these measures are likely to produce
measures taken by them on

the capability

of

on them.

The preparatory work on the study was commenced in May
1976. Four States were purposrvely selected for study, three of these were those where the family planning programme had not made much headway and the fourth where it had been relatively

successful. In each State, twb districts were selected mainly on

the basis of their performance in family planning. One of the districts was to be comparatively good and the other poor. Other factors which were taken into account in selecting the districts were their accessibility, size of population and location. The districts which were difficult of access, thinly populated or situated in a remote corner ofthe State were excluded from the selection. The latest available all-India data on districtwise performance in family planningwas taken into account for selecting the districts. The selection was made on the basis of the compilation for the
year 1973-74.

In each selected district, one urban Family Planning Centre and one Prirnary Health Centre were selected for an intensive observation of the working ofthe programme at the ground: level. The selection of these centres was made in consultation with District Family Planning Officers or Chief Medical Officers

Our Research

Problem

2l

where District Family Planning Officers did not hold independent charge and was based on their performance rating for the latest year, the average being the criterion of selection. Further down, three villages were selected from each Primary Health Centre-one each from among those rated good, medium and poor for their performance in family planning in the latest year. In the urban areas one ward was selected from each Family Welfare Planning Centre from among those rated average for their performance in the latest year. The selection was made in consultation with the Medieal Officer-in'Charge of the Primary Health Centre/the Family Welfare Planning Centre. The names ofthe States, districts, family planning/primary health centres and villages selected for the study are given in Appendix I' The study was conducted mainly through two processesdiscussion with the oflicials and non-ofrcials associated with the working of the family planning programme and associated with the implementation of the new . or likely to be associated policy at the State, district and local levels, and population interview of the acceptors and non-acceptors of the programme. These methods were suitably supplemented by a personal observation of the working of the programme in the field' The discussion was held with the help of pre-planned guide points appropriately <lrawn up for each level and keeping in view the objectives ofthe study. The guide-points adopted for a discussion with the officials are given in Appendix II. At the State ievel a discussion was held with the Secretary, Department of Health and Family Planning and such other officers as the Secretary considered necessary to call to the meeting. The discussion. with him related mainly to policy matters' For matters pertaining to the implementation of the family planning programme and the new population policy, a discussion was held with the officers of the State Family Planning Bureau. As certain items of the new policy fell in the jurisdiction of other departments, such as introduction of population studies in the educational system or administration of child nutrition programmes, a discussion was held with the Directors of Education and Social Welfare or their representatives or special officers-in-charge of such programmes. In addition to these officials, office bearers of such organisations as have been working in the field of family planning and operating at the

22

Family Planning in India

State level, such as the Family Planning Association of India and the Red Cross, were also contacted and a discussion held with them. At the district level a discussion was held with the District Family Planning Officer, the District Health Officer and where they did not hold independent charge, with the Chief Medical Oftcer or Civil Surgeon also. Besides them, a discussion was held with other officers of the District Fam ily planning Bureau. Attempts were also made to contact District Education Officer, District Social Welfare Offcer and the District planning Oftcer at some places, but it was found that the measures incorporated in the new population policy pertaining to their respective fields had not yet reached the district level. However, voluntary organisations and statutory bodies wherever active were contacted and a discussion held with their office bearers. At the local level, a discussion was held with

the medical and

para-medical staff executing the public health and family planning programmes and with school teachers, Gran Sewaks, Patwaris, Sanitary Inspectors, etc. wherevex they were involved in motivating or mobilizing people for the programme and were available for discussion. Office bearers of local bodies and voluntary organisations, taking an active part or otherwise supporting the programme, were also approached and their views obtained. However, the major focus of attention at the local level was the person who had accepted the family planning programme as well as that who had been approached or otherwise informed of the programrae but had not adopted it. Fairly

intensive,

but unstructured, interviews were held with such

general constituted a proportion of about 28 urbanto 72 rural respondents. Care was also taken to give a fair representation to women in the sample through stratified random sampling. Except in the rural areas of Bihar where no woman was willing to be interviewed, a good number of them were interviewed in the other States as well as in the urban family planning centres of Bihar.

in

persons for eliciting both factual information about their family life and views on family planning and the new population policy. The beneficiaries and non-beneficiaries ofthe programme were selected for interview both from the urban and rural areas and

Ow Researth Problem

into account their occupation. In the rural

The selection of respondents was further diversified by taking areas, abroad

classification of cultivators and non-cultivators was made for the sample selection whereas in the urban a three-way classification of shop-keepers and businessmen; servicemen and professionals; and others was adopted for the purpose. However, in the final sample that emerged marginal and small farmers, medium and big cultivators, landless agricultural labourers, industrial workers, artisans, big, medium and small shopkeepers and servicemen were all represented. 'Ihe sample thus covered a cross section of people and we made an attempt to collect from them as authentic an information as possible on their knowledge, experience and views on family planning and awareness and understanding of the new population policy. A note on the rnethod of sampling followed in the study is given in Basically, the new policy was an extension of the principle of family planning, !'A small family is a happy family." It sought to intensily the operation of this principle by a series of new measures. These measures are ofa diverse nature and relate to different fields such as education, social reform, public finance, etc. To these have been added a number of incentives and disincentives formulated by the State Governments on their own

Appendix

III.

initiative. The present study has tried to examine the various
involved in this effort.

issues

has analysed first the new policy with a view to assess their efficacy in promoting measures famiiy planning. This is followed by an appraisal of the capability ofthe adninistration in delivering the goods. It has then proceeded to find out how far the cherished principle of a small family had percolated down to the lives of the people through the existing programme of family planning and finally to investigate to what extent and in what manner the new policy had reached the people and influenced their,thinking,

It

Cseprrn

III

The New Policy Measures

raising of the age of marriage to a minimum of l g years for

societies and the labour unions through their all_India level organizations. The next largest category of measures relates to administra_ tive action, including financial arrangements. The princioal ones are freezing ofpeople's representation in the Loi Sabha and the State Legislatures on the basis of l97l population until 2001, allocation of financial assistance from the Centre to the States, where population is a criterion, to be made as per 1971 census figures tilt 2001, 8 per cent of Central assistance to State Plans to be earmarked against performance in family planning and the cho.ice of introduction of compulsory sterilizalion and such other measures as would help promote family planning to be left to the discretion of the State Governments. The measures which are of direct applicability and conse_ quence to the individual are, however, only two. One is the

The measures incorporated in the new population policy can be broadly divided into three categories: (l) those wliich are of social import, (2) those which are ofan administrative nature, and (3) those which afect the individual citizens directly. Of the 16 measures enunciated in the new policy, half fallinthe category of social programnes. The important ones amang these are introduction of population studies in schools and colleges, expanding and improving the quality of female education, associating voluntary organizations more closelv with the family planning programme, and providing group incentives to popular institutions like the Zilla parishads, the cooperative

'

The New PolicY

Measures

25

girls and 21 years for boys and the other is the increase in iloo.tuty compensation for sterilization, both male and female' ," nt. iio for person. with two living children or less' Rs' 100 persons for persons having three living children, and Rs 70 for be *ith fout or -oi. children' Besides the compensation to the ouiA in cash to individual acceptors, these amouts include i"oloOitut. incurred on items such as medicines and dressing'
transport and diet.
age of marriinstance, the provision relating to the raising of the of social import and individual consequence' age is both a matter motivation conSimltarty, the intensive use of mass media for and individual appeal' In making the stitutes toth social action whether classification we have been guided by the consideration wili have an impact more on the social u prtri."f* measure accordingly' ftuo. o. the individual plane and have classified only administrative action to get going r.u.urr, *hich neid setting in b process of any long-term social

The above classification is, however, not exclusive' For

it

ih,
oi

and do not involve

change

Siut" import. This cldssification has been done mainly for the convenience of analysis of the new policy' The table on
page 26 presents this classification'

or

effect have been placed in the category oI measures

Mresunrs rAKEN

BY

Stltn

GovrnNusl'tts

which have introduced a number ofincentives and disincentives States and to private citizens in apply to public servants in all at their own some. These measures were taken by the States State to State' The posiinitiative and naturally differed from tion in the four States selected for this study was as follows' formu' Comparative statements of incentives and disincentives are given in Appendix lV and lateiby the'State Governments
Appendix V'

In addition to the

above measures,

the State

Governments

Bihar
The Government

of Bihar have

introduced the following

measures: and Family f . ef f employees of the Department of Health separately for motivating Planning have been allotted targets

-

26

Family Planning in India

F E
L!

q

F

tr
!Q

als;EE,iF,fEii;se;;; s F!I ;f3EgIEffFiSFg;;F: giisffiffiEisF;€€:E!ii,
ll

p
F

;
oo.i rr=

a.t
Y L

.?r

s

z
F ao
ql

= ts:: _bP u'I tr o & !!B r-.9 Y-d$.d

?# F:
=a
c)

r'i

't

*1g7 -r.o
.=6

E'3

EES
E
E

t[ipti tr! I €5:d
-^ ($ i

FI H 3 E€ F(,Y;,tr:g
-i

t:

z
z
F
O

.EE Ef:i,E.g

6i

.E m,g :E=

€; *€fEit€g e ;B*'i:;
. ;;
s
i 6i

=39

iE!;;E:f ;;t€,:-;
s*Ei€€i g ;lf: ;$i ,.i
\D rod

! Q

E

FE5

ge:giEgfi
..i d

FcsECgs;;s

The New PolicY Measures

achievb eligible people for sterilization. Those employees who the target will be censured; fro-m Z5-to iess than 100 per cent of

per cent will those who acbieve between 50 and less lhan 75 and those whose achievenot be allowed to draw one increment;
ment is even less

than 50 per cent will be discharged from

tttlloou

teachers of Government primary, upper primary and for middte schools have been allotted a target of one motivation

sterilization every two months or 6 in a year, failing which departmental action witl be taken against the defaulters' i. Similurly, all Panchayat ernployees (Panchayat Sewak)' Village Level Workers (Jan Sewak), Circle employees (Halka Karichari), Anchal Inspectors (Anchal Nireekshak), Extension (Apoorti Officers (Piasar Paryavekshak) and Supply Inspecto-rs of 6 motivaNireekshak) have been allotted an annual target tions each ior sterilization. In case of default in fulfilling the target, departmental action will be taken' +. fn. n.ta staff of municipatties and notified area committees etc. have been given a tatget of motivating at least one eligible person per month for sterilization' Departmental action will be taken against thosb not fulfilling the target' 5. All medical officers and health staff of the Zilla Parishads will also be allotted appropriate targets for motivation for sterilization by the Chiei Medical Officer of the district concerned' Failing thi fulfilment of the target, departmental aclion will be taken against the defaulters. 6. All other field staff of the Zilla Parishads have been allotted a targ€t of one motivation per month each for sterili' zation, failing which departmental action will be taken against
'them.

7. All Government and semi-Government employees will given transfer T A. for three living children only' 8 All Government and semi-Government employees will

be be

of entitled to reimbursement of medical expenses for treatment upto three living children onlY. 9. All eligible Government and semi-Government employees will be entitled to reimbursement of educational fees for three
living children onlY. 10. All such persons as have more than three children shall semibe debarred from appointment to any Government and

28

Family Planning in India

Government servic e.

ll.

allotted to them will be given a certjficate oi commendation and medal. Those who achieve 50 per cent more of their quota will be given a cash reward and the employees of the Health Department who fulfil double their quot; will be given one
a

furrher child-birth. 12. All public employees who fulfil the quota of motivations _-

a declaration before appointment to any Government or sem! Government service that they will get themselves or their wives sterilized aftdr the birth of two childrea or otherwise stop any

All the selected candidates shall be required to

sign

advance increment. 13. Such Government

have upto three children will get priority in:

and semi-Government servants who

(a) allotment of residential accommodation; (b) grant of house-building loan; and (c) sanction ofioan for the purchase of motor_car. scooter.
14. Such Government employees as have got themselves or their wives sterilized afrer two living children will get priority in the allotment of motor-car, scooter, etc. 15. Such candi.dates as have got themselves or their wives sterilized after the birth of two chjldren shall be given priority in appointment to Government or semi-Government service. 16. Such persons as have got themselves or their wives sterilized after two living children will get priority in allotment

estabJishitrg an industry

of house-sites and house-building loans in the urban areas. 17. Such persons as have got themselves or their wives sterilized after two living children will be given priority in the grant of loan from Government or semi-Government sources for

or

construction

industry.

of buildings for

such

These are as follorvs: 1. The aforesaid disincentives shall not apply to:

There are two important provisos to the above measures.

.

(a) Males above 45 years of age and females above of age;

40

years

The New PolicY

Mealsures

29

(b) Males less than 45 years of age who have got themselves or their wives steri.lized; (c) Females less than 40 years ofage who have gotthemselves or their busbands sterilized; (d) Such couples as have not got a child born to them for at

least ten years before
applicable.
2.

the

above measures become

All the above

measures shall apply only in case where children are born henceforth and not to cases where three or more children have already been born'

Madhya Pradeslt The Director of Public Health and Family Planning, Government of Madhya Pradesh, issued a circular in June 1976 infor-

ming all Divisional Commissioners, District Collectors and Heads of Departments of the Gove?nment's decision to introduce certain incentives and disincentives with regard to family planning. These measures applied only to Government servants and employees of Government-aided institutions, local selfgovernment bodies and public sector undertakings and establish' ments. The measures were as follows: All such employees of the aforesaid organisations who are in the reproductive age-group and have more than three children: 1. if they do not get themselves or theix wives/husbands sterilized within six months, will lose their eligibility for the allotment of government residential accommodation, and if

they already occupy government accommodation,

will

be

charged 50 per cent more than the present rent; 2. if they do not get themselves or their wives/husbands sterilized within one year, will lose their eligibility for house rent allowance from the government in case they reside in privatg houses;

3. if they do not get themselves or their wives/husbands sterilized, will not receive facilities of festival advance, food

advance, loan for house-building, purchase of car, scooter, etc. and other advances and loans admissible from the administration except the T.A. advance; 4. if they do not get themselves or their wives/husbands sterilized, will not be entitled to convert their earned leave into cash payment or to avail of honte travel concession;

30

Family Planning in India

5. if they do not get themselves or their wives/husbands sterilized, will be entitled to transfer T.A. for three children only, but if they get sterilized, this facility will be available for all ch ildren; 6. if they get themselves or their wivesihusbands steriljzed within one year, will continue to receive reimbursement of tuition fees of their children as provided for in the rules. Otherwise, this facility will be available only for three children; 7. if they do not get themselves or their wives/husbands sterilized within six months, will not get their annual grade increment. Those who get sterilized within six months rvill get their grade increments from the due date but those who get sterilized after six months will get the increment only from the first day of the month following the date of sterilization. The circular explained that only such persons will be considered to be in the reproductive age-group whose wives are in the range of 15 to 45 years of age. For purposes of monitoring and record-keeping it has also been provided for that all such eligible employees as have either already got themselves (or their wives/husbands) sterilized or get subsequently sterilized will be issued a certificate in lieu thereof by the contperenr authority. A special provision made by the Government of Madhya Pradesh relates to the enhancement of compensation money to be paid for sterilization to the last category of acceptors, i.e., those with four or more living children. A sum of Rs. 25 was earmarked to be paid in cash to each such acceptor under the

the

tioned was stated to be an additional outlay by the State
Government from its own funds.

Central Scheme. Subsequently, this amout was raised to Rs. 50 by Government of Madhya Pradesh. The extra amount sanc-

Uttar Pradesh
The Government of Uttar Pradesh also introduced a number of incentives and disincentives for promoting family planning. These were as follows: l. Farmers who come in the category oftaiget couples and opt for sterilization will be entitled to 50 per cent rebate in their land revenue for a period of three years. 2. Families which have adopted family planning will be

The New policy

Measures

31

givcn priority in maternity ald child health programmes and will

to avail ofthese facilities. Such families over other families in the facilities given by other departments, other fabtors being the same. 3. For individuals in general (who are in the reproductive age group and volunteer for sterilization) priority shall be given in the allotment ofhouses and plots and grants of loans. 4. Whole-time family planning staff will be entitled to a motivation "bonus" of Rs 6 per case of sterilization motivated by them in excess of their quota of 2 motivations for sterilization per month per worker or 24 in a year. 5. lfa person of the eligible category does not undergo sterilization even after the birth of the third child, he will not be

be issued identity cards

will also be given priority

(a) given any loan, (b) granted a license for fire arms. (c) allowed the renewal of license for fire arms, (d) allotted a fair price shop, (e) allotted a house or plot, (f) entitled to free medical treatmedt at government hospitals, (g) given educational concessions and scholarships except merit scholarships, and (h) granted facilities offered by the Harijan and Social Welfare Department.

6. For government

to them

lated date inl977, from them:

servants, if the number of children born exceeded three after 1969 or exceeds 2 after a stipu_

the foliowing facilities will be withdrawn

(a) free treatment in government hospitals, (b) all kinds of loans, (c) allottment of government accommodation, (d) allottment of houses under the Rent Control Act or those built by the Housing Board or other simi.lar bodies, (e) facility of payment of rent for government accommoda-

tion at 10 per cent of salaries. In such cases,

the rent

(f) travelling allowance on transferformore than3l2 children,

charged witl be at market rates.

32

FamilY Planning in India

(g) encashment of leave and all rewards and honoraria, (h) allotment of houses under the middle income group and Life Insurance Corporation Schemes, and (i) maternity leave.
The instruclions on the subject also mention that similar provisions were being made for the employees of government industrial undertakings, autonomous bodies, local self-government bodies and government-aided institutions as were appli cable to governnent servants. It is also provided for that grantsin-aid to voluntary organizations for medical and health work will in future be linked with the fulfilment of family planning targets allotted to them. Punjab Recognising the fact that family planning was vital to rapid economic progress, the Government of Punjab introduced the

following incentives and disincentives. These were however,
applicable only to government servants: 1. All loans and advances will in future be given by the government only to those of its employees who liniit the number

Other government employees will be and advances provided they (husband or allowed these loans wife) undergo vasectory or tubectomy and furnish a certifrcate to that effect, or if they guarantee the use ofother methods o[ family planning so as not to have any more children born to

of their children to two.

them.

Women employees will be granted maternity leave for the birth of the first two children only. Leave entitlement will, however. be raised to five months. 3. A government employee shall not be allowed to draw travelling allowance on transfer for more than two children, unless he or she (husband/wife) undergoes vasectomy or tubectomy or guarantees that he/she shall keep the number of his/her children limited to two, as on the date of transfer, with the help

2.

of other family planning methods. 4. In respect of all such government employees to whom individual targets for family planning work have been allotted by the government, the following criteria for disciplinary action shall apply in case of non-achievement of the allotted targets:

The New Policy Measures

JJ

(a) Performance

up to 20 per cent of the allotted target: Termination of service or reversion to .the lower post, if the official concerned has a lien on such a post. (b) Performance between 21 and 30 per cent of the target: Stoppage of two increments with cumulative effect. (c) Performance between 3l and 50 per cent of the target: Stoppage of one increment with cumulative effect. (d) Performance between 51 end 70 per c€nt of the target:
Censure.

(e) Performance between 71 and90

per cent of the

target:

Warning.

tiol ofgood

5. Similarly, the following criteria shall apply for appreciawork done by the employees:

(a) Performance between 101 and 125 per cent of the target:
Issue of a "Letter of Appreciation." (b) Performance above 125 per cent of the target: Grant of an "Award" keeping in view the performance of the employee and the recomnendations of the Civil Surgeon

concerned.

Gnoup

Incrsrrvrs

Besides the above measures which are applicable to individuals, the State Governments thought of introducing group incentives with a view to encourage local self-governing bodies and other institutions like the cooperative societies and labour unions, which have a close and direct ccntact with the people, to take a more active interest and make a more earnest effort in promoting family planning. At the time of our visit 1o the selected States, only Uttar Pradesh had introduced some of these incentives. These consisted ofthe institution of an award of Rs I lakh for the ZiIla Parishad adjudged to be the best in the State in performance in lamily planning in a year, ten awards of Rs 25,00C each for the best Kshetra Sarniti in every Division and fifty-five awards of Rs 10,000 each for the best Gram Sabha in every District. These amounts were intended for being used by these bodies for creating public utility services of a capital-intensive nature like setting up of hospitals, con-

34

Family planning in India

struction of school buildings or water supply. schemes, etc. Other States were also thinking in this direction but had not taken any concrete step until we visited them in July-August,
1976.

Mresunns oF SocrAL Iuponr
The schemes relating to raising the level of female education, improving the standard of nutrition of children. introducine population studies at appropriate levels in schools ani colleges, associating voluntary organizations more closely with the family planning programme and similar schemes are undoubtedly steps in the right direction. But in tbe implemen_ tation of these nleasures, two things were particularly noticeable. First of all, there was no sense of urgency at any level in implementing these measures. Except for framing some incentives-for Panchyayati Raj institutions in U.p. and preparing some text.book lessons of an elementary nature on the problem in Madhya Pradesh, no concrete step had -population been taken so far in implementing any of these *rurur., in any State. Secondly, there was a lack of commitment on the part of government officials towards implernenting these measures. This could be because there was nothing in their tradition or training to attune them to a process of solial change through the medium of education and persuasion. the bulk of the government machinery seemed to regard these measures more as talking points or an afable propaganda Iine than real reme_ dies to the problem. This was reflected in their attitude of nagging and procrastination towards, for instance, the child nutrition programme, the female literacy programme, the exten_ sion education and mass contact programme, etc. with the result that these programmes, which by their very nature are of a long-gestation period, suffer all the more deiay in showing results owing to an attitude ofindifference and negligence in implementing t-hem by the bureaucracy. Similarly, tlie govern_ ment officials showed considerable indiference, and sometimes even hostility, towards the voluntary organizaiions engaged in family planning work. This was reflected in their attempts to witbhold grants, delay supplies and prevaricate sanctions of various kinds.

The New Policy

Measures

35

Mresunrs oF INDTvTDUAL IMPoRT
Among the measures likely to have an individual import, the provision relating to the payment of a higher amount of monetary compensation for sterilization had been put into effect in all the States at the time of our visit. ln fact, the only programme which had been released with a great deal of force in the wake of the announcement ofthe new population policy was the sterilization progranrrne. Targets for the current year (197 6-77) were drawn up in the light of the new policy and quickly transmitted to the States. There was a great deal of emphasis on their fulfilment and they were backed by a substantially higher amount of monetary incentive to the acceptors tnd a sizeable amount of Cenlral assistance to State Plans being made contingent on their performaace in the field of family planning. The top leadership of the country extended its full support to the new population policy as well as the specific programme set forth for the year in the light of this policy. The Prime Minister addressed a personal letter to all the Chief Ministers in this regard. The Members of Parliament were advised to tour their constituencies and exhort the people to adopt family planning and help realize the targets set forth by the government. A full-scale propaganda campaign was opened in support of bringing down the birth-rate as quickly as possible and, therefore, realizing the targets set for sterilization and other forms of family planning. Although other forms of family planing were mentioned, all the emphasis was laid on sterilization. It was in this background that the States, being the implementing agency, received instructions or advice from the Cdrtre to launch a massive campaign fbr sterilization, In the then prevailing state of emergency in the country, any adv.ice or instruction given by the Centre was generally taken as a mandate by the States. These instructions were taken in the same light and as if to prove their credentials to the Centre as being capable of carrying out the mandate, the States mounted a massive effort to sterilize as large a number of people as possible. The States which were labelled backward in family planning on the basis of their past performance made all the more vigorous efforts in order to wipe out the stigma attached

36

Family Planning in India

to them. Therefore, they allowed a free hand to the adminstration to scoop as large a number of people as possible and sterilize them. This is how U.P. and Madhya Pradesh exceeded the targets allotted to them in less tharr six months of the year (197 6-77) and Bihar was well on rhe way to performing the
same feat.
. This was possible by organising a large

number

tion camps and pressing into

of

steriliza-

many of them came because of official pressure ofvarious kinds-a threat of prosecution tothe shopkeepers, of delay in the sanction of loans or grant ofsubsidy to the cultivators, of difficulty in the allotment of house-sites or surplus land to landless agricultural labourers and so on. After being operated upon these persons were handed over a cash award which they accepted in the spirit of 'hush' money. Those who were truly motivated, in fact, needed no cash award. But even they accepted the money, but in a diflbrent spirit-in the spirit of a gift from the government. To a large extent, this has been the role of the monetaxy compensation for sterilization. The provision relating to the raising ofthe age of marriage has not been implemented in any part ofthe country yet. The States were looking to the Centre to enact a law on the subject or suitably amend the provisions of the Child Marriage Restraint Act of 1929.1 In theory, however, this is a good measure. If fostering responsible parenthood is one of the aims of the new policy, the marriages of girls and boys of lower ages than stipulated should in no case be allowed. However, its efficacy, like that of other measures, will depend on how it is.
implemented. MEesunrs oF SrATE IMPoRT
The measures of State import incorporated in the new policy, such as freezing ofpeople's representation in the Central and r This hls b:en done by the Gcvernment of InJia only in March
1978.

service the field staff of various government departments for bringing people to the camps under the quota system or otherwise mobilizing them for lending a helping hand to the government in its special efforts to promote family planning. But all those who were brought to the camps were not willing acceptors of the programme. A good

The New PolicY

Measures

37

State legislatures and devolution oitaxes' duties and grants-inaid to State Governrnents on the basis of 1971 population till the year 2001 seemed to have had an impact on the States' A lack of perspective and/or effort in restraining population growth on the part of some of the States like U.P. and Bihar was unwittingly earning them a bonus in the form ollarger financial assistance from the Centre and increased representation in the Lok Sabha and the State Assemblies. On the other hand, States like Maharashtra and Tamil Nadu, which were doing very well in limiting population growth, were getting a reduced representation and share. With the incorporation of the new provisions the imbalance belween effort and gain will no longer continue and a measure of stebility and firmness will hold good in the matter of allocation of legislative seats and financial assistance among the different States. The provision relating to 8 per celt of the Central assistance to State Plans being contingent on the performance of the States in the field of family planning has had a very salutary effect on the States, particularly those which had a rather poor record of performance in this field' On the formulation of this provision, they had rather to sit up and think seriously how to accelerate the pace of progress so as to, at least, achieve the targets allotted to them by the Centre. This would not only save them the loss of sizeable revenue from the Centre but also the odium ofbeing called backward. The States which already had a good record of performance felt all the more encouraged to register a good achievement so as to win a larger share in the Central assistance as well as earn the approbation of the Centre. Although this measure has yet to show results in terms of the assistance the various St.ates will get from the Centre, it has already made a mark in shaking off the inertia of many of the State Governments and mobilising them all for a much greater effort than before. The provision allowing for full rebate in income-tax on all amounts donated for family planning purposes to Government, local bodips or registered voluntary organisations approved for this purpose by the Central Ministry of Health is a measure of minor significance. As it is, donations for family planning are not very large nor do donors appear very much influenced by

38

Family planning in India

action on the part of the Centre, but granting the to do so. None of the States in our sample had, however, introduced compulsory sterilization formally. U.P. and Punjab were reported to have made certain proposals in this regard to the Centre but the details of these proposals were not known. All the four States have, however, introduced a series of other measures for promoting family planning. These measures were in the nature of inceniives and disincentives and were directed towards public servants in all the States and in a limited way to the general citizens in U.p. and Bihar. These measures are discussed State by State.
freedom to the States

the introduction of compulsory sterrlization and such other measures as the State Governments considered necessary and desirable for promoting family planning to the discretion of the State Governments, were only enabling provisions, not involv-

the fact that their donations will be excluded from the assess_ ment of income tax, Exemption from income tax did not seem to count much in their calculations. The provision is, therefore, only an innocuous one without any significant impact. The other two provisions falling in this category, i.e., leaving

int

_uoy

Bnnn GovrnnMrNr Msnsunrs
The Government ofBihar had allotted targets separately for m,otivating eligible people for sterilization to different categories of employees of the Department of Health and Family plan_ ning, teachers of Government primary and middle schools,

lized on account of this measure. Not only had it placed them under the Sword of Democles but also lowered their prestige greatly in the eyes of the public who now regard them, for the purpose of continuance in service, dependent on the goodwill of the people to ofer themselves for sterilization. The lower category of staff especially the primary school

made no secret of the fact that they were feeliag highly demora-

employees of Panchayati Raj institutions and field statr of municipal and notified area committees. It was provided for in this measure that those employees who did not fulfil the quota allotted to them would be liable to disciplinary action including discharge from service. This measure cast a gloom over a large majority of the employees affected by this piovision. They

The New PolicY

Measures

39

teacher, vaccinator, auxiliary nurse-midwife, etc', felt particularly concerned as they wielded very little authority otherwise to influence people to agree for sterilization. Cases came to our notice where more than one employee of the sane department or office were canvassing the same person or group of

a person motivated by a junior employee was grabbed by his senior to be registered as a case motivated by him. There were three measures which specifically applied to prospective public employees. One stated that all such persons who had more than three children shall be debarred from appoinrment to any government or senri'gove rnment service. This kind of a blanket ban caused serious practical problems, For senior appointments, particularly on technical posts, both in the government and semi-government organizations, naturally, such a ban was difficult to be applied. Persons of the requisite qualifications and experience cannot always be found among the ranks ofthose who have restricted their families to three children only. Secondly, if expertise was the criterion, h.ow could it be correlated w.ith the fam:ly size of the candidates. The second measure stated that before appointment to any government or semi-government service, all the selected candidates will be required to sign a declaration that they will get themselves or their wives sterilized after the birth of two children or otherwise stop any further child-birth. This measure allowed a wider choice of the family planning methods than merely sterilization and also indirectly cautioned a prospective employee that the birth of more than two children to him will entail a breach of contract and may invite penalties. This could have the effect generally of restraining the future public employees from having a family of more than two children. The third measure applicable to prospective public employees stated that such candidates as have got themselves or their wives sterilized after the birth of two children shall be given preference in appointrnent to government or semi-government service..This was a good measure, but the insistence on sterilization had caused much resentment. It would have perhaps been adequate if it was provided for that preference will be
among colleagues, and also whete

persons

for sterilization, thereby causing an unnecessary rivalry

40

Family planning in India

given to those who have restricred the birth of children only.

to

two

Of about seventeen measures of incentives and disincentives framed and introduced by the Governm""i"isilr"r, only two applied the €eleral public and that too largely in the urban -to areas. One of these measures stated that su& p"rsons as haue got themselves or their wives sterirized afrer th'; rivl;; children would get priority in allotment ofhouse-sites uod hourl-Uuilding Ioans in the urban areas. The other measure urJgn.A ,o"f, persons a priority in the grant of loan from gon.Lrn.o, o. semi-government sources for establishing un iniurtry o. structing a building or buildings lor eslablishing "oo_ an industry. These measures however sound, caused nuch adierse reaction due to undue emphasis on sterilization. There are also certain provisos to the aforesaid scheme. One ^ of these stated that males above 45 years ofageanA females over 40 shali not attract any of the disincentives incorporated in this scheme. This proviso is perhaps based on the beliefthat men above 45 and women above 40 had already completed their reproductive span, and therefore, need not go in for or be subjected to any kind of birth control. This is tJchnically not a corlect basis. Another proviso stated that such coriples as have 'child born to them for at least ten years before thenot got a aforesaid measures become operative shall be exempt from the application of any of the disincentives. This was considered an appro_ priate measure for it did not unnecessarily insist on steriiization or any other fornr of family planning from those who had already stopped child births for ten years or more. Taking an overall view of the incentives and disincentives introduced by the Governntent of Bihar, it isseen thatthe overwhelming majority of them appliecl to public servants, inch'ding the prospective employees. Th. -.uuu*, applicable to the general public were only two and that too only to certain specified classes of people. These sections, both puOiic servants and specified classes of general public, constituted only a sniall fraction of the total population. On a rough estimate, not more than 10 per cent of the people, in terms of family units, were covered by the scheme. The rest of the population was nor affected by these lneasures in any manner.

The New Policy Measures

4l

Most of the public servants were educated and many of them 'were self-motivated tov ards family planning and actually practised it. Many of the private citizers residing in the urban areas, particularly the educated ones' were also self-motivated and practised family planning in some form or the other' In any case. this was not the hard core of the population which needed to be converted to family planning. The hard core consisted of the large masses of people living in the rural areas who wete illiterate, poor, underemployed and largely ignorant both of the need for and practices of family planning. For this large mass of people no incentives and disincentives were framed by the government. Of all the States in India, Bihar is one ol the most rural. 90 per cent of its population lives in the villages' The scheme of incentives and disincentives formulated by the Government of Bihar, which is largely urban- educated-oriented, therefore, remained highly circumscribed in its appeal or application.
MADHYA PnaopsH GovmrMENr MEASURES

The Government of Madhya Pradesh introduced a scheme which was more a scheme of disincentives for there were hardly

any incentives therein. The scheme applied to employees ofthe State Government, local self'governing bodies, public undertakings in the State sector and institutions aided by the State Government. There was no scheme for the general public or private citizens. lt was provided for in the measures incorporafed in this scheme that such employees of the aforesaid organisalions as are of the reproductive age and have more than three children, unless they get themselves or their wivesi husbands sterilized, *ill be denied facilities and conveniences like the allotment of government residential accommodation; house rent allowance if they reside in private houses; loans for house building, purchase of car, scooter, etc. transfer T'A' and reimbursehmeni of tution fees for more than three children; home travel concession and the annual grade increment.

Here. as in Bihar, the insistence was on sterilization' Apart from the fear of the unknown whicb is common to all surgical operations, there was an apprehension among a sizeable section of people that vasectomy leads to impotency or at least

42

Familv Planning in India

ut d.; of- resistence majority oi people and consiCer_ able hostility to the measure among many. The sterilizalion camps, and campaigns were being conducted in a manner as if these fears djd not exist and even if tfrey Oia, li"V Ola ,,o, matter. This kind of an approach led to many untoward inci_ dents including violence in different pa.ts of ttre itate, The Government of Madhya piadesh h"d ;i;; alloued targels to certain categories of government servants. The targets were of two kinds_one for aclual sterilization operation or loop inserrion and the other for motivatlon fo. sierlfi"ation or loop insertion. The former ciass of targets were allotted to dis_ trict level medical officers only such as ihe Civit Su*geons, trre Additional Civil Surgeon and the District Healrh an"O Familv Planning _Oflicer. The purpose of allotting th;r; t"rg;r^;;;;; involve these officers directly in professlonal medical work rather than leave them to exercise superv;sion alone. The targefs for tnotivation werc allotted to specified cate_ gories of employees of the public Health and fu_ity ftann;ng Depatment from the district level downwards uoJ otfr.. categories of public servants such as "".tuin the primarv School Teacher and the patwari. While such ta.gets wer" liotred to the employees of the public Health alnd nu*it/'irtunniog Department in previous years arso, the other depurtments' emproyees were involved in this kind of work duriig for the first time. However, both the cut.gori., if 1976_77 puUfc servants showed considerable annoyan., *ilh this kind of target-setting. What irked them particularly was that if, they were nct able to fulfil their quota, they would be proceeded against departmentally for disciplinary action. Sinci motivalion was interpreted in terms ofactua tr""gl, for and handed over for sterilization ""r., ed it wourd resurt in the employees and frustration in tire 'ottrei. iin.. t.i. o*n career was at stake, naturally all conceivable means would be adopted to fulfil their quora. This will oritt., U.looa fo, tfr" development of their career nor for rendering an unbiased service to the people,
to sterilization among a large

causes a weakening of the. sexual urge and that tubectomy causes sickness of some kind or the o-ther and a weakening of the stamina of the woman. There was u g.,

*.,".";;;::T,iffi:fi,.t1i;tff:T:;

''

The New Policv Measures

43

The Government of Madhya Pradesh had increased the quantum of money to be paid for sterilization to the last cate' gory of acceptors, i.e., those who had four or more children. Under the Central Scheme a sum of Rs 70 was earmarked to be spenl on an acceptor falling in this category. This amount included the money payable to the acceptor directly as well as the expenditure incurred on items such as drugs and dressing' diet, transport, etc. On a bifurcation of this amount among the
several sub-heads, only a sum of Rs. 25 was left for direct cash paynent to the acceptor. Later on, the Government of Madhya Pradesh added another Rs 25 to this sum and made it a total of Rs.50. The extra amount being spent on this item, it was claimed, was met by the State Government from its own budget. The following table illustrates the point.
T.nsru 3.2

Bnr.tr-up oF CoMPENsATIoN MoNEY FoR STERILIzATIoN IN Me.onve PR,lorsn

(in

rupees)
Persons with

Item '

Perconswitlt 2
less living

children living children more living children Vasec- Tubec- Vasec' Tubec' Vasec' Tubectomy

or

3

Persons v'ith 4 or

tomi

tomY tomY tomY

tomY

Cash payment m accepror Drugs and Dressing

100

100

l0
5
5

Diet
Transport
Miscellaneous Purposes Fund**

IJ 20
5

50 10
5

50
15

t<Jrs+ ,{ J rs*
tA
15

20
5

5

< s{
25 70

'tn

30 1s0 100

10

Torer

100

70

* This amount is being additionally spent and met by the State Government from its own budget. ri Expenditure on the following items will be met from this fund:
(l) Community awards,
Campaigns.
(2) Group Incentives, (3) Equipment, (4) Special

44

Family Planning in India

therefore, decided to raise the amount to Rs. 50 and to brins thiscategoryonparwiththathavingthreechildren.

It was felt by the State Government that Rs. 25 was too small an amounl to enthuse anyone for sterilization. Moreover in their view the persons with four or more livl'ng clildren constituted a category more an:enable to accept sterilization than others. It,

Urran Pnaorsg

GovERNMENT MEesunEs

The Government of

Uttar pradesh

introduced

the Government towards the farming community, this measure seemed to appeal and influence the thinking of the cultivators. However, the insistence on the part of the Government that sterilization was the only methotl acceptable to it to allow this concession created strong controversy and hostility to the
measure.

the incentives, two were parricularly notable. One ,tut.d rhai farmers ofthe eligible category who opt for sterilization will get a rebate of 50 per cent in their land revenue for a period of three years. Although the quantum of land revenue paid hy mar_ ginal and small farmers was so small that a rebate of 50 per cent would not amount to more than a few rupees, yet this gesture did not fail to attract the attention of the cultivators owing to their emotional attachment to land and all interests and rights therein. Not so much in terms of money as an expression oigoodwill of

ral public, including the government servants if they quuiifi.A for them, and some to the government servants only. AmonE

incentives and disincentives. Sonie of them applied to

a

n

umber

of

the

gene-

feelings to some extent-at least in the sense th at it made them realise that the government is not all for punitive action but also has a reward to offer to those who make a determined effort not

The other incentive related to the payment of a motivation "bonus" of Rs. 6 per person motivated for sterilization by the whole-time family planning staff in excess of their quota of two motivations per month per worker or 24 in u y.ur. Th" bonrrs or incentive money was to be paid to such members of staf as exceeded their targets. While the feelings of ali government staff who were allotted individual targets were hurt by being made to do a kind of contractual work. tlie work which supposedly im_ pinged on their pride and prestige, this jncentive assuaged their

7

he New Policy

Measures

45

only to fulfil but to exceed their quotas. In other words, like those who fail to fulni their quotas attract some punishment, those who exceed then att'act some reward. It was, however, not clear as to why this incentive was being ofered only to whole-time employees of the Family Planning Department. The provision should have beea extended to all such public servants as were allotted a quota for motivation for sterilization Conceptually it was also a good measure that such families as have adopted family planning will be given priority in mater-

nity and child health programmes and will be issued identity cards to avail of these facilities. Other things being common,

such families will also be given priority over other families in the facilities offered by other departments of the government.

of this measure bristles with It obviously suggests that those families which have adopted some form of family planning or the other will have to register themselves with the primary health centre or the urban family planning clinic. On an average, a primary health centre citers to a population of one lakh persons or 20,000 families, The population is scattered over a hundred villages, many of which lie in the interior or far-flung areas not connected by all-weather roads or regular public transport. For most of the families residing in distant villages or for that matter in villages other than those on the peliphery of the PHC, even if they have adopted family planning, it will be quite some task to reach the PHC either for registration or for availing of any facilities ofered. Still more difficult, if not impossible, will be the job for the PHC staffto verify the claims of such families that they have really adopted lamily planning in a regular way and to continue to oversee the position periodically. The socalled sub-centres were so ill-equipped both in respect of manpower and medical aid that to depend on them for the execution of this nreasure will amount to court failwe ab initio. In the urban areas the position was none the better. The
However,
implementation
serious difficulties.

the

urban family planning clinics were generally attached to Iarge hospitals and depended on the clientele ofthe hospitals for their work. Very little independent work was done by thenr by way of extension, motivation or follow-up action. They also covered a large population, 50 000 each on an average, and the majority of the lower strata of society, where the intensity of work really

46

Family Planning in India

lies, was either a floating population or resides in slum areas where the family planning staf generally did not visit. While it was not difficult for such people to reach.the clinic to avail of

the claims of such families that they had adopted family planning and to continue to check this from time to time. The U.P. Government did not insist on steri.lization in applying certain disincentives to government servants. What was laid down was simply that if the number of children born to a government servant exceeded three after 1969 or exceeded two
some cases, for the staf to verify

any facilities ofered, it was a difficutt task, fraught wrth risk in

after a stipulated date in 1977, facilities like allotment of government accommedation, different kinds of loans, free medical treatment, etc., will be withdrawn. The rationale of the condition that the number ofchildren born after 1969 should not exceed three was difficult to understand. To apply this measure with retrospective effect and that too with reference to a period as far back as seven years was considered harsh The disincentives being applied to the general public, however, made sterilization necessary. It is laid down that if a person of the reproductive age does not undergo sterilization even after the birth of the third child, he will not be given any loan, allotted a house or plot or entitled to free medical ffeatment at government hospitals and dipensaries etc. There was a great deal of hostility among the peopie against these measures. They felt aggrieved that they were being subjected to an unwarranted denial ofeven their most basic rights such as the right to free medical treatment at government hospitals, allotment of a plot of land or grant ofa loan, including the crop ioan without which a large majority of the small and marginal farmers could not do even for a single season. They were also sore on the point that sterilization was the only method prescribed by the Government to let people avail ofthese facilities. So strong was the reaction of the people against these disincentives that the government was compelled to withdraw them in December 1976, i.e. in about six moths of their announcement. Tbe U. P. Government was allotted a target of 4 lakh sterilizations for theyear 1916.77 by the Centre. The State Government increased it to l5 lakhs on its own and distributed them to three categories of departments-5 lakhs to the Department

The New Policy Measures

of

Education, and 5 lakhs to other departments excluding the police and the judiciary. The departments, in turn, allotted monthly quotas for moti_ vation for sterilization to their field staff, p-uiding for certain

Health and Family planning. 5 lakhs to the Department of

of disciplinary action being taken a_sainit them in the event of their not being able to fulfil their quota. Apparently, they were very shaken and depressed and going aboui their -work in a manner as if they were already awarded some kind of a
punishment. The field staff

ex(eeding them. The employees of all the departments, who were allotted a quota, were very unha"ppy with this kino of work having been assigned to them and felt apprehensive of some kind

penalties for not fulfilling them and cirtain iicentives for

of the

Department

the provisions were so strictly enforced in their case that over 24,000 employees of the Department were not paid their salary for the month of June 1976 for their failure to complete their quota for the quarter April-June 1976, Besides this, the State Government conveyed its displeasure to the District Collectors and Chief Medical Oficers concerned. The demoralization was ,o g.."t in th" ranks of the employees of this department at thai time that many of them felt the need to resign their jobs. Only the want of a: alternative livelihood restrained them from doing so. The actions taken by the State Government had hurt their"pride and they still nurse a feeling of deep grievance.
PuNlas GovBnllrrrrnr MeAsunBs The Government of punjab had introduced a scbeme of incentives and disincentives which was applicable to Government servants only. There was no scheme for the general public. Any scheme which applies only to a select class of peopie -like the government servants who are generally better informed, more

P.lanning were particularly agitated. In the first place, the quota allotted to them was much higher than that allotied to the employees of other departments. Secondly, penal

of

Health and Family

educated, largely urban and predisposed to family planning, and masses where the real problem lies, tenOs to be symboiic. At best, it can be said to be a pace_setter provided it

not to the

54

Farnily Planning in India

Planning Programme in the District. Both are independent of each other. The 'M.P. Model' has an advantage over the .Bihar Model' in the sense that here functions haie been clearly demarcated and assigned and an independent officer is in-charge of family planning at the district level. This is, however, against the basic assumption that public health, medical care and family

planning are inter.related and that best results are achieved

when they are integrated. Between the Punjab and the U.P. Models, the latter seems to have an edge. The Punjab Modol provides for a number of personnel to look after various components of the public health, medical care and family planning programmes. The large number of personnel raises the problem of coordination. The U.P, Model provides for only three officials to look after public health, medical care and family planniug programmes. Thus, the C.M.O. of U.P. may not face the problems of coordination to the degree which his counterpart in punjab may have to. Besides, the shortage ofqualified manporver also tilts the balance in favour of the U.P. Model. As mefitioned above, the head of the family planning programme at the district level has a challenging role. In order to enable him to play his role effectively, it is desirable to provide him with necessary resources, both material and manpower. Whereas the districts of Punjab and U.P. are comparatively better equipped personnel-wise, there were lesser number of senior medical officers at the district level in Bihar and Madhya
Pradesh. UnsaNr AnEes

In the urban areas, urban family welfare planning centres have been organized by the Government as well as by local bodies and voluntary organizations. The Government of India provides assistance to urban centres on an approved pattern to the extent of meeting their full cost. The stafing pattern of these centres is based on the population which a Centre is required to serve. A11 the eight urban centres which we visited in Bihar, M.P., Punjab and U.P. were being run by the respective State Governments. All these centres were attached to district or other

O r gani

zati on and Administr at ion

f,f

hospitals. The urban unit of Aruritsar was, however, making referrals to District Family Planning Bureau and Government Women's Hospital, Amritsar. These centres can be divided into two categories on the basis of the population which they were serving, viz. those serving a population between 25,000 and 50,000 and those serving 50,000 and above' The urban centres of Hoshangabad, Datia, Ropar and Amritsar belonged to the first category. The urban centres of Gaya, Dhanbad' Rampur and Allahabad belonged to the second category' The prescribed
stamng pattern for these categories is as under:

UnnaN

Feltlrv Wnpens Pr,e.rlxtltc CENTRE wITE e PoputlrroN BrrwnrN 25,000 ro 50,000
No. of posts z

Part-time Medical Officer (One male and one female) F.P. Extension Educator (Male) F.P. Field Worker (Male)

A.N.M.
Attendant

UnnlN F.turrv Werrenn Pr.eNNtl'tc CBllrns HevrNc Popuretlots oF 50,000 AND ABOVE
No. of posts Full-time/Part-time Medical Offi cer (One mate and one female) F.P. Extension Educator (Male) Lady Health Visitor F.P. Welfare Worker (Male)

t

A,N,M.
Attendan

t

Sweeper (Part-time)

In order to cater to the needs of male and female population, provision has been made for one male and one female medical officer at each urban family planning centre. However, the urban centres of Dhanbad and Ropar did not have any medical officer on their rolls. Urban centres of Hoshangabad, Amritsar and Rampur had one medical ofticer each on their rolls. Urban centres of Gaya, Datia and Allahabad each had two medical officers on their rolls. All the medical officers, however, were female. The situation being as it is, it is doubtful whether a

56

Famly Planning in India

female medical oficer can effectively cover the male population, and also whether male population can approach and discuss freely with female medical officers. It is, therefore, essential that for effective coverage of poupulation each urban centre should have two medical officers in position, one male and one female. Secondly, whereas an urban centre which covers a population of 50,000 and above was provided with a Lady Health ^Visitor,

latter. Let us list briefly the functions of a Lady Health Visitor. A Lady Health Visitor is responsibie for providing family planning infornration and clinical and supply services to women on selected days. On other days of the week she has to work in the field as community educator. She is also responsible for insertion of the I.U.D. She supervises and supDlements the work of the A.N.M. Thus, a lady healrh visiior plays an important role in family planning work. This highlights the importance of staffing each urban centre with a iadv Health
Visitor.
Since lst April 1976, a new pattern of staf was proposed to be introduced at Urban Family Welfare planning Centres. The revised pattern provides the following staff.

However, this numerical justification does not *..- L Le sound and, in our opinion, adversely affects the performance of the

the urban centre which covers the population between 25,000 and 50,000 has not been provided with a Lady Health Visitor. One possible justification for this could be that since the former caters to the need of a large population its staff should be more than that of the latter which covers a smaller population.

UnneN Fevrr,y WrrranE prlNNrnc

CENTRE

PopurerroN BErwrrr 25,000
F.p. Extension Educator/Lady Health F.P. Field Worker (Male) Auxiliary Nurse or Midwife

wrrg

A

to

50,000 No' of posts

visitor

I I

Uns.aN FaruLy W runr PLANNTNG CENrnn HevrNc A PoPULATIoN oF 5O,OOO AND ABovE
Medical Officer (Preferably female) Lady Health Visitor

No. of posts

I
1

Organization and
Auxiliary Nurse or {idwife F.P. Field Worker (Male)

Administration
Z

57

I
1

(N.B. An additional Medical Officer to be provided wbich function under the post-partum programme)

Storekeeper-cum-Clerk

in

the

Centres

places the revised pattem of stamng had not reached' Many of ihe local authorities were not even aware of this change' We' however, felt that this change was likely to affect the performance of the programme adversely. Taking first the category which caters to a population between 25,000 and 50,000' the revised pattern does not provide for any Medical Officer' In the absence ofany doctor, we do not know how the centres are going to function, who will check the eligibility of persons iro"gnt for sterilization or for IUD or for that matter any other famiiy planning method: who is going to perform operations and in caie of any complications who is going to look after the patients? In short, we cannot think of a clinic without a doctor' if th. pu.por. of the Government was that these centres would provide only referral services (this is also irrational) than that should have been made clear. Perhaps the Government felt that since the urban centres were generally attached to the nearby hospitals functioning in the area, medical officers working there wili look after the urban centres in addition to their normal duties. If this was so, we are afraid it was rather impractical because they alteady have sufficient work at their clinics which keeps them busy. Thus, to expect these persons to do family planning work in addition 1o their own duties seems to be too much especially when no doctor is enthusiastic about doing family planning work. It may, therefore, affect the performaace of the programme both quantitatively and qualitatively'

It

was too early

to have a feel of this change because at most

Secondly, provision has been made either for a F'P' Extension Educator or a l,.H.V. Instead of providing a choice between these two. it would have been better if the Government had made

a provision for

both of them'

If

there is no F'P' Extension

Eiucator, then who is going to look after extension education' The shortcomings of extension education in the family planning programme are well known and need not be emphasized' If ixtension education is properly carried out, then we will not
have to offer inducements or resolt to coercion in family planning'

58

Family planning in India

things and are somewhat more easily motivated. This, however, not mean that urban people do not need any type of extension education which might help them in making up their minds for acceptance or otherwis; of a new p.oiru--" o, policy. Unfortunately, from the recent changes maie Uy tne Government of India in the staffing pattern, it appears as if there is no need of educating the urban people 'about the acceptance of the small family norm. Surely, there would have been no need for this, had orr.p.ogru--" been based not on persuasion but compulsion. Since it is based on a persuasive approach and its educational and motivational aspect is one of the weakest parts of the programme, we feel that extension education needs to be strengthened considerably. Thirdly, whereas earlier there was a provision for only oo" A.N.M., th" new pattern provides for two. This will make a good impact on the performance of the programme,

pared to the rural are more easily amenabie ti accept new

effective service to the clients. Some significant changes have also been made in the staffing pattern of that category ofurban centres which serve the population of 50,000 and above. Whereas earlier it had two Medical Officers (one male and one female), now it has only one Medical Officer, preferably a female. The absence of a male Medical O^fiicer is-going to pose serious problems, such as, a heavy load of work for the female medical officer and a neglect of the male clients. Moreover, as the Government wants to-popularize male sterilization more than female, the uppointmeni of a female Medical Officer seems to be rather odd. Secondly, the post of rnale F.p. Extension Etlucator has been abolished. It is an established fact that urban people as com_

It is, however, not to suggest that a L.H.V. has no useful role to play or when the question of a choice comes she should be dropped. A L.H.V. has an important role to play whicn a F.p. Extension Educator, or for that nratter an! other field staff, cannot play. It would have been better if ihe revised pattern had made a separate provision for a L_H.V. for each clinic. This would have gone a long way in providing an efficient and

does

Since the problems faced

centres are more or less the sarne as those faced by the field statr of the PHCS, they have been discussed together ut u ,.purut"

by the field staff of the urban

Organization and

Administration

59

place later in this chaPter. Runer- Annas

gramme has been integrated with public health and maternity and child health programmes at the Primary Health Centre (PHC). Generally, one PHC is located in each community development block. The PHC has a number of sub-centres which operate as the primary functional units' These sub' centres have been organized on the basis of population coverage. Each sub-centre generally covers
10,000.

In the rural areas of the districts, the family

planning pro-

a population of about

The PHC is headed by a medical officer' Besides him, there are one or two other doctors to assist him. In M.P', Punjab and U.P.. the re are two doctors in each PHC-one is the Medical Officer Incharge and the other the Second Medical Officer' In Bihar, each PHC has three doctors. One is Medical Officer Incharge and the other two are designated as Medical Officers'

areas, as stated above, the family planning been made an integral part of public health and service has MCH services. Hence, family planning units have been

In the rural

attached to PHCs and additional staff have been sanctioned for this purpose. The additional staff besides others includes one medical officer. Thus, out of two or three' asthe case may be'

one medical officer is paid from the family planning budget' However, no medical officer is exclusively reserved either for family planning or public health or MCH service' All look after these services jointlY' The rationale behind providing two medical ofrcers at each PHC is understandable. First of all, the work relating to all the three services, viz., public health, MCH ar:d family planning is very heavy. Secondly, the area covered by each PHC is very larie. Thirdly, in case of any emergency or otherwise if a medical oficer has to proceed on leave, there is another doctor to look after the work. And lastly. out of the two medical officers, one ought to be a lady. This will enable the PHC to cover satisfactorily both the male and the female population' However, we are not in a position to appreciate the Bihar Model which provides for three medical officers in each PHC'

60

Family Planning in India

It was

explained

provided for the three services but since all of them worked jointly for each service, this argument did not appear to us to be very convincing.

by the authorities that three officers

were

family planning side. This distinction is made on

population. With regard to staffing of the sub-centres, we were informed that there were two types of sub-centres in a pHC. One category of sub-centres belong to MCH side and the other to
the basis

that one cannot live safely in them. Thus the A.N.M.s are provided with a place to live and work which is not only outside the village but also not safe to live in. Besides this, for obvious reasons the A.N.M.s flnd it difficult to cover the male

M.P., Punjab and U.P. had a lady medical officer on its staf. Before discussing field staff's position, problems etc. perhaps a few words about sub-centres may not be out of place. The sub-centres of the PHCs are generally manned Uy e.N.U.s. At the peripheral level, they are not only health units but also depot holders. They take the message of family planning to the interior areas hnd as mentioned earlier they generally cover a population of about 10,000. In this connection, it may be mentioned that the workload of the A.N.M. i.e., to cover a population of about 10,000 is much to.o heavy. It is not possible for her to discharge her responsibilities effectively and efficiently over such a large area. The problem of workload becomes particularly serious when viewed in the light of the facilities provided to the A.N.M. at the subcentre. Since the buildings housing the sub-centres are generally located outside the village, ihe A.N.M.s do not feel secure. They have generally to live there alone. Besides. the condition ofthe buildings is hardly satisfactory. The buildings of a few sub-centres, which we visited, were in such a condition

Since a PHC covers the entire population in its area for family planning, it is desirable that it should have a lady medical omcer to look after the female population. lndia still being an orthodox and conservative society, especially in the northern parts like Bihar, M.p., and U.p., it is essential that these parts must have a lady medical officer with whom the conservative women can talk and discuss their problems freely. However, none of the pHCs which we visited in Bihar.

O r gan i zal

ion and Admini

st r ation

61

whether expenditure of the sub-centre is met out of MCH funds or family planning funds. Whereas the family planning

programme provides for only one A.N.M. for each sub-centre, the MCH programme provides for one A.N.M and one Dai for
each sub-centre.

In order to improve the performance of the family planning programme, especially in rural areas, it is essential that subcentres should be strengthened. There is a good case to have two persons at each sub-centre. In addition to the A.N.M, the other person should preferably be a male. This will not only provide security to the A.N.M but also help in covering the male population in a much more effective way. Immediate measures to improve the buildings ofthe sub-centres are also necessary. Moreover, while opening new sub-centres of constructing buildings of sub-centres, the Government should see that they are within, or at least near, to villages.
FrEro Sr.lrp

in the implementasuccess of the programme depends upon the efforts put in by the staff in educating the people. To a certain extent this also reflects the inter-state or even inter-district differences in the performance of the programme. During our field work we tried to find out from the eligible couples, whom we met, whether any family planning worker had visited them and talked about fanily planning. The majority of the persons stated that nobody from the family planning centres had ever contacted them. Out of those persons who had been contacted by the field workers, we tried to find out as to how many times they had been contacted in a year. The frequency of home visits bythe workers came to once or twice per year on an average.l
The field staff occupy
an important position

tion of the family planning

programme. The

t

This 6gure

is calculated on the basis of our discussions with the eligible persons and the field workers. In mary cases, official figures
could not be relied upon because during our home visits we found ihat

field workers often failed t0 trace those persons who, as per their
statement, had been contacted by them several times, Hence, the above figure was arrived at on the basis of visits confirmed by both the eligible persons and the field workers.

62

Family planning in India

There are two main factors which are responsible for the low level of contacts between the clients and the family planning field workers. First of all, the worker-client ratio is not satisfactory. For example, an urban centre which covers a population of 25,000 to 50,000, has a sanctioned strength of three persons to look after field work. Thus, one worker is responsible for covering a minimum population ofg,333 to a maximum of 16,666. In an urban centre covering a populatiou of 50,000 and above, four persons ..are responsible for field work. One worker has therefore to look after a minimum population of 12,500. The situation is equally bad in the rural areas. A primary health centrc covers a population of about one lakh and is responsible for public health, medical care and family planning altogether. It has normally a sanctioned staff of about 18 persons (about l0 for family planning and about 8 for the other two services). It may, however, be mentioned that the staff, other than family planning staf, have only marginal responsibilities for family planning. One worker is
on an average responsible

the client-worker ratio is very low and makes it extremely difficult for a worker to cover the entire population falling in

for about 10,000 poputation. Thus,

his charge. Secondiy, the performance offield workers is generally not satisfactory. All the concerned authorities at the state, district a"trd local levels invariably pointed out the problem of low work input. Workers were working neither in the spirit nor to the ' extent it was expected of them. For a programme like family planning, the interaction between ciients and workers is crucial. The success of the programme is directly related to the eflectiveness of the workers' contacts with the clients. This leadusto investigate as to why the family planning field workers often fail to fulfil their responsibilities. Among the different government departments, health depart.,

ment occupies, comparatively speaking, a low status. And within rhe health department, family planning occupies the lowest position. Not only in governmental.bureaucracy but also in the society, family planning is not looked upon as a very respectable work. Thus, enjoying a low status, the family planning department with its emphasis on rural field work, makes itselfthe least desirable place for posting.

Organization and

Administration
role

63

Secondly, the effOctiveness of the

performance is co-

related wirh awareness of role-perception:

Awareness-+Motivation+Action
Almost all the field staff, whom we met, did not possess the necessary background which could enable them to be aware of their role. Most ofthem had taken up their occupation because economic necessity rather than by professional calling.2 Besides, they were not suitable to work in the rural areas. Leaving aside some who had an exposure to rural life, the rest. were essentially used to life in urban areas. They were not able to adjust themselves for living in rural areas. Everyone was trying for his or her transfer to urban areas or a place near

of

them.

A

thus being used for
a transfer.

substantial amount of time of the field workers was an unproductive activjty, nanely, seeking

When the field staff do not possess the necessary background

which will enable them to be aware of their role and to work in the rural areas, the training cannot help much, particularly when training is given for a short duration. All the field workers at the urban centres and the PHCs which we visited, were trained in family planning work. The training had, however, not helped them in any meaningful way in carrying out their duties efficiently. In fact, while talking with the field staffwe got an impression that none of them had taken up the training seriously. This is the reason why they were not able to distinguish between "Family Planning" and .,Family Welfare Planning." What they meant by "Family Planning" was sterilization generally. If a person is not sterilized and is using, for instance, condorus for the last three-four years aad did not have any child during this period, still according to them rhis
person is a "Non-acceptor" of this family planning programme.

Though we

did not study the nature,

contents, etc. of the

? We were surprised to learn from some female field staff that

inspite of the fact that they were unmarri€d they had to put on all the marks of a married woman. Otherwise women, especially rural, would not take them seriously and would not like to listen about family planning programme from them. Thus, they were doing this because they did not want to lose their job-economic necessity and not their interest in the programme was the main motive force.

64

Family Planning in India

training being given to the field staff, yet it looks that this training does not necessarily prepare them to be aware of their role and motivate them lbr their work. When the social ..background, job expectation and the training do not motivate the field worker to discharge his
duties effectively, then the higher level bureaucracy has

to

come

forward and take up the responsibility of inducing the worker to carry out his duties. The bureaucracy can induce workers to work either by providing necessary physical facilities or by providing guidance and supervision or by introducing a scheme of incentives and disincentives. However, during our discussions with ofrcials and workers at different levels, we found thai very little effort had been made for a proper
orientation of the staff towards the programme. The officers of District Family Planning Bureaus w€re required to make supervisory visits to urban and rural service units. Similarly, the officers of the PHCs were required to make such visits to sub-centres in their area. We found that these visits were neither regular nor intensive. Those centres which were easily accessible or near the headquarters were visited most. The purpose ofl these visits was mainly to check accomplishments. The visiting oflicials seldom tried to study and analyse problems or ofer guidance to field staffwith regard to problems faced by them in the implementation of the programme. During our discussions the visiting ofrcials also gave us the impression that they were only interested in the fulfilment of the targets and did not bother to resolve any local problems or difrculties. With a view to review the progress of the programme and to remove bottlenecks, monthly meetings are required to be held at district and PHC levels. Though in every district and at each PHC, visited by us, these meetings were being held but discussions were only confined to a review of achievements. Difficul-

ties and problems faced by the field staff

were not properly work to field staflwas being done attended to, Assignment without keeping in view the conditions prevailing in different areas. In short, at these meetings, there was no two-way communication. This had created uneasiness in the mind of the field

of

staf.
Another way of motivating the field staff is to provide certain incentives and disincentives to them. The schemes of incentives

Organization and

Adminisftation

65

and disincentives have however been introduced by the four States in our sample only after the announcement of the new population policy by the Centre.s These schemes apply to all public servants, including those who were allotted individual targets for motivation for sterilization and other forms of family planning. For such public servants incentives are few and far betweeo and generally weak, whereas disincentives are more numerous and hard. These kind of schemes are not going to be very effective in motivating the field staff. In fact, these have caused more demoralisation than inspiration among them. One way of making these schemes efiective is to incorporate measures for opening further avenues of promotion for the stafl. At present, the staff does not have any career mobility. If specific schemes of career development are adopted as incentives to the field staff, these will go a long way in motivating them towards rendering an efficient and dedicated service. Family planning programme administration, like other bran' ches of Indian administration, is no exception to the general rule of political interference. During our discussions with officials at various levels, we were told about frequent political interference in the programme, especially in relation to appointment, transfer and promotion of staff and disciplinary action against them. In one ofthe states, a very senior ofrcial confes' sed that he was not in a position to devote much of his time to the family planning programme as most of his time was being taken up by the politicians who came to him with a "request" relating to someone's appointment or transfer or promotion or about disciplinary action. This had resulted in appointing a number of persons among the field staff of his department who otherwise would not have been appointed. Since these persons were not qualified but had political backing, they were not much interested in doing any work. Supervisory officials were finding it difficult to get work done by them. In fact, in some cases where officials tried to take some disciplinary action against such persons, they were harassed by the politicians and made to retrace
0

their steps by their seniors. Very often, they themselves
as

The schemes of incentives and disinectives,
Governments of

worked out by the State

Bihar, M.P., Punjab

and U.P, have been discussed in

detail in Chapter Il I.

66

Family Planning in India

were transferred from that place. Under such circumstances, most of the officials expressed their inability to take any corrective action against such staf.
URBAN-RURAL

Drpnrnrxcrs

Because of the restrictions inrposed by the nature of the study wewerenot able to make an in-depth study ofthe organisational structure of the urban and rural ciinics, but we did come across certain factors which highlighted the differences between

them. Urban areas are generally associated with all the characteristics which we call modern. Literacy, education, employment and media of communication like radio and newspaper are all present in a larger rneasure in urban than in rural areas. All these characteristics of urbanism in turn make for a greater acceptance of the norms of small family. Ifwe accept this thesis, we find that urban and rural family planning clinics face different problems and probably require different forms of organization to deal with them. The urban
clinics generally attract more acceptors simply because the urban people as a class are not only densely populated but also better educated and betttr motivated. On the other hand, the rural clinics are faced with the problem of dispersed population which is also less educated and less inclined to accept the

family planning programme. This means that to conracr and recruit the acceptors, the rural clinic would require an extension capacity much greater than that of the urban clinic. This in turn requires more technical competence in the field staff and better organizational efforts to motivate the people. Rural ciinics therefore require additional incentives to recruit and retain the qualified and experienced staff as well as more resources and better working conditions to utilize their services. This highlights the usefulness of establishing different types of clinics in urban and rural areas. We are, however, not suggesting that at present there are no differences between the two. Wbat we want to say is that the criteria which were kept in ruind while developing the organizational sttucture of the two types have now become obsolete. In order to identify and meet the needs of these rwo types it is desirable that some in-depth comparative studies of urban and rural clinics be undertaken.

Organization and

Administration

67

OnceuzartouAr-

PATTERN

For administrative convenience, the Govemment has prescribed a uniform pattern of staffing' While this system might have served the purpose of bureaucracy for sanctioning of
grants, prescribirrg educational qualifications for the staff, etc., it has certainly not served the interests of the family planning programme. This is because it is not possible to enforce uniform standards all over the country which is known for its diversity. The rigidity of the staffing pattern has in fact affected the performance of the programme in many areas. For example, in U.P. there is an acute shortage of A.N.M.s. and as a result a large number ofthe posts are lying vacant. Had there been no rigidity, the U.P. Government would have made use of male health workers who are available with them in good number. Thus, the present rigidity of the staffing pattern needs a change. While the Government of India may prescribe the staffing pattern, there is a need to allow the State Governments to make the necessary changes therein in the light of the local conditions.

CoMMITTEES

The vigorous and effective implementation of the family planning programme calls for the setting up of governmental machinery which will provide for adequate policy making .and administrative and financial control. For this purpose, a number of committees have been set up at the state and district levels. These committees aim at reviewing the performance of the programme, enlisting cooperation between offcials and non-offcia1s; and, seeking co-ordination amongst government departments; and, government departments and non-official agencies. Their details are as under.
CABTNET

Sun-Couurttrr

At the apex, there was a Cabinet Sub-Committee on Family Planning in each of the four States, viz. Bihar, M.P., Punjab .and U.P. This Committee gave policy directions and reviewed the progress ofthe programme periodically.

68

Family Planning in India

Whereas in M.P. it was headed by the Minister of Public Healt} and Family Planning, in Bihar, Punj ab and U.P. it was headed by the Chief Minister. The M.P. and Punjab Committees consisted of 7 officials each and that of Bihar of 5. The U.P. Committee consisted of 6 ofticials and 5 non-officials as reported by the State Family Planning Bureau. During 1974-75, the M.P. Committee did not meet at all and the Bihar and U.P. Committees met only once. In Punjab it was only in 197 5-76 that this Committee was constituted, Femr,y
PLANNTNG

CouNcrr.iBoenn

The Family Planning Council/Board provides a forum for effective communication amongst government departments and non-officia(s associated with the programme. It also lays down broad guidelines for the implementation of the programme.

Out ofthe four States, Punjab

not constituted this Council. The M.P. Council consists of l0 officials and 21 non-officials and is headed by the Minister of Public Health and Family Planning. The U.P. Council consists of 23 officials and 15 non-officials and is headed by the Minister of Health. The Bihar Council has a membership of 22 of whom 6 are officials and 16 non-oficials. In M.P. and U.P. this Council had not met at all during 1974-75, whereas in Bihar it met only once,

is

the only State which has

SrArB-LrvsL Co-onorNlrroN Coulrlrrrrt

The State-level Co-ordination Committee aims at securing co-ordination amongst the various government departments and also with the non-official agencies. All the four States have set up this Committee. In M.p., it is headed by the State Family Planning Officer, and in Bihar, Punjab and U.P. by the Chief Secretary. Whereas the M.p. and U.P. Committees consist of both officials and non-oficials (7 officials and 5 non-officials in M.P., and 13 officials and I nonofficial in U.P.), the Punjab Committee consists of l4 officials

and that

12 officials only, During lg74-7 5, did not meet at all, the U.p. Committee met twice and that of Bihar thrice. The puniab Committee
the M.P. Committee

of Bihar of

Organization and
was constituted only

Adminislration

69

in 1975-76.

Gnet.lrs Cotrltulrrrn
The State Grants Committee advises the government about the disbursement of funds amongst voluntary and local bodies engaged in the family planning work. It also advises about undertaking ofnew schemes and starting ofnew centres of family planning. Grants Committees were in existence in all the four States. The M.P., Punjab and U.P. Grants Committees were headed by their respective Health Secretary and that of Bihar by the Director of Health Services. Whereas the M.P. and U.P. Grants Committees consisted of 4 offcials each the Grants Committee of Punjab cousists of 4-5 officials, and that of Bihar of 3 officials. During 1974-75, tbe Grants Comrnittees of M.P. and Punjab met once and those of U.P. and Bihar twice. In addition to these Committees, U.P., unlike other three States, has a Publicity Co-ordination Committee comprising 20 officials and 5 non officials. It was headed by the Health Secretary. This Committee reviews the work done with regard to publicity of the family planning programme. During 1974-75, it met only once. A statement on the composition of State-level Committees in the four States is given in Appendix VI. At the district level, each district, which we visited in Bihar' M.P., Punjab and U.P., had an Action/Implementation Committee. It consisted of heads of development departments of the government in the district. The Collector/Deputy Commissioner was its Chairman and the Civil Surgeon/District Family Plan' ning Officer its Member-Secretary. This Committee co'ordinates, supervises and reviews all mattets pefraining to the implementation of the family planning programme in the District. In all the eight districts, visited by us, we found that this Committee was not functioning property' It was not meeting regularly. Besides, attendance in its meetings was generally

poor. Ithas actually failed to serve the purpose for which it
was consttiuted.

In Punjab, a District Co-ordination Committee was also functioning in each district. The Deputy Commissioner was its

70

Family Planning in India

Chairman and the District Mass Education Officer (Family Planning) its Convenor. Besides them, it consisted of representatives of those official and non-official agencies which are functioning in the district in the fleld of mass education. Its main function was to ensure that mass education activities concerning family planning are effectively carried out. Like the District Action/Implementation Committee, this Committee was also not functioning properly. We did not find such a committee in Bihar, M.P. and U.P. In conformity with the directives of the Central Government, the State Governments had constituted these committees at the State and the district levels to help the implementation of the programme. However, during our discussions with officials and non-officials in the States at various levels, we discovered that these Committees had not been functioning properly. Generally, these Committees did not oreet regularly or frequently, Moreover, the attendance in their meetings was not satisfactory. This shows a lack of interest on the part of the members constituting
these Committees

StArrsrrcer, SysrEu For monitoring the progress ofthe programme each service unit keeps the records of various activities undertaken during the course of implementation of the programme. These records range from the information on potential acceptors to the budget and expenditure of the unit. Since it was not within our objectives to look into the entire records ofthe service units, we restricted our enquiry to only those records which were directly related to our study. These were as follows:
(a) Records pertaining to the potential acceptor. (b) Records of motivational activities of the field staff. (c) Records of services rendered by the clinic.

Rrcono PmrelttNc ro rnE PorENTrlr. Accspton
This record is maintained in respect of the persons who are in the reproductive age-group and are considered eligible for practising family planning. Through surveys data is collected on

Organization and

Administration

7l

the eligible couples and maintained in a register called "Target

Couple Register" at each sefiice unit' The quality of these

regi;ters and the extent to which they were kept upto date varied

from State

In Bihar, these registers were not only with regard to the record of statistics but generally incomplete io ro-. cases misleading. The position in the States of M'P' and U.P. was bettor but by no means satisfactory' In all these three States supervisory personnel were also not paying proper attention tothe maintenance of records. In Punjab, however, the registers were generally complete and periodically updated'

to

State.

Atthough the Central Government have specified the contents ofthe "Target Couple Register," yet at certain places the specifications laid down by the Centre were not being followed' lf properly maintained, these registers can supply vital information which can be helpful to the planners in identifyittg the weak spots of the programme and the possible ways for improvement' We feel that the "Target Couple Register" must, inter alia, contain information on the socio'economic background ofthe prospective acceptors, whether they already follow any method and if so what and the reason and source of their motivation'
REcoRD oF MoTIVATIONAL AcrlvrrlEs oF THE FIELD STAFF

The main function of the field staf at the service units is the motivation of eligible couples for family planning. For this purpose, each field worker has been allotted an area in which he/she has to cover all eligible couples not only at the preacceptanqe stage but also at the acceptance and follow-up
stages.

In most of the service units in Bihar, M.P., Punjab and U.P. the records pertaining to motivational activities of the field staff have not been maintained. At other units such records werekept but were not satisfactory. Although the field staff has the responsibility to keep adiary of their work, yet we found that they were not properly instructed by their superiors in this respect. Many ofthem did not even know that they were required to keep

such a recotd. Thus, the responsibility for this state ofaflairs rested mainly with the officers incharge of the se ice units. Acceptance and use of family planning methods depend on order to assess these the motivi,tion to regulate fertility.

In

72

Family Planning in India

motives and bring about the necessary changes therein a systematic effort has to be made by the field statr A record of these efforts is a valuable source of information about the knowledge, attitude and practice of family planning among the eligi_ ble couples, both acceptor and non-acceptor. lt i, heie that the record of motivational activities of the fielcl staff assumes considerable importance.

Reconos oE Srnvlcrs

RENDERED

gy tuE Crturc

relative acceptance by the people and ofthe performance_target Consequently, this record receives a greater attention of the officers incharge of the service units and is more regularly maintained than other records. . Since the family planning programme is target_oriented, the importance of this record need not be emphasised. With the atrnouncement ofthe new population policy the family planning programme has assumed considerable importance. The incen_ tive of 8 per centof assistance offered by the Central Government to all those States which achieve their annual target has changed the outlook of the State Governments ol Bihar, M.p. and U.P. In these States we noticed that there was a heavy concentration of attention on the farnily planning programme

Each service unit is required to maintain a record of familv planning methods serviced by it. On the basis of this record service statistics are consolidated and supplied to the higher levels. This data gives an idea of the family planning methods,

ratio.

and

the fulfilment of their targets. This .,mad', rush for achieving the targets had led to a raanipulation of the records at a number ofservice centres. False cases of sterilization were registered many of which on verification were found to relate to persons

the State Governments were lying

a great emphasis on

who were non.existent. Cases a.lso came to our notice fake certificates of sterilization had been issued.

in

which

Rrponrrlc
The family planning programme has a prescribed format for periodical reporting to the Central Evaluation Unit of the

Organization and Administration

IJ

Ministry of Health and Family Planning'a The reporls originating from the Primary Health Centres are consolidated at .uJh high.t administrative level, i.e. the District and the State' until they reach the Central Government. A number of reports

quarterly and annual-are called for and consoli-monthly, Stut" level by the State Family Planning Bureau in dated at itt. all the States. Th€se reports usually are extracted from the record kept at the service units and contain information on

various aspects of the programme. The data supplied by the service units raises the problems of deliberate misreporting and incomleteness. The Central Government has prescribed a mechanism for improving the reliability and validity of the data' The mechanism consists of spot checks and sample checking' With regard to delayed and incomplete reporting, even salary disbursements have been made contingent on tle complete and timely submission of rePorts. Almost in all the centres we visited in Bihar, M P' and U'P' we found that thg officers incharge of the programme were not aware of the ntechanism for ensuring the reliability and validity ofthe statistics. The position was better inPunjab where this mechanism was more effectively used'

Ev.lLu.{rIoN
The importance of evaluation of family planning programme' or for thai matter of any programme' needs hardly be emphasized, but we ditl not find any effective system at the State level for evaluating the reports collected from the service units in any State in our sample except Punjab' It was only in Punjab that these reports were first discussed every month in the

Directorate of Health and Family Planning, and subsequently at the Secretariat level amongst the Secretary (Health & Family Planning), the Regional Deputy Directors of Health and Family Flanning, the Regional Director (Family Planning) of the Government of India and the officers of the Directorate' The purpose of these discussions was two-fold: to review the progress and to chalk out the programme for the future'

4 For details see, India, Department of Family Planning, Manual Family Planning Records and lRelartts (New Delhi, 1968)'

of

74

Family Planning in India

We have also noticed the problem posed by the proliferation ofthe reports. This is one of the reasons for the non_submis_ sion of reports in time. Moreover, preparation of these reports takes a considerable amount of time of the staffwhich is at the cost of clinical and extension work. Since the service statistics system is primarily meant for the evaluation of the programme, it should not hinder the service efforts themselves. Further_ more, not all the reports are analysed and used for the purpose for which they are called. There is, therefore, both scope and the need for rationalizing the system.

Vor,uNreny OncrNrzArroNs
As discussed in Chapter I, voluntary family planning associations have played a crucial role in initiating the family planning movement in many developing countries. Voluntary organizations in a country often begin their activities by offiring family planning services through private clinics. They also direct their
efforts towards creating

a wider base of public support for through a mass communication campaign. _planning Gradually, they start lobbying the Governments to enact a policy with regard to family planning. Thus, presence of voluntary organizations in a country is a positive foice for the adoption of a national family planning policy or programme. While voluntary organizations were responiible for the initiation or adoption of an official policy/programme on family planning and in facl welconed the government's acceDtance of the responsibility, with the passage of time they became uneasy, if not unhappy, about this development because of the unhelp_ ful attitude, generally, of the government towards them. In what follows we have made an attempt to examine briefly the existing relationship between the government and the voluntary organizations in the States of Bihar, M.p., punjab and U.p. Family Planning Association of India and the Red Cross are the two main voluntary organizations which run family planning clinics in many parts of India including Bihar, M.p., punjab and U.P. Besides, there are a few voluntary organizations which are of a local nature and either run family planning clinics or provide relerral services for family ptanning. Voluntary organizations' clinics have been made responsible for fanily

Organization and

Admtniitration

'15

providing family planning services in the area undel their jurisdicti,on. They have also been made responsible for educa- ' iional and .motivational work in their area' The State Governments allot them yearly targets for sterilization and IUD insertion. It is worth examining how far these clinics have been equipped for discharging successfully their responsibilities' The- Government of India have a scheme of assisting voluntary organizations' clinics. The scheme envisages grantsin-aid for approved pattern of staff and free medical supplies' Government grants are smaller than needed because with full grants there is a danger of taking away the sense ofparticipation if voluntary organisations and of inviting criticism for inade'quate coniol of what essentiaily would amount to a full
government commitment.

The Government had prescribed a staffing paltern for the clinics of voluntary organizalions on the basis of which each ciinic was given grant-in-aid, but from lst April 1976 a new

pattern has been introduced by the Government for

these revised pattern, a post of part-time female clinics. Under the Medical Officer, two posts of Extension Educalors, one post of

female Family Planning Field Worker and the post of the Attendant have been abolished. Instead a post of Lady Health Visitor and two posts of A.N.M.s. have been created'D Whereas the old pattern provided for two Medical Officers' one male and one female, the new pattern provides for only one Medical Officer, preferably male. This change is going to affect the performance ofthe clinics, because, firstly, the reduction in the number of Medical Officers is bound to affect adversely both the quantity and quality ofthe services being rendered to the clients. Now one Medical Officer has to do the work which
Old Pattern 1, Medical Officer
New Patlet 1, Medical Officer

(Male) I 2. Medical Offcer (Female) I
(Part-time) 3. Extension Educator (Male) 4. Extension Educator (Female) 5. F.P. Field Worker (Male) 6. F.P. Field Worker (Female) 8.

I

I I 4. A.N.Ms, I 5. Clerk-cum-StorekeePer I 7. Clerk-cum-StorekeePer I

(Preferably male) 2. Lady Health Visitor 3. F.P. Field Worker (Male)

I
1

2

I

Attendant

I

76

Family Planning in India

sterilized by a male surgeon. Thus, this step would act as a disincentive to female clients. Earlier, there were two Extension Educators, one male and one female, who were responsible for education and motivation ofthe people in their jurisdiction. But under the ne\ry pattern there was no one to look after this part of the programme. The problem of education and motivation of the people is important and becomes serious when viewed in the context of, first, our programme being based on a persuasive approach, and second,
that the educational and motivational part of tbe programme has not been attended to regularly and sytematically so far. Moreover, at least part of the population covered so far by the programme was ..self-motivated', and needed only slight persuasion. Henceforth, we have to contend largely with the hard core of the population which is quite resistant to and against the family planning programme. This section of the population needs much more educational and motivational eflort than the earlier one. This underlines the need for an intensive mass media programme. Thus, when there is a need for strengthening the mass media efforts, the new pattern has not only not made any provision for it, but has reduced the statr already provided for. Some of the voluntary agencies which we visited also pointed out the problems faced by them on account of low pav scales prescribed for the staff. These agencies were therefoi- not able to recruit well qualified persons and if recruited, they were not able to retain them for long.6
6

was being done earlier by two Medical Officers. Secondly, the eligible population comprises both males and females. In a society like India's which is very traditional, consenative and orthodox, it is difficult, and in some parts impossible, for women to come out to discuss their problems and to get themselves

Planning staff:

For example, Matra Sadan, a voluntary organization doing family planning work in Jharia (District Dhanbad, Bihar) since t958, has the following pay scales prescribed by the Government for Familv a) Medical Officer
b) Lady Health Visiror c) F.P. Welfare Worker
.r') Clerk-cum-Storekeeper

Rs. 350 p.m. (fixed) Rs. 250 p.m. (fixed) Rs. 135 p.m. (fixed) Rs. 150 p.m. (fixed)

Organization and

Administration

77

Besides these difficulties, voluntary organizations' clinics were facing serious problems with regard to the receipt of grants-in-aid and medical supplies' So far as the grants-in-aid were concerned the situation was very disheartening in the sense that the State Governments of Bihar, M.P. and U.P. were not giving grants in time. Medical supplies were also not only irregurar but often insufficient. However, in Punj ab these agencies were receiving a better deal than in the other three States. The representatives of these agencies were of the opinion that the attitude of the concerned State Governments was not at all helpful. Grants were sometimes delayed for years. In such circumstances, it becomes very dimcult for them to carry on their work. On the other hand, the government felt that these agencies were not doing good work. They did not supply the necessary information and returns in time to enable the Government to review their performance and take necessary action for sanctioning the grants and supply of medicines, etc. Unfortunately, this problem of non-cooperation has eropped up because ofa misunderstanding ofthe role of the voluntary agencies. During our discussions with government officials at various levels, we found that they considered the voluntary organisations as their competitors. Inspite ofthe announcement of the New Population Policy which envisages a greater involvement of the voluntary agencies in family planning work, there has not.been any change in the attitude of the State Governments. In none of the four States, the Governments had drawn up or were seriously thinking of drawing up a strategy to associate these agencies more intimately with the family planning programme. The review of existing relationship between the government and the voluntary agencies points out three factors that hamper a harmonious relationship, viz., communication, coordination and attitude. It is evident frorn the above review that there was a lack of effective communication between the government and the voluntary agencies. At the national level, communication was sought by the inclusion of representatives of voluntary
Everybody, inclutling the authorities of Matra Sadan and the Civil Surgeon, Dhanbad, felt that with these pay scales no one can afford to live in Jharia town,

78

Family Planning in India

agencies in the Central Family Planning Council, which advises the Union Government on broad policy issues connected with family planning. The etrectiveness of this communication can be gauged from the fact that this Council meets once a year. The importance of communication at the lower levels, especially in a federal structure where considerable autonomy prevails at the provincial and local levels, needs hardly be emphasized. Although voluntary agencies are operating mainly in urban areas yet wherever they were operating there was no institutional arrangement to associate them with the

formulation and implementation

of the family planning

to include them in the family planning committees and where such committees did not exist, by holding periodic meet.ings between the
programme. Efforts should, have been made
opposite numbers. With the adoption of the offcial family planning programme, the role of voluntary organizations has changed. Though they are continuing to co-exist with the government organizations it is necessary to define their role in the context of increased participation of the government in the programme. The possible changes that can occur in their role can be one or a combination of the following:

The voluntary organizations may carry on their usual activities in areas where they have a base, without overlapping or duplicating government-ron services; 2. Therc may be a division between governmental and voluntary agencies' activities by demarcating areas of work and/or services to be carried out by each; 3. The voluntary agency may be allotted only certain types
1.

of work to feed the government services; 4. The voluntary agency may fill, wherever it can, the interstices of the main programme run by the government; 5. The regular programae may be run entirely by the government. The voluntary agency may undertake only selected items, such as running ,'model clinics" or imparting population education. 6. The voluntary organization may withdraw altogether.
Whatever be the future arrangement,

it

seems certain that

O r ganizat i on

and Admini

s tr

ation

'79

be generally supplementary and complementary to the national programme. Voluntary agencies should however be given a chance to decide, in consultation with the government, what they could do best instead of being made to accept the decisions of the government blindly. There should be a forum for joint consultation and coordination of the activities of the two. With mutual consulta_ tions, functions could be delineated between them. Some of the areas in which they can play an important part are publicity and propaganda, extension and community education, evaluation and social research and service demonstrations by organising and running model clinics. harmony between goverument and voluntary agencies. There is a marked difference between the professed and the .,felt,' attitudes, which creates misunderstanding between them. For example, voluntary agencies see the government as full ofred tape, requiring too much paper work especially where money is involved; wanting to take over the clinics which they have built at the cost of years of effort; making the programme impersonal; aad providing services during government workinc

with government-run programme. These would

voluntary activities would only be small in volume as compared

Attitude is the other factor responsible for the lack of

hours only.

On the other hand, government officials regard voluntary
clinics when reorganization is needed; wanting help without any strings; and, too informal about their working and book_ keeping. Thoughthe role of voluntary organizations and the government is complementary, the respective status of each partner has not been clearlv defined. The Government in their attempt to implement the family planning programme have tried to involve the voluntary organizations as a partner, but in actual practice the latter have been assigned, over a period of time, the role of an .'associate," i.e., a member of ,less than
agencies as the ones which demand action from officials which is contrary to rules and regulations; possessive about their

equal status'. Thus, in a situation where one pa ner gets relegated to a lower position and the other limits its role. bv and large, to finding loopholes in the modus operandi ofthe former, a mutually satisfying relationship is very difrcult to build up.

80

FamilY Planning in India

The problem of population control is a very difficult one It is, therefore, necessary that the combined eforts ofthe government and the voluntary agencies be harnessed to a much greater extent than what they are today. Voluntary agencies have, therefore, to play a greater role. Fortunately, both the government and the voluntary agencies have recognised this fact. But no concrete steps were taken by the Government in enlisting the cooperation of the voluntary agencies in a greater measure or reorganizing the working ofthe clinics run by them in a fruitful manner.
and the job ahead is very challenging. EDUcATIoN ANo

MortverloN

The basic assumption underlying the family planning programme seems to be that individuals, on their own, will control fertility provided the rationality ofdoing so is properly communicated to them and/or they are offered a package of incentives and disincentives to do so. This highlights the importance of the role of communication in making individuals favourably disposed to the idea of family planning and to the acceptance of a method of family planning. In order to develop a Javourable disposition on thepart ofpotential acceptors, the family planning programme relies on a variety of interpersonal and media presentations. Adoption of an innovation or new practice follows the sequence of awareness, interest, evaluation, trial and acceptance. While the media campaigns help in creating awareness and providing information, the interpersonal communication involving family planning field workers friends, relatives and community and religious leaders helps in providing a favourable evaluation prior to the trial and acceptance ol a new practice. In India both media and interpersonal presentations are said to be used. In what follows we have made an attempt to analyse how they are being actually used in the
States in our samPle'

The media and interpersonal communication used across the family planning programme include:

to

put

(a) Film Shows (b) Mass Meetings (c) Group Meetings

O r gani zat

ion

an

d

A

dmini st r at ion

8t

(d)

Camps

(/)

(e) Home Visits
Exhibitions

(g) Posters (ft) Pamphlets/Folders

(i)

Puppet Shows

While the mass media have considerable potential for
influencing the thinking of the people, it is diftcult to establish a direct correlation between the intensity of mass communication and the performance in the field of family planning. With regard to the working of the important components of the communication system we offer our comments as follows.

Auoro.vrsuel Mrrpnrel

the necessary basic audio-visual material such as films, film strips, film projector, and audio-visual van. The district
bureaus were required to arrange film shows, etc. in the urban and rural areas in their jurisdiction. The position of films was very unsatisfactory in the sense that there were only a few films available and that too were very old. People had seen them several times and as such they did not have the desired impact. There is need for well-produced films relating to family planning. The Government should also explore the possibility of promoting the idea of family planning

The district bureaus of family planning were provided with

through regular commercial films. With regard to film projecror it may be mentioned that at most of the places it was

not in a working condition over a number of months. The same was the position of audio-visual vans. They were standing idle either for want of repairs or for petrol. Besides. these vehicles cannot be used extensively in Bihar, M.P. and U.p. where many of the villages are not connected with all-weather roads. As regards the urban family planning centres and primary Health Centres the only equipment available with them were a few charts and n"odels ofthe reproductive system. They had no other equipment and depended on the District Bureau for
arranging any film show, slide show or any other mass show. Such shows organised by the District Bureau were few and far

82

Family Planning in India

between particularly

in the rural

areas.

ExrrusroN Wonr
Mass and group meetings, home visits, exhibitions, posters and pamphlets were the other methods reported to have been used in both urban and rural areas to motivate people towards
no accuracy can be vouchsafed for these activities as no systematic and correct record any data on was maintained in respitt of them nor was there any check-up or scrlrtiny of this data. Ii is, therefore, difficult to have even

family planning. However,

ofthe amount of extension work being planning centres. Although it was claimed done b/ the family that a good deal of such work was being organised, we found it very much wanting when verified from the people whom we met and interviewed during the course of our study both in the urban and the rural areas. This was mainly beqause the family
an approximate idea

planning field workers, generally were neither adequately trained nor much interested in extension work for it involved considerable touring in the interior areas or remote villages to which they were averse. Moreover, the number of family planning field workers at the PHC and sub-centre levels was grosly inadequate for the task assigned to and expected of
them.

Virtually no family planning field worker had a clear concqr tion of his role as an extension agent. Almost invariably they perceived it to be a job to "persuade" people to accept sterilization. Inter-personal communication through home visits is recognised as one of the most effective methods to persuade people to adopt family planning. But in the areas covered by our study, such visits, although stated to be quite numerous, were actually few and far between. Instead, summary methods were generally employed to "induce" people either by the otrer ofmoney or the use of coercion to go in for sterilization. Immediate steps should, therefore, be taken to reorient the entire field staff so as to improve their competence and instil a better sense of service in them. All officers whom we met at the various service centres and at the State and the district headquarters, were optimistic about the efficacy of the mass publicity programme in creating a

Organization and

Administration.

83-.

.

favourable climate for family planning. They were, however, not satisfied with the way in which. it was being carried out. They wanted to intensify it but were not in a position to do so for a number of reasons, the nost important being..the lack of finance. Everyone pointed out the inadequacy of funds for rna$s publicity purposes. We were told that a sum of Rs 3000 , only. was provided in the budget of a District Family Planning Bureau for publicity. This was hardly suficient; even to maintain the equipment in a state of good repaiq. B"esides., this,
new posters, pamphlets and hand-bills had been issued, for a long time. The old literature was still in use but had lost rnuch of its appeal. Even this was in short supply. Whiie the importance of publicity in popularising the family planning programme was recognised on all hand.s, no positive steps have , been taken for a long time either to. augment the funds for publicity or otherwise strengthen the working ofthe publicity proglamme.

no

Besides this, specific techniques of_ communication for. motivation were not evolved keeping.in view the differences of. geographical location, income, education and socio-cultural . background of the people. For example, persuasion approach may have to be different for rural and urban populations,. While social adjustment is relatively. an impprtant factor ig.. determining the family planning behaviour of the people in the. rural areas, rational object-appraisal is a more important. determinant of such behaviour in the urban areas, There should.. be a periodical assessment of the family planning beliefs,and attitudes of the different classes of people through standardized KAP surveys. Such surveys, would provide useful guidelines for designing a suitable communication strategy for family
planning.

Popularrorv EoucerIoN

With regard to the introduction of population value.s in. the.' educational system, very little work had been done.until the, time ofour visit to the different States for the present study in, 1976. U.P. was considering to introduce populatiotr studies: at' the higher secondary stage, i.e., for classes 9 to 12. They. intended to make it a part of either the biology or the geueral -

84

Family Planning in India

science or social studies course but not an independent subject. For students up to the middle school stage they did not favour the idea of incorporating population studies in their syllabuses. For them, they wanted to train the teachers so that they could give some general lessons to the students. The Government of Punjab was thinking of introducing population studies in the curriculum of classes sixth to eleventh but they felt that it would not be possible to do this before the academic year 1979-80. In Madhya Pradesh, some elementary literature had been prepared for both students and teachers. It was being sent to training colleges for a trial on an experimental basis in selected schools in their areas. On an experimental basis, population study and health education had also been introduced

lately in the curriculum

of B.Ed. and M.Ed.

courses

at

the

Government College of Education, Jabalpur. We did not find any thinking being given to this subject in Bihar.
CoNcr,uorNc OBSERVATIoNS

For every programme which strives to meet the needs of the nation within limited resources, both human and material, improved organization and administration are a necessity. For planners who aim at maximum utilization of available resources, organization and administrative structure must become a priority concern. Though the extent to which the Government had recognized its importance cannot be documented, yet it was found that the situation was not quite satisfactory. In fact, the failure of organizational structure and administra-

tion essentially reflects the lack of symbiotic relationship
between the process of planning and administrative change. In other words, there is a lack of effective dialogue between the planners and the administrators. The basic conclusion on the administrative side which emerges is that the new programme was undertaken rvithout

creating the necessary organisational and administrative under-

pinnings. In particular, the administrative infrastructure for translating the programme into efective action was inadequate and incapable of delivering tbe services. Urban family welfare planning centres were generally

Organization and

Administration

85

attached to district and other hospitals where primary attention is devoted to medical work and family planning work generally receives only secondary attention. Moreover, the supervision and control over the family planning field staff was very lax'

In the revised pattern, the post of medical officer has been abolished at the urban centres covering a population of 25,000 to 50.000. This will create further problem for these centres to

carry out the programme effectively. The area of operation of a primary health centre was too large. It comprises on an average about 100 villages and one lakh of population. The resources, both human and physical'
at its disposal

example, provision lor indoor beds for tubectomy cases is extremely limited and in most cases the tubectomy operations are done atthe sub-divisional or district hospitals, which again have a limited capacity. Besides this, it involves sending cases far away from their homes. Secondly, the PHC is ill-equipped for extension work for family planning. Most of the audio-visual equipment such as a projector, publicity van, films, etc. are located at the district
headquarters and are available to PHCs once in a while. Thirdly, the sub-centres were particularly under-staffed and ill-equipped for the job. There was generally one A.N.M' and at some places one Dai or attendant was also provided. But being women, their movements were generally confined to their head' quarter village and the closeby villages where they can easily reach. The interior and distant villages were generally neglect' ed. Moreover, they were generally not able to reach the

for handling the tasks were very limited. For

menfolk of the villages.

The attitude of the State Governments towards voluntary organizations was generally indifferent and these organizations often found
admissible

it difficult even to get the assistance normally to them in time or regularly. A review of their

relationship is urgently called for. Educational and motivational aspect of the programme was one of the weakest parts of the family planning programme' Since the progtamme is supposed to be based on persuasive approach, the importance of it need not be over-efirphasized' However, it had not received adequate attention from the

.186

Family Planning in India

concerned authorities. Though some attempts to improve the 'situation was being made in some of these States, they werc far from satisfactory. In fact, all these were piecemeal effo rts i and there was no coordinated effort in this regard.

Cneprrn V

The People-Their Attitudes and Reactions

With a view to find out the people's attitudes and reaction to the family planning programme in general and the new population policy in particular we made a sample selection of a cross section of the people an{ interviewed them intensively' The sample consisted of a total of35l persons and included both rural and urban, beneficiary and non-beneficiary, and male and female respondents. Through stratified random sampling we tried to strike a reasonable proportion between these diflerent and contending groups. For details on our sampling design
please refer to APPendix

III.

tion. One was the widespread fear of the Government ilith regard to family planning prevailing in the selected States at the time our study was made. Our investigating team was often suspect in the eyes ofthe people, particularly in the rural areas, who thought that it was part of the governmental set-up out to "motivate" people for sterilization. This made many a respondent try to avoid meeting our team altogether. Consequently, we had to resort to take some substitutes in some areas and make do with such number of respondents as were available in the other areas. The second was the occurrence of floods in Amritsar District, Punjab in August'September of 1976 on account of which we could not visit any village and select any respondents there. The third was the unwillingness of women respondents in the rural areas of Bihar to give us an

Certain factors, however, militated against our sample selec-

88

Family Ftanning in India

interview. Therefore, we did not get any female respondent from the villages ofBihar. Nevertheless, the sample was fairly representative of the different classes of people iesiding in the selected areas. The broad features of the samfte ate given in the following table.
TABLE 5.
1

SaruPLn on PnnsoNs State and 4District

Ssr,rcrro

Acceptors Rural Urban

Rural

Non_Acceptors

(hban
Female

Total

Male Femsle Male Female Male Female Male
Bihar

Gaya Dhanbad
M.P.

18

24

,l

10

17
19

4r5a

2

2353
i 3

Hoshangabad

Datia
Punjab

I
9

62
f,

t2
IJ

47 50

Ropar

Amritsar
U.P. Allahabad

414
I

^ 3

:
7 o

o

3 3 d

Rampur

13 11
87

13

10

2 2

3

)
J

2

49

4 37

2

2
24
351

Torar,

50

29

l6

per cent rural and,28.2 pef cent urban respondents. The male_ female ratio was 3: 2, i.e., 60 per cent and 40 per cent, or 2ll !o 140 in absolute numbers, It is significant to note in this context that wt ereas .the number of female respondents in the

Of the 351 respondents, 196 had accepted the programme or the other of the family planning m€thods and .155 were those who had not, Thus, there were 55.8 per cent acceptors aad,44.2 per cent non_acceptors in the $ample. The rural-urbim composition was 252 to 99 or 7l .g
and were following one

The

People-Their Attitudes and

Reactions

89

aggregate fell much short of the male in the rural areas, they exceeded the males in the urban areas both among the acceptors
and the non-acceptors. This was partly due to the fact that we got no representation of women in our sample from the rural areas of Bihar owing to the prudishness of women there totalk to male investigators and partly explained by the reason that 6 of the 8 urban family planning centres in our sample being exclusi' vely maned by lady doctors, women naturally had a preponderence over men in their clientele. Of the 140 women respondents in the sample, 87 or 62.1 per

53 or 37.9 per cent non'acceptors. Among men, 51.7 per cent were acceptors and 48.3 per cent non-acceptors. As between town and village, 59.6 per cent of the urban respondents were acceptors as against 54.4 per €ent ofthe rural and proportionately there was the same difference between the non-acceptors from the two areas. Although religion was no criterion for selection, it reflected itself in the sample as shown in Appendix VII. The age composition of the sample is given in Appendix VIII.
cent were acceptors and LrrERAcy The educational level of the respondents is shown in Table 5.2 on page 90. As expected, the level of education was low both among the acceptors and the non-acceptors. About 59'7 per cent ofthe former and 63.2 per cent of the latter were illiterate, 18.4 per cent of the former and 20 per cent ofthe latter were literate only upto the Primary level and 12.8 per cent and 9.7 per cent in the two categories respectively had their education up to the Middle Pass level. The number of those who had their educa' tion up to the Matriculation standard or above was very small, being 18 and l1 respectively in the two categories. Proportionalely more of the urban than rural and more of the male than female respondents were educated. As between the acceptors and the non-acceptors the level of literacy was as given in Table 5.3 on page 9 1. OccupArroN The occupational structure Table 5.4 on page 92.

of the sample was as given in

90

Family Planning in India
Tasr,B 5.2

Drst sutrox
IIliterate

oF REspoNDENTs By LEvEL oF EDUCATToN
Acceptors

Non-Acceptors

'District

Stale

and

Literate up to

Middle

Matri lllite- Lite- Middle MotiPass cula- rate rate Pass culation and
above

Primary
Pass

up to

t

rcrl

Primary
Pass

and
above

Bihar
Gaya Dhanbad

23642 18533 1054 13 4 1633 111 1953 1772
J 5

l2 l6

533 431

M.P.
Hoshangabad

Datia
Panjab

2

13732 17432
IJ J

Ropar

Amritsar
U.P.

2
1

a1

21
I

Allahabad

4

Rampur

I
3t

Tor,cr

15

11

Cultivation and agricultural labour were the main occupations of the respondents in the countryside and shop-keeping and service in the towns. 49 per cent of all respondents followed cultivation as their main occupation. Their proportion in the acceptors was 46.9 per cent and in the non-acceptors 51.6 per cent. Agricultural labour was followed by 14.2 per cent of all respondents as their main occupation-l3.8 per cent of the acceptors and 14.8 per cent of the non-acceptors. Ssrvice accounted for 14.5 per cent of all employment. l5.g per cent of the acceptors and 12.9 per cent of the non-acceptors were in service ofone kind or the other. l2 per cent of the- respondents were in business, usually running small shops. Their proportion

The People* Their Attitudes ond

Reactions

9l

Test-r 5.3 PEtcerrecn DtsrntguuoN or AccsProns ,c.l'lo NoN' AccEPToRs gv LrrsRlcY GnouPs
Literacy GrouPs
Category

of

Illiterate

Upto PrimarY
Pass

Middle
Pass

Maticulation and
above

Respondent s

Acceptors Non-acceptors

54.4 45.6

53.7 46.3

62.5

a.l
37.9 100.0

37.5

Tor,nr

respondents. Among these were industrial labourers, artisans and the miscellaneous workers like mechanics, bicycle repairers, rickshaw pullers, etc. It may also be explained in this context that of the 140 women respondents' onty Z were employed-3 as agricultural labourers. and 4 in service. For the rest the occupations followed by their husbands were taken as their occupations. The cultivator class being the most important both among the acceptors and non'acceptors, it was considered necessary to identify them by the size of their holding' Consequently, data : was collected on the land held by each cultivator and then i classified into four categories. Holdings of upto 2 acres of land ' constituted the first category, of above 2 to 5 acres the second, of above 5 to l0 acres the third and above 10 acres the fourth' The first categoiy signified marginal farmers, the second small small number

per among the acceptoff and non-acceptors was l2'7 and 11'0 other occupations accounted for a very cent r;spectively. The

of

farmers, the third medium farners and tle foruth big farmers' : The data on this classification is presented in Appendix IX'

EcoNot{tc Sr,lrus

With a view to find out whether economic status of a person had any correlation with his attitude and response to family

92

Family Planning in India
t{ l-t

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86

rsEFs;.*g

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The People-Their Attitudes and

Reactions

93

planning, we tried to collect data on the income of the respondents. Income is a sensitive matter and any direct investigation into it is almost immposible. We, therefore, tried to assess the income of the respondent by a number of indirect questions and inferences such as the quantum and quality ofland held by him (by quality we meant whether it was irrigated or unirrigated and if irrigated by what source) and the kind of crops grown; the average wage rate prevailing in a village for agricultural labour; the nature of goods handled or services rendered by a shopkeeper and his probable monthly or annual trade turn-over; and length of service and pay scales of the servicemen, etc. On the basis of information thus collected we figured out the income most likely to accrue to a respondent and placed him in the apporpriate income- group. The four broad economic groups commonly in use in the administration for extending certain facilites to the people on the basis of their economic status such as the allotment of

or house sites or grant of house building loans etc., were adopted by us for the classification of our respondents. These groups or categories were .economically weaker section', lowincome group, middle income group and the high income group. Persons with an income of upto Rs. 300 per month were
houses

classified as belonging

to the economically weaker section.

Those with an income of Rs. 301 to Rs. 600 per month were placed in the Iow income group, those with an income of Rs. 601 to Rs. 1500 per month in the middle income group, and those with an income of above Rs. 1500 per month in the high income group. On this score the data turned out to be as given in Table 5.5 on page 94.
The economically weaker section constituted the largest single group both among the acceptors and the non-acceptors, but proportionately there was a big diference between the two categories. Whereas among the acceptors the weaker section formed 39.3 per cent of the total, among the non-acceptors its proportion was 56.1 per cent, signifying that the majority of the nona€ceptors belonged to the economically weaker section ofthe society. The low income group was almost on par with the economically weaker section among the acceptors, being 36.2 per c€nt of the !ot&l, but among the non-acceptors it was at a lower level, 26,4 per cent. This shows that more of the Dersons

94

Family Planning in India

T,{srr

5.5

DrsrRrBUTroN op RrsponorNTs By THEIR EcoNourc Srarus
State and

Acceptors

Non-Acceptors

District

E.W.S. L.I.G. M.I.G. H.I.G. E.W.S. L.I.G. M.I.G. H.I.G.
Bihar
Gaya Dhanbad
17

1l
11

14

61 4-

1373 195l1
r2

M.P.
Hoshangabad
5 8
10

54
7

1St

Datia
Punjab

651
5

Ropar

12

Amriisar
U.P.

t l)
16

I

7

6
1

I

I ll

I
f,*

I
11 lJ
-

2

Allahabad Rampur

31
t0

5

I

2

Torar,
E.W.S.

L.I.G. - Low Income Group.
M.LG. H.I.G.

Economically Weaker Section.

-

Middle Income GrouP. High Income Group.

in the low income group accepted the programme than those it. The same trend is visible in the other two income groups, i.e. the middle income group and the high
who rejected income group. In both, the proportion of the acceptors was higher than that ofthe non-acceptors. Analysing the data income-group-wise, the position emerges as given in Table 5.6 on page 95.
NulaeER oF CHILDREN PER FAMILY

In order to find out at what stage the respondents stood in the matter of their family size when they decided to accept or reject the family planning programme, information was collected

The People-Their Attitudes and

Reactions

95

T.lsI-r 5.6
PsRcrl.rtecs DtstntsutloN or Accrprons eNo NoN-eccrprons sy INcoras Gnour
Category

of

Respondents

E.Iry.S. L.I.G.
47.O
5

Income-Group s

M.I.G.
63.3
36.7

H,I.G.
66.7

Acceptors Non-acceptors

3.0

36.6

ToTAL

100.0

100.0

100.0

100.0

Nota; Abbreviations same as in Table 5.5.

on the number of living children they had. The position was as given in Table 5.7 on page 96. It may be seen from the above table that the number and proportion ofthe acceptors increased with the increase in their

family size. The largest number of acceptors were those who had six or more children already born to them. They constituted 30.6 per cent of the total acceptors. The next Iargest group
was of those who had five living children each before they opted for family planning. They formed 24 per cent of the acceptors. The next group of 42 or 2I.4 per cent was of those who had 4 children each. Thus, 76 per cent ofthe acceptors had adopted family planning only after they had four or more children each. Only 24 per cent had adopted it when they had 2 to 3 children each. Even in this group the acceptors with 3 children constituted 16.3 per cent and those with 2 only 7.7 per cent of the total. Thus, those who fell in line with the current slogan "Hum

Do Hamare Do" constituted less than
acceptors.

8

per cent of the total

On the other hand, the trend was quite different among the non-acceptors. Here the largest single majority was of those who had four children each, followed by those who had three. The two together constituted 60.6 per cent of the non-acceptors. This signifies that the majority of the non-acceptors consisted of those who did not consider having three to four children good enough for practising family planning. The two higher groups of non-acceptors with five and six or more children

96

Family Planning in India
p

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The People-Their Attitudes and
each, constituti ag

Reactions

97

17 .4 and 13.5 per cent of the total respectively, were obviously more amenable to family planning than the two lower groups. This was because of two reasons. First of all, the more the number ofchildren one has above a certain minimum (in the present case four, which incidentally also allows for the occurrence ofa certain amount of balance between sons and daughters), the more amenable he is to adopt family planning. Secondly, the more the number of children a person has, the greater, generally, is the attention and effort devoted to him by the family planning staf and other agencies concerned for bringing him round to adopt family planning. This is why there were more of acceptors and less of non-acceptors in the higher size-groups of family (5 or more children) in our sample. These reasoris also explain as to why those respondents, both acceptor and non-acceptor, who had only two children each could not be considered to be more anenable to family planning than the other size-groups,

MEN-WoMEN RArro

One significant fact which emerges from an analysis of the that proportionately more women were inclined to adopt family planning thao men. Taking all the women in the sample together, we find that as inaJry as 62. I per cent of them were acceptors and only 37.9 per cent non-acceptors. On the other hand, the proportion of acceptors to non.acceptors among men was about half and half. More precisely, the acceptors among men were 51.7 per cent and the non-acceptors 48.3 per cent. Among the non-acceptors, women were far less than men. Roughly, they constituted a proportion of l:2, i.e. whereas only 34.2 per cent ofthe non-acceptors were women, 65.8 per cent of them were men. Among the acceptors, however, the proportion of men was somewhat higher than that of the women. 55.6 per cent of them were men and 44.4 per cent wonen. The difference was of the order of 11 per cent, and was mainly due
sample is

to two reasons. First, men were more easily and directly accessible to the family planning agencies for canvassing than women. Secondly, more facilities were generally available for vasectomy than tubectomy, particularly in the camps. Over and above

98

Fatnily Planning in India

these reasons, women have almost invariably to take the permission of their husbands for adopting family planning, whereas men generally do not have to depend on the consent of or even consultation with their wives in the matter. In the final analysis, therefore, it appears that subject to the removal ofthe handicaps m€ntioned above, more.women were likely to opt for family planning than men. In other words, more of the women were

psychologically prepared for practising family planning than men. This is a hopeful sign.

AwenrNnss oF

FAMTLY PLANNTNG

of the family planning programme were they knew of family planning. Interestingly enough, all of them named sterilization. Some were aware of some other methods of family planning as well but there was none who did not know of sterilization. What was more. they spoke of sterilization in a manner as if sterilization was family planning and family planning was sterilization. None of
A1l the acceptors
asked as to what

them knew anything at all ofspacing ofchildren for better health of the mother and more careful and attentive upbringing of the child or had any definite knowledge ofthe various methods of family planning and their relative effcacy. Their awareness of the family planning methods was as given in Table 5.8 on page 99.

The majority ofthe acceptors knew of sterilization only as a method of family planning. They constituted 52.6 per cent ofthe total. Another 24.5 per cent knew of sterilization and the loop, and 9.7 per cent of sterilization and the condom.
The former group i.e. those who knew of sterilization and loop consisted mainly of women located in rural areas and the latter, i.e. those who knew of sterilization and condom were mainly men located in urban areas. The accepto$ who knew of all the three methods were only 15 or 7.6 per cent ofthe total. Those who knew of four methods, i.e. sterilization, loop, condom and the contraceptive pill, were only 8 or 4.1 per cent of the acceptors. The last two groups ,consisted largely of men and women who were educated upto the matriculation or above standard
because the avenues available

and were mostly in service. They were better informed mainly to them for acquiring knowledge were more than mere family planning sta.ff or other

The People-Their Attitudes and Reactions

99

sitiis
9 S= 'i o;* "l {v-o = s c4

llildl
.r I N

t3

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100

'

Family Planning in India

agencies propagating family planning. Being educated and mostly in service, their contacts were more than those of an ordinary man .or woman and many of them possessed a radio or transistor and read newspapers and other literatue. Of the other methods known to the acceptors, two were aware ofcoitus interruptus or the withdrawal method and one of the rythm. However, none .of them was quite sure that these would be absolutely foolproof in stopping a pregnancy. The above findings indicate that extension education was not evenly balanced as between the different methods. There was a concentration of effort on propagating sterilization and a comparative neglect of the other methods. The family planning field staff admitted that this was so and advanced three reasons. One was that as a matter of policy the State Governments favoured the propagation of sterilization more than of any other method because being the terminal method it ensured a permanent achievement and could be counted solidly in the progress of the family planning programme. Secondly, the perlbrmance of the family planning field staff was judged largely, if not wholly, in terms of the cases canvassed and brought forrh for sterilization. Therefore, in the interest of their own careers, they had to devote a much greater attention to sterilization than other methods. Thirdly, monetary backing in the form of incentive money was available only for sterilization and for no other method. Although by itsetf the incentive money would hardly bring round a person to accept sterilization, yet coupled with canvassing (which often included a good deal of ofrcial pressure) the money did play a supporting role. However., the main disadvantage of concentrating on sterilization to the point of neglect of the other methods, is that many of those who would like to practise family planning short of sterilization often find themselves in a dilemma. The dilemma is which other method will give them equally satisfactory results. The family planning staff hardly did anything to resolve this dilemma. On the contrary, they often seized this opportunity to hammer in with greater force the inevitability of sterilization. This repelled many of the prospective acceptors from accepting sterilization and often made them resign altogether from practising family planning. The awareness of the family p'lanning methods among the

The People-The.b Attitudes and Reactions

101

non-acceptors was as given in Table 5;9 on page 102. The most striking thing about the non-acceptors was that 41 or 26.5 per cent of them were not aware of any 'method of

family planning. Obviously, nobody had contacted them to suggest any. While we were informed by the family planning staff at the time of selecting the sample that all non-acieptors
had been approached and tried to be persuaded to accept family planning but when actually contacted by us about a quarter of them categorically stated that nobody had approached them and askedlhem to practise family planning. This wds corroborated by the fact that when we sought the assistance of the

family planning staffin locating the non-acceptors who were not easily tracable, the staffwas found equally wanting in their knowledge of their whereabouts. A large majority ofthe respondents who had no knowledge of any method of family planning belonged to the economically weaker section and the low incorne group of people, most of them lived in urban slum areas or the Harijan and poor bustees in the villages and occupationally constituted petty peasants, landless labourers, casfral workers and wayside shopkeepers. 'The rest of the non-acceptors were all aware of ster.ilization but only a quarter of the total knew of other methods' This. again goes to show that there has been a concentration of attention on sterilization and neglect of other methods in the spread of knowledge about family planning. The second best known method was the loop'and the third lhe condom. Only an insignificant number of two knew of the pill. No other method was known to any of the non-acceptors.
SouRces oF AwARLNESS

In ord", to find out to what extent the diferent agencies were responsible for spreading the knowledge of family planning, ilata was collected from the respondents about the primary source of their information. The position was as given in-Table
5.10 on page 103. The above table indicates that the role of the family planning

'

personnel in making people aware of family planning was not very large. Only 47.3 per cent ofall respondents came to know of it through them,41 per cent were informed by other sources

t02

Family Planning in India

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The People- Their Attitudes and Reactions

103

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104

Family Planning in India

the manner in which the
authority, in a brusque

p;;;i"';;';#H:f ;i.fr j."J'f;lllllil',i';'il,11"fr:0,,f : being held and exhorted them to undergo steriiization.
This was so_called exlension education was

propagating family planning *u, "on...n-.d. Wf-l "t has been on for a number of years ty *u, merely Ueing informed to get ready for.sterilization "o* unA U.ing l;led up for an operation. The family planning programme wis largety being concentrated in camps and campaigns. Every year two to three campaigns were launched by the government in what are generally called family planning fortnights or months. It was during rhese periods tha-t rhe famili plarnjng'p.rrono.r unO some other government ofrcials lte tle patwar"is ,oO tU. fto"t staff went round, usuallv
going

.Ou.ution,, can be almost wholly ruled out so far as ttre iamiiy planning personnel or for that matter any other government agency

and 11.7 per cent were totally ignorant. Being aware is not being sense, mucb less being eciucateJ. what was lacking in number was further .on po.nd;;;;-;;;;";d; the manner in which it was told. The term ,.."t.orion ""j

informed, in the real

family planning, i.e. during particular periods,

being largety carried out or the people

;.r; ;;;;;;i"rmed
iith

a snow

man_ner and through quick campaigning. what was often rold was rhat steriliz"ti;, or tubecls a simple, quick and safe operation";;;;;;; wfricf, ,Lp. 19m-V, birth permanently and that it carries a reward "f,la from the government in the form of incentive money. To ,h. _o." of the prospectiveclients it wu" ui* qiietry aadeo rnar rn case ofneed for a child_birth later it could be reversed also. Nobody explained how an .p.."ri", ir'"peitrmeo, in what mannerit stops the conception;nd what its consequences -no-t are to the health of a person. More often tlan ,h. paigners themselves did not know of the mechanism "uaof a steritization operation nor did they h""" th;;;l;;;;io ."pruin it to the peopre even if they knew. ;d;;;;;;;mme was generally time and rarsef bound. their mission i,ul ,.qu;"L Catch" rather than to- carry conviction. For this ihe f.amily planning personnel or other government offcials were not to blame primarily but rhe cou.rn-.niitr.ii.'iju"i"g lrnp".r.a an urgency to the programme to show quick resuiis and in no less a tangible form than steriljzation, i1 was the Govern-

of of

:fflTrry

The People-Their Attitudes and

Reactions

105

ment which had reduced extension education to such straits. In the above circumstances, it was not surprising that the family planning programme came to be known in the common parlance as "Nasbandi Programme" and a large number of people, to the best of their ability, tried to avoid being caught for sterilization. Whenever a campaign was launched or camp held, even for other forms of family planning than only sterilization which was indeed rare, a scare spread through word of mouth to distant places and among a large number of people "Nasbandi-wale earahe hein. Hoshiyar rahura, Bhai." (The operators of sterilization are coming. Beware.) This is how the category consisting of friends, relatives and neighbours became the second largest source of information on family planning, the word information being used only in the sense of being made aware that something was going on about I'amily planning, more probably that a sterilization drive was on. This group was

largely a rumour group and, therefore, still less specific in imparting knowledge about family planning than the family planning staff. Nevetheless, 21.9 per cent of acceptors and 34.2 per cent of non-acceptors got their first wind of family planning through this group. The persons who were really informed, or rather better informed, were those who had as their source of knowledge the radio, the newspaper or other literature, more often a combination of ali the three. They were mostly educated, urban and economically better off. However, their proportion was very small, being only 8.7 per cent among acceptors and 5.8 per cent among non-acceptors, or 7.4 per cent in the total. Their knowledge was self-acquired, more specific and varied.

fore, we drew a complete blank on the part played by voluntary organizations in our sample villages. However, in two of the eight cities in our sample thexe were

A word about the role ofvoluntary agencies in disseminating information about family planoing is also necessary. Iu none of the villages falling in our sample was there any voluntary organization working nor was any youth, women's, social or cultural organization associating itself actively with the propagation of family planning. In fact, none of the kinds of organi"ation mentioned above existed in any of the villages. There-

voluntary organizations which were propagating the family

106

Family Planning in India

planning programme and running family planning services. These were at Allahabad aud Amritsar. But as the institutions selected by us for intensive study at these places were other than those run by voluntary organizations, their role in disseminating knowledge about family planning does not get reflected in the above table. Even otherwise, their role would have been very small. We visited these institutions and found that owing to lack of funds and staffthey were not engaging themselves in any kind of outdoor extension work, but were confining themselves to

communicating only with such persons as came to theit clinics for health or maternity reasons. This was confirmed by our visits to three other institutions located at Lucknow, Patna and Jharia. There too theirworkwas confined to rendering advice on family planning only to those who came to their clinics and providing clinical services to them.

Pnecucr oF FAMTLY PlauNtrc
We now go over to the actual practice of family planning among the acceptors. They were asked as to which method of family planning they had adopted. The result was as given in Table 5.11on page 107. It will be seen from the above table that only three methods were adopted by the acceptors-the sterilization, the loop and the condom. Although some of them were aware of the pill as well, none had used it. Any other method than the three named above had also not been used by any acceptor. Steriliza' tion was way ahead and towered over the other two methods used. 175 or 89.3 per cent of the acceptors had gone for sterilization, only 12 or 6.1 per cent for the IUD and 9 or 4.6 per cent for the condom. This is as was expected. With a high concenffation ofattention and effort on sterilization and a neglect of the other methods, the result could not be any different' During our investigations, we carne across some very interesting cases which are worth narrating. Two of the respondents told us that although they were using the condom for a number of years, they were not recorded as acceptors by the family planning staff on the plea that they were not taking delivery of thc condom from any recognised agency. As there was no

The People-Their Attitudes and Reactions

107

TlsrE

5.1 |

DrsrnrrutroN oF AccEPToRs BY METHoDS oF Feltr,v PIINNTNG Anoprro
Stale and Method Adopted
Yaseclomy Tubectony

Dislrict

IUD

Condom

Pill

Any other

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record to substantantiate their claim that they were regular users of condom, they could not be treated as acceptors. Although there was no such rule or instruction, the over-zealous staff was applying its own rule aud goading these persons to get themselves or their wives sterilized. Ultimately, one got himself and the other his wife sterilized. The entry then made against their names read as follows, "Earlier us'ing condom but now (the date) got himself/his wife-sterilized. " In another case, both husband and wife were sterilized with' out the kuowledge of the other and both were recorded as acceptors separately. The woman was sterilized during a campaign when the husband had gone on a pilgrimage andthe rvro was sterilized later on in a camp. Both did not inform each other for different reasons-the woman for fear of being reprimanded and the man for fear of being considered sexually

108

Family Planntng in India

incapacitated. In yet another case, a man had got himself sterilized but still his wife became pregnant. When he offered himself for a check-up and a second operation if necessary, he was quietly advised to get his wife sterilized this time to make it doubly sure, He dutifully followed the advice. After ascertaining what methods of family planning were followed by the acceptors, we naturally enquired why they had adopted fan:rily planning. Their responses are presented in table
5.12 on page 109.

because of the prevalence of a wideof the government with regard to family planning at the time our investigations were conducted. Consequently many people did not want to disclose their mind to us and some deliberately tried to put us of the track. We had, therefore, to employ some supplementary questions to arrive at the truth. One such question was at whose instance they had adopted family planning. Another was where they were operated upon for sterilization. Taking the supplementary questions first for analysis, we found that as many as 115 ofthe acceptors had adopted family planning at the bidding of the family planning staff and 27 at the instance of other government offcials. Together they constituted 72.5 per cent ofthe acceptors. Thus, oficial counsel or advice was the largest source of motivation o[people towards fa"r:rily planning. Of the rest, 37 or 1g.g per cent were self-motivated and 17 or 8.7 per cent were motivated by friends or relatives. It was, however, a different story as to why the counsel or advice of the officials prevailed. It came out in answer to the second question-',Where were you operated upon for sterilization?"-that 137 or 69.9 per cent ofthe acceptors had been sterilized in camps specially organised for the purpose. The common sites for the camps in the rural areas were big villages, locations where village festivals and fairs were held, including weekly markets, and sometimes the primary health centres themselves. In the towns the camps were generally held near the crowded localities inhabited by the lower middle and poor class people. Preparations for tho camps were made well in advance. Mobile units of medical staff were deputed to peiform
spread fear

tion. This was largely

To find out the real motive of the people for adopting family planning was one of the most difficult tasks of our investiga-

The People-Their Attitudes and Reactions

109

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Family Planning in India

the operations. Family planning field staff would go round the neighbouring villages or localities usually in government vehicles to exhort and "persuade" people to come forward for sterilization. Revenue offcials, block staff and school teachets were also often pressed into service for mobilizing people for operation at the camps and generally free trasport-trucks, pick-ups, etc.-were provided to carry people to camp-sites. At the camps, the assembled people were given refreshments, usually tea and snacks, before operation, and care was taken that

nobody slipped away. Where camps were held jointly or separately for tubectomy, women patients were kept in improvised wards for 4 or 5 days and, besides free dreessing and medicine, were given free meals. Every acceptor, whether of vasectomy or tubectomy, was also given a cash award at the time of his or her discharge from the camp. Broadly, this was the scenario in which a large majority of acceptors had undergone sterilization. In such a situation, obviously, a large majority ofthe acceptors were unwilling or involuntary participants. They had been brought to camps through the exercise of ofrcial influence and display of authority and were made to sign onthe dotted line. They had no escape, €xcept at the risk of incurring the displeasure of the officiald which very few of them could afford. While 27 or 13.8 per cent cf the acceptors were bold enough to admit that they had undergone sterilisation because of pressure brought to bear on them by the family planning staff or other government oficials, as many as 1 18 or 60.2 per cent gave us only an omnibus reply that they had adopted family planning in order to limit the family size. Actually, limiting the family size was not the reason, not the real reason at least, but the consequence ol practising family planning. We pointedly asked this group to tell us why they wanted to limit the size of their families and the result we got was quite interesting. A large majority ofthem looked askance at us and could not immediately hit upon a reason to justify their action. Some said, "The officials visiting our village had told us that it was not good to have too many children and those who had three or more must undergo sterilization. So, we did." Some told us, "We have had no children born to us for the last many years but we were advised by the officials to make it 'pucca' by

The People-Their Attitudes and

Reactions

III

undergoing sterilization. Hence, we did." A few looked obviously too old and long past their youth to need sterilization but still they had it. Perhaps, their answers were nearer the truth. They revealed that they had gone in for sterilization primarily because of the pressure or influence of the offcials rather than of their own free wiil. The muted look of the many revealed even more. While they knew their mind, they were not willing to disclose it to us. In all probability this was because they did not want to antagonise the officials, at whose instance they had adopted the programme, by telling us the truth. In order to find out further whether there had been any prolonged orientation of the people on family planning by the officials we addressed one more question to them. The question was, "How many times had the offcials propagating family planning met you before you adopted the programme?" The answers gave us an average of L6 meetings. In other words, the officials had met them only once or twice before adoption. Thus piecing together the inf<rrmation we collected through different questions, one fact which stood out clearly was that a large majority of the acceptors in this group had adopted the programme not because of the exercise of a free will exposed to a process of thinking, reasoning and deliberative decisionmaking but due to the pressure or influence of the ofrcials brought to bear on them through quick campaigning and snap decisions. In this context table 5.13 on page 112 may also be seen. It shows the primary source of motivation of the acceptors. Going back to Table 5.12, we find that 1 I or 5.6 per cent of the acceptors had opted for family planning in order to protect the health ofthe women bearing children and 8 or 4.1 per cent because they found it difrcult to maintain a large family. The

.

two together constituted

a

group

in

which the number of

children already born was large enough and discretion suggested to them to restrain themselves frorn bearing any more. Sorne of them considered it necessary so as not to expose women to any further hazards of child-birth and others so as not to add any more burden to supporting an already large family. This was a group which wanted to stem the rot which had already set in and did not want any more rotting. The merit in their case lies in the fact that they had perceived the rot and wanted to
stop

it.

112

Family Ptanning in India
TABLE 5.

l3

DISTRIBUTIoN oF AccEPToRs BY THEIR PRMARY

Souncr
State and Influence

or Morrverrou
Own

of

Dislrict
Bihar
Gaya Dhanbad

ofrcials

initiative

Advice of friends and rclatives

z7
23

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Hoshangabad
17

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Punjab

lo

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lo

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U.P. Allahabad
23
19

,
5

6

,
I
,'

Rampur

6

Tor.lr-

142
18.8

t7
8.7

PERCENToTToTAL 72.5

On the other hand, there was a group which had a more positive approach to family life. 18 of them had adopted family planning in order to provide a good upbringing to their children and 14 were actuated by a desire to improve their standard of living. The two together constituted only 16.3 per cent of all acceptors. Although the group was small, it was enlightened and largely self-motivated. These were the people who had realized early in their married lives the necessity of family planning and acted upon it. They were all educated, generally above the middle school standard. A good number of them were high school graduates and some had received still higher education. They were both from the urban and the rural areas but the majority of them belonged to towns. It was in this group that the methods like the condom and the IUD were Iargely used.

The People-Their Attitudes and Reactions Those who admitted that they had adopted

ll3

family planning

because ofthe pressure exercised on them by the family planning sta.ff or other government ofrcia.ls were a mixed group which

of interest or affinity of outlook. They came both from the rural and the urban areas. Although the majority of them were men, yet there were some women too among them. Most of them were illiterate but there were some who were literate upto the primary pass level. They belonged to different age-groups and diftbrent communities other than Christian. Some were residents ofa rehabilitation colony where certain facilities being extended to them were made contingent upon their adopting family planning (which virually meant sterilization), some were shop-keepers who were threatened with a "Challan" (prosecution), somb were small cultivators to whom grant ofcrop loans was "delayed" and sorne landless agricultural labourers to whom allotment of land under the scheme of redistribution of surplus land was withheld "for the time being." It may, however, be added in fairness to the family planning programme that they all had four or more children each. This does not mean that they were fit subjects for the exercise of pressure but only that they were highly eligible for practising family planning. This should have been brought home to them through a process of education, persuation and motivation rather than coercion. It is also clear from Table 5.12 above that nobody had adopted family planning for the lure of money. We asked both directly and indirectly whether money had played any part in inducing a person for undergoing sterilization. Even the most indigent of the acceptors in our sample denied that money was
had no particular identity any consideration. Whereas the amount of incentive or compensation money being paid earlier to an acceptor was Rs. 10 for vasectomy and Rs. 20 for tubectcmy, it had been raised in the wake of and formed an important plank ofthe new population policy. The revised amount varied from Rs. 25 to Rs. 100 a-s a direct cash award to an acceptor, depending upon the number of children he or she had immediately before undergoing sterilization. While these were the rates adopted by the Governments

of Bihar, Punjab and Uttar Pradesh, the Government of Madhya Pradesh had gone a step further and raised the minimum amount to Rs. 50 in order to make the incentive still

114

Family Planning in India

more attractive. Of the 175 persons among our respondents who had gonein for sterilization (vide Table 5..11), 39 or 22.3 per cent had done so after the introduction ofthe revised rates. They were, therefore, exposed to a much greater temptation to accept sterilization than those who had gone in for it earlier. Nevertheless, none of them admitted that he had been actualed by a desire for money. They cited other reasons asgiven in Table 5.12 but not the lure of money. Judged in the light ol

our own observation that there were strong

feelings against

sterilization, both explicit and muted, among a large number of people, their denial that money was a motivating factor does not appear to us to be implausible. The policy behind the offer of a higher amount of incentive money, therefore, does not seem to have any basis in peoples' motivation. Inthe final analysis, we find that 13.8 per cent oftho acceptors had adopted family planning because of the pressure exercised on them by government offcials. Another 58.7 per
cent can also be legitimately counted to have adopted feunily planning because ofthe pressure ofofficials. Although there is no direct evidence to support this contention, all the circumstantial evidence leads to this conclusion. A small number of 3 or 1.5 per cent of the acceptors were unable to identify as to why they had adopted family planning,9.1 per cent had perceived the baneful eff€ct ofa large family and decided not to beget any more children and 16.3 per cent felt the necessity of limiting the family size so as to have a better standard of living or provide a decent upbringing to their children. Nobody had adopted family planning for the lure of money, not exclu-

sively at least.

NoN-eooprroN or

F.q.N{rry

PrlnNrNc

Equally important with reasons of adoption were the reasons for non-adoption of the family planning practices. We enquired from the non-acceptors as to why they had not adopted family planning. Their answers are summarised in Table 5.14 on
pages I 16- 17. As the above table indicates, 4l or 26.5 per cent of the nonacceptoru had not adopted family planning because they did not _know of any method. While it is true that they had no definite

The People-Their Attitudes and Reactions

1r5

knowledge of any method of family planning, it does not necessarily mean that they would have adopted the programme if they had the knowledge. What the reply indicates is that even the first step of informing them what family planning meant and what the different methods rtrere to practise it had not been taken in their case. This points to a serious lacuna in the €xtension effort. Nevertheless, we asked this group a direct question, .,If you have the knowledge of or are imparted knowledge on the use of various methods of family planning, will you adopt any of these?" Nobody gave a ready consent. They gave different answers but the consensus of opinion was that they would have to consider the matter and then only they could decide whether they would adopt any. Quite a number of them, l7 out of 41 to be exact, also added, "Sir, iif you are hinting at 'Nasbandi', then we will not accept it. It is very harmful." Apart from expressing their opposition to sterilization, perhaps unwittingly they gave themselves out by their answer that they were not quite as ignorant of family planning as they were presenting themselves to be. The second largest group of non-acceptors, 36 or 23.2per cent

was of those who felt that children

were gifts of God or that planning was anti-religion or anti-God. This shows tbat family they had a very tradilional outlook on family life. They certainly needed some amount of "brainwashing" before they could be expected to adopt family planning. Obviously, thistoo had not been done.

There was another group which felt that if they adopted family planning, by which they meant largely sterilization and to some extent loop insertion and no other method, they would suffer from ill-health or weakness. Some men among them also felt that sterilization would lead to impotency. Together they constituted a group of 35 or 22.6 per cent of non-acceptors. This feeling had occurred largely because ofthe negligence ofthe family planning field statr in taking even the most elementary aflercare of the loop insertees and the persons sterilized. Once a person was sterilized and discharged from the camp or hospital or fitted with loop and allowed to go home, he or she was generally forgotten and lefr to fend for himself or herself in case any complications arose. This allowed a free scope

116
l

Family Planning in India

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People-Their Attitudes and Reactions

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118

Family Planning in India

for the rumours to spread and they did a considerable damage to the programme. While the loop did cause bleeding and backache in many cases, the near absence of any follow-up action or even of precaution helped the rumours to blow its ill
effects out of all proportion. One such rumour which we heard quite often was that if the loop was allowed to stay in the womb for a long period it would cause cancer ofthe uterus.

Equally harmful were

the rumours about sterilization. All

kinds of illnesses and

weaknesses, including impotency, were being blamed on sterilization. Very little had been done to scotch the rumours or disprove the accusations. This has allowed a

prejudice to grow in the minds of many people against family planning, Among the rest of the non-acceptors there were 8 who wanted to have one or more sons and 3 who desired to have at least one daughter before they would agree to adopt family planning. The desire ofthose who had no son and wanted to have one is understandable and can be readily conceded. But whether they would stop at that and would not like to have more sons is a moot point. Similarly in the case of those who already had one or more sons but wanted to have some more it was difficult to say where the process would end, or at what level their desire for sons would dry up. Those who wanted to have at least one daughter might not have one until another couple of sons are born or might like to have another son following the birth of a daughter. As there is no scientific basis to determine in what order girls or boys will be born and there is a lot of soothsaying in these matters in the rural areas, the chances are that the desired balance may not be struck until it is already late in the day, i.e. about half a dozen children are already born. At that stage, family planning has no particular significance. It looks nore like an act of despair than a measure of practical policy, Why we have emphasized this point particularly is that we did not find any ofthese non-acceptors having less than four children alreadY. There was a group of 18 women, constituting 1 1.6 per cent of the non-acceptors, who wanted to practise family planning but were helpless because their husbands or mothers-in-law were opposed to it. Each of them had 3 to 4 children already born to them and had realized that an indefinite child-bearing would be

The People-Their Attitudes dnd Reactions

u9

detrimental to their health. They were, therefore, keen to adopt family planning but tleir husbands, or mothers.in.law, where they were strong enough to exercise a decisive influence, would not permit them to do this on ideological grounds. They were orthodox people and felt that child-birth was an act of God and an attempi to stop it by artificial means would be an interference in the act of God and, therefore, irreligious or immoral. About half the women in this group y'rere Muslim and a large majority of them belonged to urban areas. The realization that too many child births were detrimental to health was the result of their frequent contact with the medical staff of the hospitals and dispensaries which they used to visit for their ailments. Many of their ailments were traced to their weak health and they were advised to avoid further child births. Primarily, the advice was in favour of sterilization, but failing that the loop
was suggested. Since the sterilization could not be undergone v'ithout the consent or at least the knowledge of the husband and other family members, it was summarily ruled out. The loop was acceptable but the fear ofrhe husband and/or the motherin-law, in the eveJrt ofdetection, gripped them so much that

to be the only persons among the non-acceptors who were fact, they earnest and keen on practising family planning. were only technically non-acceptors but were actually willing to adopt family planning if they were given a chance, or proper
us

they finally opted out of the loop as well. Nevertheless, it showed that they were convinced ofthe utility of family planning and had they been allowed to exercise a free will, they would have adopted it, but the circumstances beyond their control prevented them from doing so. The two groups in the sample, i.e. the one of women who wanted to practise fanrily planning but could not do so because of the opposition to it by their husbands or mothers-in-law and the other ofthose who had tried a method but forsaken it for its failure to give them the necessary satisfaction, appeared to

In

knowledge, to do so. They were mentally prepared for it but only circumstantially handicapped. It is significant to note in this context that of lhe 26 non-acceptors who were earnest about
practising family planning as n)any as 2l were women and only five men. The women constituted as high a proportion as 39.2 per cent of all female non-acceptors, whereas men formed

120

Family Planning in India

only 4.9 per cent of their total. The big dr'ference between the many more women were willing to practise family planning than men. However, altogether this group constituted only 16.8 per cent of the non-acceptors. The remaining 83.2 per cent were not willing to adopt family planning. They were not mentally prepared for it and most of them needed considerable amount of reorientation in their outlook and attitude before they could be expected to fall in line. Although a wide variety of reasons was given by the respondents for not accepting the programme, going deeper into the question, we found that their non-acceptance stemmed mainly from a life slyle which is really hard for them to chage. Centuries oid, deeply ingrained values, which glorify motherhood, masculinity and raising of large families; highlight the importance of having sons for a variety of reasons, not the least of which is for the performance of after-death oblations; confer social prestige inter alia on the basis ofthe family size and denigrate sterility, are not easy to supplant, particularly when no serious, systematic and sustained effort has been made to reform the

two indicates, again, that

system and reorient the values.. Coupled

with this, in many cases, are the economic compulsions to have a large family which alone ensures a better income to meet even the most modest needs of daily life in an otherwise grim situation ofgross under-

employnent and low returns.

Klrowreocr oF NEw Porrcy

Measunrs

would be appropriate to ask them first of things which were more immediate and closer to them than the distant Dational policy and the answers we received justified our approach. Of the 196 acceptors, as many as 128 or 65.3 per centhad no

With a view to find out whether the knowledge of the various incentives and disincentives and other measures being introduced by the government to promote family planning had reached the local levels and if so in what form, we enquired from the acceptors and the non-acceptors separately whether they knew of any such measures and if so what. The result was as given in Table 5. l5 on pages 122-23. We did not put a direct question to the respondents whether they knew of the new population policy because we thought it

The People-Their Attitudes and

Reactions

121

knowledge of any of the measures introduced lately by the respective State Governments for promoting family planning' This was not surprising. With the extension efort being so limited and thinly spread as we have seen above, the result 'could not be much different. Moreover, the new measures had been introduced only a short while before we made our enquiries. Only a few weeks to a few months h3d elapsed betw€en the introduction of these measures and our investigations' During such a short time it was not likely that they would be known to many people unless an effort was made to publicise them expeditiously and widely. This was not done. Consiquently, news was trickling down slowly and gradually and only those people came to know of these measures who -were either reading newspapers or were in more frequent contact with the staff of the primary health centres or of the hospitals and dispensaries in the towns or had a direct personal experience of any of the measures. Of the 68 persons who knew ofthese measures, 38 or more than half knew ofonly one item, i.e. a higher amount of incentive money or compensation being paid for sterilization now than before. The major source

of information was their

own experience. 29 of these persons sterilization after the amount of compensation had undergone money had been increased and had received the higher amount' 'They were, therefore, aware of this measure' The other t had
€ome to know of

it from other sources' mainly through

casual

talk with the staff of the primary health centres or city hospitals

which they had visited in the meantime' the groups had only a vague knowledge ofthe Howevei, both rew measure. By andlarge, they knew either of the amount which a person had himself received or that a certain higher

and

dispensaries

different categories of acceptors were under

the new scheme' not know whether any payment was made for They also did food or transport. This was the state of knowledge of those

amount was being paid now than earlier, but did not know what amount exactly was admissible 1o which category or what the

'who knew ofonly one measute in a package of incentives and .disincentives introduced by the State Governments in the wake of the new Population Policy.

Another '14 or7'1per cent of the acceptors knew of two items, the higher incentive mon€y for sterilisation and the

t22

Family Planning in India

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The People-Their Attitudes and Reactions

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124

Family Planning in India

raising of the age

of

the exactness ol their knowledge of the former r,vas no bitter than that of of 38 acceptors discussed above. They were quite as Jh9 S^toul indefinite about the amout of money being payaLle to diferent categories of acceptors and other facilities being available under the scheme as the other group. The ,ou..., o1 tieir information about this measure were also the same as those of the other group. 8 ofthem had known it from their own experience and 6 through their contact with the staf of primary iealth centres or the city hospitals and clinics vjsited by them. In addition, 3 of them had also read about it from the handbilts issued by the District Family Planning Officers of two districts, Gaya and Hoshangabad, but did not rem€mber what was mentioned therein except that some higher amount of monev was beins offered for sterilization. As regards the other measure, i.e. thi proposal to raise the age of marriage, 9 of them had read about iJ in the local papers and 5 had heard of it fronr friends and neighbours. When asked to state exactly what they knew about it, surprisingly 8 of them did not even know whetLer the mea_ sure bad already been introduced or was in the proposal stage. Their reply was ofthekind ..we had read/heard about it quite sometime back. We do not know exactly whether it has been introduced or not. Perhaps, it rright have been by now or might come soon." In addition to these g, another 3 did not know what the proposed ages were. Only 3 of the group had a definite information both about its still being a proposal and what the proposed ages of marriage were. Alf thl : were educated-2 matriculates and one middle pass. Two of them were in service and one was a businessmen, The remaining 16 respondents who knew ofthese measures were better informed than others both in respect of the number of items and the contents thereof. Four of them knew of hieher incentive money for sterilization, raising of rhe age of marrlge and certain other incentives being offered to the acceotors. Among the other incentives known to them were the grani of a rebate of50per cent in land revenue to those farriers who agreed to be sterilized and the assignment of priority in the allotment ofhouses and plots and grant of loans to those indi_ viduals who volunteered for sterilization. These incentives were

measures, one already introduced and one proposed,

marriage. Although they knew

of two

The People-Their Attitudes and Reactions

t2s

being offered by the U.P. Government and were known to three of the respondents in this category who belonged to U'P' Surprisingly enough, even an important incentive like grant of 50 per cent remission in land revenue was not widely publicised and only an insignificant number of cultivators knew of it' The other respondent in this category belonged to Bihar. He knew of only one other incentive, i.e. grant of priority in the allotment ofhouse-sites and house-building loans to persons who had undergone sterilization after two living children. All four ofthem knew that the cash award being offered for sterilization ranged from Rs. 25 to Rs. 100, depending upon the number of children one had before undergoing steriiization' Those with two children or less got Rs. 100, those with three Rs. 50, and those with four or ntore children Rs' 25. They also knew that the raising of the age of matiage was not yet enacted into a law but that it would be enacted soon and that the proposed minimum legal age of marriage was 18 years for girls and 2l years for boys. However, only one of them knew that the remission in land revenue was admissible for a period of 3 years only after sterilization, while the other two were under

thi

it would be available for life' None of what manner exactly the priority would be them linew in given in the allotment of houses and house-sites ald grant of l,oans to those who opted for sterilization. All the four of them were middle pass or above in education. Three ofthem were cultivators from the tural areas and one a shopkeeper from an urban area. Two of them were in the middle income group
impression that
and two in the low' There was another

group of five who knew of the higher sterilization, raising of the age of marri4ge incentive money for and ofthe disincentives or disadvantages that applied to those who did not undergo sterilization or otherwise limit the number of children to two or three. It is significant to note that aU these five respondents were public servants. Three of them belonged to Madhya Pradesh and two to Punjab and that none ofthem had any knowledge or stated to have any knowledge of any incentive other than the cash award for sterilization' Since the Governments of Madhya Pradesh and Punjab had introduced schemes which consisted largely of disincentives and since these were applicable only to public servants, it was natu-

126

Family Planning in India

man to whom these were not applicable. The Government of Madhya Pradesh had not provided any incentives to public servants as such, which were not available to the general public. On the other hand, there wasa set of disincentives which were exclusively applicable to public servants. In fact, the only incentive applicable to the general public itself was the payment of a cash award for undergoing sterilization and none other. It was, therefore, not surprising that the respondents from Madhya Pradesh falling in this category knew of only disincentives which applied to them and ofno incentives for there were none which existed. In the case of Punjab, there were a few incentives as well, besides the disincentives, which were applicable to government servants. But tbese were ofsuch a flimsy nature, compared to the disincentives which were very hard and fast, that most of the government servants did not consider them incentives at all. When their attention was drawn xo the provision of the issuance ofa letter of appreciation or the grant of an award to those employees who exceeded the achievement of the target allotted to them by a certain percentage and the increase inthe quantum of maternity leave from three to five months to such female employees as restricted the birth of children to two only, the respondents reacted with the remark that these were hardly the incentives which would enthuse anyone. They refused to recognise these as incentives on the ground that these were not at all material to the career of a government servant, whereas the disincentives were very harsh, definite and far-reaching in their consequences. Being educated andin public service, all the respondents in this category were well informed of the provisions of the various measures. It was, however, interesting that despite being acceptors themselves, they were very exercised about the disincentives. Their general attitude was that although they were not affected by such measures as ineligibility for allotment of government accommodation or grant of loans, they were still covered by the provisions of disciplinary action for not being able to fulfil the quotas of motivation for sterilization or loopinsertion allotted to them. Further, the penalties provided for under this measure were unduiy severe and would adversely

ral that they alone would know of them and not the common

The People-Their Attitudes and

Reactions

127

affect their careers permanently. They, therefore, felt greatly agitated, resentful and apprehensive about the operation of this measure. Moreover, they felt that the scheme of dis-incentives, being applicable to public servants only and to no other class of citizens, was highly discriminatory and partisan in its approach. In their opinion, this was not good for the morale of the public servants. The most knowledgeable among the acceptors was a group of seven who knew of four items and knew them fairly well. The four items were higher incentive money for steri.lization, raising ofthe age of marriage, other incentives and disincentives. Five ofthem were public servants agaiu, and two private citizens. All of them were fairly well educated. Four of them belonged to urban ateas and three to rural. Among the rural respondents, one was a village level wo.ker, one a school teacher and one a big cultivator and local leader. Two of the respondents were rvomen and five men. The major sources of their information were their contact with public authorities and the newspapers. Three of them belonged to Bihar, three to U.P., and one to Punjab. None of them belonged to Madhya Pradesh because in Madhya Pradesh there was no scheme of incentives (other than higher incentive money for sterilization which constituted a separate category in our classification) in operation either for

public servants or private citizens. Of the three respondenls from Bihar, two were public servants. They had a good knowledge ofthe various measures of incentives and disincentives introduced by the Government of Bihar as well as of the proposal to raise the minimum age of marriage. They, however, did not know of all the incentives and disincentives incorporated in the scheme because the list thereof was too long for anyone to remember. Nevertheless, they were quite familiar with the various provisions affecting public servants. The third one was a businessman of good
standing and an under-graduate. He too was well informed on the various measures but not quite so on those affecting public servants as on those pertaining to the general public. The lone respondent from Punjab was a lady teacher. She

knew of the various measures fairly well. Although she felt sore on the point that the Government of Punjab had singled out public servants for the application ofincentives and dis-

128

Family Planning in India

incentives introduced by it, she did not make a sharp distinction between the severity of the disincentives and the mildness of the incentives as had been done by the other two government servants discussed above in the analysis of the previous category. She, however, added that the enhancement of the period of maternity leave to five months was of no particular use to woman employees. It would only result in idling away time. Instead,
some

other suitable incentive, like the grant

of

an advance

increment, should have been introduced by the Government. The three respondents from Uttar Pradesh were, again, well informed of the various measures announced by the Government for promoting family planning and of the proposed revision in the minimum legal age of marriage. Two of them were government servants and one was a big cultivator, in fact a landlord. The two government servants were among those

-

who had been given targets for motivation for sterilization. They, thereforc, knew the various measures fairly well, both those which were applicable to the general public and those which were applicable to public servants. The landlord was a
benign type ofperson of olden days who would hold court every evening of bis proteges and admirers over a'hookah'and the 'pandan'. While he would tell the assembly of the incentives and di"incentives being otrered by the government, he also told them of the ill-effects of sterilization which he and some of his acquaintances had experienced. The result generally was to generate a disinclination rather than an inclination for family planning (which for all intents and purposes meant only sterilization) among his audience. In sum, of the 196 acceptors 128 or 65.3 per cent were entirely ignorant ofthe new measures introduced by the Government for promoting family planning, 38 or 19.4 per cent had only a vague knowledge that a certain higher amount of incentive money was now being paid for undergoing sterilization. 11 or 5.6 per cent knew of the higher incentive money as well as ofthe proposal to raise the age of marriage but had no definite idea ofthe provisions of any of these measures and only 19 or 9.7 per cent had some definite knowledge of one or more of the measures introduced or proposed to be introduced by the government. Thus, about 90 per cent ofthe acceptors among the respondents were either uninformed or very little informed

The People and

-Their Attitudes

and

Reactions

I29

only 10 per cent rather well informed of the new measures. Ofthese 10 per cent, 6 per cent were again public servants who were informed of these measures more as a part of their duty to motivate people than otherwise. Only 7 or 4 per cent of the acceptorsfrom among the general public had a fairly good and definite knowledge ofthe new measures. The knowledge of the various incentives and disincentives and other measures among the non-acceptors was as given in Table 5.16 on pages 130-31. The non-acceptors were less informed of the new measures adopted and proposed to be adopted by the government for promoting family planning than the acceptors. This was expected. They had less contact with the family planning and health staff which was the main source of information to the people on these measures. In many cases they deliberately avoided meeting the staff for fear of being caught for sterilization. The incidence of literacy was also lower among them than in the acceptors. Economically also they had a lower status, generally, within comparable groups. It is, therefore, notsurprising that proportionately there were more of the ignorant and less ofthe informed in their ranks Of the 155 non:acceptors, ll4 or 73.5 per cent had no knowledge of the new measures, 27 or 17 .4 per cent knew of only one item, i.e. higher incentive money being ofered for sterilization and 8 or 5.2 per cent of two items, i.e. the higher incentive money and the raising of the age of marriage. Of the latter two categories, 32 persons had only a vague knowledge of one or the other item. Only 3 had a definite knowledge-2 of the actual amount being admissible to the different categories of acceptors ofsterilization and one ofboththe actuai amount andthe specific minimum ages of marriage proposed to be enforced for boys and girls. All the three were educated, 2 belonged to the rural areas and one to the urban. One of them was a serviceman and two cultivators but both had good urban coniacts. One ofthem was a regular subscriber ofa newspaper also. The major source oftheir information was their urban contact. Of the rest, two knew of the higher incentive money for sterilization, raising of the age of marriage and certain other incentives being offered to the acceptors of family planning. One of them belongedto the urban and the other to the rural

130

Family Planning in India

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The People-Their Attitudes and Reactions

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132

Family Planning in India

area. Both were educated above the middle school standard. One was a business man and the other a cultivator. While both of them had a fairly good knowledge of the first two items, they had only apartial knowledge of the third, i.e. the other incentives being oflered by the respective State Governments. The businessman respondent knew of priority being given in the allotment of house sites and grant ofhouse building loansto persons who had got themselves or their wives sterilized after the birth of two children. The cultivator respondent knew of the grant of a rebate of 50 per cent in land revenue to such farmer couples of the eligible category as had undergone or were willing to undergo sterilization. In both the cases the knowledge was incomplete. The former did not know that the

priority for house sites and house-building loans was admissible only in urban areas and the latter that the rebate in land revenue was being granted for a period ofthree years only. Both the respondents had no knowledge of any other incentive
either.

The only respondent who had a knowledge ofthe higher
incentive money for sterilization, the raising of the age of marriage and the disincentives introduced by the State Government was a public servant in Madhya Pradesh. He was a matriculate and well informed of the various measures but was very critical of the scheme of disincentives. His complaint was that the State Government had unnecessarily made sterilization compulsory for all public servants who had more than three children,

failing which the various disincentives would apply to them
irrespective of whether any ofthem followed any other method of family planning or not. In his view, by de-recognising other methods of family planning and making the disincentives hard, punishments, the State Governmeut had taken a very harsh
measure.

The number of non-acceptor respondents who had a knowledge of four items, viz. higher incentive money for sterilization, raising of the age of marriage, other incentives and the disincentives, were only three. All ofthem were public servants and well educated. They had a fairly good knowledge ofrhe various measures but were particularly well informed about the incentives and disincentives applicable to public servants. They all felt that whereas the incentives being offered to public ssrvants

The People-Their Attitudes and

Reactions

I33

varied from negligible to small, the disincentives were uniformly
severe.

In the final

analysis of the knowledge ofthe non-acceptors

about the new nreasures, we find that only 4l or 26.5 per cent knew ofone or more of them. Of the knowledgeable persons, as many as 27 or two-thirds knew of only one item, i.e. the payment of higher incentive money for sterilization. They constituted 17.4 per cent of the total non-acceptors. Those who knew

of two or more items, vide Table 5. 16 above, were only 14 or 9 per cent of the total. In the depth of the knowledge of the
various measures,

all those who knew of only one item and 5 those wbo kne w of two were only vaguely informed. They constituted 20.7 per cent ofthe non-acceptors. Only 9 or 5.8 per cent had a fairly good knowledge of one or more measures. All of them were educated, middle pass and above, had good urban contacts, and were economically better offthan mo$t respondents among the non-acceptors. Five of them were in

of

service, three cultivators and one a businessman, After enquiring into the state ofknowledge ofthe respondents,

both acceptor and non-acceptor, about the new measures adopted and proposed to be taken by the respective State
Governments for promoting family planning, we pointedly asked those who had a knowledge ofthese measures whether they knew that these measures were being taken in pursuance of a new national policy on population control announced by the Government of India in April 1976. Ofthe63 acceptor respondents who had a knowledge of one or more of these measures, 45 or.

66.3 per cent did not know that these were a part of a new national policy. In fact, they did not know that anything like a national population policy had been announced or was afoot or what its aims and objectives were. Their whole idea of these measures was very vague and woolly and none of them could correlate these with a policy adopted at the national level with a definite aim and perspective. Only 23 or I1.7 per cent of the acceptors knew that a new national policy on population control had been adopted by the
Government of Irdia and that the various measures of incentives and disincentives introduced or proposed to be introduced by their State Goverrunents were a part of that policy. Although some ofthem didnot know exactly or definitely the provisions

t34

Family Planning in India

of these measures, they all were aware of the fact that a new policy had been launched by the Government of India some time back with a view to control and regulate the growth of population over the whole country. Most of them had a fairly good knowledge of the various measures. All ofthem weie educated and about half ofthem belonged to the service class. The main source of their information were frequent contacts with the officials including the health and family planning staff, contacts in urban areas and reading of newspaper s.
Among the non-aqceptors, only 41 had a knowledge of these measures but as many as 30 or 73.2 per cent of them did not know that a new national population policy had been announced by the Government of India and that these measures were being taken in pursuance thereof. Most of them. knew ofonly one measure, i.e. the payment of higher incentive money and thought that this was a kind of compensation or fee being paid to those who were williog to undergo sterilization. None of them had any idea that this was one of the several measures of a national

policy designed to control the growth of population. Only 11 or 7.1 per cent of the non-acceptors knew that a new population policy had been adopted by the Government of India and that these measures were a part thereof. AII these persons were educated and about half of them were, again, servicemen, indicating thereby that both among the acceptors and the nonacceptors the educated ones in general and those in service in particular were better informed on the national population
policy. OprrroN oN NEw Polrcv Mr.lsunss

Of the

various measutes introduced

or

proposed

to

be

introduced by the Government in pursuance of the new population policy, only two were commonly known. These were the payment of a higher incentive money for sterilization and the proposal to raise the age of marriage. These were applicable to the general public, whereas most of the other measures applied to public servants and were known to them only. We therefore, decided to ask the opinion of our respondents on these two measures. Naturally, we put the question only to those who had a knowledge of these measures. We have seen above that

The People- Theit Attitudes and

Reactions

135

68 of the acceptors and 41 of the non-acceptots knew of the of measure providing for the payment of a higher amount
questions monetary incentive fo r sterilization. We asked them two the quantum of money being paid for sterilization to-the acceptor good aud, second, whethel the higher amount being offered noliwould attract or induce more people to undergo sterilization. The answers we received are presented in Table 5'17 on

on this issue: one, whether they regarded the increase in

page 136.

' it -igttt

appear somewhat paradoxical that whereas 97 or 89 per cent of the respondents, both acceptor and non-acceptor' *ho w.r. aware of this measure considered the increase in the quantum of compensation or incentive money good, almost an equal number thought that the h:gher amount would not attract mtre people to sterilization. This clearly shows as stated earlier

that contrary

incentive of cash reward for

the policy makers, the financial sterilization was no motivating been accustomed to receive a cash award factor. But having for sterilization for a pretty long time, a feeling had grown in the rninds ofthe people that sterilization was some kind of a sacrifice or service rendered to the government or society which merited a reward, and if it was so, it was better that the reward was adequate rather than meagre. It was in this context that a large majority of our respondents felt that the payment of a higher amount of compensation money for sterilization was

to

the belief

of

good.

the higher amount would induce more people to come forward for sterilization' As many as 9l or 83.3 per cent ofthe respondents, who were aware of this measure of higher incentive money, felt that it would not induce more people to take to sterilization. They opined that

It

was, however, another matter whether

however keen the people might be to avail of a financial benefit, they were not willing to barter their reproductive capacity for a monetary gain. This is corroborated by the fact that not a single
respondent from our sample admitted

that he had undergone

sterilizatiorr for the sake of 5.12 supra. Five respondents from among the acceptors and seven from the non-acceptors thought that the increase in the qu artum of money being paid for sterilization was not a good step' They money as

may be seen from Table

136

Family Planning in India
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The People-Their Attitudes and Reactions

13:l

stated that the main purpose of the government in increasing the amount was to attract more people to undergo sterilization but this objective would notbe fulfilled because a large majority ofthe people had a fatalistic outlook on the birth of children and many

of tn.to also felt that a large family, particularly the one consisting of a good number of sons, wastheirbest asset for economic security and raised their social prestige' Since very little had been done to educate the masses on the virtue ofa small family, the old ideas still persisted among them to a large
exrcnl.

Coupled with this was also the fear that sterilizati on involved some risk to their health or caused sexual inadequacy' These respondents further said that although many people might not be vocal about it, there was a general apprehension that sterilization was harmful in some way or the other' It was their considered opinion that the new measure would not achieve the

desired result, i.e. to attract more people to sterilization' It was, therefore, a wasteful expenditure and was not a good measure in that sense. Although numerically small, this was a group oi persons which was fairiy well educated and well

informed on the various issues involved in the implementation ofthe new policY measures. While none of the respondents from among the non-acceptors people to thought that the new measure would induce more undeigo sterilization, a group of eight from among the u.."piorc felt that it would. Ali the eight had undergone sterilihad zation themselves but when asked whether any of them could done so for the sake of noney, all ofthem denied nor to they cite the example of anyone else whom they had. known have done so for the sake of money' Nevertheless, they mainpoverty tained that because of wide-spread poverty, and extreme might in some cases, some people might have accepted or survey accept sterilization for monetary benefit' However' our not find any supportive evidence to this view'

did

While nothing can

about the future' none ofthe li5 respondents in our sample who had undergone sterilization had admitted that he or she had done so for the sake of money. proposal Lastly, we asked the respondents their views,on the question only to raise tire age of marriage. Here too we put the said

bi

with certainty

138

Family Planning in India

to those respondents who were aware of this measure. It may be recalled in this context that only 30 ofthe acceptors and 14 of the non-acceptors knew ofthis measure. We asked them whether they considered the proposal to raise the minimum legal age of marriage from the present I 5 years to 1g years for girls and from

the present

18 years to 21 years for boys good. are presented in the following table. TABLE 5.18

their

answers

Dtst

sutroN op RrspoNorNts By THErR OprNroN oN THE
RersrNc on rue
Acceptors

Aor or.M*nrecp
Non-Acceptors

State and

District

Yes
Bihar

Whether raising the age of marri, ge was good

No

Cannot say

lYhether raising the age of marriage was good Yes Na Cannol say

Gay^ 3 Dhanbad I
M.P, Hoshangabad 4

1

l)1

Datia
Punjab

3

1-1
l^

Ropar

Amritsar
U.P.

z-1
I

1

Allahabad

4
3
1

Rampur

2t10

Toul
be remembered that

While analysing the data compiled in the above table it must it relates to a class of respondents. both acceptor and non-acceptor, who were largely educated, about 40 per cent of whom were in services, many of whorn. were

medium

to big cultivators and some in good, flourishinE

The People-Their Attitudes and Reactions
business. Many

t39

of them had frequent contact with government personnel' om.iuft, including the health and family planning they as a and some had other good urban contacts' A11 told' than the group *".. better informed and more enlightened in our sample' leneral tun of respondents '16'7 per cent of the Wi ft this proviso, we found that 23 ot it good' acceptors who were aware of the measure considered this would proThe consensus of opinion among them was that develop uid. b.tt., scope for the young men and women. .to gr.ut"i t"n'" of responsibility before their personality und u iirv g"t -^tri.i. only 4 or 13.3 per cent ol them thought that and it wai not agood measure. They felt that soon after boys should be married so as to keep girls Xtainei puberty, they it"*in proper discipline. They further argued that even the pr.r.nt ug" ii-its foi marriage were not being observed by manY 'pt"pr. i"?. and thi new measure providing for still "illages be a totally impractical proposition for ;i;h". ;g" limits would th! rurai areas. Three or 10 per cent of the acceptors did not other' They e*press th"m.elves on this measure one way or the show whether it was a good simply said only time would good They could not say at this stage whether it was

-.uro.". p., ."ni

or not. Of the

il; ;."

its being good as the one given by per u.""prort who subscribed to this view' Only two or l4'3
reason for

7l'4 non-acceptors who knew of this measure' 10 or good and cited more or less uguin considered it to be

Although cent'ofthem thought that it was not a good measure' their arguments both were oppor.d to the proposed measure' *"i. Oi"..tti"a1ly opposite to each other' One ofthem argued The that there should be no restriction on the age of marriage' it proper that boys other was an orthodox Hindu who thought tradition of uiO girrc be married early. He said this was the ordained by the scriptures' our Jountry and societv and was who Anong the non-acceptors also there were two respondents measure' did not express any opinion onthe new non-acceptor' Taking all the respondents, both acceptor and 33 or 75 per cent together, who were aware of this measure good' the proposition to raise the age of marriage "oitiO"r"A cent thought that it was not good' and 5 or 11'4 e o, f:.0 per of per cent did not express ariy opinin' Apart from the number

140

Family Plannhtg in India

peopJe. Therefore, no general inference can be drawn

respondents, who had a knowledge of this measure and were therefore asked to express their opinion on it, being very small (only 44 out of 351 in rhe sample), the fact that thJy comprised a group which was better educated and better informed than the general run of respondents conditioned their response to a con_ siderable, extent. They did not constitute a cross-section of

opinion expressed by them.

from the

CoNcLUDINc OssrnverroNs

the programme had remained official_led u fu.g.'_";ority people had adopted it because official pressure "ra wis brought of to bear on them. The ways of exercising pressure were many and varied_threat ^ of a prosecution to shopkeepers, delay in the grant of crop loans to cultivators, withholding of ailotment

As a general conclusion the study has revealed that although family planning was intended to enlist un u.tiu" puiii.ipation of the people, the motivatioa of the people towa.As tl" ,,"w popu_ lation policy was simply not of the requisite level. ny anO tu.g"

certain facilities to a clars of people to whom they were normally admissible, and ofl.er of inducement of certain benefits to ceitain p.opf" to *fri"f, tfr.y were not normally entitled. These tactics had caused both intense fear and acute resentment among the people. The fear was so intense that many oflhe acceptors who had adopted the prograrmme at the bidding of ttre otrc;als would not admit that they had done so under thi pressure of the oflicials. They parried the question and gave oniy round-aboui *rr..r. By a series of supplementary questions the fact was brought out that as many as Il5 or 5g.7 per cent of the acceptors had ldopted the programme because of the pressure of the officjals. Only 27 or 13.8 per cent of the acceptori were bold enough to admit this openly. The two together constituted u totil of tqZ o, 72.5 pet cent of the acceptors. There was a high concentration of effbrt and attention on sterilization and a neglect of the other methods, so much so that the family planning programme had come to be known in comrnon parlance as ..Nasbandi programme.,, This is evidenced

less agricultural labourers, denial

of

o?-iunO

to funa_

The People-Their Attitudes and Reactions

l4l

by the fact that as many as 175 or 89.3 per cent of the acceptors in our sample had gone in for sterilization and only 2l or 10.7 per cent for the other methods. This high concentration of attention on sterilization was due to the fact that the Governnlent as a matter of policy favoured sterilization to any other method. Consequently, a large number of sterilization camps were held every year in each State and a cash reward was offered for sterilization only. done a great harm to the programme as a whole, On the one hand, coercive methods were used extensively to acheive the targets set for sterilization and, on the other, wild rumours

The identification of family planning

with sterilization had

spread about the baneful effects of sterilization. Both caused considerable resentment among the people and shook the foundations of the programme. Very little effort had been made to educate the people on family planning. Extension education was virtually non-existent, the extension staff being largely busy in canvassing people for sterilization under the quota system. Consequently, people had remained largely ignorant about the various methods of family planning and their relative efficacy and a sizeable number maintained a traditional outlook on family l1te. 26.5 per cent of the non-acceptors in our sample had no knowledge of any method of family planning, 23.2 per cent considered children a gift oI God and another 22.6 per cent did not adopt family planning for a variety of misconceptions.

There were however some hopeful signs. Wherever the family planning services were provided within the reach of the people, there was a beiter response indicating that family planning adoption is largely supply led. That is to say that more people tend to adopt family planning if the services are closer to them. The second hopeful trend was that women were becoming more concious ofthe need for family planning. Inspite of strong religious taboos, even Muslim women \,vete becoming more conscious. 34 per cent of the lemale non-acceptors in our sample wanted to practice family planning but for opposition to it froar their husbands and relatives. About half of these women were Muslim. The number of respondents who had a knowledge of the oew

142

Family Planning in India

policy measures adopted by the government, both Central and State, was very small. Only 68 or 34.7 per cent of the acceptors and 4l or 26.5 per cent of the non-acceptors knew of some of these measures and that too not very deeply or precisely. A majority among both the informed acceptors and non-acceptors knew of only one measure, i. e. the offer ofa higher amount of monetary incentive for sterilization. A distant second number was of those who knew of two measures, i. e., ofhigher monetary incentive and the proposition to raise the age of marriage. The other measures were known only to a very small number of people, a large majority of whom were urban educated and service class people. Such little knowledge ofthe new measures was partly due to the fact that only a few weeks to a fewmonths had elapsed since these measures were introduced wlen our investigations began and pa-rtly because very little publicity and extension work had been done on the new measures. There was very little r'mpact of these measures on the people. Even the higher amount of incentive money by which a great store had been set by the policy makers, failed to attract people to undergo sterilization. Noi a single respondent admitted that he had undergone sterilization for the sake of money nor anyone cited any case where money had played a motivating part. The provision to raise the age of marrige was still a proposal and, therefore, did not affect any one. Other measures related to the scheme of incentives and disincentives introduced by the State Governments on their own initiative. By and large, these schemes were highly restricted in their scope. In two of the four States in our sample these applied only to public servants and in the other two largely to public servants. Public servants were generally educated and selfmotivated towards famiiy planning and needed no particular incentive or disincentive to motivate them. Further, the incentives offered were generally of a weak and minor nature but the disincentives were harsh and definite. Whereas the incentives hardly enthused any public servant, the disincentives did definitely generate a sense of cynicism and demoralisation among a large majority of them. Where the disincentives applied to the general public, they also did not take kindly to them. So strong was the reaction of

The People-Their Attitudes and

Reactions

143

the people against them in U.P., where these applied most to them, that the Government was forced to withdraw the scheme within a few months of its introduction. It was clear therefore that the scheme had not been based on any study ofthe people's

motivation.

CHAPTER

VI

Overview and Policy Implications

The policy of incentives and disinoentives, which constituted an important part of the new population policy of the Government of India announced in April 1976 was according to the findings of the present study a prime example of nonpolicy. If therewere any sound basis for formulating the policy, the Government has succeeded in concealing it effectively, for the deficiencies in the policy are so glaring and ttre damage done to the programme so extensive that it would have been more advisable if the policy was not formulated. The most important limitation of the policy seems to be that it was not based on any serious examination of the motivations and preparedness either of the people or of the adntinistralive machinery. The extensive experience of the Government with other policy areas would have normally led one to assume that major policy measures are preceded by an intensive and indepth analysis of the various factors which make for the success or failure of the policy measures. Of all the factors, the factor of people's motivation is the most decisive one in a measure of this kind. Experieuce in India as well as abroad has repeatedly shown that in a democratic system the use of any kind of force is counterproductive. There is therefore no option to education and persuasion, processes which are complex in their character and undoubtedly exasperating 1o a Government bent on quick results. Even so, there is no demonstrable case that such schemes ofincentives and disincentives can be sold to citizens

Overview and Policy

Implications

145

without a massive campaign
ciousness and preparedness.

of

bringing about mass cons-

If the Government of India had any data to the contrary suggesting a level of motivation of the people to accept the new package, neither the policy pronouncement nor any of
the ofrcial publications reveal what the basis in fact was' There is, therefore, ample ground to feel that there was no sufficient study of the basic data.

The findings of the present study do however indicate that certain ofthe measures, such as freezing of people's representation in the Lok Sabha and the State Legislatures on the basis of the 19?l census until 2001 A.D.' did make for a sizeable impact on the State Governments. The same cannot be said as far as the scheme of incentives and disincentives as

applied

to the citizens and a whole

class of civil servants is

concetned.

shows that the new policy of disincentives was based on totally erroneous incentives and data, if any, in terms of the motivations of the people' For instance, the incentive of additional financial reward was based on the assumption that it would provide an important incentive to the people to accept sterilization. The evidence collected during the. present study showed that this was in fact not so. Not a single person admitted having been influenced by the lure of higher incentive money to undergo sterilization. The financial incentives, at any rate the ones visualized in the programme, thus meant nothing to the people inspite of the much advertised poverty of the Indian masses.

In other words, the study

Similarly, other parts of the package were based on a variety of assumptions regarding how the people, and even the civil servants, would react to the prescribed measures. All these assumptions were essentially invalid and demonstrated that public policy which in a real sense is not based on essential requisites of the policy process but on the hunches and predilections of officials, however exalted, is foredoomed to
failure.
Indeed

Instead of supporting the reasonable popular response to family planning progranme which had been forthcoming over

of the

is now quite apparert that the policy implications new package were utterly disastrous to its objectives.

it

t46

Family Planning in India

the years, the new package of incentives and disincentives has led to profound hostility both of the citizens and even more

importantly ofthe State instrument, viz., civil service engaged in the implementation of this package. Undoubtedly the matters were made highly complicated by the seeningly innocuous provision inthe new package ofthe scheme of compulsory sterilization to be implemented at the option of the State Governments. In the process of implementation ofthe new package, this option virtually became the population policy in all the four States under study which took to it with a vengeance resulting ultimately in the total collapse
of the policy itself.

fanfare, the instrumentalities for implementation of the new policy package did not exist in adequate measure. The infrastructure necessary for carrying out the programme, especially in the rural areas, was exceedingly poor and whereever it existed it was too deficient to perform the necessary tasks. As a result, ad hoc arrangements had to be made and sterilization camps had to be established in the countryside in a haphazard fashion which led to many clinical complications. This created further scare amongst the population and aroused their hostility to the programme. During our study we also found that the figures of sterilization were inflated in the records ofa nunber of service centres. Upon investigation it was revealed that in many cases the persons who were reported to have sterilized simply did not exist. Such fictitious adopters of sterilization created all kinds of problems to organisational discipline. Also in many cases we found that false certificates were issued about sterilization to keep to the prescribed quotas for the officials. In sheer organisational terms, we found above all that the Primary Health Centres were, to put it mildly, grossly underequipped and understaffed. Not only was there an acute shortage of properly trained medical personnel to undertake family planning work in these centres but they also were quite often poorly supplied with the various family planning devices. This indicated an odd feature of the programme that the policy was made without giving adequate thought or attention to the question of organisation for implementation. This

It is

also very important to record that despite all the

Overtiew and Policy

Implications

147

inadequacy in organisational infrastructure was not less disastrous to the programme than its inability to mobilise
people's motivations. Ofno less negative consequence was the manner of use of the civil service in the implementation of the programme. Not only did the harsh measures create severe dilemmas for this entire class, but they also turned one ofthe major adversaries of the scheme. Besides they also became victims of many of the harsh measures leading to their severe demoralization. In retrospect, the new policy brought about a severe devaIuation ofthe government and the governmental apparatus in the eyes of not only the people but even the civil service itself. In that sense, the implications of the programme were far reaching. This was in many ways the first major programme since independence where the people wsre pitted against the government. Everything the latter did was suspect and created a credibility gap in the government's relationship u'ith the people going far beyond the confines of the population programme. No wonder therefore that this became the biggest political issue in the history of independent India, and played perhaps a decisive role in the Lok Sabha elections of 1977. The new population policy package, especially the scheme of incentives and disincentives, thus illustrates severe deficiencies of the public policy making process in India. Above all it shows trow poor the information base of the policy was. None of the four State Governments which we studied had made any efforts to develop the necessary information base before starting the implementation ofthe new policy. Instead, they issued a series of orders without any qualms as to what impact they would have on the citizens or the civil servants or on the policy itself. In that sense the programme showed a massive political failure. The emergency prevailing in the country no doubtplaledan important role in the failure of political comnunication. The deficiencies in the ihfornation base were compounded down the line in all the facets of policy making. Indeed, the

policy implication of the implementation of incentives and disincentives truly suggest the need fbr a more organised public policy process and its implementation.

The immediate adverse implications of .the new policy to

148

Family Planning in India

the overall family planning programme have by now become widdly known. To put it mildly, the programme has been badly discredited in the eyes of the people in all the States where
forcible sterilizations were made.

For a nation which has faced severe stresses and strains of inadequate food supplies and low per capita income for the last thirty years or so, it needs hardiy be emphasised that India
needs

to planand control its population. From that point of

view it was unfortunate that the new population policy package was not made an integral part of the overall plan of development and programme of the State Governments. One of the

Governments have yet conceived of a population policy for Itself in terms of its economic development, manpower needs,

important findings

of the study is that

none

of the State

population distribution, etc. The new population policy with accent on sterilization was clearly a Central Government programme directed from the top. From every count, this has been another maj or limitation of the programme. The events of the period from April 1976 to about January 1977 have only confirmed the experience from many other areas, how a socially sensitive programme pushed from the top without a careful study and planning especially at the grassroots can be counterproductive and almost destructive of its objectives. There is no doubt that it will take years before the family planning programme in India, by whatever name it is called, recovers at least in these four'States and perhaps in many others. This is not to say that the situation on the ground is bereft of hope for the dissemination and acceptance of family planning. It is an important finding of the present study that, like many other crucial services, the adoption of family planning practices. is supply-led. In other words. whenever a progranme and the
services are taken closer

to the people, there is a greater degree'

of their acceptance and adoption. With additional effort on the extension and educational dimension of the programme, the
process could be accelerated and made considerably speedier. The most important positive fiinding of the study is tberefore

to take education, family planning technology and the infrastructure as close to the people and in as quick a time as possible. the three dimensions are crucial for the future of the pro* gramme of population planning in India.

All

Overview and Policy Implications

149

Of no less significance is the finding that women, even from the minority communities, were keen to leam and practise family planning. The reasons for their motivations differ. The religious sanctions which many of them fear are also to be reckoned with. Nonetheless, larger and larger number of women seem to be more wiliing to adopt family planning measures which are now available, Several other studies have already shown how

women's education is an important pre-requisite for their acceptance of famiiy planning. The present one only confirms this trend and reinforces the need for a more concerted effort in the direction of providing every possible assislance to women for adopting the family planning devices. It is also an important finding about family planning organisation that whenever a clinic or a Health Centre is headed by a medical practitioner who has an aptitude for and dedication to family planning work rather than to general medicine,
people's response has been more systematic and more extensive. Organisationally speaking therefore it will be far more effective and desirable to create specialised family planning services in the primary health centres and as close to the grassroots as possible with medical practitioners who are genuinely oriented

to family planning located in them. These hopeful findings suggest some important policy options. First of all, there is a need for an extensive programme for developing mass consciousness of the people about the family planning programme and the various techniques of doing so. The traditional programmes of education and extension have been largely based on official media and bureaucratic apparatus. This is good as far as it goes. But it is not good enough. The coverage by these instruments is still very limited. The problem is aggravated by the serious erosion of people's faith in the governmentai machinery arising out of the disastrous programme of forced sterilization in family planning during 1976-77. It will be years before this instrument becomes
effective again. What then are the options in this direction? Ideally speaking

family planning should be made a major public issue and in that sense a political one so that all political institulions are
involved in promoting the requisite level of mass consciousness. The unfortunate events of 1976 and 19'17 may not make this

150

Family Planning in India

immediately feasible.

programme

of a broader welfare, including not only family planning measures but also maternity and child care, public health, etc., should be brought closer to the people in their day to day lives. In this process, first of all, the political organisations including the Panchayati Raj system should be greatly utilised. Some ofthe States are already doing this. The practice needs to be extended to other parts.
Nonetheless, overthe coming years the ideals

of family

Of great policy significance is also the role of voluntary effort. While organised voluntary eflo$ is not a universal national phenomenon, there are many parts of the country which have extensive traditions of people's initiative and coming together for such work. The effectiveness of such voluntary agencies in mobilising people in diverse fields such as education, marketing, credit etc. has been ably demonstrated in different parts ofthe country. Health has been a more recent entrant into this field. The state should make a more conscious efort to encourage this process and to support people's movements in this direction in whatever form they exist. The payof may not necessarily emerge overnight. Even so, the efficacy of voluntary effort as against state action is widely known and
accepted. This needs to be strengthened. This does not mean that the Governmental machinery should not have a role. Indeed the essence of public policy in population planning should be geared to the development of an extensive infrastructure of family planning and taking these services as close to the people as possible. Instead of becoming over-concerned with the setbacks of the. disastrous campaign of 1976-77, more eforts should be directed in building the sinews of the programme. As other state activities in the fields of rural development, employment guarantee, education, etc.

grow, there would be a natural fallout in favour of family planning programme. Indeed the various types of economic development activities and family planning measures could be more effectively tied up if the necessary organisational means for fanily planning are created and nurtured over the next few years. This is no mean task, for even in urban India the organisational infrastructure is still inadequate. In the rural areas it is almost non-

Overview and PolicY ImPlications

151

existent. This progrmme itself would involve investment
development

in

the

necessary manpower base and supporting and para-medical services. The figure of a mere 5000 medical and odd family welfare centres for a colurtry of India's size is but a drop in the ocean. As the present study has noted even the existing FHCs are woefully understaffed and under-supplied to maintain proper health and family planning services to the rural people. A systematic efort to develop them technically and with supporting services should be the cornerstone of the population planning programme which could be re-established in the next few years. There are of course several specific suggestions emerging

of

out of the study. These have been discussed in the respective chapters. It is not therefore necessary to repeat them here' Besides many ofrne issues have become dead as a result ofthe
political developments culminating in the Lok Sabha and subsequent State elections in 19'17 . Most of the State Governments have already resiled lrom their earlier positions in their respective areas. The danger however is to go too far in the reverse direction. This therefore calls for a great national debate ofthe issues of population and development not only in aggregate sense for the country as a whole but more specifically in disaggregated terms at the State level. Indeed any further delay in doing so
dangerous at this crucial State level. None of the State Governments have yet developed their respective population profiles for the next 10-20 years. This must be encouraged by the national planning agency and the Central policy apparatus' In other words, a greater political or policy consciousness needs to be developed in this programme as in many others' The efforts of the present study are a small contribution in that direction.

is

APPENDIX

I

Lrsr oF

SELEcI ED UNITs

Urban Family State

Health
Centre

Primary

Vitlages

District

Planning Centre

(Rural) Bihar
Gaya

Lady Elgin Zenana Hospital, Gaya.

Bodhgaya

Belida

Bairani
Amua

Dhanbad

Civil Hospital,
Dhanbad.

Nirsa

Kaliasole f)umaria
Kerabank

M.P.

Hosbangabad

Civil Hospital,
Itarsi.

Dolaria

Dolaria
Rohana

Semrikburd Datia

District Hospital,
Datia.

Indergarh

Punjab

Ropar

Civil Hospital,
Ropar.

Bharatgarh

Jaunia Rarua Rai Chikau Jhakian

Beli
Naggal-Sirsa

Amritsar

Urban Family, Planning Unit,
Rambagh,

Rural areas

were
Chaka

inac-

cessible due

Amristar.
U,P. Allahabad

to floods.
Dadari
Dhanua Dabhanva

Dufferin Hospital,
Allahabad,

Rampur

Civil Hospital,
Rampur.

Bilaspur

Manpur Ojha Lalpur Bisarad Nagar

A?PENDIX

II

Guron Poturs ron DrscussroN wrtg Opnctlrs

I.

STATE LEVEL

ine j.owttr of population. In this connection, a discussion will and Family Ue tr-eta with the Secretary, Depaflment of Health - Planning and also, if necessary, with the Secretaries, DepartWelfare, and the Department of -rnt oi Education and Socialtheir nominees' With the latter Food and Agriculture or with two officers the discussion will relate mainly to the subjects incorporated in the new population policy pertaining to their ,"rp..tiu" fields. A discussion wiil aiso be held on the steps taGn or proposed to be taken for the implementation of the

The main subject of discussion at th'e State level will be the policy measures adopted by the State Government for checking

adopted new population policy as announced by the Centre and ttisregard the discussion will be held with the ty th. itut.. In Director of Medical and Health Services, the State Family Planning Planning Officer and other officers of the State Family regard to the schemes falling in the jurisdiction Bureau. With of the Department of Education, Social Welfare or Agriculture' a discussion will be held with the Director in'charge of the department concerned or his nominee' The broad guide-points along which the discussion will be suitheld are as foliows. Ttese are only suggestive and can be in the light of the situation obtaining ably expanded or modified both in respect of the adoption of policy and the u

in

State

organisation of the Programme. -I. What is the broad policy frame of your State for curbing the growth of population, particularly for the next 3 years' i'e ' the remaining period of the Fifth Five Year Plan?

National Population Policy recently announced by the Centre? proposed 3. What speciflc measures have been taken or are yout State for implementing this policy? to be taken by

2. How Joes this frame flow from

or is related to the

154

Family Planning in India

(i) Introducing compulsory sterilization. (ii) Raising the age of marriage. (iii) Increasing monetary incentive to acceptors. (iv) Introducing or expanding the scheme
incentives.

of

group

(v) Introducing or strengthening the applied nutrition programme (ANP).

(vi) Expanding
education.

or

strengthening facilities

for

female

(vii) Introducing population studies in the educational system
of the State.

(viii) Expanding

assistance

to voluntary organisations

engaged

in promoting family planning. (ix) Introducing incentives such as grant of priority in house-

building loans, allotment of house-sites etc., and other
such schemes.

(x) Introducing disincentives such as refusal or reduction

of maternity benefits, refusal of house-buitding loans, allotment of houses or house-sites, loans for purchase of

vehicles, etc.

(xi) Formulation of special schemes for promoting family planning among the rveaker sections of society, such as small and marginal farmers, landless agricultural labourers, scheduled castes arid tribes, etc. (xii) Any other measures taken or proposed to be taken.
4. What are the salient features of the various schemes mentioned above? 5. What is your rating of the efficacy of the various measures taken or proposed to be taken for promoting family planning? 6. What is the thinking of the State Government on the question ofcompulsory registration of marriages? If it is decided
have compulsory registration, what administrative arrange-

to

ments are envisaged for the purpose? 7. With the'recording of births being so scrappy. particularly in the rural areas, how is the minimum marriageable age sought

to be enforced?
8. A higher monetary incentive for sterilization will attract only those who are in dire need of money. This is not likely to increase the ranks of family planning acceptors appreciably.

Appendix

II

155

What particular advantage is then seen in raising the amount of monetary compensation? 9. What is the thinking of the State Government on intro. ducing compulsory sterilization? Will it be socially desirable, psychologically acceptable to the people and adninistratively
feasible?
10.

If it

is decided

to introduce

compulsory sterilization in

the State after the third child, how many more doctors, nutses, clinics and hospitals will be needed to cope with it and in how

will it be possible to provide them? Howdoesthe State Government feel about freezing of people's representation in the Lok Sabha and the State Legisla' ture on the basis ofthe population of 1971 until 2001?
many years
11.

12. What is the reaction of the State Government to the freezing of the devolution oftaxes, duties and grants-in-aid to the State on the basis of the population of 1971 until 2001? 13. What is the opinion of the State Government on the

provision in the new population policy that 8percentofthe Central assistance .to State Plans will be specifically earmarked against performance in family planning? 14. What steps are being taken by the State Government for extending facilities for sterilization and medical termination of pregnancy to rural areas? How long will it take to cover adequately the whole State with such facilities? 15. How and since when have the public health, M.C'A. and A.N. programmes been integrated with the F.P. Programme in the State? 16. What have been the results of such integration? Has there been an increase in the ranks of F.P. acceptors as a result thereof? If so, to what extent and how has it been
measured? 17. Has

the responsibility for the motivation of citizens towards responsible reproductive behaviour been made an integral part of the normal programmes and budgets of the different departments of the State Governmeut? 18. What is the system of registration of births and deaths in the State? Is it working successfully? If not, what steps are 'proposed to be taken to improve its working? 19. What steps have been taken or are proposed to be taken to dispense better health care to the nursing and expectant

r56

Family Planning in India

mothers and the young children?
20. In what manner has

the use of the mass media

been

intensified or is proposed to be intensified by the State Government for propagating family planning?

21.Is the State Government conducting any research on reproductive biology? Ifso, with what results? If not, does it propose to conduct such research, and if so, on what lines? 22. lt is understood that certain categories of Government employees have been allotted quotas for bringing persons for
sterilization and ifthey fail to fulfil their quota, penahies like withholding of pay or increment will be imposed. How does the State Government justify these? What is the reaction of the employees to these measures?

II.

Drsrnrcr Lrvnr

At the district level, the discussion will relate mainly to programme planning. The discussion will be held with the District Family Planning Officer and other officers of the District Family Planning Bureau, the District Health Officer and the District Planning/District Development Officer. With regard to specific schemes incorporated in the new population policy such as the introduction ofpopulation studies in the educational system or impoving the standard of child nutrition, a discussion
be held with the District Educalion Ofrcer, the District Social Welfare Officer or the District Agriculture Officer as the case might be. The broad guide-points along which the discussion rvill be held are as follows: 1. Is there a proposal to introduce compulsory sterilization in your district during the current year? If so, what arrangements have been made or are being made to enforce it? 2. How is the current year's quota for sterilization and other forms of family planning allotted to the district by the State Government proposed to be fulfilled? 3. What categories of public servants have been allotted individual quotas for motivation for sterilization. What is their reaction to this kind of work? 4. What arrangement has been made for the payment of higher incentive money for sterilization? How is the scheme working? How is it being received by the people?

will

APPendix

II

157

5. Whom is the higher incentive money atlracting to undergo sterilization? To what extent is this measure likely to increase

the ranks of accePtors? 6. What is your rating of the efficacy of the various measures planning? taken or proposed to be taken for promoting family is the state of recording of births and deaths in your 7. What district, particularly in the rural areas? To what extent do births and deaihs go unrecorded? If the recording is not satisfactory, how will the proposed legal minimum age of marriage be
enforced? 8. What administrative arrangements are proposed made for the registration of marriages in your district?

to

be

medical termination of pregnancy in your district? 10. What steps have beentaken or are proposed to be taken

9.

What are the facilities available for sterilization and

for augmentinglhese facilities' particularly in the rural areas of district vour district? How long will it take to cover the whole facilities? adequatelY with such t t. Sinle when have the public health, M'C'H', and A'N' programmes been integrated with family planning programme in y-our district? ln what manner has the integration been

of such integration? Has there the ranks of F'P' acceptors as a result been an increase in thereof? Ifso, to what extent and how has it been measuted? proposed to be taken 13. What steps have been taken or are of girls, particularly above the for raising the livel of education
12. What has been the result

eflected?

middle school standard? 14. Have any arrangements been made

or are proposed to population studies inthe schools and be made for introducing colleges of your district? Ifso, what? your 15. Is any child nutrition programme runnlng rn since when and how successfully? Is there district? If so, what' the urrj ,.n.-. or proposal to augment, improve or strengthen
working of the Programme? in the tO, Wtrictr voluntary organisations have been working in your district? What has been their field of family planning role in Promoting familY Planning? proposed to be associat17. iow are voluntary organisations

158

Family Planning in India

are these organisations proposed to be involved

ed more closely with ihe promotion of family planning in your district? 18. What has be en the role of popular organisations like the Zilla Parishad, the District Cooperative Union, the Labour Union or Unions etc. in propagating family plaming? How
more

these measures?

mothers and the young children? 22. How is inter-departmental or inter-agency coordination effected implementing the family planning programme in your district? 23. How are the various incentives and disincentives introduced by the State Government being implemented in your district? What is the reaction of the people and/or public servanrs ro

How do these incentives promote or are likely to promote family planning? How is extension education on family planning organised in your district? What is the role of the mass media in this work? Is the extension education and the use of the mass media proposed to be intensified? If so, in what manner? 21. What steps have been taken or are proposed to be taken for dispensing better health care to the nursing and expectant

policy? 19. What kind of group incentives are being given in your district to whom and for what purpose? Are these proposed to be introduced/strengthened/revised? If so, in what manner?

intimately with the impiementation of the new population

one or the other of the family planning practices? 25. What difficulties, if any, does the District Administration experience in getting adequare and timely supply of the necessary drugs, medicines, other material and equipment for running the^programme or in the posting of medical and para-medical
staff.

24. What steps does the District Administration take for fulfilling the quota of sterilization and other family planning targets allotted to it by the State Government from year to year? What methods does it use to get people round to adopt

160

Family Planning in India

sion Educator, L.H.V., A.N.M., etc.) to the eligible couple s? How is their work supervised? 8. What is your rating of the efficacy of the various methods used for motivating people, such as inter-personal communication, group meetings, mass meetings, film shows, etc? 9. Are any targets allotted to your centre by the district authorities for sterilization, loop insertion and other forms of family planning? On what basis or criteria are the targets
allotted? 10. What steps are taken by your centre for fulfilling the quota of sterilization and other family planning targets allotted to the centre? What methods are used to get the requisite number ofpersons round for adopting one or the other of the family planning practices?
11.

within the jurisdiction M.T.P., your centre, what is done in such cases? of 12. What is the quota of your centre for sterilization and other forms of family planning for the current year? How is the programme being organised and run so astofulfilthe quota within the stipulated time? 13. Have any camps been organised or are being organised for the purpose? If so, in what manner? What are the facilities offered and incentives provided to the acceptors at these
is not available at your centre or camps? 14. Have any individual quotas been allotted

If

any particular facility, such as for tubectomy or

for sterilization

and other forms of family

planning to the staffof the centre

and other public servants? If so, what and to whom? 15. What are the rewards and penalties for the fulfilment and non-fufilment of individual quotas. What is the reaction ofthe staf of the centre and other public servants to this
scheme? 16. How is the inter-departmental coordination effected at the block/centre level? How are the employees of other departments

made to work for this programme?
17. What are the arrangements

disbursing incentive or compensation money for sterilization? Whom does this incentive attract generally to undergo sterilization? What is the reaction of the people to this measure? 18. What steps have been taken to publicize the various

for

Appendix

II

159

III Loc,ll Level
At the local level, i.e., the Primary Health Centre for the rural areas and the Family Welfare Planning Centre for the urban, the discussion will relate mainly to the implernentation of the programme. At these centres a discussion will be held with the Medical Officer-in-Charge of the Centre and other staff such as the Second Medical Offcer, where there is one, the Extension Educator, the Lady Health Visitor, the Family Planning Field/Welfare Worker and the Auxiliary Nurse
Midwife. Besides these, the Block Development Officer and certain Extension Officers of the Block for the rural areas and some Municipal Officers like the Health Officer and the Education
Officer for the urban may also be contacted and a discusion held with them on particular items of the programme. Further, at the village or the Ward level a discussion will also be held with officials like the Village Level Worker, the Patwari, the School Teacher, the Sanitary Inspector, etc., as and where they have been associated with the implementation of the programme and are available for discussion. While specific questions will be asked from the officials who are directly concerned with particular items, the broad guide-points along which the discussion will be held are as follows:
1. What are the facilities available for vasectomy, tubectomy, I.U.D. and other forms of family planning in the area covered

by your Centre? 2. What is the mode of organisation of the programme for the different methods? 3. How are people eligible for practising famiiy planning identified? What are the criteria laid down for the purpose? 4. Are any records maintained of such persons? Are these periodically updated? 5. What other records are maintained by the Centre/Subcentre?

6. How are eligible persons motivated for practising family planning? What are the criteria for recommending particular methods to particular persons? 7. What is the frequency of the visits of the field staff (Exten-

to

incentives u*,".",,,o1','"::^::"rby the state ment for promoting family planning? To what extent are people aware of these measures and what is their reaction to them? 19. To what extent have the said incentives and disincentives been effective in mobilizing people, including public servants,

*u

o"".:l

undergo sterilization

or

adopt other forms of family

planning?
20. Are any voluntary organisations engaged in family planning work in your area? If so, which and in what way? 21. ls there any definite plan or instructions from above to associate these organisations more closely with family planning

work?

If

so, what?

the Gram Panchayats, the Cooperative Societies, the Labour Unions etc. associated with family planning work? Is there a plan to associate them more closely with the programme? If so, in what manner?
22. How are the Panchayat Samiti,
23. Is any scheme of group incentives operating in your area? If so, which and what are its salient features? 24. What is the role of local organisations like Mahila Mandals, Youth Clubs, Young Farmers' Associations, etc. in promoting family planning? Is there any scheme to associate them more intimately with the programme? 25. Has anything been done so far, in the wake of the New Population Policy, for expanding and strengthening-

(a) female education, (b) child nutrition, (c) care of the expectant and nursing mothers.
26. To what extent are people in your area aware of the proposal to raise the legal minimum age of marriage for boys and girls? What is their reaction to the proposal? 27 , What is the state of registration of births and deaths in your area? To what extent do these go unrecorded? Ifthe

position is grossly unsatisfactory, how is the legal minimum age of marriage proposed to be enforced? 28. What mass media communication facilities are available to the centre for propagating family planning? What is the frequency of their use? Are you satisfied with their use? If not, what is proposed to be done to intensify their use?

162

Family Planning in India

29. What difficulties, if any, do you experience in the propagation or execution of the programme in respect of:

(a) staff; (b) supply

of

essential goods

and

equipment;

(c) transport and communication; (d) any other matter.

30. What are your suggestions for improving the working the programme?

of

Apprsorx
SrurcrroN

III

or Accrrrons eNn NoN-accEprons
S.q.MPrtlIc DEstcN

For the selection of acceptors and non-acceptors of the family planning programme it was necessary to conduct a census of all the eligible couples residing in the selected villages of the Primary Health Centres and selected wards of the Family Welfare Planning Centres. These couples would constitute the universe for the selection of the sample. However, owing to
lack of time and resources at our disposal it was not possible for us to carry out a census. Consequently, we had to depend upon the record of such couples maintained by the Primary Health Centre in the rural and the Family Welfare Planning
Centre

in the

urban areas. This record was compiled by them

after conducting a census and was periodically updated. The recerd is called the "Target Couple Register." A target couple

practising family planning, the by the criterion that the rvife should elicibility being determined be of the reproductive age, i.e., between 15 and 45 years. The target couple registers are maintained village-wise in the rural areas and ward-wise in the urban: Since we had decided to restrict our enquiry to a referetce period commencing from lst April 1975 and ending with the date of visit of our investigating team to a centre in the months of June to
is

that who is eligible

for

August 1976, we called out the names of such couples from the target couple registers as had during the said period adopted the programme and ofthose who had been approached and can' vassed to adopt the programme but had not adopted it. Thus, we got two categories ofpersons from the target couple register, one of those who had accepted the programme and the other of those who had not. The acceptors and non-acceptors were then stratified separately into two to three broad occupation groups. In the rural areas the stratification was made into cultivators and noncultivators and in the urban into shopkeepers and businessmen;

164

Family Plannlng in India

servicemen and professionals; and others. The principal occupation of a person as recorded in the target couple register formed the basis of the classification of the couples and accordingly they were placed in the different strita. In the case of women who were not following an independent occupation, the eccupation of their husband was taken as their occupation. Each of the aforesaid stratum was further stratified into male and fenale categories. The narnes of the persons falling in a substratum were arranged in an alphabetical order and from each sub-stratum a sample of 25 per cent prospective respondents was drawn at random with the help of Tippet's Random

Number Taltles. In actualiy constituting the sample, however, a number of diffculties were experienced. In the first place, a widespread fear and an intense suspicion of the government prevailed in the country, particularly in North India, with regard to famrly planning at the time our study was conducted. People were generally unwilling to talk, much less give an interview, to an outsider on anything connected with family planning. This made many a respondent falling in our sample try to avoid meeting our investigating team altogether. The non-acceptors among them feared that we would have them hauled up for sterilization. The acceptors felt that we might involve them in some further complications. Consequently, we did not get the full complement any where. In some of the areas where the number forthcoming was too small we had to resort to substitution, care being taken to select the substitutes from among the similar type, but in most of the areas we had to make do with such number as was available. Another difficulty was with regard to getting riomen respondents from the rural areas speak to our investigating team which consisted of only male investigators. An experienced lady investigator had been recruited for the study but she left thejob during the very first visit to the field and time did not permit us to appoint another lady investigator. We had, therefore, to conduct field investigations only through male investigators. Except in Punjab, this inhibited the women in the rural areas

of the other three States in our sample, viz., Bihar, Madhya Pradesh and Uttar Pradesh, from coming forward to give an interview. Whereas such women from U.P. and M.P. could

Appendix
somehow be persuaded to

III

165

Consequently, we had to go without any representation of women in our sample from the rural areas of Bihar, Yet another difficulty experienced was with regard to the occuirence of heavy floods in the Amritsar district ofPunjab in the months of August and September 1976, on account of which we could not reach any villages there inspite of successive

team, those

talk and give an interview to our in Bihar altogether refused to give an interview.

attempts. Therefore, there was no representation of respondents from the rural areas ofthat district in our sample. Even in the city of Amritsar many localities were flooded or

by floods. We could, get only a small number of respondents from there therefore,
were covered with slush and n)ud caused and that too with considerable difficulty.

ApppNorx IV

INcpNrrvrs Fonrrlurarso By SrATE GovpnNusrrs non

PnououNc

FAMTLY PtaNNrNc
States

Incenlircs

Bihar M.P. Punjab
1. Additional monetary incentive for sterilization offered to persons 2. Certincate of Commendation to public servants for fulfilling quota

U.P.

having 4 or more

children

Yes

of motivation for

sterilization

Yes

3. Letter of Appreciation to Government servahts for exceeding quota

of
1

motivations

4. gnspecified award

to

25Y.

for sterilization by

for good performance in sterilization 5. Unspecified award to Governvants
motivation for more tha'f, 250/1 6. Monetary incentive of Rs 6 per case of motivation for sterilization in ercess of the quotar 7. Cash award to public servants for exceeding the quota of motivation for sterilization by 50j{ or more 8. One advance increment for fulfilling double the quota of motivation

to

Yes

public ser-

Yes

ment servants for exceeding quota of motivation for sterilization by

Yes

Yes

Yes

for

sterilization*+

Yes

9.50"1 rcbate in land

revenue

for

3

years to target couple farmers for undergoing sterilization 10. Period of maternity leave to female Government servants raised to 5 +Admissible to whole-time family planning staf only. **Admissible to employees of Health Department.

Yes

Appendix

IV
States

167

Incenlives

Bihar M,P. Punjob

U'P'

months

tt. Priority to public servants
uDto thre€ children

if the birth of children is rcstricted to 2 onlY
having

in-

aj allotment of lesidential accom' b) grant of house-luilding loan c) grant of loan for the Purchase

modation

Yes Yes Yes

of car, scooter, etc' 12. Priority to Governnlent servants who get sterilized after 2 children in th! allotment of car' scooter etc' Priority to candidates v'ho get 13.

Y9s

sterilized afler 2 children

14.

irioritv to

Dointment to Public

in apscrvices

Yes

adopted family Planning in maternity and child care Programmes and in facilities made available by

families which have

15.

nersons who get sterilized after 2 children in allotment of house-sites and house-building loans in urban areas 16. Priority to persons who undergo

other Government Departments

Yes

.,

Priority to

Yes

sterilization
17.

in the allotment

of

houses and Plots and grant ofloans

Yes

Priority

in grant ol loan from Government or semilized after 2 children
government sources

to

persons who get steri-

18. Number

b,iitoing. for such industtv . of incentives oflered

ing an industry or

for

establishl constructrng

.,.

1T

rl

-5

APPENDIX

V

DIsINcENTIvEs Fonruurerro ny Srarn

GovrnNurxts ron pnouorrNc FlIr,rIr,y pr,anNrNc
States

Disincentives

Bihar M.P.
Disciplinary action proposed to be taken against public servants fail_ ing to achieve the quota of motivation for sterilization etc. allotted to them 2, Grant of Transfer T.A. to public
1.

Punjab

U.P

3.

bursement of medical expenses to

Free medical treatment or reim_
2/3

sewants upto 2/3 children only

Yes Yes Yes Yes
Yes

Yes Yes Yes Yes
Y9t

children only 4.
R

public servants limited upto

to public servants limited upto 3 children only 5. Grant of maternity leave to female
children only 6. Denial of encashment

eimbursement of educational fees

Yes

Yes

public servants limited upto

2/3

leave

more than 2/3 children only 7. Denial of Government residential accommodation or payment of en_

to public servants havint
by public

of

Yes
earned

Yes

Yes

I".
Yes

hanced rent

having more than 2/3 chilaren 8. No house-rent allowance to public

servants Yes

servants having

children

more than

3

9, Denial of all loans and advances to public servants having more than 2/3 children
10,

Yes

Denial of annual increment ro public servants having more than
3 children

Yes
Yes

Yes

Yes

11.

No allotment of

th€ Housing Board

houses built by

or L.LC.

or

Appendix V
States Di sincentive s

t69

Bihar M.P. Puniab

U,P.

other similar bodies or under M.I.G, Scheme or Rent Control

.
12.

Act to public servants having more
than 2/3

No appointment to public services

children

Yes

children

for persons having more than three
Yes

13. Appointment to any public service contingent upon signing.a declara-

tion to limit the birth of children to 2 only 14, If a person of the eligible category

Yes

does not undergo sterilization after the birth of upto the third child, he

will not be-

a) given any loan b) grant€d a license for first arms c) allotted a fair price shop d) allotted a house or plot of land e) entitled to flee medical treatment at Government hospitals

Yes

or allowed to license

renew such

a

Yes Yes Yes Yes

f) granted educationalconcessions or scholarships except merit

scholarships Departm€nt

Yes

g) granted any facilities offered by

the Harijan and Social W€lfare
Yes 15. Number ofdisincentives

introduced 6

8

4

15

Nole.' The U,P, Government are reported to have withdrawn all disincentives applicable to both the general public and the public
sefvanls.

APPnNoIx

VI

Corvrposluox
Members

or Sters-ttvrI, Couurrrrrs
Status Number held in
1974-75

of

Contmittee

Oficial

Non-

Toral

of
Chairman

meetings

oftcial

Cabinet SubCommittee

Bihar M.P.
Punjab

5

5

7 7 7

Chief Minister I Minister of Public Nil Health and F.P, (ConstitutChief Minister

-

ed

in 1975-

U.P.
F.P. Councill

6

)

l1

Chief

Minister

76)

I

Boad

Bihar M.P.
Punjab

6
10

16

2l

22 31 38

Minister of Health
Minister of Public Health and F.P.

Nil

23
15

(Not constituted)

u.P.
State Level Coordination Committee

Minister of Health Nil

Bihar M.P. Punj4b

12

7 14

5

12 12 14 14 3 4

Chief Secretary state F.P. Officer Chief Secretary

.

Nil

2

(Constituted in 197576)

u.P.
Bihar M,P.

13

Chief Secretary

Grants Committee
3

Director, Health
Services

2

4

Secretary Public Health and F.P.

1

Appendix VI
Members

Itr
Stalus Number

of

Conmitee

Oficial

Non-

Total

ol
Chairms

offcial

meetings hen tn
1974-75

Punjab

4-5

U.P. Publicity Coordina' tion Committee Bihar M.P.
Punjab

4-5 4

Secretary, Health 1 Secretary, Medical 2 and Health

*l**. *
5 25
SecretarY, Medical and Health

| constl-

-J
I

tuted

u.P.

20

Appntolx VII
DrsrrusurroN or RrspolrorNrs sy Rrr,rcroN
State and

District Bihm

Acceptors HMSCTotalHMSCTotal

Non-Acceptors

Gaya 31 4 Dhanbad 2T2* M.P.

35 17 6 --i: 29 158_124 |

23

Punjab

Hoshangabadlg2tZZZ05_25 Datia 21 2 | 24 Zt 4_ 24 13 _ 6

26

Ropar 10 t4 Amritsar2-Z-431_4
U.P.

19

Allahabad 28 Z 1 31 t2 51 18 Rampur 16 7 -3 I 27 6 7_ 3 16 Torar. 154 f9 Z0 3 196 l0Z 35 8 5 155 'A ro TorAL 78.6 9.7 l0.Z t.S 100.0 69.0 22.6 5.2 3.2 100.0
-Hindu M-Muslim s
C
H

-sikh

-Christian

Appendix

VIII
O\ $

173

l:

l( t^
li s t:9
I

RX

r.t \O

@\o

Ec
\o

tl
\o t.-

tl
erl
at ao

II
cl\ i

FII$ s l\ A \ ls * tr s a
* lI I

6o1 in eQ Qo+
tro

l6:. l\ !

ooF ll

<l i

rn

a..l

s3 .'N
.rq
\oo

ls:. ..r
|

G

tl

:rI

t

It ttl

l-

l* ts t:
I

l*
EZ Z0r !I]!4 ls t- s

NN

X$

HF
Ni

eg

tu4
U

TEI

l€

3lF z E"li Pl
F

I'
l^
I

x'

tl
N I I
q\i

r.!
FrQ

s

x
h

ao \g

(nui

(nr+

lo I

a.l F.

an an

@

v-)

taF

a{

l-i :

tI

tl
.

t.E=
cs

!l-

N

q

s _S

G>ds

(,Q

,E 5- =E EF q. T: .3Ec di . o cl 'i a d
EA

i

€ €'o :-^

c< \

Fa €E
= <F1

39 FN

I F ti

Appexotx

IX

DrstnItutIoN or RnspororNr CultlvaroRs ny or Tsrrn LANo HorotNcs
Acceptors

rnr

Slzr

Non-Acceptors

State Upto Above Above Above Upto Above Above Above and 2 2to5 5toI0 10 Total 2 2to, sto10 l0 Total Districi qcres acres acres acres qcres acres acres ocres
Bihar

caya Dhanbad
M.P.

4
6 7

ll24 -15
4

2
10

2

l3 l1

Hoshangabadl

2
2

Datia

l0
IJ lJ

1

t2
_lo

2

J

Punjab

Ropar
Amritsar
U.P.

3

4

5

I

z

3

5

I

1
10

Allahabad

11

Rampur

7

3l 6-1

r)
14
1

I
80 100.0

TorAL

ol"ro'fot^L37.0 30.4 19.6 13.0 100.0 33.7 28.7 21.3 16.3

34 28 18 12

92 27 23 17 13

Index

Asia, 4-6 Audio-Visual Aids,

council/board, 68
81

methods, 106-7 organisation, 5G4

Birth rate,

19

Cabinet Sub-committee, 67-8 Causes of Poverty, 18 Central assistance to State plans'

role of commurication. 80-4 Family planning Practices reasons of adoption, 108-14
reasons

o[ lack of

knowledge,
I 14-20

Comnittees, 67-70
Dandekar, V.M., 17 Developing countries, 3-5

reasons of non-adoPtion' Field Staff, 61-3

l2l , 129

Differencesin urban-rural clinics,
66

Gavin Jones, 4 Grants Committee, 69-70 Group Incentives, 33 Growth rate of economy, 16
Incentives to general Public, 28, 30-l public setvants, 28, 31-3

Disincentives to general public; 27-8, 31 public servants, 27, 29'33
Economic develoPment, l, l8 Economic status of respondents, 9l '
93-5

Indonesia,6-7
Malaysia, 7

Educational l€vel
89-9r

of

respondents'

Evaluation, T3-4
Extension work, 82-3

Male-female ratio among resPondents,88-9,97-8 Maternity leave, 32, 48
Measures of

Falsification of records, 72, Family planning
awareness,98-105

146

Measures taken bY
Governments Bihar, 25, 27'9, 38-4r

individual import, 24-6' 35'6 social imPort, 24-6, 34 State import, 24-6, 36-8
State

bureau, District, 50-1 bureau, State,50-1

176

Family Planning in India
Progress reporting, 72-3 Raising

Madhya Pradesh, 29-30, 4l-4 Punjab, 32-3, 47-9

Uttar Pradesh, 30-2,

44-7

the age of marriage,

36,

Monetary compensation, 36, 43-4 Motivation bonus, 44-5

138-40

New policy measures, knowledge

of,

120-34 144, 148

Rath, Nilkantha, 17 Rebate in income-tax, 37-8 land revenue, 44
Records of

New population policy, 19, 23-6

-olicy limitations,
Objectives of planning, 16 study,20

Number of children per family, 9zl-7

motivational activities, 71-2 potential acceptors, 7r-1
services rendered, 72

Sample Selection, 20-1, 23, 87-8,
t63-5

Occupational stnrcture
sample,89-91

of

the

Scheme of the study, 23 Selected demographic indicators, 14

Opinion on monetary incentive, 134-7 raising the age of marriage, 13840

Singapore,9-10
State level coordination committee,
68-9

Statistical system, 70-3

Orientation

of the

staff towards

Sterilization
ad hoc arrangements 108, 110, 146

the programme, 64-5
Pakistan, 8 Per capita consumer expenditure, 17

as population policy, 146

propagation, 100, 104-5
quotas for motivation, 42, 44, 47-9
27

-8, 38-9,

income, l6 Philippines, 8-9 Policy options, 149-50 Population education,83-4
Government

Taiwan, 1l
Target-setting, 42, 46-7 Thailand, l1-3
estimates,

of India

Urban family welfare
centres,50,54-8

planning

t4
growth rate, 15-6, 19 hard core, 41

Voluntary organisations, 74-80, 105-

of India,

6,

150

15

policy, 2-3, 5-6, 19-20, 23-6 Primary health centres, 50-1, 59
Processes

Women's interest in family planning,
118-20, 149

of study,

21-3

World population, I

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