Population Policy and family planning.

The most prominent deficiencies and mistakes of India’s family planning programme are, it is argued, related largely to a typical bureaucratic (and perhaps political too) predilections, hazy perceptions about effective strategy, and relatedly a chronic mismatch between expressions of priority and actual fund allocation to FPP, which were confounded by a distinct lack of openness (until very recently) towards the experience and expertise of the international community.

Visaria and Chari write, “the Planning Commission that was bold enough to make India a pioneer in the field of population policy in 1951 was hesitant in its approach”.

• (1951-56) - setting up of family planning clinics for those who needed such services (what is known as ‘clinic- based approach’), the chief emphasis during this period was on natural method (example: rhythm).

• document also clearly identified “an effective curb on population growth” as an important condition for improvement in the level of living, but by the end of Second Plan (1961) only 411 clinics were set up, all failing to attract expected number of clients, and sterilization was not financed by the FPP till 1960. The pace of increase in voluntary contraceptive acceptance by the end of Second Plan was slow, and the record of voluntary attendance in family planning clinics was poor.

• In the Third Plan the clinic based approach was sought to be replaced by an extension-education approach in which health workers were to visit women of childbearing ages to motivate them to limit their family size. This extension approach recognizes the importance of appropriate information- education- communication (IEC) procedures for wider acceptance of FPP. While the extension approach was supported in principle, this focus faded before it took root. The ‘target approach’ was readily understood. The extension approach was overwhelmed by the pre-occupation to achieve ‘target’ - Visaria and Chari. With the setting up of demographic goals and targets to be achieved by the health department, the programme began to be entrenched in what K Srinivasan named as HITTS model: health department operated, incentives based, target-oriented, time- bound and sterilization - focused programme.

• During the (1969-74) the FPP was integrated with the maternal and child health (MCH) programme implemented through the primary health centers (PHCs) in rural areas and urban family planning centers in towns. The Minimum Needs Programme was formulated which combined three services: health, nutrition and fertility reduction. The incentive programme both for acceptors of vasectomy and tubectomy and for motivators was stepped up, with enhanced incentive amounts for acceptors. With a strong desire to achieve much faster reduction of birth rate the government of India, following HITTS model, opted for organizing sterilization (chiefly vasectomy) camps on a mass scale - ‘camp approach’. Measures beyond family planning such as legalization of abortion (the Medical Termination of Pregnancy Act being enforced in April 1972) and the raising of the minimum age of marriage among girls to 18 years were also introduced during this period.

• Emergency.

• In the post-emergency period followed a tremendous backlash on the FPP, so much so that, to quote from Karan Singh’s autobiography, “family planning became a dirty word”. The new government renamed ‘family planning programme’ as ‘family welfare programme’ (FWP for short), and it reduced the targets on sterilization and proposed to rely more on education and motivation for achieving demographic goals. The new government issued a new Population Policy Statement in 1977, which reaffirmed the entirely voluntary nature of FWP, and against the compulsory sterilization.

• The change of government in January 1980 marked a turning point in the programme and helped to restore it to some extent with continuing emphasis on its voluntary nature. During the revised , 1980-85, a Working Group of Population Policy set up by Planning Commission formulated a long-term goals and programme targets for family welfare programme. The health-based, time-bound, target-oriented FWP was revived with lesser emphasis on sterilization and a greater emphasis on spacing methods and on child survival programmes. These were to be implemented through all sub-centers and primary health centers in rural areas, without any aggressive campaigns or mass camps for sterilization. The importance of involving various NGOs, social groups such as mahila mandals and other similar organizations was recognized, and effort was to be made in this direction. The tubal ligation of women began to rise steadily, and it became a dominant method of family planning, especially with a limited availability of spacing methods.

• The Seventh Plan (1985-90) continued the tradition of target-setting and population projections, and it envisaged a reduction in the rate of growth down to 1.53 per cent during 1996-2001. Despite a low key approach to family planning, the Seventh Plan witnessed a slow but steady increase in the number of acceptors of female sterilization. There was greater emphasis on reversible methods and, younger couples were offered incentives not to have more than two children
• One notable development from the early 1990s has however been intensification and expansion of the women’s movements within the country and outside, which have been very critical of FPP’s policies and directions characterized by overwhelming responsibilities imposed on women for achieving fertility reduction and demographic transition. The preponderance of female sterilizations as a dominant method of family planning in the country is, it is argued, due to the pressure brought on women by the health department officials in order to fulfil their own quotas of family planning. This has often been viewed as a serious infringement on women’s fundamental rights.

• The process of democratic decentralization was sought to be set in motion along with the passing of constitutional amendments 72nd and 73rd enactment of Panchayat Raj and Nagar Palika Acts in 1992. The primary health care including family planning, primary education and provision of such basic amenities as drinking water and roads became the responsibility of the panchayats. The reservation of one-third of the seats in panchayats for women members was also enacted, with the aim of boosting the process of women’s empowerment. The powers of state governments to impose coercive FPP through its primary health centers and sub-centers have also been sought to be curtailed. While this process of demographic decentralization is still in place, its speed and intensity vary widely across the states.

• Meanwhile, the deliberations and recommendations of the International Conference on Population and Development (ICPD) held in Cairo in 1994, organized by the United Nations, came up with a Programme of Action (of which India was one of the signatories), which viewed population policies as an integral part of programmes for women’s development and rights, women’s reproductive health, poverty alleviation and sustainable development. It was strongly felt at the Cairo Conference that population policies, which are dominated by macro demographic considerations, and acceptor-target-driven programmes are unnecessarily and unevenly burdening women with the task of regulating reproduction to meet the macro goals. It was argued that henceforth population policies should be guided primarily by the considerations of reproductive health, reproductive rights and gender equity, rather than solely by the concern of fertility regulation as hitherto practiced. Following the Cairo Conference deliberations and Programme of Action, the government of India adopted the Reproductive and Child Health approach to family planning and population stabilization, and the method-specific and acceptor-based family planning targets were abolished in the country as a whole since April 1996.

• Decentralized planning and programme implementation.

• Convergence of service delivery at village levels.

• Empowering women for improved health and nutrition.

• Child health and survival.

• Meeting the unmet needs for family welfare services.

• Under served population groups like urban slums, tribals, hill areas, displaced, migrants, adolescents and men to be included.

• Diverse health care providers.

• Collaboration with and commitments from NGOs and private sector.

• Mainstreaming Indian systems of medicine and homeopathy.

• Contraceptive technology and research on reproductive and child health.

• Providing for the older population.

• Information, education and communication. National Commission on Population, State / UT Commissions on Population, Coordination Cell in the Planning Commission, Technology Mission in the Department of Family Welfare created.