Socialist Health Review 1985 Vol. 1, No. 4, March: Politics of Population Control

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Title
Socialist Health Review 1985 Vol. 1, No. 4, March: Politics of Population Control
Date
March 1985
extracted text
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POLITICS OF POPULATION CONTROL

141
EDITORIAL PERSPECTIVE
Manisha Gupte

146
THE DISASTER
Anurag Mehra

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Working Editors :

Amar Jesani, Manisha Gupte,
Padma Prakash, Ravi Duggal
Editorial Collecive :

Ramana Dhara, Vimal Balasubrahmanyan (A P),
Imrana
Quadeer. Sathyamala C (Delhi),
Dhruv Mankad (Karnataka), Binayak Sen,
Mira
Sadgopal
(M P),
Anant
Phadke,
Anjum Rajabali, Bharat Patankar, Jean D'Cunha,
Mona Daswani, Srilatha Batliwala (Maharashtra)
Amar Singh Azad (Punjab),
Ajoy Mitra
and Smarajit Jana (West Bengal)

Editorial Correspondence :

Socialist Health Review,
19 June Blossom Society,
60 A, Pali Road, Bandra (West)
Bombay - 400 050 India
Printed at :
Omega Printers, 316, Dr. S P. Mukherjee Road,
Belgaum 590001 Karnataka

148
THE PRICE OF ASSISTANCE
Ramala Buxamusa

160
POLITICS OF BIRTH
IN INDIA
Sucha Singh Gill

CONTROL

PROGRAMME

166
CONTRACEPTIVE RESEARCH IN INDIA
Kusha

173
MOTIVATION FOR FAMILY PLANNING
Ilina Sen

179
A BIZARRE MEDLEY OF CARROTS
Vimal Balasubrahmanyan

182
THEORIES OF REPRODUCTIVE BEHAVIOR
Martha E. Gimenez

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Editorial Perspective

POPULATION CONTROL: FOR OR AGAINST PEOPLE?
hereas Malthus related population and popu­
lation growth to consumption, Engels and
Marx related them to production. By the Malthusian
hypothesis, population could be checked by means
of forcing down the wages which would in turn
lead to a natural increase in death rates. Marx
posed the question as to whether overpopulation
was in relation to the natural resources or to the
needs of the prevailing system. This debate, the first
on the issue of overpopulation represents to date
the crux of the ideology supporting the reasons for
population growth and consequently the measures
necessary to curb it.
The capitalist mode of production as a pre­
requisite demands a surplus population from which
an everready supply of human material — surplus
labour — is created for exploitation. Overpopulation
has therefore to be seen in terms of this mode of
production and not as a consequence of the 'Eternal
Laws of Nature' (Meek, 1971). In capitalist society
the actual producers are alienated from the means
of production because the latter are owned by the
capitalist.
Production is geared to the market
demand and not to the human needs of the popu­
lation. Therefore, the Malthusian prediction that
growing populations would be the main cause of
world-wide starvation is a historical error. The
truth is not 'how many people' but 'how many
people who can afford to buy enough food just to
stay alive.'

In his polemical writings against the Utopian
thinkers of his time, Malthus expressed contempt
for the poor. He claimed that the unemployed poor
were a burden on Nature's reserves and therefore,
had no right to live, leave alone to reproduce.
Biased heavily in favour of the English aristocracy,
his pseudo-analysis about the 'inferior ranks of
people' offers a rescue even today to population
control propagators when they have to explain
'undesirable' events, the rational and truthful ex­
planation of which can result in 'undesirable' con­
sequences such as the conscientisation of the
oppressed masses (Bondestam, 1980).
The Real Facts About Poverty
Malthus' observation that a reduction in popula­
tion size would release the otherwise limiting

March 1985

resources is only apparently true. When the entire
family lives at a subhuman level of subsistence,
having lesser children does not increase the standard
of living perceptibly. They still live below the pover­
ty line; often all of their life is spent only in com­
bating death from hunger and starvation. Escape
from death however does not mean any improvement
in the standand of living. Malnourishment, unhygie­
nic conditions and strenuous physical labour, all
together increase body weakness and decrease body
resistance to acute and chronic disease. Morbidity
creates further poverty (due to inability to work,
expenditure on disease) and eventually leads to
death. Either way death seems inevitable. The reason
for producing or wanting to produce more children
is economic and its resultant is the surplus lives
produced.
Among the poor, the cost benefit of having more
children is greater than when they have less. At a very
young age, the child becomes either a direct wage
earner or helps enhance the family income indirectly
(baby sitting, filling water) by relieving the adults of
household chores. Having many children is thus
not only beneficial but also necessary because not
all children that are born would live beyond the age
of five. It is only when a steady income flows in
regularly that having more children becomes a
liability. A small family norm is a middle class value
and to force the poor into accepting this norm with­
out improving their economic and social conditions
is inhuman.

Release of resources through population control
is possible only when resources are universally
available and uniformly distributed. The inequa­
lities in access even to basic services such as health
care become apparent through the fact that though
80 per cent of the Indian population is rural, only
46.2 per cent of the total health budget is allocated
for this population. Worse still, the public health
personnel are so overburdened with family planning
responsibility that primary health care has become
synonymous with birth control for the rural
population.

The poor live in deficits and debts, therefore a
reduction in family size will not create any savings.
Population control cannot ensure that the released
141

resources, however insignificant will be invested to
benefit the poorer sections of society. A fair distri­
bution of resources is possible only in a socialist
society where the means of production are distribut­
ed fairly. The propaganda that population control
will release available resources is just an eyewash
(Quadeer 1976).
Neo-Malthusians and The Ideology of
Population Control

The Malthusian theory of arithmetic increase in
food production and the geometrical increase in
population and the ensuing doom was belied by
bourgeois development in Europe in the 19th century
as also through the import of this development into
colonial India. It was at this point that the capitalist
forces in the form of neo-Malthusian arguments
introduced the 'population bomb' hysteria. NeoMalthusian ideology was part of the reactionary
counterstrategy against rising socialist forces. They
propagate the view that demographic factors aie the
main cause of economic and social difficulties
experienced by developing countries and to control
natality is the neo-Malthusian solution. This propa­
ganda is furthered to divert public attention from the
real facts about poverty and in order to disorganise
and weaken struggles aimed at democratisation.
The propagators of family planning can be
broadly classified into people who apolitically and
genuinely believe that population control is the ans­
wer to the world's problems and neo-Malthusians
who use family planning to propagate their own
ideology. But the distinction is not sharp. For instance
Margaret Sanger who did pioneering work in challen­
ging religious orthodoxy regarding contraception
considered that the American public was being too
heavily taxed to maintain a 'growing stock of morons'
(referring to the American poor) who 'threatened
the very foundation of American civilisation'. Her
statement was recollected with fervour by the neoMalthusians whilst unleashing a population control
programme among poor Puerto Ricans with lowered
intelligence.

The neo-Malthusian ideology holds the distri­
bution of existing resources as being inversely
proportional to the growth of the 'teeming millions'.
The truth is that the existing resources are concen­
trated in the hands of a few in a capitalist order.
The underlying fear behind this gross misrepresenta­
tion of facts is the imminent possibility of socialism
gaining terrain due to the rising unrest among the
unemployed
and the exploited working class.
Capitalists even today form the major donors to the

142

population control funds throughout the world,
either through private agencies or through 'legitimate'
government bodies.

The Population Control Policy
The 1974 World Population Conference at
Bucharest gave a call (in fact Dr. Karan Singh, the
then Health Minister of India, did) for 'development
being the best contraceptive'. Ironically, one year
later, India plunged into coercive and inhuman
sterilisations under the Emergency regime of Mrs.
Gandhi. Even on the global level, governments of
developing countries and private population control
agencies were planning family planning as the
primary strategy for development policies. Program­
mes were made more accessible, more attractive
and more efficient (Wolfson, 1978).

Though
donor agencies
recognise social
problems, very few have been prepared to support
these activities without population control being
the frontal strategy of approach to solve problems
of poverty and unemployment. Maternal and child
health (MCH) is the classical.example where donor
agencies have diverted their funds to, since MCH
is closely related to fertility. Family planning comes
along as an indispensable part of the package.
Donors make it quite plain that they consider deve­
lopment to be impossible without curbing the birth
rate. Family planning is the unavoidable condition
to be fulfilled when a developing country asks for
international aid.
In post-independent India, most of the leadership
belonged to the upper and privileged classes. They
often had westernised values and were sharply
different from the people they were supposed to
represent. Independent India had proclaimed socia­
lism from the roof-tops but in truth only the Indian
bourgeoisie as a class had benefited with the elite
becoming more privileged day by day. Due to
technical incompetence and the quest for profits,
there was an increasing dependence on western
countries for technical and.monetary assistance. A
vicious circle emerged because this dependence
created further incompetence and servility Foreign
experts virtually shaped India's policies and also
acquired a great deal of influence on their imple­
mentation (Banerji, 1980). As the economic condition
of India deteriorated under free enterprise and
lopsided development, foreign aid acquired a crucial
role in shaping Indian policies. Inthe field of popula­
tion control, western capitalists were able to push
in their anti-third world ideology along with aid for
development.

Socialist Health Review

•India was the first developing country to begin
implementing a national programme on family
planning as a state policy in 1951. in 1963, a
revised and extended variant of the official family
planning (FP) programme was put into action.
Population control (PC) has become a priority
increasingly, in fact with fanatic fervour it has been
proclaimed that PC is so urgent that it cannot await
improvements in the economic and social fields. It
is like putting the cart before the horse. Though the
Fifth Five Year Plan promised a "frontal attack on
the citadels of poverty" what was actually imple­
mented was an inhuman, anti-poor PC programme.

The role of the Indian government in unleashing
all the repressive state machinery on the poor for
forced sterilisation has been condemned the world
over (Wolfson, 1978). Yet, even today the use of
force, pressure, utilisation of the bureaucracy and
panchayats at village and taluka levels as well as
monetary incentives have become accepted as a
form of motivating people to accept FP. If PC is
seen independent of development, then motivation
and incentives are seen independent of the
individual's social existence. Target methodsand
coercion can also be understood when PC is treated
as a substitute for development (Mamdani, 1972).
Family planning is much easier to implement than
major advances in the areas of education or the
economy and though it has been repeatedly stated
that FP is part of the package of development, it has
been thrust as a substitute for development and
structural change.
The Feminist Perspective
It cannot be denied that birth control has created
more options for women. Knowledge and availability
of birth control measures is a matter of women's
rights because women should be allowed to govern
their own fertility. Repeated pregnancies and the
drudgery of constant child-rearing not being condu­
cive to good health, it is of extreme importance that
women have access to safe and effective methods
of contraception.

The disturbing factor however is that the
aggressive incentive based population control
programme has not allowed this right to stay with
the woman. Policy makers decide whether a woman
should have children, if so how many or whether
she should be allowed to abort her own foetus.
Doctors and social workers in clinics for abortion
and contraception tend to adopt moralistic attitudes.
Pharmaceuticals decide that women should passively
accept the contraceptives that fetch the largest

March 1985

profits to the manufacturers. Third world women
are constantly used for the field testing of dangerous
contraceptives. Primarily black and Spanish-speaking
women are targets of sterilisation in the USA.
Cultural biases in India naturally compel a woman
more than her husband to accept the FP operation
and poor as well as lower caste rural women have
been targets of the mass sterilisation camps as well
as those for Copper-T insertions. Powerful patriarchial institutions in fact have strengthened their
hold over the woman's reproductive organs through
birth control.

Even the bourgeois state fills in the gaps either
at home or outside it through population control
and birth control. A woman's leaving home for a job
does seem as though she has a greater freedom of
choice, but in truth it is the flexibility and compulsion
of the changes in the labour market that have left
her with no choice but to enter the production force
as a wage earner. Even if a woman is a wage earner,
her family labour always comes first. The birth
control policy monitors her 'reproductive' and
'productive' duties. Abortion laws should also be
seen in the same context. Population control has
increased state and international control on a
woman's intimate physiological function under the
guise of 'making available a birth right'.
The alarming anti-woman trend in the new
reproductive technology (NRT) needs to be studied
carefully. Unichem and German Remedies will
probably be given the licences to manufacture the
injectable contraceptive NET-EN in India. Hormonal
implants which render infertility for upto five years
are being tested on Indian women inspite of
dangerous side-effects. Amniocentesis for female
foeticide has been covertly recommended by FP
propagators since girl
babies are the future
'breeders'. Research to develop a 'male child pill' is
being recommended (Postgate, 1973). With the
growing concept of surrogate motherhood, women
could be converted into breeders in a reproductive
brothel where the most powerful socio-political con­
trol over women's reproduction would be made
possible (Dworkin, 1983). Here, the 'valuable' ova
and sperms from white couples could be merely
incubated in the wombs of brown or black poor
women, sterilised for convenience (Corea, 1984).
We open this issue with Ramala Buxamusa's
article based on her Ph.D. thesis which exposes the
impact that foreign aid has had on the Indian
population policy. International aid to the third
world for development contains major funds for

143

population control in an attempt to prevent the
developing countries from becoming socialist. She
traces how the initial resistance of the Indian govern­
ment broke under international pressures.

Sucha Singh Gill's article convincingly examines
the ideological content and class bias of the birth
control programme. According to him, the emphasis
of the Indian planners on population control is an
attempt to weaken the class struggle in India.
In the third article, Kusha relates her experiences
in a contraceptive testing unit in a working class
area of Bombay. During her association with this
unit for many years she saw contraceptives ranging
from diaphragms to hormonal implants being tested
for field trial on working class women inspite of the
unpleasant and dangerous side effects they created.
Her first hand experiences are eloquent.
Ilina Sen focuses on the motivational aspect in
the family planning programme. When the earlier
subtle motivations failed to increase family planning
acceptance, the government plunged into an aggre­
ssive disincentive based coercive birth control
campaign. Ilina examines the social and psycholo­
gical theories on which the motivational strategy
was founded and highlights the fallacies that accom­
pany the present family planning programme.

Vimal Balasubrahmanyan takes a critical look at
the trend in the incentives and disincentives in family
planning without making a single comment! In a
carefully prepared collage and not without a glint of
humour, she traces the dangerous trend over a
period of two years (1982-84).

The last article in this issue by Martha Giminez
is reproduced from the Review of Radical Political
Economics. She discusses the micro economic and
the sociological theories that analyse reproductive
behaviour and presents a marxist critique of the same.
She argues that reproduction should be conceptua­
lised in the context of a given mode of production.

—manisha gupte
A-4 Nav Samaj
Nehru Nagar
Vile Parle (East)
Bombay - 400 057

References
Banerji, Debabar: Political economy of Population Control in India
in Poverty and Population Control ed. Bondestam Lars and
Bergstrom Staffan, Acad. Press Inc, London, 1980.
Bondestam, Lars : The Political Ideology of Population Control in
the above book.

144

Corea, Genoveffa How the new reproductive technologies could be
used to apply to reproduction oi the brothel model o! socte!
control over women. Second international interd.scipl.nary
congress on women, Groningen, the Netherlands, Apr.l

17-24,1984.
n , ki
Dworkin, Andrea : Right Wing Women. Perigee Books. New York,

1983.
r
_
Mamdani, Mahmood : The Myth of Population Control: Family, Caste
and Class in an Indian Village, Monthly Review Press, New
York, 1972.
Meek, Ronald (ed) Marx and Engels on the Population Bomb, The
Ramparts Press Inc. California,1971.
Postgate, John: Bat's Chance in Hell New Scientist 58 (841) : 12-16,

1973.
Quadeer, Imrana : Population Problem — A View Point, MFC Bulle­
tin, No. 10, October 1976.
Wolfson, Margaret : Changing approaches to population problems,
Published by the Development Centre for the Organization of
Economic Cooperation and Development in Cooperation with
the World Bank, 1978.

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Socialist Health Review

The Printed Word
newsclippings on health and medicine, july - September 1984
Health Policy and the Health
System
Deccan Herald, 21 July : A 58year old man was electrocuted
at Ram Manohar Lohia Hospital,
New Delhi when the metallic
stand for hanging the glucose
drip came into contact with the
overhead light, which had been
known to be giving 'shocks'.
Business
Standard, 2 Aug :
USAID has offered to develop
basic infrastructure (buildings
for health institutions, residen­
tial complexes) and to improve
the health delivery system,
(including family planning and
maternal and child health) in
Bhiwani Mahendragarh and
Sirsa district of Haryana. In
phase I the USAID has released
Rs. 7 crores.

The Daily, 15 Aug. : Yet another
patient of the ESIS hospital at
Kandivili in Bombay leapt to
her death from the third floor.
The patient had been consi­
dered 'rowdy' apparently be­
cause she was not able to bear
the pain due to acute apendicitis, for which she had been
admitted a month previously
but had not been operated
upon. The reasons for the
delay in operating
remain
unclear.
The Hindu, 30 July'. The Working
Group of.the Central Council of
Health and Family Welfare has
made the following recommen­
dations : (1) The creation of
mobile opthalmic units in all
districts and stringent action
against unauthorised persons
conducting eye camps; (2) A
whole-time trained TB officer
March 1985

with supporting staff at the
directorate level for proper
suppervision and monitoring
of the national TB control
programme (3) All hypeiendemic districts to be covered
with multi-drug regimen pro­
jects during the 7th plan period;
and (8) All states to repeal the
Leper's Act of 1888.
Financial Express, 18 Sept : The
government has sanctioned a
budgetary allocation of Rs.
547.46 crores for the central
sector health programmes for
1984-85 as against Rs. 482.02
crores in the previous year.

The Telegraph, 19 Sept. ; In the
WHO regional committee for
southeast Asia,India has offer­
ed its 'vast reservoir of trained
medical manpower' to neigh­
bouring countries for meeting
their immediate requirements
and in organising training pro­
grammes for their medical
personnel.

The Hindu, 25 Sept. : The Eighth
Finance Commission has reco­
mmended a monthly allowance
of Rs. 400 for doctors serving
in rural areas.
Hindustan Times, 28 Sept. : A
steering group appointed by
the planning commission has
proposed the allocation of
Rs. 13936 crores for health and
family welfare in the 7th Plan.
It represents 8.3 per cent of the
total public sector outlay of Rs.
180,000 crores envisaged for
the period. The health sectors
share in the 6th plan was just
3.3 percent.
Out of this,
Rs. 10457 crores (about three

fourths) will go to the family
welfare sector.
Medical
technology
and
developments in
medicel
practice
The Hindu, 12 Aug : By the end
of 1984-85 three medical colle­
ges in Tamil Nadu, all district
headquarter hospitals and 22
hospitals at the taluk level in
the state would be equipped to
deal with accident and emer­
gency cases.

Financial Express, 20 Aug : A
production of Rs. 350 crores is
envisaged in the 7th plan for
the manufacture of medical ele­
ctronic equipment. The Depart­
ment of Science and Technology
has estimated that a tentative
investment of Rs. 60 crores
would have to be made during
the plan. During 1982, the total
production was of order of
Rs. 13 crores but is expected to
rise to Rs. 20 crores in 1984.
But the demand is estimated to
be Rs. 45 crores worth. In
1976-77 20 MEE
products
termed 'life saving equipment'
had been exempt from customs
import duty. The list has now
risen to 47 items.
Protests, Strikes and
Agitations
Times of India, 8 July: 7,000
medical personnel of the Gover­
nment and municipal hospitals
—4,000
resident
doctors
1,500 post graduates, and 1,500
interns will go on an indefinite
strike to protest against the
Maharashtra government’s de­
cision to start private medical
colleges accepting capitation
fee.
( Contd. on page 147 )

145

to the public. Unfortunately theconfusion wasfurther
intensified by our 'experts' who issued absurd and
incorrect statements. And those who could have
provided relevant information were instructed to be
silent. In fact, by dramatising operations like the
'neutralisation' of MIC, scientists further complicated
the situation. Rather than providing information and
assurances backed by facts, our scientist-politician
combine preferred to dramatise the situation and
mystify technology. A demand for information and
public access to records and to data is an important
component of the demands put forward by a number
of people's groups working on environmental and
health issues.
We have to work to pursue and
support these demands,

— anurag mehra
405/B-39
Yogi Nagar
Boriwili (W)
Bombay 400 092

Here is a brief list
information.
1.

of references which might yield

Toxicity of MIC and its quantitative determination in air
(German) Arch. Toxikol. .20 (4) 235-41, 1964

Pocket guide to chemical hazards. U.S. Department of
Health (lists properties, symptoms, first aid etc.)
3. Industrial Hygiene and Toxicology Second edition. Patty,
Clayton and Clayton (for other isocyanates like toluene
di-isocyanate — TDI)

2.

4.

High Polymers. David and Staley, Vol XVI. John Wiley
1969 (for TDI)

5.

(For experimental work on isocyanates) Ann. Occup. Hyg
8. 1965

6.

The dictionary of organic compounds. Chapman and Hall

Poss-Bhopal reports/studies published to far.:
1. Bhopal City of Death. Eklavya, EI/208, Arera Colony,
Bhopal Rs. 3/- 62 pp

2.

Bhopal Gas Tragedy. Delhi Science Forum, B—1,2nd
floor, J Block, Saket, 48 pp New Delhi 110 017 Rs. 5/-

3.

Human responses to isocyanate exposure by R. V. S. V. —
Vadlamudi and V. A. Shenai of Department of Chemical
Technology, University of Bombay in Science Age,
January 1985.The same issue carries three other articles
on Bhopal.

( Contd. from page 145 )

The Telegraph, 18 Aug. : About
6,000 junior doctors in all the
7 medical colleges in U. P. are
on indefinite strike in protest
against the alleged police assa­
ult on doctors of the Swaroop
Rani Hospital in Allahabad.
Professional bodies in
health care
Times of India, 25 July : Should
doctors working full-time as
medical advisors to pharmaceu­
tical companies be allowed to
hold office in professional asso­
ciations of physicians ? The
issue is being hotly debated
following attempts
by two
doctors from multinational com­
panies to seek election as
presidents of two such bodies.
The issue is of particular rele­
vance in view of the coming

election of the Association of
Physicians of India, the largest
organisation of medical specia­
lists with a membership of
4,000. The post of president is
being contested by two profe­
ssors of medicine from Banga­
lore and Bhopal respectively
and by Dr. Paul Anand, a fulltime director of medical research
of
Glaxo Laboratories.
Six
months ago Dr. A. S. Kochar
from, the same company had
sought elections as president
of the American College of
Chest Physicians (ACCP), but
the attempt had failed on
procedural grounds.

Indian Express, 21 Aug : A comp­
laint has been registered against
an alleged
quack who was
operating as a qualified medical
practitioner.
His credentials

were first suspected by the
manager of a bank which had
granted the 'doctor' a loan. The
Maharashtra Medical Council
sources say that for each such
case detected many others may
go unnoticed.

Free Press Bulletin, 7 Sept : A
doctor who is a Congress (I)
MLA and the chairperson of the
Maharashtra Small Scale In­
dustries development Corpo­
ration has had his name struck
from the registers of the
Maharashtra Medical Council
for negligence and violation of
medical ethics ayear ago, conti­
nues to practice. The complaint
had been registered by a patient
whose left leg had been crippled
following a wrongly admini­
stered injection in the knee cap.

The news items have been compiled from the files of the Centre for Education and Documentation, Bombay.

Compilation : AJ, PP

We request readers to

send us relevant items, especially from the regional press.

March 1985

147

THE PRICE OF ASSISTANCE
The Family Planning Programme in India
ramala buxamusa
The evolution of the family planning programme has been greatly influenced by the foreign aid it has
received The author describes how (i) the nature and origin of 'aid' has changed and (ii) how and why the
initial resistance of the Indian government to such a>d crumbled. Not only the family planning policy but the
methods of contraception promoted through the programme were determined by the aid. received directly from
donor agencies or via international bodies such as the several UN agencies.

commonplace assumption that goes virtually
unquestioned these days is that lhe chief
cause of every problem from the growth of slums to
unemployment, famine, pollution, liberation, wars
and strikes isoverpopulation. Futurologists paint a
pessimistic picture of the world in 2001 AD especi­
ally with regard to the third world and call for popu­
lation control, that is family planning as the supre­
me panacea for all social evils. Similar views prevail
amongst the Indian planners who accept the views
that originated chiefly in the first world.
It is the hypothesis of this study that the present
population policy is largely the outcome of factors
other than mere socioeconomic and political changes
in the country. The impact of external assistance as
aid and loan received in cash as well as in kind has,
over a long period of time, influenced the govern­
ment's population policy. Although the government
has shown ambivalence in implementing the popula­
tion control programme, and although it is not
officially accepted that the government's program­
mes rely largely on foreign aid, it can be proved
that this external assistance has mainly been respon­
sible for the population policy and programmes in
this country. (1)
The Pre-Plan Period : 1947 to 1952

During World War II there was a lull in organi­
sed birth control activities. After the war statistical
studies quickly gained momentum as valid science
and "Asia's teeming millions" became a vital subject
for investigation, particularly with the growth of
political movements in India, China and south east
Asia. The deepening food crisis in these areas frigh­
tened many American thinkers into the belief that
they would turn communist (Borie, 1948).

As early as in 1946 the Swedish National Asso­
ciation, financed by some Americans tried to build
up a liason between societies interested in popula­
148

tion control but as the time was not ripe efforts
failed (FPAB 1948). Later in 1948, with the deepen­
ing food crisis all over the world the Family Plann­
ing Association of Great Britain and the Swedish
National Association under the leadership of Marga­
ret Sanger organised the 1st International Confere­
nce on Population of the World : Resources in Rela­
tion to Family in London.
Here for the first time
the 'dignified' term of family planning, actually a
euphemism was used in place of 'birth-control . The
conference stressed the importance of human
fertility research and an effort was made to involve
the UN body but met with no response from the UN
(FPAB 1948). In 1948 was born the Family Plann­
ing Association of India (FPAI) as a private body.
This body was affiliated to the parent body, FPA
Britain from which it received funds in cash and
kind. During this period there was no direct govern­
ment aid nor multilateral (eg. UN) aid to India.

In 1949 China turned communist and this sho­
cked the imperialist world particularly the USA. It's
reaction and attitude was to "save India atleast".
Many thinkers expressed the view that it was essen­
tial to check India's population (Vogt,1949). Thus
fertility control in India and the third world became
a priority for the US monopoly organisations. One
hears of birth-control only from the mouths of
Americans, Swedish and British individuals and
their organisations in the pre-independence period.
Catholic opposition did not permit the first world
governments nor the UN to get involved in birth
control programmes. Private organisations preview­
ing "danger donated funds to Indian private
organisations to open clinics and publish literature
to favour birth control. A beginning was thus made
by the private organisations in the family planning
field in India.
The First Five Year Plan 1951-1956

The nations which the imperialists feared would
be lost to communism became known as the
Socialist Health Review

population powderkegs” of the "underdeveloped”
world and population control programmes were
designed for them. India was selected for special
attention. The first in-roads into the population
control programme in India were made by private
organisations such as the Hugh Moore Fund, the
Rockefeller Foundation, the Ford Foundation and
Swedish and British businessmen (Mass,1978).

target of attention, Lady Rama Rau was made the
first joint secretary along with Margaret Sanger the
pioneer of the birth control movement (FPAI, 198081). Margaret Sanger's views on birth control sound
markedly racist today; she held that the growth in
numbers of poor of the world was a burden and a
threat to the peace of the "civilised” and needed to
be checked.

Politically the subject of birth-control was sen­
sitive. In the West there was Catholic opposition to
birth-control, forcing private organisations to move
with caution. The first approach was to spread the
ideology of "overpopulation” through seminars,
conferences, publications and through statistics. In
1952 the UN, for the first time, was persuaded to
collect the demographic statistics of the third world
countries (Mass, 1978).

India accepted the need for population control
and incorporated a family planning programme in
its health ministry. It officially opted for the clinical
method and the opening of clinics. But in the first
three years only the rhythm method was propagated.
Private organisations such as IPPF and the Interna­
tional Red Cross donated in cash and kind to their
clinics using diaphrams, foam tablets, condoms and
conducted sterilisation operations in Bombay and
Calcutta. These FPAI clinics were the first of their
kind in the world (FPAI annual reports). Sanction
for the use of contraceptives (mainly condoms, foam
tablets and diaphrams) in the government's own
clinics and the Rockefeller and the UN sponsored
projects in Punjab and Bengal respectively was
given only in 1955 (Ministry of Health Reports,
1952-1956). The Government's action in the first
plan was negligible. This is confirmed by the fact
that although the government sanctioned as much
as Rs. 65 lakhs, no more than Rs. 31 lakhs was
spent. This could not be due to mere moralist
objections to artificial birth control programme alone.
The need for birth control although accepted in
principle by our planners, was not felt to be such a
great necessity. Hence the difference between allo­
cation and implementation persisted over many
decades.

Rockefeller, Moore and other private mono­
polies which had been supporting population studies
earlier now made moves to start private international
organisations. In 1952 under the sponsorship of the
National Academy of Science, John D Rockefeller
III convened a conference of demographic experts
and population specialists in Williamsburg, Virginia
to establish a non-profit organisation, the Population
Council. This organisation was to provide a pre­
viously lacking "respectable base from which to
influence professional and academic sectors to
finance a more scientific approach to population".
Between 1952-58 the budget of the council
was quadrupled, rising from 4.5 million dollars to
18.3 million dollars. A large part of the 1958 budget,
8.4 million dollars was provided by Ford Foundation.
It is said that over 500,000 dollars, nearly 80 percent
of all the Ford's Fund for population control came to
the Population Council. The Rockefeller Foundation
also donated 3.4 million and the Mellon family 2.9
million dollars to Population Council (Mass, 1978).

With the creation of the Population Council in
New York, British and Swedish businessmen were
moved to organise the Third International Seminar
in 1952 at Bombay. The Family Planning Association
of India (FPAI) managed the show. Many foreign
European dignitaries who attended expressed
Malthusian views and an International Planned
Parenthood Federation (IPPF) was founded, with
headquarters in London. Swedish and British mono­
polies were not able to donate as much as American
monopolies and in the 1950's IPPF's budget was
comparatively less than that of Population Council.
It supported all the affiliated Family Planning
Associations of the world. India being the major
March 1985

The Second Five Year Plan : 1956-1961 (March)
During this period, the liberation movements in
the third world grew stronger. The economic
condition of most of the third world deteriorated.
For instance, India faced its direct majer foreign
exchange crisis in 1957 when the rupee was
devalued. At this time, Coale and Hoover rejected
the classical Malthusian theory but postulated that
due to economic improvement death rates fall but
not birth rate, and therefore, economic development
is not possible. Thus the argument popular in the
west was that investments in population control
were more beneficial than investments in develop­
ment programmes (Coale and Hoover, 1958).

Third world governments however, were not
keen on finances from private donors. The Ford
149

Foundation and the Rockefeller Foundation finding
that they instead were being cold shouldered helped
in funding the UN. The UN also received funds from
the Population Council. In 1956 the UN carried
forth
the recommendation of the International
Social Science Council to collect demographic
statistics (ECAFE, 70). It later moved two govern­
ments in the third world—one in Asia in 1957 and
other in Latin America, to start demographic training
centres catering to the people of neighbouring
countries. In these institutes consultancy services
wers supplied by the UN. Most of the consultants
were generally officials on leave from private popul­
ation control bodies (for instance, Parker Mauldin,
an Officer of the Population Council took leave from
his office and came to the Bombay Demographic
Training Centre as a UN Consultant on the subject)
(Population Council Report, 1957). The idea was to
irain third world people in demography in order to
spread the awareness of the need for population
control. Thus ironically a member of the Population
Council, (the ideology of which was not accepted
by the third world), was allowed to help in training
and advising Indians on the subject, as he came in

the guise of a UN expert. This trend of private
organisations
infiltrating the third world
through international bodies like the UN and
thus gaining acceptance is continuing even
today. It is in this way that their unacceptable ideas
influence the population policy of the third world.

The WHO was in fact, severely critcised for
organising such programmes for curbing population
and controlling tropical diseases. This was inter­
preted as being not so much for the benefit of the
third world, as for providing lucrative business for
European and American drug cartels (Mass, 1978.)
An analysis of WHO's own reports reveals that
the projects funded in the third world mostly
relate to field and human trials of the drugs
and chemicals being developed by first world
firms (Times of India, 1981) Critics point out
that but for these programmes, the firms would
never have been able to develop the products
or conduct such trials in the third word on
their own.

At the same time the Population Council,
independently started aiding demographic teaching
in Asian and African universities and began collect­
ing demographic statistics as well so as to spread
awareness for the need to control population
growth. However, in the name of action research,
they also carried out the testing of certain contracep­
tives which had not been tested or approved by

150

their own government. The first world Drug Laws
were too stringent and the lax laws of the third
world on the other hand, offered wide opportunities
for such testing.
The Ford Foundation, which had earlier showed
interest in population control through other organisa­
tions now took a bold step. It independently started
organising population control programmes in the
third world, with its first programme being in India
in 1959 (Ford Foundation, Report 60).

In 1956-57 the Indian government showed great
resistance to private organisations aiding the family
planning programme, although they accepted in
principle the need for population control. But in
1958 faced with financial crisis the government's
resistance broke down a little. India called for
development aid from foreign countries which
brought in aid first from the Ford Foundation that
year and Bonnie Mass has stated that in 1959 India
received 9 million dollars for publicity and campaigns
for population control (Mass, 1978). Later others
came with aid for agriculture and small industrial
development. Along with development aid came
assistance for population control. Various Universities
departments of Economics were aided by the
Population Council to start teaching demography.
One notices a strange situation here: the Indian
government allowed the private organisations to
directly carry out certain population programmes
but did not itself get totally involved in the progra­
mme. However it began to show a keen interest in
implementing population programmes.
Several
demographic training and research units were started
by the government and plans were made to carry
out empirical research on contraceptives previously
tested by FPAI in their clinics. Oral pills and diffe­
rent methods of sterilisations were tested by the end
of the plan.

The government expenditure in the second plan
was ten times more than that in the first plan. This
may have been a result of increases in foreign aid
for FP after 1958. One also notices that after 1958
the private voluntary agencies were getting more
funds from private organisations and increased their
activities. For instance, FPAI started more pro­
grammes as its funding organisation the IPPF got
66600 dollars from the Population Council in
1959-60 (UN, 1968).
Third Five Year Plan : 1961-66

With the continuation of the cold war, came a
tremendous investment in defence all over the world.
Economic stagnation and inflation pressures hit the
Socialist Health Review

first world. As a chain reaction third world countries
were_the most affected. The UN economic survey
report of 1963 indicates the widening gap between
the first and the third worlds. All this affected private
organisations and they became more interested in
selling the idea of population control. They attem­
pted to involve the American government, but
president Eisenhower rejected family planning
(Wiessman, 1970). Many writers persisted in their
argument that Vietnam and other liberation wars of
Asia, Africa and Latin America were the result of
overpopulation.
Therefore
population control
activities were most essential in the third world.
Still others stressed that the widening gap between
the first and third worlds was due to third world
overpopulation. (Berelson, 1964).

The growth of pessimistic thoughts about the
overpopulation of the world caused some of the
private organisations of USA for instance Draper,
Moore. Harper & Row, Cass Canfield and Rocke­
feller to set up the Population Crisis Committee
which was the political action arm of the Population
Control movement. The US government officials
served as representatives in the above committee
(Wiessman, 1970). With the consent of President
Kennedy, Richard Gardener was allowed to offer aid
for the Population Control Programme of the UN
marking the beginning of US government aid to
population control (Chandrasekhar, 1969).

bio-medical
1961-66).

testing in

India.

(Ford

Foundation,

India was the first country in the world to experi­
ment with sterilisation and its result was utilised to
formulate a sterilisation programme for the world
(Population Report 1973). The government at the
beginning of the plan paid no heed to the recomm­
endations of the Ford Foundation but later in 1963
with the increased economic crisis, accepted 'the
extensional approach' (UN India, 1966). Was the
government's willingness to permit experiments by
foreign institutions before its acceptance of the
programme due to a fear of mass reaction, or was it
due to foreign pressure ?
Thus we see that the private bodies gave up
doing research in demography and moved directly
to support action programmes. The money allocated
in the third plan by the government was forty times
greater than that in the first plan and foreign private
agencies contributed more money to family planning.
In this plan period, although the reports do not
clearly indicate the relative proportions of foreign
private aid and multilateral aid (Health Directorate
Report, 1961 -66).
The Three Annual Plans : 1966-69

With a programme from J. D. Rockefeller III, the
White House gave a 'New Look', to foreign policy.
USAID made birth control a part of foreigh assist­
ance and permitted President Johnson to judge a
nation's "self help' in population planning as a
criterion for giving Food for Freedom Aid. Develo­
ped rich nations thus directly pressurised under.
developed poor nations through economic aids
which the poorer nations could not refuse (Wiess­
man, 1970).

The prolonged war in Vietnam continued to
drain US wealth, while severe inflation hit many
countries of the first world. The painfully slow rate of
economic growth was noticed not only in India but
in all the third world countries. Population control
continued to siphon off funds from develop­
ment. As a result of this, all the food shipments of
USA "Food for Peace" programme under PL 480 aid
to the third world had to be expended on Family
Planning ie birth control programmes (Cleaver, 1973)
USAID and many suspectedly private organisations
moved to give population control a more inter­
national touch.

In India, by the end of the second five year plan
it was realised that the economic plan targets were
difficult to reach, secondly the policy resulted in
widening the disparity in people's living standards.
(Report 1960-61). In 1962 the Ford Foundation
advised the government to take up the extensional
approach ie to carry FP service to the door of the
client through mobile units, camps and clinics. Besi­
des Ford the other major donor to the Indian Volun­
tary agency FPAI was IPPF whose joint secretary
was Dhanvanti Rama Rau. The Ford Foundation
and FPAI experimented with mobile units and
sterilisation camps and IUCD, initiating the period of

The Ford, Rockefeller, Moore and other founda­
tions began to give larger donations to the inter­
national agencies resulting in larger budgets for
the Population Council and IPPF. Among their many
activities was especially encouraged the distribution
and testing of contraceptives. In 1966 the Popula­
tion Council went on to emphasise the use of Lippes'
loops which had already been discarded in the west.
They were either donated freely as aid to the third
world countries or else loans were granted for their
purchase or were manufactured in third world
countries. In India, the Population Councilfunded the
opening of the Lippes' loop factory at Kanpur, the

March 1985

151

machinery for which was sold to the government by
the Council (Population Council, 1966).

USAID donated assistance in cash and kind for
population control along with development and food
aid to India. In April 1966, the Population Council'sbio-medical division continued to fund the testing
of contraceptives and launched the International
post-partum family planning programme. This wasto start more direct FP assistance through a hospital1
base to all women who came for delivery or for
Medical1 Termination of Pregnancy (MTP). (Massr
1978). Although the acceptance of family planning
appeared voluntary, the very fact that it was linked
with delivery and abortion facilities detached it from
the free will and volition of both the women as well
as the hospitals that opted to receive the programme
funds. But until 1969 funds for the post partum
programme did not reach India (UN Report, 1970).
Today this post partum programme has resulted in
the acceptance of family planning measures being
made a pre-requisite for obtaining medical treatment
for deliveries or abortions. Thus a strange form of
"compulsion" was created not overtly, but by
skillfully narrowing down choices for women.
Faced with growing opposition from third
world radicals and nationalists, private monopoly
houses tried to move more cautiously. Through the
UN a multilateral touch was given, by making
family planning a human right in December 1966,
adopted by 12 countries and later by all UN count­
ries within a year. This resulted in the WHO, UNICEF,
ILO, ECAFE and UNESCO directly donating funds for
family planning and supplying contraceptives (UN
Assistance 1968). In 1967 the United Nations Popu­
lation Trust Fund (UNPTF) was formed whose major
financial resources came from US donors and the
USAID. In 1969 UNPTF became the UN Fund for
Population Activity - UNFPA - and by the seventies,
UNFPA dominated population control activities in
the world (Mass.1978). With growing antagonism
USAID routed its funds through small as well as
better known organisations such as Pathfinders and
the IPPF. Private voluntary agencies in the third
world were also willing to use their good offices to
put to test oral contraceptives and experiment with
the effectiveness of various delivery systems of
family planning in their respective countries (OFECD,
1975).
In India The Third Five Year Plan was greatly
lagging behind in its targets in 1966. The country
was faced with another great economic crisis resul­
ting in a severe drain on it foreign exchange. During

152

this period it is interesting to note that the "Develooment Aid" was bracketed with the family planning
programme. The USA instead of signing annual or
multiyear (food) sales agreements deliberately
doled out food only for a few months at a time to
ensure, through pressure, that family planning
programmes were, carried out. One notices that aid
from USAID was the greatest to India during this
period. It not only supplied money and PL 480 funds
(such as oral pills in 1967-68 and then condoms
for the Nirodh Marketing programme for testing
as well) USAID in 1966-69 donated funds to start
the "Intensive District Area Programme" providing
nutrition programmes along with family planning.
By 1968 SIDA, DANIDA and Japan signed the
bilateral contracts with the Indian government and
supplied contraceptives and equipment for family
planning services (Ford Foundation, 69). Private
organisations like the IPPF, Pathfinder and the
Population Council which function through volun­
tary organisations tested lUCDs of different types
and shapes, oral pills were tested and sterilisation
experiments were conducted in their voluntarily-run
clinics, hospitals or dispensaries.

One notices that with each plan the priority
accorded to the different methods of contraception
has changed. In 1966-67 the government's stress
was on IUCD; in 1967-68 sterilisation was officially
emphasised and in 1968-69 it was Nirodh (Ministry
of Health-Family Planning, 1966-69). Were these
changes made by the government as a result of
mass demand ? or were they the result of the supply
of contraceptives as part of the external aid as India
did not produce them indigeniously (UN,1970) ?

The government allocated in the first annual
plan Rs. 149.30 million, in the Second annual plan
Rs. 310 million and Rs. 370 million in the third plan
for family planning. Incentive schemes were given
emphasis in the second and third plans. One notices
nearly a 100 percent rise from the sum allocated in
the first annual plan. In this plan period almost 84
percent of the allocated funds were spent (Ministry
of Health, 1966-69). This may have been a result of
USAID compulsion to expand the FP activities and
the PL 480 funds or it may be because the incentive
schemes were offered to the acceptors and promotors
of family planning. The most prominent trend in this
period is the increase in direct involvement by the
first world countries and the UN, instead of only
private monopolies and their international organisat.ons. With this the pressure for acceptance of
arnily planning by the third world, especially by
India, becomes greater and more rigid.
Socialist Health Review

this period it is interesting to note that the "Develomachinery for which was sold to the government by
the Council (Population Council, 1966).

USAID donated assistance in cash and kind for
population control along with development and food
aid to India. In April 1966, the Population Council's1
bio-medical division continued to fund the testing
of contraceptives and launched the International
post-partum family planning programme. This wasto start more direct FP assistance through a hospital
base to all women who came for delivery or for
Medical Termination of Pregnancy (MTP). (Mass,
1978). Although the acceptance of family planning
appeared voluntary, the very fact that it was linked
with delivery and abortion facilities detached it from
the free will and volition of both the women as well
as the hospitals that opted to receive the programme
funds. But until 1969 funds for the post partum
programme did not reach India (UN Report, 1970).
Today this post partum programme has resulted in
the acceptance of family planning measures being
made a pre-requisite for obtaining medical treatment
for deliveries or abortions. Thus a strange form of
"compulsion" was created not overtly, but by
skillfully narrowing down choices for women.

Faced with growing opposition from third
world radicals and nationalists, private monopoly
houses tried to move more cautiously. Through the
UN a multilateral touch was given, by making
family planning a human right in December 1966,
adopted by 12 countries and later by all UN count­
ries within a year. This resulted in the WHO, UNICEF,
ILO, ECAFE and UNESCO directly donating funds for
family planning and supplying contraceptives (UN
Assistance 1968). In 1967 the United Nations Popu­
lation Trust Fund (UNPTF) was formed whose major
financial resources came from US donors and the
USAID. In 1969 UNPTF became the UN Fund for
Population Activity - UNFPA - and by the seventies,
UNFPA dominated population control activities in
the world (Mass.1978). With growing antagonism
USAID routed its funds through small as well as
better known organisations such as Pathfinders and
the IPPF. Private voluntary agencies in the third
world were also willing to use their good offices to
put to test oral contraceptives and experiment with
the effectiveness of various delivery systems of
family planning in their respective countries (OFECD
1975).

In India The Third Five Year Plan was greatly
lagging behind in its targets in 1966. The country
was faced with another great economic crisis resul­
ting in a severe drain on it foreign exchange. During
152

pment Aid" was bracketed with the family planning

programme. The USA instead of s.gmng annua or
multiyear (food) sales agreements d®l'b^ey
doled out food only for a few months at a time to
ensure, through pressure, that family Planning
programmes were carried out. One notices that aid
from USAID was the greatest to India during this
period. It not only supplied money and PL 480 funds
(such as oral pills in 1967-68 and then condoms
for the Nirodh Marketing programme for testing
as well) USAID in 1966-69 donated funds to start
the "Intensive District Area Programme providing
nutrition programmes along with family planning.
By 1968 SIDA, DANIDA and Japan signed the
bilateral contracts with the Indian government and
supplied contraceptives and equipment for family
planning services (Ford Foundation, 69). Private
organisations like the IPPF, Pathfinder and the
Population Council which function through volun­
tary organisations tested lUCDs of different types
and shapes, oral pills were tested and sterilisation
experiments were conducted in their voluntarily-run
clinics, hospitals or dispensaries.
One notices that with each plan the priority
accorded to the different methods of contraception
has changed. In 1966-67 the government's stress
was on IUCD; in 1967-68 sterilisation was officially
emphasised and in 1968-69 it was Nirodh (Ministry
of Health-Family Planning, 1966-69). Were these
changes made by the government as a result of
mass demand ? or were they the result of the supply
of contraceptives as part of the external aid as India
did not produce them indigeniously (UN,1970) ?

The government allocated in the first annual
plan Rs. 149.30 million, in the Second annual plan
Rs. 310 million and Rs. 370 million in the third plan
for family planning. Incentive schemes were given
emphasis in the second and third plans. One notices
nearly a 100 percent rise from the sum allocated in
the first annual plan. In this plan period almost 84
percent of the allocated funds were spent (Ministry
of Health, 1966-69). This may have been a result of
USAID compulsion to expand the FP activities and
the PL 480 funds or it may be because the incentive
schemes were offered to the acceptors an.d promotors
of family planning. The most prominent trend in this
period is the increase in direct involvement by the
first world countries and the UN, instead of only
private monopolies and their international organisa­
tions. With this the pressure for acceptance of
family planning by the third world, especially by
India, becomes greater and more rigid.
Soc/a/ist Health Review

This desire for limiting population led to a
marked increase in bio-medical testing to discover
the best contraceptive". In many cases women
were not even aware that their bodies were being
used for experimentation since they had approached
the clinics for other medical treatment. Worse still
others, because of financial incentives, sold their
bodies to be used as ''guinea-pigs" for experiments,
the result of which could not be guaranteed; doctors
themselves could
not often predict
possible
reactions (Scheuer, 1972)
Family planning now became a goal to be
reached, a tempting solution to the financial crisis
and thus the human element was completely
ignored. Protection of basic human rights, especially
the rights of women, which the UN proposed as the
aim of this programme, were completely ignored.

The Fourth rive Year Plan : 1969-74
The green revolution in certain parts of the
world increased food production; but the Vietnam
was continued to drain USA's public investments
and world-wide inflationary conditions instead of
improving had further hiked prices. Liberation wars
and guerilla movements developed in the third
world. All these conditions moved the private and
government donors of the first world to loosen their
purse strings for population control activities still
further. During this period we see that the deve­
lopment aid increased in absolute terms but one can
observe that the rate of growth for population
control aid was much higher as compared to that in
1961. Development aid increased from 5200 million
dollars to 7800 million dollars. Population assistance
rose from 6 million dollars to 198 million dollars
(UNFPA, 1974). In 1969 President Nixon in a reveaing message to the committee of the White House
stated that the UN, its specialised agencies and other
international bodies should take the leadership in
countering the problems of overpopulation in the
third world and that the US should co-operate fully
with such programmes (Singer 1971).

All this created a climate for symposia, confe­
rences and debates on the population problem. The
chief cause of every problem was seen as over
population. Economists worked out the cost-benefit
analysis of population control investment versus
development investments insisting that the former
was more beneficial than the latter. The World Ban
received for the first time donations from the US
and other first world countries for activities in
population control. Under the leadership of Robert
McNamara it frantically called for population
March 1985

control and assigned from its budget 27.0 million
dollars in 1973 (World Bank) in India. The World
Bank started population project in Rajasthan and
Andhra Pradesh in 1974.
USAID, faced with objections from many third
world countries rechanneled aid through multilateral
and a few private international agencies. By 1973
100 million dollars of AID Funds entered the develo­
ping countries once again through private organisa­
tions for population control activities. By 1971 many
new private organisations such as Family Planning
International Assistance, Association for Voluntary
Sterilisation, Asia Foundation and the International
Confederation of Midwives had been founded. Path­
finder, a private organisation receiving funds from
USAID had by 1973, 35 projects in 44 developing
countries which were funded directly by private
organisations and not by governments of the third
world countries. IPPF in 1973 launched programmes
to integrate family planning with rural development
and when its activities expanded, it received increa­
sing recognition by government. (USAID, 1973).

USAID was very keen on promoting bio­
medical research and in developing new contracep­
tives. It donated 3 million dollars in 1970 to the
Population Council to develop the ''once a monthpill" and the Indian Council Medical Research Unit
cooperated in testing in India (USAID, 1973).
In-mid-1971 when the New York Population
Council started its International Committee for
Contraceptive Research (ICCR), in India a Contra­
ceptive Testing Unit (CTU) in Delhi with 14 centres
in different cities of India was set up. This duplica­
tion was unnecessary as already there existed the
Institute of Reproduction in Bombay which had its
centres in major cities of India. The ICCR tested
intra-uterine device on 50,000 women over a period
of one year. The ICMR has conducted research on
various intra-uterine devices and hormonial contra­
ceptives. About 50,000 women are estimated to
have taken part in these tests for the ICCR.
It is interesting to note that the population
control activities which were started in 1952 by
foreign powers with the sole emphasis on demo­
graphic research were transformed by the 70s into
direct population control of the third world people.
IPPF was the only.international private organisation
whose budget rose very fast as this organisation
concentrated on family planning activities and
worked on a voluntary basis in third world countries.
But the budget of other private agencies like

153

Rockefeller, Ford Foundation did not increase and
private organisations and USAID started donating
more liberally to IPPF.
India, despite enjoying some fruits of the
Green Revolution due to an increase in food produc­
tion, could not check the growth of poverty and
unemployment. The inflationary crisis continued to
increase as well. World-wide inflation had further
worsened her economic conditions. The Indo-Pak
war for the liberation of Bangladesh further upset
her economy and in 1971 the Indo-Russian pact
strained her relations with USA triggering off other
repurcussions.

The family planning programme was again
given the highest priority and the population policy.
became
in principle
more ante-natal. Upto
1970-71 USAID and Ford Foundation had given
major support for family planning. Their consultants
advised the Planning Commission, the Health
Ministry and the ICMR. When relations with the US
were strained USAID and Ford Foundation- were
asked to wind up their population control units and
their aid ceased to flow (Seal, 1974).
After a little lull in donations in 1971-72 funds
from multilateral organisations and other govern­
ments were gradually stepped up. One sees SIDA,
CIDA, UK and Norway donating large funds to
support the building of the National Family
Planning Institute in Delhi and some research on
nutrition and health programmes in India. UNFPA,
ILO, UNICEF and WHO, whose activities were
limited in India gradually became the major donors.
Both private and multilateral bodies were heavily
supported by the USA. By the end of the plan an
experimental area development scheme — India's
first population project — was launched by the
government with aid from the World Bank, IDA and
SIDA. When USAID stopped functioning directly,
many voluntary private organisations like IPPF,
AUS, Pathfinder Fund, FP International Assistance,
Christian Church Associations, and the International
Red Cross started funding small voluntary organi­
sations in India and thus many rural and urban
clinics, hospitals and dispensaries were opened. The
organisers were invited for seminars and conferences
abroad and they were donated contraceptives and
money. Many organisers came back and stressed
sterilisation and offering incentives like radios,
buckets, sarees, transistors.

In the Fourth Five year Plan Rs. 315 crores
.were allocated but government expenditure after
1972 reduced as USAID and Ford Foundation

154

found themselves in disfavour at the government
level as a result of the Indo-Russian pact. The
USAID policy statement indicates 'AID recognised
early that many instrumentalities would need in
helping developing countries to attack their
problems of population growth. Direct assistance
could be helpful in those countries receptive to the
bilateral approach. In some others however, assist­
ance from multilateral agencies and from private
organisations appeared to be more welcome - thus
USAID shall help multilateralsand private organis­
ations and they shall work independently .
The Fifth Five Year Plan : 1974-79

The decade of the Seventies began with a
further upset of the already deteriorating world
economy —the oil crisis hit the western world. At this
crucial period in 1974, the World Population Year
was celebrated and the activities of population con­
trol expanded. The first international conference on
population sponsored by the UN was held at Bucha­
rest Various proposals and plans of action were put
forward which would drastically‘ reduce birth rates
in the third world Planners of the conference were
confident that they Vvould be able to strike an agree.
ment on 'plans of action' for family planning.
Surprisingly third world countries formed a powerful
block and opposed the US experts' 'plan of action'
intended to stabilise the third world's population
growth, treating birth-control as a factor which could
be detached from the health and well-being of the
women, family and society. Many of the socialist
countries protested against what they considered the
absurd theory of "population explosion." They felt
instead that development would
itself bring
down the birth-rate. ( Mass,1978 ) Experience had
shown that poverty was the main factor responsible
for over-populatiOn. Hence they argued that to
insist that family planning was more important than
development was to see the problem from the
wrong end.

The social and political consciousness of the
third world made it necessary that population progra­
mmes of the future would have to be couched in
more subtle terminology. In order to make it palatable
to the third-world recipients John D Rockefeller II
was the first to put population planning in a develop­
mental framework. He argued that population
programmes and overall development programmes
should indeed go hand in-hand.. "We recognised
that reducing population growth is not an alternative
to development, but an essential part of it for most
countries" ( Mass, 1978 ).
Socialist Health Review

Though there was a protest and an apparent
setback for imperialists at Bucharest, the working
group of the conference comprised representatives
from many countries who chose to make the final
draft. They voted to retain neo-Malthusian 'target'
figures which proposed that the birth rate of the
underdeveloped nations be reduced to an average of
30 per thousand by 1985. Despite the vehement
protests of the third world, the end results of the
report of the conference were heavily influenced by
the opinion of the first world.
The Population Council concentrated on its bio­
medical testing even after 1975. Till 1975 the Inter­
national Committee for Contraceptive Research
carried out tests on 12 new potential fertility control
methods. However, faced with objection in the third
world the Population Council handed over the post
partum projects to UNFPA and donated large funds
to it ( Mass, 1978 ).

The Pathfinder Fund with a budget in 1965 of
100,000 dollars expanded in 1975 to 3.5 million
dollars and supported approximately 150 studies in
more than 40 countries. Its office in New Delhi
which was set up in 1964 was later closed down
( Mass, 1978 ).
By 1975 the Family Planning International Asso­
ciation funded by the Planned Parenthood Federa­
tion of the American IPPF and other voluntary world
church organisations, services aided by USAID be­
came the single largest source of contraceptives and
other family planning supplies to the third world.
Nearly 1000 church related hospitals, clinics, dispen­
saries and private groups were supported.

The Co-operative for American Relief Every­
where (CARE) began by 1970 to support birth
control and by 1975 gave birth control the highest
priority. Many other private organisations like OXFAM
(England, Canada), Christian Aid (England), Asia
Foundation, American Voluntary Association for steri­
lisation supported family planning ie birth control as
their highest priority projects ( UN, 1979 ).
UNFPA whose activities expanded in 1974 and
which was in charge of the world conference split
up its global role of population assistance into three
phases by mid-1976 :
(1) Traditional technical
assistance-transfer of technical know-how (2) Fina­
ncial support to assist government and non government bodies to expand activities. (3) Phasing out
of assistance or foreign experts at the country level
which will expand the programme.

March 1985

India's economy suffered grave setbacks due to
world inflation. In response to the Bucharest confe­
rence, assistance from the UN, as well as voluntary
organisations took a more subtle form and was linked
with rural development, child care and nutrition. For
example, families accepting birth control were given
free tube wells, free meals, or free maternity and
child health benefits. The government too accepted
this approach and integrated family planning with
nutrition. This can be seen as a method of making
family planning a prerequisite for nutrition benefits
from the government.
Meanwhile, after the 1971 war, political con­
sciousness was reaching a new peak with mass pea­
sant uprisings throughout India. The movement by
Jay Prakash Narayan was to have important conse­
quences for the future. The political overtones of
this and other movements and the insensitivities
of the ruling party led to the declaration of the
emergency and the upsetting of the five year plan.

In 1976 the central goverment in an imp­
ortant move to make state governments accept the
family planning decided to freeze the population
based at the 1971 level for the next 25 years for
determination of representatives in the Lok Sabha
and state legislatures. This compelled the leadership
of many of the states to accept compulsory
sterilisation and offer incentives viz. Rs. 150/- if
performed with two living children, Rs. 100/- if with
three living children and Rs. 70/- if performed with
four and more (Times of India, 1976). Maharashtra
declared that government servants who were not
sterilised and had more than two children would not
be given ration, housing facilities, or free hospital
services (Times of India, 1976). To add to these
frightening and unjust disincentives, in the Pune
Municipal Hospital a sick person was not admitted
unless and until one family member was sterilised
and produced a certificate. All these measures led
to great opposition to family planning among the
public and to the Congress regime and the Congress
was voted out of power. With the advent of the
Janata Party, Raj Narayan, the Health Minister
modified the Population Policy. He eliminated all
forms of compulsion and gave family planning a
new dignified name —- family welfare programme,
which in substance remained the same.
In this plan as compared to the earlier one,
Rs. 497 Crores were allocated. The major donors
during the Fifth Plan were UNFPA — 40 million
dollars; World Bank —21.2 million dollars, and
SIDA — 10.6 million dollars.

155

With more funds coming in, the expenditure rose
in each successive year. For e.g. in 1976-77 it
increased almost to Rs. 1 6793.89 lakhs mainly due
to the so-called incentives for sterilisation and IUCD
programmes. Although it increased during Janata
regime there was a fall in the expenditure and
surprisingly enough, the external aid received during
those last two years of the plan exceeded earlier
donation. This was because during the Janata
regime, "family welfare" (nutrition, child welfare,
post partum programmes) were used as a bait.
Before the sixth plan began in 1980 a year passed
without a five year plan but activities on Family
welfare increased during this year.
The Sixth Plan : 1980-85

With the world situation remaining practically
the same, with increasing recession, the emphasis
on the need for population-control continued.
Bilateral aid, earlier rebuffed, was now welcomed
by the Indian Government. Permission for adoption
of villages in the third world by the UN and by the
World Bank was now extended to bilateral organi­
sations like USAID, CARE SIDA and others. In
India too this became a common feature. Monetary
crisis has made India sign a development pact with
many First World countries. Although the total
figures of external aid was not available, the
Indian government allocated Rs. 1010 crores for
family welfare of which Intensive District Develop­
ment (ie development of primary health centres and
family planning in districts by multilaterals and
bilateral units) accounted for nearly Rs. 225 crores
(UN, 1980-81). The India Population- II programme
of Intensive District Development based on the
experience of Population-I programme was extended.
Their aim was "to promote family welfare to lower
the fertility rate through the creation of facilities for
integrated delivery of services for health, nutrition,
MCH, contraceptives and medical termination of
pregnancy, closer to the homes of people particularly
in rural areas" (USAID, 1980-81).
The external aid for India Population ProjectII has involved many donors The multilaterals
UNFPA and the World Bank consented to support
projects in 18 districts with 95 million dollars. Per­
formance Budget, 1980-81). On examining bilateral
involvement one finds that USAID which had
stopped donating for the family planning programme
since the Indo-Soviet pact of 1971, agreed to donate
40 million dollars supporting 12 districts and the
above project is still being implemented (USAID
paper, annexure). Further UK and DANIDA who had
earlier supported the sterilisation programme and

156

National Health and Family Welfare Centre building
funds, donated 63 million dollars to carry out family
welfare and health programmes in 15 districts
(Performance Budget, 1980-81).

It is not easy to get statistics on the foreign
contribution to family welfare but one is aware that
a good quantity of Copper T manufactured by the
Population Council has reached India, and today
besides sterilisation, this is the foremost method of
family welfare adopted by the government for which
substantial incentives are being given.

The state of Maharashtra which was declared
as the foremost in the use of Copper T for three
consecutive years was exposed in a racket uncovered
by the Indian Express (1984) The number of
eligible couples in Maharashtra, were found to be
much less in number than the acceptors of Copper
T I When the government field surveys for inspection
were conducted, it was found that nearly 25 percent
of the copper Ts inserted ie 726 lakh Copper T
inserted, worth four crores were fictitious cases.
The annual reports of ICMR indicated that the
Population Council, Ford Foundation and WHO
continued to give funds for bio-medical contracep­
tives research. The FPAI received laproscopes from
IPPF in 1979-80 and organised camps in rural areas.
For example a welfare organisation in the village of
Tara, used laproscopes in Raighad District while the
taluka hospital had none. A demand for laproscopes
was made. Thus by 1984 almost all districts of India,
especially in Maharashtra, got laproscopes.

In 1970 the direct involvement of Ford Founda­
tion which had started since 1959 was stopped. In
1971 JRD Tata founded the Family Planning
Foundation of India (FPFI) and the Ford Foundation
stepped in as one of its major donors. (Ford
Foundation, 1980).
The FPFI by 1972 took up action-cum-research
projects, demographic research and later biomedical
testing of contraceptives. The activities which were
initially directly handled by the Ford Foundation were
now aided by it. Its role thus remains important even
today, and its philosophy continues to influence the
Indian population policy. In 1979 the Ford Founda­
tion donated 700 000 dollars ie almost 50 percent of
the FPFI's total budget (Ford Foundation, 1980).
Though the acitivities of the Family Planning Founda­
tion began during the Fifth Plan period, it was only
during the sixth plan period that it took on a more
prominent role to carry forward the philosophy of
the Ford Foundation by organising and founding
seminars, conferences, action research, etc.
Socialist Health Review

Table 1
Nature of Assistance of Imperialist Powers to
private voluntary organisations and the government for Family Planning Programmes
and central government plan allocations :

The following data has been tabulated to (a) understand why the population policy has undergone
changes and (b) to find out what the impact of the external assistance ie. private, government and multi.
lateral (2) has been, and (c) how and in what way it has affected Indian programmes.

Phase

Plan Period

Donor Agency to
India

Recipient
Agency in
India

Central govt.
allocation for
FP

I

Pre Plan
1947-1952

Private

Private

British government
had no programme

First Five
Year Plan
1952-1957
March

Private
Multilateral

Private
Government

Rs. 65.00 Lakhs

Second Five
year plan
1957-61 March

Private
Multilateral
Private

Private
Government
Government

Rs. 479.00 Lakhs

IV

Third Five
year plan
1961-66 March

Private
Multilateral
Private
Government

Private
Government
Government
Government

Rs. 269.70 Lakhs
with provision for
Rs. 500.00 lakhs

V

Three Annual
Plan 1 966 to
1969 March

Government
Private
Multilateral
Private

Government
Government
Government
Private

Rs. 750.01 Lakhs

Fourth Five
Year Plan
1969 to 1974
March

Governments
Multilateral
Private
Private

Government
Government
Private
Government

Rs. 3150.01 lakhs

Fifth Five
Year Plan
1974 to 1979
March

Private
Multilateral
Private

Private
Government
Government

Rs. 4970.00 lakhs

VIII

1979-1980

—

—

Rs. 1180.00 lakhs

IX

Sixth Five
Year Plan
1980 to 85
March

Multilateral
Private
Private

Government
Private
Government

Rs. 10100.00 lakhs

II

III

VI

VII

Figures of Donation received not indicated as assistance is in cash and kind.
Data collected from various yearly reports of :
1) Population Programme Assistance United States Aid to Developing Countries; 2) Reports of
the Ministry of Health; 3) Annual Reports of the Directorate General of Health; 4) Annual Reports of the
Ford foundation; 5) Annual Reports of the Rockfeller Foundation; 6) Annual Reports of the Population
Council; 7) Annual Reports of the International Planned Parenthood Federation; 8) United Nation Funds fo
Population Activities; 9) Aid for Family Planning pamphlet by Emerging Population Alternative. (Mimeograph)

Note
Source

March 1985

157

Summary and Conclusion

In the pre-independence period the efforts of
birth control were carried out by a few concerned
individuals in India. A couple of foreign organisa­
tions funded Indian birth control clinics. There was
no state level movement.
In the First Five Year Plan the Government
accepted family planning as a programme. The
major emphasis particularly in the early years lay on
the rhythm method, due to the diffidence of
the government. Private organisations funded gene­
rally by private organisations were free to propa­
gate other methods.
In the 60s the increased economic crisis, the
shortage of food, the growth of liberation move­
ments brought first world governments to focus
their attention on the importance of population
control to avoid major social and political upheavals.
Development aid was increasingly linked to popu­
lation programmes and there were an increased aid
flow from governments of the First World to the
governments of the third world.
In India, the programmes of voluntary organi­
sations served as important pointers as to what
direction the government policy would take. It was
also their advice and donation which compelled the
government to change prescribed contraceptives
during each plan period. It gave or promoted what
it received and tested what it was asked to as the
economic crisis made them helpless and forced them
to accept assistance which led often to indebtedness.

trend is to support 'integrated' projects which
include health, nutrition, and development. Multi­
lateral and governmental aid have become the major

source of finance for the Indian govenment though
it still remains to be analysed whether these pro­
grammes are development oriented or whether they
are basically family planning programmes with
merely an acceptable cover.

The point of this article, is not merely to criticise
the idea of birth-control itself which should be
available to women as their basic right. This paper is
also aimed at examining the history of the fallacy that
family plannining is a solution to the problems of
poverty, underdevelopment and unemployment. Has
the bogey of overpopulation been created by the
leaders of the first and third world countries and
exaggerated merely to divert attention from the real
problems facing them ? More important have the
woman's basic needs been forgotten in the quest
for ever-higher targets of achievement in family
planning measures? Do we in the Third World
want a reduction in the birth rate, at any cost ?
NOTES
1.

Performance Budget 1977-78 Ministry of Healh and Welfare
Government of India P. 184 "The expenditure on the family
welfare programme is basically met out of the national exche­
quer. Some assistance which forms a small proportion of the
total expenditure on the programme is received by way of
international cooperation from some of the international
agencies".

2.

Private'Donors to India are most often the monopoly houses
or its funded voluntary organisation. Many of these voluntary
organisations are also funded by government aid agencies
eg. The Ford Foundation, the Rockefeller Foundation, Hugh
Moore Foundation, International Planned Parenthood Fede­
ration, Population Council, Pathfinder Funds,Medical Christian
Association, International Red Cross, Peace-Corps, OXFAM,
Population Crisis, Voluntary Sterilization Association and
other private receiving agencies. Family Planning Association
of India, The Family Planning Foundation, Indian Red Cross,
various Rural & Slum Developmental Agencies, Gandhigram
Institute etc.

3.

Multilateral Donors are the agencies funded by more than
one monopolies and governments such as bodies of United
Nation and recently the World Bank eg. WHO, ECAFE,
UNICEF, UNFPA, IDA and others.

4.

Bilateral-Government - First it was USAID United State Aid
to Developing Countries, NORAD Norwegian Agency for
International Development, BODA British Overseas Develop­
ment Assistance, SIDA Swedish International Development
Authority, DANIDA Danish International Development Agency,
CIDA Candian International Development Authority, France,
Japan,
Korea,
Finland, Representative of Germany,
Australia.

After the World Population Year, 1974, the
approach has again changed. It is now recognised
that development is essential for birth control pro­
grammes to make a headway. Thus increasingly the

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158

Socialist Health Review

Selected Bibliography

Buxamusa R. M. The Sociological Analysis of the Popu­
lation Policy of India : Unpublished Thesis of De­
partment of Sociology Bombay University, 1976.
Berelson, Bernard & Steiner Gary, H uman Behaviour,
Marcourt Brace &• Company, 1964.
Chandrasekhar S., India's Population, Meenakshi
Prakasham Madras 19b7.
Coale, Ansley. J., & Moover, E.M., Population
Growth and Eonomic Development in low Income
Countries, Princeton University Press, Princeton,
1957.
Concerned Population Alternative,
New York :
1970 to 75.
Cleaver H. M., Social Digest 1972.
Mass, Bonnie, Population Target. The Political Eco­
nomy of Population Control in Latin America.
Published in Canada 1978 or 1980.
Planned Parent-hood Federation Bulletin Bombay.
Seal K. S. Past performance ard Assessment of Family
Planning Paper presented in Seminar on India's
Population Future, 8th October, 1975.
Singer F. ed. Is there an Optimism Level of Population
USA 1972.
Vogt William; Road to Survival: Englished 1949.
Weissman. S, Why the Populatioa Bomb is the Rockefeller
Baby . Rampart 1970.
Reports

Agency for International Development, population
service office of the war. On thinger: Population
Programme Assistance". Washington DC 1968,1980.
Development Assistance Committee (DAC), Basic
Figures on Aid to Population Programmes, 1969-1972
Organization for Economic Co-operation and Deve­
lopment, Paris, May, 1974.
ECAFE, Population Cleaning House and Information acti­
vities for tbe 70's A review by the Secretariat of
the Economic Commission for Asia and the Far
East, 1 973.
Emerging Population Alternative, Report on Population Aid,
(Mimeograph) (Publisher not known).
External Assistance-and its utilization in Family Planning
Programme, ( Publisher and author unknown )
(Mimeograph)
Family Planning Association of India, Report'.- 19541981 Bombay. II-PAI, Annual Reports:- 1963, 1964,
1965, 1967-68 1970-71 Delhi.
Ford Foundation, Annual Reports : 1959-1981.
India's Family Planning Programme In the Seventies,
New Delhi - 1970.
F. F........... India's Family Planning Programe: A brief
Analysis, New Delhi, July 1971.
International Assistance for Population Programmes ReceMarch 1985

pient and Doners Views. Development centre of the
Organization for Economic Co-operation
and
Development, Paris, 1970, 1973, 1980.
International Planned Parenthood Federation, The
History of Contraceptives, 8th conference of Interna­
tional Planned Parenthood Federation, Santiago,
April, 1 967.
I.P.P.F. World Survey Factors Affecting the Work of
Family Planning Association : London 1969.
I.P.P.F. Annual Reports :- 1955, 1969, 1975, 1980.
Path Finder Fund : The Pathfinder Fund Pioneer in
Family Planning, USA 1966-1969.
Population Council Annual Report, 195 7-1981
New York.
Population Crisis: Population Problems and Policies in
Economically Advanced countries : The population
crisis committee, New York 1972.
United Nation, Population, Bulletin No. 1 New York,
1951.
U.N. World Population Conference Report :- Rome 1954,
New York 1958, India New York 1£66 and 1969,
New York 1971, Bucharest 1974, Rome 1974.
USAID. The Population : A Challenge, USAID and Family

Planning in less Developed Countries Aid policy 196162, 1970-71, 1975-76, 1980-81.
USAID : American Repo iter, 1960, 1966, 1969, 1970,
1975.
World Bank, Population Planning, Washington 1972.
World Bank, Report 1976, 1982.
Government Publications
Indian Government, Director of Health; Report 195456 New Delhi 1960, Report 1956-56 New Delhi,
1964.
I.G.D.M. Annual Report, 1957-1980
Indian Government, Minister of Health Report :
1951-52 to 1964-65 Government of India Press.
Indian Government, Minister of Health and Family
Planning Report : 1965 to 1975, New Delhi.
Indian Government, Minister of Health and Family
Welfare 1976 to 1982, New Delhi.

dr ramala buxamusa
Research Unit on Women's Studies
SNDT Women's University
Vithaldas Vidyavihar
Santacruz (W), Bombay 400 049

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159

POLITICS OF THE BIRTH CONTROL PROGRAMME IN INDIA
sucha singh gill
The myth that projects population control to be the cure-all for all social and economic problems has a class
bias. According to the author the emphasis of our planners on population control is an attempt to weaken
the class struggle in India by absolving the exploiters of the responsibility for peipetuating inequalities and
shifting the blame from the capitalist order to the people.
The article oeals with two major issues in the
family planning programme (i) that overpopulation is a major cause of poverty and fii) that persuading people
to accept the small family norm is the only way that population growth may be controlled.
It examines the
socio-political content of these issues and emphatically suggests that eardication of poverty and unemployment,
and guarantees against insecurity, sickness and the death of children must be demanded as a prerequsite for
accepting the small family norm.

the last many years the family planning pro­
gramme has overshadowed all aspects of our
social life including the development of health
services. In fact health services have been oriented
drastically to suit the needs of this programme. All
activities of the health institutions and their staff
are subordinated to the fulfilment of family planning
targets. While assessing the work of the health staff
including the doctors, the only criteria has been
performance in family planning work. Their annual
confidential reports, efficiency bars, transfers, rewards
and punishments are all based on the achievements
of this programme.
The family planning programme is getting nearly
as much budget as the entire health sector which
contain programmes of equal or even more impor­
tance. During the 1974-79 period the health sector
was allotted Rs. 681.66 crores and the family
planning programme received 645.00 crores. In the
sixth plan the health sector and family planning
programme got Rs. 1821.05 crores and 1010.00
crores respectively1. Later on during the time of mid­
term appraisal Rs. 68.00 crores were shifted from
the general side to the family planning programme.
(Planning Commission, 1983) A population Advisory
Council was also set up under the chairmanship of
Health Minister to keep population control under
close watch and advise the government on policy
matters. The 13th item of the new 20-Point Pro­
gramme is specifically related to popularisation of
family planning
programme with the
people.
(Planning Commission, 1983). This renewed emphasis
on the population control programme intends to
achieve the long term goal of planning to reduce
birth rate from 33 in 1980 to 21 per thousand in
1995 and increase the couple protection rate from
22.5 percent in 1980. to 36.6 percent in 1984-85
and 60 percent in 1995.

160

Although the programme is given the name of
family planning and lately, family welfare, in essence
it remains primarily a birth control programme. This
is evidentfrom the fact that as compared to Rs. 1 078
crores allocated for family welfare programme in the
Sixth Plan only Rs. 250 crores were for nutrition
programmes(Planning Commission, 1980). The progra
mme is not linked up with important aspects of future
plans necessary for the welfare of each family such
as education of children, their employment, security
of family against sickness and old age or rehabilita­
tion of the destitutes. There is no provision in the
programme to protect the family against economic,
social and psychological insecurities being increa­
singly generated by the socio-economic dynamism
of Indian society on the capitalist path. In this situ­
ation the family planning programme remains as an
intervention by the government only to limit the
number of children through birth control measures.
However what matters most for individuals
who plan their families is a better future. They want
to improve the economic and social status of their
family through education and employment of their
children and accumulation of non-human assets.
Both these assets human and non-human, are a
guarantee against sickness, old age and destitution
in addition to the psychological satisfaction. Obvi­
ously, they need a minimum number of children
particularly male ones for this purpose. Nothing is
done where actual planning is required and couples
are left on their own, unprotected against various
types of insecurities. Thus family planning or welfare
programme is a misnomer and emerges prominently
as a birth control programme.

The Poverty-Overpopulation Myth
The Population contiol programme is one of the
key programmes in India. Indian planners view the
Socialist Health Review

limiting the growth of population as one of the
main objectives of planning. In the words of the
planning commission, " it is almost axiomatic that
economic development can, in the long run, bring
about a fall in fertility rate. However developing
countries with large population cannot afford to
wait for development to bring about a change in
attitude of couples to limit the size of families as the
process of development itself is stifled by population
growth". (Planning Commission, 1980). During
the
emergency (1975 77), a naked expression of
this hidden message of the Planning Commission
was seen. The poor people were forcibly sterilised
in huge numbers and in a manner worse than
animals because the government and the Planning
Commission could not wait for a change in their
attitude.
The success of development planning and parti­
cularly solution of major economic problems such
as poverty and unemployment have been linked up
with the success of population control programme.
Planning Commission states, "All plan projections
of reduction of poverty and unemployment will go
wrong if success is not achieved in containing the
growth of population". (Planning Commission, 1980)

This policy of the government to control popu­
lation has a class bias (Banerji, 1971).
Indian
society is a class divided society. Rural and urban
poor belong to oppressed classes — poor peasants,
tenants, artisans, agricultural/industrial proletariat
and others engaged in a number of odd jobs. These
poor people have a very weak material base and
are deprived of the means of production. They live
on their family labour. Their greatest asset is their
labour power. It is the sole source of their income,
prosperity and security against old-age, sickness
and other adverse circumstances. The poor people
without children generally become beggars and
destitutes in their old age as there is no institutional
arrangement in our society to look after them. The
material need of the poor to have more children is
more acute as compared to the rich.

A number of studies in India show that among
the poor households poverty is not caused by the
large family but rather, it provides some relief
against it (Mamdani 1972, Mamdani 1976, Nadkarni
1978). The poverty of the poor households origi­
nates from their poor command over the productive
resources such as land and capital assets. According
to agricultural census 50.62 per cent holding with
less than 2.5 acres of land operated only 8.97 percent
of total cultivated area. On the other hand, the top
March 1985

15.17 per cent of the holdings with more than 10
acres of land operated 60.63 percent of the area in
1970-71. Almost the same trend is observed from
data about 1971-72 from the 26th round of National
Sample Survey ( Laxminarayan and Tyagi, 1976 )
Land is the most prominent asset in the rural areas
and it accounted for 66 per cent of the total assets
in rural India in June 1971.
According to the
Reserve Bank's All India Debt and Investment
Survey ( RBI, 1971-72 ) 9.34 percent of rural
households were landless and 27.63 per cent of the
household owned less than 0.50 acre of landAccording to this survey the top ten per cent of the
rural households accounted for 50.56 per cent of
the total rural assets (Basu 1976). The distribution
for assets in urban areas is even more skewed with
major part of the private corporate industrial struc­
ture being under dominant control of top monopoly
houses (both Indian and foreign). Thus the poverty
of the poor families emanate from their weak
material base rather than family size.

In the same way unemployment in society
cannot be explained in terms of population growth.
It can be explained only in terms of management
and development of the economy on capitalist lines.
The dynamism of capitalist development produces
large scale unemployment. Marx points out, "the
labouring population therefore produces, alongwith
the accumulation of capital produced by it, the
means by which it itself is made relatively super­
fluous, is turned into a relative surplus population;
and it does this to an always increasing extent.
This is a law of population peculiar to the capitalist
mode of production; and in fact every special historic
mode of production has its own special laws of
population, historically valid within its limits alone'*.
Even in professional jobs like that of teachers,
doctors and engineers there exists unemployment,
though there are a number of illiterate persons
needing teachers, sick people in need of doctors
and a large number of projects needing engineers.
In a capitalist economy resources are directed towards
profit maximisation
rather than towards social
usefulness. Many resources including an unemp­
loyed labour force can be socially useful but remain
unutilised for want of profitability. Unemployment is
a typical characteristic of capitalist development.
It is not due to high population growth. In capitalist
economies there is a fundamental right to property
but no such right to work.
The emphasis of Indian planners and policy­
makers on control of population through birth
control measures as a precondition for the success

161

of plan to eradicate poverty and unemployment
is an attempt to conceal the basic causes of these
problems. It is an attempt to project population
growth as the villain of every problem in society.
This tries to conceal the root cause of such problems
that is unjust socio-economic systems. It helps in
diverting attention from the exploitation of society
being carried out by multinationals in collaboration
with local monopoly (and non-monopoly) capital,
exploitation of labour by capital (both in industry
and agriculture), and exploitation of tenants and
peasants by landlords, moneylenders and traders.
It is this system of exploitation which is responsible
for a shift of resources (income and wealth) from
the poor to the rich and is the basic cause of poverty.
The control of the exploiting classes over state
power to maintain the existing system of socio­
economic organisation of society on capitalist lines
is the basic cause of unemployment and other
problems of Indian society today.

Poverty and Family Size

Family size is the only asset which the poor
possess and it provides them income and security
of various types. Since the family size and from it
the family laboui is the mainstay of the poor, they
have a greater need for children. Added to this is
the fact that the survival rate of children in India

particularly in poor families is low. In 1971 infant
mortality rate was 129 per 1000, 138 for rural and
82 for urban areas. In 1978 Infant mortality rate
was 126-136 for rural and 71 for urban areas.
Inspite of the wide claims of improvements in the
health services the infant mortality rate has not
gone down, particularly for the rural areas, where
three fourths of India's population resides. The
infant mortality rate though slightly low for male
as compared to female is quite high in India. In
1978 it was 120 for male and 131 for female. Data
on the infant mortality rate of different income
groups/classes is not available. In their absence,
let's look at the data of scheduled caste/tribe. Infant
mortality rate in case of these two categories is
higher than the average. In 1978, it was 152 for
scheduled castes as compared to all India rate of
126. Similarly infant mortality rate in the women
workers is high. It was 143 for farmers, fishermen,
hunters, loggers and related workers; 150 for
production and related workers, transport equipment
operators and labourers. (Registrar General of India
1983). The magnitude of the problem can be
162

judged from the fact that a fourth of the children
in India die before attaining adulthood. Thus the
survival rate of children is low particularly among
the weaker sections and oppressed classes in India.
The socio-economic dynamism of society on the
capitalist path levies very meagre resources with
these sections.
So they cannot afford medical
facilities of their own. They are denied even the
shabby public health facilities available in our
country. That is the reason that most infant deaths
below one year take place unattended by trained
medical practitioners. Percentage of such deaths was
58.3 in 1978.
The state of other necessities of life
needed for good health is also deplorable. In India
most of the people do not have facility of hygienic
and clean drinking water. Even now 57.70 percent
of the people are drinking water from wells and 5.31
percent from pond/tank and rivers. Only 34.35 per
cent of population drinks water from taps and
handpumps. (Registrar General of India, 1983)
Average calorie intake in our country is 1880 which
is even less than the minimum calories needed i. e.
2250. Inspite of three-fold increase in the food grain
production our per capita consumption is stagnant
since 1956. The poor do not get reasonable good
diet, clean water and secure shelter in life. These
factors are responsible for high motality rate in the
children, thus the need of the poor to produce more,
in order to get a minimum number of surviving
children. Even in a prosperous state like Punjab, on
the average 1.10 children per family had already
died when a survery of the sterilised couples was
conducted (People's Health Group,)
Childern are also source of income before their
adulthood. Though child labour is legally banned
yet a large number of children from poor families
are labourers. Both in urban as well as in the rural
areas children can be seen doing all types of odd
jobs to earn wages or help in family work in produ­
ctive activities. According to the Government of India
survey 3.7 percent of the Children were full-fledged
workers in 1978 — 4.2 percent in the rural areas and
1.5 percent in the urban areas. In the rural areas
4.8 percent of male children and 3.5 percent of
female children were workers. About 80 percent of
child labour were children of farmers, fishermen,
hunters loggers and related workers and 11.64
percent of production and related workers, transport
equipment operators and labourers.
Thus children
belonging to the poorest families do not attend the
school - but contribute to the family income. On
paper children may be shown in schools but a large
number of them from poor families drop out and
Socialist Health Review

child in the family .Even in a relatively prosperous
state like Punjab where a lot of people from the
villages are employed in government and semi-gover­
nment jobs, the average number of children after
which the couple accepted sterilisation was 4.47
with 2.48 boys. The figures for the agricultural
workers was a little higher i. e. 4.54 and 2.58
respectively (The detailed break up is shown in
Tables I Er II.)

join the labour market at a very early age. In addi­
tion to being full-fledged workers a majority of the
children, particularly in the rural areas, contribute
significantly to the family labour. It is obvious that
child labour can not be stopped by implementation
of legislation but through material upliftment of the
poor families in the society.

Apart from these economic factors, there are a
number of social reasons why people need to have
more childern, particularly male ones — emotional
security, social status and continuity of family, are
some of them. For these reasons common people
have an urge to have more than one surviving male

Only four percent of the couples accepted
sterilisation after two children — the norm recommen­
ded and propagated by the government. None of
the agricultural worker's families accepted to stop
after two children.

Table I
No. of Children per Family in rural Punjab (percent of couples already sterilised).
Category

No. of children/family

1

2

3

4

5

More than 5

In general

Nil

4

22

30

22

3

Agricultural workers

Nil

Nil

14

37

30

19

Table II

No. of boys per family in rural Punjab (percent of couples already sterilised)

No. of boys/family

Category

1

2

3

4

5

In general

7

48

38

4

3

Agricultural workers

7

42

40

9

2

Table III

Minimum no. of children they could imagine
(Boys-f-Girls)

Boys
Girls

No. of
couples
(percent)

March 1985

14-0

1+1

24-O

2-f-1

24-2

34-O

3+1

34-2

Nil

2

4

66

21

2

4

1

163

In this survey which was carried out in the rural
areas of Punjab 98 per cent of the couples could
not imagine less than two boys for a family. This
survey was conducted by the family planning staff
whom the villagers always want to please by men­
tioning the least number of children there should be
in a good family. Taking into account the average
loss of 1.10 children per family, one can imagine
that their desire to produce 4 to 6 children or
2 to 3 boys is not unnatural
A family without a male child is still looked
down upon and parents with one male child are
still considered as blind in one eye.
The two
children norm propagated by the government is
not acceptable to people at large. These are in fact,
family norms of educated middle class. It is for this
class that children remain a burden to be borne by
families for a considerable period in India. They
have to be reared, well-looked after, educated and
even helped to get a middle-class job. In this way
they have to be supported for 20-25 years before
they can be of economic use to the families. That is
the reason must of the middle class people have
been following small family norms and not primarily
because of family planning propaganda. It is worth
mentioning that many of the countries have never
propagated family planning and still their growth
rate is almost nil. For example USSR had never
launched a family planning programme of the type
we see here in our country. Although that govern­
ment always encourages its citizens to produce a
number of children, half of the couples produce
only one or two children.
It needs to be reasserted that poverty is not
explained by big family size but by the weak
material base or by lack of productive resources
at people's command. The link between eradica­
tion of poverty, population control and the idea
subscribed to by Indian planners, that the success
of the former is linked to the success of the latter,
is ideological. It is not based on a scientific analysis
of our socio-economic reality but rather, it amounts
to consciously making the whole thing stand on its
head.

The idea of projecting population growth and
large family size as the basic problem of society is
an attempt to hold people responsible for their
problems and exonerate the ruling classes from this
responsibility. It is an ideology of the ruling classes to
shift the blame of existing social and economic mess to
the people in general. This-ideology of victim bla­
ming' is being widely used by the ruling classes in
164

all fields of life to blur the rising consciousness of peo­
ple. This fact, that the poor do not find the two child
norm suited to them and therefore do not accept it
is used by the rulers to attack the poor, an attempt
to pre-empt the attack by the poor on rich.
Birth Control Programmes :
A Subtler Form of Class Oppression

The rigorous implementation of small family
norm and population control on the unwilling poor
leads to the use of some form of open or tacit com­
pulsion. The officials entrusted with the task of ful­
filling the targets, compel the field staff to bring
erough number of cases for sterilisation. The field
staff uses various means ranging from incentives of
financial help to the threat of officials and local
influential persons to complete sterilisation targets.
Given the unjust socio-economic system, such threats
work only on the unorganised poor in the country.
This take the form or direct class oppression of the
poor, the worst form of which was faced during emer­
gency period of 1975-77.
Sterilisation particularly of the women has mainly
become tha birth control method of the poor. The
side effects are multiple. One is the development of
complications arising out of sterilisations and even
deaths of some women. Back-ache, pelvic pain and
other problems make the women chronically ill. In a
survey conducted in Punjab more than 80 percent
of women complained of one or more problems
after the operation. (People's Health Group). This
adversely affects their capacity to work and conse­
quently the earnings of the working class families.
’'For women of labouring class . . . tubectomies may
be a dangerous intervention, productive of family
conflict and tragedy; if it decreased the women's
output then children are made to do her work, while,
if she is forced to keep her economic activity at the
same level, children then have no protection against
either the hopelessness or savagery of her feelings".
(Pettigrew, 1984). Therefore, tubectomy operations
are not only inappropriate but harmful to working
class families. For obvious reasons, doctors, engineers,
lawyers, college/university teachers or bureaucrats
hardly use this method. Nobody has ever asked those
recommending tubectomy to poor women as to why
they do not get their own women sterilised.

In this context birth control programmes not
only becomes a political enterprise but a subtler
form of class oppression. It hits them hardest but
conceals the identity of the attacker. It directly trans­
mits the class conflict into family conflict among the
Socialist Health Review

poor. It is an attempt to blur the class conflict and
hits the poor through control of their reproductive
system. By thrusting upon the unwilling poor sterlisation and particularly the tubectomy operations
make the poor economically weak and psychologi­
cally shattered. This reduces further their capacity to
organise and fight against their oppression and
exploitation. It is a way to dominate economically,
politically, culturally and socially to perpetuate the
system of exploitation. This leaves them ideologically
confused, socially shattered, politically weak and
psychologically perplexed. This is an offensive of
the exploiters against the exploited to weaken them
to avert the offensive. It is a serious attempt by the
rulers to reduce the number of their enemies in order
to reduce the risk to their oppressive regime. It must
be emphasised and re-emphasised that too small a
family among the poor is economically, socially and
politically a weak family and is bound to affect their
class strength. Therefore, pro-people elements in the
society must understand that birth control progra­
mmes are a part of the ruling class strategy of repre­
ssion of the poor in general. But this is presented as
a programme of welfare of the people. This needs to
be exposed as a thoroughly anti people programme
which affects the very vitals of the people. It operates
at a very subtle level and intends to control the most
senstive part of life that is, reproductive system.

The political nature of this programme must be
made clear to the people. The failure of the ruling
classes must not be allowed to be projected as fail­
ure of the people. The un-willingness of the poor to
accept the two child norm of the ruling classes must
not be allowed to be used as a pretext to use frank
and hidden compulsions against the poor. The eradi­
cation of poverty and unemployment and guarantees
against insecurity of old age, sickness and death of
children must be demanded as a pre-requisite for
accepting the small family norm. The impatience of
ruling classes to thrust birth control programmes on
the poor even with coercive methods before even
attempting to solve the socio-economic situation
which make a large family desirous needs to be
understood and opposed. The only check against
this on-slaught is through the conscious organised
force of the poor.

— sucha singh gill
Peoples' Health Group
Street No. 3
Guru Nanak Nagar
Gurubax Colony
Patiala 147 001

March 1985

References:
Banerji, D. Family Planning in India - A critique and a. perspec­
tive People's Publishing House, New Deih 1971 pp 55—56

Basu, Sreedekha, Pattern of asset-holding in Rural India—A study
of top asset holders. Economic and Political Weekly, 11 (28),
1034—41, 1976
Lacminarayan, H and Tyagi, S. S. Some aspects of size-distri­
bution of agricultural holdings. Economic and Political Weekly
11 (41) 1637-40, 1976

Mamdani, Mahmood. The Myth of population control, Monthly
Review Press, New York 1972
Mamdani, Mahmood. The ideology of population control Economic
and Political Weekly 11 (31-33), 1.41-48, 1976
Marx, Karl. Capital, Vol I. Progress Publishers, Moscow, pp591—92

Nadkarni, M. V. Overpopulation and the rural poor Economic and
Political Weekly 11 (31—33) 1163—72, 1976

People's Health Group. Survey of Ghanua block, Patiala covering
300 couples in which one of the spouses was sterilised, to ascertain
family size and people's on idei! family size. Patiala, Un­
published.

Pettigrew, Joyce. Problems concerning the tubectomy operations
in rural areas of Pubjab. Economic and Political Weekly, 19 (26)
995—1002, 1984
Planning Commission, Sixth Five Year Plan 1980—85. Government
of India, p. 21, 375-87
Planning Commission. Sixth Five Year Plan 1980—85 Mid—term
appraisal. Government of India, 1983 p 99.

Registrar General of India. Survey on Infant and child mortality
1979 Ministry Home Affairs, New Delhi 1983 pp 27-30
Reserve Bank of India
1971—72.

All India Debt and Investment Survey

Just Out
The Political Ecology of

Disease in Tanzania
by Meredeth Turshen

Rudgers
University Press
Diotribution Centre,
PG. Box 4869 Hampden Station, Baltimore MO 21211, USA,
25 dollars

The book looks at disease in Tanzania and
argues that it is not the inevitable consequence of
climate or geography but the result of colonialism
and capitalism. Colonial rule changed the ecology
and economy of the country, imposing frontiers
that did not respect African settlement, bringing in
new diseases, and starting wars of conquest that
touched off epidemics. Women were particularly
affected — their social position was lowered, their
political power was eliminated, and their role as
valued food producers was lost. After 1961 the new
government tried to meet the basic needs of its
people, and on some levels it achieved a measure of
success but certain programmes, like the reorientation
of the system of food production, were unsuccessful.
165

CONTRACEPTIVE RESEARCH IN INDIA
Testing on Women
kusha
Field trials to determine the efficacy and safety of a particular contraceptive are very often carried
out in a dubious manner in the third world on womon from the deprived sections of society. Research institutes
are either coerced or tempted by international funding agencies (sometimes through the government) and are
used as laboratories to test out potentially dangerous contraceptives The author relates her experiences in a
contraceptive testing unit (CTU) located in the working class area of central Bombay. Inspite of visible side
effects, contraceptives ranging from diaphragms to hormonal implants to injectable contraceptives as well as
new drugs to induce abortion (MTP) were tested on women in exchange for a modest monetary incentive.
Introduction
amily welfare programmes have to be com­
mitted to the emanicipation of women and their
being accepted as equal partners in decision making
in all spheres of developmental activities. Interna­
tional women's year has created a widespread
awareness of the inequalities between men and
women. It threw light on the steady decline of women
in the labour force, and on the poor participation of
women in socio-economic and political activities.
The report on the status of women brought out the
urgeney of providing facilities for training women
and to provide an opportunity for their access to
sources including tools and skills so that they
could enhance their contribution to their family and
to society.

In the field of family planning, it is important to
understand the acceptability of a particular contracep­
tive, reasons for choosing one method over the
other and assess what makes women and men
continue or discontinue using a method of their
choice. It is also important that family planning
education is given to both men and women
emphasising the inter-relationship between family
planning and the status of women, since it is a
recognised fact that the status of women directly
influences the acceptance of family planning. At the
same time the availability of family planning educa­
tion directly contributes to the status of women by
conferring on her a basic human right to choose.
The term 'family planning' was changed to
'family welfare' on this basis and entirely on the
premise that when an eligible couple is contacted
for family planning, it is the 'couple' who equally
share the responsibility of deciding the type of
contraceptive they will use, the number of children
166

they will have and when to have them. What is
generally happening in reality in the field of family
welfare is just the opposite. The ideal contraceptive,
acceptable to all people from different strata of
society, at the same time being harmless, effective,
easy to use, easily available and cheap simply does
not exist, at present. What is more disturbing is
that research towards attaining this ideal is also not
given priority.
Goverment Policies

The initial approach of setting up clinics in
different parts of the country and waiting for people
to accept fertility regulating methods (FRM) was
based on the several so-called (KAP) studies which
indicated family planning acceptance. However, the
policies of the government changed from time to
time due to pressures from foreign government and
non government agencies mostly from the west since
these agencies provided money and aid in kind.
Later, the approach was changed to family planning
extension programmes wherein family planning
workers moved in the community and set up depots
to distribute condoms. However targets were not
fulfilled and once again the approach was changed.
Family planning was then integrated with maternal
and child welfare programmes and in 1966 post­
partum programmes were launched.

These changes of approach were only made on
the basis of whether targets were being met or not.
For instance at first the number of conventional
contraceptive users was considered; the number of
IUD users was counted without any consideration
of the removal rate after IUD_ insertion and so on.
The same was true with pill users and the extent of
bogus sterilisation is only too well known. The
KAP studies were mostly useless because the ethos,
needs or priorities of the people was not considered.
Socialist Health Review

Added to this in several states the government in
its enthusiasm to achieve targets bungled their
programmes by coercing people to accept IUDs or
sterilisation operations.

The state governments got away with this
callous approach to meet targets as far as women
were concerned. Women were made to suffer
humiliations, indignities and often serious physical
side-effects, but the strategy boomeranged on the
government when men were forcibly sterilised. A
government was toppled I Even then this patriarchial
male-dominated society did not care to understand
what suffering women had been made to undergo
for so many years. If women complained they we e
told to bear the side-effects. Now during the past
few years, probably to pacify the male ego and to
stay in power, the government's stress is once
again on women —catch them anywhere, in hospitals
after delivery or in abortion and child welfare clinics.
Women have to accept any contraceptive that suits
the authorities.
Review of literature
Dr. D N. Kakar has done a study of women
using either the pill, IUD, or injectables Kakar, 1984).
The study throws light on several factors responsible
for a method being continued or discontinued. It is
strange why a similar study was not done on the
use of condoms. It is because men cannot be both­
ered to accept the responsibility of
using this
method ? Though Dr. Kakar's book deals only with
women's contraceptives, it sheds light on several
important factors which are directly connected with
physical problems faced by women due to contracep­
tive usage and male attitudes to contraception. In
several case studies it was pointed out that women
discontinued contraceptives because of side effects
such as spotting or intermenstrual bleeding. Several
women said that they needed much greater medical
attention when these side effects took place. They
needed reassurance and understanding from their
husbands but were instead treated with a certain col­
dness Dr. Kakar asks, "how many husbands would
be genuinely concerned about providing comfort to
their wives without being able to derive sexual grati­
fication ? " It is usually the woman who bears the
brunt of physical discomfort and at the same time
takes the responsibility of avoiding a pregnancy.

Annual reports of the Indian government and
many of the western offices of population have shed
light on the amount of foreign aid in the nature of
cash and kind. The main contributor to the population
control fund and even to the concerned UN body is
March 1985

the USA. The UN has set up a special division on bio­
medical research and over ICO million had been
spent by 1972. The division has clinically tested 45
different drugs and six different devices on 45,000
persons — mainly'women of the third world. Among
those who have been funding the population activi­
ties in the third world countries in cash or kind either
through the government or through private agencies
are US, UK, Netherlands, Japan, Germany, Canada,
Norway and Denmark. In India, WHO and Ford
Foundation are the major contributors for research
in contraceptives. IPPF, Pathfinders and Population
Councils are other important donors. By 1980 over
7,500 subjects, mainly women in Bombay alone
were involved in some of the trials in contraceptive
testing.
Historical background of a contracptive unit
The family planning unit of the government of
India was started in 1954. It had three main objec­
tives - (i) testing of contraceptives for their efficacy,
safety and acceptibility; (ii) conducting research in
reproduction and fertility control; and (iii) develop­
ing newer contraceptives. In 19 6, the FP unit was
reorganised as a contraceptive testing unit (CTU).
The first clinic w< s set up in the industrial area of
central Bombay. Located in the premises of the
mother and children welfare society, the health of
mothers and children formed an integral part of its
work from its very inception. The social workers'
attitude then was to educate women and men of the
community in every facet of health. Stress was laid
on the overall education of people through organi­
sing the community around the clinic. Men, women
and children came to the clinic not only for FP meth­
ods but for all their socio-economic and other perso­
nal problems. Some of the activities started at the
clinic were (1) Education of men and women and
children through exhibitions, group talks not only on
FP but also in health care, antenatal care, post natal
care, womens movement and nutrition education.
Women and girls were given sex education. (2) The
entire community was screened for TB by taking
mini x-rays and treated or referred for admission to
a hospital. (3) To get the entire community involved
in the welfare activities, health day, 'makar-shankranth' day, children's day, women's day and so on
were celebrated. (4) Women were encouraged to
speak in meetings and debates, their mahila mandal
was set up and skits and songs were staged by the
women themselves. Competitions in essay writing,
painting, were held. Classes in first aid, nutrition and
adult education were conducted. (5) Efforts were
made to help women continue education and to

167

secure jobs. (6) Even separate clinics were conduc­
ted for ANC and PNC as well as for babies. Sterility
being a major problem of the community, sterility
clinics were also conducted.

Research activities

Between 1958 and 1962 it was found that older
women with large families were the only ones wno
were attracted to the clinics. As welfaie activities
increased and as more welfare clinics were set up
in different parts of the industrial area in central
Bombay a larger number of younger women began
to attend the clinics. Foam tablets, spermicide jellies
and diaphragms were the conventional contracepti­
ves available at that time. Each woman attending the
clinic had to undergo a test for PAP smear' and
colposcopy examination to rule outcancer and other
gynaecological complaints before contraceptives
were given to her. Field trials on foam tablets were
conducted. Several foam tablets like Contab and
Planitab, were tested. The CTU developed a "24hour CAP test", to assess the harmlessness of foam
tablets and contraceptive jellies Several batches of
foam tablets and contraceptive jellies received under
a code number were tested by this method which
was standardised and recognised internationally.
When several jellies were d squalified, there was a
hue and cry by the pharmaceutical companies manu­
facturing these jellies. They pressurised the CTU to
abandon the test but the CTU was firm and this
rigid stand taken by the unit prevented the release
of these sub-standard contraceptive jellies into the
Indian market.
By now there were six clinics, three being in
industrial areas, two attached io hospitals in Bombay
and one in a rural area attached to a PHC In the
first year of their existence the community had acceppted these clinics truly as family welfare centres.
There was an excellent rapport between the research
staff and the family members. Those who participated
in research trials knew fully well the implications
involved. With the arrival of IUDs and later the
hormonal pills welfare activities were curtailed. The
government started thinking in terms of cost benefit
;or the entire FP issue. No funds were teleased for
activities which were meant for the welfare arid
education of the people.

Women were offered money for participating in
research. The health of women did not remain the
prime consideration of these centres. Several types
of IUDs were tried. Now with education, younger
women had started attending FP clinics for spacing
their children. Eminent gynaecologists based in
168

Bombay made some modifications in these IUDs.
Comparative studies with different types and sizes
of IUDs were conducted to find out the ones that
had minimal side-effects and low failure rates. Copper
T and Lippes loop are the outcome of this research
and both are now extensively used by women all
over the world.
In 1958 and 1959 Dr. Gregory Pincus introduced
hormonal contraceptives. The CTU at that time was
asked to introduce in their field trials 10 milligram
doses of this hormonal contraceptive. This move was
resisted by the social workers as they did not want
to endanger the health of Indian women. During the
sixties and seventies, the government accepted
lower doses of hormonal contraceptives for trials in
our country. Then began the exploitation of women
in contraceptive research.

In the field of research, the funding authorities
selected their own research scientists, institutes and
private agencies to carry out the research in what
they believed was the impoitant area Policy deci­
sions were also in their hands. What we see today,
therefore, is that contraceptive research is being
conducted in the area of "someone else's" choice
No research is being done to evolve safer mechanical
barrier methods, neither to improve the efficacy of
the older methods nor to evolve indigenous safe
methods The mode of administration of hormonal
drugs, the dose and the content have varied But
they still remain the dreadful hormones tampering
with the woman's body Listed below . are some of
the contraceptives, in which research trials were
conducted :
Foam tablets : These are used by women just
prior to coitus A wet tablet is inserted in the vagina
releasing foam which acts as a screen against pene­
tration of sperms which are killed by the chemical
action The women’s cervix and vaginal walls could
be affected, resulting in irritation, burning and white
discharge for many. Efficacy isaround 40 percent.

Diaphragm and jellies - or jelly alone :
Spermicidal jelly is applied to the diaphragm
and inserted in the vagina within an hour before
coitus. The diaphragm acts as a mechanical barrier
and the jelly destroys the sperms. Efficacy is good,
but this method requires privacy and facility for
washing. As above, the cervical canal and the
vaginal walls are affected and may cause irritation,
burning and white discharge.
Intra-uterine devices (IUD) :
There
are
several types and sizes of these devices— the
Socialist Health Review

important ones being the Lippes' loop, maxguli coil,
CuT, CuY, Sonawala and Merchant's devices, and
others. All these are inserted within four to seven
days of menstrual flow. Being a foreign body inside
the uterus, changes in endometrium and release of
chemicals occurs resulting in cramps, irregular
bleeding, perforations, white discharge and abdominal
pains. Some women also complained of headache
due to copper devices (Interestingly when a Lippes
loop wasinserted headaches disappeared) Unnoticed
expulsion is another problem. Perforation with IUDs
are well known and the whole of the abdominal
cavity could be affected.
Oral pills : Hormal steroids are the basis of
each pill. The woman has to swallow one pill a
day for each day of the month (with a gap of seven
days or otherwise depending on the type of steroids).
There have been three-a-month pills too. These
gave woman a severe bout of vomitting, giddiness
and headaches. Women complained of headaches,
nausea, giddiness, dizziness, weight gain, weight
loss, rise in blood pressure, continuous bleeding or
intermenstrual spotting. Pills have adverse effects
on liver function, immune response of the body and
cause vitamin B complex deficiency. The oral pills
either inhibit ovulation or bring about changes in
cervical mucous prevailing pregnancy. Drop out
rates are very high.

Injectables : There are two types of injectables,
injection Depoprovera and injection NET-EN. Both
are known for their adverse effects. These are given
to women either once a month, once in three months
or once in six months depending on the dose of
steroids. Those women who were given 300 mgs
(once in six months) after delivery continued to have
bleeding severe or moderate to spotting daily for
over four to five months. Woman developed pro­
longed ammenorrhea (absence of menstrual flow).
The drop-out rate was very high. Although injection
Depoprovera was withdrawn by the government on
hearing of the dangerous effects private agencies
even today are promoting these through their outlets
in India as well as in many other third world
countries. Once the injection is given it cannot be
withdrawn and the woman has to suffer as long as
the effects of the injection persist in her body.

Implants : These are silastic subcutenous
implants introduced in women's thighs. The hormones
are slowly released into the blood stream and act
to prevent conception. Those tried in the CTU clinics
were supposed to protect women from pregnancy
March 1985

for eight months but the majority of subjects become
pregnant within six months. Side-effects are same
as those of hormones. Women had to undergo minor

surgery for removal of empty implants which would
get embedded in the muscles.

Vaginal rings : These are inserted in the vagina
on the fifth day of the menstrual period. It is removed
only at the next menstrual period. The vaginal rings
are absolutely useless for the majority of women
who have no proper toilet facilities. But they were
being tried for the prestige of an individual scientist.
The vaginal ring caused irritation, burning in the
vagina and white discharge. It would also slip off
and get lost.

Nasal spray : This drug is dangerous and
useless for the majority of our women. It could
affect the nasal cavity, thalamus, brain and even
the heart as the woman is expceted to spray the
drug daily through her nose in definite quantities.
Poor malnourished women were cajoled into
participating in this trial.
In all the hormonal drug trials women were
required to give blood samples at definite intervals
to assess the release of hormones in the blood
stream. As many as 80 blood samples were
collected in some of the trials. At least 10 to 15
blood samples required to be given by each
woman participting in each of these trials. Not
one
lady medical officer has ever raised her
voice in protest against this exploitation of poor
women. Medical officers are mere aware of the
hazards a malnourished woman on these trials had
to undergo. Yes, women were paid for participating
in these trials. But that did not mean that these
women had been bought that they could be used as
guinea pigs. Are the women doctors so inhuman as
not to understand the gravity of the situation ?
The health of poor weman is being sacrificed for
others — mainly for those funding nations and
agencies and in order that the elite may know if a
contraceptive might be dangerous or not. Few
middle class or upper class women will agree to
participate in such trials.
Research in male contraceptives

••
Mention has to be made of Dr. Padma
Vasudevan who has used her knowledge in polymers
for evolving a new method of contraception for use
by men. Condoms and vasectomy operations are so
far the only two methods for men, condoms being
the most harmless and the easiest to
use.

169

Dr. Kothari of the KEM Hospital has also conducted
some research on developing intravas device (IVCD).
But Nothing has been heard of this research for some
time now. Nasal sprays were also to have been
tried out on men. It is reliably learnt that although
men were being approached for trials, not a single
man could be enrolled for this trial inspite of being
offered VIP treatment. Men apparently could never
be bothered with any such trivial contraceptive
research trials !
Birth control methods under trial

(a) Morning after pills : Trials with 'Morning
After' pills are in progress. These are hormonal pills
to be swallowed by women the day after coitus. It
is too early to say what the side-effects it may have.
Women on this trial are also required to give a
number of blood samples.

(b) Pellets : These are expected to arrive
soon for trials on Indian woman. It is not yet known
as to which part of the woman's body will be
tampered with this time.
(c) Vaccines : These are also expected to
make their way into India. These vaccines will affect
the outer covering of the ovum making it impossible
for sperms to penetrate and for fertilisation to occur.

(d) Prostaglandins for abortion: When a
woman desiring abortion (MTP) goes to a hospital
she cannot choose the method by which she will be

aborted. Even though there are safe methods which
could be improved by research, a drug prostaglandin
is being tested. This drug not only gives the women
severe camps, abdominal pain, vomitting and diarr­
hoea but in some cases was the cause of incomplete
abortion. Women under the trial programme suffered
tremendously. This is another case where advances
in science are also being used against women.
Amniocentesis was a method developed to help
detect an abnormal foetus yet it is now being used
extensively for sex determination of the foetus
which has in turn led to sex selective abortions.
From the CTO Records

Women of India, mainly from the weaker section
of society, are being subjected to all kinds of
inhuman treatments at home and even in places where
they expect help and service. The following are a
few instances recorded in the clinic which illustrate
the attitude of husbands towards the wife vis a-vis
her reproductive responsibilities.
Case 1 : During the late 1950s, the early years
of the FP programmes, foam tablets as contracep­
tives were being offered to women. A mother of
five children accepted this method after consulting
her husband. A packet of 12 tables used to be
issued whenever she wanted the stock. Once, a
clinic staff removed one tablet from the pack to test
the foaming capacity of the tablet and issued 11
(Contd. on page 178)

Campaign Against Long Acting Contraceptives
The government has decided to allow family
planning institutions and private gynaecologists and
obstetricians to import the injectable contraceptive,
Norethisterone enantale (or NET-EN). The ICMR has
been conducting studies on the drug for some time
now under the WHO multicentric trial programme.
The report of the study has not yet been made public
and components of the study have not been compl­
eted as yet. NET-EN is a synthetic progestogen,
similar to Depo Provera which has been the centre
of a raging controversy among experts regarding its
safety and suitability for women. Several women's
groups, people's science groups and people's health
groups have come together to protest against the
introduction of NET-EN or any other long-acting
contraceptive, such as Depo-Provera or contraceptive
implants. The demands of the campaign are : Ban
NET-EN; Ban
all injectable contraceptives; All
exports of the ICMR and other studies should be
made available to the public; A public inquiry and
debate must be instituted before such controversial

170

contraceptives and drugs are introduced into the
country. The campaign group's first action was a
demonstration at the closed-door experts' meet
convened by the Family Planning Association of
India ostensibly to help make the decision on
whether or not to use NET-EN and/or Depo Provera.
The demonstrators distributed pamphlets and stated
their
demands to the assembly.
Sympathetic
participants later disclosed that discussions had
centred around how best to use the injectables and
not whether or not.
For further information on the campaign, please
write to Women's Centre, Yasmeen Apartments,
Yeshwant Nagar, Santacruz (E), Bombay. So far the
following groups have decided to participate in the
campaign—Women s Centre, Forum Against Oppre­
ssion of Women, Medico Friend Circle, Committee
for Protection of Democratic Rights, Shramik Mukti
Morcha, Kashtakari Sanghatana, Yuva Sangharsh
Vahini and others.
— p. P-

Socialist Health Review

Response

how medicine has rationalised Society's and Men's
notions about women we begin to question our own.

Dear Editors : I would like to begin by congra­
tulating Ilina Sen on a principled stand from which
many women withdraw feeling that it is not worth­
while raking up a lot of muck. With the result that
we continue to be invisible and inaudible. It is imp­
ortant that women emphasise their contribution and
insist on recognition if certain deeply ingrained atti­
tudes and assumptions are to be rooted out.

May I say how much many of us have looked
forward to and enjoyed both the issues of Socialist
Health Review ?

As for Dhruv Mankad's reply - if it had ended
with the first paragraph it would have been excusable.
Even there • there is the implication that among all
the people listed to who contributed to discussion
there was no one else who chose to make such a
fuss over nothing. It is also astonishing that an edi­
torial perspective is produced without actually read­
ing the articles referred to. I will not raise questions
of thoroughness (marxist or male) for fear of being
labelled ignorant and presumptuous. Let us just look
at the rest of the reply. It is so typical that it merits
some examination. A perfectly legitimate protest is
called "petty" and "unprincipled", because the misun­
derstanding is not sorted out in private When such atte­
mpts are made in private, our experience is that the
jokes which are the normal response deprive it of all
seriousness. Secondly the "allegations" are called
"wild", the reasoning "immature" and the presump­
tions "incorrect''. This leads to "bickering and qua­
rrels". All this is old hat. Whenever a woman protests
about such omissions - the assumption is always
that the basis is emotion, hysteria, imbalance and
irrationality. The old myths about what the ovaries
can do ! Finally after a.I this heavy-handed, high
school masterish chastising of such infantile behavi­
our Dhruv Mankad actually says he is restraining
himself. This is admirable. I for one am really curious
to see what his less restrained public behaviour is
like. Finally of course the accusation that such reac­
tions are not "responsible". I think it is time we
began to examine our own reactions a little more
responsibly and critically. It is ironic that in an issue
on Women and Health such stereotypical reactions
should be produced. When I mentioned my own
angry reaction to a friend the response was that such
debates would not do the magazine much good. On
the contrary many of us feel it is far better to discuss
these things frankly and openly and expose our own
weaknesses, so that we can make a beginning tow­
ards recognising and dealing with them. For too long
now, the questions raised by women have been sub­
sumed to a larger good, be it the Family or the Cause.
Perhaps it is time at least when we are talking about

March 1985

h.No. 3-6-170/a

Vasantha Kannabiran

Hyderguda, Hyderabad 500 029

Dhruv Mankad replies
I agree with Vasantha and Ilina that generally a
woman's contribution is, consciously, or unconsciou­
sly ignored and that whenever she protests against
this, it is rejected as hysterical. I also accept that, gene­
rally men, including myself, do have conscious or un­
conscious patriarchal prejudices, having been under
their influence for many generations. But in this parti­
cular instance, neither in the 'lapse' nor in the res­
ponse to the'protest', were these prejudices at work.
I do nor call the protest 'petty and unprincipled'
because the misunderstanding was not sorted out
in private, as Vasantha seems to have assumed. Nor
do I call it unprincipled because the protest was not
based in principles (which of course, it was). I call
it that, because it was not carried out in a principled
manner. To me, a principled way of protesting when
a lapse occurs on the part of a comrade J hope Ilina
grants me that status), is for the purpose of correct­
ing this error, not just to denounce his/her weakness
in strong terms. If that is so, then one does not
proceed to accuse the comrade of anything without
first giving him/her a chance to explain whether it
was an error at all, and if it was, under what circum­
stances it was committed. I think I have tried to
point to this in my response. I felt that Ilina should
have given me a chance to explain -in PRINT, not
in private.
Regarding Vasantha's objections to the terms
that I have used in my response viz., 'wild
allegations', 'immature reasoning', 'incorrect pre­
sumptions', I can only say that I do now realise that
these are the very terms about which women are—
and ought to be — sensitive about. I did allow my
own sensitivity to be blurred by anger.

By all this, I do not claim that I am completely
free of patriarchal prejudices. But I am unable to
accept any trace of 'stereotypicity' in this particular
instance, where in the first place I was not directly
responsible for the original lapse.
Finally I do wish to ask Vasantha as to how
she came to the conclusion that I have implied that

no one among those with whom the article was
discussed has made "such a fuss over nothing". The
line in question (of my response) merely states a
fact regarding how I came about the content of the
article by Binayak and Ilina and that's just what it is
supposed to mean.
1877 Joshi Galli, Nipani
DhruV Mank ad
Belgaum District Karnataka 56

foj

’Vi

lol

Working Editors Reply : We believe that much of
this debate would have been avoided if, in the first
instance, we had explained how exactly we produce
each issue. We do so now especially in reply to
Vasantha's query about how an editorial perspective
can be produced without actually reading the arti­
cles referred to. The editorial perspective for each
issue is written and circulated among the editorial
collective months in advance (for instance, the
editorial perspective for the June'I 985 issue was
circulated sometime in November, 1984). Articles are
'commissioned' with the perspective in view and in
consultation with the author of the perspective. The
collective is supposed to send their comments to
the author, who incorporates them as s/he sees fit
and sends us a final draft for printing. Given the
geographical distances, it is not possible for the
author of the perspective to read all the articles to
be published in the issue, although the contents
of each are generally known. The Working Editors in
Bombay then add to the perspective, an introduction
to the issue containing short synopses of the
articles. This is how we worked in producing the
first issue as well. Unfortunately, given the fact that
we were, at that
time trying to accomplish
unfamiliar tasks and had to face an array of 'teething
troubles' in producing that first issue, we did not
check either the copy or the proofs as accurately as
we ought to have. Hence the ommission of Ilina's
name in the perspective, (with which Dhruv had
nothing to do). After having produced four issues,
we are now a little more confident and better
organised and are careful about checking everything
closely. But if there are ever such lapses, please
bear with us. Please be assured that we will endea­
vour to see that prejudicial bias, of any kind,
conscious or unconscious, is not projected through
SHR.
ion®:
Dear Friends: Your editorial (SHR 1:2) speaks of
health organisation as some sort of minimal structure
for the poor (working classes), just to keep them
from being unproductive to capital. Perhaps your
analysis is correct for India (but even there you
should think more on the social role of the hospital
and the whole gigantic structure of the health

172

institution), but it is not correct and could be
misleading for 'capital' as such (which would include
industrialised countries as well). I think in our
countries (in particular Switzerland) the health
institution has been growing to gigantic proportions
- - providing a well-defined and reductive sort of
'health', but providing it all the same --- because
of the powerful interests that are gravitating around
it. It would be the same for a television production
capital, an etertainments producing capital, and so on •
All these, health included, are capitalistic commod•tes and lead to profit and accumulation. In the
same way as you make money forcing people to go
in for colour television (the advertisements are
increasingly directed at the working classes) and for
personal computers (Spanish and Italian immigrant
parents here seriously think of investing 4,000
to buy one fortheir 14-year old boy), they make
money by sending people to ever-growing numbers
of hospitals and giving them an increasing number
of drugs. Thus the model presented should be more
elastic and realistic and try to rouse people about
the lack of medical care as well as the profit aspect
of this care.
I dislike very much the statement that "women
can relate onlv to other women when it comes to
health and their bodies because only women can
truly unlerstand one another's problems ' ( SHR l:2,
66). It is unmotivated, purely sentimental, imported
from liberal (or radical) not marxist feminism Should
a worker in the industry were to say that he cannot
'truly understand' the exploitation of a poor peasant,
what would you say ? It would be a pity to give
emahasis to a thinking that separates what should be
united (working class) and unites what should be
separated (rich, middle class from poor women).
The paper on amniocentesis is vague and
uncertain (at least in its wording which is often ambig­
uous). Sometimes it seems to say that the reasons
were medical (deformations, and so on) but that
the social context made it a real danger to female
embryos; and sometimes it seems to say that it was
introduced to help the massacre of female embr/os.
A more careful wording (and perhaps thinking;
could help the reader find a way to action without
being misled
We found the paper on the Bhutali phenomenon
very important and well-written But we lack the
background for understanding what 'adivasi’means
tor instance. The paper does not help in understand­
ing the relevance of the phenomenon (are there a
few villages or some thousands in this situation
Does the phenomenon occur a few times a year or
several thousand times a year ? ) If you would like
your journal to be read in the world could you
please define terms such as adivasi, lakhs and so on?
8, Bugnons
Dr, Bruno Vitale
1217, Meyrin (Geneva) Switzerland
Adivasi : aborigines; lakh : one hundred thousand.

—W. E.

Socialist Health Review

MOTIVATION FOR FAMILY PLANNING :
A Short Critical Review
ilina sen
An important component of the family planning programme of the sixties and the seventies was
motivation which meant planned efforts to persuade the public accept the small family norm as well as the
particular method of birth control. This concept of motivation became important particularly in the mid- sixties
and several strategies were evolved and implemented over the years — mass education about family planning,
mass mailing schemes and the use of incentives and disincentives. The article takes a critical look at these
strategies, the social political background which gave rise to them, their implementation and effectiveness. The
author further examines the assumptions on which the entire motivational strategy was founded and finds
them inadequate and full of deeper fallacies.

^/^mong social development plans of the govern­
ment in the years since independence, thefamily
planning programme has perhaps received greater
funds and attention than any other single programme.
A central element of the family planning programme.
as it evolved in the sixties and seventies, was its
attention to motivation. By this was meant conscious
and planned efforts to influence the public to accept
(a) the small family norm, and (b) a particular
method of birth control among the many available.
In this paper we will attempt to understand this
phenomenon of motivation for family planning in
greater detail. We shall do this with reference both
to actual strategies adopted for motivation in the
period before 1977, (a year which marks a watershed
of sorts in the history of the Indian family planning
programme), and with reference to the theoretical
and intellectual basis on which these strateg:es were
founded.

Motivational Strategy — What It Consisted of

The Indian family planning programme was
developed in response to what the planners percei­
ved as the "population problem'. Briefly stated this
meant that they saw a high rate of population growth
as a4najor road block on the path to planned deve­
lopment and had visions of the gains of Industrial
agricultural growth being swallowed up and reduced
to nothing by the growing number of hungry people.
Family planning was always an euphemism fora
policy of population control and a euphemism based
on the faith that the surest way to control the rate
of population growth was to get individual families
to "plan' their (small) size, which in any case was in
their own interests. In the first decade of indepen­
dence, the approach to family planning, as to much
else, was relatively relaxed. While family planning
was designated as a key sector in policy/plan docu­

March 1985

ments. the adoption of specific family planning
practices was left for the individual couples to decide
upon. The state made available at health care
centres, a variety of alternatives in birth control
under a cafeteria approach.

The result of the 1961 census showing a
decennial growth rate of population that was
markedly higher than that of earlier decades (popul­
ation growth rate was 14.23 percent in the period
1931-41, 13.31 per cent in the period 1941-51
and 21.64 per cent in the period 1951-61) brought
on the first signs of panic. The FP bureaucracy felt
the need to be radical, and the strategy of community
motivation was among its most radical innovations.
The concept of motivation gained importance in
the family planning programme in the years following
the 1962-1963 report of the Director of Family
Planning. This report, known popularly as the Raina
Report (1963) seriously questioned the clinic type
of family planning services that were then available,
and under the broad heading of'extension approach’
laid down the basis lor a new strategy, relying on
community motivation. It recommended the position­
ing of an extension educator at each block who
would educate and motivate people to become
FP acceptors. Hard on the heels of this report, in
1965, came the the IUD breakthrough. All, it seemed
that was needed to curb the population growth rate
was to (a) motivate the people to have fewer children,
and (b) insert IUDs. In 1965 also occurred the first
evaluation study of the FP programme by the
Programmes Evaluation Organisation (PEO) of the
Planning Commission (1965). Following this spate
of activity, PF was separated completely
from
health and established as a separate department.
United Nations team that evaluated the programme
at the request of the government (UN, 1966) in the

173

same year spoke optimistically of the education of
the public, through opinion leaders, satisfied
customers and all available types of mass media.
The Mukherjee Committee on IUCD (1965) urged
for a mass publicity and communications wing for
the new department in addition to the army of staff
recommeded by the Raina Report. One of the first re­
sults of this decision to go in for mass motivation was
thus, a fantastic expansion of the Department of
Family Planning. The staffing pattern recommended
visualised a Block Extension Educator (BEE) at each
of the over 5000 Primary Health Centres, assisted
by male FP workers, and female ANMs covering
20,000 and 10,000 population respectively. Full
and part-time paid voluntary workers were also
employed (numbering over 75 000), in addition to
extension staff for the urban clinics. However, in later
years, the Kartar Singh Committee was to acknow­
ledge that the actual
coverage of extension
educators had remained much lower.

The motivational strategy consisted of a massive
educational programme supplemented by the field
work of the extension educators who directly
motivated eligible couples. The strategy for mass
education was to flash continuously a few ' mean
ingful and understandable" messages to the public
such as "Do ya teen bachhe bas". The country was
simultaneously plastered with the red triangle
of family planning. This simplistic approach often
had no real relevance to the life situation of the
public that was being educated; for instance, the
slogan "do ya teen bachhe bas"; was cut down to
its present size from "do ya teen bache bas; doctor
ki salah maniye", when it was discovered that the
average Indian villager had no doctor to consult.
Films, radio "traditional media," were all used for
educational purposes, and although the degree or
support to the programme from the mass media unit
of the Ministry of Information and Broadcasting,
was impressive, the contents of these media pro­
ducts, were unimaginative and often reflected the
upper class bias of the producers and of the progra­
mme. A lot of the propaganda was centered around
a stereotype of two families, the large family is
always shown to be poor, unhappy, rural, dark and
desi. The other familly, urban, middle-class and
westernised is, needless to say, the small and happy
one (Banerji, 1971). Songs were written and sung
about FP by ferrous playback singers. FP fortnights,
contests and exhibitions were organised in remote
small towns and magazines were encouraged to
bring out special FP supplements.

In 1969, was started the Mass Mailing Scheme.

174

This mailed suitable informative literature directly
to opinion leaders from all walks of life. Even though
research found a "good" response to mass mailing,
no precise indications regarding the outcome of this
expensive exercise are available.

These remained the main prongs of the motiva­
tional strategy throughout the sixties. However, from
the late 1960's, two parallel but conflicting trends
are visible in the programme and its strategy for
motivation. The painful realisation around 1968, that
the IUCD had failed to deliver the goods, intensified
the reliance on sterilisation, if necessary by coercion
At the same time some rethinking took place on the
whole issue of community motivation. In practice a
"hard" and a "soft" line of action are discernable,
and these can be followed up separately for con­
venience.

The 'hard' line :
IUCD insertion figures came down from 909,
726 insertions in 1966-67 to 478,73 in 1968-69
In hindsight, it appears that there could have been
many reasons for this perhaps the natural limits of
demand had been reached. However, the interpreta­
tion put on this trend by the planners, was that there
were shortcomings in the motivational efforts.
Community motivation being carried out at great
expenses, was not having the desired results. This
realisation led to the adoption of cruder measures.

Incentive for sterilisation or IUCD insertions
have always been spoken of in official family
planning circles as "compensation for wages lost."
The 1965 Mukherjee Committee report, had spoken
of paying compensation to IUCD acceptors (Mukher­
jee Committee, 1965). While perceiving tne danger
of malpractices that may result, this was thought to
be less than the danger that would threaten the
programme if compensations were not paid. Compen­
sation was tried on a small scale in some states, for
instance Madras, in the 1950s, and was started on
a national scale in 1964. The motivator's fees that
went along with compensation was admissible not
only to private citizens but also to Government
Servants including FP workers. Rates of compen­
sation were graded as being higher for sterilisations,
and lower for IUCD insertions The rates were revised
in 1965, and again in 1966. Incentives and target
orientation
of the programme led, in the late
1960s, to an increasingly greater emphasis on steri­
lisation with growing tendency to using coercive
methods, in addition to widespread malpractices
because of the system of the incentives. Any attempt
at cutting down on compensation / incentives was
however, strongly resented by the medical FP staff.
Socialist Health Review

The idea of using disincentives finds expression
in the 1970 document entitled "Master Plan for total
Health Care in rural areas" (GOI, 1970) which fortu­
nately, was never implemented. This advocates the
professional access of the FP acceptors to all health
services The first non-birth incentive scheme was
begun by the United Planters Association of South
India (Upasi) in selected tea estates in the Nilgiris
under the consultancy of Doctor Ridker of USAID.
Female tea pickers who had enrolled had a monthly
deposit of Rs. 5/- made into their retirement benefit
plan by Upasi as long as they did not get pregnant.
Specific amounts of the total sum were forefeited in
case of pregnancy.
The first mass vasectomy camp was held in the
Ernakulam district of Kerala in 1971 (Kumar, 1972).
A very large number of sterlisations were performed
during the camp duration. The camp and the district
collector who had organised it were hailed in FP
circles in India and abroad Such camps were held
in subsequent months in several other states, and
they were all marked by certain special features.
Higher than usual rates of compensation were given
in cash in addition to gifts in kind during the dura­
tion of the camp and the entire administrative machi­
nery of the government of the area was mobilised
for publicity and organisation work during the camp
The Kerala camp also happened to coincide with the
leanest agriculture season, when special incentives
such as a week's extra ration took on a special signi­
ficance. The demographic quality of those sterilised
in the camps was never properly established by inde­
pendent authorities and in any case the attendance
at such camps fell off after the 1972 Gorakhpur inci­
dent in which 11 persons died of tetanus, following
vasectomy. The camps wera discontinued shortly
thereafter.
The declaration of the Emergency in June 1975,
brought the family planning programme to the fore­
front of Indian politics 1 he subtle coercion used
earlier was now exercised openly to promote sterili­
sation. Perhaps the turning points was the announce
ment of Sanjay Gandhi's 4- Point Programme later
in 1975, in which FP played an important part. (FP
had not been mentioned in the 20-Point Programme.)
Sterilisation figures picked up massively—2.5 million
operations were performed in 1975-76 as against
1.35 million in 1974-75 and only 0.9 million In
1973-74.
The growing panic at non-performance in a
topheavy programme finds its culmination in the

March 1985

National Population Policy of 1976 (Singh, 197G).
Though this document did have some developmental
content, for instance, stress on female education,
only its most coercive aspects were put into effect
The policy graded incentives according to the
parity of acceptors, and advocated disincentives for
government servants not practising FP. Compulsory
sterilisation was left to the discretion of individual
states as the centre lacked the infrastructure to put
such a policy into effect. However, to prod the
states into activity in this regard it was stipulated
that in all matters of aid allocation to the states,
the 1971 population figures would be followed till
the year 2001, and that eight percent of the total
central aid would be specifically linked to perfor­
mance in family planning In the prevailing political
climate this was interpreted by most of the states
as a clear directive, and the states vied with one an­
other to fulfil targets, and to give an impression of
success. In many states, departments such as police
and education were used to mop up people for
sterilistation, and states like MP and Bihar, fulfilled
the annual target for sterilisation in less than six
months of the year 1976-77. One state, Mahara­
shtra, actually passed the bill on compulsory sterili­
sation, and this was only prevented from becoming
a law by the grace of the President. The political
consequences of these events are only too well
known

The soft line :

The "softer” trend in the programmes of motiva­
tional efforts, the carrot that accompanied the stick,
remained much less effective, often amounting to a
lip service only to liberalism and can be traced from
the same period as the beginning of the "hard ' line.
Like the hard line, the 'soft' line was prompted by
the realisation of failure.
Doubts began to be cast on efforts to motivate
from about 1970. In that year the, second PEO report
found the contacts of the FP staff with the local
community to be limited and felt that "carrying the
messages of FP to the village people required a
knowedge ... of their . . . norn s, values, and experi­
ences/' (PEO, 1970 , Some of the pioneering writ­
ings on population, for instance that by Mamdani,
had already pointed out that a large number of
children may be an asset in certain class/production
situations, and that in these situations it was unrea­
listic to expect that people would adopt the small
family norm merely because a well intentioned de­
partment advised them to do so (Mamdani, 1972).
It was also perceived that high fertility had a close

175

relationship with high levels of infant mortality, and
in general, with low levels of development. The PEO
report briefly acknowledges these trends when it
says that "the desire for a small family is more due
to economic reasons rather than due to changes in
social norms." (PEO, 1970). No concrete approaches
in this direction are however, suggested. Similarly*
in 1969, the UN evaluation of the programme com­
plained of "gap in our knowledge of the motiva­
tional process" (UN 1969). All the soul searching
led to a few "changes and departures" in the
programme's strategy to motivate the people, and
these can now be taken up.

The fallacy of de\.eloping FP in isolation from
health was realised, and in 1968, maternal and child
health services were integrated with immunisations
to children and the theme of reduced infant morta­
lity used to
establish
contact
with eligible
couples and to motivate them to accept FP. Since
however, this was also the period of targets and
incentives it is doubtful if this led to any real
changes in the approach or not. Possibly it only
meant that the already harassed staff were over­
burdened with finding time for MCH and that
these services actually suffered in consequences.
The post-partum programme was launched in 1969
in selected hospitals in the country on the basis of
the following philosophy: "the months following
delivery or abortion... are significant periods of high
motivation during which women can be approached
concerning future child bearing". Since however,
the actual number of hospital deliveries in India
form so insignificant a part of the total, the demogr­
aphic impact of this programme could not have
been very high at the best of times. The Country
Statement for India at the 1974 World Population
Conference in Bucharest with its slogans "Develop­
ment is the best contraceptive", is also an acknow­
ledgement that more fundamental changes are
necessary before the small family norm can be
internalised. (World Population Conference, 1974).
The approach document to the Fifth Five Year Plan
saw FP as part of the integrated package with health
and nutrition in the Minimum Needs Programme
(Planning Commission. 1977). However, these pious
intentions remained unredeemed and from 19^5
onwards, in the holocaust of the Emergency, all
voices of reason were drowned.
The year 1977 saw a change in government, a
change that had taken place at least to some extent
as a direct reaction to an unpopular FP programme.
The new government redesignated the department
176

as that of Family Welfare and seemed anxious not
to repeat the zeal for birth control through sterilisa­
tion
The Policy statement of the department of
June 1977, stressed the voluntary nature of the
programme,
emphasised the cafeterial approach
(allowing the acceptor to choose from a wide variety
of methods) and recognised the need of linking FP
with other welfare programmes. (GOI, 1977). How­
ever, it also expressed concern with the high
population growth rate end fixed birth rate targets
of 30 and 25 per thousand to be achieved by the
end of the fifth and sixth Plan periods respectively,
(as against the then current 34.6. in 1973 as per
Sample Registration estimates). It was also stated
that the policy of linking eight percent central aid to
the states to their FW performance was to continue.
In a separate publication " guidelines for media and
extensions personne’" humility of approach and the
pro-mother and pro-child nature of the programme
were stressed (FWP, 1977). But the Minister for
Health and F.W. made it clear in numerous press
statements that incentives for sterilisation would
continue. In effect, while some lifting of pressure
cartai Yy took place, no real change occured, and
certainly no basic assumptions were challenged
either by the Janata Party government, or by the
Congress government that followed.
The Assumptions Behind The Strategy of
Motivation : The 'Relevance' of Theory.

We shall now examine the theoretical assump­
tions on which the entire motivational strategy was
founded. Intellectual
support for
motivational
attempts in the family planning programme, were
imported mainly from American agricultural exten­
sions and industrial psychology experience. Continued
support was provided, once motivation did become
the accepted strategy, from KAP (Knowledge, Attitude
and Practice) studies in family planning and from
'communications' theory. The periodic evalutions
of the programme (twice by the Planning Commis­
sion, and twice by the United Nations) also dealt
with the theoretical issues.

The classical ''diffusion model" that theorised
on how and why innovations were adopted was an
American agricultural extension creation. It demarc­
ated the following stages in the diffusion of an
invention — awareness, interest, evaluation, trial,
adoption — and classified the target population into
innovators early adopters, non-adopters and so on.
Informal sources of information were held to be
the most important at the awareness and interest
stages, and neighbours and friends were named as
Socialist Health Review

the most important motivators at the evaluation,
trial and adoption stages. This theoretical framework
was held to have usefulness for "people who are
faced with the problem of diffusing new ideas and
practices". (Bohlen, 1257).
Of the social and industrial psychology theories
that lent support to motivational experiments in
India, the following deserve mention :
(a) Maslow's theory of the Heirarchy of Needs
that graded human emotional needs as ''basic
psychological safety, belongingness and love,
esteem, and self-fulfilment needs", in that order
(Maslow, 1954). Satisfaction of needs at one level
motivates the individual to seek satisfaction of needs
at the next level, and so on. The most important
applications of Maslow's ideas, have been in the
labour management and advertisement fields.
(b) McClelland's theory of Need Achievements
that stated as a first premise that an individual's
success in economic activities was due to his need
for achievement or''N-Ach" (McClelland and Winter,
1969). Further premises, developed over several yea­
rs, were that asociety's levels of economic achie­
vement depended on prevalent levels of N. - Ach
and that it was possible to teach N-Ach. The last
belief had important implications for the Indian FP
programme, where much of the motivational strategy
was based on the belief that the extension educators
could teach the small family norm.

(c) Herzberg's Motivation Hygiene theory which
opined that in a work situation, achievement was
affected more by the workers’ inner urge to succeed
than by environmental factors (Herzberg, 1966). The
latter had more importance as sources of dissatisfac­
tion.

All these theories had an element of psycholo­
gical determinism about them. Their view of the
individual was that of a 'blank field' that would
produce predetermined responses to given stimuli.
Developed in the context of early and aggresive
capitalist growth, they had a totally atomised
concept of a human being who could be egged on
through this or that process to have more "N-Ach"
or more "inherent urge to succeed". Instead of
viewing the individual as a product of a set of
social circumstances, they viewed society as the
product of diffeiential drive/or N. Ach of its individual
components. Only this totally top-sided view of
history and society could produce the delusion that
'small family norm' could be taught regardless of its
relevance to the life situation of a particular couple.
March 1985

The other important source of intellectual
support came from theories on communications
research, developed orginally in the advertising and
broadcasting fields, but later studied with particular
reference to family planning. Communications
research developed an impressive vocabulary.of its
own. Communication was broken up into its "main
elements"- source, message, channel, receiver,
bottlenecks, networks and so on. Great importance
was attached to identifying particular areas of com­
munication "breakdown" and removing the particular
source of a problem. A certain amount of’communications research also went into special areas of FP
motivation like the whole question of incentives.
Incentives were formally classified into positive/
negative, acceptor/diffusor, individual/group, immediate/delayed Rogers, a prolific writer on communica­
tions, worte regarding incentives, that while they do
result in an increase in the "quantity of FP
acceptance", they are likely to affect "quality"
adversely. Rogers, (1973). However such cautions
were seldom heeded by those on the programme
bandwagon, and more encouraging findings of
communications research have continued to enrich
motivation vocabulary.
Once the programme was properly launched in
India, KAP studies conducted by the department
itself, as well as by obliging university faculties,
became the main prop of the programme against
which motivational strategies were planned and
evaluated. Rao and Mullick have reviewed over 200
of these studies, and their main theme is that of a
KAP gap in India. (Rao and Mullick, 1974). Awar­
eness of FP methods is high, attitudes towards FP
are favourable, but the actual practice of family
planning by eligible couples is low. The model is
obviously based on the classical diffusion theory
outlined above. The methodology of the KAP studies
has come under increasing attack in recent years. It
is to be doubted if a simple linear, relationship
between K, A, and P exists in as complex an area as
this. The measurement of attitudes through surveys
or ordinal scales is again of questionable validity.
There is, in any case, a vast difference between an
attitude, which is a complex socio-psychological
entity and an opinion, which is what the questionaires used in the KAP studies elicited.

Some of the inadequacies of the theoretical
bases of the motivational strategy are pointed out
above. Certain other and deeper fallacies however,
have affected the entire programme and we can now
turn to these.
177

The FP programme was prompted in the main
by a fear of population size, that is, by (correct or
incorrect) considerations of macro population policy.
It being unrealistic to expect that family planning
decisions should reflect population policy norms
rather than individual life experiences, people were
quite dishonestly sought to be converted with the
message that the small family norm was good for
them; proposition that was simply not correct.
Considerable evidence was available even in the
late sixties that a large family norm may be mora
suitable in certain situations (for instance in poor,
labour intensive agrarian economies and where
poorer classes are subject to heavy depletion in
children ever born). Some of this sort of under­
standing did creep into the programme rhetoric from,
time to time, but made no real difference, as the
real moving force behind the programme
was
never the happiness of individul families
As far as the macro understanding goes, it is
not difficult to see through it at all. The argument
that over population eats up the gains of develop­
ments is not a new one. Not only does it divert

(Contd. from page 170 )
tablets. That night the wife received severe beating
from the husband. He suspected that his wife had
used one foam tablet with another man.
Case 2 : Having got fed u p with her husband
forcing her to undergo repeated abortions a woman
quietly got an IUD inserted The husband got
suspicious and forced his wife to get it removed.
Inspite of removing the device, she was thereafter
maltreated and .beaten up often. After a few months
inspite of her being pregnant she was thrown out
of the house in the middle of the night, the reason
being that she had not taken her husband s permi­
ssion to get the IUD inserted.
Case 3 : There was a case of a doctor's wife
who had to undergo repeated abortions each time
after a 'sex determination test' revealed a female
foetus.
Case 4 : Women have to bear the burden of
looking after the family and also take the responsi­
bility of contraception. There were several instances
when a woman could not be offered any method
immediately as she required treatment for some
gynaecological complaint. The period of treatment
was always short — a month or two in each case.
Her husband would be asked to use a condom or
refrain himself till she was alright. But in most cases
the women would conceive during this period and
either continue with an unwanted pregnancy or
be forced to undergo an abortion.

178

attention from more fundamental questions like
models of development or distribution of resources;
one also senses behind it a fear of people, people of
certain nations, certain races and certain classes. It
is another manifestation of the old Malthusian
bogey that the poor are responsible for their own
poverty because of their large numbers.
Birth control, which was all that family plann­
ing ever meant in India, can be advocated on many
grounds. But certainly it cannot be advocated as a
uniform prescription for all, without any regard for
human dignity or individual liberty. The events of
1977 amply illustrated that the people would not
buy an irrelevant product, however sophisticated
the packaging. The tragady is that no real lessons
appear to have been learnt.

ilina sen
CMSS Office Rajhara (Kanday) Durg MP 491228

References
Banerji, D. Family Planning in India : A critique and a perspectivePeople's Publishing House, New Delhi 1971
Bohlen, Bealand G.M. The Diffusion Process, Special report n. 18.
Agricutural Extension service, Iowa State College, Ames, lowas,
USA. 1957
(Contd. on page 181)

Any one who has worked in FP clinics has
come across women belonging to various religious
groups who demand oral pills to postpone their
menstrual periods so that they could participate
fully in religious and social functions or even go for

an outing. If given a chance, women can decide
how they would like to utilise scientific discoveries.
Conclusion

In conclusion, the poor women of the third
world countries like India get exploited not only by
the government, the research institutes, private
individuals in the field of contraceptive research
butalso by men who care verylittle about their health
and their comforts.
Research on
biith control
measures which could be used by men has not been
undertaken with any degree of seriousness.
For instance although the condom is really
a harmless and effective method for men, no serious
studies have been conducted on its being accepted
or rejected by men. Women just leave condoms
behind at the hospitals if they are distributed
knowing fully well that husbands will not use them.
The statistics on condoms are based not on the
numbers used but on the total number issued.
There is no proper follow-up nor any serious effort
to promote this harmless contraceptive. Is it because
it is to be used by men ?

Reference
Kakar D. N. Women and Family Planning, Sterling Publishers Private
Limited, New Delhi, 1984, p. 34

Socialist Health Review

A BIZARRE MEDLEY OF CARROTS
vimal balasubrahmanyan
In the last tno years the government in achieving its aims of population control has proposed a number of
incentives and disincentives. The authoi h^s compiled reports from newspapers in Hyderabad, which tell eloqu­
ent story about the government's priorities with regard to the family planning programme.

* | *he following collection of news items over the

period 1982-84 presents a picture of the Establ
shment's preoccupation over incentives and disin­
centives to achieve population control. They are
arranged in a roughly chronological order and a
number of the items happen to be from Andhra
Pradesh because they were reported in newspapers
in Hyderabad where I live. If the readers were to go
through newspapers pulished from other cities the
picture from other states would be much the same.
I've left out a large number of items which tend to
be repetitive and which are only too familiar today
to the average newspaper reader in this country ie,
announcement of a 'camp' with date and venue,
total number of operations proposed to be performed
and quantum of incentive money offered. I' ve
included a few oddities which are not strictly about
incentives but which add further piquancy to the
total mosaic. I refrain from making any comment as
the collage speaks eloquently for itself.
1982

The Bihar cabinet sub-committee on family
welfare announces 33 cash prizes of Rs. 10 00/
each for gram panchayats achieving the "highest
target ' of sterilisations in the current year. As second
and third prizes 66 cash awards would be given to
gram panchayats at the rate of Rs. 5,000 and Rs.
3,000 each respectively.
:©: Extract from a panel discussion on Calcutta
Doordarshan's family welfare programme One doc­
tor comments on the uneven performance of different
states in curbing the birth rate and another responds :
*'l suggest, but you may not like the idea, that birth
control should be made compulsory by law."
:©: A new scheme is introduced on an experimental
basis by the union ministry of health to enlist the
help of private practitioners to achieve tubectomy
targets. A private practitioner will be entitled to
receive Rs. 50 for each case of tubectomy out of
the admissible compensation amount of Rs. 170 to
the acceptor, irrespective of whether or not the doc­
tor charges his own fee from the acceptor.

March 1985

Industrialists led by J.R.D. Tata announce a con­
tribution of Rs. 10 lakhs to the Family Planning
Foundation of India and Rs. 5 lakhs every year hence
forth. Mr. Tata tells newsmen that the allocation of
Rs. 1,000 crores for FP in the Sixth plan is barely
one per cent of the total outlay and is inadequate
to check population growth.

:©: Mr. Sat Pal Mittal, MP and chairman of the Indian
Association of Parliamentarians on Population and
Development, suggests incentives for FP acceptors
like : cash awards, additional bonus, allotment of
houses, plots, commercial shops or booths, rebate
in income-tax and exemptions from import duty.
Other suggestions : three increments for an employee
opting fora terminal method after one child and two
increments for an employee opting for terminal
method after two children However, an employee
having a third child should have his increment defe­
rred by six moi ths, and by one year for any subse­
quent birth.
•©: Package of disincentives suggested to the health
ministry by the Asian Parliamentary Forum for fami­
lies with more than two children : higher rate of
interest on loans, low priority in housing, higher rate
of income tax. leave travel expenses only for two
children; free medical treatment or reimbursement
for only two children, no paid maternity leave for
women after two children, public officials who
exceed the limit of two children during their tenure
of office be made to resign from office.
1983

:©: Union government announces that green cards
will be issued to individual acceptors of terminal
methods after two children. Such green card holders
will be accorded recognition, priority attention and
preferential treatment.
:©: During 1982-83, East Godavari district performed
27,937 sterilisations against the target of 27,900
thus giving i 00.13% achievement for the district.

i©2 At special sterilisation camps organised in three
AP towns, State Bank of India provided incentive

179

money at the rate of Rs. 115 per woman and Rs. 95
per man in addition to gifts for motivators.

ig: A laparascopic 'mela' took place in Kumbakonam,
the city of festivals in June 1983 when as many as
1,225 women were operated upon. The district coll­
ector who organised the camp said it was a world
record for a single day. So great was the response
that the camp was extended for a second day. The
highlight is described as the fact that as many as
263 women were below 25.
io: Maharashtra having won a Rs. 2.5 crore award
for outstanding FP performance in 1982-83, announ­
ces an ambitious target of 687,000 sterilisations in
1983-84, though the target fixed for this state by
the centre is only 601.000 sterilisations.
io: The Gujarat goverment announces a 20-day
foreign trip for district panchayat officers and
employees with best performance in family welfare
programme. The new scheme is introduced to
maintain ’round-the-year' tempo of the programme.
District officials with best performance would be
sent on study tours to foreign countries at state
government expense while the staff of taluka and
village panchayats would be sent on a 20-day tour
within the country.
io: The Kerala government offers incentives of a
would tour at government expense to the collector
of the district which registers the maximum number
of FP operations in a two-month campaign. During
the programme incentives to acceptors would be
enhanced from Rs. 145 to Rs 170 for women. Men.
undergoing vasectomy would get Rs. 155 .while
promoters would receive Rs. 20 for each vasectomy
case and Rs. 15 for each tubectomy against the
earlier Rs.10. The state health minister expresses the
hope that Kerala would win the Rs 2.5 crore cash
award given every year by the Union government to
that state which performs the maximum number of
sterilisations.
ig: The Delhi Administration announces 'attractive'
prizes like wrist watches and cash awards for
motivators and acceptors as part of a family welfare
programme.

ig: After the announcement of an enhanced incentive
of Rs. 200 for acceptors of sterilisation, there was an
unprecedented turn-out at FP camps in Madras
--posing problems for the organisers who ran out of
funds.

ig: A health ministry working group on incentives
and disincentives suggests that any violation of the
180

small family norm should disqualify a person from
standing for an election. Such violation should also
disqualify a person from appointment to university
senates directorship of a bank, vice-chancellorship
and gybernatorial posts.

io: An expert group appointed by the Family plann­
ing Foundation of India, chaired by Justice G. D.
Khosla, reiterates the disincentives recommended
earlier by bodies like the Asian Parliamentary Forum
and other working groups (listed in the earlier news
items). In addition the Khosla committee suggests
low priority for admission into educational institu­
tions for third and subsequent children.

io: A DAVP ad issued by the Delhi Administration
announces special attractions by lucky draw during
a family welfare campaign : Male sterilisation :
(apart fro n normal incentives) : Rajdoot motorcycle,
TV, Phillips transistor radio, and HMT watches.
Copper T (apart from normal incentives) : Colour
TV, black and white TV, pressure cookers and HMT
ladies watches. The ad urges readers to 'avail
opportunity' and says : ''Do not wait for tomorrow".
1984

ig: TISCO of Jamshedpur wins the 1983 award from
FICCI (Federation of Indian Chambers of Commerce
and Industry) for promotion of FP among workers.
TISCO's FP programme achieved 7,249 sterilisations
during 1982-83.
io: Health ministry's advice to state governments on
wooing the public to take to sterilisation : issue
green cards entitling acceptors to jump the queue
for certain facilities and to provide five state lottery
tickets of the next draw to acceptors.
w The Andhra Pradesh state government gears
itself to achieve the FP target for 1984-85 through
a larger number of camps and more incentive
schemes. Acceptors' awards to carry prizes of
Rs. 400, 200 and 100 through a lottery system in
sterilisation camps where over 100 operations are
conducted.
>r -If*-

■ «

. •••

*

ig: A DAVP ad for a special FP drive in Delhi
announces a target of 7,000 sterilisations and
10 C00 IUD insertions. To achieve this an 'additional'
amount of Rs. 25 and Rs. 5 respectively would be
given to the motivator for each case of sterilisation
and IUD.
ig: The Sadhana Samiti in collaboration with the
AP government organises a cartoon competition
with cash prizes on the theme of family welfare, the
Socialist Health Review

topics being : small family, spacing, sterilisation,
MTP, late marriage and maternal and child services.

The Kerala government announces a lottery
exclusively for sterilisation acceptors Men and
women undergoing the operation would receive free
lottery tickets and there would be a draw once
every three months

The Population Advisory Council has before it a
proposal by which a public servent will be sacked if
a child is born to him besides the two or more exist­
ing children after one year from the prescribed date.
Other proposals : Security bond of Rs. one lakh
maturing after 20 years for those undergoing sterilisa­
tion after one or two daughters; a bond of Rs. 60,000
for those undergoing sterilisation after one son and
one daughter or after one or two sons; income tax
rebate for persons not having more than two
children; to promote late marriage employers should
pay Rs. 25 per moth to unmarried working girls over
20 years with a matching contribution by the govern­
ment for three years. The amount will be credited to
their account and will be available after three years.
To postpone the birth of the first and second child a
small monthly allowance may be paid to newly
married employees.
io: The AP health minister Rammuni Reddy, calls
for a hike in incentives for FP acceptors, citing the
example of Maharashtra where such a hike enabled
that state to bag the cash award of Rs. 2.5 crores.
He feels that if the state fixes a target of five lakh
sterilisations, the extra expenditure involved would
be offset by the bagging of the national cash award.

fo: The Madhya Pradesh government introduces a
'green card' system for those undergoing sterilisation
after two children : each green card holder will get
preference in employment, health cover and financial
assistance under various schemes; two years relaxa­
tion in age for employment and 5% extra marks in
interviews; also free medicine and medical care in
government hospitals; children need not pay fees in
professional courses. In rural areas, landless card
holderswill get priority in land allotment and house
plots, as well as 20 bamboos and ten wooden poles
free of cost from the nearest forest depot, licences
to open retail shops for fuel and kerosene, priority in
allotment of cement, priority in getting loans for
milk cattle, grants for setting up wells, pumps and
bio-gas plants.

fo: The Indian Express reports a 'massive fraud*
and "statistisal acrobatics" in Copper T figures by
the Maharashtra government in its efforts to ensure
that it again wins the Rs. 2.5 crore annual cash
prize awarded by the Union government.
March 1985

•©: The Rotary Club announces a two-day 'mini
camp at Nellore in AP with a target of 300
sterilisations. An incentive of Rs. 145 for women and
Rs. 125 for men will be given, plus free food to
attendants and milk to children accompanying the
parents.

fo: The Punjab health secretary announces a plan
to introduce a raffle scheme to attract acceptors of
sterilisation. Apart from prize Rs. 1,000 each at
monthly draws, a quarterly state-level draw would
have a first prize of Rs. one lakh. The scheme would
not be a burden on the exchequer as the funds
would be drawn from the prize money earlier won
by the state from the centre for its FP performance.
Approval from the centre is awaited.

vimal balasubrahmanyan
605/1 Lancer barracks
Secunderabad 500 026

(Contd. from page 178)
Family Welfare Programme, Guidelines for media and extension
personnel. New Delhi 1977
Government of India. Ministry of Healh. Master Plan for the pro­
vision of health services in the rural areas. New Delhi, 1970.
Government of India. Ministry of Health and Family Welfare. A
statement of policy New Delhi, 1977
Herzberg, F- Work and the nature of man. Staples Press, London
1 966
Kumar, Krishna. S. Kerala's pioneering experiment in vasectomy
camps. Government Press Trivandrum, 1972
Mamdani, Mehmood. Myth of population control, Monthly Review
Press, New York, 1972
Maslow, A. H. Motivation and Personality Harper 8 Row, 1954.
New York
McClelland, D. and Winter. Motivation economomic achievement
Free Press, New York 1973
Mukherjee Committee. Report of the Committee on Administrative
and financial aspects of the HJCD. Government of India, Ministry
of Health and Family Planning New Delhi, 1971
Kartar Singh committee. Multipurpose worker committee : report
Government of India Ministry of Health and Family Planning
Programme Evaluation Organisation. Report of the Family Planning
Programme Planning commission, New Delhi. 1965
Programme Evaluation Organisation, Report on the Family Planning
Programme. Planning Commission. New Delhi. 1970
Planning Commission. Approach Document to the Fifth Five Year
Plan. New Delhi 1977
Raina, B.L. Family Planning progress report for 1962-63. Directo­
rate General of Health Services Ministry of Health, New Delhi
Rao, K. J, and Mullick- Research in family planning in India. Vikas,
New Delhi. 1974
Rogers, E. M. Communications strategies for family planning Free
Press, New York. 1973
Singh, Karan. National Population Policy Statement. New Delhi
1976
UN Department of Social and Economic Affairs. Report on the
Family Planning programme in India. United Narions. 1966
UN Department of Social and Economic Affairs. Report on the
family planning programme in India. United Nations. 1969
World Population Conference. Country Statement Government of
India. Prcc. World Population conference. Bucharest, 1974

A 81

THEORIES OF REPRODUCTIVE BEHAVIOR

A Marxist Critique
martha e gimenez
This article is reproduced from the Review of Radical Political Economics, Micro-economic theories
that view children as consumer goods or home produced goods which parents either purchase or produce subject
to income, price, and taste constraints, are essentially voluntaristic. Sociological theories, on the other hand,
stress the socially determined and coercive nature of reproductive behavior. From the standpoint of historical
materialism, both theories are open to criticism. It is argued that a scientific analysis of reproduction should
transcend the voluntaristic and deterministic alernatives which are the hallmark of bourgeois thought. Instead,
using the method of historical materialism, reproduction should be conceptualized in structural, concrete,
and historical terms', i.e., as (he reflection of the reproductive strategies of classes in the context of a given
mode of production
This article is reproduced from the Review of Radical Political Economics.

conomics is all about how people make
choices. Sociology is all about why they don't
have any choices to make. Historical Materialism
is all about how and why people make historically
specific choices.Current theories of fertility fall within vol untaristic or deterministic frameworks.
Microeconomic
theories are voluntaristic: they rest on the assump­
tion that individuals are free to decide whether they
want to have children and how many, and that such
decisions are based upon a comparsion between the
utilities to be expected from children and those
expected from allocating resources to other goods.3
Sociological theories, on the other hand, are deter­
ministic.
Sociologically,
reproductive behavior4
is socially determined; it is rooted in the social and
economic structure which determine the set of role
alternatives, rewards, and punishments confronting
individuals at a given time and, consequently, it
cannot be adequately investigated if viewed in
purely voluntaristic terms.5

The shortcomings of microeconomic and soci­
ological theories of reproductive behavior may be
traced to their ahistorical approach to the study of
social reality and their conceptualization of reprod­
uction in terms of
individual behavior and its
determinants. Historical materialism6 transcends the
opposition between voluntaristic and deterministic
viewpoints and offers a historical and structural
approach to the study of reproduction which shifts
the focus of theoretical concern to the reproductive
strategies of classes and sectors of classes in
historically specific contexts.
The epigraph above sums up the content of
this essay. The methodological assumptions under­

182

lying microeconomic and sociological theories will
be outlined and critically examined. Rather than
exploring specific applications of these theories, I
develop a critique of their theoretical foundations
which is based on my interpretation of historical
materialism. Several conditions for a scientific Marxist
analysis of fertility are delineated.

The Economic Theory of Fertility

The dominant contemporary theoretical efforts
at explaining fertility behavior stem from the use of
microeconomic theory Children are viewed as con­
sumer durables7 or, in the most recent developments,
as household produced goods8. The main assump­
tions common to both types of analyses is that
households (like firms) behave rationally, maximiz­
ing their utility in a context of scarcity: households
characterized by given tastes or preferences can
choose to consume/produce children and/or comm­
odities. The theory of fertility as consumer behavior
also emphasizes income and price constraints: house­
holds with given tastes"... are viewed as maximizing
utility subject to the constraints of income and prices
Thus three factors—income, tastes, and prices—are
the basic building blocks of fertility behavior.9 The
theory of feitility as productive behavior adds a
fourth relevant constraint: time. The quantity and
quality of children and other household goods
will be thus a function of the time and resources
allocated to their production.
The essence of this approach to fertility behavior
lies in the importance given to choice. It is assumed
that children and commodities can be described by
an indifference curve whose points represent combi­
nations of children and commodities providing the
same amount of utility to the household. Households
are, consequently, indifferent when confronting the
Socialist Health Review

options offered by an indifference curve and, when
facing a set of indifference curves they will choose
that which — given their income and price limitations
— maximizes their utility.

The Sociological Criticism

Sociologists emphasize social constraints on in­
dividual choice. Sociologically, reproductive behavior
is socially constrained behavior; it is a key dimension
of adult sex roles and, as such, it is supported by a
networK of social, economic, and psychological rew­
ards and punishments that rule out the desirability of
alternatives to the performance of family roles.10
Sociologists have convincingly argued that chil­
dren cannot be appropriately considered as equiva­
lent to consumer goods or home produced goods
because the social context of reproduction introduces
elements in their process of "consumption/production" that render untenable the main assumptions
upon which the economic model rests. Essentially,
this means that parents are not free to choose the
quality and quantity of children. With respect to
quantity, societies vary in their normatively sanctioned
desired family size; advanced Western societies
seem to have settled upon two as the minimum.
Quantity interacts with quality as it is assumed that
an only child is likely to have ' problems" that could
be avoided by having at least two.1’With respect to
quality, parents cannot raise their children at a level
separate from their own or that of other siblings;
i .e., they are not free to choose between possible
combinations of high and low quality children.
Furthermore, parents cannot raise children acc­
ording to arbitrary rules : there are general socially
established minimum standards of child quality as
well as specific standards linked to class, socioeco­
nomic status, ethnicity, religion, culture, etc. Finally,
parents lack control over the initial quality of their
children so that they lack a basis for balancing their
potential utility with that of other goods; they cannot
reject them if they do not conform to expectations
nor can they exchange them or abuse them as they
could any other good at their disposal.12

The substance of the sociological approach to
productive behavior is the following:
People make their "voluntary" reproductive
choices in an institutional context that severely con­
strains them not to choose non-marriage, not to
choose childlessness, not to choose only one child,
and even not to limit themselves solely to two

Like economists, sociologists begin ''post festum"
with the results of the process of historical develop­
ment (e.g., norms, sex roles, desired family size,
parental roles, etc.) having acquired the stability of
coercive and constraining "social facts." Neither
economists nor sociologists deal with the historical
specificity of the fetished facts they study and this
is why, from the standpoint of historical materialism,
their scientific contributions are inherently ideological.
The Marxist Critique
The ideological nature of economic and sociolo­
gical theories does not stem from deliberate distor­
tions nor from errors that could be eventually corre­
cted. Under capitalist conditions, ideology becomes
an inextricable aspect of the social sciences to the
extent that those sciences are limited to the partial
investigation of social reality thus overlooking aspe­
cts of it which while less obvious and apparent are
just as important and as real. The material basis
of this phenomenon is rooted in the peculiar nature
of the social reality treated by capitalist production
whose defining feature is the "fetishism of commo­
dities '.ll
Capitalism, as a mode of production presuppose
the universalization of commodity production; i.e.
the transformation of labour-power into a commodity
and the satisfaction of all needs through market ex­
changes. It presupposes, therefore, the existence of
two classes; the capitalist class which owns the
means of production and the working class which
owns nothing but its labor-power and must sell it
in the market for wages which it must subsequently
exchange for goods and services needed for survival.
The reality of the market is only one aspect of the
totality of capitalist relations. This is the sphere of
exchange and circulation of commodities which
Marx describes as follows:

... (it) is ... a very Eden of the innate rights of man.
There alone rule Freedom, Equality, Property, and
Bentham, because both buyer and sellerof a commo­
dity, say of labor power, are constrained only by their
own free will . . . Equality because each enters into
relation with the other as with a simple owner of
commodities, and they exchange equivalent for equi­
valent. Property, because each disposes only of what
is his own. And Bentham, because each looks only
to himself. The only force that brings them together
and puts them in relation with each other, is the
selfishness, the gain, and the private interests of
each.15

children.13

At the level of production there is neither freedom
nor equality. Property relations assert themselves as

March 1985

183

relations of domination : workers are actually ’ free"
to choose between starving or working under the
sway of capital and the contradiction between their
interests and those of the capitalist class results in
protracted class struggles whose outcome determine
the working conditions found at a given time.

In the capitalist mode of production, the market
mystifies the appropriation of unpaid surplus-value
by the capitalist class because, at the level of market
exchange it appears as if capitalists and workers ex­
changed equivalent for equivalent; as if the wage
were equivalent to the workers' output. Actually
the value of wages is equivalent only to the value
of the goods and services needed to reproduce the
labor force on a daily and generational basis.16 The
value of the workers’ total output, on the other
hand, is greater than the value of wages in a propor­
tion determined, ultimately, by the class struggle;
the difference is surplus-value, the product of
surplus labor time, which capitalists appropriate at
the level of production and realize at the level of
market exchange.
The market exchange of commodities, through
the tyranny of the laws of supply and demand, ob­
scures not only the relations of production between
capitalists and workers but also the relations among
capitalists themselves which, in their eyes appear as
relations among things — their products — which
they are unable to control. This is the fetishism of
commodities which results in the perception of things
and relations among things while class relations and
relations of production remain outside the purview
of the members of capitalist societies, including
social scientists.
The universalization of commodity production
ensures the pervasiveness of commodity fetishism
which is, from the standpoint of historical materi­
alism, the material basis for determining the
boundaries between science and ideology’1 as well
as their inextricable combination to the extent that
scientific practice remains limited to investigating
the level of exchange and circulation of commodities
while overlooking the level of production. Marx
states the point as follows:

Man's reflections on the forms of social life and,
consequently, also his scientific analysis of those
forms, take a course directly opposite to that of their
actual historical development. He begins, post festum, with the results of the process of development
ready to hand before him. The charactersthat stamp
products as commodities, and whose establishment
is a necessary preliminary to the circulation of

184

commodities, have already acquired the stability of
natural, self-understood forms of social life, before
man seeks to decipher, not their historical character,
for in his eyes they are immutable, but their meaning..
The categories of bourgeois economy consists of
such like forms. They are forms of thought expressing
with social validity the conditions and relations of
a definite, historically determined mode of produc­
tion.1*

The economic theory of fertility is an object les­
son on the meaning of commodity fetishism and, as
such, it shares the basic ideological flaws of
economic theory in particular and social science in
general criticized by Godelier.lJ An application of
Godelier's major critical insights to current theorizing
about fertility can be summarized in four major
points.
1. The microeconomic approach to fertility takes
as a point of departure the obvious and visible
maximizing behavior of individuals and overlooks
the structures that render possible such forms of
individual reproductive behavior. It bypasses stru­
ctures which are "... part of reality but not of visible
relationships"-0 and limits the scientific analysis of
fertility to its fetishized dimensions. It does not
inquire, in other words, into lhe historically specific
conditions under which it becomes possible for
scientists to conceptualize fertility behavior in those
terms and for people to ask themselves whether they
can "afford" a child; instead, it justifies its analysis
on the basis of a formal theory of rational choice 21

2. It defines fertility behavior in terms of a
formal theory of rational action
as optimizing
behavior in a context of scarcity. Such a formal
theory of rationality is a poor basis for a scientific
analysis of reproductive behavior because it explains
nothing about its content, its origin, and its change.
The use of formal rationality is ideological. Whether
it is conceived as a universal feature of human
nature or as a product of capitalist development,
formal rationality functions as an apologia of
capitalism. In its light capita'ism can be pseudo­
deduced from human nature (and consequently en­
dowed with ahistorical immutability) or it can be
considered as the source of rationality thus relegating
everything else to the realm of tradition, religion,
custom, and other substitutes for reasoned analysis.-2

3. The reliance on formal rationality and indivi­
dual behavior necessarily leads to neglect of the
social nature of the criteria by which individuals

Socialist Health Review

maximize their uti.ity. The subjective utility of children
for individuals or households is taken as the basis
for explaining how reproductive behavior operates.
It is assumed that those utilities, as well as their
hierarchical ordering in a map of indifference curves
responds solely to individual subjective preferences
which can be collected and statistically analyzed,
thus providing a pseudoscientific analysis of social
needs. It is obvious that such statistical analyses are
insufficient to scientifically explain not only the
needs and hierarchy of needs dominant in a given
social formation at a given time but also, what is
more important, the reason why the satisfaction of
some needs as well as the form in which such needs
are satisfied are deemed more "rational" than others.

4. The theory of choice is based upon a concep­
tualization of income as an individual attribute.
Income is viewed in purely quantitative terms : the
amount of income accruing to indivldualsthus deter­
mines, given tastes and market prices, the combina­
tion of goods and children that best maximizes their
utility. The exclusive concern with the quantity of
income reflects the narrow basis of the analysis
which remains at the level of market relations and
unavoidably overlooks the relevance, for the
explanation of fertility behavior, of the relations of
production and class relations in which all indivi­
duals participate. It obscures the existence of quali­
tative differences in the sources of individuals'
income, differences that stem from their specific
location in the mode of production.

The scientific kernel of the economic theory of
fertility lies in the identification of the economic
constraints that shape fertility behavior under capi­
talist conditions, and the articulation of those
constraints with individuals' tastes into a theory
potentially useful for the study of reproductive
behavior. The universalization of commodity produc­
tion, which implies the satisfaction of all needs
through the market, does incorporate child-bearing
and rearing into market relations both symbolically
and practically to the extent that such activities
presuppose monetary outlays. Market considerations
and relations do qinvade the household forcing its
individual members to behave in an optimizing
manner in order to maintain or improve their standard
of living, and that optimizing behavior necessarily
affects reproduction.
»
On the other hand, the economists' insights on
the nature of fertility behavior are scientific for they
express "...with social validity the conditions and
relations of a definite historically determined mode

March 1985

of production;*'23 but they are also ideological
because they do not acknowledge the histoneal
nature of those conditions: i.e., their basis on the

capitalist mode of production which not only makes
possible the theory and the practice of fertility
behavior as consumer/producer behavior but also
gives it a historically specific content. Their analysis
is limited to the subjective, individual, and formal
aspects of fertility behavior; i.e. to its fetishized form.

The Marxist Alternative
These critcisms suggest three specific conditions
for a scientific Marxist analysis of reproductive
decisions.

1. It should define reproduction in structural
rather than individual terms.
Instead of investigating reproductive behavior
primarily as the behavior of individuals who, given
certain individual attributes (income and tastes) and
market prices, choose to consume/produce children,
Marxist analysis would investigate the reproductive
structures characterizing a given social formation at
a given time. As Engels pointed out,

... according to the materialistic conception, the
determining factor in history is, in the final instance,
the production and reproduction of immediate life.
This, again, is of a twofold character : on the one
side, the production of the means of existence ...
on the other side, the production of human beings
themselves, the propagation of the species.-’
Linder capitalist conditions, given the twofold
nature of production, it becomes necessary to investi­
gate the relationship between the capitalist mode of
production and the capitalist mode of reproduction
(in the biological and social sense) it presupposes.
The capitalist mode of reproduction is the complex
structured totality formed by the combination of the
material and social elements that enter into the
biological and social reproduction of human beings
through historically specific (i.e., capitalist) relations
of reproduction (relations between the sexes,
independent from their will, mediated through their
relationship to the material and social conditions of
production and reproduction) 25 Consequently, the
study of the relationship between capitalist modes
of production and reproduction is not equivalent to
studying the ''interaction" between "family" and
the ''economy". At the market level, economy and
family appear as things in themselves that "interact*'
with each other in ways that reproduce market
relations thus obscuring the relations of production
185

and the relations of reproduction which underlie
market behavior. Under capitalist conditions (as
well as in all modes of production based on the
private ownership of the means of production) the
social relations of reproduction are sexist relations.
A structural and historical analysis of the relation­
ship between the capitalist modes of production
and reproduction entails, therefore, the investigation
of the relationship between capitalist contradictions
and sexism both at the levels of public production
and at the level of the modes of reproduction that
characterize specific classes and sectors of classes.
From the standpoint of historical materialism, this
investigation is a nececssary preliminary step for
the sound study of reproductive patterns for it
would disclose the historically specific constraints
determining individual reproductive behavior at the
market level.

2. It should define reproduction in real, concrete
terms, rather than formal terms.25

In the Grundrisse, in the section on ''The Method
of Political Economy/'-7 Marx makes an important
distinction between three kinds of concepts : imagi­
nary concretes,

abstractions of simple definitions,

and concrete concepts. The substance of his argu­
ment is the following:

It seems correct to begin with the real and the
concrete, with the real precondition, thus to begin,
in Economics, with e g , the population, which is the
foundation and the subject of the entire social act
of production. However, on closer examination this
proves false. The population is an abstraction if I
leave out. for example, the classes of which it is
composed. These classes in turn are an empty
phrase if I am not familiar with the elements on
which they rest ....... If I were to begin with the
population, this would be a chaotic conception
(Vorstellung; of the whole, and would then by
means of further determination, move analytically
towards ever more simple concepts (bhegriff), from
the imagined concrete towards ever thinner abstra­
ctions until I have arrived at the simplest determina­
tions. From there the journey would have to be
retraced until I had finally arrived at population again
but this time not as the chaotic conception of the
whole, but as a rich totality of many determinations
and relations. The concrete is concrete because it is
the concentration of many determinations, hence the
unity of the diverse -rf

The economic theory of fertility is a "thin abstr­
action" a formal analytical construct that distills the
essence of the reproductive experience of the vast
majority of the people living under capitalist condi­

186

tions and reifies it into an ahistorical, formal theory
of rational choice. The development of a real and
concrete concept of reproduction as a "totality of
many
determinations and
relations"
involves
"retracing the journey" in order to elucidate its
historically specific structural foundations. This calls
for the investigation of the content given to
formally rational individual behavior by the location
of individuals and households in the mode of pro­
duction. In the context of capitalist social formations,
the apparently homogeneous population of indivi­
duals who, at the market level of analysis appear
engaged in formally similar optimizing behavior as
consumers/producers of children, disappears at the
level of production where it is replaced by a hetero­
geneous population divided in classes whose
rational behavior has qualitatively different contents.

At the level of production, the rational behavior
of the capitalist class is dominated by the problem
of investments; how to invest to maximize profits.
The rationality of the working class, on the other
hand, is dominated by the problem of survival : to
sell labor-power for the highest possible wages.
Survival is ensured by compliance with the goals of
the capitalist class and, in that sense, the rationality
of the working classis " ... complementary, deriva­
tive, and dependent" upon the rationality of the
capitalist class. - The relationship between these classes is contra­
dictory and complementary at the same lime. The
contradiction between capital and labor is obvious:
the higher the wages, the lower the profits and vice
versa; hence the presence of class struggles as a
permanent feature of capitalism. They are comple­
mentary in terms of their role in the production
process : the ongoing smooth functioning of capita­
lism depends both on the rational behavior of the
capitalist class (e.g , making adequate investment
decisions; and the rational behavior of the working
class (e g , adapting its needs and work patterns of
the conditions set by the capitalist organization of
production). The rational behavior of the capitalist
class can be fully effective to the extent it counts
with a subordinate, malleable, and controllable labor
force It follows that, while the rationality of the
capitalist class is unitary (i.e , its class interests and
its goals as defined in the production process
coincide), the rationality of the working class has
contradictory dimensions rooted in the context from
which it is defined. From the standpoint of the
working class, the rational pursuit of its class
interests is in the contradiction with capitalist inte­
rests both in the short (e.g., struggle for higher
Socialist Health Review

wages/salaries) and the long run (e.g. struggle to
abolish capitalism). On the other hand, from the
standpoint of the capitalist class, the working class
behaves rationally to the extent it overlooks its own
interests and, instead, conforms and adapts its
behavior to capitalist demands inside and outside
the production process.
At the level of reproduction, it becomes nece­
ssary to investigate the ways in which capitalist and
working class rationality (i.e.. the pursuit of their
class interests) affect the reproductive behavior of
both classes. To define reproduction in real,
concrete terms means, therefore, to inquire into the
conditions surrounding the reproduction of classes
rather than merely the reproduction of "individuals"
or the "human species."

With respect to the reproduction of the rational

pursuit of class interest, rational profit-seeking
behavior and reproductive patterns are, in principle,
functionally related. Reproduction is an integral part
of the overall rational behavior of the capitalist class
aimed at preserving its economic and political
power. Capitalist class families seek to ensure that
their children will also be members of the capitalist
class

and

this inevitably affects

their family-size

decisions.

The analysis of the reproductive patterns of the
working class is more complex because the rational
pursuit of class interest and the content of formally
rational reproductive behavior are relatively indepen­
dent. Workers cannot directly affect the outcome of
the class struggle nor further their class interests
through changes in their reproductive patterns. This
assessment of the relationship between reproduction
and working-class interests rests upon the crucial
distinction between labour-power, the capacity for phy­
sical and intellectual activity, and laborers or workers,
the owners of labor-power. While the production of
labor-power presupposes the existence and reprodu­
ction of the workers, the demand for labor and the
level of wages are determined not by the existent
number of workers, but by economic and political
considerations establishing the quantity and quality
of labor-power needed at a given time. Under capi­
talist conditions, whatever their rate of natural incre­
ase might be, workers are constantly in excess of
the demand for labor-power. Reproductive decisions
in other words, do not affect, directly, the size of the
reserve army of labor.

Workers do, however, respond to the uncertain­
ties of the labor market by attempting to improve

March 1985

their own individual situation and this has importan’
implications for their reproductive behavior. They
msy attempt to improve their children's "life chan­
ces" in the market by restricting their family size
so that each child has larger claim on the family's
scarce resources. On the other hand, they may find
that a large family is beneficial because it increases
the size of a family network which affords protection
against the insecurities of the labor market. The
specific ways in which different sectors of the work­
ing class adapt to changing demands for labor power
and the relationship between those adaptive patterns
and changes in the status of women in the context
of unchanging sexist relations of reproduction are,
consequently, of key importance for understanding
their reproductive behavior. Rational working-class
reproductive behavior is, therefore, another maniestation of the dependent, complementary, derivative
rationality that suits the needs of the capitalist class.
What appears at the level of the market as the ratio­
nal optimizing behavior of individuals is a structural
effect of the processes through which different
sectors of the working class adapt their behavior to
the productive and reproductive demands of the
capitalist class. The changing content of that
formally rational reproductive behavior reflects those
changing demands and this topic will be considered
in the section that follows.

3. It should analyze "taste" on an objective
rather than subjective basis.
It is important to investigate the relationship be­
tween the requirements of the capitalist mode of pro­
duction and the historically specific hierarchy of
socially structured alternative and needs confronting
different classes at a given time. Marx's analysis of
the needs of the working class is pertinent at this
point and applicable to all classes :

.. the number and extent of . . . necessary wants,
as also the modes of satisfying them, are themselves
the products of historical development, and depend,
therefore to a great extent on the degree of civili­
zation of a country, more particularly on the
conditions under which, and consequently on the
habits and degree of comfort in which, the class of
free laborers has been formed. In contradistinction
therefore to the case of other commodities, there
enters into the determination of the value of labor­
power a historical and moral element/0

A given number of children can thus be viewed
as an integral part of the "historical and moral
elements" that enter in the determination of the
value of labor-power which includes the means of
187

subsistence necessary for the reproduction of the
labor-power of the workers and their future substi­
tutes : their children.K1 Different kinds of labor-power
have different values and are reproduced in contexts
requiring a variable number of children. This is a
matter that can be empirically determined for different
classes and sectors of classes. While that number is
subject to a variety of historically specific social
constraints (e.g., pronatalist sex roles, norms about
family size, tax advantages for families, etc.) and
fluctuates in tune to changes in wage levels and
market prices, there is at any given time a family
size which appears rational within a framework
defined by the power of the capitalist class. The
extent to which that family size is overtly or tacitly
used by social scientists to evaluate the rationality
of the fertility behavior characterizing specific
countries and/or sectors within a given country is a
matter to be empirically established.

In so far as economic theories of feitility over­
look the three conditions discussed above, they will
retain ideological and apologetic implications for
they will conceptualize capitalist reproductive
behavior either ahistorically (i.e., as rooted in an
utilitarian "human nature") or as the abstract result
of "modernization" and "rationalization" processes.
The concrete consequences of such approaches are :
a) the misunderstanding of reproductive behavior
and its determinants; b) the tacit acceptance of
capitalist structures, processes, and contradictions
which remain outside the scope of scientific concern;
and c) the use of the empirical effects of capitalism
as a variety of "factors" (e g., cultural, technological,
educational, etc.) that could "explain" variations in
reproductive behavior.
Conclusion

As Marx pointed out in this famous passage :
Men make their own history, but they do not make
it just as they please; they do not make it under
circumstances chosen by themselves, but under
circumstances directly encountered, given, and
transmitted from the past.32
The deterministic and voluntaristic theoretical
assumptions underlying sociology and economics
respectively are transcended by historical materialism
which, while allowing for the importance of indi­
viduals active intervention in social life, it also
acknowledges the historical boundaries that give
meaning to that intervention and make it possible.
From the standpoint of historical materialism it is as
abstract and one-sided to argue that individuals are
free to choose their family size given income and

188

price limitations as it is to argue that they have no
choice whatsoever because their behavior is socially
determined. The economists' individualistic/utilitarian
assumptions are as misleading as a basis for devel­
oping a scientific analysis of reproduction as the
sociologists’ oversocialized conception of man.
Both capture partial or fetishized aspects of social
behavior without dealing at the same time with the
structures that produce and reproduce those ‘'social
facts" on an ever expanding scale. A scientific
analysis of fertility cannot be limited to mapping the
reified consciousness emergent in the context or
universalized commodity production nor to describ­
ing the various forms in which coercive "social

facts' , impinge upon reproducliva behavior. A
scientific analysis must specify the structural mech­
anisms that make possible those forms of objectivity
and consciousness at a given time. The identification
of those mechanisms rests upon a structural con­
crete, and objective definition of reproduction as
the reproduction of c’assses and relations of
production in the context of a historically specific
mode of production.
Notes and References

2. J. Duesenberry in Demographic and Economic
change in Developed Countries. Universities — National
Bureau Conferences Series No.11 (Princeton: Prince­
ton University Press 1960), p. 233. I have added the
statement about historical materialism.

3. See; Gary S. Becker. "An Economic Analysis
of Fertility/' in Demographic and Economic Change in
Developed Countries, op, citL, p 209.231; R.A. Easterlin,
"Toward a Theory of Fertility," in S. J. Behrman et.
al, eds. Fertility and Family Planning ; A World View
(Aun Arbor: U. of Michigan Press, 1969), pp. 127155: and T.W. Schultz, (ed ), Economics of the Family
(Chicago: University of Chicago Press, 1974).
4. The concept of reproduction can be used to
indicate three different levels of analysis : human
reproduction, reproduction of the labor force, and
social reproduction (Edholm, et, at. 1977). This
essay has methodological critique of the economic
and sociological approaches to the study of human
reproduction. By theories of reproduction it is meant,
consequently, theories of fertility and reproductive
behavior will be used as interchangable terms. On.
the other hand, the critique suggests that human
reproduction cannot be adequately studied in isolation
from social
reproduction and the reproduction
of the agents of production. Such shifts in levels of
analysis will be made explicit in the text and should
not pose difficulties for the reader.
Socialist Health Review

5. See, for example, K Davis. 'Population Policy
Will Current Programs Succeed?" Science 1 58 (1976),
PP. 730-739, J Blake, "Are Babies Consumer Dura
bles?," Population Studies 22 (1968). PP. 5 25; Coer­
cive Pronatalism and American Population Policy,''
in Ellen Peck and J. Senderowitz, eds., Pronatalism:
The Myth of Mom and Apple Pie (New York; T. Y,
Crowell. 1974). PP, 29-67.

6. Historical materialism is the science of history
originally developed by Karl Marx and F. Engels. For
a historical analysis of its emergence and an enlight­
ening and systematic discussion of its main concepts
see Goran Iherborn, Science, Class and Society (Atlan­
tic Highlands: Humanities Press, 1976, especially ch.
6. "Working-class Struggles and Theoretical Breaks.
The Social and Theoretical Formation of Historical
Materialism"). Marxist theory is a more general con­
cept which has been used to indicate a wide range
of theoretical standpoint, from idealist to mechanical
materialist reading of historical materialism. Through­
out the essay and for reasons of style, both terms
will be used as if they were synonymous
7. Op. cit\n footnote 3; also Easterlin, loc cit, in
footnote 3.
8. Schultz, op, cit in footnote 3.
9. Easterlin, op. cit, in footnote 3, p. 128.
10. Davis, op. cit. in footnote 4; Blake, op, cit, in
footnote 5.
11. For recent research and discussion of the
advantages and disadvantages of the one child
family in comparison to the family sizes see Sharryl
Hawke and David Knox, One Child by Choice (Engle­
wood Clifis N.J. Prentice Hall, 1977).
12. BlaKe (1968), op cit in footnote 5, pp. 15-19
13. Blake (1974), op. cit in footnote 5, p. 30.
14. Karl Marx. Capital Vol. I (New York Internaitonal Publishers 1907). pp 71-83.
15. Ibid p. 176.
16. Ibidpp. 170-172.
17. For further elaboration of this perspective,
see: Therborn, Science. Class and Societry op. cit. in
footnote 6. pp. 367-8 and Alfred Sohn-Rethel,
Intellectual and Manual Labor (Atlantic Highlands:
Humanities Press, 1978).

18. Marx, op. cit. in footnote 14, pp. 75-76.
19. Maurice Godelier. Rationality and Irrationality
in Economics (New York: Monthly Review Press)
1973, p. 7-49.
20. Maurice Godelier, "Structure and Cont­
radiction in Das Kapital" in Michael Lane ed,.
Introduction to Structuralism (Boston: Basic Books.
1970). p. 347.

21. Economic rationality is equivalent to formally
defined rational behavior (i.e. optimizing behavior
or selection of means and ends in terms of marginal
Marc/i 1985

utility) and, as such, it can be understood in terms
of the formal theory of rational choice which under­
lies much of the theoretical development of modern
social science, including economics. For a detalied
analysis of this point see M Godelier, Rationality and
Irrationality in Economics (New York: Monthly Review
Press. 1972) and Anthony Heath. Rational Choice and
Social Exchange, a Critique of Exchange Theory
(New York: Cambridge University Press. 1976).
22. Godelier, op cit. in footnote 1 . pp. 15-21.
23. Marx. op. cit. foot note 14, p. 76.
24. F. Engels, The origin of the family, Private
Property and the State (New York : Internatianal Publi­
shers, 1972) p. 71.
25
The methodological argument developed
in this essay presupposes knowledge of concepts
such as mode of production, social formations, rela­
tions of p’Oduction mode of reproduction, relations
of reproductions, and so on. It is true that the theo­
retical elaboration of historically specific modes of
reproduction < biological and social ) is still in its
early stages and widespread knowledge, let alone
agreement, about their adequacy cannot be expected.
On the other hand, a detailed presentation of my
own understanding of these issues, which I have
stated in a recent article (see M. E. Gimenez,
" Structuralist Marxism on 'The Woman Question,' "
Science ft Society, Fall, 1978, pp. 301-323), would
necessarily break the continuity of the argument.
I think, though, that readers familiar with Marxist
and feminist theories should have no difficulties in
understanding my usage of the concepts mode of
reproduction and relation of reproduction.
26. Marx's distinction between imaginary con­
crete, formal, and concrete or real concepts is one
of his most important, albeit cryptically stated
methodological insights. The significance of these
distinctions is the following : unlike empiricist and
idealist epistemologies which seek an understanding
of social reality through the discovery of universally
valid categories of analysis, Marx's methodology
shows that such categories are themselves the
product of specific historical relations ; they are
valid in all modes of production but on the other
hand, they possess their "full validity" only for and
within the historic relations that produced them
(K. Marx, Grundrise London: Penguin, 1973), p, 105.
27. Ibid., pp. 107-8.
28. Ibid., pp., 100-1,
29. Godelier, op. cit. in footnote 19. p. 37.
30. Marx. op. cit. in footnote 14. p. 171.
31.. Marx, op. cit. in footnote 14, p. 172.
32. Karl Marx, The Eighteenth Brumaire of Louis
Bonaparte (New York; International Publishers, 1969),
p. 15.

189

Dialogue

Rural Energq Situation : Consequences for Women's Health - 4 Comment
Shobha Rao
In recent years there has been a growing awar­
eness among nutritionists and other scientists regar­
ding the problem of undernutrition in our country.
Despite the fact that several studies reported in litera­
ture come out with diverging opinions and findings,
their importance cannot be overlooked since they are
likely to influence national nutritional planning. One
of the recent studies by Batliwala (SHR 1,2) is of inte­
rest in this context and needs to be critically studied.
The scrutiny is of importance for two reasons.
First, while many studies deal with the problem of
undernutrition in general, very few have discussed its
nature in the case of women. Secondly, the study
claims to offer an alternative facet of improving
women's nutrition and health which is rather interes­
ting and might have consequences for policy implica­
tions.
The main conclusions of the study are given as (i)
women contribute the greatest share in human energy
expended, but in comparison to this energy output,
women get a lower share of food intake and face a
nutritional deficit, (ii) In addition to nutritional
deficit, women face health hazards due to the village
energy system (iii) Redusing energy expenditure.......
energy saving-is recommended as an additional facet
of improving women's nutrition and health.
Let us start with the central issue i.e. women
contribute the greatest in human energy expended.
The relevant figures are given in Table 2 (1:2,). tl sho­
uld be noted that not only the difference in energy exp­
enditure of men and women is negligible, but the way
these estimates are obtained is also questionable.
For example, one of the assumptions is that the
ratio of caloric costs for any activity for female to
that for male is equal to the ratio of female BMR.
The author appears to be unaware of the fact that
in recent years the notion that the BMR in an indi­
vidual is constant, has been questioned and evidence
is coming up to show that it is not.
Therefore,
although we doubt very much that this could be so,
it would have been better if the author had cited
appropriate references. The reason why the author
suspects this negligible difference is due to the fact
that men on average work for 4 hours a day, whereas
women work for 6 hours. However, it cannot be
neglected that men are engaged in heavy activities
190

whereas most of the activities of women are of a
sedentary
and
moderate
nature.
Considering
that the caloric costs of moderate and heavy
activities differ significantly, the observation that the
difference in energy expenditure is marginal could be
well so. In short, the methodology of obtaining
the estimate of energy expenditure appears to have a
weak basis.

Coming to her estimate of the intake of men,
women and children, the situation is even worse. She
uses crude ratios such as 2:1.5:1 (balls) based on res­
ponses to oral questions put to the local women and
applies this ratio to the overall cereal consumption of
the family for the day thus obtainingi ntake estimates.
The author gives no information whatsoever on
whether this ratio is based on the responses or a
sufficiently large sample of women, nor on how
the figure 4.24 kg of overall cereal consum­
ption has been arrived at.
The conclusion therefore
that a man has an intake surplus of 800 calories
whereas a wo nan has an intake deficit of about
100 calcries is unacceptable in the light of the
weakness of her methodology.

Further, she goes on to claim that this 'calorie
gap' suffered by women is not of equal concern to
all and brings in Sukhatme's theory. Her criticism
of Sukhatme's theory only reveals that she is
missing the essence of this theory. It is necessary
to understand that it is the nutrition science itself
that offers body weight and level of activity as
indicators while
defining calorie requirements.
Thus, according to the current concepts, individuals
similar in age-sex, body size, doing similar acti­
vities are assumed to have the same energy needsAlternatively, if an indiviqual maintains his body
weight and activity over time, his requirement is
assumed to be constant.
Sukhatme is bringing out the fact that these
assumptions are not supported by experimental data.
For, if the above assumptions were true, we would
not witness the large variation in intake (coefficient
of variation of the order of 1 6 percent) of individuals
similar in age-sex weight and doing similar activities
(Widdowson 1962, Harris 1962). Nor would we
observe the coefficient of variation in weekly mean

Socialist Health Review

intakes of the same individual to be as high as 13
to 15 percent. Sukhatme thus brings out the fact
that the current definition fails to explain the large
variation observed in intake or balance.
His theory on the other hand explains the nature
of this variation with the help of the concept of intra­
individual variation. Just as the blood glucose
concentration in a healthy active man in fasting
condition varies between 60 mg and 120 mg per 100
ml of blood, there is evidence to show that a man
can do a given amount of work on a range of intakes.
Thus, intra-individual variation is the fundamental
source of variation and therefore it is hard to obtain
a one-to-one relationship in daily intakes and expend­
iture. Finally, it is worth mentioning here that intraindividual variation is related to short-term fluctu­
ations such as observed over few weeks or months,
but cannot be taken when considering long term
periods (of several years or a life long period) as the
author seems to consider. It would in fact be wrong
to visualise this hypothesis in such a way and
comment on long term adaptations and so on.
Nutrition science has yet to go a long way to study
the phenomenon of 'adaptation' which the author is
speaking about.
The author seems to assume that undernutrition
is the sole cause for the several facts mentioned such
as more female deaths, high maternal mortality rates,
low birth weight and so on. It is well known that a
number of social and environmental factors also
contribute to this and it is difficult to show a causal
relationship between undernutrition and these facts.
Just the same way, it has been shown that although
low birth weight could be one of the factors respon­
sible for high infant mortalityr ate, most infant deaths
in developing countries are due to past neonatal
causes and diarrhoea is observed to be one of the
main causes, thus indicating the influence of poor
environment.

Although her concern about women's health is
well understood, isn't it a fact that the issue has its
roots in the law status of women, both social and
economical in our society. There is therefore, no
dispute that every effort should be made for proper
implementation of current health services to ensure
that they reach needy women.

To summarise, the lack of sound methodology in
obtaining estimates of intake and expenditure serio­
usly questions the finding that worren face greater
nutritional deficit. Therefore, her suggestion for
reducing energy expenditure or for energy saving are
not appealing. Further, there is no reason to consider
that physiological responses of the body for increased
intake or reduced expenditure could be same. Today
in developed countries individuals find ways to spend
there energy by means of jogging, bicycling etc. in
order to keep their muscles active and to maintain
proper body stature. Therefore it is necessary to
give a thought for the possible consequences, good
or bad, of energy saving.
Finally, it is clear that energy saving in practice
will not be achieved without enough technological
and economic resources. This is not to deny the
role of technology, but at the same time it is impor­
tant that changes introduced for saving women's
energy should fit in the culture of our rural life. For
example, replacing traditional chulas by gas stoves
to reduce health hazards may not be a wise step.
But instead it is necessary to convince villagers that
there should be a proper outlet for the smoke to go
out and see that every house in fact, has one such
outlet. It is our experience that in the past few
years, bore-wells have been installed in almost
every village but the fact is that women still go for
fetching water to the old village well, without
realising that that this water is unsafe for drinking.
It is therefore a basic minimum education for the
women for their own wellbeing that should precede
such technological and other advances.

dr. mrs. shobha rao
Scientist,
Maharashtra Association for the Cultivation of Science
Law College Road. PUNE 411 004

Witch Hunting Among The Bhil Meenas of Rajasthan
Narendra Gupta
The problem of witch hunting as reported by
Kashtakari Sanghtana SHRI (1:2, 1984) is prevalent
among all adivasi and primitive societies in varying
forms. The problem as envisaged in the report has

March 1985

no ready solution because the tradition is very old
and ^deeply rooted within the culture. The practice
of witchcraft evolved as a system of beliefs to face
the unknown supernatural world and its adverse

A91

manifestations in day-to-day life. To find any
resolution of this problem would require a greater
insight into adivasi culture, environment, social and
religious institutions.

Southern Rajasthan where we work, is mostly
inhabitated by Bhil Meena adivasis. Here the
incidence of witch-hunting has decreased considerably
in the past few decades. It is now present in a
different and milder form. Among the Bhil Meenas,
witchcraft forms a part of magical rites and can be
performed by magicians who are called as "Zangars"
in the local dialect. These zangars are not medici­
nemen and they are approached when all other
measures of resolving the crisis have failed. The
first agency in any sort of crisis is the bhopa who
is a faith-healer, an adivasi with powers to call
supernatural spirits into his body. At a sanctified
place he goes into a trance when the spirit enters him.
The problem is explained to this spirit and it suggests
remedies. If all such remedies fail then the possibility
of a witch is considered. A magician is approached
to ascertain the involvement of a witch. (There are
very few magicians in this area.) These magicians by
performing magical rites through the night will
confirm the presence of a witch and provide either
the description of witch or her exact name or address.
Through another set of magical rites the magician
will invoke the witch and ask about her presence in
in the family facing crisis and what she requires to
leave the diseased person or the family. She is never
however offered any of the things she wants but
tortured and forced to leave by magical charms. In
some cases the woman who is believed to be a witch
is brought to the magician and put in his control.
There have been some instances when a woman
identified as a witch was killed but not in an open
trial. These women were killed secretly by the family
members facing crisis. Generally witches are con­
sidered to be females in this area however there are
also male witches. They are thought to be stronger
than women witches.
Who is this witch? Why did such a concept
and practice evolve? Some of the explorations and
causes mentioned in the report in SHR seem logical
but only in the present-day context. However, we
need more definitive knowledge. Adivasis aie a brave
and courageous people. At the same time they have
a carefree attitude towards life and believe in enjoying
it. Therefore, poverty has a very marginal effect on
them. It is only recently that they have turned

192

agrarian and have started taking up jobs out side
their homeland. The concept of storing things for
the future is also very new to them. Hence any sort
of condition leading to material hardship, lowered
resistance to disease cannot be a sufficient reason for
the continuing practice of witch hunting, which has
become institutionalised in this society for centuries.
Similarly, inaccessibility to health care facilities,
disruption of communications and shortage of money
are very new occurrencs which are not even well
perceived by adivasis and cannot be the cause of
frustation leading to witch hunting.

To the Bhil Meena adivasis, death is an integral
part of life and is not seen as something ghastly. Death
even in action (hunting, war, orb of snake bite) does
not inspire awe or horror. It is also believed among
them that the soul, the divine force in the living body,
after death goes to the land of dead to rest with
ancestors who are believed to have influenced their
every day affairs, when alive. According to them
this soul may also take the form of an evil spirit and
return to this earth to finish its unsatisfied desires.
This evil spirit on earth makes its home in the body
of a human being, (mostly woman) as it is the woman
who can beget. Such a woman will change into a
witch. There are lots of descriptions of witches
which vary from place to place.
One more possible reason for the practice of
witch hunting among adivasis could be their cultural
configuration which is close to nature and the core of
their own cult practices. Although primitive, it is
representative of their beliefs and religion. During
the course of their day-to-day life they have to
encounter the v.ildness of this configuration. Wild­
ness provokes wildness, and it is this animistic
behaviour of adivasis which finds its expression in the
form of witch hunting. The reason for diminished
incidence of witch hunting in this area can also be
attributed to the influence on adivasis of Hindu
religion. Adivasis in this area have made many
adjustments to fit in with this new influence and it is
always considered superior. This constant interaction
with new patterns of culture has resulted in a
diversity of cultural practices and traits which are
less animistic.

A practice like this is barbarous and should stop,
but the people who practice it, do it within a set of
concepts and unless these concepts are changed, it
is very difficult for people to get away from it.

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PIN

"First, we have the working class, which because of the
principle of population is always too numerous relatively

to the means of subsistence alloted to it — ie. over­

population due to underproduction. Second, we have the

capitalist class, which as a consequence of the same
principle of population is always able to sell back their
own product to the workers at such a price that they get

back only just as much of it as is necessary to keep body
and soul together. And third, we have an immense section

of society which consists of parasites and self-indulgent

drones, in part masters and in part servants, who appropriate

•

gratuitously a considerable quantity of wealth — partly
under the name of rent and partly under political titles —

from the capitalist class, paving for the commodities
produced by the latter above their value with the money
they have taken from the capitalists themselves. The

capitalist class is spurred on in production by the
impulse towards accumulation; the unproductive classes,
from the economic point of view, represent merely the
impulse towards consumption and prodigality. And this is
the only means of escape from overproduction, which exists

alongside overpopulation relatively to production. Over-

consumption by the classes standing outside production is
(recommended) as the best remedy for both overproduction

and overpopulation. The disproportion between the working
population and production is neutralized by means of the

consumption of a portion of the product by those who do

not produce, by idlers. The disproportion represented by
the overproduction of the capitalists (is cancelled out)

by the overconsumption of the extravagant rich."

—Karl Marx

(From Marxs's 'Theories of Surplus Value*, Vol. 3
Reproduced from Meek, R. L. (Ed) “Maixjind Engels on the Population Bomb

Ramparts Press, Inc., California).
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