BACKGROUND MATERIAL on The People's Tribunal on Coercive Population Polices and Two Child Norm
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BACKGROUND MATERIAL
on The People's Tribunal on Coercive Population Polices and Two Child Norm
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BACKGROUND MATERIAL
on
The People's Tribunal
on
Coercive Population Polices
and
TWo Child Norm
Date : 9th & 10th October 2004
Venue : Indian Social Institute (ISI)
New Delhi
Organised by :
Human Rights Law Network; UP & Bihar Health Watch; SAMA; The
Hunger Project;Jan Swasthya Abhiyan
Tribunal Secretariat:
Human Rights Law Network
65, Masjid Road, Jangpura, New Delhi-110014
Tel. : 91-11-2432/4501, 2431/9856, 2431/6922,
Fax: 91-11-24324502
E-mail: hrlndel(g),vsnl.net/ slicdelhi&lvsnl.net
INDEX PART - A
Page No.
Author
Title of the Article______
1-7
Mohan Rao
India’s Population Policies: A
1.
_______ I
________ critique__________
A summary of the National
Policy and the State
Leela Sami
8-15
Population Policies of U.P,
2
M.P, A.P, Maharastra and
_________ Rajasthan._________
Population Stabilization :
A. K. Shiva
16-22
Why penalties are
3.
Kumar
_______ meaningless ?_______
Governance for Population
23-26
A.R.Nanda
Stabilization in India: Need
4.
for a Paradigm shift.
Re-examining policy
Mohan Rao;
27-36
approaches: The Natonal
5.
Devaki Jain
population policy 2000
Panchayati Raj and The Two- Mahila Chetna
37-48
child norm: Implications and
6.
Manch
_______ consequences_______
The myth of Population
Explosion: Reflections in
49-54
Dr. Almas AH
7.
NPP and State Population
__________ Policies_________
Over-Population as
Vikas
Underdevelopment: The
55-62
Adhyayan
8.
Myths behind the Population
Kendra
__________ Control -1________
Over-Population as
Vikas
Underdevelopment: The
63-70
Adhyayan
9.
Myths behind the Population
Kendra
Control - II_
Javed & Others Vs. State of
71-98
SCC
10.
Haryana and Others
Two Child Norm: Sate
Colin
A1 - A4
Governments
Poised
to
10.1
Gonsalves
Blunder
ICPD issues and Us - Some
99-104
Dr. Mira Shiva
11.
Reflections
Reflections On ICPD and
105-106
Ashish Bose
12.
After
_
S.no.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
GOI, MoH &
Strategy in 150 CMP districts
FW
____ for Family Planning
A. K. Shiva
Population Stabilization: The
Kumar
case Against Coercion
Myths about Population
Amit Sen
growth among Muslims:
Gupta
Tilting at Windmills
Lindsay
Where have all the Services
_________ gone.......?_________ Barnes
A draft concept note on the
study of the implication of
SAMA
state population policy on
Local self Governance (PRl)
_________ & Women_________
Jansankhya: Bhram Aur
SAMA
Tathya
Jan Sasthaya
People’s Heath Charter
Ahhiyan
A booklet on Jansankhya niti:
SAMA
Kiska Fayda ? Kiska Nuksan
Abhijit Das
Targeted Negligence
Pictures on Medical
Abhijit
__Negligence
107-111
112-116
117-119
120-122
123-130
131
132-135
136-151
152-153
154-155
INDEX PART - B
S.No.
State
Page
No.
Details of the
Testimonials
Source
1.
HARYANA
1-11
Details of the
individuals who
have suffered due
to provision of
disqualification in
the Haryana
Panchayati Raj Act
(Mahendergarh
District)
PRIA
2.
RAJASTHAN
14-18
Women’s
experiences with
the Public Health
System
PRAYAS
3.
H. P.
19-36
Case study of the
individuals against
whom show-cause
notices were
issued under H P.
Panchayati Raj (A)
Act, 2000
SUTRA
4.
M. P.
37-50
Details of the
cases pertaining to
female Sarpanchs
who has been
ousted from the
post of Sarpanch
and their
grievances
SAMA/
BGVS
5.
U.P.
51-74
Case studies of the
victims of
Sterilization in the
Districts Of U P.
Newspaper
Clippings
6.
BIHAR
75-76
Cases of the
victims of
tubectomy
(Medical
negligence)
BVHA
7.
ORISSA
77-79
Cases of
unsuccessful
sterilization
BGVS /
PHA
India’s Population Policies: A Critique
Introduction
3aden.osn.pl.lc t™ beds n^sCher the yom while concerns™ ramilyt|,al
pro.nmme - one of
development, by the early mneUes itt as nc eas- gy
a
ln
*
the largest public health imtiaUvC"1" pressure generated bv women’s groups and health
realization, partly as a consequen
rPcconsldcrauon of die programme, and in part in
oroups in the country calling for a radical reconsiac^a
p
lation 3nd Development
^^SedTpo^ ■< docent I—'-
i v;cUniizino over-all social development as
The Committee proposed a hollsl'“PPr°
T with qTc health department so dial the
the goal. ltProP°scd Ac,dcaofmCrSinSJZlConc astJcl of an overall health service could oc
nnportance of family planning as onc’ anX°n'^"Cd’the target and the incentive approaches
emphasized. The Committee had re501^1*
„cn(]a for action. Further, the Cominittcc
several months before these were to enter the 1
=
for developnlCnt offered by the
had fiagged the importance o
Yet it came in for criticism for the manifest
s-
o„.he.3—d—
[g, nothing
else will havePopulaUon Policy (GOf
that -.four population policy goes -ong
^^X.onal
nuiiton
i
- -rby Parliament
.
Government of India announced a Dra
tcd
modified, acccp
accepted
by Parliament and
and a National
1996 13)2 In Fcbruarv last year this draft was modihca,
I
Population Policy (NPP) 2000 announced.
The National Population Policy 2000
The National Population Policy annmmccd
towards voluntary and informed choice; and eonsen o
•
health care services, and contmuation of the target
apF
-
.
administcring famlly pianmng
sen ices” (GO1: 2000:2) .
imet need for contraception and
The immediate objective of the NPP -s to meet die un
is to bring the Total Feruhty Rale to
health infrastructure. The medmm-term objective ts to
Health and Innndv Welfare. Ke/-"
‘
""
' Government of India (1994). Minislry
l)f ! teahh and 1- a.ndy Welfare, l^of, S.ouonen. on Xunonol
I’opuldtion I’ohcy. New Delhi.
r toveninient of India (I9‘X» Mnnstry
I'.mulotion Policy. New Delhi
of I leallh and l annb Welfare, XuUonol Populanon I'oIk v JfKHi
■Government of India <2(KX1) MimstnNew I Xrlhi
1
V
replacement levels by 2010 through inter-sectoral action and the long-term objective is to achieve
a stable population, consistent with sustainable development, by 2045.
Towards this end the goals set out include:
1. Making school education free and compulsory up to age 14;
2. Reducing IMR to below 30 per 1000 live births;
3. Reducing the Maternal Mortality Ratio to below 100 per 100000 live births;
4. Promote delayed age at marriage;
5. Achieve 80 per cent institutional deliveries and 100 per cent deliveries by trained persons,
6. Universal access to information and counseling, and sendees for contraception with a wide
basket of choices;
7. Plundered per cent registration of vital events - births, deaths, marriages and pregnancy;
8. Prevent and control communicable diseases, especially AIDS.
The strategies to achieve these goals include twelve items. Some of these are: decentralized
planning and program implementation through Panchayati Raj Institutions (PRIs); convergence of
health services at the village level; empowering women for improved health and nutrition;
ensuring child survival interventions; involving diverse health care providers; strengthening IEC:
developing increased partnership with NGOs and the private corporate sector; and finally,
encouraging a range of clinical, laboratory and field research on maternal, child and reproductive
health care issues. All these strategies are to have a special focus on under-served populations,
namely, urban slums, tribal communities, hill area populations.and displaced and migrant groups.
Efforts are also to be directed towards increasing participation of men in the programme.
(2^
Over the same period, several state governments also announced population policies of
their own. This paper seeks to briefly comment on some aspects of these policies in the light oi
India’s experience with the development of her health and family planning programmes.
II
It is widely recognised, although reluctantly accepted, that health and population are
governed bv larger socio-economic issues, indeed determined by them. The Working Group on
Population Policy4 for instance recognised that population and development are two sides of the
same coin; and that if levels of fertility are to decline, attention will have to be paid to increasing
employment, income, food security, literacy, levels of health and so on. These in turn would
induce declines in infant and child mortality’ even as they generate an increasing demand for
family planning sen ices.
In contrast the NPP is deafeningh' silent on these larger issues contouring health and
population. The questions that thus need to be considered are: what have the macro-economic
reforms of the nineties meant for these critical determinants of health? How do these in turn
impinge on issues in family planning? How have they affected structures of delivery of these
services? It is now recognised that reforms have meant a deceleration of employment in both
rural and urban areas5, a significant casualisation of the work-force, especially involving the
4 . Government of India, Ministry of Health and Family Welfare (1980), Report of the If orbing Group on
Population Policy, New Delhi.
5 Sen, Abhijit (2002), "Agnculturc, Employment and Poverty: Recent Trends in Rural India ’, paper
presented at the International Conference on Agrarian Reforms and Rural development in Less Developed
2
3
stocks while at the same time an
caloric requirements. Is n any won o
Rates (1MR), accepted as one: ol the most c* j
as
Table j makes evident. Infant Mortality
detcmllnants of family planning, have been
jmr
from ,q per
**!
“
r“
XpS'by » .nereaae in IMRs »seve.d sides in ihe coenny
Tabic I. All India Infant Mortality Rates
Total
Year
110
1981
105
1982
105
1983
1984 d 104
97
1985
97
1986
95
1987
95
1988
91
1989
80
1990
1991* 80
1992* 79
1993* 74
1994* 74
1995* 74
1996* ' 72
1997* ‘ _74_
72
1998
Rural
119
114
_1_14_
113
107
105
104
102
98
86
87 ~
85
82 ~
80
80
' 'll
' 77
’ 77 *
Urban
62
65
66
66
59
62
61
62
58
50
_53_
75
44
J>3_
"45
52
_48
46
45
45
(ii)
$
1999
(iii)
70
.....I
■
S...TO 10 OIT«
(SRS). New Delhi
...
CliaSSXiS
“■
IX'lhl
<■ ,
MSHulletin Vol 35. No 1. April
(U, > OR(il. Sample Registration System (2(H) 1). SKS
.r ...e
'da.
“S“sSSX . .......
!■ ( oho mi (
.. . -.. . . ..
H..™-.. .. . .............. ...... ...
and Pohticdl H ccklw Vol XXXVI. No.26.
3
4
being whittled down. India’s commitment to universal and comprehensive Primary Health Care,
as a signatory to the Alma Ata Declaration and as enunciated in the National Health Policy of
1983. has been significantly weakened. As a result, universal and comprehensive Primary Health
Care finds no mention at all in the NPP. Indeed that we have the announcement of a NPP without
links to a National Health Policy, which is yet to be unveiled, is abundant evidence of distorted
priorities.
As the data in Table II make evident, health expenditure has shown a secular decline,
particularlv marked in the programmes for the control of communicable diseases, while that for
family planning has shown a continuing increase. At the same time, the state has provided
impetus to the growth of the private sector in health care through a range of subsidies and
schemes. It is thus not surprising that even as health care becomes more inaccessible, and
expenditure on health care is emerging as the leading cause of indebtedness8, reports of starvation
deaths and outbreaks of epidemics have started pouring in9.
Table II: Expenditure on Health and Family Welfare (in rupees crores).
Plan
Period
Amount
Total Plan
Investment
(All Dev
elopment
Heads)
Health
(Centre and
States)
%of
OutTotal
Lay/
Plan
Exp.
Family Welfare
Out
lay/
Exp.
%of
Total
Plan
Control of Com- *
mmuni cable
Diseases
% of
OutTotal
lav/
Heak
Exp.
h___
16.5
23.1
28.4
64___
69___ 27,7
10.2
23.1
11.1
127
11.5
268.12
0.01
3,33
0.1
65.2
51-56 Actuals 1960
First
_5____ 0.11
3,01
140.8
Second 56-61 Actuals 4672
0.29
24,9
2.63
Third
225.9
61-66 Actuals 8576.5
1.06
70.4
2.12
140.2
Annual 66-69 Actuals 6625.4
1.76
278
2.13
335,5
Fourth
69-74 Actuals 15778,8
1.25
491.8
1.93
760.8
Fifth
74-79 Actuals 39426.2
0.97
118.5
1.83
223.1
79-80
Actuals 12176.5
27
524
1.04
1010
1.87
97500
1821
Sixth
80-85 Outlay
1.27
1387
1.85
2025.2
Sixth
80-85 Actuals 109291.7
7.7
1012.7
1.81
3256.3
1.88
3392.9
Seventh 85-90 Outlay
180000
1.43
3120.8
1.69
3688.6
218729
Seventh 85-90
1.28
784.9
1.56
960.9
90- 91
Actuals 61518
1.3
856.6
1.58
1042.2
91- 92
Actuals 65855
4.2
1045
1.5
6500
1.75
Eighth
434100
7582.2
92-97 Outlay
97-02 _____
Outlay_ ___________
859200
Ninth
_______
________ ___ ___________
Source: Government of India. Planning Commission (V)97),Ninth Five Year Plan. 1997-2002.
Vol.11. New Delhi.
The collapse of the public health system, without which of course even the NPP cannot
be implemented, has been hastened by macro-economic policies initiated by the government. This
has not on lx led to cuts in publgcjiealtl^expenditure, but by introducing cuts in expenditure in
K Krishnan, T.N. (1999), "Access to Health and the Burden of Treatment: An Inter-State Comparison’, in
Mohan Rao (Ed), Disinvesting in Health: The World Bank Prescriptions for Health, Sage, New Delhi.
9 Baru, Rama V. and Sadhana, G. (2000), “Resurgence of Communicable Diseases; Gastroenteritis
Epidemics in Andhra Pradesh ", Economic and Political Weekly, Vol.XXV. No.40.
4
■
“ZX*
'■»,-'T
Kzzr
j
new
reproductive morbidit.es, even as the spectre
RCH approach.
•n,ere»re,however.sign.r.ewhproems"ilhtaX “ DM»
high as this rs. account lor
reproductive causes alone lately .econo f« J»
“ iTZcZofTeSXordcate Wto
n
1SOSO.
that a vertical
considerably strengthened.
Indeed noting that vertical programmes had not
’Expert Group had boldly
o
Health and Family Welfare
Fn in twelve medical colleges around t
Enm twelve n
,„r .ince 1994, tls use was restricted
While Net En has been available tn the’
mcdicai care and f°llc'*-up "°l
since it was felt that the use of sue i a c
|arpC trial carricd out by the ICMRtn the 1980S,
method unsu.tablc as a temporary contraceptive
Health A 1'ubl.e Health Persjxxtive ./<c—“
■■'Qadev-r. Imrana (lWS)."RcProduchv
if<...A/v Vol XXX111. No 41.
>• Rao Mohan (2(X>1). Populat"'" I olicn-s
ll eck/v. Vol XXXVI. No 16
,lr.lccl,t,vcs
'■-Bal Vmeeta <•< «/. ■Injectable C onlracej-tne.
Vol XXXV. No 50
ami Political
.. ................ .... ............ """"""'
..... .
...... .
/
reported within the first six months of use, raising the vexed question of the risk to the foetus in
utero.
One very real fear is that given coercive population control policies, the vast potential for
misuse of this contraceptive will become a reality. With a target-driven population control policy,
despite the NPP’s commitment to the contraiy, the needs of a woman user arc overlooked in the
haste to bring down birth rates. Indeed it was this very feature at a camp in Andhra Pradesh in
1985 that led women’s groups to file a petition in the Supreme Court against injcctables13.
9
)
While the NPP is unequivocal in rejecting any form of coercion, the incentives to be
given to couples and to Panchayats for generating acceptance of family planning sits uneasily
with this commitment Yet it is the population policies announced by various states that blatantly
violate the letter and spirit of this commitment of the NPP. These state policies, with a slew of
disincentives, have brought in coercion. Thus the policies of Uttar Pradesh, Madhya Pradesh,
Rajasthan and Maharashtra disqualify persons married before the legal age at marriage from
\
government jobs, link financial assistance to Panchayats to family planning performance, and in a \
move recalling the period of the Emergency, the assessment of medical officers and other health
personnel to performance in the RCH programme. The MP policy links the provision of rural
development schemes, income generating schemes for women, and indeed poverty alleviation
programmes as a whole, to performance in family planning. Both Rajasthan and Maharashtra
make “adherence to a two-child norm” a service condition for state government employees.
Maharashtra in a G.O., since rescinded in the face of protest, announced the two-child norm as an
eligibility criterion for coverage under a range of schemes for the poor, including access to the
PDS and education in government schools. Andhra Pradesh, which has many of the above
features in its policy, goes further and links construction of schools, other public works and
funding for other rural development schemes to performance in family planning. Allotment of
surplus agricultural land, housing schemes, benefits under IRDP, the SC Action Plan and the BC
Action Plan are also linked to acceptance of sterilisation. In a macabre metaphor of the lottery'
that is the life of the poor in the country, awards of Rs. 10,000 arc to be given to three couples~per
HisEict’cHosch by lottery, sterilised after two children.
These policies are in complete disjunction with the NPP and indeed with the
commitments made by the government of India at the 1994 ICPD in Cairo. It is curious that
policy makers, so anxious to control numbers, need to be reminded that such policies are
completely unnecessary as a significant demographic transition is underway in large parts of the
country. And that areas where this transition has lagged behind need assistance towards
strengthening their health services and augmenting their anti-poverty programmes and not
measures that punish the poor. As the NPP itself points out, there is a large and unmet need for
family planning sen ices. In such a situation, without meeting this unmet need, to propose
punitive measures is both irrational and absurd.
The disincentives proposed are anti-poor, anti-dalit and anti-adivasis with these weaker
sections having to bear the brunt of the withdrawal of a range of measures meant precisely to
mitigate poverty and deprivation. The National Family Health Survey (NFHS) for 1998-99
reveals that the Total Fertility Rate (TFR) is 3.15 for SCs, 3.06 for STs, 2.66 among OBCs and
3.47 among illiterate women as a whole14 In contrast it is 1.99 among women better-off and thus
educated beyond Class 10. Imposition of the two-child norm and the disincentives proposed in
13 Bal, Vineeta ct al (2(X)0), ibid
International Institute of Populati'ion Sciences (2000), National Family Health Survey: India, 1998-99.
Mumbai.
6
the state policies would thus
of ameliorative measures as pitiabh
populations will bear the brunt o c
thal dc facl0 deprives SCs and STs o jo
inadequate as they are. In add!lion to pny aUsaU^
employment opportunities
the organised sector, these exphe p
available to them in the public sector.
The dalits, the adivasis and the
proportion of the mo^hty lo“d ,n
STs and OBCs was 83 84 and It>« Pert
Five Mortality Rate is 113 among
,
.0 «2 »»«
mJvetX AatthHMR among the SCs
compared to 62 among others. Similarly die Under
1Q3 among
0BCs
; moose a two-child norm under such
on—
*”
The disincenli.es proposed atr
ShSteXconttol over ho»
•niece as s.so —»liXnXdWdiX”
these communities arc a reflection o
growth is a chimera, so is a Muslim rate of
added that just as the Hindu rate of
J anti-democratic and violate several
population growth. FinaHy the poises ^e
d py
nght lo Hvel hood,
X^XiSnX“??nL.n'n.l eovona.^ « W is
“•
Rights of the Child.
Wha to. is lbs iapon »'^“ZSs^V^"k°orC
language Of rights and gender justice *eyumply a deep^
o..
concern with their health and well being.
scclions of dic population, they will be victims of
economic policies, further Wna^in8 &
k
of course is that this is being done
the drive to control their numbers. Th
8
* socio-economic development
supposedly to remove a demographic stumbling block
Centre of Social Medicine and Community Health,
School of Social Sciences
Jawaharlal Nehru University
- I.RC11 study cued ■» <h>pta. J A
iTee.lon. or Dependency'. Sage. New Delhi, JXX)
7
!
/
r
/
8 ‘
’
MaX0^ 'p'0" I>OiiCy an<1 fhC St:,,C Po'’ubti‘”’ I>Riic^ -r
h>a Pradcsh’ Rathan, Maharashtra, and Andhra Pradesh
policies of five Indian states; namely. Uttar
a?d .AndhIn the year 2000.
Pradesh^ Madhya PrTdTsi?^^
the Gdvenunem of India ’eS t ’
«nade an explicit commitment to” vol 1
^Pfatton Policy tNPP) document which
while availing of Reproductive and Child H^Rh'S) Cl,<1’CC
O’nSCn'
target free approach in administering family Xum^JZ'"
:!-
,
'
maternal health ’TncT
3 1106(1 t0 s,niuItaneously address issues of child survival
comprehensive package of RCH^e0'I6 ‘nCrCasin& Olltrcach aild coverage of a
sectors working in partnership/*
“ 7 S0VCrnmC!1!' iiidlistry and voluntary NGO
addresf unmet nLd^flr'crt111
°{thrCC tinie fr3mcs: iis ''nmediate objective is to
to provide integrated servi/^V011, healthcare infrastructure and health personnel and
medium term SZV 7™ 7° rcProdLlctivc and child hcahh. The
vigorous implementation of inte'"27
t0 replacenient levcl hy 2010. through
is-lel achieve a stable nnnnl t’ 7° 7 °perat‘ona* strategies. I he long- term objective
sustainable economic I’rowtl 10,1 - ih
7 3 1CVel consislcn’ with the requirements of
econotmc growth, soctal development and environmental protection.
achieved at an all-Imha^wl'b^OIO T|PP ‘IStS lourlccn s<-1ciodemographic goals to he
RCI-I services suonlies t t 7
°
1CSC
dC addrcssi”g the unmet need for basic
Infant Mortality Rates ('IMR’t'H
'ncreas‘ng access to schooling, reduction in
immunization deh 7
Ma,crnal Mortality Ratios (MMR), univcrsalisation of
trained personnel md ninr“a?c or g'rIs’ universalismg the number of deliveries bv
delayed ;:vvra<>e
l‘’crcas,nS; thc number of insnrntiom,! deli verics. ;ich:-..'\ ir.7 i
marriage for girls, i
registration
converuenve or ’o(-|. g‘S 1,1 10,1 of vital
Vllai cvonls. coni...I ..I .oinmunicol.lv o;
programmes
llomcopathyUSMIl) -mH P,08t'animes and
aild ’‘‘‘dian Systems of Mcdicm.
j;h:
1 1,1MlSMIl).andconvcr
Cenceofmm
....... S(,c|.|i
p,.,)g,a;i.11JCS
convergence
of different
eou.;sellirK jX„S „-T™BC /” Si"S-
■'
fu
population slabilis ition
't <lc^nt,alis'-tJ planning, the empowermeni of women'lo;
N( Osee o,
7
'“'‘l S""ivi'L »'l“'oo’b........ .
•eclot.and cncomagement of research in contiwrtm
w1;;
h’ <>'der to promote me policy, it lists a nunmer ol mc-Mm
............... , = ■
a number of
- ••
ni
'■uiS'""l!; r',r c
”n’p'”ry ...............
» - ri-r Wd,
exemplary
pcrfoi mance
Also, a fenil" 'vein O ^'7-
2^,V'
all“
-o
l -'oc wi'', lt ’
,
, A* SOl'l,1' l,'slll;,lloo is Io be iovco Io .oopte. oebov llu- I’.n-cnv
■
...... o. less d„ldre„ „.|,o u,„lcrg„ . ................. .
.
................... .
I
h
reward couples who marry after the legal age at mamage g.
their first child after the pge of 21 years, accept he small .a.
terminal method after the birth of their
revolving fund for income generating activities y
g
provide community health care servi.es, the -tabhshment ot
centre? in rural areas and the urban slums, a wide choice
safe and legal abortion, and vocational trammg for guls.
. fir marriage, naxe
• • norm and adopt a
-. oposed to have a
f help groups who
. AeS and child care
motives, facilities for
•- free approach and a
One of the central features of the policy is a commitment to a ta
..’graphic goats set by
refusal to use disincentives or coercion in order to achieve tU
b. dies at the lowest
the state. The NPP also stresses the need ;or in,volvet “ . - '
t of the goals that
level- i.e. the Panchayati Raj Institutions (PRI s)-m the achieve:
v
only oi rights,
make for population stabilization. It suggests the dev on
e Ecncradon. This
™
and pov.era ,0 Lhe FW? but also
■ atraliscd. In doing
latter is extremely critical in order for decision mak ng40broader
tru .no..- of democracy and
so, the NPP extends the scope of population policy to L.....
welfare.
With the NPP as the background, we move on to examine the sta- k f
l.Uttar Pradesh:
f population to pressure on
The population policy of Uttar Pradesh links the growth o
ent to improve the
natural resources, and declares the inability of the state and ds g
assure. It mentions
quality of life of the people, in the face of this growl in pop •
.ttcmpl to stabilise
the need to address issues of gender and ch.ld development m th-
population growth.
In terms of its specific objectives, the following ase
The need to reduce TFR from 4.3 in 1997 to ._.6 m ..
- Proportionate increases in use of contraccplixe mcthcu .> v
-
same
• ■
Increase in average ano of the mother at the’u.ith of het hi.
Reduction in unmet need for both spacing and terminal methou;
Reduction in MMR from 707/ 1000,000 live births min/ t250 in 2016.
Reduction in infant mortality from 85/1000 live ’>111
.
2010 to below
; i3 2010 and 67 in
m
2016Reduction in incidence of sexually transmitted disc.v.;*- (SI.
infections (RTFs)Increase awareness of AIDS.
I
ir.-z demand tor the
<! i epi■*
»I VC •.! a*, t
maXTInLd
imProve RCH ^lude raising the average age of effective
enhancing the ’ UC1|nS
musing on adult education, empowerment of women and
erdianctng the mvolvement both of the private and voluntarv/NGO sector and the role of
achieve its objectives; which
’• ™™g?aom
before
’
PRrs°ZnX'b^SCdl?•d?5UrSement Of 10 percent ofthc total financial resources for
■ rewarded Wh J3 n W
~perforTn” wel1 in the provision of RCH services will be
revenue the PRJ’^ tOta Cransfer oTfunds wilbamount to only four per cent of state
contracentive
tO be'entirely responsible for advocacy, identification of
contraceptive needs and recording ofivital events.
’
■
perfo^nrmanCC.°f Jaiedi'cal oncers and health workers is to be based on their
cfficiem RCM111
6 RCH pr°Sramme- Wbite ostensibly, this would mean more
reach tarrmt^ Ser,Y1CeS’ 11 would Pcrhaps place extreme pressure on health workers to
appraisal of h m 'T
IO ’“g °f family sizC' Also’ linki"S performance
health
Indlvldua,.s t0 Performance in RCH would probably result' in lopsided
nenlerf f ICr pr0VIS10n’ leadlng to an overemphasis on family planning and a
■ d.seases
SUCh
COntrol °f comm’"1^ab!c
Tiie document also c.
calls for -‘an active dialogue with the GO1 for wider availahili’v of
injcctablcs and other
-- new technologies through private, commercial and governmem
channels in the state”, The state thus intends to actively push the introduction of the.-c
newer technologies.
0
ace and wh i
Sl°n ° ^1C S<Zkernnient to disallow those who marry before the legal
women who
'han tW° children from government service will adversely affect
implementnfininar-?o/VC n°
thC'r agC at inarriaSC- In this case, even the
ncc.’ssarilv
"h
rCSCrvat:3n for women in elected bodies and employment will not
women Y reSU
SrCaler
equity, except in a narrow sense for some sections of
2. Madliya Pradesh
'he population policy of Madhya Pradesh stresses the need to emb
iiieji I ci I*;';
ixui.ihty. which mipinge upon the quality of life and the b.dnmhet v.cc:: p.p-d
• vsomces and the envmonmcnt. Inc policy document memiem. 'he p < H '_der.h
1
I
3. Rajasthan
The population policy of Rajasthan, like those of Madhya Pradesh, and Uttar Pradesh,
also links deceleration in the population growth rate to sustainable development. It
mentions the need to reduce infant mortality, gender discrimination and undemutrition,
and to increase household security.
.. With regard to its specific objectives, it mentions
The need to increase the median age at marriage for girls from 15 in 1993 to 19 by
. :2010 through education and increasing awareness.
- Increase institutional deliveries from 8% in 1995 to 35% by 2016 and assistance by
.trained persons in child delivery from 35% in 1995 to 75% in 2010.
- -.Educate
’-'Educate all ‘women in the reproductive age groups about antenatal services and on
. j9s..teblishing linkages between female health
--- workers,
--------- , anganwadi workers and trained
fr"-dais
r‘dais at the village level.
? ..
■ xJipproved child health is to be achieved .through assuring better quaIjty^ARt;.care,;
.^strengthening links between ICDS and healthworkers, and coverage of.all.>children?^>:
tor immunization and Vitamin A dosage’.
w. I
.
■
<
it1 regard to operational strategies, it mentions the need to encourage men to use lowcost sterilization services, and recognizes that quality of the sterilization and spacing
methods need to be improved. While the thrust of the policy is on provision of RCI1
services, improvement of management of service delivery systems, encouraging
involvement of PRI’s, NGO’s the private sector,and co-operatives , and on information,
education and communication (IEC).
Ihcrc arc,‘however, a number of incentives and disincentives mentioned, which include
the debarring of persons with two or more children from.contesting cicctions. I; ;> •iso
mentioned that “the same provisions can be considered lor other elected bodies like c opcialixe institutions and as a service condition for state government crapioxec... the
policy also stales that “the legal provisions barring people with more than tuo children
Joni election to panchayats and municipal bodies is a testimony of the firm political w;il
and commitment to population control.”
I he policy is cautious <on tiie question of introducing new reproductive technologies.
although the policy draft mentions that1 “ new contraceptive methods, as and 'Ahen
approved by the GO1 will be introduced to make new technology accessible.’ i inallx. it
mentions the need to address issues ot infertility. K fl’s and female literacy.
5
decentralisation underway in the stale and speaks of the n.ed io change the thrust
family welfare from female sterilization to include raising the age at marriage tor women,
provision of RCH services, universalization of education and empowerment of women.
1 he specific objectives of the MP policy include:
Reducing total fertility rates from 4 in 1997 to:2.I in 20i I.
Increasing contraceptive usage and sterilisation services
Increasing the age of the mother at the birth of her first child from 16 years m 1997 to
20 years in 201 1.
- Reduction in MMR from 498 to 220 between 199'* and 2011 through greater
registration oi pregnant women, increases in proportions of institutiona aixi tmmea
deliveries and pregnancy testing centres.
Reduction in 1MR through • increases in, immunization, use of Ora: kehydration
Solution (ORS) therapies- for diahorrea in rural areas, rcduciioi*. :: inci .2 nee of .Acute
Respiratory Infections (ARI’s), coverage of pregnant women and « hildren ”■ ’th
Vitamin A, Iron and Folic Acid (IFA) tablets.
- ‘ Increases in levels of HIV testing.
- Services for.infertile couples.
; j.
Universalizing access to primary education by 2005; wi:h a goal of ensuring that 30%
of girls in the age group of 14-15 years in -2005 would complete elementary
education.
".••4
; he strategies advocated by the policy document include the r.
■■ i I’-olve PR.I s. and
to empower women in the endeavour to reach population s:
..’.ation. A number of
initiatives are suggested such as
making men realize their responsibility to empower women.
strengthening local women's groups.
ieducing the burden ol housework and drudgery on women by ’ roviding cooking gas
connections and electricity to rural households.
Reservation of 30% ot government jobs for women.
1 lowevcr me MP policy also has a number of disincentives. Th- •/ a.elude
Derailing ol persons who marry before the legal age !•.».’ marriage from seeking
government employment.
Persons who have mure than two children will be debarred I: i i cuniesiing Panchayai
elections.
1 hv piovision ol rural development schemes in villages will depend upon the level ot
family planning performance by Panchayats. The flow of resour.: es to PRl’s i^«also to
be hnked to performance in RCH. While there is no
ilic commitment to
mcrc.isiiig dcvolulion and control of resources to PRI' . t.
rjitotions are to be
made responsible for the implementation of the RCH prom a
1 mfoimancc by Panchayats in family planning is also to b« i.'ikcd to the smiting ot
income gcncialing schemes for women and poverty allcviau • n piogrammes
■' b'sg1 '5^' -rJifl
/s
4. Maharashtra
The population policy of Maharashtra begins with a slatemeni of the need to bring down
the rate ot population growth. Its specific objectives include:
; -Reducing TFR to 2.1 by 2004.
. ’ ^Reducing CBR to 18 by 2004.
/
-Educing IMR to 25 by 2004.
i .*<o7’i <.^e<^uclnS neonatal mortality to 2 by 2004.
. The policy extract lists a number of measures in order to achieve these objectives. These
include:
Ihe provision of subsidies and perquisites to government employees is : r be linked to
acceptance of the small family norm or permanent methods o: fami: -mnmg
bin:couples.
1
Sendee in government
-----------’ :s also to •be dependent
*
•
jobs
on the acceptance
the small••
family norm.
Pro vis: on ol village aeaith schemes will also be linked to the performance of
panchayats in the KCH programme.
Assessment of medical oiticers will depend upon their level of performance in the
KC1-I programme.
■ • ■
Persons having two or more children will be debarred from contesting panchavat
elections.
,
Othei schemes include cash incentives to couples undergoing sterilization after the
irth of one or more daughters, training of dais, and strict enforcement of the Child
arriage Restiaint Act. the ban on prenatal sex determination testing, etc. Also,
women’s self- help groups are to be set up at the village level.
•unaing of PRPs will depend upon performance in the RCH pro: ■•.mime.
The policy makes no provision for the representation .of women in elected or other
bodies. It also docs not mention the devolution of resources or deci
..a- m: •
owers
to PRI s.
5. Andhra Pradesh
1 he Andhra Pradesh, population
policy links population stabilizatio’. <o impi
mcnls in
impr’
standards of livir.ig and quahix of life of the people. Il stales that “pn . iclion o’ !ood may
not keep pace with
...i growing population....pressure on land and vlhcr facilities will
increase further, i
rest.king ih social tension and violence... housing in both rural and
unemnlovn” "''i lveoi;,e :1 scrious
scrious problem
problem.... .there
.there will
will he
he an increase in
eausir- | .m'!” "'1'C'L’. W'!l
se,ious pressure
Pressure on ihe
the country s natural resources
seiious
m >■ oicsi.KKT. oescrtilication and more natural calamities."
—as
1
Thd demographic goals as stated in.the policy include-
.induction in CDR from 8.3 in.1.996 to 7.0 i---- ---^;pXr°n •"S"' 66-° inI"6 to 30.0 in 2010 and fs o
MMR from 3.8
■;- Reduction
Keduc,'™ in
in" rrTr
i'8 in.
in ‘"''O »• lAi" 2°io’nd o.Si„
....
,
...Keduction in TFR from 2.7 m 19?,6. to.1.5 in 2020
. • ■
- >•
. - increase,„ couple Prdeelion Rate frqm.4S,8
ini 1996
■ to 70 % ' in’ 2010:an^l 75®iiS^? :
U z U.
’ 7■ •
_•
7 •
•’£.•
--
•.
•
'
•
• v * *-'! f« - - •
‘
llicse objectives are to be attained.by:
(b• Of SpacinVerminal and ,nale contraceptive methods/ tablets
coveraSe of pregnant women for TT inoculation and provision oflFA
(c) Increasing the number of trained and institutional deliveries
e f SSh^S r'refeiTat1
eqU:ty in a^^^ility of services.
fr\ d \ V- tlnsP0,I°’ musics and neonatal tetanus by 1998
babies'1"2 diahOm-al deaths, deaths due to ARI’s and incidence of low birth weight
<S) ieductmn^nT10 "‘T7 !Te,S’ increasinS the niedian age at marriage for girls and
fh) Red.S
r C a2 moderate malnutrition among children.
Reduction in the incidence of child labour.
s/cin^Xihods ’Zb"' °f Tra.,i?n!" S,ra'C8icS rel”'i"8 '» PromoWon of
of RT,“''n''8
dC"veri« “ «<="■“
increasing female literacy and child'"0™’5";6
abortions, preveodon and
!"'Cras' ’s' ”
I— sector in
of girls, and
="d -
»^’x:as^xorin"n,iv“,o be uscd h’,ho ad,icvcme‘”of its
I he document explicitly lists
0 ^Im'inc'theTn
7.1^1’ perrformancc 111 RCH
1)
At the
mtes of couple protection will
of s011001 buiidinss’pi,biic woiks a”d
programmes
like^TR YSFM° \V
Sanitation Scheme.
' ' "
iT lnadC. ,hc criteiion for ^'1 coverage under
C'
SeC('°"
1 lollsill!l Scheme, and Low Cost
-’) Iiindmg for programmes under the DWCRA
and other social groups will be
ilepcndcni on KCI1 pcrfornunncc.
•) At the individual level, cash prizes will bc awarded
lo couples ndopting (c:mjna!
nicilurJs of family planning..
1
’
*
->■ Ai.o'inent of surplus agricultural land, housing sites, as well as benefits t.- .der IRDP,
. vuuoa 1 lan, BC Action Plan to be gh-en in preference to acceptors of terminal .
n'cmcns 01 coitiracepi:on.
-spec.;;; health tnsura.-ce
•nsbra.-:ce schemes for acceptors of terminal methods of family
J’T‘ul c<hlcesSx°ns? subsidies and promotions as well as government jobs to be
ns 7'’>‘riClec*10 those who accept the small family norm.
awurds on the basis of performance to sendee providers.
i. aw ai d of Rs. 10,000 each to 3 couples to be selected from everv district on the
,n:cky dlP’ lron‘ lhe following categories: (a) 3 cnuples per distr'; t with two
giri
’
gin children
cmiorcn ;adopting
permanent methods of family planning (Lj 3 couples per district
one
child
adopting
]permanent methods (c)3 couples per district with two or les-;
wim
cniidncn
*........
J
•
’
adopting vasectomy.
reliJin^J? d.°CUmcntjuentions the need for involvement of people’s rep^sentatives,
comm? Ca e7’ prc^ess*onal social bodies, professionals, chambers of i dt.strv and
del-iJr JC’ y°U-hLWOinen and flIm actors and actresses. While it underscores ..tc need for
resoui-cJt ° riShts t° PRI’s, there are no provisions for delegation or dv.-oiution of
icsouices to the panchayats.
To- r
.Nayonal Population Policy lays the groundwork for a policy of
population
stabilization
and n J?" J " ?
'based
”~'J on the Prem'se that the provision of health, sa
; security
and
protection
of
vulnerable
affirm'- thJ?' vuInera^e 8r°ups is a.precondition for population st; ’ ’ it . It also
-,need for a policy based on the ethics of inforn
inforn-w- <heicc u '
■ r-tln
Joins.;
;t
eschews
any
measure
that
would
be
ethical?.
I
izardo
is
■
reive
ethicali
How'
I..’?’,"10
’,ohc,vs ail suSg<-‘st some measure of disincentives in vrdc.
..chieve
JiC’r
(
‘
'■'ci:!
.
ii?.
^•^eirch .iJima;
Jawaharlal Nehru University
IX-lhM 10067.
A
A
/F
f-
L>-j. '
/
’ Population stabilization
Wiry penalties are meaningless?
A K Shiva Kumar
Population stabilization:
Why penalties are meaningless?
A. K. Shiva Kumar’
March 2Cu1
India has re-affirmed its goal through the National Population Policy announced in March
2000 to rapidly achieve population stabilization. Public discussions and debates around
the population question are, however, shrouded in confusion and misunderstandings
Particularly disturbing are the moves to impose disincentives of various kinds that
penalize people for having more than three children. States like Maharashtra seem to
have issued such orders, and many other states are contemplating such unnecessary
measures. This brief note lists the many arguments against the use of penalties ano
disincentives for achieving population stabilization.
Any discussion on penalties and disincentives, however, needs to be situated within the
cvcra’!
tr. population ^tnhilization
Common myths
There are many myths surrounding population. Two however cloud people's reasoning
and perceptions the most.
First, many believe that India is a poor country because of its large ano growing
population. Many argue that India's per capita income is low because there are just ’ar
too many people. Such reasoning has very little basis. The fact is that population size is
not associated with economic prosperity in any predictable manner. China, for instance
the only other country with a larger population - 1.26 billion in 1998 - reported a GNP
per capita of USS 750 in 1998 against India's figure of USS 440. Similarly. Malaysia anc
Nepal have almost the same population - between 20-21 million. Yet GNP per capita m
Nepal was S210. And in Malaysia, it was S3,670. Within India too, Andhra Pradesh and
Madhya Pradesh reported similar levels of peculation - 73 million and 78 million
respectively in 1998 Yet in 1997-98, per capita Net State Domestic Product in Madhya
Pradesh was only Rs.8,114 - almost 30% lower than the per capita State Domestic
Product (Rs. 10,590) in Andhra Pradesh.
There is a related-myth - that India's large population is the reason why the economy is
growing so slowly. This again is not true. Between 1975-95, China's GNP per capita
grew annually by 6.8%, and India’s by only 2.6%. Even in the 1990s. after the initiation
of economic reforms. India's growth record has not been as good as China’s Between
1990-98, India's GNP per capita grew by 3.8%. and China’s by 9.2% Within India too
between 1991-98. per capita State Domestic Product grew by 7.6% per annum m
Gujarat - a state with an estimated population of 47 million in 1998 On the other hano
The author is a development economist and Special Advisor to UNICE«
suggestions may be seni to stikumar@uniccf .org
m India
Common?. .
6
Por-jiason staOiitzabon
Why nenaii cs £fe meamne =Si7
7
A K Shiv.'
Puruao ever, thougn
-----per capita State Domestic Product grew by only 2
-S% pejr annum in
the State has a smaller populatic.. --- estimated
—L—--" at 23 million in 1998.
itself is not the reason for low incomes anci s>ow
The reality is thai large popula:
growth. Economic well-being ha:: ..:e to do with population size ancHi
,heir
how effectively society invests in its people - m thei health, in the r eaucat.o
well-being. The more secure people are. the more prosperous a i
Second, another common myth is that a large and g owiny
ve at a wronc
the persistence of widespread poverty in India. Thu. « “ ;
.
ei..., an<t improve
conclusion: that by rapidly lowering birth rates, India can
P lhe b,rt._ rates i,-,
standards of living. This again is not true In 19.9' .
*
Guiarat and 24.1 in
Gujarat and Orissa were similar - 25.4 births per 1.01)0
1993-94 Orissa. Yet 48.6% of Orissa' spopulation hve »:
Kerala and Haryana
almost twice the proportion «n c.-arat (24.2/o). »
Bt.t the oirth rates in the"
reported very similar rates of poverty, in 1993-j', - ar* >un
o
Q whereas •n
two states are vastly different. I.; 1999, Haryana reported a oirth rate
Kerala, it was only 18.
standards of living is neither
The link between fertility reduction and improvements in
-R te (TFR)
obvious nor automatic. Bangladesn. for instance, rr duced ,ls To^‘vert
any
dramatically from 6.8 to 3.1 between 1975-98. But tms as n
i
significant way. Similarly, Kerala has lowered its fertility rates to less th
is difficult to claim that there is no poverty in the State. Even in tap
States of America, where fertility rates are relatively low
0
.
a denial ol
replacement rates - poverty persists. Human poverty has is
fertility
opportunities that can persist in countries irrespective of population .ize
rates.
- to cover up for serious policy failures.
A major misconception
There aic a number of misconceptions surrounding population. Quite unlort^H^
in particular dominates current thinking on ways to achieve popu a ‘an
Many argue that coercion and an authoritarian approach are what wi yie
results. Some even go to the extent of advocatin j that India shou
one-child policy. There are at least ten_50pd rea:.pns wny India s wu
penalties and disincentives.
n-.-f-voct
r hina s
clear of
hand with a L«oad and
I list, even in China, the coercive population policy went hand-mthe proven way
(•guitable expansion of social and economic opportunities lor women
much of China’s fertility
to reduce population growth And so it is not entire y clear how
decline can actually be attributed to the one child pc licy
'Slf'1
17
J
3
Population stabilization:
Why penalties are meaningless?
A.K. Shiva Kumar
i
Second, enforcing a one-child policy may be possible in an> cu1"c°r^^e^°ggg^y
China, but such measures are likely to have disastrous pol.tical ^0"^^nCeS '
J.
mocracy.
In India, the pol.tical and human wounas ot
Populaho
ontrol
easures initiated during the Emergency rule under Mrs. Indira
;:go. are still to heal.
i jn China, ’where there is a strong son
Third, in countries of South Asia and even
p^eferenceTsuch restrictions will inevitably promote further dJcnJ'n^^ ^crease
children. Instances of female feticide and even temale infanticide ar
feature
This is a particularly serious concern given that the most alarmmy
‘
of the preliminary results of Census of India 2001 is the worsening female-to-male ratio
in the child population aged 0-6 years.
Fourth, ^imposing restrictions on the number of children violates people’s freedoms and
inHiwidual rinhtc
Family planning der.isinns by their very nature are
.IH the
d^s^ reiaiing to loCe? affection, family security, and togetherness. Why should the
State or any political party want to forcibly interfere?
■' ‘ route of
Fifth, why should coercion be used when there exists a well-proven alternative
Bangladesh
and
Indonesia
investing in social development and people's capabilities?
,f
have been able to lower their fertility rates without use of coercon. Within 1 ^ia-tselUe
have Kerala's example - a state that has invested well in people s hea.th and
t
■
And the social development route yields very quick r-, suits] Keraia. in fact haclaihg
fertility than China in 1979, but by 1991, its fertility rate of 1.9 was 'ower than China s
2.0. And now, Bangladesh has shown that it is poss.ble to reduce fert lit rates rap.dly
without use of any coercion - by empowering women, educating peop
access to reproductive health care.
children. For instance, according to the National Family Health Siin/ey-2 m 1998-9
almost half (47%) of ever-married women consider two to be the ideal nu
children, and 72% consider two or three to be ideal. At the same t.me peop >s
knowledge of family planning methods is also high. The same
reve
morripd
knowledge of contraceptive methods is nearly universal, with 99/o o curren y
women recognizing at least one method of contraception and at least one mo
..method of contraception. Ignorance is no longer the issue. The reality is t lai a majo i
of women lack adequate access to safe and appropriate reproductive hea
serv,c '
and the freedoms to make choices. Why penalize people if the State is no a e o
its obligation of ensuring adequate provisioning of basic social services?'
There are also serious problems associated with the implementation of disincentives and
penalties.
Seventh,Ipenaltfes tend to get reduced to tokenism, and they are difficult to implement
For example, political parties and some state governments want to debar those with
II
more than two children from contesting for elections - or holding elected office
IS
i
.-n r.:ab;iiza:k-n
pt r.n't'vs are meaning’
Ar' Shiva b-~'3f
anything, such a move is impractica’ ■ How can rhe State or pci .
. parties meaningiu.iy
rac
births, deaths, marriages, remarriages and divorces among party members
(existing and potential)./'Tne country does not have a well-deveioped civil registration
|SRjirPF According to MIC S 2000 - an extensive survey on chitdren carried out by
- barely 35% of all ’ ;rths r; registered. When this is the situation, what are the
prospects of establishing c proper monitoring system? Many ioopholes are already
being discussed. There are, for example, already talks of how'the pull of political office
pA h- 6
°J P°wer ,s ptumoting ‘divorces on paper’ and even ‘adoption on paper."
us mg any kind of ban or. political participation is likely to reduce the entire syste. • of
elections to a mockery of democracy. This is indeed a heavy price to pay.
Eighth/, penalties tend to be unfair and inequitable in terms of how they affect dii<
at
groups QfpeopI6 in society. The N: tional Family Health Survey - 2 for 199c 99 rr
:s
inat India s total fertility rate (TFR) - the number of childr
a woman would r ear
•g
nnn.rT^r° uct,ve years ~,s ^-35. i
TFR is 2.27 in urba: areas (where or.' 26''.
popula :on reside) whereas k is 3/ 7 :n rural areas with 74% cf the count-, s -c •.
Similarly, the TFR among Schedivc d Castes is 3.15; it is 3.06 am eng So:- m :cjS:
thA TO09 °ther Backward C3stes, and 2.66 among the rest of the pep..
h
arnon9 illiterate women is 3.47 whereas it is 1.99 among women *wno ..ave
twn0 h ihC/te? beyOnd C,ass X‘ The PrClP°saI therefore to ban people v;?.r m . r.
nn
nnn ? i
rom contesting for elections is clearly biased against rura anu
ar.c • : cala9a’nst less educated persons, against those belonging to ‘ 2 s
S'’
nd
VA/hrTh ac ward Castes, and the poor in general/It favours urban reside; '
-e
ma’ ♦aVef
access to education and pmper health care, and dischmi--4 —
f .^Ori \ 0 1 e rura’ P00r ancl the disadvantaged. Such a measure will u: \
ic
^nate few who have historically enjoyed an unequal access to eppon
rhiin^L °r 3 ma-ionty °f Indians. Any measure that debars people with m
. .. .n rom c°ntesting for elections is also strongly and unfairly biased aa<5..<^
and it ignores the reality of the poor
Nintf], imposing penalties has little ethical or moral justification. For example
'/ iie
^vernments like Maharashtra want to deny the third child the right to fr<
dkr ■,S
a^an^y absurd. The Constitution of India assures every chn^n?m,nu ,On 7 *be
10 ^ree and compulsory education up to the ago
And
ri9^education - if the child happens to be the thud - seemv
rl^ari CO?0 1 ut|, ,na’ I* *s shameful to penalize a child for no fault of hers
•
eany vIOlates the Convention on the Rights of the Child that Indm has ranhed
•it
’: ::r
:1 .»
dninn
rnos^ P°Pular argument advanced in favour of imposing penalt -hn: i;v
thA oi
Se?'Or po,ltic‘ans W'11 set a" example to others. Do politoans tr; ? : ■ T: - mat
Dolitip66 °ra
IS S° na,ve9 Citizens are concerned about the ethical and me. u. values of
to Add3^5 a 0Ul the corruPt*on and misuse of office, and about their lack o: c mmitment
that threSS,-9 senous issues of poverty and human deprivations Politicians who behove
-hildm^y Cd'n fedeem their political image by advocating and having less ’han three
oronn^n/1105
6 l|Vin9 ,n a makb--believe world Younger politicians thems‘.-iv_ find the
reorodt intqUl1^ r,^,culous Very often, it is advocated by those who arc wav ’ --yond then
com?nrmM e, 30 Produchve)/ears But such statements aie ai j typically
i-.anced m
e ivmg rooms by those who are educated, who havt.- secure jot
.-.'ho have
---- ;—;
o
o
5
Population stabilization:
Why penalties are meaningless?
A.K. Shiva Kumar
o
access to good health care, ano who have not experienced child deaths in their families
for several generations. Stabilizing India's population can hardly be achieved though
such farcical and superficial interventions.
Conclusion
Population stabilization is not a technical issue that has a technical solution.. The answer
does not lie in pushing sterilization or chasing targets. For population stabilization, it is
important to improve people’s access - and women's access in particular - to quality
health care. Immediate steps are needed to revitalize community health programmes
throughout the country. At the same time, the contraception mix needs to be enlarged.
Women must have access to emergency obstetric care even in remote areas. But mere
physical provisioning is not the solution. It is critical to involve people - and enable
women in particular to participate in decision making and to have a say in decisions
relating to reproduction and livelihoods.
The argument is often made tnat India is too poor to afford the many investments
needed to stabilize population Can India afford to expand contraceotion choices,
ensure universal access to safe and appropriate reproductive services, and ensure
health for all? Or for that matter, can India afford to universalize elementary education9
Investing in basic health and education is not entirely a matter of resources. It has much
to do with priorities and the pciitical will to address issues of population and human
development. The issue is more than merely one of affordability. It is a matter of getting
priorities right.
It is well established that high ncomes are not a prerequisite for social development.
Several countries like China, Cuba, Costa Rica, Sri Lanka, and even Kerala in India
have recorded remarkable gains in health and education at relatively low levels of
income. Nations do not have tc become rich in order to provide for people's health £nd
education On the contrary', the only way for them to become rich is to invest first in
people's health and education
At another level, the world is now discovering (he obvious — that women’s empowerment
is critical for human development. There is a closely related issue — that of gender
equality and the influence it has on the ability of women to exercise their choices freely
and without fear. The roots of the population issue lie in social realities - and in social
constraints (or unfreedoms) that women in particular face. Sustained and informed
advocacy is needed to change mindsets to enable women to act with greater freedoms
Reducing infant and child deaths is essential in order to restrain population growth It
has been established all over the world that reductions in infant mortality (or
improvements in child survival) precede reductions in fertility rates
Several
mechanisms connect lower child death rates to lower birth rates - including the
replacement factor and the insurance factor. Reducing child deaths can help societies
move towards family building by design than by chance. The interventions for improving
child survival are well known - better education, improved access to health care, better
nutrition, higher earnings, safe drinking water, and better sanitation Not surprisingly
o
I
Population stabilization:
Why penalties are meaningless?
A K Shiva Kumar
these are the same interventions that are needed for empowerng women, for improving
standards of living, and for stabilizing population.
India, however, has much ground to cover in terms of improving child survival. Current
trends under the period of economic reforms are disturbing. Despite the higher growth
rates in the 1990s, there has been almost a halving in the annual rate of reduction in
infant mortality. India’s infant mortality rate has been stagnatin . .at around 70 deaths per
1,000 live births for the past four or more years.
The time has come to stop counting people, and to begin . !;*ting on people. Public
action is required to expand people's capabilities, to enlarge opportunities, to invest in
their education and health, and to promote women's empov.r. nent. The simple mantra
to population stabilization is: take care of people and populat
.*.’ i take care
'tself.
r
7
Population stabilization
Why penalties are n-.eaningfess?
A -L Shiva Ku.—ar
Select references
EC°nOmiC SUreey 1999-200°-
of Finance,
Ma'-°(2000)- “°"a
wT?il97GNTwDXia (19S9)' C°mpend'um of lridia's Fertility and Modality Indicators
eaSp^nT'560 and A' K' Sh'Va Kumar (200‘)- Women in India: How free? H-w
r^!h; ■ Report commissioned by the United Nations Resident Coordinator in India, New
Amartya Sen (1999), Development as Freedom, Alfred A. Knopf, U.S.A.
UNDP (1995), Human Development Report 1995, Oxford University Press, New York.
UNDP (2000), Human Development Report 2000, Oxford University press. New York.
UNICEF (2000), The State of the World’s Children 2001, UNICEF, Nev/ York
Governance for Population Stabilization in India:
Need for a Paradigm Shift
A. R. Nanda
and <
he.ill
disc r<
failur
icadi
pmp
divisic
< o.ilil
like e
the
I he r
birth
tor
the
and
A s would
w<>
communitv As
be seen
later, the fundaments of the*
arena
(Ontc
Child
of
the1
c ommumt v.
by
c ommumty
jiaradigm shift in approach to the
pojiul.ition and development
problem in l( PI) Programme of
Ac lion I'l’f-I and the National
Population Polic y 'NPP1, 2000, are*
in tunc* with the spirit of Gandhiji's
vision in resjjre t of the* population
proble*m in India.
some
sc hold
retlcc
simple
require
and c ii
thread
people
and su
Scholars and thinkers of preindependenc e India like P.K.
Waltal, B. 1. Ranadive and Radha
Kamal Mukherjee were influenced
by Western eugenists. NeoMalthusians and birth controllists
in viewing population control and
family planning as a panacea tor removing
Ihc*
population
issue1
has
mostly
beem
perceived as a demographic or numerical
concern ot the* elite's rather than a genuine*
concern of the* individual or the* family
particularly ot the* poor and the1 marginalizc'd.
Ibis nc‘O-Malthusian mind sc't has by and large*
pc’rvaded the* planners, policy-makers,
administrators, elitist scholars and the* rich and
upper middle* c lass of c itizenry. It has been, to
quote* z\martya Sen, one* of 'authoritarianism'
rather than 'cooperation'.
A balanc rd non-judgmc’iitai two-way linkage
between
population
stabilization
and
20
3
Lac kw'ardness. poverty, unemplcmerit and .ill
othcT hardships in Indian sue ietv A bureauc rat
in British India, leonard Rogers
ij
longtime1
hc*alth adviser to the India ( )ttk e* is quoted as
saying that he might have been "better
employed in finding a lethal gas which might
put the* excess population out ot its misery".
Radha Kamal Mukherjee, who headed the sub
committee on population ot the National
Planning Committee' ot the Indian National
Congress in the1 1 9 M)s. convened the* first
Indian Population Conterenr e in I uc know' in
19 if), and influenced the1 loji-sided narrow'
mindset on population problem in India, which
sustainable development lac ed with cross
bec ame very pervasive* in the1 jirocc-ss o’ polic y
cutting perspectives of human rights and
dignity as well as gender equality, eejuity and
justice, constituted the basic perception of
and
programme
formulation
and
implementation in the* post-independent India.
Mahatma Gandhi, when he countered the
arguments of the exponents of international
the post-World War II cold war era were
skillfully utilized by US and othc*r Western
birth control movement trying «o make India an
arena for their experimentation in the 1920s
and iOs. While stating that ''uncontrolled
reproduction was a social problem" and that
'Indians should have* smaller but healthier
c ountries to give a sc lentific ' c loak to view the
population problem of India from a negative*
and narrow' |)erspe*c tive of numbers. The fear
of 'population bomb' and
population
explosion' was unleashed on the* same*
families". Gandhiji advocated women's
empowerment and gender equality to enable*
women to take decisions on child-bearing and
resisting and negotiating with their husbands for
pedestal of anxieties as the- nuclear war , which
engendered
quick-fix,
short-cut
and
dehumanized policy prescriptions, and 'topdown targets' of family planning bereft of the
abstinence. He believed in 'Gram Swaraj' - rule*
recognition of a two-way linkage* of population
HEALTH FOR THE MILLIONS ! Auquet S«,ptcmt>ri A Oftobce Nov^nibrr 2004
Ihc* reports of demographers and scholars in
pure1 <
sc ienti
empiric
polk y.
they, I)
over tI
mindse
this <
mather
w it h st
s.il ist.K
t t )»n| th'
and ps
( acenl
researc
the toll
I he e\r
m India
ot five
nation,
emph.v
nec ess,]
the poj
requirei
based a
method
v\as t.ik
buildini;
.Hid tin
K’esc‘arc
c onstitu
m lulv '
broader
their re|
" I he < r
planning
lia:
Nanda
)y
the
the
e seen
of the
) to the
pment
ime of
at ion a I
00, are
ndhiji's
>ulation
t preP.K.
Radha
fenced
Neorollists
fl and
<)\ ing
nd all
•UKTat
gtime
ed as
etter
-night
>ery
• subional
ional
first
'vv in
rrow
'hich
olicy
and
idia.
rs in
/ere
tern
the
live
fear
i >n
me
lich
ind
opthe
ion
and development, and the primaev of women's
health and rights in the process. The cause was
discredited for various reasons which included
failure of early fertility limitation programmes
leading to coercive measures, unfulfilled
prophesies of a global famine, as well as
divisions and oppositions in the family planning
coalition from newly powerful constituencies
like environmentalists and feminists.
The mindset to go for a policy of compulsory
birth control persisted, starting in the global
arena from 1927 Geneva World Population
^°??oe?Ce throu8h the ]979 China's 'OneChild Policy' to the attempts, off and on, by
some Indian politicians, bureaucrats and
scholars for 'two-child norm' policies. All this
reflects fundamentally an alarmist and oversimplistic view of a complex issue, which is
required to be perceived with care, empathv
an circumspection. One could see a common
thiead running through the mental make-up of
people who present their arguments, theories
and suggest solutions of this type. Whether the
pure demographers, population pseudoscientists or bureaucrats present theories
empirically, interpret data or statistics or suggest
policy strategy and programmatic prescriptions,
tney, by and large, have not been able to get
over their basic Neo-Malthusian and elitist
mindset and obsession with numbers in treating
us complex and human issue. The
mathematical formulas and statistical analysis
with scientific' rigour are not sufficient to provide
satisfactory explanation to the issues of a
complex human behaviour in family, community
and psycho-social-cultural settings. To quote
Greenhalgh: "an over-reliance on quantitative
fkSe? h
135 constrained our understanding of
the full complexity and context of fertility".
The evolution of population stabilization efforts
«n India by government goes back to tlx* onset
< five year development plans in 1951-52. A
national programme was launched which
emphasized 'family planning' to the extent
cessary for reducing birth rates to stabilize
e population al a level (onsistent with tlx*
requirement of national economy. A clinic>ased approach with equal emphasis on natural
method hke rhythm as on some contraceptives
v'as ,aken cautiously, along with awareness
(ing and research on new contraceptives
< nd their acceptability. A Family Planning
< search and Programme* Committee was
constituted, which in i:Its. first
f
meeting at Bombay
,n K'ly 195 3 took quite
* * a comprehensive and
broader view of the family planning. To quote
I heir report;
The committee (‘mphasized that the family
planning programme should not be < onceived
2-*i
of in the narrow sense of birth control or
merely of spacing of the birth of children. The
purpose of Family Planning was to promote, as
far as possible, the growth of the family as a
T"
in a manner designed to facilitate
the fulfillment of those conditions which were
necessary for the welfare of the unit from the
social, economic and cultural points of view.
The functions of a Family Planning Centre
would include sex education, marriage
counseling, marriage hygiene, the spacing of
children, and advice on such other measures
(including on infertility) as necessary to promote
welfare of the families".
Around the same period in China, the new
Communist Government under Mao Tsetune
looked at population basically as an asset, and
took many benign measures of social
development which brought in more equitable
■’ccess to basic health, education, assets
(including revolutionary re-distribution of land)
and income over next 20 years. The concept
ot family planning services that China followed
was in tune with what the Bombay familv
planning research and programme committee
had conceptualized.
Instead ot a top-down prescriptive target
approach. China went in for a localized
( onJfni’nity approach. The Cultural Revolution
made the bureaucrats and ;
service providers
more responsive and accountable to^he local
party hierarchies, the communes and the
Production Brigades, and purged them of their
elitist-intellectual hatred or indifference for (he
peasants. They became more alert to the
needs of the communities and were
res|M)nsible to meet these needs in an equitable
manner. Such a style of governance brought in
quick results in all
all indicators
indicators of
of social
development including women's status; and the
fertility rate* came down very sharply by 1970s
The perception of the families and that of the
state* converged, when it came to ac< eptance
of a small family norm. Only with the contagion
of western education, the threat perception of
growing numbers took deep roots in the
mindset of some Chinese scholars, and leaders,
and they advex ated many restrictive population
policies like the 'One-Child policy' which
appears to have created more societal and
family problems like skewed sex ratio, female
mfantK ide and foeticide, rather than helping in
sm<x)th stabilization of population. There arc thus
lessons to be learnt fre
................... om the* Chinese experience
in governance. We tend to misrepresent the
C hinese story, whenever we compare the Indian
situation for advrxating coercive policies like*
two-child norm" and the* coneomitment regime
of incentives and disinc entives to solve* our
population problem quickly.
HEALTH FOR THf MILLIONS / August-September & October November 2004
£
21
( outer
1994 a
c onstit
.k tion <
< ountrs
INDUSTRY
experie
HEAL.TH
v.irious
(Irmogi
strategi
I
\ i
primacs
within t
of care
iffittsiam co-orami. ■
MRTeR SUPPLY
COMMUNKATIO\
\
\
X Kr
\
I he prpolicy
1
$
*6RICUCrURf:
indicate
develop
demanr
product
g< )vernn
in this I
method
epu CATION
target-F
I.hjix he
It is a pity that our bureaucrats, advisors,
planners and policymakers paid a lip servic e to
the rational and sane advice of the Family
Planning Research and Programme Committee
in 1953, and instead, adopted disjointed,
verticalised and top-down c ontracc’ptist
programmes with targets of sterilization. A
Department of family Planning was < resiled in
the Health Ministry in 1966; the programme
was made 'Centrally-sponsored'; financ ral
incentives were introduced tor sterilization
acceptors; and sterilization was macle targetoriented. /Mthough the programme was
integrated with maternal and child health during
the’ Fourth Plan (1969-74), and further with
health and nutrition in the Fifth Plan (1974-79)
with creation of multi-purpose* workers,
introduction of mass motivational efforts and
population education, the primary objective
was to achieve targets of male and female
ster ilizat ion imposed from above. The1
compulsory and coercive nature* of
the*
programme during 1975 and 1976 made if
highly unpopular.
From 1977 onwards, a damage control exercise
began by re-christening Family Planning as
Family Welfare with voluntary acceptance of
contraceptive targets without .my coercion as
the key strategy and recognition that it is an
integral part of a comprehensive policy
covering education, health, maternity and child
care, family welfare, women's rights and
W
bc’yond < ouple protec lion rate*' tor mtegratic.'.
The* 'Action Plan ol 1986 did make a
distinc lion between eight
family planning
measures, and six ’beyond tamih planning
mc*asuic*s; but a lew measuics were taken
for implementation as ( entrails sponsored, w • ,
very little ownership and commitment In n
a 'Natio
the NPf
< iverridii
developi
people,
state governments and district administiatm: ••
pi ovide
I he* Karunakaian ( omimttee set up by NIX
199 1 missed the* wood lor the tree
n
bet omc
v learlv r
and tw
emphasizing on disincentives aiound tw'O-c h <1
norm in the form ol disqualitic ation tor MP-
stahiliz
develoj
Ml As and other elected r epi esentatives \
(. <institution amendment bill was inhoducec;
Rajya Sabha the;ealter, and is pending b<r
slralegit
whit h
c onsideration
even
now.
Some
sta’governments have gone* m tor legislations on e •
same* measuie tor panchavati raj and urb
local bodies. Il is well-know'ii that sir
pnrsnet
Decentr
implem
deliver
empow
measure's for population stabilization alien.rthe* poor, maigmali/ed and w'omen free
nutritior
the uni
political empower(111*111. arid arc* count-'
'•ervice*
undersf
adolesc
plannee
produc ti\e.
In 1993, the NIX' proposed the formulation < •
a national population polic v to "take a long
term holistic view ol .icvelopment, populatk
growth and environmental protection", and :<■
nutrition. However, demographic targets and
goals along with contraceptive tu’.gets did little
suggest policies and guidelines for formulatin'
of programme’, and a "monitoring mechanisrwith short medium and long-term perspectiv
and goals". I he expert group headed by M ?
Swaminathan prepared a draft Population Polic .
in 1994, which c ontained many positive and
to motivate the workers and supervisors to look
innovative recommendations. The Internationa
HEALTH FOR THE MILLIONS / AuguM Scptrmbe* A October November 2004
( .ire a|
( omprel
and ann
|)artners
medicine
and pro\
the ope
rights, gr
c ross-cu
was sug
movemt
objectis
through
7/O\
]
ion.
? a
ng"
ng"
up
.ith
om
ns.
' in
by
likl
Ps,
A
i in
lor
He
he
an
ch
He
>m
ol
Kt()
>n
rn
s.
hl
al
Conference on Population and Development,
1994 adopted a Programme of Action, which
constitutes a paradigm shift in thinking and
action on population issues globally and in each
country's context including India. Based on the
experience of containing population growth in
various countries and the negative fall-outs of
demographically-led insensitive policies, and
strategies, the Programme of Action gave
primacy to human rights (reproductive rights
within these rights), gender concerns, 'quality
of care indicators rather than demographic
indicators as well as social health and
development.
The prescription for governance in such a
policy framework was for need-based,
demand-driven, client-centered services and
products of population and development from
governments. Government of India acquiesced
in this POA and abolished all contraceptive
method - specific targets from above in a
Target-Free Approach (TFA) in 1995-96 and
launched the Reproductive and Child Health
Care approach from 1998. The first ever
comprehensive and holistic NPP was formulated
and announced in February 2000, followed by
a 'National Health Policy' in 2002.
lhe NPP 2000 started with a premise that the
overriding objective of economic and social
development is to improve the quality of life of
people, to enhance their well-being and to
provide them with opportunities and choices to
become productive assets in society. It very
clearly recognized the close inter-relationship
and two-way linkage between population
stabilization
and
socio-economic
development and enunciated goals and
strategies — both social and demographic —
which would have to be* simultaneously
Pursued
in
a
svnergistic
manner.
I decentralization ot Planning and programme’
implrmentation, convergence of service
delivery at community levels, women's
empowerment for improved health and
nutrition, child health and survival, meeting
the unmet needs for all family welfare
mt vices,
with particular emphasis on
underserved population groups including
adolescents, increased male participation in
planned parenthood. public-private-NGO
partnership, mainstreaming Indian systems of
mc’dic ine, better IEC and motivational measures,
and provision for older population c onstituted
the operational strategies with reproductive
f'Khts, gender equity and quality of care as the*
< ross-c utting conc ern. A 100-point Action Plan
was suggested to be pursued "as a national
movement" for achieving multi-faceted
objectives — short, medium and long term
through a "multi-sectoral endeavour, requiring
2.^
constant and effective dialogue among a
diversity of stakeholders, and coordination at all
levels of the government and society". Spread
of literacy and education and women's
participation in the paid work force together
with a "steady, equitable improvement in family
incomes" have been recognized as important
as equitable access, quality and affordable
reproductive and child health services aimed at
population stabilization.
The governance for implementing, the strategies
and programmes / Action Plan of the NPP
need to be suffused with a transformation of
the conventional mindset and style of
functioning of the bureaucrats, technocrats and
service providers vis-a-vis the approach to
population issues, accountability, planning,
monitoring, and coordination and synergy vertical as well as horizontal. Positioning family
planning in the wider canvas of reproductive
health with a life-cycle approach and the overall
arena of primary health care and other key
programmes of education, nutrition, water,
sanitation, employment and poverty alleviation
(in fact, the entire gamut of gender-sensitive,
rights-based and equitable social development’
with a participatory community needs
assessment periodically for every village and tor
every ward of a town should be the starting
point in any exercise of planning and designing
of
programme
implementation.
The
authoritarian top-down target settings and
bureaucratic monitoring of targets need io be
replaced with work-plans based on CNAA with
the active participation of PRIs, urban local
bodies and community-based organizations like
self-help groups, particularly of women. Such
holistic plan for health, population and so< ial
development is to be prepared for each ot lhe
6, 40, 000 villages and each ward of (>,000
urban areas. The district plans, state plans and
the Central plan should be based on the
community level plans reflecting the perceived
needs of each family, and each community.
Implementation of the work plans for eac h
community should be monitored by the elec ted
members of the ward of the panchayat / urban
body with technical and financial assistanto
from government - NGOs - private sec tor,
and all elements of 'social audit' built into this.
'Quality of Care' indicators should be1 the most
important ones to be monitored rather than lhe
quantitative targets pei se. Only then could the
efforts at population stabilization proceed on a
smooth course, and could turn into a people's
move’ment produce desired results.
Ibis write-up is based on the Convocation
Address delivered by the author at the 4(i"‘
Convor ation of the International Institute of
Population Sciences, Mumbai in 2004
Air. A. R. N.ind.i
!/»<• / \» < Hint-
I )uvt
nf l\>/ml.itit hi
I < mtn I.it i. tt) tit Im h.i
•Mr. \.im!.i /i.is bffi)
tlw I < nntfi s<‘< tft.it i
Altfiisfr nf I ff.ilth
.null.irmly Wt'lf.itr.
< .< n t < >t ln< h.i .inti
.j/mi \ff\f(l .Is flu(
( tinumwitim-t.
HEALTH FOR THE MILLIONS / AuguiVSeptember & October November ?004
&
n
21
3»7
Re-examining Policy Approaches
. 'phe National Population
Policy 2000
Introduction
i>irl child was
^wXhTcouW have been a moment for somber
as an occasion
On the 11"’ of M'V 2000
“"" w“h,,°"' “use
SSUsr.phic alarm bdISnnS.nS.
■in fanuly planning have
hav*
he proi,ram, one cf.
’ of the
Over the years while ■ concerns
. p Was increasingly bemg realized that
development, early m the nmeties
in the world, had reached a dead en
largest public health initiatives i..s
as a resuh of the Press^ gear
»
DevelopmcI-„
for a radical reeons.dcra
fional Conference
out a new
an Expert Group to chart Committee
■
,
the Swanunathan
—
grQup c^P^^pro
,
described as
In part as a result of this
eroups and health groups in the c^ “ .
fn preparation lor the th.rd ^ciecenmal
(1CPD) at Canoin >
population polic\
Report, proclaimed a policy
hcbsucapprcaaivlsu^^^^^
TheCommiueelmdProl>oscd’.,„
family planning with
ser/ice could be
rhe goal U propo^ <l« ito 0*'“'f. and
r only one. aspect o an
,ncentive approaches
■ r.
. ejected both the target and t
Committee had
"XS°t!»'cmiSe'’M reeold^
- the ICPD agenda
Xd by the 73^ and
' institutional arrangements or deve1 P
dlsJunctlOn
Yet it came m tor chucish
^ Amendments to the Const.tut.om
■
between its policy pel spccnvc and recon
undersianding ihm
based on rhe recomm^^s of
.ifour pppnlarion
„„ Na,1„na, Popolm.o.i. Mg'pol,cy (NPP)
of India announced a Dtv
3rccntcd by Parliament and a .
this year this draft was mod.f.ed, accept
2000 announced
I
I 1
- ---- ---■
•-•A**
«.«'*
i
The National Population Policy 2000
The policy announced “afl'irms commitment of the government towards voluntary and
informed choice and consent of citizens while availing of reproductive health care services, and
continuation of the target free approach, in administering family planning services” (GOl: 2CC0:2)2,
The immediate objective of the NPP is to meet the unmet need f.r contraception and health
infrastructure. The medium-term objective is to bring the Total fertility rate to replacement levels
by 2010 through inter-sectoral action and the long-term objective is to achieve a-stable population,
consistent with sustainable development, by 2045.
Towards this end the goals set out include:
1. Making school education free and compulsory up to age 14;
2. Reducing IMR to below 30 per 1000 live births;
3. Reducing the Maternal Mortality Ratio to below 100 per 100000 livebirths;
4. Promote delayed age at marriage;
5. Achieve 80 per cent institutional deliveries and 100 per cent deliveries by trained persons;
6. Universal access to information and counseling, and services for contraception with a wide basket
of choices;
V.Hundered per cent registration of vital events — births, deaths, marriages and pregnancy;
8.Prevent and control communicable diseases, especially AIDS.
The strategies to achieve these goals include twelve items. Some of these are: decentralized
planning and program implementation through Panchayati Raj Institutions (PRIs); convergence of
health services at the village level; empowering women for improved health and nutrition; ensuring
child survival interventions; involving diverse health care providers; strengthening IEC; developing
increased partnership with NGOs and the private corporate sector; and finally, encouraging a range
of clinical, laboratory and field research on maternal, child and reproductive health care issues. AU
these strategies are to have a special focus on under-served populations, namely, urban slums, tribal
communities, hill area populations and displaced and migrant groups. Efforts are also to be directed
towards increasing participation of men in the program.
At the same time as the Union government announced the NPP, several State governments
/ including Rajasthan, Uttar Pradesh, Maharashtra, Madhya Pradesh, and Andhra Pradesh announced
population policies of their own. Other states are in the process of doing so.
1 he Singanuria Sreenivasa Foundation, Bangalore, and the Centre of Social Medicine and
Community Health of Jawaharlal Nehru University, New Delhi, felt that this was an opportune
moment to reflect on these policy initiatives both at the Centre and the States. At the same time, it
was necessary to raise issues and concerns regarding certain critical areas impinging both on health
and population. The issues on which the colloquium sought to focus on included concerns in public
health, the relationship to macro-economic changes with particular reference to equity, women’s
agency and the possibilities offered by decentralization. Towards this end they organized a
Colloquium on Population Policies in Bangalore on the 19th and 20,h of November 2000 The
colloquium involved academics, representatives from health and women’s groups, elected women
Gavcrnmcnt of ladi.i. Ministry of Health and Family Welfare, National Population Policy 2000. New Delhi. 1996.
2
represent™, from PKls in K.mauka .nd Kerall and represent, ves fro™NCftJJ
developmental work. The p.nieip.nls were largely from the .oulhern st. e
persons with a histor, of seiions engagement with health .nd popul.uon
. Offic. k ta the
Ministr, of Health and Family Welfare at the Centre both and from Kanta^a o ned them dnnng
selected sessions. What follows is a brief summary of the presentations and d^cussions.
Salient Issues: Equity and Social Justice
Dr.Devaki Jain initiated the discussions and outlined the agenda. Over the last se,^r^^
there had been a quantum leap forward both in our understanding of tssues related to POP^‘°
and in articulate networks engaged in research and advocacy. The areas of
the links between the economic and social sectors, between the macro and mtcro She argued t
the forward movement offers an opportunity for those interested m poverty -ad.cat on n. eqmty
in social justice to reflect on social policies with special reference to the sociaHy~excluded group
-The National Population Policy (NPP), following the ideas of the Swaminathan
- had attempted to move away from both the two-child norm and target-based approach. The.e as
O however a subtle disincentive approach in the sections dealing w.th
for delivering the policy. At the same time, the NPP also emphas.zed the .mportance^of high. qua! ty
social development services at the ground level as being the most c™c'^
J" hichlishts the
people who would like to have fewer children to exerc.se that wdl. The NPP also h^hhghts th
importance of local government structures and the need to g.ve them much more space to deslg ,
implement and monitor social policies.
The colloquium was a coming together, to tease out the implications of the pohcies and to
bear influence on both policy and programs at various levels. Some parucipants at^he^wlloq
she observed, were members of the Population Comm.ss.on headed by the Prime N1lnl^r.
were members of several Working Groups set up under the aeg.s of the Gommiss.on They could
carry the insights and concerns from the colloquium into the d.scuss.ons tn these^groups. Further,
the colloquium could build a wider constituency of informed persons to bear ,nfluen“
^a.
level policies and programs. Her particular concern was that m poor coun nes,
extreme inequalities, the language of rights that should inform state pohcies was bluri ed b.the
very poverty and inequality. She also shared her concern regarding the mstruments of dehvery■o
z-j health and population policies and the need to have real devolution o power to e gras
,
Oto women in particular What is required is to use the knowledge that .s ava.lable to put on the
ground progressive policies that are enabling and empowering.
Mohan Rao, in his introductory remarks, argued that the colloquium ought to examme three
related sets of issues. At the conceptual level, the question to be asked is < o we ave a popu a i n
policy or a family planning policy? Imbricated in a population policy oug t to e a ‘s'
development, with macro-issues of income, employment, food, health and rights as the locus an
not merely strateeies for generating acceptance of contraceptives Second, what are the mstrun
for such policy? How are macro-economic forces shaping the enabling conditions nevessary
health and family planning'’ What, then, are our priorities with speciHc reference to 1 “
are issues of livelihood, poverty, inequality, hunger and ill health reflected in the
< A
there was a need for reconsidering some of the tools to attain the goals of the Nl P, specifically
SO
move to induct long-acting, provider-controlled and women-centered hormonal contraceptives in
some states and policies of incentives and disincentives in all of them.
Mala Ramanathan and Sanghamitra Acharya pointed out that the fundamental premise of
the NPP was questionable. This was the concept of population stabilization. This concept emanated
from the exercise of constructing Life Tables in a population and was thus a statistical abstraction.
Further, there are no historical precedents of populations achieving replacement or belowreplacement levels of fertility without preceding structural changes in the economy. Finally, they
pointed out that the language of rights emanating from the.ICPD at Cairo was marked by its
absence in the NPP. Padma Prakash argued that the fundamental question elided in the NPP related
to the nature and pattern of development. It was evident historically that while the relationship
between population and socio-economic development was complex and contingent on a number of
inter-related factors, population was the outcome of socio-economic factors and not the other way
around. Blindness to this lead to the incoherence in policy we witness today. On the one hand we
pursue a path of marginalizing and displacing populations through development projects as at
Narmada. On the other hand, we have coercive population control policies. The question she
mooted was, given this pattern of development, is it possible to have a people-oriented population
policy?
Padmini Swaminathan drew attention to several myths regarding population and
development. One overwhelmingly popular is, of course, the concept of over-population. But
perhaps equally significant was a misunderstanding of processes involved in demographic
transition. Thus not only .had the wrong questions been posed, the wrong lessons were frequently
drawn. Tamil Nadu’s fertility transition thus indicated to some people that we did not need the high
achievements in social development that had characterized Kerala. Political will, and female work
participation rates were isolated as an explanation for T.N’s case. Questions related to the nature
and type of work participation were bypassed in arriving at simplistic policy lessons. Again,
questions related to how macro-economic policy affects female work participation rates have not
been raised. Detailed district level analysis on female literacy and work participation, however,
revealed problems in these associations: districts with high female literacy and work participation
rates were also districts with high fertility while the converse was also true. There is thus a need to
rethink the simplistic understanding of complex issues related to population and socio-economic
change. Development thus did not automatically ensue from a reduction in numbers. There was
-3^ also a fundamental need to bring back issue of equity and structures of governance into policy
discourse.
Thelma Narayan pointed out that the NPP was based on a certain assumption regarding the
relationship between population and resources that was questionable. She wondered if the NPP is a
reflection of pressure from institutions such as the World Bank, which guide not only economic
policy but also health policy? Field experience indicates that what is expressed in policy documents
is not reflected in practice. Thus although the program is said to be target-free, this is not the
actually the case. Indeed Karnataka had come up with a pulse-lUD approach, subsequently
abandoned, that had no sanction from policy. Narayan drew attention to the fact that e\en in
Karnataka, a state with a relatively well developed and better performing health system than in
other parts of the country', financial cuts had meant that health funds were adequate only for Salary
expenditures of personnel. As a result health services were crumbling with training programs at a
4
31
and folic acid tablets. Issues of
standstill. Indeed PHCs did not have adequate SUPP^SWerC thUS
°n?e
women’s nutrition and education, and their ’^f^^Vy^ianmnu program had contnbuted to
agenda. It would not be exaggeration to state that
f
genera.e rehable data on
increase discrimination against females. When th health y
heal,h Qr popuiatlon.
births and deaths, it is difficult to beheve we can have a sounap
U Jth H Sudarshan substantiated Narayan s
A member, of Karnataka’s Task Force on
a heatth pohey to which the
arguments. He drew attention to the fact t rat w
be separated from health, drinking
population policy could be linked. Population a
synergistic manner, have to be
water and sanitation as a minimum. These togemex
tion eIC He drew attention to the
combined with other inputs such as income, employm
..ally for the empowerment
need for decentralized structures for tmplementalion of programs, P
of grassroots workers, the ANMs.
j
oniilation policy. It was cased on
Andhra Pradesh was one of the first states to ^"^‘"^^mographic transition wherein the
singular reading of Tamil Nadu’s success m achw.
determinant. Tins. Sheela Prasad
a
commitment
of
the
state
was
seen
P
fijnded
health reform package that is
political
maintained, must be seen along with the World Ban
of such reforms was not addressed,
being implemented in the state. T ie question o •
pursued family planning targets wit a
Instead, policy commitments to the contrary,
had therefore come together to launch a
vengeance. Activists from health and women s groupsJStcnlization
slate was deaf
forum known as GATS, an acronym for Groups Aga
intervencd and persuaded the
to protest from GATS, yet the World Bank sens.womerf s heaUh had a.P.
state to go soft on targets. The question she ra
Andhra was that very young women
realized Its demographic goals? The scenano
m
hystercctomy. The
were getting sterilized, and due to problems
small measure. She cautioned that the
boom in private nursing homes had contributed
>
adolescent girls now become the
RCH approach and its emphasis on adolescents not mean
focus of the program.
I
Ravi Duggal argued that
c not in fact a population policy but a family
b°'Xe« .h= Nauonal and .he S.a.c mM.
affirmations to the contrary, are ushering in e
Maharashtra's policy for example recommends w> ' ‘ ‘
host of other welfare schemes for the third child onwards.
pDS and education facilities and a
.j such niothcrs are ineligible to
contest in elections
i rihocme manifested in the collapse of
Duggal drew attention
wthdrawa o
’ nvatc sector as , result The
’ i to the overall wi
pr.nary health care and the completely unregulated g
regrenable that the Nl’l’ envisages
private sector has little comnutincnt to social goals, an
■
^ence with vertical programs m
a lamer role for this sector, at pubhc cost lie a so n
(jHC sys,em cvclt a genderthe past had revealed their manifest limitations
ising that the Nl’l’ does not relied the
sensitive KCK approach would run aground It ts thus surpns g
need for strengthening Primary Health Care, and not merely primary level care, which is distinctly
different.
Mohan Rao in his presentation dilated upon this last point. Data on deaths due to
reproduction, high as this is, accounted for merely 2.4 per cent of deaths among females in the
country. A focus on reproductive health among females was thus epidemiologically misplaced. In
all age groups among women, including the reproductive years, communicable diseases and anemia
accounted for a significantly higher proportion of deaths. This pattern of diseases and deaths,
dominated by the quintessential diseases of poverty, can only be dealt with by a comprehensive
system of universal Primary Health Care. He drew attention to the fact that macro-economic policy
had led to deterioration in enabling conditions for health: in access to incomes, employment, food
etc. This had been compounded by state withdrawal in its commitment to primary health care. This
perhaps explained the alarming increase in infant mortality rates in ten states in the country.
Rao argued that the NPP did not adequately address these necessary, enabling conditions.
What is more disturbing is that co-opting the language of rights, there is a move to introduce longacting and injectable contraceptives into the program in the name of choice. Here too, the
systematic erosion of public institutions had played an important role: contraceptive research was
being guided not by public interest or the interests of women’s health but by multi-national drug
companies and other private interests while the Drug Controller of India turned a Nelson’s eye.
Jaya Velankar forcefully argued the case for opposing coercive population policies initiated
in some states. Recalling the policies under the period of the Emergency, the Maharashtra State
Population Policy, for example, states that acceptance of a two-child norm is essential for eligibility
to the government’s welfare schemes, niggardly as they are. Further, assessment of performance of
bureaucrats is to be on the basis of performance in family planning. Acceptance of a two-child
norm is, again, made mandatory for qualifying for election to local PRIs. At the level of villages,
group incentives are being proposed, which if history is a guide, will mean that dalits will bear the
brunt of the policy. These are only a few of the range of incentives and disincentives proposed that
are anti-poor, anti-women and anti-democratic. The induction of hazardous contraceptives like
Neten and Norplant, exposes the hollowness of the claims to gender sensitivity of the policy. ■
Several speakers joined Sabu George in drawing attention to the worsening of women’s
status and health in the country with a sharpening of anti-women ideology. This was reflected in
various ways: the use of reproductive technologies for female feticide, the burden of ill health
imposed on women due to sterilization, the deterioration in sex ratios across the country, including
Kerala. A practicing obstetrician, Shama Narang drew attention to the daggers of new reproductive
technologies such as preimplantation genetic diagnosis (PGD) that could be used for the abortion of
female embryos. Decisions regarding the use of health technologies cannot be left to doctors alone
but must be guided by a moral vision of a society.
Ena Singh argued that the present context provided a window of opportunity to concerned
people. The main positive feature of the NPP was its commitment to a program without coercion.
There were other positive features such as the commitment to decentralization and to quality of
care that should be welcomed. It might be pertinent too to recall that it was donors who were
opposed to targets in the program. However, there was a disjunction between the national policy
6
33
-ntives are inconsistent with state
the iield and •»“SJ
*
„d su.e policies. Further, su.e
possible that the Commisston could set up one m
of coercion and to monitor the program.
decentralization, K.R.Nayar
dd contest the desirability and nee
decenrralizetion and
could be 7“^*/l^.rfizalion In this
:»r <h»s »P
deeentrahzauoo. For .nsian
.
variOus forms of
dec(1„cenMi<>"
“ o'e™’Cs and Subeenlers Above
out in the NPP. The focus on. te'hn°^
research that .s ep.demio og.ca
Aleyamma Vijayan observed that women^
po„c, n
renecled in any other
only when a populate. pohe^.s
X -rdXXXenre The
* aohreved
Kerala's success
had been positive on t—
While the experience with decen ra
growth in the private sector,
not really changed an a e
substantiated Aleyamma
■ — Vs
i
3
tremendous
Lijja, an elected member of a J^aT ca'reTs taking place imposing
__ oKerala
observations. She noted that Pnvat.zation oj med
care sccnart
in I was the
suffers
from neglect and
burden on the people. The second worry ng featu
syslem
medicalizat.on of health. She noted ^.^H^tion. As a consequencea even natal care is not
unable to avail of loans
concentrates only on family planm g
optionSi and are v
that Kerala was an
provided at PHCs Only the very poo -‘
attention to the fact
i0 access private care utilized, the PHCs^ SIscicnlisls believed Thus men bear no
extremely masculmized society.
abortion
responsibility for family planning
Rr* 11
'
of PHCs. ♦the
unregulated
and n
contraception. Given the poor state c. .
lhCbal The PR1 representatives from Karnataka
gi own
shake the anti- ..............major problems they identified for
health care, male m.g1 ationi and land sc involved in private scetm
poor state of schools, poor he?ic health services and the
1- expense
>nhernloTC ,he preoccupat.on in
Furthermore
concerned w,th the poor state of pubh
result of the government s (aihuc.
medical care that grew as a I-----
31
the PHC system with family planning meant that even basic medical care was not available. They
pointed out that in their districts of Northern Karnataka, it was educated and rich women who
availed of private medical care for sex determination of the fetus followed by abortion if it was a
female. This practice, they averred, had spread to almost very village. They were also unanimous
that Panchayats are given responsibilities without power. Further, there was little support to their
initiatives from higher levels. Despite all this they can now make certain that health workers are on
the job and schoolteachers too report to work and anganwadis are working. Their own first priority
would be to get more funds to get the health and education system working.
Reflecting on the discussion of health administration, Devaki Jain pointed out that currently
social development schemes were delivered through departmental functionaries but Elected
Women Representatives (EWRs) ot the PRIs were asked to take the responsibility for effective
implementation. 1 his was not possible, as they had no jurisdiction and authority over either funds
or personnel, i he component plan scheme, by which 30 per cent of development funds from al!
sectors was to be spent on women, was in fact being handled by a committee of extension
departmental functionaries. Even in Kerala where there is a process by which EWRs and
unctionaries design the utilization together, the component plan funds could not be utilized
appropriately. It was thus necessary that social development programmes, including the funds
related to them, could be devolved into committees of EWRs, and community-based organizations.
The capacity of these persons to design, implement and monitor these programmes needed to be
strengthened. Within the health sector, the personnel and the funds for availability of care,
including access to< reproductive health, could be placed in the hands of the EWRs. It is well
established that women’s capacity for self-determination is constrained by the authority of men and
other hierarchies and traditions. For this to be opened up, it is crucial that gender relations are
s la en and women are able to reclaim power or agency through the recasting of power structures,
or such a transformation to take place, the political sphere and financial power are crucial levers
t iat Panchayat Raj system offers. It has thus to be made a part especially in implementation of
services to the poor and marginalized.
Areas of Concern
Given the w:ide-ranging nature of the discussions, the colloquium prioritized the following areas of
concern.
It is clearly necessary to distinguish between the philosophy and actions towards a population
policy, and those towards a family planning policy. The former should include, besides
demographic concerns, larger issues ot sustainable and equitable development. In this context it is
necessary to spell out the links between niacro-economic policy and population. The government's
repeated stress on the need to stabilize the size of the population as a precondition for economic
development misjudges the linkages, and sidesteps the lack of effective and equitable development
policies
le NPP is not linked to an effective and equitable health policy. The fact that health itself receives
low priority among planners is a matter of great concern. It is desirable, and eminently possible,
that at least five per cent of GDP be earmarked for health.
x
It
It is
is unambiguously
unambiguously clear
clear that
that the
the state,
state, and
and stale
state alone,
alone, can play the necessary role in the universal
provision of comprehensive Primary Health Care,- irrespective of people s a i ity to pay. nmary
Health Care, as envisaged at Alma Ata, to which India is a signatory, not only implies preventive,
promotive and curative health services, but all inter-sectoral efforts to promote
t an pro on-,
life. It is thus deeply disturbing that the NPP appears to regard Primary Hea t care as mere \
primary level care.
The increase in the incidence and prevalence .of communicable diseases, in Infant Mortality Rates
and in maternal mortality attests, among other factors, to the erosion of pu ic ea t services in t e
country. There is an urgent need to arrest this alarming trend. Technology-determined vertical
programs that are expensive and ill designed cannot achieve this task. No inancia or uman
commitment to RCH can improve women’s health without the necessary enabling conditions
outside the health sector, and in the absence of universal and comprehensive Primary Heakh Care.
♦
The dilution of the state’s commitment to public health, and the subsidies gl^n t0 1
NGO sectors in the name of efficiency, bode increasing inaccessibility to health care for the people
of the country. There is an urgent need to regulate the private sector that is currently not
accountable to any institution, while simultaneously improving managerial and supervisor'
capacities in the public.
Disincentives, incentives and targets have no place in a family welfare program. Pirsh l^ey are
unnecessary, as birth rates have commenced a decline in large parts o t e country, econ
experience in the past indicates, they are ineffective and serve only to generate false program
performance data Third, the financial allocations for incentives are a drain of scarce resources that
ought to be utilized for strengthening Primary Health Care. Fourth, they inflict damage on the
credentials of a so-called welfare program by deeply alienating people, t e poor an power ess in
particular, from the health care system. Finally, they profoundly violate democratic ng ts n eet
considering the NPP is framed in the discourse on rights, it is fundamentally at variance wit ,
policies of incentives, disincentives and targets.
There is an urgent need to strengthen MCH services that have suffered as a consequence both of tlvcollapse of the public health system and the focus on the family planning program nyen t ic state
of women’s health in the country', and the state of public health services, t ere is a so ute y n
place for the inclusion of long-acting, provider-dependent, hormonal contraceptives in t c ami \
planning program Thus the induction of Nelen, Norplant, or other such contraceptives must h
firmly resisted. Al the same time, there is a need to promote uscr-contro c , .a e, e ectiv_ anc
temporary' methods of contraception. Equally important is the need to monitor anc systematic,,
study the health implications of contraception, including sterilization.
Training at all levels, from medical colleges to training programs for grass-roo.> workers needs to
be reconceptualized Health personnel have to be trained to respect and be sensitive to people
Training programs for public health personnel have been sorely neglected as a consequence of fund
cuts.
9
•wu^T***’*
3C
Strengthening the PRls is an important step in the right direction even though the experience has
not been the same all over the countiy. PRIs need to have a real devolution of powers, including
financial powers, from Zilla Parishad down to Panchayat levels. They have a crucial role in the
planning, monitoring and implementation of all health and family welfare programs, but cannot
supplant the role of the state.
The exiting data collection system leaves much to be desired. This has to be strengthened as part of
the overall strengthening of the health care system rather than by initiating parallel systems of data
collection or launching ad-hoc studies.
Research should be an on-going activity of all health and family welfare programs rather than end
term project appraisals that lead to neglect of process oriented research. Research funding should
not be centralized but should be available at different levels for appropriate, epidcmiologicaliy and
socially relevant inter-disciplinary health research. There is no place for donor-driven agendas of
research that are all too frequently epidemiologically misplaced. In this context, there is an urgent
need to strengthen public institutions of research that at one time produced nationally and
internationally acclaimed epidemiologically relevant studies but are now suffering the
consequences of systematic neglect and fund cuts. Public health research is too important to be left
to private bodies and institutions that have their own agendas or NGOs not equipped to carry out
epidemiological research. This has been the case especially with contraceptive research as
illustrated by so-called research carried out with quinacrine and with Norplant. In this context, the
role and position of the Office of the Drug Controller of India has to be substantially strengthened.
PRIs should be involved in the ethical review of research since ideas of informed consent Eave
proved problematic in the Indian context. There should be a renewed focus on the family, on
groups such as landless laborers, dalits, and other marginalized groups, especially in the light of
globalization and SAP.
Mohan Rao
Devaki Jain
Acknowledgements
We are grateful to the UNFPA for supporting the colloquium.
10
3*
t
-/
PANCHAYATI RAJ
AND
THE 'TWO-CHILD NORM':
IMPLICATIONS
AND
CONSEQUENCES--
I
A Summary otihe—
Preliminary Findings of Exploratory Studies
in
Andhra Pradesh, Haryana,
Madhya Pradesh, Orissa, and Rajasthan
Mahila Chetna Manch
January 2003
I
I
"r-i
38
I
Panchayati Raj and the 'Two -Child Norm':
Implications and Consequences
I
I
A Summary of the Preliminary Findings of Exploratory Studies
in Andhra Pradesh, Haryana, Madhya Pradesh, Orissa and Rajasthan
i
Introduction
India’s National Population Policy (NPP) of 2000 is a
significant move towards a humane and effective
development policy aimed at improving the overall quality
of life by promoting better awareness of and access to health
care options with a focus on women. As a signatory to the
International Conference on Population and Development
(ICPD) Plan of Action in 1994, India focused on inter-linkages
between population, development and gender. This new
approach was implemented at a time when widespread
grassroots changes were taking place in Indians a result
of the 1992 Constitutional Amendment. This amendment
aimed at revitalizing and guaranteeing regular election
of local bodies - panchayats — that brought forth a critical
mass of women and underserved sections of society into
these institutions of decentralized local governance.
At variance with the NPP, many states had come forward
with legislation that would disallow persons having more
than two children to contest panchayat elections and would
disqualify (•lectcd members of l^inchayati Raj Institutions
(PRIs) who had a third child after a stipulated date. This
clause, however, did not apply to a person who already had
more than two surviving children before the stipulated date,
1
f
•I
31
unless s/he had an additional child after this date. This
measure, commonly known as the ‘Two-Child Norm . was
seen as a way to regulate family size and thereby contain
population growth. It also positioned elected representatives
as ‘role models’.
Some states extended this norm beyond pcvichayciti raj
elections to cover municipalities, agricultural produce
committees and cooperatives, and also to exclude persons
from various state-sponsored programme benefits such as
loans, subsidies, poverty alleviation programmes, and
eligibility for government jobs.
/
This legislative measure has caused concern amongst
experts and women’s organizations because it is often
implemented in a non-equal opportunity environment,
where women and underserved groups stand to suffe, the
consequences of acts that fall beyond their control. The
measure is therefore of a nature to potentially encroach
on nationally and internationally agreed upon pnnc.ples
of informed choices and on reproductive rights. It could
have implications for democratic participation as well as
for women’s autonomy. It was argued that the mcas^
could be coercive and, in a highly patriarchal society s
as India, could ultimately penalize women who had little
or no control over reproductive decisions.
These concerns have, however, remained unexplored,
warranting detailed studies to examine vanous d-™nsJ™
and fallouts of the legislative measures. An informed publ .
debate could guide policy formulation. It was with this v.e
that the Ministry of Health and Family Welfare Gove, nm
of India, commissioned studies, supported by bM I A,
Andhra Pradesh, Haryana, Madhya Pradesh, Orissa, and
Rajasthan.
•>
The Studies
The Mahila Chetna Manch. Bhopal, undertook these studies
in 2001-2002 with a common framework. The five states
where the studies were conducted have slightly different
histories in terms of the introduction of the Two-Child
Norin for panchayati raj institutions. Rajasthan was the
pioneer in introducing this norm for panchayats and
municipalities as early as in 1992. but the norm became
operational in the state only in November 1995. Andhra
Pradesh, Haryana and Orissa also had the norm in place
in 1995. These studies are thus the first to examine the
experiences in some depth and set the tone for discussion,
debate, and further research.
Study Objectives
The studies seek to capture the experiences an
perspectives of those who have been disqualified or have
been subject to the process of disqualifia.tion on the basis
of the Two-Child Norm provision, as well as of those w o
arc indirectly affected, such as the spouses of disquahHed
persons. The studies also include perspectives of those
implementing this measure. The studies examinei hou
different groups in civil society, and how the media, percei
this measure.
The study objectives were to:
1.
Understand and analyze the .mplications and
consequences of the Two-Child Norm on men and
women, with special reference to their reprodm Uve
rights:
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Ho
2.
3.
Draw out and document legal and other constraints
and experiences of implementation of the norm
from the viewpoint of those who were affected
directly or indirectly, legally or otherwise; and
Make recommendations based on perspectives
emerging from the studies.
he concerns covered can broadly be grouped under two
eads: a) identification and socio-economic profiles of those
disqualified because of non-adhcrencc to the norm, the
effect of the disqualification, and mechanisms adopted to
avoid disqualification, and b) issues related to
implementation, including legal action thereof. The details
covered are as follows:
The historical perspective
Consequences of disqualification across
gender, caste and class
Socio-demographic profile of disqualified
persons
Constraints in accessing and adopting family
planning services
Abortions and related responses among
women PRI members and wives of male PRI
members
Implementation issues: filling vacancies,
mechanisms to avoid disqualification
L
Methodology
The studies are essentially exploratory and participatory
11
in nature and use primary and secondary sources of data.
Secondary data on memberships in panchayats and related
information have been obtained from offices of the Election
Commissioner of respective states. State population
censuses have been used for demographic data. Desk
reviews of policy documents, instructions, legislative
debates, judicial rulings and press-clippings have provided
additional information crucial to the studies.
Primary data were generated through fieldwork that was
carried out from July 2001 to March 2002 in two to three
phases. The research teams were briefed about the TwoChlld Norm and its related aspects, and were given intensive
training for three days. This included a one-day practical
training in the field. In each state, a minimum of two
districts was purposively selected, assuming that the data
would be available in official records. However, district
based pursuit of information did not yield results because
either none or very little basic data on disqualified persons
were available with concerned authorities (with the
exception of Haryana and Rajasthan). Hence, the final
selection of districts was based on availability of cases.
When informal sources pointed to the existence of affected
or disqualified cases based on local knowledge, these cases
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were pursued. Consequently, the number of districts studied
increased in all states. The districts included, and some
of their study-related characteristics, are given in Table
1.
■
. * I
Content analysis of court rulings
Rationale for linking population stabilization
with disincentives.
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*
*1
Table 1: Districts Included in the Field Survey
States/districts
Andhra Pradesh
1. Nalgonda
Some characteristics
Limited information on disqualified
members; high urbanization
3. Mehboob Nagar
Limited information on disqualified
members; high urbanization
Relatively large number of disqualified
members
5. Gurgaon
Cases at various stages of inquiry,
appeals and litigation; Mewat was
selected here as the most backward area
of the state; Muslim population
6. Faridabad
Relatively large number of disqualified
cases; industrially advanced
Madhya Pradesh
7. Betul
8. Vidisha
9. Hoshangabad
Statcs/districts
Some characteristics
Rajasthan
Limited information on disqualified
members; low urbanization
2. Ranga Reddy
Haryana
4. Ambala
Table 1: Districts Included in the Field Survey (contd.)
Better CPR, declining decadal growth
rate and declining sex-ratio
Low sex ratio, higher decadal growth
rate, agriculturally rich
New cases of disqualification
18 Ajmer
Aimer and Alwar identified for special
population policy measures, high GBR.
large number of PR! representatives
and also of disqualified members
19 AJwar
20. Sawai
Madhopur
21. Jaipur
Identified for special population policy
measures, high GBR
Identified for special population policy
measures, high CBR
A total of 262 respondents were interviewed with the help
of eight semi-structured interview schedules meant for
different segments of respondents as categorized in Table
2. The interview schedules were prepared in English and
were also translated into Hindi. However, the regional
language was-used wherever necessary. In addition, twelve
Focus Group Discussions (FGDs) were conducted with
community members at the village level and forty in-depth
case studies were prepared. The following table provides
details of those who were interviewed in various capacities
10. Sehore
11. Neemuch
New cases of disqualification
Table 2: Statewise Number of Respondents Interviewed
New cases of disqualification
Respondents
12. Bhopal
New cases of disqualification
Policy Makers
Programme implementera
Health and Medical officers
Lawyers
Media Persons
NGO persons
Anffciniwn: workers
Panchayat representatives
Total
Orissa
13. Cuttak
Limited information on disqualified
members
14. Khordha
Limited information on disqualified
members
Limited information on disqualified
members
15. Dhcnkanal
16. Puri
Recent case of disqualification
17. Angul
Limited information on disqualified
members
AP Hiryint MP Orltii Rajasthan Total
14
2
6
3
2
1
18
4
5
2
3
4
9
3
1
1
2
2
20
4
3
4
6
3
19
3
4
3
5
4
31
5
5
8
6
7
13
2
4
2
3
2
29138
26
38’
22
23
262
49
54
68
44
47
* 20 affected. 18 noivaffected
“ 20 affected. 7 noivaffcrted (plus one chaif|>erRon and once ex-chanpeison
intrivirwcil in the same schedule.)
ol I'llll HHIIIU ip.UllV wl»«»
7
I
I
Ibout theT^T Wh° br°Ught °Ut imP°r‘ant concerns
studies TheW
COnSCqUCnCes were s<^cted for case
studies. These concerns related, for example, to abortion
ex selection, wife desertion, or legal battles.
representatives. Participants shared their perspectives on
t e law, its implementation, and its consequences. In MP
additional FGDs were conducted as part of a second phase
of heldwork since disqualifications started only in November
Table 3: State Wise Case Studies Conducted
Andhra Pradesh
9
Constraints and Limitation of Data
Haryana
9
Madhya Pradesh
9
Orissa
6
Rajasthan
7
Data on disqualifications had to be collected at district and
block levels. Even where some information was available
at the state level, there were discrepancies. In several
instances actual numbers, when seen at the district and
block levels, surpassed those recorded at the state level.
Total
40
In addition, 12 FGDs I---------were conducted with questions on
various issues related to
~ the norm. Their break up is: Table 4: State Wise Number of FGDs
Andhra Pradesh
2
Haryana
2
Madhya Pradesh
4
Orissa
2
Rajasthan
2
Total
12
The FGDs were held at the village
”
level. The 25-30
participants included community members
of all1 age
age groups
groups
----------and different social groups, but did not include panchaijat
8
There was uneasiness and reluctance of officials in some
slates to reveal information or to give interviews on the
subject of disqualification. Given the sensitivities involved
with the Two-Child Norm and its implications, difficulties
encountered in eliciting responses of panchayat members,
especially women, had also to be kept in view.
I
i
Inadequate and inconsistent data on disqualified persons
(except in Rajasthan and Haryana to a certain extent),
official icluctance to part with information, the limited
timeframe, and nature of issues to be investigated meant
that very systematic samples could not be drawn. Nor was
it possible to have ‘control groups’ i.e., a similar number
of panchayati raj representatives with identical socio
demographic backgrounds, but not disqualified. There was
an added dimension due to the fact that some of these
persons had exceeded the norm but had not faced
disqualification. This also meant that the sampling
techniques followed in these studies were not through
rigorous procedures characteristic of large sample and
quantitative techniques. The nature of this study is such
1
.a
If
9
■
\
with panchayats gave a list of 7 cases in 9 districts. However
a quick visit to 10 districts showed 27 cases in 9 districts.
There are admittedly a large number of disqualifications
for which data are available in individual case files. For
instance, the district which gave details of 7 cases (which
formed part of the above-mentioned 27 cases) reported that
information on about 20 cases existed but that it would
be inaccessible, even at the block level. Data were similarly
not available in Andhra Pradesh. Most cases in Andhra
Pradesh were pending in civil courts with stay orders cn
that though the data are qualitatively indicative and
methodology rigorous, the findings are not statistically
representative.
In Madhya Pradesh, though the law had come into effect
in January 2001, the disqualifications started when
fieldwork was almost over in November 2001. The
consequences were therefore captured in the second phase
of the study.
/
Data/Information Available at the State Level
disqualification notices.
Where data were available from various sources, they showed
basis of the Twolarge numbers of disqualifications on the
’
Child Norm. In Rajasthan, there were: 63 disqualifications
in the one and a half years after the 2000 elections . Between
1995 and 1997, 412 cases of disqualifications had been
Emerging Concerns
While the efficacy of the norm achieving intended outcomes
has not been proven, there seem to be a large number
of unintended outcomes influenced by the implementation
environment and socio-political realities. These are
documented. One study in Rajasthan had estimated 1,579
disqualifications but with no break-up of social group. In
Haryana, in one and a half years after the 2000 election,
the list included 275 disqualifications. The actual number
for the state as a whole could be higher as the three study
districts alone showed as many as 166 cases in one an
a half years after this election. In Madhya Pradesh, the
law became effective from January 2001. There was no
awareness or action taken till October 2001, but from
November 2001 onwards, i.e. almost a year later, 52 cases
were reported from 7 of the 45 districts in the state. These
were reported in a four-month period. In Panna distnet
164 representatives had been given notice by the end o
March 2002. By then 8 districts in the state had about
200 cases.
In Andhra Pradesh and Orissa ve.7 little data were available
at any level. The Orissa State Election Commiss.on dealing
reflected below.
Proper Information dissemination not in place
.
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It has been observed that the process of
disqualifying defaulters starts only if a complaint
is lodged against any candidate’s nomination at
the time of the election or after election. It has
been noticed that people are generally uninformed
about the provisions of law and come to know of
the norm at the time of nominations or when they
receive notice, but do not fully understand its
implications. This happens more often with
women.
Case studies and FGDs unequivocally show that
low levels of literacy in general, combined with
ignorance about the law even amongst educated
11
10
.31
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contesters, and in particular among implementors,
has meant wastage of resources - both human
and financial - for those who were subsequently
disqualified. For example, amongst those
disqualified, slightly more than half (54 percent)
were either illiterate or had primary education,
whereas 3 percent were graduates or
postgraduates. The rest were educated up to
middle level (16 percent) and higher secondary
level (27 percent).
FGDs and interviews with NGOs and media persons
show that the norm has gone unquestioned. No
debate is taking place on the implications and
potential consequences of the norm on human,
democratic, and reproductive rights.
Economically and socially most vulnerable sections are
the worst affected
The norm-based disqualifications of persons and
others affected in the process (such as their
spouses) consist of a higher share of socially weak
sections of the population: 78 percent of all cases
studied belong to scheduled castes (SC), scheduled
tribes (ST) and other backward castes (OBC).
At least 70 percent of affected persons have an
annual income below Rs. 30,000/- per annum
whereas 30 percent were in the lowest annual
income group of Rs. 11,000/- per annum.
Norm a potential tool for misuse
First and foremost, disqualification hinges upon
birth of a third/additional child after a stipulated
12
A
date. Manipulation and misrepresentation of date
of birth are common and relatively easy because
of a high prevalence of home deliveries and nonregistration of births. On the other hand,
disqualifications were also being contested on the
basis of false certification of sterilization.
US is a Backward Caste, 7th standard pass, young
female sarpanch in a panchayat that has traditionally
been the political stronghold of the upper caste/class.
After three children, she had a sterilization. She was
elected sarpanch in the August 2001 elections. The
problem started after the election results were
announced. She was physically attacked by rowdy
elements when she was coming in a procession
organized by her supporters. Chilly powder was thrown
on her face. Her opponents filed a case against her
in October 2001 saying that her third child was born
after May 1995. Everyone in the village knew that
US had neither the knowledge nor the money to
defend a case in court. Her husband is a bus conductor.
US feels that rich politicians, to keep control and
power in their hands, are misusing the Two-Child
Norm law. She also feels that potential candidates,
who are poor like her, will not be able to run around
courts and spend money defending their cases, and
that this law is not in favour of the poor.
(Case study from Andhra Pradesh)
It has been observed that complaints usually start
from opposing camps after nominations arc filed
or after elections are held in order to settle old
scores or to retaliate.
13
’“A
14
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It has been observed that prolonged court
procedures and stay orders benefit some PRI
members by giving them time to complete their
tenure.
who was about one and a half years old at the time
this research was being undertaken.
(Case Study from Andhra Pradesh)
Policy makers assumed that this law would
influence fertility decisions of panchayat members
towards a small family size, and that others would
follow their example. The case studies indicate
that such an assumption may not hold true. There
are many instances of disputing the age or date
of birth of the last born child, tampering with
records and evidence (such as angantvacli
immunization records and pulse polio campaign
records), procuring false certificates, collusion with
local officials, and getting stay orders, etc.
As high as 95 percent of the disqualified persons
belonged to the age cohort of 21-39 years. There
were cases where much older relatives replaced
younger, albeit disqualified persons, because of
the stipulated cut-off dates set for disqualification.
This defeated the very purpose of reducing the
age from 26 years or more to 21 years for contesting
panchayati raj elections and encourag ng the
younger generation to participate in PRls.
There are other contested issues such as stillbirth
and birth of twins. While some states factored in
the stillbirth of the third child, or subsequent .rdant
or child mortality in determining aPP“cabil'* °f
the norm by having ‘two five children as the bas s
other states only had ‘two children M the bfll.
Similarly in the case of twins, the applicability
Case studies across states show that the norm
has been used as a strategy to either pre-empt
potentially promising political rivals or remove
them after their election. Conversely, it is possible
for some to violate the Two-Child Norm, yet work
around political factions and continue in their
SX™
in diircren. -k « ■>*
Rajasthan’s law addresses this issue.
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posts.
Women face double-edged challenge
.
„„al hone and did aoi bnnE her book ior more^hon
two years. When people enquired about his wi
old them that she was sick and had gone to he.
parents. In the two years that his wife was away,
he married again. This second wife also had a son
I
i
were disqualified
Forty percent of all candidates
a, 50 percent of
or involved in legal processes
and 38 percent of backward
scheduled castes i
L in Orissa, women constituted
castes were women
of all such cases; in Andhra
about 55 percent
stituted about 48 percent,
Pradesh this category con
further marginalized by this
Thus, women are
legislation.
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15
14
■
New women entrants in panchayats showed
pai ticipation across wider social and economic classes
as compared to earlier patterns when most came from
dominant castes and classes and from higher age
groups. This has been possible with the family support
they now receive. At the same time, however, the
Two-Child Norm acts as a barrier for them because
they are not in a position to stop their child-bearing
after a certain numbers of children, particularly in
the face of a prevalent son preference.
(Based on case studies from Haryana)
The nexus between the norm and violation of
reproductive rights is complex and not always
statistically quantifiable. Yet cases have been
observed of abortion, desertion, divorce, extra
marital affairs, (because the legal wife was sent
to her natal home to hide the third pregnancy or
child) and of giving away of children in adoption.
Although it is extremely difficult to access
information on a subject as sensitive as prenatal
sex determination and sex selective abortion of
the female foetus (people did not easily spcal^ of
it), the case studies have documented four
instances of prenatal sex selection prompted by
the need to adhere to the norm.
SB, a 30-year old Schedule Caste woman, was elected
ward member in 1997. She and her husband earn
a living by making leaf cups and plates. They have
four children. The first three are daughters. The
16
youngest is a son. She underwent sterilization when
her son was 6 months old. During her fourth
pregnancy, she had a sex determination test and was
told that it was a female. She had an abortion. In
her next pregnancy, she had the test done again and
learnt that it was male. She continued the pregnancy
and delivered her fourth child, a son.
At the time that she was removed from her post as
ward member, she had four months of her tenure
left. At that time, she told the District Collector that
since so many other PRI members also had four
children, they too should be removed. In reply, she
was informed that there were no complaints against
the others. In her case, the Block Development Officer
(BDO) had conducted an enquiry and verified the facts
from the Angantuari record, in which her children’s
names had been entered. SB stated that the complaint
against her and one other ward panch was made by
the male panchayat secretary as she, along with the
village people, had had him removed for
misappropriating funds of the monthly remuneration
of ward panches.
(Case study from Orissa)
In the studies, some reported cases of induced
abortions and attempted abortions seem to be
linked with stopping the birth of a girl child as
the third/additional offspring. There were a few
cases where the male foetus was retained even
in the face of disqualification, because for these
parents the benefits of having a son far outweighed
17
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3
47
the benefits of being a panchayati raj
representative. This issue needs further probing.
RP, a sarpanch, has six children through three wives.
The last child, a boy, was born in February 2001.
When asked about the Two-Child Norm, he took this
very lightly and said that he had heard about it from
the panchayat secretary. When informed that he was
subject to disqualification because of his son, he
replied, “The sarpanch's post is not going to support
me during my old age, but my son will. It docs not
really matter if I lose the post of sarpanch.”
(Case Study from Madhya Pradesh)
There was evidence of women getting discouraged
in view of long drawn out court cases, enquiries
and mental trauma resulting from the dilemma
between continuing in the post and a simultaneous
desire for a son or a large family. The mental trauma
is noted especially where the law has been in place
for some time. This defeats the intent of the 73"'
Amendment that attempts to facilitate and
encourage entry of women across class and caste
into panchayats.
S.M. is an educated Other Backward Caste (OBC)
woman who was selected as a pradhan of a panchayat
committee in 1995. She continued until 1998 when
she was disqualified. Her natal family was politically
well connected. She had contested on a general scat.
The birth of her third child had been a major source
of tension, though she tried to suppress evidence
I
IS
-------------------------- n 17
and pretend that the baby was from her husband s
fictive first wife. She did not want the third child,
a second son, but her husband did. “Two sons are
like two eyes,” he would say. “We end up producing
children due lo men. women arc not to be blamed",
laments S.M. She had three abortions after the
election.
S.M. showed visible signs of extreme tension. As a
lactating mother, she could not openly feed her
undeclared child or take it to meetings. Despite being
politically connected, knowledgeable about the
panchayati raj system and wanting to work, her
functioning was clearly impaired by her tense slate
of mind.
(Case study from Rajasthan)
In Sum
Population growth, is an issue that requires a multi pionged
strategy and the Two-Child Norm for panchayati raj
representatives has been seen as one of the ways to achieve
it. The five studies in Andhra Pradesh, Haryana, Madhya
Pradesh, Orissa and Rajasthan attempted to understand
the impact of this norm on governance and on fertility
decisions and reproductive rights. Although qualitative in
nature and drawing from limited primary data, they
demonstrate that the way the norm is conceptualized and
currently implemented is not without serious unintended
negative consequences. It becomes exclusionary,
particularly of those at the lower end of the caste and class
hierarchy, and discourages women from participating in
grassroots decentralized governance though PRls. The
IQ
I
manner in which fertility decisions arc impacted by the
law is not in keeping with the client-oriented spirit of the
National Population Policy or the rights-orientation
articulated in the Plan of Action of the International
Conference on Population and Development.
It appears that to the legal mind, the Two-Child Norm is
firmly positioned against issues such as population
explosion, resource depletion and sustainable development,
requiring measures to contain population growth. The
norm, therefore, is not seen by the legal mind as directly
interfering with the right of any citizen to take a decision
in the matter 01 procreation, as they see it as only generating
a legal consequence for a person who has had more than
two children on the relevant date of seeking elected office
under the Act. Given the composition of disqualified persons,
it is the persons from socially disadvantaged groups and
their spouses - women - who are likely to bear the brunt.
More importantly, the entire question is that of the efficacy
of an externally imposed norm that is inherently coercive
when seen from the perspective of informed choices and
reproductive rights. The Two-Child Norm for panchayati
raj institutions thus requires further informed critical public
debate and appraisal.
Several research issues have emerged from the studies.
These include, for example, the need for documentation
and maintenance of a database over time; the need for
critical analyses evaluating the efficacy of the Two-Child
Norm from a political, legal and socio-economic perspective;
assessment of the long-term effects of the norm on
reproductive health and reproductive rights; and the
implications for women’s autonomy.
a
* 1
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1
The Myth of Population Explosion:
Reflections in NPP and State Population Policies
Dr.
Almas All
discussion on population issues it
invariably begins with such
expressions like: "India has over
one billion people," - “it is the
second most populous country in
the world," - “in near future it will
cross China and will become the
most populated country in the
world," “large population of India is
the real reason for high levels of
poverty, low per capita income
and slow economic growth" and it
is often stated that an uncontrolled
explosion is responsible for holding
India's progress an economic
growth and is identified as a
significant hindrance for
the
country's development.
First of all I must take on the
question - yes, a very difficult
question whether India is going
through a population explosion or
put it simply whether India's
population is still growing at an
alarming rate. The question admits
NO r » th- °; as!mP,e answer-surely a definite
NO. But this straight-forward answer on its own
will not convince any one and take us very far.
We have to ask many other related questions
as well as we have to understand some basic
issues.
!
1
t
i'
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V
it
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tt
fist
O'
u
T*
w
th
■
At the outset let us start by asking ourselves a
very important and pertinent question i.e. "in
Ind'a, even today when we talk of population
why is there such an overwhelming concern for
"numbers'? No doubt, I agree, "numbers" are
always fascinating and usually carry with them
the ring of "so-called" inevitable truth. But,
unfortunately enough, in our country
population related numbers have become
matters of grave concern and often
misinformed public debate.
It is a tact that, in the last five decades India's
population has increased from 36 crores in
1951 (around the time of Independence) to
over 102 crores in 2001. The growth in
numbers of India's population has become a
perennial source of worry for everyone —
politicians, public leaders, administrators
bureaucrats, development planners, public
health experts, demographers, social scientists,
researchers and even to the common man. To
be trank, there is some sort of a “fear
psychosis" about numbers - some kind of a
number phobia". Whenever, there is any
32
R
ui
of
d<
ci
C(
st
m.
fe
m.
rehiy
Let me begin with the most basic issue i e the
issue of population growth. It has to be
understood that population growth occurs
naturally and has taken place everywhere in all
regions ot the world and India is no exception.
In order to understand this in a correct
perspective, there is a need to understand the
concept of demographic transition is usually
presented m terms of three stages of
stages of
demographic evolution:
i
*
Pg
rY<
♦
❖
❖
❖
First stage is high birth rates and high death
rates (high balance)
Second (intermediate) stage is high birth
rates and low death rates (high rate of
natural increase) and
Third stage is low birth rates and low death
rates (low balance).
!
;
*
1
1
1
1
I
b
5b
With the advancement of economic and
material progress, education, women's
!S
ias Ali
’Sues it
such
<s over
is the
•ntry in
B it will
ne the
in the
India is
'els of
come
and it
'rolled
olding
’omic
as a
the
i the
ficult
;oing
>n or
dia's
it an
imits
finite
own
/ far.
ions
•a sic
empowerment
and
availability
of
contraceptives birth rate start declining slowly
at first and rapidly thereafter and soon a stage
is reached ,.e. third stage where the birth and
death rates are equal once again i.e low
balance. Th,s cycle of changes which occurs b
any population .s known as demograph c
transition.
5 apmc
Let us have a closer look at the second
(intermed.ate) state, which is of high rates of
natural increase as a result of faster decl.be h
thX .nft a hiX'l
l
ineir initial nign levels
b'rth ra,eS maintai^g
&
This scenario characterized the world
demographic growth in second half of the 20*
WnrH'Y Wlth,an unProcedented growth rate
in lesl thanfe'?0 d°Ubled frOm 3 to 6 bi,lion
1999 and in/
y^e/rs between I960 and
99 and increased from 5 to 6 billion in just
12 years (from 1987 to 1999) while it had
tr/l bin°Ur "h65 35 mUCh ,0 double from 1 5
onwards, "ho^tlJ/ttirtKc/^Sd'wa^
was primarily the result of achievements L he
then
^xne/i^?."7 3dvanced coun'des and the
orXemn
C°St Of
o modern medicme and replicating them in
tveloping countries. Knowledge acquired in
urb.ng the spread of killer diseases^
started declining rapidly while birth rates
rates
continued to remain high. This led k
to a phase
rap'd growth in population from
•i 1951 to
As seen from the above table in 1951 the
total population of India was little over 36
crores which grew to about 44 crores in
th 6dandJ° ab°Ut 55 Cr°res in 1971- During
the decade 1951-61 absolute increase b
population was about 8 crores, decadal
growth rate was 21.6% and average annual
exponent'3! growth rate was 1 96 The
penod between 1961-71 recorded Ihe
highest ever decadal growth rate of 24 8%
'th a corresponding average annual
exponential growth rate of 2.22 with an
absolute increase of about 1 1 crores The
penod between 1971 and 1981 recorded a
marginal decrease in decadal growth rate
from 24.8«/o in 1961-71 to 24.6®% £1971
However, after 1981, in fact the population
growth
decadal
red'^d rate (both
eXP°"
en‘ial growth rate and
» rate) has
20 years the
rate and annual average
/ gr°Wth ra,e has come d<
214
d^neVnlfo
8, 1971-81 ,0 223-9% and
214 H
2-2,2odoUnn8
2.14 during 1981-91 to 21.3% and 1 93
respectively during 1991-2001. In fact the
recent decadal growth during 1991-2001
reg.stered the sharpest decline sin«
independence.
I^^nd 28Xth -ra,e haS COme d°Wn
TWs meanS in India, population growth rate
has defmitely been declining steadily over the
a st two decades. Moreover, Fertility has also
declined in the past, say in 1951, a woman
would have an average of over 6 children
(though many of them would die early) but
now the average is little over 3. That is.what
the
be
urs
i all
ion.
Population of India at
ec t
the
illy
of
Years
1901-1951
1951-61
1961-71
I 1971-fii
I 1981-91
[1991-2001
ith
th
of
tth
a Glance: 1901 - 2001
Total
Population
in CRs.
Absolute
increase
(in Crs.)
23-36
13
36-44
Decadal
growth
rate
Average annual
exponential
growth rate
8
♦21.6
1.96
44-55.
High growth
11
♦24.8
2.22
55-68
13
Rapid high growth
♦24.6
68.84
2.20
16
♦23.9
2.14
84-102
High growth with definite
18
♦21.3
1.93
signs of fertility decfine
Phase of demographic
transition
Near stagnant population
|
1
I
I
HEALTH rOR THE M.LLION? 7
——
4
-J
bL?"
h-,rchnical ,erms TFR (Total Fertility
h
come H
35 6 Or m'>nas come down to 3.2 in 2001.
child30 'S i,!1lnd,a cotjp|es oow having fewer
s-SiSE^^—
f'm rTh" TS' C,H'p,eS <)l->
till too J
tW
°VCral1 gr‘nv,h in num,’ors
c led -Po ?/ ;'gh' " ‘S bet‘H,se "<
is
ter ih v ^o/a"on|A1o'”«’fu'n"Past trends in
yt'l'ty and mortality i.e. from 145 1 to 148 1
"x;
h
declini
simply,
and be
train u
since it
will ta
rnport.
been a
h‘1S —Itellin
s ■« 6% LM2,,
^e%;^X
POIS
ln
!n aXool
"6'31 mOr,3li'y "'^^ns
h
population and increase in life
grS3 This6;15 h|elped ,O accelera't' in built
g owth. This tendency of growth is termed
• . Population Momentum in demoyrtohic
terature. In short. India has high XpXn
theX?,8 derS°nS (ab0Ut 6O‘5'“) ^o tire in
‘<JJ
to wanting more children. Even if fertility (<
j
P<,,>,ta,„,, g„nv„, ir,
tproductive age group or will soon be
1951
2
3
Crude Birth Rat.
e (per 1000
population)
Total Fertility Rate
1981
I5
6
I
I
17
I
R
I9
10
Maternal Mortality Ratio
(per 100, 000 live births)
Infant Mortality Rate
(per 1000 live births)
Literacy Rate as Percentage
Persons
Males
Females
Contraceptive Prevalence
Rate %
1991
Current
NPP Goals
for 2010
361
48'3
846
1028 (2001 Census)
1111 Current (estimate)
40.8
33.9
(SRS)
29.5
28.8
(SRS)
SRS 2000)
3.6
(SRS)
2.9 (NFHS
6.0
4.5
(SRS)
4
COI
❖
Hh
co
20*
❖
Hig
Inf.
There h
on po^
decade
Popular
1994
history (
a signify
approac
policy is
previous
control
recogni
reprodu
r,ghts.
significai
country
thinking
language
number
reprodu'
includes
- rhe N.
~
Population (in million)
Th
re;
cot
India's Demographic Progress
1
❖
“■ ‘X";' I"-* ■l™" •» -A™
e
Sr. No. Parameter
The ci
some
? ,hat ,here is a tremendous -In
NA
NA
2.1
Belov. 30
80
(SRS)
63
(SRS-2002)
18.33
27.16
43.57
56.38
29.76
52.21
64.13
39.29
65.38
75.85
54.16
22.8
44.1
48.2
Full Immunization of infants
(from 6 vaccine preventable
diseases)
98-99)
100
1 10
(SRS)
10.4
(1971)
21
437
. 407 (1998)
<92-93)
146
(1951-61)
8.86
1 107
(NFHS- 98-99)
56%
Nation;
(NPp-2(
To meet
all needs
43.8%
34%
"""H F0R THE —'' —& ottolw.Now.nt>er .00.
i
i
ANC checkup (3 visits)
Institutional Deliveries
i
100%
from the
i
oriented
the spec
i
couragec
NPP as
developn
100%
80%
Governn
Populatic
2000 is
signiricar
and viev
basoned
s fewer
increase
use the
is high.
1 though
- period
eolation
1 was as
iwanted
'o). Only
was due
ty could
acement
’I’ty and
endous
in near
•or- next
per sons
ults of
dechmng fertihty start showing explicitly. Put
sirnpb/, this decline does not look very rapid
and because India is like a fast moving expre s
tram whose brakes have just been applied bu
since .Ms very heavy and moving very fast i
wdl take time before it actually stops The
The current high
I ‘ ‘ population growth rate in
some parts of the
-.2 country is due to:
❖
The large size of the population in the
8,°“p
<•
Higher fertility due to unmet need for
20%)raCePt,°n (eStirnated contribution
onepeooauhtbeen manV ChangeS in the thinking
cutting issue is the provision of quality services
and supplies, information and counseling
besides arrangement of basket of choices of
contraceptives, m order to enable people make
informed choices and enable them to access
quality of health care services.
decades Th
TUeS during the last
decades. The international Conference on
1994 waTin nd Development <ICPD), Carlo
The NPP 2000 provides a Policy framework for
advanc|ng goals and pnoritizing strategies during
❖
High wanted fertility due to p
prevailing high
Infant Mortality Rate (IMR)
(estimated
contribution about 20%).
V of populatio'nXking^'bmughl abo^
a significant shift in frameworks, strategies and
approaches relating to population and public
obey issues. It involved a paradigm shift from
7
conmlf Io Psu/tam^T'
The peeta'5 J;:,Tcp'dPS”"
" "* w-'"”’ <«« i"
30
isv* “s’"h-”
H Nat,on‘‘1> Population Policy (NPP) 2000 Y
t I uCade ,o meet the reproductive and
to ach
needS,Of 'he Pe°plc o' lndia and
o achieve net replacement levels (TFR of 2.1>
y 2010. it is based upon the need to
simultaneously address issues of child survival
maternal health and contraception while
increasing outreach and coverage of
childKnSiVe Pa?age °f reProductive and
child health services by Government, industry and
the voluntary/non government sector working in
partnership. The schemes/programmes have
been undertaken to implement the strategic
hemes listed in the population policv for
achieving the immediate objective of meeting
he unmet needs for contraception, health care
nfrastructure and trained health personnel and
to provide mtegrated service deliverv tor basic
reproductive and child health care. Some of the
bva
8Oals ,o be achieved
uy 201°, while will lead to stable population by
2045, are:
7
National Population
Policy, 2000
(NPP-2000)
•(
ds
improve the quality of lives that people lead to
enhance ther well-being, and to provide them
wuh opportunities and choices to become
Productive assets in society. It is an articulation
of India s commitment to the ICPD agenda as
applied to the country, and forms the blue print
for population and development related
programmes in the country. Further, the Policy
aff.rms the commitment of Government
towards voluntary and informed choice and
consent of citizens while availing of
reproduct.ve health care services and
continuation of the target free approach in
dministenng family planning services. A cross
Covemment of |ndia adopted the Nitioml
India adopted the t.L;
>n February 2000. The
□ historic document and
significant step forward in t''0' U'Tlen, ‘'H'' 3
the right direction
1.
K” Fs .'p
To meet the demands in full for basic
reproductive and child health services
supplies and infrastructure.
2.
i.
Reducing maternal mortality to below 100
per one lakh live births
4.
Ach|Oving universal immunization of
children against all vaccine preventable
diseases
special concerns of reproductive health I
NfT X'erT'T'.5 ,<>rte and
Tl’9
develooment
cvntrality of human
vclopment, gender equity and equality and
HEALTH FOR THE MILLIONS /
August-September & October-November 2004
Q
j5
5.
Achieving
80%
institutional deliveries
and 100% deliveries
by trained persons
6.
Increasing use of
contraceptives with a
wide
basket
of
choices
7.
Achieving
100%
registration of births,
deaths, marriages and
pregnancies
IP^L STA7£\
■
8.
9.
jBtrrcjt
HiALrH
7.
Promoting
small
family
norm
to
achieve replacement
levels of fertility by
2010
1 1. Providing for the older population.
------------------- 3 12. Bringing
about
convergences in implementation of related
social sector programmes so that family
weltare becomes a people's centered
programme
n order to achieve, the above national sociodemograpHc goals by 2010 the following 12
strategic themes have been identified. These are:
3.
36 " HEAL™ ™™
Collaboration with and commitments from
Decentralized planning and program
implementation
levels6'^6 °f SerV'Ce delivery at village
Empowering women for improved Health
and nutrition
4.
Child Survival and Child Health
5.
Meeting the unmet needs for family
welfare services.
7
7-
Given I
Momet
popular
we intr
norm a
impose
pressur
childrer
tree. 1
particu
growth
non-government organizations and the
private sector;
9.
11. Promoting delayed
marriage for girls
2.
8.
Under-served population groups:
< unfortu
a) Urban slums;
Popula
b) Tribal
communities,
hill
area
(ignora
population, and displaced and migrant
paradi;
populations;
under;,
c) Adolescents;
becaus
d) Increased participation of
men in
paradig
planned parenthood
believe
or the
Diverse health care providers.
ingrainc
Integrating
Indian
System of medicines
,n
providing
reproductive
and
child health services
10. Making
school
education r~
up to age
14
free
and
compulsory
and
reduce drop out at
primary
and
secondary school
levels.
1.
6.
Mainstreaming Indian Systems of Medicine
and Homeopathy;
10. Contraceptive tte< hnology
‘
and research on
reproductive and < hild health
12. Information.
Communication
Education
and
The NPP is gender sensitive and
incorporates
a comprehensive holistic approach to health
and education needs of women, female
adolescents and girl child. It also seeks to
address the constraints to accessibility to
oeoV,Cet.- d.Ue
tO
heavily
Populated
geographical areas and diverse socio-cultural
patterns in the population. A primary theme
running through the NPP is provision of
quality
services and
supplies
and
arrangement ot a basket of choices. People
must be free and enable to access quality
health care, make informed choice and adopt
measures for fertility regulation best suited to
them. It is in this sprit that the NPP advocates
a small family norm.
A number of State Governments have
announced or are in the process of
formulating their State Population Policies
Thejdea of a State Population Policv was in
was in
fat to identify and address priority issues
pertinent to the specific State within a broad
framework of the National Population Policy
keeping the letter and spirit of the PoA ICPD
in tact. Unfortunately some States' have
formulated State Population Policies which
are framed in the old population control ■
a?K- aVe Seltargets for l°wering
ertility within a specified time frame The
driving force in some of these states policies
and demographic targets, population control :
objectives and disincentives, despite the fact
that the Po, ICPD to which India is a signatory
and NPP 2000 strongly rejects such an *
approach. Whatever may be the reason, the
The sir
reduct
marria^
The st
througE
Therefc
be eaS'
encour.
this st
generat
As alrt
women
before
of Biha
level t
achievt
female
also bt
adolest
social
enhanc
would .
❖
Pro
froi
❖ Inc
edi
fina
❖
Pro
inf<
ma
ext
ser
Eos
anc
of I
unfortunate fact is that some of these State
Population Policy documents are innocent
(ignorant) of any reflection of the major
paradigm shift that population policy has
undergone both globally and nationally
because either they are unaware of the ICPD
paradigm shift (which is indeed difficult to
believe in this age of information technology)
or the "old population control mindset" is so
ingrained which is still very hard to discard.
area
migrant
men in
its from
nd the
Given the crucial importance of Population
Momentum (which in a way assures further
population growth in near future, no matter
we introduce "two-child"/ even "one-child"
norm and unwanted fertility in our country to
.mpose a "two-child"/ one-child" norm to
pressunze people to go for less than two
children may simply be barking up the wrong
tree. This may be neither relevant nor
particularly effective in bringing down the
growth rate.
•edicine
arch on
and
•orates
health
emale
eks to
lity to
-dated
ultural
theme
on of
and
’eople
■uality
adopt
ted to
>cates
have
•s of
licics.
/as in
‘•sues
»road
’olicy
ICPD
have
.'hich
ntrol
ering
The
licics
ntrol
fact
Hory
i an
the
4I
The single most important factor that
can
reduce momentum is rising the age at
marriage/ cohabitation especially for girls.
The strongest impact of this can come
through mcreasing years of schooling for girls.
Therefore, population momentum can only
be eased out significantly by policies that
encourage women to delay child bearing as
this stretches out the time between
generations.
As already mentioned earlier, over 50%
women in India ages 20-24 years are married
(ok the a8e of 18, over 60% in the States
ot Bihar, Rajasthan and UP. At the national
level the age at marriage is likely to be
achieved by a further rise in the level of
ema e education. Population momentum can
also be curtailed, in part, by investing on
adolescents with emphasis on raising girls
social and economic prospects and
enhancing their self-esteem. Measures that
would accomplish this include.
4-
<•
<•
❖
Promoting valued roles for women apart
from the motherhood.
Increasing y'
—- women's access to
young
education, income earning work and
financial credit
Providing young v.
c
women
and men with
information about
--t reproductive and
marital rights, health
andI sexuality and
-............
extending their access to appropriate
services and
Fostering equality between young women
and men and improving their perceptions
of marital responsibility.
The social development of women in terms
of health of women, low infant mortality,
education and higher age at marriage are
seen as causal factors in the reduction of the
fertility. The various proximate determinants of
fertility such as age at marriage, contraception
etc. are affected through changes in gender
relations. When formal education is seen is an
essential life skill, norms regarding girls'
education change bringing with it an increase
age at marriage. Similarly, as more women enter
labour force employment, child's care becomes
more incompatible. This increases the costs of
having children. Smaller families than become
desirable. As women get more educated and
aware of modem contraception they are able
to translate their desire for fewer children into
practice provided there is higher degree of
mter-spousal communication facilitating
reproductive decisions. Better health and well
being of women enhances child's survival.
The insurance motivation for high fertility
diminishes as a consequence. If this is
possible, the role of coercive, target oriented
(like two-child/one-child norm) policies
become highly debatable.
Recently announced Common Minimum
Programme (CMP) of the UPA Government is
a very progressive document but among its
provisions is a line "A sharply targeted
population control programme will be launched
•n the 150-odd high-fertility districts" (We hope
it means multi-dimensional inputs and upgraded
livelihood health services for children and
mother, keeping their basic needs in line with
NPP).
It is indeed a little worrying trend because at a
time when the Reproductive and Child Health
(RCH) Programme is recording significant
structural and long term impact, the Indian
experience does not warrant a shift back from
the social development approach. There
appears to be a very thin dividing line between
awareness creation, gentle persuasion,
voluntary decision and of course force/
coercion. If this approach is not handled
properly, it will ultimately end up in a situation
leading to "two child" norm and the chances
of widespread sex pre selection and sexselective abortions of the female fetus leading
to distorted sex ratio in 0-6 year's child
population. The other probable fall out of this
focused campaign mode approach may be that
the health functionaries might be pre-occupied
again with family planning goals/targets and
terminal contraception (citing as voluntary
adoption), neglecting services related to
women's health and quality of care, the two
cardinal features of Reproductive and Child
Health (RCH).
Dr. Almjs Ali is the
Sennx Adstsiir m the
Pupation Found.UH>n
ot
N<.w /)effw
Dr At M.D.
lAtec^me), Phi).
iCinKjl
is j physician by
tr.in^tf' with .in
ntere^t r» tribal health
and research He also
has flair for social and
ds'seiopmmt needs
HEALTH FOR THE MILLIONS / August-September & October-November 2004
■ >7
sr
GW®©
VIKAS ADHYAYAN KENDRA
Vol VII #7/2001
information bullet? '<
Over-population as Underdevelopment.
The Myths behind “Population Control” — I
< y
"
I
p^Xpo!^
India in 1994 and ‘reproductive’ health rather than f
Y P
5
foregrounded as a new slogan from the Cairo Conference (1994) °n PoPu^ °
and Development But for all this, birth control continued to be the mam
component of the population policy. During the Emergency a po icy st»
was issued affirming the priority accorded and commitmen
P’ P
problems’ The 1993 National Health Policy stated the long-term demographies
g a“ f”a„Z Infant Mortality Rate <1MR> by 2000 bn. is yet t. be aehrey 1
And since 1991 with the imposition of SAP this Policy began to be stead y
undermined. In fact SAP led to massive injections of foreign assistance
Y
planning like the USAID project (1992) worth $325 m to provi ° '™ova
Fn family planning services’ in UP and subsequently to the whole of the cou iy.
As a result the dangerous hormonal implant, Norplant, was used on migran
th" site'tbe same year but withdrawn .iter protes^ by womens
groups In 1992 it again introduced another dangerous dr g,
p
»
and then Quinicrine to produce sterility in women. The case was ta^cn
Supreme Court leading to a ban on Qumicrine. The point however '^hat t e
•liberalisation’ of the drug policy under the SAP regime and forclEn
welfare programme raises such a threat, without fulfilling the urgent need for
!
!
’
1
safe and cheap contraception.
Since adopting the SAP-induced population policy which is not to mi prove
demographic balance and well being through greater government "'vesUnjn
in the public sector the government has been implementmg the neo-Maltbusu
solution that views birth control as the 'panacea for India s pov rty and
underdevelopment. Population policies since have been careful to ..void any
analysis of the impact of SAP on demographic balance and well beinu-
Q PACTS against MYTHS
for TKIVATECIRCULATIONVONLY*<)
I4or instance the Committee on Population
Populatio
(Karunakaran Committee) of the National
Development
Council
had
madobjectionable proposals1 like the bar or,
government recruitment of girls and boys
getting married at an early age, bar on
contesting election for people not following
the small-family norm, and the use of army
and para-miliatary forces to serve the cause
of the health and population stabilisation
though later some of these obnoxious
proposals had been withdrawn. The
government on its part while it conveniently
overlooked the positive recommendations of
the Swaminathan Committee it introduced
the 79th Constitution Aunendment Bill to the
Parliament whereby people having more
than two children would be disqualified from
contesting parliamentary election. Such
disincentives/incentive driven coercive
policies and tactics, far from promoting small
families, precipitates pressure on women
and on the poorer classes, who, even if they
are aware of the relevance of small families,
have very little control over their own
reproductive lives. Already, the politics of
population control has become apparent in
some of the States where such a exclusive
and punitive policy at the panchayat and
other levels is preventing democratic
participation of women and the poor.
According to the Indian Express (17-1-2001)
an OBC woman sarpanch in M.P, Shashi
Yadav, has become the first victim of this
legislation. On giving birth to her third child
on September 23,2001, the local District .
Magistrate imposed Section 36 of MP
i>lanCh,ayit Raj Act ^slating that any
lected office bearer giving birth to a third
hild after January 26,2001 is automatically
•barred, lhe new law was made effective
‘fter the February 2000 panchayat election
irough the amendment bills adopted by the
(ate Assembly on March 29. Since then the
■Hectors office has received other similar
>mplaints about violation of the 2-child
■ inn.
the final analysis, it is not merely issues
Ke SAP and economic globalism but also the
’ininant ideological pattern, which
inforces changes in the class-biased
proach to the demographic question,
toricallv, an important component in the
nographic imbalance was (he mass
I'ACi'S a^ninst MYTHS
enforced disk : ion of population following
communa’
- • during Partition. The
recrudesce-:
communalism aid today,
fundament; .. . .-.re ideologies th -.t seek in
denying pc.
their basic rights in the
name of reb' ~ .. While unconcerned about
providing a
.• to safe contraception and
improved qi
y of life, the approach seeks
to punish th. ; rginalised through coercive
measures.
. communalism specifically
exploits this nrmT'oach iin launching a special
campaign ,
ntrol the numbers of
‘backward’ ■
rities. By stressing the
communal di
hi mixed areas and fuelling
tensions ario.ii.
mg out of limited economic
opportunitie ; i a specific area or region,
such enginec e conflicts lead to the exodus
of certain sec i
of the people from specific
localities ; r
States resulting in
demographi
balances (via riots and
displacements o .cople from their habitats)
ultimately succeeding
_ iin ghettoising a
community.
<
Apart from avoid’ ig any critical evaluation
of the SAP-in . ced analysis of the
demographic b. lance, bilateral and
multilateral aid pencies — the World Bank,
USAID, UNFPA/' c. — determined to reduce
“population growth” — employ various
fertility control measures on women in the
South. These methods2 as Dr. S. Brahme
explains are, firstly, imposing “population
control” as a major <(•• mdition for development
aid;
secondly,
dumping
hazardous
contraceptives am(’ techniques on women;
and thirdly indulging in an i ncessant
ideological and propaganda war. An
illustration of the last is the US, which has
touted population growth as a threat to its
national security! (Quoting the journal, the
Washington Quarterly, (1989) Shiva‘ points
out: “As difficult and uncertain as the task
may be, policy makers and strategic planners
in (Jiis country have little choice in the
coming decade but to pay serious attention
to population trends, their causes and their
effects. Already, the US has embarked on era
of constrained resources. It thus becomes
more important than ever to do things that
will provide more bang for every buck spent
on national security. Policy makers must
anticipate events ami conditions before thev
occur. They must er ploy all (he instruments
of state craft at the d ■•posal •
tpopmen:
i
I
i
1
> .
I
i
fundamentalism viz
ugious
fho r
largely
unaddressed.
Despite
/
denouncement the Vatican for instance is !
considered the best guarant^ of
Ot
ln?
est annwel1 being in matter£‘ °nX
nth
and re-production especiallv ir.
nealth
women in the South. Les"we foS^th0
greatest challenge at the 1994 UN Confere
on Population and Development (ICPD?
Cairo, was-and it was not met
UCFD)’
thf. pclifc of tab wXX DC’“Zt
-y
incorporating some of the progressive
language of women’s’ and human rights
groups. The former US Administration unde?
Prcdom Clinton had f„c„ssed o““"
environment, population and woman’s riehls
rfB” s~ ~ «
naturalofresources
must.^2
be freed
growth
US TNCa. And
. for
tta SS
.““TJ."/1' req“;re
V.
I
“■* i-’^in!
minerals from abroad especially
thTus83 ?eveloped entries. That gives
the US enhanced interest in the political
! ‘
atican, and place women of the South icentre of the ‘nonnlo^- , , boutil at the
anEdXltrhae
What this imaerialistic view — the link
between resources and population growtit
XoZeiUently,blind t0 is
poTuTtion
I
by aPProPriation of
resources
South
Su?hm 6 COmm011 Pe°ple in the
south. Such appropriation - which is
y Drafl
introduced in August 2001S. >.
- tang high,, £x°°
stated nothing significant
’ had
question, which th^Sth m"6 P°pulation
long held to constitute a m
haS
primary health care More^0^^^111 °n
monetary involvement of these^d L3^31
to primary . health ca^
‘
correspondingly low vet th * • n S 1 been
health policies it aisn
r lnfluence <m
Instead the Draft repeafr Ot?°rtlOnally hi&h!
that progress in^.“1,“' ‘’““opty
e°nnetS
2002) that “a "o” <™
that. POputaioT^-^t^^^^hg
attainment of certain qn •
standards and do not precede
r
folIows
^Po^ation Policy T£1j°rZoals ofIndia’s
by making them^fZe t^°Wer W°men
Z^odT^
Planing
dX:th^oXfirStdeme-d in tbe
was later reviv • ln the earIy 80s- 11
package bv „
Z" ° 3 more ^fined
6
7 Population “experts” by
togreaouruaafim. "p :
„
iV alS0 fuels social aad political
nstabihty and unrest, as the’Zapatista
Day'S
on New Year’s
I'
Moreoyer/in the liberalised economy in
particular the language of‘choice’ becomes a
handy tool for whole variety of “population
.-Oth?°d eZper*s’It; makes population control
the demal of the right of the mdividual to
;freely and responsibly choose to have or not
have children - appear as free choice in fte
marketplace of contraceptives. But poor
women in the South as targets of such
Programmes are not 'free consumers^
Coercion rather than choice characterises
them situation in such programmes als^a
major component of other global aid
packages. (However,, due to popular
resistance to such control measures
governments have dubbed it 'Family
S f
the W°rld Bank masks it as
Safe Motherhood’!)
In India the myth exposes women to the
danger ofjiaving hazardous drugs invaded
b
n a guarded and veiled
manner and without
_
; proper information or
monitoring.
monitoring. Since
Since ; all such drugs target
------’ 'has to bear the major burden of
women, she
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this “liberalised” approach The conventional
sterilisation programmes being already
largely women-oriented (96% tubertomy and
3.5% vasectomy in 1993), these changes,
instead of moving towards a policy that
would protect her, pushes her into further
pain and suffering.
Incidentally/right choice’ is also being used
by unscrupulous sections of the medical
fraternity to promote certain pre-natal
diagnostic test for foetal sex-determination.
The Pre-Natal Diagnostic Techniqus
(Regulation and Prevention of Misuse). Act
to regulate this and ban sex determination
tests (passed in 1994) is a weak one and not
checking the trend, which, would, through
abortion of the female foetus, not only lead
to serious demographic imbalance, but also
jeopardise maternal health. Increase in
female infanticide in some States has already
affected the sex ratio adversely.
Finally, the government by failing to take up
any of the positive recommendations of the
Swaninathan Committee in 1994’exposed
itself as being anti-woman and anti-poor. ..
Instead it went ahead and introduced the 79th
Constitutent Amendment Bill to the
Parliament, whereby people having more
than two children would be disqualified from
contesting parliamentary elections believing
in the policy of incentives and disincentives.
Undoubtedly, disincentives and indirectly
coercive tactics of this nature, far from
empowering them precipitates pressure on
women and the poorer sections.
MYTH: Women having multiple
deliveries are an important cause in the
high rate of maternal deaths in the
South
FACT: This view is related to the one
commented elsewhere in this issue but takes
into account ^the particular problem of grand
multiparity. It is a well known fact that
grand multiparity is linked with inflated
maternal mortality figures in the South but
to a very limited extent in the more affluent
North. An illustration is the very low
maternal mortality in the North also in cases
of high parity. Studies in Nigeria had also
shown that high maternal mortality is
associated to high parity only if child
mortality is high. This is a parallel to the
FACTS against MYTHSM
finding in most countries of the North: what
kills the mother is not the parity but the
poverty.
Even if it is assumed a poor country with
inflated mat: rnal mortality in the high
parity range, t can still be concluded, as have
been shown m various computer simulation
studies, that the elimination of all grand
multiparty (_ > parity 5) completely will mean
a less than 5% reduction of maternal deaths.
This and sim b •^r findings indicate the limited
value of targ ng grand multiparous women
with steril •‘.tion in order to reduce the
overall ma.e.aal mortality. It must be
underscorec
owever, that the vast majority
grand mult . ious women actually have
an Hi
unmet neec -erceived by them, for fertility
control. Th’? important maternal health
aspect of g nd multiparty is distinctly
different fror.; one blaming grand multiparity
as a major “cause” of maternal mortality.
MYTH: Birth control also efficiently
reduces the maternal mortality ratio.
FACT: It is clear That zero fertility, will
automatically mean zero material mortality.
It is less clear what the impact is of fertility
regulation in the reduction of the mortality
ratio. The latter ratio is defined as the
number of maternal deaths to 100,000 live
births. In a Bangladesh study in the early 80s
it was shown that the impact of fertility
regulation was unexpectedly limited. Two
villages were set up for comparison, in which
one was subject to an intense fertility
regulation drive whilst in the other no
fertility regulation propaganda was made. In
the first village, the fertility was reduced by
26% in relation to the non-fertility regulation
village. Unexpectedly, the maternal
mortality ratio was identical in the two
villages. The explanation was that the
intensive fertility regulation programme had
not conveyed any increase in the safety a*
birth in the village. That is, thos
pregnancies being needed did not enjoy an;
better protection in the fertility regulatic
village than in the other village.
A conclusion is that fertility regulatio .
while reducing the actual number oi
pregnancies, did not achieve a better safc'.y
at birth or could even have been
counterproductive to better safe mother.
5^
MYTH: Birth control, after all, was an
important factor in the decline of
maternal mortality in the North.
FACT: In the North the maternal mortality
ratio dropped considerably from levels of
around 1000 to about 5 maternal deaths per
100,000 live births over a period of 300 years.
Much of this decline occurred prior to any
kind of modem contraception was available.
A similar pattern has been found in other
situations. Much more important a factor was
the advent of midwifery, particularly in
remote areas and the recognition of health
and hygiene for the reduction of post
delivery infection. Still further was the
availability of antibiotics and blood
transfusions and when antenatal care and
hospital deliveries were introduced for and
utilised by >90% of pregnancies.
Fertility regulation has its own value, which
is indisputable. Health-oriented provision of
contraceptives in order to empower women
(and men) to plan for optimal reproductive
health and voluntary spacing of births do not
need discussion. The controversial point is
when birth-control is claimed to be so
efficient in the curbing of the inflated
maternal mortality in the South that it is
given.priority
ahead
of a
more
comprehensive and efficient maternal and
reproductive health care. Studies have since
demonstrated conclusively that "efficient
health-care is more effective than fertility
regulation in preventing maternal deaths."
MYTH: By effectively addressing the
unmet demand for contraception will
result in
significantly reducing
population growth rates.
PACT: Proponents of the family planning
approach cite data showing that in many
countries of the South almost half of all
women of child-bearing age want no more
children but (unfortunately) lack easy access
to birth control. Fertility rates would drop
by a third if this unmet need were met.
Ibis argument entails a huge assumption:
without transforming social reality
('specially the powerlessness of women visa vis men and the meagre access of the poor
to food security and other resources - women
will in fact be able to act on their stated
desire for fewer children. But this begs this
I,;vS'I2S aKi''«istMYTHSA;;> '. ■;<
question whether many women indeed
declare their preference for fewer children
yet lack the power to act on their preference
- even if the technical means of birth control
were available?
In other words, to believe that the mere
provision of contraception will suddenly
allow women to step out of their subordinate
role in the family, or alter the fact that
children still represent a source of security
for many parents in countries of the South,
is to ignore the findings of decades of
fertility-oriented research.
Moreover, if unmet demand were truly as
great as it is assumed, why have population
planners had to and still resort to incentives
and disincentives? In some cases, outright
coercion has been deemed necessary to get
people to accept birth control, suggesting
that people must be made to set aside their
own judgements, about their need for
children!
As part of their single-minded effort to
promote birth control a number of agencies,
globally and nationally along with willing
governments have not only sought to respond
to existing contraceptive demand, but have
actively worked to increase it. While some
strategies are relatively innocuous - TV sit
coms promoting new family size norms — a
wide variety of incentives and disincentives
are used to induce people to undergo family
planning measures or to use contraception
MYTH: Birth control directed towards
‘high risk" women will also be
particularly successful to reduce
maternal mortality.
FACT: Most maternal deaths occur among
women with medium number of children in
the family (parity 2-4) within the 20-35 age
group. This fact is, however, often overlooked
in the risk approach strategy for lowering of
maternal mortality. The consequence is that
interventions in Tiigh risk” pregnancies will
improve conditions in small groups of women
and will have limited overall impact on
maternal mortality. This conclusion is
derived from various findings. A Bangladesh
study (1968-70) was highly revealing It was
calculated that if all births had been averted
in women i) below age 20. ii’ above age 39
and iii) beyond parity (> the maternal
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I jyiYTH: Islam does not permit family planning.
I
I FACT: The basis of this myth emanates from the logic that Islam values the family I
I and encourages procreation. In support of this cor
rsion, two pieces of evidence
I are often cited viz., that the Qur^an prohibited Mue •ns
from killing their children
I for fear of want. Second that the Prophet exhorted uslims
to multiply. However,
I this argument does not do justice to the complexity
the Islamic position and the
I totality of its teachings. Otherwise, it would be imp^.
t
I fact that the Prophet knew that some of his comp. _ble to explain_ the established i
including his cousin
Ali,
I practised al-‘azl (coitus interruptus) and yet he did otons,
6
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prohibit the practice.
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I The bigger picture of the Islamic position on family lanning is its departure point
I in encouraging the life principle. Hence, the Prophets exhortation to multiply and I
I the Qur’anic prohibition of infanticide, a wide-spread pre-Islamic practice involving j
I bom children which was motivated mostly by. econo -aic and gender considerations.
I But such a basic position does not necessitate the o qclusion that con traception,orJ/|
I even abortion, is prohibited. Indeed, historically, th< majority view among Muslim t
I scholars on contraception has been that it is perm’ jible with the wife’s consent, J
I though perhaps disliked in certain cases. The wife’s consent is required because
I Islam recognises the wife’s right to sexual enjoyment and procreation.
1
I A leading proponent of this view is Imam al-Ghazali (d.llll) who also notes on i
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contraception that there are no such prohibitions. In fact, the opposite is true. His
I analogical
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logic is startling in its simplicity. In one part of his argument, he notes
I that, despite
prophetic exhortation to multiply, it is nevertheless permissible n
I for a Muslim the
to remain single. The effect of remaining single on multiplying, he
I
reasoned,
is
no
different than the effect of practising al-'azl. Since the one is : i
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I permitted, it follows that the other, without more, is also permitted. He further
I argues that although contraception is permissible, it is 'makruh* (adjective meaning i i
disliked or disfavoured”) if practised to avoid, for example, female offspring. One
I
t
major
justification for this conclusion is that preference for male offspring is frowned
I
I upon in the 'Qwr'an’. Al-Ghazali, however, supports contraception for other’reasons t
as protecting a woman from the dangers of childbirth, avoiding poverty, anrkv<*
I such
even preserving a woman’s beauty?
*
I
I In the case of family planning through contraception, the wish to avoid poverty does
I not infringe on the right to life of a born human being. To the contrary, its goal is to
I preserve a dignified quality of life for those already born. On the other hand, using i
I contraception to avoid having more females reflects a worldview and a value system
I antithetical to that of the Qur’an. It was thus 'makruh! and discouraged by scholars ?
I like al-Ghazali.
3
I
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I Other jurists agreed with al-Ghazali’s basic position on contraception but disagreed
I on what constitutes *makruh' behaviour. Such disagreement may very well have $
I been founded in their disparate historical and cultural experiences. In other words, >5
I these are the kind of differences anticipated and tolerated by the principle, viz., that
I laws change with changes in time and place, and perhaps the other principles of *?
I 'ijtihad'.
I Concretely, according to the 1961 and 1981 census reports the number of Muslims in I
I comparison to the total population of India during the last 20 years (1961-81) has t
I risen from 10.7 per cent to 11.4 per cent i.c. 0.7 percent only. Additionally, during 4
I
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the 1981-89 period Muslims accepted temporary methods of family planning that
was enhanced by 11.4 per cent in comparison to previous period whereas Hindus for
instance such increase was only 10 percent. Family welfare Operation Camps in
various districts of West Bengal during 1980-94 showed that a large number of
Muslim women were getting operated along with Hindu women. Most were from
low-income families and the daily grind of maintaining 3-4 children were their main
driving forces while adopting the permanent method.
MYTH: Artificia I contraception is unethical and voluntary abortion may never
be licit and it is against the teaching and doctrines of the Roman Catholic
Church.
FACT: In technical terms of Catholic moral theology, the moral permissibility of
artificial contraception and voluntary abortion is a “solidly probable opinion”, i.e.,
one that all Catholics may follow in g^ood conscience. Contraception is not only licit
■’
’
| i(”>i>ut may often be morally mandatory. "Likewise,
the choice ofn an abortion
—- a choice
|
______ r--T1__ 1______________________
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J
_______ i_ 1_______________
that, -•ironically,
becomes more necessary when
artificial
contraception
is banned — is
I a moral option for women in many circumstances. This is common teaching among
I Catholic and Protestant moral theologians.
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In this context it must be noted that the problems of over-population, merely dumping
1
condoms on them cannot solve the death of women from reproductive-related causes,
]
but they will also not go away without condoms. Furthermore, as some experts and
’i
specialists have maintained,
ieu, auuiLiuii
abortion lias
has performed
peiiuniieu a cruuiai
crucial luxe
role m
in uiusu
most wu
countries
.ixulj.co
that has moved from al
’’ fertility
'*’*■ rate
' to replacement
’
. levels rates
• 7 Artificial
*
high
...
contraception and abortion are not the final or main solution to these problems, butfqj
they are essential options.
MYTH: The Roman Catholic Church’s position to contraception and other
artificial forms has no negative impact on efforts to provide reproductive
health care services to women and the fight against the AIDS pandemic.
FACT: The Roman Catholic Church under the aegis of the Vatican exerts enormous
power and control to foil
any
torprovide
reproductive health care-services for
|
-----, efforts
-----------------------u poor women in the South and to stop AIDS.
4
Toillustrate:
] ^^„sPec^^y
I
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In 1999, the Vatican
released an official document sstating that providing Catholic
_______________
women who had been raped in Kosovo with emergency contraception was
equivalent to promoting abortion. Previously, in reference to women in Bosnia,
the pope went to the extent of stating that raped women should “accept the enemy”
and make “flesh of their own flesh”;
In 1996, in Nairobi, Kenya, where the AIDS epidemic exploded among young
women, Cardinal Maurice Otunga, Kenya’s leading R.C. church official, burned
boxes of condoms and safe sexual literature. The same year, Kenyan Catholic
Bishop John Njue had even propagated false scientific information by claiming
that condoms are to blame for the spread of AIDS;
In 1996, the local R.C. church in Tegucigalpa, Honduras prevented the distribution
of one million condoms by health and election officials at polling stations during a
primary election. Honduras has the highest incidence of AIDS in Central America;
FACTS against MYTHS
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mortality ratio would have declined from 570
to 430 per 1000.000 live births. Even with
this extremely non-realistic achievement of
virtually cutting off all births from
recognised risk” groups, a very limited gain
in maternal mortality would have followed.
In spite of the widespread belief that age and
parity are exceptionally important in any
strategy for the reduction of maternal deaths
can be concluded that it is not the age/parity
distribution of births that explains the lower
material mortality in the rich North. Instead,
most maternal deaths occur to women at low
risk. This seemingly paradoxical point can
V
be explained by the fact that available risk
markers are not very efficient in predicting
maternal death, h’or instance, there are no
risk markers to predict death from abundant
vaginal bleeding due to a non-contracting
uterus, nor to death causeway post-delivery^
infection. But there is one albeit an
inefficient risk marker for eclampsia, that is
pre-eclampsia (high blood pressure
associated with pregnancy). Still, it is known
that a significant number of eclamiptic deaths
appear quite unexpectedly like “out of the
blue.”
Learning the Population Jargon5
Crude Birth Rates: xhe crude birth rate. CRB, literally measures the number of live births for\_
every t ousand women. The CRB refers to a country as a whole or to a pa icular subgroup within a
^ru<^e reIers f° the fact that it does not take into account the age structure of a population,
w ic greatly affects the number of births ii. any given year. For example, if two countries have the
same num er of people, but one has twice as many women of childbearing age, it will have a much
ig er crude birth rate. For this reason, the CBR is not directly comparable across countries, or even
across time. It is often used by demographers when better measures are lacking.
Total ^Fertility Rates: This rate, or TFR, can be thought of as the average number of children that
a woman will have over her reproductive lifetime. It is hypothetical in the sense that it does not
represent the lifetime experience of any particular woman or group ofwomen, but represent a mposite
measure. The TFR is calculated as the sum of birth rates specific to each age group ofv
on and
assumes that each cohort’s fertility will hold during the lifetime of the ‘hypothetical womaif
t
Population Growth Rate: The population growth rate is the rate at which a particular population
is growing each year. It is calculated relative to a base population size (say, the population size in the
preceding year), and reflects the effects of births, deaths, and migration.
Replacement Level: A population that is at replacement level will exactly replace
course of a generation with no growth and no decline. In the industrialised North, replacement level / ’
usually corresponds to a TFR of 2.1; in other words, each woman would bear two child'
rep ace herself and the other to replace her mate (The additional .1 births is necessary
/set a
$ma number of infant deaths and childless women). In the South, replacement levels arc
jsvhat
higher about 2.5 — because of the higher infant death rates,
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-sFacts Against Myths is a monthly bulletin offactual
information on a number ofdevelopment myths and
fallacies, etc, including information against alien
development models, paradigms and false concepts
on caste, creed and gender.
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Produced and Published by :
Vikas Adhyayan Kendra
D-l Shivdham, 62 Link Road,
Malad West, Mumbai 400 064, INDIA |
« : 882 2850 & 889 8662
Email : vak@bom3.vsnl.net.in
Fax: 889 8941
Design & Layout: Kartiki Desai
Printed b> : Omega Offset, 4574, Shettv Gaily
Bclgaum 590 002. S 0831-424124/433429
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VIKAS ADHYAYAN KENDRA
Vol vn# 8/2001
INFORMATION BULLETIN
Over-population as Underdevelopment:
The Myths behind “Population Control” — II
r
’ a
he 2001 State of the World’s Population report, published by the UNFPA
states that the world population will grow by 50%, from 5.1 b. in mid-2001 to
9.3 by 2050, with all the projected growth taking place in the South.
Undoubtedly, population growth is a serious concern but a bugbear especially
among population “experts” in the North. The seemingly intractable
problems of poverty and under-development of the region invariably ends
up in the ^conclusion that
virtually all of its problems are
rooted in “population explosion”,
“over-population”, etc. The
underlying themes of these
problems are that the poor are
poor because they have too many
children. To illustrate: India is
backward “because it has too
many people” and similarly other
iQj
countries of the South are what
and where they are because they
are not doing enough to control.
their exploding populations” and
having failed “in meeting
population targets”. To that
extent the only “solution”,
therefore, is family planning.
I
Q^FOR?rRiVATEy0RtUIl\TldNyo^ LYiJ^)
•***wwr%i
z
H
This victim-blaming syndrome has been
increasingly evident not only at the
national level but also in the global
discourse on the future of the planet. The
South, with their large populations, are
blamed for all manner of social and
environmental ills giving rise to a number
of assumptions on controlling population
growth in the region. The three main ones
being
Rapid population growth is the
primary cause of the problems of
underdevelopment and threatens
the entire natural world;
The poor of the South must be
persuaded to have fewer children
whether or not their conditions of
poverty change;
Like other western development
schemes, birth control technology
can be delivered to women in the
South in a top-down-, technocratic
manner with the right combination
of media advocacy. The goal is not
to improve health care services but
to prevent pregnancy (viewing
women as objects of reproduction
rather than as subjects of their own
decision-making goals and in
defining their own life);
This philosophy has since shaped the
activities of most population “experts” and
organisations and international aid
agencies in the South as well as among
ethnic minorities and poor communities in
many parts of the North itself. In 1958
Sweden became the first government to
provide international aid for population
control, first to Sri Lanka and then to
Pakistan. In 1966 the UN General
Assembly reached a consensus about
population assistance” a label that
eschewed control and limitation. The label
ms since become a euphemism for all global
funding of condoms, IUDs, the pill and
Karman tubes, as well as US university
demography department, international
bureaucracies and local workshops. These
C KA ere nea~inst MYTHS
“experts” have also appropriated the
language that appears reasonable,
progressive and eve.: sensitive — some of it
is even co-optea from the women’s
movement. To illustrate: a 1989 de
classified US National Security Study3
states that the US support derives from a
concern and spacing of children. Thus, it
smuggles and fits into its population
control policy the language of‘choice’ that
global financial institutions including
institutions like the Vatican also find it
convenient to introduce in their rhetoric.
Further, the obsession with the thesis of
“over-population” (the Demographic Trap)
is one of the biggest global red herri ngs in
the development discourse. Sustr-• nable
energy and relative scarce resources,
practised in the South, but used within a
framework confuses cause and effect. While
this confusion is basically ideological, it
reveals how ideologies mask reality and
determine perspectives. Moreover, it soon
becomes clear that the obsession with
population is a substitute for a proper
concern with social justice: this must be
avoided at all costs, for it also calls into
question the dominant ideology in the
world and mimicked by the ruling bloc in
the country.* Is it any wonder, then,
population growth ii: India continues to be
a seemingly intractable problem with
crores having already been invested on its
“control”. Taking a closer look at the
rhetoric of population planning therefore
becomes an essential prerequisite in
dismantling some long-standing myths
that has accompanied it.
MYTH: The major causes of hunger
and poverty in the world today are
uncontrolled population growth and
density.
FACT: Not so!
Western Europe has an average
population density of about 98 people per
square kilometre <with Holland having
over 1,000 per sq.km.\ Africa as a whole
has an average of only 18 people per sq.km
T
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i
assistance and population planning every bit
as much as new weapons systems)".
These policies and ideologies fail to however
consider an important aspect of religious
fundamentalism viz., the fundamentalism
most women are confronted with but left
largely
unaddressed.
Despite
its
denouncement the Vatican for instance is not
considered the best guarantor of women’s
interest and well being in matters of health
and re-production especially in respect to
women in the South. Lest we forget: the
greatest challenge at the 1994 UN Conference
on Population and Development (ICPD),
Cairo, was - and it was not met — to transcend
the politics of both Washington DC and the
Vatican, and place women of the South at the
centre of the ‘population’ discourse: as
subjects, determining their lives and health,
not as objects of State, or Extra
Constitutional State systems and the
demographic Establishment.
,
In the circumstances it is hardly surprising
that India’s National Health Policy Draft
introduced in August 2001 has been critiqued
as being highly inadequate. The Draft had
stated nothing significant on the population
question, which the health movement has
long held to constitute a major drain on
primary health care. Moreover, the actual
monetary involvement of these aid agencies
to primary .health care has. been
correspondingly low yet their influence on
health policies is disproportionalljr high!
Instead the Draft repeats the usual tautology
that progress in public health has been
nullified by population growth. However, as
Prof. Malini Karakal noted in “One India,
One People" (January 2002) that this mantra
contradicts all evidence available globally
that population stabilisation follows
attainment of certain socio-economic
standards and do not precede them.
XA1YTH: One of the major goals of India's
\^/Population Policy is to empower women
by mailing them free to exercise choice
in the variety of new family planning
methods.
FACT: This myth first emerged in the North
during the 60s, 70s and in the early 80s. It
was later revived into a more refined
package by population “experts" by
incorporating some of the progressive
language of women’s’ and human rights
groups. The former US Administration under
President Clinton had focussed on the
environment, population and womens rights
as driving force for its foreign policy in a new
global politics. The. underlying motive,
however, was the urgency to control
population growth in the South because its
natural resources must be freed for the
growth of US TNCs. And above all “...the US
economy will require large and increasing
amounts of minerals from abroad especially
from less developed countries. That gives
the US enhanced interest in the political,
economic and social stability of the supplying
countries."3
What this imperialistic view — the link
between resources and population growth —
is conveniently blind to is that population
growth is sparked off by appropriation of
resources from the common people in the
South. Such appropriation - which is
necessary for diverting resources from people
to TNCs — also fuels social and political
instability and unrest, as the Zapatista
uprising in Mexico highlighted on New Year’s
Day, 1994.
•
Moreover, in the liberalised economy in
particular the language of ‘choice’ becomes a
handy tool for whole variety of 'population
control” experts. It makes population control
— the denial of the right of the individual to
freely and responsibly choose to have or not
have children — appear as free choice in the
marketplace of contraceptives. But pool
women in the South as targets of sucl
programmes are not 'free consumers’
Coercion rather than choice characterise
their situation in such programmes also
major .component of other global a
packages. (However, due to popul
resistance to such control measun
governments have dubbed it Fam
Planning’ and the World Bank masks it
'Safe Motherhood ’!)
In Indio, the myth exposes women to
danger of having hazardous drugs inv:
into her, frequently in a guarded and v
manner and without proper informnti*
monitoring. Since all such drugs t:
women, she has to bear the major bun’
i
I
GC'
this liberalised approach. The conventional
sterilisation programmes being already
largely women-oriented (96‘T tubertomy and
3.5% vasectomy in 1993\ These changes,
instead of moving toward ; a policy that
would protect her, pushes her into further
pain and suffering.
Incidentally,‘right choice’ is also being used
by unscrupulous sections of the medical
fraternity to promote certain pre-natal
diagnostic test for foetal sex-determination.
The Pre-Natal Diagnostic Techniqus
(Regulation and Prevention of Misuse). Act
to regulate this and ban sex determination
tests (passed in 1994) is a weak one and not
checking the trend, which would, through
abortion of the female foetus, not only lead
to serious demographic imbalance, but also
jeopardise maternal health. Increase in
female infanticide in some States has already
affected the sex ratio adversely.
Finally, the government by failing to take up
any of the positive recommendations of the
Swaninathan Committee in 1994 exposed
itself as being anti-woman and anti-poor.
Instead it went ahead arid introduced the 79th
Constitutent Amendment Bill to the
Parliament, whereby people having more
than two children would be disqualified from
contesting parliamentary elections believing
in the policy of incentives and disincentives.
Undoubtedly, disincentives and indirectly
coercive tactics of this nature, far from
empowering them precipitates pressure on
women and the poorer sections.
MYTH: Women having multiple
deliveries are an important cause in the
high rate of maternal deaths in the
South
FACT: This view is related to the one
commented elsewhere in this issue but takes
into account^the particular problem of grand
multiparity. It is a well known fact that
grand multiparity is linked with inflated
maternal mortality figures in the South but
to a very limited extent in the more affluent
North. An illustration is the very low
maternal mortality in the North also in cases
of high parity. Studies in Nigeria had also
shown that high maternal mortality is
associated to high parity only if child
mortality is high. This is a parallel to the
Tacts against myths.#.
finding in m< - countries of the North: what
kills the m.r is not the parity but the
poverty.
Even if ft i; .;sumed a poor country with
inflated mr rnal mortality in the high
parity range can still be concluded, as have
been shown
various computer simulation
studies, thn he elimination of all grand
multiparty (_ parity 5) completely will mean
a less than 5^ reduction of maternal deaths.
r findings indicate the limited
This and sin
ng grand multiparous women
value of tar;
rion in order to reduce the
v/ith steril
overall ma. aal mortality. It must be
^wever, that the vast majority
underscorec
Ijus women actually have an.«^- j
grand mult
mceived by them, for fertility
unmet neec
important maternal health
control. Ti
aspect of g ad multiparty is distinctly
different fro:v one blaming grand multiparity
as a major “cause” of maternal mortality.
MYTH: Birth control also efficiently
reduces the maternal mortality'ratio.
FACT: It is clear that zero fertility, will
automatically mean zero material mortality.
It is less clea_* what the impact is of fertility
regulation in the reduction of the mortality
ratio. The latter ratio is defined as the
number of maternal deaths to 100,000 live
births. In a Bangladesh study in the early 80s
it was shown that the impact of fertility
regulation was unexpectedly limited. Two
villages were set up for comparison, in which
one was subject to an intense fertility
regulation drive whilst in the other no
fertility regulation propaganda was made. Ir
the first village, the fertility was reduced by
26% in relation to the non-fertility regulation
village. Unexpectedly, the materna1
mortality ratio was identical in the two
villages. The explanation was that the
intensive fertility regulation programme had
not conveyed any increase in the safety r
birth in the village. That is, thos
pregnancies being needed did not enjoy an;,
better protection in the fertility regulatk
village than in the other village.
A conclusion is that fertility rcgulatio
while reducing the actual number
pregnancies, did not achieve a better safe .
at birth or could even have bo
counterproductive to better safe mother.
£7
assistance and population planning every bit
ds much as new weapons systems)”.
These policies and ideologies fail to however
consider an important aspect of religious
fundamentalism viz., the fundamentalism
most women are confronted with but left
largely
unaddressed.
Despite
its
denouncement the Vatican for instance is not
considered the best guarantor of women’s
interest and well being in matters of health*
and re-production especially in respect to
women in the South. Lest we forget: the
greatest challenge at the 1994 UN Conference
on Population and Development (ICPD),
Cairo, was - and it was not met—to transcend
the politics of both Washington DC and the
Vatican, and place women of the South at the
centre of the ‘population’ discourse: as
subjects, determining their lives and health,
not as objects of State, or Extra
Constitutional State systems and the
demographic Establishment.
In the circumstances it is hardly surprising
that India’s National Health Policy Draft
introduced in August 2001 has been critiqued
as being highly inadequate. The Draft had
stated nothing significant on the population
question, which the health movement has
long held to constitute a major drain on
primary health care. Moreover, the actual
{W
monetary involvement of these aid agencies
to primary .health care has. been
correspondingly low yet their influence on
health policies is disproportionalljr high!
Instead the Draft repeats the usual tautology
that progress in public health has been
nullified by population growth. However, as
Prof. Malini Karakal noted in “One India,
One People” (January 2002) that this mantra
contradicts all evidence available globally
that population stabilisation follows
attainment of certain socio-economic
standards and do not precede them.
One of the major goals of India’s
Population Policy is to empower women
by making them free to exercise choice
in the variety of new family planning
methods.
FACT: This myth first emerged in the North
during the 60s, 70s and in the early 80s. It
was later revived into a more refined
package by population “experts” by
incorporating some of the progressive
language of women’s’ and human riS s
groups. The former US Administration under
President Clinton had focussed on the
environment, population and women s rig ts
as driving force for its foreign policy in a new
global politics. The underlying motive
however, was the urgency to control
population growth in the South because its
natural resources must be freed for the
growth of US TNCs. And above all “...the US
economy will require large and increasing
amounts of minerals from abroad especially
from less developed countries. That gives
the US enhanced interest in the political,
economic and social stability of the supplying
countries."3
What this imperialistic view — the link
between resources and population growth —
is conveniently blind to is that population
growth is sparked off by appropriation of
resources from the common people in the
South. Such appropriation - which is
necessary for diverting resources from people
to TNCs - also fuels social and political
instability and unrest, as the Zapatista
uprising in Mexico highlighted on New Yearns
Day, 1994.
|
Moreover," in the liberalised economy in
-------------.‘ ’
particular the language of- “
choice*
becomes3 a
h^T/uoffor whole'variety of “population
control” experts. It makes population control
- the denial of the right of the individual to
freely and responsibly choose to have or not
have children - appear as free choice in the
marketplace of contraceptives. But pooi
women in the South as targets of sue!
programmes are not 'free consumers
Coercion rather than choice characterise
their situation in such programmes also
major component of other global a'
packages. (However, due to popul
resistance to such control measure
governments have dubbed it Fam
Planning’ and the World Bank masks it
'Safe Motherhood’!)
In India, the myth exposes women to
danger of having hazardous drugs invr
into her, frequently in a guarded and y<
manner and without proper informatv
monitoring. Since all such drugs t:
women, she has to bear the major burc’
*
\
8
this “liberalised” approach. The conventional
sterilisation programmes being already
largely women-oriented (96‘?3 tubertomv and
3.5% vasectomy in 1993), these changes,
instead of moving toward ; a policy that
would protect her, pushes her into further
pain and suffering.
Incidentally,‘right choice’ is also being used
by unscrupulous sections of the medical
fraternity to promote certain pre-natal
diagnostic test for foetal sex-determination.
The Pre-Natal Diagnostic Techniqus
(Regulation and Prevention of Misuse). Act
to regulate this and ban sex determination
tests (passed in 1994) is a weak one and not
checking the trend, which would, through
abortion of the female foetus, not only lead
to serious demographic imbalance, but also
jeopardise maternal health. Increase in
female infanticide in some States has already
affected the sex ratio adversely.
Finally, the government by failing to take up
any of the positive recommendations of the
Swaninathan Committee in 1994 exposed
itself as being anti-woman and anti-poor.
Instead it went ahead arid introduced the 79th
Constitutent Amendment Bill to the
Parliament, whereby people having more
than two children would be disqualified from
contesting parliamentary elections believing
in the policy of incentives and disincentives.
Undoubtedly, disincentives and indirectly
coercive tactics of this nature, far from
empowering them precipitates pressure on
women and the poorer sections.
MYTH:
Women having multiple
deliveries are an important cause in the
high rate of maternal deaths in the
South
FACT: This view is related to the one
commented elsewhere in this issue but takes
into account the particular problem of grand
multiparity.4 It is a well known fact that
grand multiparity is linked with inflated
maternal mortality figures in the South but
to a very limited extent in the more affluent
North. An illustration is the very low
maternal mortality in the North also in cases
of high parity. Studies in Nigeria had also
shown that high maternal mortality is
associated to high parity only if child
mortality is high. This is a parallel to the
< FAcrs against MYTHS.#?
•y •
finding in m< " countries of the North: what
,r is not the parity L-ul the
kills the mpoverty.
Even if it i. . sumed a poor country with
inflated m: rnal mortality in the high
can still be concluded, as have
parity range
various computer simulation
been shown
studies, tha he elimination of all grand
multiparty (_ parity 5) completely will mean
a less than 5^ reduction of maternal deaths.
This and sin . r findings indicate the limited
ng grand multiparous women
value of tar;
i ion in order to reduce the
with steril
overall ma.M. aal mortality. It must be
□wever, that the vast majority
underscores
grand mult . ious women actually have an
mceived by them, for fertility " ■
unmet neec
important maternal health
control. Tj
nd
multiparty is distinctly
aspect of g
different froione blaming grand multiparity
as a major “cause” of maternal mortality.
MYTH: Birth control also efficiently
reduces the inaiemal mortality ratio.
FACT: It is clear That zero fertility, will
automatically mean" zero material mortality.
It is less clear what the impact is of fertility
regulation in the reduction of the mortality
ratio. The latter ratio is defined as the
number of maternal deaths to 100,000 live
births. In a Bangladesh study in the early 80s
it was shown that the impact of fertility
regulation was unexpectedly limited. Two
villages were set up for comparison, in which •<
one was subject to an intense fertility
regulation drive whilst in the other no
fertility regulation propaganda was made. In
the first village, the fertility was reduced by
26% in relation to the non-fertility regulation
village. Unexpectedly, the maternal
mortality ratio was identical in the two
villages. The explanation was that the
intensive fertility regulation programme had
not conveyed any increase in the safety a
birth in the village. That is, thospregnancies being needed did not enjoy an ,
better protection in the fertility regulatic
village than in the other village.
A conclusion is that fertility regulatio
while reducing the actual number
pregnancies, did not achieve a better safe \
at birth or could even have be- n
counterproductive to better safe mother.
—— — — — — — — — —
j
------------------- --- ---
_
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1
1
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■
I
V
V
I
the 1981 89 Period Muslims accepted temporary methods of family planning that
as en ance y 11.4 per cent in comparison to previous period whereas Hindus for
nS ance suc increase was only 10 percent. Family welfare Operation Camps in
1S ncts
West Bengal during 1980-94 showed that a large number of
lnWS*lni woiPen Yere &etting operated along with Hindu women. Most were from
Hnv’1100?16 ami ies and the daily grind of maintaining 3-4 children were their main
driving forces while adopting the permanent method.
I
1
a z•
ChurcL
I
I
?
contraception is unethicaland voluntary abortion may never
lt lS againSt the teachin^
doctrines of the Roman Catholic
I
I
I
In technical terms of ^Catholic moral theology, the moral permissibility of
artificial contraception and voluntaiy
’-----j abortion iis a “solidly probable opinion”, i.e.,
one that all Catholics may follow
follow, in jgjood conscience. Contraception is not only licit
may °ften be morally mandatory.
r. Likewise, the choice of an abortion — a choice
that, ironically, becomes more necess.
mnrQi
"r
more necessary when artificial contraception is banned — is
a i
moral option for women in many circumstances. This is common teaching among
^acnoiic
Catholic and Protestant moral theologians.
j
I
|
his context it must be noted that the problems of over-populatio
>n, merely dumping
f . °mS °n..them cannot solve
death of women from rcoroduct
buc cney WJ1 aiso not g0 away
condoms Fu
!
.
tha?haS performed a crucial role in most countijes
that has moved from
contracention
fertlhty rate to replacement levels rates7 Artificial...
C(
I
I
I
I
{ they
th^e^enS X"
01656
b^’ “!
Cath°lic phurch’s position to contraception'and other
MYTH: T" “
artificial
forms
h
I
health
care
^ices^^
0-^011^ i^a~
tO
reProducti^
health
women and the fight against the AIDS pandemic.
I
FACT: The Roman C
Catholic Church under the aegis of the Vatican exerts enormous
I z^°Wer^nd COntro1 10 foil any efforts to
• provide reproductive health care-services for
J ^/specially poor women in the
the South
South an
and to stop AIDS. To illustrate: *
J
In 1999, the Vatican released
women whn b
u
' f” Offkial document stating that providing Catholic
■
women tvhn
u__
eouTva"ent
to n
r "____
KOSOV° With Agency contraception was
I
I
I
the pope went toT
O.boFtl°n- Previously, in reference to women in Bosnia,
and make “flesh oAheir own flth";
W°men Sh°Uld “aCCept
|
1° 1996, Gardinol
in Nairobi,
ivf’ Keny“’ where the AIDS epidemic exploded among young
women, Cardinal
<
Maunce Otunga, Kenya's leading R.C. church official, burned
boxes of condoms
Bishop John Niue^nd5^6 SeXUaI Ilterature- The same year, Kenyan Catholic
that condoms are to hl->
P''°pagated false scientific information by claiming
nuoms are to blame for the spread of AIDS;
of on9e9miffioi0co’‘t1"?
, Honduras prevented the distribution
I
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I
primary election Hn^d 7
an<1 olection officials at polling stations during a
y election. Honduras has the highest incidence of AIDS in Central America;
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„ FACTS against Al YTHk—
J
-
mortality ratio would have declined from 570
to 430 per 1000.000 live births. Even mtb
tms extremely non-realistic achievement of
virtually cuttmg off al] births from
ininSk”
a veiy ^mited gain
in maternal mortality would have followed
In spite of the widespread belief that age and
parity are exceptionally important in any
ra gy or the reduction of maternal deaths
can be concluded that it is not the age/parity
stnbubon of births that explains the lower
material mortality in the rich North. Instead
most maternal deaths occur to women at low
sk. This seemingly paradoxical point can
be explained by the fact that available risk
markers are not very efficient in predicting
maternal death. For instance, there are no
risk markers to predict death from abundant
vaginal bleeding d:;e to a non-contracting
uterus, nor to death causeway post-delivery
infection. But there is one albeit an
inefficient risk marker for eclampsia, that is
pre-eclampsia (high blood pressure
associated with pregnancy). Still, it is known
that a significant number of eclamiptic deaths
appear quite unexpectedly like “out of the
blue.”
Learning the Population Jargon5
?r
every thousand
literally measures the. number of live births for*C
countiy. “Crude* refers to the fart th
C0Untry as a whole or to a Pa' icuIar subgroup within a
which greatl v affertc
** d<?cs not take mto account the age structure of a population,
same number of ueonlp iT t
k°
&ivcn year. For example, if two countries have the
higher crude birthX
WOmen Childbearing age, it will have a much
across time. It
J
this reason,.the CBR is not directly comparable across countries, or even
'
hy demographers when better measures are lacking.
a worri&n wifi have
?e thought of as the average number of children that
represent the lifetimp pytv •r
uctive lifetime. It is hypothetical in the sense that it does not
measure. The TFR^;^^ei!“OfMyparticuIar.yomanorgn)uPofwomen,butre^esenta • mposite
assumes that each cohortS -n
°f blrth rateS specific to each age group of w< ^en and
Po
.
chcohorts fertility will hold during the lifetime of the “hypothetical woman
poPu^ation growth rate is the rate at which a particular population
is growing each
Piding ymi,
thC
Si“ ln lhe
course of a X'noraH™
a“ at I*Place,aent,eveI W>'1 exactly replace Itself ear the
usually corresnondc tn
no decline. In the industrialised North, replaccrr'’nt level
replace herself and
m °thcr words> each woman would bear two child;
no to
srXn
„,2Te,fof infantd°
the other
her 111310
mate ll^
(The
additional .1
.1 births
births is
is necessary
n™
set a *
small number
tlT to rePla«= k<2r
10 additional
higher - a^ut 2 s b
C1?lldless wonien)- In th6 S™th, replacement levels are
. uwhat
about 2.5 - because of the higher infant death rates.
I
r
—————
I
; aftS
is a monthly bulletin of factual
I
and fabc co
^topmrnt modelSi
b
on caste.
-__
caste, cre^An-j
creed and gender.
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y^lWMATr^
Kilt
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KO
Produced and Published by:
Vikas Adhyayan Kendra
D-l Shivdham. 62 Link Road.
Malad West. Mumbai 400 064. INDIA |
® : 882 2850 & 889 8662
‘-mail: vak@bom3.vsnl.nct.in
Fax: 889 8941
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nXled b;L,OmcE’ Ofr”(’ 4574-G»»y
Bclgaum59O002.S
L __ _
0331^24124/433429
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, .4
t
7!
(2003) 8 SCC
JAVED v. STATE OF HARYANA
g the provisions of
Commission was a
■ c 'ed and, if so, the
was also required to
T’ Tefore, the terms
he Government was
’ ’ to take sufficient
on was not inquiring b
're some general
Commission. In this
’ / mataka v. Union
observations made in
a'i
enough to cover
■quiry. It is further c
ra s 184 and 186 of
ssion is purely factd 'nitive judgment.
i may or may not be
rte hat the stage for
report the authority d
io has.no power of
can be enforced. A
tai in Sinha v. Jyoti
report made by the
Xc '37 of 1850) is
both finality and e
ed □ Ram Krishna
judgment, to submit
a not enforceable
.ommendation of the
ov much stress has
espondent 1 to have f
t f ne observations
communal riots, its
err s in future.
y a question of any
vh i some adverse
led counsel for the 9
ic Government
report is yet to be
tl
it won’t be the
h
a
b
359
appropriate stage to approach the Court. There may be occasions where after
consideration of the report the Government may decide not to take any action
a£ainst
person concerned yet the observation and remarks may be such
which may play upon the reputation of the person concerned and this aspect
ot the matter has been fully taken care of under clause (/;) of Section 8-B of
the Act. It is not, therefore, necessary that one must wait till a decision is
taken by the Government to take action against the person after consideration
of the report. We have already dealt with the point about the rioht to have and
protect one s reputation. We. therefore, find no force in the submission that
Respondent 1 had approached the Court at a premature stase. No other point
has been urged on behalf of the appellant. In our view, the judgment of the
High Court calls for no interference.
12. In view of the discussion held above, the appeal is dismissed. There
will, however, be no order as to costs.
c
d
(2003) 8 Supreme Court Cases 369
(Before R.C. Lahoti. Ashok Bhan and Arun Kumar jj )
JAVED AND OTHERS
’ D r•
Petitioners:
Versus
STATE OF HARYANA AND OTHERS
..
Rcspondents.
Wnt Petition No. 302 of 2001+ with CAs Nos. 5355-7'’ 5380-S2 5385 86
5397-5450 of 2003, WPs (C) Nos. 269, 316, 315, 329,562 63 258 4M
395, 420, 438, 475, 507-08, 495, 567, 560, 559, 561,538 539 579~of'7001'
19. 30. 32. 1.49-50, 79, 94. 130, 93. 127, 144, 169, 168. 128 177 IP“ '
e
f
i
I
g
h
91. 178. 184. 183, 185, 68 of 2002, 430 of 2001. 213-14. 162. 230 P5’
228, 254, 296, 280, 281, 305. 317, 309 of 2002, CA No 36')9 of'’002 WP
onmNO^3°K °f 20°2, CA NO' 4053 Of 2002- WPs (C> Nos.~34I-42W395 of
-002, CA No. 4066 of 2002, WPs (C) Nos. 396, 406 of '’00'’ CAs Nos
4501. 4487 of 2002, WPs (C) Nos. 402. 336. 424, 355 38 L 3^0 430 3 '
421.404 of 2002, CAs Nos. 5080-81 of 2002, WPs (C) Nos. 443, 457 45 ]’
of ..002, CA No. 5270 of 2002, WPs (C) Nos. 462. 491 495 of'’002 CAs
Nms. 5902-03 of 2002, WP (C) No. 278 of 2002. CA No. 7034 of 2002
I s (C) Nos. 612, 574, 607. 240, 655, 676-77, 547, 645. 620 682 of 200"’
8 of 2003. 669 of 2002, 18. 28. 40 of 2003. CA No. 2033 of 2003, WIN (C)
Nos. 63, Pl, 123 of 2003, CA No. 2395 of 2003, WPs (C) Nos 149 193
003 "'•'t5.’ I6h18^ 245’ 247-48’ 250' 257’ 268’ 270. 277 and 28! oi
2003, decided on July 30, 2003
, A<- Panchayats aild Zila Parishads — Haryana Panchavati Rai Act 1994
1 »r 1,94)
S.. 17S<1)«,> « 177(1) — El«to„
Uk
p’„S
Up-fSarpaneh or Panch - Disqualification - Persons having more than two
ntdfiL.il le^fT d,s,‘?ual,"cd — Arbitrariness — Classification based on
intelligible diflercnfia and such d.flerentia having a rational relation to the
object sought to be achieved viz. implementation of family planning
t Under Article 32 of lhe Constidiiion of India
P
e
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00
—
.
X
..wiMHWfcrr, ,,16--;^, MH,,,
P
cd
rr
A
p
x
2
p
X
?
w x
o
£
zr
S a
§
(2003) 8 SCC
SUPREME COURT CASES
is
PoSno^PoiicvT^d'X
„r
-ith National
g-gj.«
a
B. Constitution of India - Art. 14 - Arbitrariness - Test restated
Up-Sarpanch or Ranch — Disaualifirlr C tc!>,on to the officc of Sarpanch,
living children disqualified
n
" 7 CrS°nS having n,ore than
provisions are not InaeS i^coml X,natT 7 Mei e'V bCCaUSe sil“i,ar
other institutions of local self 'ov
" ' el.CCt,On to Public ofl'ces >" b
Parliament and also in
slat ons of .“."“c0'’ in StatC Lc«isl£““re and
held to be discriminatorv - Aft" <■ r ’7,.Sta‘es’ ,he Pr<''’ision cannot be
family planning by the State the «•> llluiatlng a.un,f<,rin policy regarding
tlic
SSJZ -S5.-Si
r “»"
c
D. Constitution of India — Art u
n- • ■
•
implementation of a Ie<»isiafivp rw\r.
Discrimination — Phased
discriminatory — A legislation mu i i ’C) acJ0SS die country - If
discriminatory merely because sindK
T'C Can',Ot be held to be
other States — Likewise a State leo^t/r IS atlons llavl' no( bccn ,,lade by
organ cannot be held to be discriminmorv'n" "a r1eS,>etl ol.a governmental d
not made in respect of othpr <>
*
J merely because similar legislation
policy of far-reachina implica^tion?dTC^ |Orgi!ns
the State “ A uniform
in phased manner by legislation introduC ^71“° SfaU Can b<? imPle,ncnted
at the top level -.Such ItXtT^
lhe grass-root level or
merely because the State policy h id 7777
^7 l°
discriniinatory
other levels also
° ht*en introduced simultaneously at e
provisions of Sections I
ISSUepwas lhe vires of the
1994 (1 1 of 1994). The said rrovision 7
* aryana Pancllayad Raj Act.
living children from holding h"
y a P?rSOn havine
than two
enforcement of disqualification's n7
'7 ofhces ,n I’anchayats. The
date of the commencement of the
poned ,or a Pen(,d ol onc year from the
up to the expiry of one year of th- m ? J)e,son hi,ving more than two children f
This postponement for one year
of l,le Acl is nf>t disqualified,
commencement of the Act the nornrd 7^ 1 r'^ a)IlccPhon 011 or around the
a woman has conceived •« t X ’ 1’
FT"0'' bci"g ni,le monlbscouples would not be disqualified Tho ? °f *7 AC‘ •1-en a"y One of such
election, if any person boldine unv of'tl>7'7 7' ^'^b^'hOed on the date of
giving birth to a child one year after the r-T °. 'CCS lncurs.a disqualification by 9
subject to disqualification and h di<-iht i r mmcncemen(
die Act he becomes
,s
b
c
d
e
f
9
£ hS,"* " S »nh"n,“'"S ..... ,’fn" Tl«
number of living children in'•n.lino n , . i > d
results in increasing the
commencement ol the Act to ■ f ~ K ,K <J'l'ollal cllllcl h(,rn one year after the
Director is entruXi wiih theZvmT i?"
lf 'lR' IUC'Um iS
office vacant. The decision of th- it
1 "’g dn e"‘-ill"-v a,,tl declaring the
c.crston of the Director is subject to appeal to the
h
h
73
JAVED v. STATE OF HARYANA
a
i
“b«X“b,c w"“n“y °'
Ssss
achieved by the legislation. It was further contended that the^rovision is al™
discnminatoo,. It was submitted that though the State of Haryana has introduced
a similtTr1510" ° disc’ua‘lf,cation by reference to elective offices in Panchayats
or
P ovlS'°n '? not found t0 have been enacted for disqualifying aspirants
or holders of elective or public offices in other institutions of local sei
b
States"ie^offierffi'a "h
Legislatl,res and Parliament. So also all the
States i.e. other than Haryana have not enacted similar laws and therefore
people aspiring to participate in Panchayati Raj governance in the Stote of
aryana have been singled out and meted out hostile discrimination.
Rejecting the contentions, the Supreme Court
Held:
c
ru AJticl.e V4 f°rb>ds class legislation; it does not forbid reasonable
classification for the putpose of legislation. To satisfy the constitutional test of
pemnssibdity, two conditions must be satisfied, namely: (i) that the Sfic don
s founded on an intelligible differenda which distinguishes orreonTor thinoc
diffParerSr°t!Iped tog.ether from others left
of the group, Md (h) that such
differentia has a rauonal relation to the object sought to be achieved hv rhe
d he'ae6 m q^st!°n- The basis for classification may rest on conditions whichmav
Oeographical or according to objects or occupation or the like
(Para 8^
V'
1
37 j
e
f
°fBihar' AK 1955 SC 191 '■ (1955) 1 SCR
■ >955 Cri U
nereI?tehilaSSD Cation
by the imPu8ned provisions is well defined and well
Perceptible. Persons having more than two living children ^e cle^lv
distinguishable from persons having not more than two living children The two
constito e two different classes and the classification is founded on S"nteMe
he ^’h" n
U distln8uishlng one from the other. One of the objects sought to
be achieved by the legislation is popularizing the family welfare/fS, ntonn ™
programme. The disqualification enacted by the pr™ siot^ STlcWeve hf
objective by creating a disincentive. The classification does not suffer from any
mn'ldT"65?,' ThC number of children viz. two is based on legislative wisdom ft
no.
The n“”b'r '5 "
°f ■»“'>■
„
n.. Th5rl1S n° meriC in the subrajssioa Iha. the number of children whiclf one
has whether two or three or more, does not affect the capacity competence and
imnn'7 “J d’
l°- SerVe ln
office of a Panchayat and therefore the
bnhlAct Oneaof ffiTob hV "f
Wi‘h
pUrp°Se Sought t0
achi’eved
9
I
iI
I
p.
372
■»«
Purpose of (he Ac(
“URT CASK
<2003> 8 SCC
said (hat such a provision would not serve ihe
A legislation by one of the Stuec
,
(Paras 9 and 10)
suffering from the vice of hostile d scriminaf 6
‘0 be discriminatory or
because Parliament or the legiZure Xm e
nS‘ itS Citizens s™Pb> a
sumlar laws. Such a submission If accentd
haVe not chosen to enact
given to the Centre and the States withlnZ d
vio!ative of the autonomy
constitutional scheme. It is not
w
he'r resPec‘ive fields under the
enacted by a State in exercise of its ow Z !°t.ComPare a Piece of legation
another law, though pari materia it mav he h
P0Wer With the Provisions of
an°ther State Legislature within its own no> • '
enacted by Parliament or by h
are different and so do differ those wh P° ' Cr t0 Ie8ls!ate- The sources of power
referable to different or'an of To ° Zm'56 'lle P0Wer' Siniila'b'. legi ladTns
Municipalities and so onlay be XrSareg0HTment; that -.Pancha'ts
referable to different entries of Li’sts lit a
Man>' a 'me they are
such laws need not necessarily be identical 9 °f 'h<; Seventh Schedule. All
govermng legislators and parliam^tarian
S° 'S
with ^e laws
c
» no uousduui' J'h'hC'"K " "V ■
However (here
jo- Poheies „e cap,ie Xe",. '2 “ ,P»'»>' ■"« he in,plemeu,ed «, „„e
"hen the policies have far-reachin" infnlicJdons "Y P^Sed man,,er. More so.
implementation in a phased manner Vf i. ' l5 a?d are dyna'nic in nature, their d
acceptance and invited TesserTes stance T1
" reCeiveS "radual
m a phased manner is suoaeefiVp nJ"n T V inJP,enientation of policy decision
To make a beginning.
of
to spiral up or may be introduced at tL m oduced at lhe grass-root level so as
are grass-root-level institutions of loca self-J0 35 l° perco,ate down. Panchayats
There is nothing wrong in the State of Hn ’C°vernance- They have a wider base e
national movement of population control hv03 haVJng Ch°Sen to subscribe to the
go a long way in ameliorating health sorh^113?1112 3 ,eglslation w,1ich would
f
legislation. It is for othei'Tto einukue'^11' U'C S'atC °r Har>'ai,u having enacted the
satisfy
(Para 19)
in (he■ iimpugned legislation
reqXmenuXuZjusdce
(Para 4)
discriminato^ZePZqCualfficVIIS1On ‘S nei,her arbitrary
nor
unreasonable
nor 9
Act 1 1 of 1994■ seeks .n .Z^aU‘,n. conlamed in Section
«f H-O-n"
and health care of
01 the
the masses
policy. It is not ’
I Ed.: See also Sunil Kumar Rana
mH ;<• ,
UIUI
1
socio-economic welfare
naliOn;l1
2 SCC 62X1
" ar:‘ 20 ’
(H oEf S'lT
Z .Zi,a Paris,“ads
-<- - Haryana Panchayati Raj Act, 1994 h
Ss. 17^(I)(q)and 177(1)
) — Electmn to the office ofSarpanch,
JAVED v. STATE OF HARYANA
a
I
b
c
d
373
Up-Sarpanch and Panch — Disqualification — Persons having more than
two living children disqualified — Held, not violative of any fundamental
right — It is reasonable and devised in national interest
R Election — Disqualification — Right to contest election — Nature of
— Held, is a statutory right or at the most a constitutional right, but not a
fundamental right — Therefore, the statute which confers the right to
contest election can prescribe disqualifications for contesting the election
Held:
The disqualification on the right to contest an election by having more than
two living children docs not contravene any fundamental right nor docs it cross
the limits of reasonability. Rather it is a disqualification conceptually devised in
national interest.
(Para 25)
Right to contest an election is neither a fundamental right nor a common law
right. It is a right confened by a statute. At the most, in view of Part IX having
been added in the Constitution, a right to contest election for an office in
Panchayat may be said to be a constitutional right — a right originating in the
Constitution and given shape by a statute. But even so, it cannot be equated with
a fundamental right. There is nothing wrong in the same statute which confers
the right to contest an election also to provide for the necessary qualifications
without which a person cannot offer his candidature for an elective office and
also to provide for disqualifications which would disable a person from
contesting for, or holding, an elective statutory office.
(Para 22)
Jvoti Buxu v. Debt Ghoscil. (1982) 1 SCC 691; Jumuna Prasad Mukhariya v. Lachhi Ram.
AIR 1954 SC 686 : (1955) I SCR 608; Sakhuw al AH v. Stale of Orissa. AIR 1955 SC
166 : (1955) I SCR 1004. relied on
N.P. Ponnuswami v. Rcttirniny Officer. Namakkal Constitueiicy. AIR 1952 SC 64 : 1952
SCR 218; Jayan Nath v. Jaswani Sinyh. AIR 1954 SC 210 : 1954 SCR 892. referred to
e
f
9
h
>
. -Luffr-in--
G. Panchayats and Zila Parishads — Haryana Panchayati Raj Act, 1994
(11 of 1994) — Ss. 175(1 )(q) and 177(1) — Election to Sarpanch, UpSarpanch and Panch — Disqualification — Persons having more than two
living children disqualified — Held, not violative of Art. 21, having regard to
Arts. 243-G, 243-C, 38, 47 and 51-A and Sch. VH List HI Entries 6 and 20-/X
— It is a legislative measure to check menace of growing population —
Constitution of India, Arts. 243-C, 243-F, 243-G, 38, 47, 51-A and Sch. VII
List HI Entries 6 & 20-A and List II Entry 5
H. Constitution of India — Art. 21 — Right to life — Must be construed
in a reasonable and rational manner — Tests of reasonableness stated —
Art. 21 to be read along with directive principles and fundamental duties —
Hence, docs not include right to procreate as many children as one pleases
I. Constitution of India — Parts III, IV and 1V-A — Fundamental rights
must not be read in isolation but along with directive principles and
fundamental duties
It was urged that the fundamental right to life and personal liberty emanating
from Article 21 of the Constitution should he allowed to stretch its span to its
optimum so as to include in the compendious term of the article all the varieties
of rights which go to make up the personal liberty of man including the right to
enjoy all the materialistic pleasures and to procreate as many children as one
pleases.
76
1__
IT
374
Held:
SUPREME court cases
(2003) 8 SCC
fairly indicated by^theCoTstotio^Th^01^ Subj'cctive test and its contours are
a golden thread through the entire fabricr®3Uflre'?ent of reasonableness runs like
a
!
t-
colour to the meaning of fundamental right?7 35 W ' 3S P^ophically, provide
S
I
j
1
i'
i
I
!
Artde 243%°f
schemes that cat. be en^tedTpade^elopment
social
i
{
=ES -SeSSs’SS1='
aiiiigi
f
wuhin reasonable bounds.'00 dlC‘ateS “’e exPansion of populatfon'bein^kep!
9
Air India v. Nergesh Meerza, (1981) 4 SCO
Therefore, it is futile to assume n
, no
(Para 37)
’. 981 SCC (L&S) 599* ^iedon
(Para 41)
<>
77
JAVl-J) v. .STATE OF IIARYANA
3-7c
(11 of I994)layaSsain7^Hw fiiri^4ads ~ Haryana Panchayati Raj Act, 19‘M
£
a
two
living
children
disnualified
"
w F>~ PTSOns llav,?8 more than
JSSrSrtre «»nlesil»s or holding ,|,« oifcre! .talE o?ArL2
*
b
“S~ ■?
interest of nuhlir nr
— Thounh tlwrp ic
but leidsFition can
i st
* r” < Can R reliuh‘^‘d or prohibited in die
,non?I,t>' apd. health and social welfare and reform
rc?ltn?:llon 0,1 having more than two children.
r«o - Porp».« ol
c
collectiveSth nr n
a > Pi'rt *,r pU,,lic ordcr-
'”<«n>lity and
...... --I
d
'T11^ ^'°'™nee of
ntarriagTSf'^wonJ^XZi'i fbr
and any restriction thereon would be vuilativeVtl^^
enshrined in Article 25 of the Constitution.
'
e
f
Rejecting the submission.
Held:
So tlU’^^Tcle'VJUTfdper^hsC a
ssxl"- °r h0,J"'s' ■n
At. iii’.,.
(Dr)
«> hculom ol religion
,0|PUl’lic °rdei- ln<,ra,il-v ;ind
• fi scc 36() n
u,,!,,,, ttf llhllll_, |w4)
(Paras 43. 45 and 59)
9
■ children more'tha'n o'ne.1 Wha'l' is^Sd'or noi'Shib.'Sg'T religion Joes
h
no become a religious practice or a positive tenet of a religion^^A practice does
not acquire the sanction of religion simply because it is permitted Assumin'- the
practice of having more wives than one or procreating more children than one is
c
7S
376
POO3)8SCC
supreme court cases
°f PeoP,e- 1,le same can be
regulated or
id"s f"
a
»±£-";,ZVsc?S5: ffi S “
“
b
under the law as It'swnds now but th^'l' ^ ‘tll'l'lr!;n ‘han two. he is free to do so
deprirtne himself fran, h„Mm.. „ S '’"'"“W “ '“'I' Prlee and that is of
There Is nothing IHegm
(n.Lr!’Se>'Tsrr,S
c
Up-Sarpanch or Ranch — DisomlifibLk E CCp<,n r° 110 °.n’cc or Sarpanch,
children disqualified
Held dicmi r/1 r * c™ons having more than two
Sivmg.h,th?rd£S..u“ n^X
Held:
afterV^^XchZ Merelv'h °
T"' ' ll,i''d Cl’ild is b(,n’ and is
giving the child awav in adoption 'd^'r '
d
n-'PlC ilas.pullecl Wllh one child bv
m adoption the disqualitkattan is noi wl,iJ;“,“"
“e S')'"
e
,,,«.......
Up-Sarpanch or Ranch Disou-ilifi r
Lcl,(,n t0 l,le <>Hicc of Sarpanch.
children disqualified - Arif, en ha 't’t” ~ """"t a'ing n'°rc lhan ,"°
third child if their hiKhtna
W0'"en al,"osl helplessly bear a
affected most bv this dMuSfieX >C’n
d°
lhl,S
a-
hts wife to bear a third child, he would dfs^uahh hintself afC0,”PClS
Ills.,..aS!™ ™
™
' ‘.* M:w.itaii..ll holding
elected
office
imposed
children - Ilelpk-ssness of ■,, 0",ce.<"• having more than tun
f
Assuming the
the plea
plea to
to be
be corn r/1 /(Je;s,re of husband pleaded —
Assuming
exception
in fa" our
nf J
’ fa,,UrC °f
«’ cane out an
in favour of
unconstitutional
0,ucn would not render the provision g
Held :
his
bear a lhi'd ^ld -’fid disqualify not onlv
womenfolk, they Ska so heinjs a to b"'^"^, ",' "Cl1’ ”
,ndian
though they do not wish to do so ' A,’Hi ■‘'"ml’1 ‘’n-'" K:" !‘ "'"d Ch'ld eVCn
■egismture chooses to _e ou, ‘a
h
7?
I
JAVED v. STATE OF HARYANA
37?
fr” ,h'
or lhe
a
Up-Sarpanch or Panch 9— Disoiinlifi ■ I® tlOn to ‘he office of Sarpaneh.
challenged on the basis of hvSr Pr°Vision canno‘
Constitution of India
abnormal situations provision, held, cannot be adiudrcd6 r^n,3 T Cnnshtutionaiity of any
abno'TOal siruadons — Exeopliojs ,|o no(
”f 'WM™! or
b
“«» «» Bar „y S.br,„„„,s
■I-
pregnancy and consequently both of the Daren'r^ in'15
bOm °n the Second
reasons beyond their control or just by a freak of d^iritJ!.nCUr disC’Ual'fi™tion for
c
applying it to abno^dlsUuatronsdExcepdonsyd0f thC ''T Ca'lnOt be tested by
the rule irrelevant. One swallow does not make u
make the
nor render
mdteator of something is not necessarily signicLnt™™™^ 3 S,ng,e ’"^64'
64)
CONCLUSION
d
The provisions are salutary and in nublic im d 'nlr.a„VliPll’eConstituliohchallenge the constitutional validity of th-b>h
cle.s ' AH llle Potions which
be dismissed.
y °f "le ^wesatd provisions are held liable to
(Para 65)
R-M/ANWTZ/28726/C
Advocates who appeared in this ease :
e
Advocates
"prem 'SMallMl7alAI^ |P t|Bh;‘1'
Kamwal. Vishal Malik. M S Daliiva San v\
a
P'R Ra°- Senior
■‘T"1’ Anil Sl,arma- Anil
S-C-Birla. Ms Kusum Chaudhry B R Sr m'Vk’v Ma,,'Ur' Arun
f
9
h
Ahmed Khan, Bhava Dutta Shanna B S Ch |MUkMh .Ku'nar' Sunil Kumar- Anis
Suresh C. Gupta. A. Guneshwar Sharma
’^S Ay0,i Chahar- Vinay Garg.
Mohan Gupta, Ms Rachna Joshi Iss-ir Ai iv Siwacf
Shashwati Sen, Kamal
Dr Ramesh K. Haritash Ms Alka R i c
n
aSblrS- Malik- S K- Sabharwal.
Singh Yadav. Dr Kailash Chand Sarvesh B
Hari S"ankar K- R^i
Garg. R.K. Talwar. Y.P. Dhingra pinna
s
' ^LN,ldhi' K R'
Sanjay
Kohli. Monoher Singh Bakshi m! D d'ah Ar/?8 ’ n
BaliShi' S S' Nchra. R C
Ajay Pal. Rakesh Dahiya, Irshad Ahmed A P*^'S'a' Mallai’ir singl’.
Rathore. K.K. Gupta. Jamil Singh Chh .hn ’ vO'R <Mo?aniy' Man°j Swarup. R.D.
Pandey. Mushtaq Ahmed. Tara Chandra 5113™^'"^
?har'"a’ C D- Sin8h' L-K.
Ms.Ahha R. Shanna. Ms Sunita R Singh R C p” ^eclam S^rma. Ajai Bhalla.
Bansal. Harhans Lal Bajaj. Ms Lalitha K-mshik '?
S K' Bansak Ms Savi,ri
Ms Santosh Singh. Ms Vandana Shtgh Raked^ k“ M <
Dr K R' PuniaRanjit. Somvir Sinch Dcswal MpIi/
i *!5r' Mudgal, J.S. Maharatta, Rao
sandhya Goswam LMs M Sharia R i k7m
AgarWak PK' Jai"' M
Singh. R.C. Kaushik. Naresh Kumar Ra^iv T-1I
M<’r- SM Hooda' Gian
Gupta. K.K. Mohan. Shakeel Ahmed’Attar Sin^V^
Bakshi’ Pradccp
Gautam. R.R Goyal. S.K. Sinha Shanka Divn e s r' dS,nSh- Ms Praveena
Rekha Palli. C.L. Sahu. Dr Surat Singh Ashok K M3! •’ ' ^a'leSh Babu’ Ms
ai-...
B.u„ Alr„,. P„in Mn< *
378
SUPREME COURT CASES
(2003) 8 SCC
Sunita Pandit. Jaswant Rajpal. M.M. Kashyap. Ugra Shankar Prasad, Rohit Minocha,
S.N. Bhat. N.P.S. Panwar. D.P. Chaturvedi, Rishiraj Barooah. J.P. Dhanda, Ms Raj
Rani Dhanda. Ms Geetanjali Mohan. Vi nay Kr. Garg, Ms Kavita Wadia. Krishnan
Venusopal. Uday N. Tiwary.’ Prasad Vijaya Kuman Balaram Das, K.G. Bhagat,
Vineet Bhagat. Kamal Baid. Nipun Sharma, R.D. Upadhyay. Manish Singhvi and
Ashok K. Mahajan. Advocates, with them) for the appearing parties.
a
on page(s)
Chronological list of cases cited
3S3d-e
1. (1996) 2 SCC 498. Pannalal Bansilal Pitti v. State of A.P.
39\c-d
v.
Union
of
India
2. (1995) 3 SCC 635 : 1995 SCC (Cri) 569. Sarla Mudgal
b
383a
3. (1995) 1 SCC 519. State ofT.N. v. Ananthi Animal
39 \b-c
4. (1994) 6 SCC 360. M. Ismail Faniqui (Dr) v. Union of India
5. (1988) 2 SCC 433 : 1988 SCC(L&S) 577. LN. Mishra Institute of
383c-d
Economic Development and Social Change v. Slate of Bihar
383a
6. (1987) 4 SCC 238. Prabhakaran Nair v. State ofT.N.
7. (1985) 2 SCC 556 : 1985 SCC (Cri) 245. Mohd. Ahmed Khan v. Shah Bano
39 k' c
Begum
385a
8. (1982) 1 SCC 691. Jyon Basu v. Debi Ghosal
393s-/i
9. (1981) 22 Guj LR 289. R.A. Pathan v. Director ofTechnical Education
390a-/?
10. (1981)4 SCC 335 : 1981 SCC (L&S) 599. Air India v. Nergcsh Meerzo
386J
11. (1980) 4 SCC I. Kasturi Lal Lakshmi Reddy v. Stale of J&K
386J
12. (1978) 1 SCC 248. Maneka Gandhi v. Union of India
383a d
13. (1973) I SCC 261. Bar Council ofU.P. '. Slate of U.P.
39 IB’
14. AIR 1958 SC 731 : 1959 SCR 629. Mohd. Hanif Quareshi v. Slate of Bihar
393/
15. 1957 All U 300. Badruddin v. Aisha Begum
16. (1957) 2 LU 172 : AIR 1957 All 41 1 and AIR 1961 All 334 : (1961) 2 LLJ
394/7
247. Ram Prasad Seth v. Slate of U.P.
17. AIR 1955 SC 191 (1955) 1 SCR 1045 : 1955 Cri U 371. Budhan
380/z e
Chaudhry v. State of Bihar
.
385c
18. AIR 1955 SC 166 : (1955) 1 SCR 1004. Sakhawat AU v. Stale of Orissa
19. AIR 1954 SC 686 : (1955) 1 SCR 608. Jamuna Prasad Mukhariya v. Lachhi
385/>-r
Ram
382/
AIR
1954
SC
493
:
(1955)
1
SCR
599.
State
of
M.P.
v.
G.C.
Mandawar
20.
385a
AIR
1954
SC
210
:
1954
SCR
892.
.lagan
Nath
v.
Jaswant
Singh
21.
392n.
2*> AIR 1952 Bom 84 : 53 Cri 1J 354. State of Bombay v. Narasu Appa Mali
392^-/i. 393c
23. AIR 1952 SC 64 : 1952 SCR 218. N.P. Ponnuswami v. Returning Officer.
Namakkal Constituency
385u
The Judgment of the Court was delivered by
R.C. LahOTI, J.— Leave granted in all the special leave petitions.
2. In this batch of writ petitions and appeals the core issue is the vires ot 9
the provisions of Sections 175(1 )(r/) and 177(1) of the Haryana Panchayati
Raj Act. 1994 (Act 1 1 of 1994) (hereinafter referred to as the Act for short'.
The relevant provisions are extracted and reproduced hereunder:
“175. (1) No person shall be a Sarpanch, Up-Sarpanch or a Ranch of a
Gram Panchayat or a member of a Panchayat Sainiti or Zila Parishad or
h
continue as such who—
*
*
*
I
JAVED V. STATE OF HARYANA (Ldhoti, J.)
a
379
(<7) has more t(han two living children:
Provided that1 a Person.having more than two children on or up to
the expiry of one year of the
commencement of this Act. shall no?be
deemed to be disqualified.
*
*
*
' Parishad- ’lr any member °f a Gram Panchayat, Panchayat Samid or ZiIa
b
(«) who is elected
tlisqualificadons mendoned in Section RVu
r'? • any of lhe
(A) dining the term for which h ■ t
i
6 'mC °f h'S elecl101’:
disqualifications, ntendoned in sJc^J n?0" e'eC1Cd’ i,'cllls a"y
>he
shall be disqualified from continuing t k
become vacant.
e ° be a member, and his office shall
c
decided IbVth7D1“c;o?i?1eT^Whether a....... - '
;.V5JCa.nC^ ,las ansen’ shall be
application made to it by any person "o/oli^t
decision either
orJon, its
-Wn m°tion
• - Until
On die
an
Director decides that the
vacancy
has
ar
m
°
the
d.squahfied under sub-section (1) f om Conim.
'"TberS Sha11 not be
person aggrieved by the decision ofT C°.ntlnuin8 to be. a member. Any
d
by the
e,v,n^ nim a reasonable opportunity of
experie^cLnd^JSvo^TheXnc
Various '
objectives based on past
preceding law., and a,s„ lo „”““d- -i
in the implementation of
e die Consiiiudon „f mj.a refaiin, J p “•onformity
„
• with
.........Part IX of
Seventy-third Amendment. One of the ohiJ^ P hayalS added
by the
Objects and Reasons is to disqualify persons'^
°UI ‘n lbe StaIenlent of
each level, having more than two chZaRer
°n ‘0 Panchayats at
commencement of this Act to popularize f f i
year °f lhe date «f
programme [vide clause (m) of para 4 of SOR^ y We,fare/fai’diy planning
f
than two livinfchHdren from ^dTn^ihes^'cSo^ U
p" baVing more
being heard.”
a
h
enforcement of disqualification is postponedI for . 1 ^t1" Pancbayats-The
‘be date of the commencement of the Act A person
°f °ne year from
children up to the expiry of one year of rhe e
having more than two
disqualified This postponement for one year XTcareT'
iS n°l
or around the commencement of the A^t rS.
are,of any conception on
being nine months. If a woman has conceived aX
°f geStation
Act then any one of such couples would not h j co™mencement of the
disqualified on the date of election, if any personS^ 'fied' Th0Ugh no[
offices incurs a disqualification by giving binh o . f m"8
°f tbe said
commencement of the Act he becomes sub it , ?
°ne year afler tbc
isaMcd from con.inuing
hoM ,„e office. Tbe diiffi”, 'X°d “be
■>
380
SUPREME COURT CASES
(2003) 8 SCC
Director has to afford n
'S^UbjeCt '0
10 the G°v^ment. The
of office souXln he d re“b? °PPO™nity of being heard to the holder
of neural jusdce
d,Squallf,ed- These safeguards satisfy the requirements
of ^SrhavTS dh° ar^he1writ Petitioners or Wyants in this batch
b
Pirh? fl
b
disqualified or proceeded against for disqualifvino
Panch^/^1 C0nl^st,n5 the e,ect’ons for. or from continuing in the office of
SSteS nS ?f 'T '’™s incurred'l '
2
of the Act’7 Th,, orr.
T Sectl0n l77(l) read with Section 175(1)('^)
abovesaid nmv' ~
ds for challenging the constitutional validity of the
abosesmd provision are very many, couched differently in different writ
c
oetitione / 6
heard 3,1 'he ,earned counsel representing the different
L ‘'t
7 T anc' AS ag'eed t0 at the Bar’ the grounds ofchallenc-e can
d«s noi sene
C purpose sought to be achieved by the legislation; (Hi) that the provision is
XTnSii’.Jf ‘'? "'"if” ad'"“1>- *ff'“
I'^or
d
??s'<sss,:i'hof ■*" ”da'“*
6. The Slate of Haryana has defended its legislation on all counts We
S^i I S
theJeanled Standi^ Counsel for the State On nodee Shn e t ist the Co J?e’ d b eamed A,l°rney General for India’ has appeared to
as addressed ,he c°urt-we w°u,d dea! w-th
Submissions (i). (ii) and (Hi)
7. kTh<-.first three submissions are
are based
based on Article 14 of the Constitution
and. therefore, are taken up together for consideration.
constitution
A' die classification arbitrary?
8. It is well settled that Article 14 forbids class legislation- it does not
constitutive t V ^S,(,CatlO”for the PurP«se of legislation. To satisfy the
m 1Z J
r Pernilssib,1,ty- two conditions must be satisfied, namelv:
H-.,/ classification is founded on an intelligible differentia which
is ingmshes persons or things that are grouped together from others left out g
sou Jht'r ?UbP- anh
J ;at Th differentia has a rat'onal relation to the objec
sought to be achieved by the statute in question. The basis for classification
may rest on conditions which may be geographical or according o object or
occupation or the like. (See Constitution Bench decision fn Shan
out 11-y v. State of Bihar'.) The classification is well defined and well
h
I
air 1955 sc 191 :<19.S5| I SCR 1045: 1955 Cri 1J 371
JAVED V. STATE OF HARYANA (Lahoti, J.)
I
I
I
I
I
331
perceptible. Persons having more than two living children are clearly
distinguishable from persons having not more than two living children The
a' ^wo constitute two different classes and the classification is founded on an
intelligible differentia clearly distinguishing one from the other One of die
objects sought to be achieved by the legislation is popularizing the family
weltare/family planning programme. The disqualification enacted by the
proviston seeks to achieve the objective by creating a disincentive The
classification does not suffer from any arbitrariness. The number of children
b viz. two is based on legislative wisdom. It could have been more or less The
number is a matter of policy decision which is not open to judicial scrutiny.
Does the legislation not serve its object?
9. It was submitted that the number of children which one has, whether
two or three or more, does not affect the capacity, competence and quality of
a person to serve on any office of a Panchayat and. therefore, the impugned
c disqualification has no nexus with the purpose sought to be achieved by the
Act. lhere is no merit in the submission. We have already stated that one of
the objects of the enactment is to popularize family welfare/tamily planning
programme. This is consistent with the National Population Policy.
10. Under Article 243-G of the Constitution, the legislature of a State has
been
vested with the authority to make law endowing the Panchayats with
d
such powers and authority which may be necessary to enable the Gram
Panchayats to function as institutions of self-government and such law may
contain provisions for the devolution of powers and responsibilities upon
Panchayats, at the appropriate level, subject to such conditions as may be
specified therein. Clause (b) of Article 243-G provides that Gram Panchayats
e may be entrusted the powers to implement the schemes for economic
development and social justice including those in relation to matters listed in
the Eleventh Schedule. Entries 24 and 25 of the Eleventh Schedule read:
“24. Family welfare.
25. Women and child development.”
fo pursuance of the powers given to the State Legislatures to enact laws, the
• f Haryana Legislature enacted the Haryana Panchayati Raj Act, 1994 (Haryana
Act 11 of 1994). Section 21 enumerates the functions and duties of Gram
Panchayat. Clause XIX(l) of Section 21 reads:
“XIX. Public Health and Family Welfare—
(1) Implementation of family welfare programme.”
Family welfare would include family planning as well. To carry out the
9 purpose of the Act as well as the mandate of the Constitution the legislature
has made a provision for making a person having more than two living
children ineligible to either contest for the post of Ranch or Sarpanch. Such a
provision would serve the purpose of the Act as mandated by the
Constitution. It cannot be said that such a provision would not serve the
purpose of the Act.
h
11. In our opinion, the impugned disqualification does have a nexus with
the purpose sought to be achieved by the Act. Hence it is valid.
1
OBtolB'r
38^
SUPREME COURT CASES
(2003) 8 SCC
Is the provision discriminatory?
such12a
tha1t;h0Ugh lhe State:°f Harya™ has introduced
suet) j provision of disqualification by reference to elective offices in
a
ditn01^3'8’ 3 Slmilar Provision is not found to have been enacted for
disqualifying aspirants or holders of elective or public offices in other
institutions of local self-governance and also not in State Legislatures and
s™”SsS:i±,a'lf'h' S“'s "■
l™"= no,“e d
Pa^ havati Rai
°re’ “
lhal pe°Ple asPiring to participate in
meteTou hos ife d anCe
S'ale °f Haryana have been singled ont and
eiec?e Under th SCnm"la.tl0n; The Emission has been stated only to be b
Of
i ,
constitutional scheme there is a well-defined distribution
eviTsSrUeX5
,n
XI °f thC Co-P'ntion. Parliament and
every State Legislature has power to make laws with respect to any of the
atters which fall within its field of legislation under Article 246 read with
bo held
' °,rA "«»'■»" by one of ,be S,»s' c
cannot be held to be discriminatory or suffering from the vice of hostile
feSmre ’of xl
Ci‘iZenS Simply beCaUSe Parhament or the
le islatures of other States have not chosen to enact similar laws Such a
submission, if accepted, would be violative of the autonomy given to the
Sieme
Wthin ‘heir resPective f,elds Ullder the constitutional
d
13. Similarly, legislations referable to different
organs of local
are Erem M
"■' Pa'!chayats- Municipalities and so on may be, rather
and HI of h s'15' a ‘.'"c ?Cy a'e refCrable 10 different entries of Lisls 1- I'
idem cal S ?
?
ledUle- A" SUCh laWS need not necessarily be
e
~ 14. It is not permissible to compare a piece of legislation enacted bv a
Stale in exercise’ of its' own ,e£isialive power with the provisions of another
law, though pari materia itit may be. but enacted by Parliament or by another
Stale Legislature within
different and ™ -t d r/"
P°?'er l° ,e-is,ate- The sources
power are
Bench in
f a? p‘
Wh° exercise lhe Powcr- The Constitution
decl ire i InwV'J? V'
beld lhal the power of the Court to f
specific leeislm’i 1 "ndci Allicle 13 l’;ls l(> be exercised with reference to the
C.overnm V '
''hich is impugned. I wo laws enacted by two different'
Governments and by two different legislatures can be read neither in
conjunction nor by comparison for the purpose of finding out if they are
lsci,minatory An,c|e 14 does nol autho,.j7e (he s(rjkjnc d(wn Qf
(
same subiem 4° gmUnd thU‘ 'n COI1"’aSI W'tb a laW of anolher State 011 the
for tL
Provis|ons are discriminatory. When the sources of authority
for the two statutes are different. Article 14 can have no application. So is the
9
2 AIR I <>54 SC 49? : < 1955; I SCR 599
h
3S
JAVED v. STATE OF HARYANA (Lahoti J )
383
v. Anunthi
a
13-A has been inserted to make a provision for sitiila dlquai Sat on for "
EJpS
b
g Ch°Sen
h°lding the °ffiCe
" -“^a
16. A uniform policy may be devised by the Centre or hv •>
,
i
c
welcome for it receives gradual wilhng acceptance and invites lesser
resistance.
17. The implementation of policy decision in •. ^.<^4
suggestive neither of arbitrarinesf n<^ of' diXmadon
"
d
Institute of Economic Development ami Social Change v. State of Siliai^ the
pohey of nationalizing educational institutes was sought to be implemented
phased manner. This Court held that all the institutions cannot be taken
SSndImere'y because the beginning was made with one institute
viol .id n°‘COmP.Iain that “ Wi*s singled out and, therefore, Article 14 was
lolated. Observations of this Court in Pannalal Bansilal Pitti v State ofA P^
are apposue. In a pluralistic society like India, people having faith in diiferem
rehgmns, d.fferent beliefs and tenets, have peculiar problem’s of them own
e
f
9
no nethnnlfOrni
th°Ugl1 * hishly desirable' e™ctment thereof in one
go pethaps may be counterproductive to unity and integrity of the nation
In a democracy governed by rule of law, gradual progressive Change and
. order should be brought about. Making law or amendment to a law is a
slow process and the legislature attempts to remedy where the need is felt
most acute. It would, therefore, be inexpedient and'incorrect to thmk th'i
all laws have to be made uniformly applicable to all people in one go
The mischief or defect which is most acute can be remedied bv process
of law at stages.” (SCC p. 510, para 12)
' P
level1!/asnt,oksenfode8innin8’ thekrelonns niay be introduced at the grass-roo.
down P.^ L P
P °r may be ">lroduced at the top so as to percolate
Thev hhaya‘s are grass-root-level institutions of local self-governance
y ave a wider base. There is nothing wrong in the State of Haryana
having chosen to subscribe to the national movement of population control
sociTand Iconorn’ic’10'1 it'011
8° 3 l0ng W3y
an’eliorating health.
and economic conditions of rural population, and thereby contribute to
h
I
3 (1973) 1 SCC 261
4 (1995) 1 SCC 519
5 (1987) 4 SCC 238
6 (1988) 2 SCC 433 : 1988 SCC (L&S) 577
7 (1996) 2 SCC 498
384
SUPREME COURT CASES
,
(9003) R
Xd,';'T"':si,s “
(Government of India Publication, p. as)- at‘Onal PoPulallon: Policy, 2000
religious leaders'1 with^losfTnvoKenr^
a
opinion-makers and
health Programme greatly influencesThTh’i" '16 reProductive a"d child
of individuals and communities Thi
reSp°nse patterns
be attentive towards the quality mH
S ° enthuse communities to
health services, ntclud,ng XmLare C°Verage °f H11*16™' and chi,d
I
I
b
of elected leaders will
ensure dedicated in'XettTn^
levels. Demonstration of rn
admmi.strators at district and sub-district
as personal ^ple by X XZm°
"Orm’ 3S
a
~ re
c
arbitrary nor unreasonable nor discrimimito'rv 7uPU?'led p,^visio» IS neither
m Section 175(1 )(7) of Harvana Act 17<
d'lSC’Ua,lfication contained
purpose — socio-economic'welfare and /.nn4 seeksto achieve a laudable
d
consistent with the National p> i •
care of the masses — and is
of the Constitution
PoPuIa^n Policy. It is not violative of Article 14
ft,.)
ft)..
2; Ilr ,J?
vic«.po,iu of Ardae”7|li“„d',’?h, JL'I’',
kslslaiton from rhe
take up first the more basic issue'— w 7 g
validity of a law which enacts a dis . re
° '1C submissi°ns made, we
'' "" '' pe,nllssible 10 test the
e
chmEE'rmi”,''“'i’"
»r a
J
Part IX having been added m he7Z , ? 3 S,atU,e; A' ,he most, in view of
a” ‘>Ptce in ■t.nchX^v 17° • •H^'h1!'011' 3
'0
e,-io” '<’''
f
to beshan^b'11'1"'0'’31 right ~ " 'i°i"
originating in the Constitution and giicn
cannot be equated with a fundamem .17.h Ti y 3
Bul CVen so- h
same statute which confers the ri-hi m /
X ls.nothl,1g wong in the
the necessary qualifications whhoui X h
e eCll°" a,so 10 Provide for
candidature for an elective office - nd
3 PCrS°n CannM offer his
which would disable a person f7m eon'0,
f°r di<iqtiahflcations
statutory office.
contesting for. or holding, an elective
I
9
1
I
I
I
h
fl
S7
JAVED v. STATE OF HARYANA (Lahoti, J.)
1
1
i
i
I
3^5
23. Reiterating the law laid down in N.P. Ponnuswami v. Returning
Officer, Naniakkal Constituency* and Jagan Nath v. Jaswant Singh9 this
a( Court held in Jyoti Basu v. Debi Ghosal[{}\ (SCC p. 696, para 8)
"8. A right to elect, fundamental though it is to democracy is.
anomalously enough, neither a fundamental right nor a common law
right. It is pure and simple, a statutory right. So is the right to be elected
So is the nght to dispute an election. Outside of statuteuhere is no ri<>ht
to elect, no nght to be elected and no right to dispute an election
b
Statutory creations they are, and therefore, subject to siatuforv
iimiialion.”
24. In Jamuna Prasad Mukhariya v. Uahhi Ram" a candidate at the
election made a systematic appeal to voters of a particular caste to vote for
him on the basis of his caste through publishing and circulating leaflets
Sections 123(5) and 124(5) of the Representation of the People Act 1951
c
were challenged as ultra vires Article 19( 1 )(a) of the Constitution, submitting
that the provisions of the Representation of the People Act interfered with a
cittzen s fundamental right to freedom of speech. Repelling the contention
the Constitution Bench hefd that these.laws do not stop a man from speakin°
They merely provide conditions which must be observed if he wants to enter
Parliament. The right to stand as a candidate and contest an election is not a
d
common law nght; it is a special right created by a statute and can only be
exercised on the conditions laid down by the statute. The Fundamental Rights
Chapter has no bearing on a right like this created by a statute. The appellants
have no fundamental right to be elected and if they want to be elected they
must observe the rules. It they prefer to exercise their right of free speech
outside these rules, the impugned sections do not stop them. In Sakhawat AH
e
v. State oj Orissa'- the appellant’s nomination paper for election as a
Councillor of the Municipality was rejected on the ground that he was
employed as a legal practitioner against the Municipality which was a
disqualification under the relevant Municipality Act. It was contended that
the disqualification prescribed violated the appellant’s fundamental rights
g^anteed under Articles 14 and I9(l)(g) of the Constitution. The
f
Constitution Bench held that the impugned provision has a public purpose
ehind it i e. the purity of public life which would be thwarted where there
was a conflict between interest and duty. The Constitution Bench further held
that the right of the appellant to practise the profession of law guaranteed by
Article 19(l)(g) cannot be said to have been violated because in laying down
the disqualification the Municipal Act does not prevent him from practisin'’
9 his profession of law; it only lays down that if he wants to stand as a
candidate for election he shall not either be employed as a paid leoa]
h
8 AIR 1952 SC 64 : 1952 SCR 218
AIR 1954 SC 210 : 1954 SCR 892
10 (1982) 1 SCC 691
11 AIR 1954 SC 686 : (1955) 1 SCR 608
12 AIR 1955 SC 166: (1955) 1 SCR 1004
386
SUPREME COURT CASES
(2003) 8 SCC
theMun"^ °r fbetTTf Of the MuniciPality or act as a legal practitioner against
the Municipality. There is no fundamental right in any person to stand as a
candidate for election to the Municipality. The only fundamental ri«ht which
guaranteed is that of practising any profession or carrying on any a
*eCEOriaf
impugned disqualification does not violate
thar iX?0? Pnmanly.no fundamental right is violated and even assuming
hat it be taken as a restriction on his right to practise his profession of law
in th/6 tnCtlOn
d be llable t0 be uphe,d bein8 reasonable and imposed
in^the interests ot the general public for the preservation of purity in
public b
25. In our view, disqualification on the right to contest an election by
ri«ht Snor°rd<^an tW0
ng Children does not contravene any fundamental
o
nor does it cross the limits of reasonability. Rather it
is a
disqualification conceptually devised in national interest
->1 and
general statement °f ,aw which has application to Articles
-1 and _5 both we now proceed to test the sustainability of attack on
AOrticles“OinaidVa 5d'Iy °f
’mpUgned legislati<>n separately by reference to
c
The disqualification, if violates Article 21?
27. Placing strong reliance on Mancka Gandhi v. Union of India" and
Kas.un Lal Uiksh.ni Reddy v. State ofJ&K" it was forcefully urged that the d
fundamental right to life and persona! liberty emanating from Article 0] of
JclSein th'10" Sh0uldbe allowed 10 stretch its
to its optimum so as to
. ?.the coumPend'°us term of the article all the varieties of rights which
e o make up the personal liberty of man including the right to enjoy all the
materialistic pleasures and to procreate as many children as one pleases.
28. At the very outset we are constrained to observe that the law laid e
down by this Court in the decisions relied on is either being misread or read
it orced of the context. The test of reasonableness is not a wholly subjective
test and its contours are fairly indicated by the Constitution. The requirement
fn ’.eaSOnableness runs hke a golden thread through the entire fabric of
fundamental rights. The lofty ideals of social and .economic justice, the
d ancement of the nation as a whole and the philosophy of distributive
justice - economic, social and political - cannot be given a eo-by in the
name of
ot undue
undue stress on fundamental rights and individual liberty
Reasonableness and rationality, legally as well as philosophically, provide
d aOU-|,<7he llleanin8 ol fundamental rights and these principles are
deducible from those very decisions which have been relied on by the learned
counsel for the petitioners.
y
P
29. It is necessary to have a look at the population scenario of the world
and ot our own coumn.
thP iio ’f m3
the 'd'slcredil of be'ng second only to China at the top in
nc list ol the 10 most populous countries of the world. As on 1-2-2000 the
13 (1978. 1 SCC 248
14 ( 19861 4 see I
n
JAVED v. STATE OF HARYANA (Lahoti, J.)
387
population of China was 1277.6 million while the population of India as on
1-3-2001 was 1027.0 million (Census of India, 2001, Series I. India — Paper
a
b
c
d
e
I of 2001, p. 29).
31. The torrential increase in the population of the country is one of the
major hindrances in the pace of India’s socio-economic progress. Everyday,
about 50,000 persons are added to the already large base of its population.
The Karunakaran Population Committee (1992-93) had proposed certain
disincentives for those who do not follow (he norms of the development
model adopted by (he national public policy so as to bring down the fertility
rate. It is a matter of regret that though the Constitution of India is committed
to social and economic justice for all, yet India has entered the new
millennium with the largest number of illiterates in the world and the largest
number of people below the poverty line. The laudable goals spelt out in the
directive principles of State policy in the Constitution of India can best be
achieved if the population explosion is checked effectively. Therefore,
population control assumes a central importance for providing social and
economic justice to the people of India (Usha Tandon, Reader. Faculty of
Law, Delhi University — Research Paper on Population Stabilization, Delhi
Law Review, Vol. XXIII, 2001. pp. 125-31).
32. In the words of Bertrand Russell, “Population explosion is more
dangerous than hydrogen bomb.” This explosive population overgrowth is not
confined to a particular country but it is a global phenomenon. India being
the largest secular democracy has the population problem going side by side
and directly impacting on its per capita income, and resulting in shortfall of
foodgrains in spite of the green revolution, and has hampered improvement
on the educational front and has caused swelling of unemployment numbers,
creating a new class of pavement and slum dwellers and leading to
congestion in urban areas due to the migration of rural poor. (Paper by B.K.
Raina on Population Policy and the Law, 1992. edited by B.P. Singh Sehgal.
p. 52.)
f
'9
h
i
.
33. In the beginning of this century, the world population crossed six
billion, of which India alone accounts for one billion (17 per cent) in a land
area of 2.5 per cent of the world area. The global annual increase of
population is 80 million. Out of this, India's growth share is over 18 million
(23 per cent), equivalent to the total population of Australia, which has twoand-a-half times the land space of India. In other words, India is growing at
the alarming rate of one Australia every year and will be the most densely
populous country in the world, oulbcating China, which ranks first, with a
land area thrice this country’s. China can withstand the growth for a few
years more, but not India, with a constricted land space. Here, the per capita
crop land is the lowest in the world, which is also shrinking fast. If this falls
below the minimum sustainable level, people can no longer feed themselves
and shall become dependent on imported food, provided there arc nations
with exportable surpluses. Perhaps, this may lead to famine and abnormal
conditions in some parts of the country. (Source — Population Challenge,
Arcot Easwaran, The Hindu, dated 8.-7-2OO3.) It is emphasized that as the
i
- - TllMiMabW*
au-MtMi*"'
388
SUPREME COURT CASES
(2003) 8 SCC
population grows rapidly there is a corresponding decrease in per capita
water and food. Women in many places trek long distances in search of water
which distances would increase every next year on account of excessive
groundwater withdrawals catering to the need of the increasing population,
resulting in lowering of the levels of water tables.
a
34. Arcot Easwaran has quoted the example of China. China, the most
populous country in the world, has been able to control- its growth rate by
adopting the carrot-and-stick” rule. Attractive incentives in the field of
education and employment were provided to the couples following the b
one-child norm”. At the same time drastic disincentives were cast on the
couples bleaching one-child norm” which even included penal action. India
being a democratic country has so far not chosen to go beyond casting
minimal disincentives and has not embarked upon penalizing procreation of
childien beyond a particular limit. However, it has to be remembered that
complacence in controlling population in the name of democracy is too c
heavy a price to pay, allowing the nation to drift towards disaster.
35. The growing population of India had alarmed the Indian leadership
even before India achieved independence. In 1940 the Sub-Committee on
Population, appointed by the National Planning Committee set up by the
President of the Indian National Congress (Pandit Jawaharlal Nehru),
considered -family planning and a limitation of children” essential for the
interests of social economy, family happiness and national planning. The
Committee lecommended the establishment of birth-control clinics and other
necessary measures such as raising the age of marriage and a eugenic
sterilization programme. A Committee on Population set up by the National
Development Council in 1991, in the wake of the census result, also
proposed the formulation of a national policy. (Source — Seminar March
2002. p. 25.)
36. Every successive five-year plan has given prominence to a population
policy. In the first draft of the First Five-Year Plan (1951-56) the Planning
Commission recognized that population policy was essential to planning and
that family planning was a step forward for improvement in health,
particularly that of mothers and children. The Second Five-Year Plan (195661) emphasized the method of sterilization. A Central Family Planning Board
was also constituted in 1956 for the purpose. 1'he Fourth Five-Year Plan
(1969-74) placed the family planning programme, “as one amongst items of
the highest national priority”. The Seventh Five-Year Plan (1985-86 to 199091) has underlined “the importance of population control for the success of
the plan programme ...”. But. despite all such exhortations, “the fact remains
that the rate of population growth has not moved one bit from the level of 33
per thousand reached in 1979. And in many cases, even the reduced tarseis
set since then have not been realised”. (Population Policy and the La\\\ ibid.,
pp. 44-46.)
d
e
f
9
h
JAVED V. STATE OF HARYANA (Lahoti, J.)
739
37. .The above facts and excerpts highlight the problem of population
exploston as a national and global issue and provide justification for priority
a1 in policy-oriented legislations, wherever needed.
H
38.
None
of
the
petitioners
has
disputed
the
legislati
—• •
i.^ ui^puieu me legislative competence of the
State of Haryana to enact the legislation. Incidentally, it mav be stated that
the Seventh Schedule List II —
•
State List. Entry 5 speaks of “Local
Government, that is to say, the constitution and |
powers of Municipal
Corporations, improvement trusts, district boards, mining
settlement
b authorities and other local authorities for the’
purpose ol local
self-government or village administration.” Entry 6 speaks of "Public health
and sanitation inter aha. In List III — Concurrent List, Entry '’0-A was
added which reads "Population control and family planning" The lemsl ition
is within the permitted field of State subjects. Article 243-C makes provision
for the legis ature of a State enacting laws with respect to constitution of
c
anchayats. Article 243-F in Part IX of the Constitution itself provides that a
person shall be disqualified for being chosen as, and for being a member of a
Panchayat if he is so disqualified by or under any law made by the legislature
ot the State. Article 243-G casts one of the responsibilities of Panchavats as
preparation of plans and implementation of schemes for economic
development and social justice. Some of the schemes that can be entrusted to
d I anchayats. as spell out by Article 243-G read with the Eleventh Schedule
are schemes for economic development and social justice in relation to health
and sanitation, family welfare, women and child development and social
we fare. Family planning is essentially a scheme referable to health, family
welfare, women and child development and social welfare Nothin" more
needs to be said to demonstrate that the Constitution contemplates Panchay at
e
as a potent instrument of family welfare and social welfare schemes comim’
true for the betterment of people’s health, especially women’s health and
family welfare coupled with social welfare. Under Section 21 of the Act. the
f unctions and duties entrusted to Gram Panchayats include “public health and
family welfare", “women and child development” and “social welfare"
Family planning falls therein. Who can better enable the discharge of
f
unctions and duties and such constitutional goals being achieved than the
leaders of Panchayats themselves taking a lead and setting an example ?
39. Fundamental rights are not to be read in isolation. They have to be
read along with the chapter on directive principles of State policy and the
fundamental duties enshrined in Article 51-A. Under Article 38 (he State
shall strive to promote the welfare of the people and developing a social order
9 empowered at distributive justice — social, economic and political Under
Article 47 the State shall promote with special care the educational and
economic interests of the weaker sections of the people and in particular the
constitutionally downtrodden. Under Article 47 the Stair shall regard the
raising of the level of nutrition and the standard of living ol* its people and the
Improvement of public health as among its primary duties. None of these
h
lofty ideals can be achieved without controlling the population inasmuch as
our materialistic resources are limited and claimants are many The concept
1
390
SUPREME COURT CASES
(2003) 8 SCC
of sustainable development which emerges as a fundamental duty from
several clauses of Article 51-A too dictates the expansion of population being
kept within reasonable bounds.
a
40. The menace of growing population was judicially noticed and
constitutional validity of legislative means to check the population was
upheld in Air India v. Nergesh Meerza15. The Court found no fault with the
rule which would terminate the services of air hostesses on the third
pregnancy with two existing children, and held the rule both salutary and
reasonable for two reasons: (SCC p. 374, para 101)
b
In the first place, the provision preventing third pregnancy with two
existing children would be in the larger interest of the health of the air
hostess concerned as also for the good upbringing of the children.
Secondly, ... when the entire world is faced with the problem of
population explosion it will not only be desirable but absolutely essential
for every country to see that the family planning programme is not only c
whipped up but maintained at sufficient levels so as to meet the danger of
overpopulation which, if not controlled, may lead to serious social and
economic problems throughout the world.”
41. To say the least, it is futile to assume or urge that the impugned
legislation violates right to life and liberty guaranteed under Article 21 in any
d
of the meanings, howsoever expanded the meanings may be.
The provision if it violates Article 25?
42. It was then submitted that the personal law of Muslims permits
performance of marriages with four women, obviously for the purpose of
procreating children and any restriction thereon would be violative of the
right to freedom of religion enshrined in Article 25 of the Constitution. The
e
relevant part of Article 25 reads as under:
25. Freedom of conscience and free profession, practice and
propagation of religion.—(1) Subject to public order, morality and health
ana to the other provisions of this Part, all persons are equally entitled to
rXio™ °f COnSCience and the right freely t0 Profess, practise and propagate
(2) Nothing in this article shall affect the operation of any existing law f
or prevent the State from making any law—
(a) regulating or restricting any economic, financial, political or
other secular activity which may be associated with religious practice;
(Z?) providing for social welfare and reform or the throwing open of
Hindu religious institutions of a public character to all classes and
sections of Hindus.”
9
43. A bare reading of this article deprives the submission of all its force,
vigour and charm. The freedom is subject to public order, morality and
health. So the article itself permits a legislation in the interest of social
welfare and reform which are obviously part and parcel of public order,
national morality and the collective health of the nation’s people.
h
15 (1981) 4 SCC 335: 1981 SCC (L&S) 599
i
JAVED v. STATE OF HARYANA (Ldholi, J.)
a
b
c
d
e
f
9
h
39 I
44. The Muslim law permits marrying four women. The personal law
nowhere mandates or dictates it as a duty to perform four marriages. No
religious scripture or authority has been brought to our notice which provides
that marrying less than four women or abstaining from procreating a child
from each and every wife in case of permitted bigamy or polygamy would be
irreligious or offensive to the dictates of the religion. In our view, the
question of the impugned provision of the Haryana Act being violative ot
Article 25 does not arise. We may have a reference to a few decided cases.
45. The meaning of religion — the term as employed in Article 25 and
the nature of protection conferred by Article 25 stands settled by the
pronouncement-of the Constitution Bench decision in A/. Ismail Faruqui (Dr)
v. Union of India[h. The protection under Articles 25 and 26 ot the
Constitution is with respect to religious practice which forms an essential and
integral part of the religion. A practice may be a religious practice but not an
essential and integral part of practice of that religion. The latter is not
protected by Article 25.
46. In Sarla Mudgal v. Union of India'1 this Court has judicially noticed
it being acclaimed in the United States of America that the practice of
polygamy is injurious to “public morals”, even though some religions may
make it obligatory or desirable for its followers. The Court held that
polygamy can be superseded by the State just as it can prohibit human
sacrifice or the practice of sati in the interest of public order, lhe personal
law operates under the authority of the legislation and not under the religion
and. therefore, the personal law can always be superseded or supplemented
by legislation.
47. In Mohd. Ahmed Khan v. Shah llano Be^um^ lhe Constitution Bench
was confronted with a canvassed conflict between the provisions of Section
125-CrPC and Muslim personal law. The question was: when the personal
law makes a provision for maintenance to a divorced wife, the provision for
maintenance under Section 125 CrPC would run in conflict with the personal
law. The Constitution Bench laid down two principles; firstly, the two
provisions operate in different fields and, therefore, there is no conflict, and
secondly, even if there is a conflict it should be set at rest by holding that the
statutory law will prevail over lhe personal law of the parlies, in cases where
lhey are in conflict.
48. In Mohd. Hanif Quareshi v. State of Bihar19 the Stale legislation
placing a total ban on cow slaughter was under challenge. One of the
submissions made was that such a ban offended Article 25 of the Constitution
because such ban came in lhe way of the sacrifice of a cow on a particular
day where it was considered to be religious by Muslims. Having made a
review of various religious books, the Court concluded that it did not appear
16 (1994) 6 SCC 360
17 (1995) 3 SCC 635 : 1995 SCC (Cri) 569
18 (1985) 2 SCC 556 : 1985 SCC (Cri) 245
19 AIR 1958 SC 731 : 1959 SCR 629
■ Trmiiifrrry
■ .• >
^14
392
SUPREME COURT CASES
(2003) 8 SCC
to be obligatory that a person must sacrifice a cow. It was optional for a
Muslim to do so. The fact of an option seems to run counter to the notion of
an obligatory duty. Many Muslims do not sacrifice a cow on the Id day. As it a
was not proved that the sacrifice of a cow on a paiticular day was an
obligatory overt act for a Mussalman for the performance of his religious
beliefs and ideas, it could not be held that a total ban on the slaughter of cows
ran counter to Article 25 of the Constitution.
49. In State of Bombay v. Narasu Appa Mali2^ the constitutional validity
of the Bombay Prevention of Hindu Bigamous Marriages Act (25 of 1946) b
was challenged on the ground of violation of Articles 14, 15 and 25 of the
Constitution. A Division Bench, consisting of Chief Justice Chagla and
Justice Gajendragadkar (as His Lordship then was), held: (AIR p. 86. para 5)
[A] sharp distinction must be drawn between religious faith and
belief and religious practices. What the State protects is religious faith
and belief. If religious practices run counter to public order, morality or c
health or a policy of social welfare upon which the State has embarked,
then the religious practices must give way before the good of the people
of the State as a whole."
sO. Their Lordships quoted from American decisions that the laws are
made for the governance of actions, and while they cannot interfere with
mere religious beliefs and opinions, they may with practices. Their Lordships d
found it difficult to accept the proposition that polygamy is an integral part of
Hindu religion though Hindu religion recognizes the necessity of a son for
religious efficacy and spiritual salvation. However, proceeding on an
assumption that polygamy is a recognized institution according to Hindu
religious practice. Their Lordships stated in no uncertain terms: (AIR p 86
para?)
e
[T]he right of the State to legislate on questions relating to marriage
cannot be disputed. Marriage is undoubtedly a social institution an
institution in which the State is vitally interested. Although there may not
be universal recognition of the fact, still a very large volume of opinion
in the world today admits that monogamy is a veiy desirable and
praiseworthy institution. If, therefore, the State of Bombay compels f
Hindus to become monogamists, it is a measure of social reform, and if it
is a measure of social reform then the State is empowered to legislate
with regaid to social reform under Article 25(2)(Z?) notwithstanding the
tact that it may interfere with the right of a citizen freely to profess,
practise and propagate religion."
51. What constitutes social reform? Is it for the legislature to decide the 9
same? Their Lordships held in Narasu Appa Mali case2" that the will
expressed by the legislature, constituted by the chosen representatives of the
people in a democracy, who are supposed to be responsible for the welfare of
the State, is the will of the people and if they lay down the policy which a
State should pursue such as when the legislature in its wisdom has come to
h
20 AiR 1952 Bom S4 : 53 Cri 1J 354
I
■-
JAVED V. STATE OF HARYANA (Lahoti, J.)
a
/>
c
d
e
f
9
.
393
the conclusion (hat monogamy tends to the welfare of the State, then it is not
for the courts of law to sit in judgment upon that decision. Such legislation
does not contravene Article 25( 1) of the Constitution.
52. We find ourselves in entire agreement with the view so taken by the
learned Judges whose eminence as jurists concerned with social welfare and
social justice is recognized without any demur. Divorce, unknown to ancient
Hindu law, rather considered abominable to Hindu religious belief, has been
statutorily provided for Hindus and the Hindu marriage which was
considered indissoluble is now capable of being dissolved or annulled by a
decree ol divorce or annulment. The reasoning adopted by the High Court of
Bombay, in our opinion, applies fully to repel the contentiorT of the
petitioners even when we are examining the case from the point of view of
Muslim personal law.
53. The Division Bench of the Bombay High Court in Narasu Appa
also had an occasion to examine the validity of the legislation when it
was sought to be implemented not in one go, but gradually. Their Lordships
held: (AIR p. 87. para 10)
“... Article 14 does not lay down that any legislation that the State
may embark upon must necessarily be of an all-embracing character. The
State may rightly decide to bring about social reform by stages and the
stages may be territorial or they may be communitywise.”
54. Rule 21 of the Central Civil Services (Conduct) Rules, 1964 restrains
any government servant having a living spouse from entering into or
contracting a marriage with any person. A similar provision is to be found in
several service rules framed by the States governing the conduct of their civil
servants. No decided case of this Court has been brought to our notice
wherein the constitutional validity of such provisions may have been put in
issue on the ground of violating the freedom of religion under Article 25 or
the freedom of personal life and liberty under Article 21. Such a challenge
was never laid before this Court apparently because of its futility. However, a
few decisions by the High Courts may be noticed.
55. In Badruddin v. Aisha Begum21 the Allahabad High Court ruled that
though the personal law of Muslims permitted having as many as four wives
but it could not be said that having more than one wife is a part of religion.
Neither is it made obligatory by religion nor is it a matter of freedom of
conscience. Any law in favour of monogamy does not interfere with the right
to profess, practise and propagate religion and does not involve any violation
of Article 25 of the Constitution.
56. In R.A. Rathan v. Director of Technical Education22 having analysed
in depth the tenets of Muslim personal law and their base in religion, a
Division Bench of the Gujarat High Court held that a religious practice
ordinarily connotes a mandate which a faithful must carry out. What is
permissive under the scripture cannot be equated with a mandate which may
h
21 1957 All LJ 300
22 (19.81) 22 Guj LR 289
94
394
SUPREME COURT CASES
(2003) 8 SCO
amount to a religious practice. Therefore, there is nothing in the extract of the
Quaranic text (cited before the Court) that contracting plural marriages is a
matter of religious practice amongst Muslims. A bigamous marriage amongst <a
Muslims is neither a religious practice nor a religious belief and certainly not
a religious injunction or mandate. The question of attracting Articles 15(1),
25(1) or 26(b) to protect a bigamous marriage and in the name of religion
does not arise.
57. In Ram Prasad Seth v. State of U.P2^ a learned Single Judge held that
the act of performing a second marriage during the lifetime of one's wife b
cannot be regarded as an integral part of Hindu religion nor could it be
regarded as practising or professing or propagating Hindu religion. Even if
bigamy be regarded as an integral part of Hindu religion. Rule 27 of the U.P.
Government Servants' Conduct Rules requiring permission of the
Government before contracting such marriage must be held to come under
c
the protection of Article 25(2)(/?) of the Constitution.
58. The law has been correctly stated by the High Courts of Allahabad.
Bombay and Gujarat, in the cases cited hereinabove and we record our
respectful approval thereof. The principles stated therein are applicable to all
religions practised by whichever religious groups and sects in India.
59. In our view, a statutory provision casting disqualification on
d
contesting for, or holding, an elective office is not violative of Article 25 of
the Constitution.
60. Looked at from any angle, the challenge to the constitutional validity
of Section 175(l)(r/) and Section 177(1) must fail. The right to contest an
election for any office in Panchayat is neither fundamental nor a common law
right. It is the creature of a statute and is obviously subject to qualifications e
and disqualifications enacted’ by legislation. It may be permissible for
Muslims to enter into four marriages with four women and for anyone
whether a Muslim or belonging to any other community or religion to
procreate as many children as he likes but no religion in India dictates or
mandates as an obligation to enter into bigamy or polygamy or to have .
children more than one. What is permitted or not prohibited by a religion f
does not become a religious practice or a positive tenet of a religion. A
practice does not acquire the sanction of religion simply because it is
permitted. Assuming the practice of having more wives (han one or
procreating more children than one is a practice followed by any community
or group of people, the same can be regulated or prohibited by legislation in
the interest of public order, morality and health or by any law providing for
social welfare and reform which the impugned legislation clearly does.
61. If anyone chooses to have more living children than two, he is free io
do so under the law as it stands now but then he should pay a little price and
that is of depriving himself from holding an office in Panchayat in the State
of Haryana. There is nothing illegal about it and certainly no
unconstitutionality attaches to it.
ii
2^ (1957) 2 LU 172 : AIR 195" All 41 I and AIR 1961 Al! 334 : < 1961) 2 LI J 247
JAVED v. STATE OF HARYANA (Lcdioti, J.)
ai
b'
c
d
e
f
g
h
395
Some incidental questions
62. It was submitted that the enactment has created serious problems in
the rural population as couples desirous of contesting an election but having
living children more than two. are feeling compelled to give them in
adoption. Subject to what has already been stated hereinabove, we may add
that disqualification is attracted no sooner a third child is born and is living
after two living children. Merely because the couple has parted with one
child by giving the child away in adoption, the disqualification does not come
to an end. While interpreting the scope of disqualification we shall have to
keep in view the evil sought to be cured and purpose sought to be achieved
by the enactment. If the person sought to be disqualified is responsible for or
has given birth to children more than two who are living then merely because
one or more of them are given in adoption the disqualification is not wiped
out.
63. It was also submitted that the impugned disqualification would hit the
women worst, inasmuch as in the Indian society they have no independence
and they almost helplessly bear a third child if their husbands want them to
do so. This contention need not detain us any longer. A male who compels
his wife to bear a third child would disqualify not only his wife but himself
as well. We do not think that with the awareness which is arising in Indian
womenfolk, they are so helpless as to be compelled to bear a third child even
though they do not wish to do so. At the end, suffice it to say that if the
legislature chooses to carve out an exception in favour of females it is free to
do so but merely because women are not excepted from the operation of the
disqualification it does not render it unconstitutional.
64. Hypothetical examples were tried to be floated across the Bar by
submitting that there may be cases where triplets are born or twins are born
on the second pregnancy and consequently both of the parents would incur
disqualification for reasons beyond their control or just by freak of divinity.
Such are not normal cases and the validity of the law cannot be tested by
applying it to abnormal situations. Exceptions do not make the rule nor
render the rule irrelevant. One swallow does not make a summer; a single
instance or indicator of something is not necessarily significant.
Conclusion
65. The challenge to the constitutional validity of Sections 175(l)(f/) and
177(1) fails on all the counts. Both the provisions are held intra vires the
Constitution. The provisions are salutary and in public interest. All the
petitions which challenge the constitutional validity of the abovesaid
provisions are held liable to be dismissed.
66. Certain consequential orders would be needed. The matters in this
batch of hundreds of petitions can broadly be divided into a few categories.
There are writ petitions under Article 32 of the Constitution directly filed in
this Court wherein the only question arising for decision is the constitutional
validity of the impugned provisions of the Haryana Act. There were many a
writ petition filed in the High Court of Punjab and Haryana under
■
' I
a
■-
| IsKly
C!S
396
SUPREME COURT CASES
(2003) 8 SCC
Articles 226/227 of the Constitution which have been dismissed and appeals
by special leave have been filed in this Court against the decisions of the
High Court, fhe wm petitions, whether in this Court or in the High Court
were filed at different stages of the proceedings. In some of the matters the a
High Court had refused to stay by interim order the disqualification or the
proceedings relating to disqualification pending before the Director under
ec ion 177(_) of the Act. With the decision in these writ petitions and the
appeals arising out of SLPs the proceedings shall stand revived at the stage at
which they were, excepting in those matters where they stand already
concluded, fhe proceedings under Section 177(2) of the Act before the b
Director or the hearing in the appeals, as the case may be, shall now be
concluded. In such of the cases where the persons proceeded against have not
iled then replies or have not appealed against the decision of the Director in
view of the interim order of this Court or the High Court having been secured
by them ithey would be entitled to-file reply or appeal, as the case may be.
c
wi tin lo days from the date of this judgment if the time had not already
expired before their initiating proceedings in the High Court or this Court.
uc of the cases where defence in the proceedings under Section 1170) of
the Act was ra.sed on the ground that the disqualification was not attracted on
account of a child or more having been given in adoption, need not be
reopened as we have held that such a defence is not available.
d
67. Subject to the abovesaid directions all the writ petitions and civil
appeals arising out of SLPs are dismissed.
[Connected Matter]
(2003) 8 Supreme Court Cases 396
(Before B.N. Kirpal, V.N. Khareand M.B. Shah, JJ.)
( Record of Proceedings')
RAMESHWAR SINGH
Versus
STATE OF HARYANA AND OTHERS
..
e
Petitioner;
Respondents.
f
Writ Petition (C) No. 504 of 2000, decided on September 22. 2000
|,il,ishads — Haryana Pauchayati Raj Act, 199!
livi
i ii
~(l)(q)
Validity of — Condition of having more (han
o stliving
u d "bchildren
1 " prescribed
Prescr’bed as a disqualification for a candidate desiring
stand for the office of Sarpanch or Ranch of a Gram Panchavat or
V atn
M
a nle,nber 01 i’anchayat Samiti or Zifa Parishad - lick!, is 9
nersm™ h. Id5' nOn-^ten?lon <*' said disqualification to other legislators and
persons holding public offices would not be an infringement of Art. 14 of the
Constitution — Constitution of India — Art. 14 — Discrimination
Writ petition dismissed
W-M/24808/S
Advocates who appeared in this case :
h
B.S. Mor and Mahinder Singh Dahiya. Advocates, for the Petitioner.
(It
E
Al
TWO CHILD NORM
State Governments Poised to Blunder
Colin Gonsalves
After the Supreme Court made mistaken observations in respect of the ‘two
child norm’ in Javed v/s State of Haryana, several state governments have taken steps
and are on the brink of enacting legislation to enforce a Two Child Norm. A blunder
of epic proportions is about to be committed.
From 1951 to 2001, India’s population grew from 360 million to 1020 million.
This growth has been characterized as a ‘population explosion'. The antidote, we are
told is the punitive enforcement of the two child norm. To understand the folly of
such a step one must, as Dr. Almas Ali explains in ‘Population and Development’,
separate myth from reality in the population debate.
All nations typically go through three phases: the first of high birth rates and
high death rates, the second of high birth rates and low death rates and the third of low
birth rates and low death rates. After World War II. advances in health technology -
including the discovery of antibiotics - caused a dramatic decline in the death rates.
This caused population to grow at an unprecedented rate. 84% of India’s population
increase took place during this period. At the same time, and this is not commonly
known, the Total Fertility Rate (TFR) i.e. the average number of children a woman
would have, came down from 6 in 1951 to 3.2 in 2001. Yet the population continues
to grow not because of the family size but because of. what is called, ‘population
momentum'. This is an accelerated in-built growth due to the high percentage of
young people (60%) in the population who, even as they have fewer children, produce
large quantum increases. This takes place despite the fact that family size is declining
across the board for rural and urban families and for poor and middle class families
alike.
The single most important factor that reduces momentum is the raising of the
age of marriage. The strongest impact of this comes through increasing the years of
schooling for girls. In Sri Lanka where this has been done fertility rates were quickly
reduced without coercion.
1
Based on a misunderstanding that poorer people and particularly those in rural
areas and slums are having too many children some were quick to suggest a two child
norm with punitive disincentives. Superficial comparisons were made with China and
its one child norm. A closer look shows precisely how wrong these comparisons
were. China's TFR drop from 2.8 in 1979 to 2.0 in 1991 was comparable to Kerala’s
TFR drop from 3.0 in 1979 to 1.8 in 1991, the difference being that as compared to
China’s atrocious human rights record, in Kerala there was no coercion. Stress on
education and development did the trick. However the Chinese decline also stemmed
from the emphasis placed on education by the Chinese Communist Party during the
prior decade - 1970-1979.
It was the realization that education, development and woman and child
welfare was a better way to lower the family size rather than punitive disincentives
that led to the paradigm shift from Population Control to Reproductive Health at the
Cairo Conference in 1994. It was agreed that quality of life be emphasized and that
there would be no force, coercion, incentives or disincentives. India too got out of its
‘Emergency Model' family planning approach and introduced the Target Free
Approach and followed this up with the National Population Policy (NPP) 2000.
NPP 2000 defined the overriding objective as the improvement in the quality
of lives. One of the several immediate objectives was to address the unmet needs of
contraception. 25% of poor families seek contraception but are unable to get it. There
is no mention made in the Policy of the two-child norm, of targets or disincentives.
The two-child norm came in by a side wind. Persons who were disqualified
from contesting Panchayat elections in Haryana filed a petition in the Supreme Court
impugning the constitutionality of the State notifications laying down the norm. In
these proceedings, the Central Government appears to have given the Supreme Court
the impression that the two-child norm was indeed part of the National Population
Policy. Nothing could be further from the truth. The consultations that took place
prior show that the two child norm with its package of disincentives were
emphafically opposed due to the anticipated adverse impact on poor women and
hence omitted from the Policy altogether.
2
43
The decision of the Apex Court in Javed v/s. State of Haryana is a classic example of
how a Court can make a terrible mistake while dealing with an intricate social issue
merely because the parties before the court are unable or unwilling to properly explain
the complexities involved. The court made several mistakes. First it relied on an
obsolete 1960's Club of Rome framework and characterized ’’the torrential increase in
the population....as more dangerous than a Hydrogen bomb” (Russel). It quotes with
approval two obscure writers on the subject who say that “the rate of population
growth has not moved one bit from 1979”. Nothing could be more wrong. The truth
is that India has experienced the sharpest fall in decadal growth from 23.81 in 1991 to
21.34 in 2001. This is the lowest population growth rate since independence!
Secondly, it refers to the Five Year Plans from the lsl to the 7th (ending 1991)
with their emphasis on punitive disincentives and fails to notice the landmark
departure in approach in the Cairo Conference (1994) with the emphasis on
development, quality of life and women welfare and the rejection of disincentives.
Thirdly, it fails to notice that none of the grounds taken in the petition related
to the impact on women. Towards the end of the judgment under the title ’’incidental
questions" reference is made to the impact on women but even these are dismissed out
of hand. The Court was not informed that population experts throughout the country
were unanimous in their view that the impact on poor women would be immediate
and severe.
What are the implications and fallout of the judgment? Dr. Ali points out that
research conducted in Orissa, Rajasthan, Haryana and Madhya Pradesh indicates that
the norm to disqualify candidates has led to the desertion of wives and families,
seeking of abortions with the associated abortion related health risks, giving away of
children for adoption and initiation of new marriages by male elected members.
Women bear the brunt of the disqualification clause.
For breach of the two child norm several States have put together a package of
punitive measures including exclusion from elections, exclusion from ration cards,
kerosene and other BPL incentives, denial of education in government schools to the
third child and withdrawal of welfare programmes for SC/STs.
3
These punitive measures will operate mainly against poor women. Total fertility is
3.47 among illiterate women as compared to 1.99 for the middle classes. The infant
mortality rate among SCs, STs and OBCs is 83, 84 and 76 respectively as compared
to 62 for others.
I hese sections have a high wanted fertility rate due to the prevailing
high infant mortality rate.
Clearly, to impose the two-child norm is to widen the inequality gap among
the people as the disincentives would disproportionately impact on the already
deprived population. More terrible, the two-child norm would provide an impetus for
an increase in sex selective abortions and female foeticide, worsening the alarming
decline in the child sex ratio noticed in the 2001 Census.
I here is a lesson to be learnt from this.
judiciary.
NGOs are the natural ally of the
In matters of general social significance they ought to be brought in to
guide the Court and give it the larger picture, particularly, when the contesting parties
have narrow vested interests.
To conclude:
momentum will carry through for the next 30 years after which
the falling H R will assert itself and India will move into the third phase of low birth
rate and low death rate. In the meanwhile, India must stop counting people and start
counting on people, and invest in them, thus improving the quality of their lives.
Colin Gonsalves
Senior Advocate
65. Masjid Road, Jangpura
New Delhi-1 10014
24324501/24316922
colin_legal@yahoo.com
4
ICPD Issues And Us - Some Reflections
Pr.
sin
Por
w<
Dr. Mira Shiva
. Ill
.Ac
’3^38'
^71/^
xSMBBk, ./ /: 1HUB/v
VI
It was not just the emergency period that gave
family planning a bad name, but it was the wav
the F.P. Programme had been planned with
netting ot targets number wise and gender
w ise. Dr Ashish Bose had called this "Targetitis".
Duiing the emergency as a post graduate in
c A C. Ludhiana I heard from my senior doctor
and teacher how on his way back from Delhi
to Ludhiana, he had been stopped and
matched to a F.P. camp for forced sterilization
and how he had escaped by the skin of his
teeth when he demanded to talk to the
collector w horn he said he knew. If this could
happen to a senior doctor, what would have
been the rate of le«cr mortals, .m.any of whom
wcm not rwn mamed nor had a living child. It
rrrrr11' EcbJ3,!> (-ruel was the putting of
itcu Copper T m women, even with blatant
infection. Women complained of white
discharge and all those involved in women's
health were well aware of it. How could trained
10
HEALTH FOR THE MILLIONS / August-September & October-November 2004
doc tors and health peisonnd putting in lUCDs,
the numerous family planning < amps not feel
the need to address the other gynecological
problems? Apparently there was no budget for
treating intec tions, only for ( onlra( eptives. I he
entity called RTFs was born muc h later with the
shift of family planning to reproduc tive child
health programme passing through the other
stages of programme planning, renaming i.e.
family welfare, maternal and child health RTI's
initially were understood as Respiratory Tract
Infections as was taught in medic al education.
The recognition of the obvious, as a significant
rc’produc live health concern i.e RTI's STD's
earlier c ailed V.D./venereal disease was a
significant shift. Even though even today the
efforts that needed to go in (heir prevention
and management are inadequate and
sometimes totally irrational.
It was the women's movement and some
health groups including a few demographers
who raised their voices against
...........
coercive
population control policies. Since the
-- ...a Family
Planning Programme was
a government
programme and FP was a holy cow, any
questioning of the polic y, or of unethical clinical
trials, of cuniiacepiive
contraceptive technologies
technologi
e.g. nor
plant, nett en. was considered
as 'anti
establishment anti development'
as well as
'anti national' activities.
Women's health movement was strong in India
and similar voices were heard from other Asian
countries Bangladesh, Philippines, Indonesia etc
Many groups come together as women
resisting against hazardous technology and
coercive population control policies and
demanding right to qualitv reproductive health
services and sate contrac eptives.
The preparatory- phase of ICPD saw several
organisations working in women's health and
community health become activelv involved in
the process besides many others. There was a
spectrum and at one end. were population
controllers, with their total faith in technology
fixes, most of which were targeted at women
to decrease 'numbers' and at the other end
were groups who believed in a woman's right
to 'safe birth control', and her right over their
bodv. her lite and her reproduction.
Pre ICPD at \ HAI we organised state level
workshops in Himachal Pradesh. Madhya
'P'
Io.
po
I lit
not
rm
net
wit
'wi
sh<
asp
mig
of I
terr
has
disc
pap
anc
the
anc
gov
jour
PRIs
ICPI
difh
Sou
'pof
saw
repr
par
exp
con
com
opp
and
mak
hav i
their
and
The
part,
of c
tend
reac
Talk
'tech
to s;
not
RTI's
the <
and
conti
FP w
educ
160
Shiva
lUCDs,
iot feel
■logical
get for
bs. The
-ith the
e child
other
ing i.e.
i. RTI's
/ Tract
cation,
uficant
STD's,
was a
ay the
ent ion
and
some
iphers,
ercive
Family
nment
v, any
clinical
g. nor
'anti
veil as
n India
Asian
ua etc.
omen
,y and
s and
health
everal
h and
Ived in
was a
jlation
lology
omen,
•r end
s right
r their
• level
adhya
Pradesh and Uttar Pradesh. We insisted that
since the International Conference was on
Population and Development, and therefore we
would address 'development' issues besides
'population' concerns. The objective was to
look at the diverse state level concerns on
population as well as development.
High maternal and infant deaths, poor nutrition,
non-availability of health services, specially
emergency services, transport, resources,, the
negative impact of tourism in Himachal Pradesh
with importing of 'city culture' and demand of
'wine and women', increased opening of liquor
shops by state governments to raise revenue,
asphyxiation of the rural economy, forced
migration to towns for menial jobs, disruption
of families, inadequate options for the youth in
terms of livelihood and absence of vocational
based education, were some of the issues
discussed and concern expressed. Analytical
papers, statistics along with heated discussions
and debates ensured that the state VHA's and
their member institutions were well informed
and actively involved along with other
government officials, socially conscious
journalists, representatives of women's groups,
PRIs etc. and grassroot workers.
ICPD prep com 3 in New York showed the
difference in the perspective of the North and
South, and also between those who were for
'population control at any cost' and those who
saw 'family' planning, contraception as a
reproductive health concern, involving both
partners, as well as the state, which was
expected to meet the need for safe
contraceptive besides basic needs of its people,
ensure the survival of the children, provide
opportunities to women, prevent discrimination
and violence against them so that they could
make choices about their lives, which included
having some say, in the choice of the father of
their children, besides the number of children,
and the spacing between them etc. etc.
The need for sensitivity at a human level to the
partner was found to be one of the main areas
of concern. The use of the word 'gender'
tended to and still tends to provoke patriarchal
reactions.
Talking of 'choice' of contraceptives as 'technology fix' alone, when she had no choice
to say 'no' to her partner, even when she was
not well, or when, because of the rampant
RTI's, the pleasure of one partner was 'pain' for
the other — reflected the need for recognising
and giving of real choices to women, beyond
contraception. The need for health personnel,
FP workers and society to look beyond the FP
education brief, given routinely, where gender
sensitivity and even fertility awareness — that
ovulation takes place only once a month is not
communicated.
It was articulated again and again that
'reproductive rights' alone were not possible
without women's social and political rights, and
their being respected as a human beings and
not mere statistics in an increasingly patriarchal
world.
ICPD Cairo saw massive debates on abortions,
on structure of family, on inclusion of sex
education in schools etc. Vatican and Islamic
countries expressed their concern about the
need to protect 'family values' and norms, as
free availability of contraceptives would
triviafize sacred relationship. Others saw access
to contraception and abortion as their right.
Many feminist groups saw family as an
oppressive institution and some wanted
definition of family to include, same sex
partners. Many Islamic country representatives
pointed out that the highest incidence of rapes,
teenage pregnancies, pre marital sex was in
these western countries, which wanted the rest
of the world, to include sex education in
schools, when apparently it was they who
needed them the most and also some 'self
control' in an era of increasing permissiveness
trivialization of sex, of sexual relationships
marriage as well as abortions. 'Freedom' and
'choice' had to be used with responsibility.
Cairo saw entry of big time players in this field.
Financial commitments made by developed
countries were 0.7% of GDP, with 20:20
initiative. The provision made by developed
countries have not been met.
Where many of these are concerned some
debates are relevant even today. Just as
increasing age of marriage, increasing age of
first pregnancy was seen to have a definite
impact on decreasing birth rates, so also was
the call to increase the age of V sexual
encounter, faithfulness of partners and use of
condoms to prevent STD, HIV/AIDS.
It is a pity that neither has gender sensitivity, nor
gender responsibility increased as it should
have. This would have reflected in decreased
'inflicted' pregnancies, decreased abortions,
decreased STD's HIV/AIDS and decreased
sexual violence.
It is a great pity that instead of building and
using every possible defense and preventive
measure, specially where male participation and
male responsibility is concerned, talking about
'abstinence' and 'being faithful' is seen as
abnormal — prudish and by dumb followers of
HEALTH FOR THE MILLIONS / August-September & October-November 2004
B
George Bush or the Vatican. The 'sex ad'
irrespective with whom, takes priority over
relationships and 'condom' is the saviour. When
it is known that manufacturing defect, storage
defect and problems with proper and regular
use of condom does not make condom, a
100% sate protection, in our social context.
Recent reports have even indicated decline in
condom sales, inspite of all the promotion of
condoms. Prevention efforts of HIV/AIDS that
relies
only
on
condoms
with
condombification" of the programme, without
also pressing for greater responsibility in sexual
behaviour, is a cause of concern not just for
HIV/AIDS but also FP and reproductive health.
Male responsibility is reflected in the number of
male sterilization vasectomy (even with the
easy no scalped vasectomy' being available)
male contribution in family planning and
contraception is grossly inadequate and
decreasing, male contribution in permanent
sterilization is merely 2% (Fig:l)
Figure 1: Current Use of Contraceptive Methods
Pill
2%
IUD
2%
Condom
3%
Not Using/,.
wfeap
Female
Sterilization
34%
Any Traditional
Method/Other
Method
5%
Soruce: NFHS-2, Indi3, 1998-99
The developing countries were concerned
about the issue of migration, internal as well as
international and also about the workers right
of family reunification when workers stayed
away for many many years from their families,
to earn and send money to their families.
In the exhibition halls of the Conference in
Cairo, the imagery of the population issue was
created, with use of words like population
bomb, population explosion, visuals and posters
of people looking like ants falling off the earth
and looking like huge garbage heaps with
people piled on each other abounded. Pictures
showing rows of pregnant women. Most of
12
S
HEALTH FOR THE MILLIONS / August-SeptembeZ&'6?.oi«-Novemli7^ '
The
Gap
betv
with
ineq
instil
dise<
and
says
obvi
The
same
of liv
entit
periposs
on t
poin
uner
In the exhibition halls these images,
undoubtedly created 'fear psychosis' as with
'nuclear war' and 'communism' evoking 'racist'
feelings in general public and also greater 'victim
blaming' with further removal of understanding
of the gender and socio-economic aspects of
the population issue. Most women have little or
no say, where pregnancies are con< erned and
instead of strengthening them, they have been
blamed and disempowered.
The stringent national immigration laws by these
very countries demanded free movement of
their products, yet restricting free movement of
people was pointed out as double standards.
In su
eldei
mon
of r
addr
of th
then
mort
prog
Furtb
with
maq
creat
Chapter 3 on Equity Economic Growth and
sustainable development was seen as the
critical chapter by various women" groups
from the south.
The early 90s was the period when Uruguay
Round of GATT had already been initiated and
pressure on developed countries to open up
their markets and decrease their import duties,
tariff barrier had already started and in 1995
following the Dunkel Draft with only "take it or
leave it" option given WTO literally as a supra
national body came into existence.
Male
Sterilization
2%
Any
Method
52%
these people were brown or black and many
of these people were 'women', projected as
the 'problem creators' the root of the
population problem.
The
mult
restr
ecor
inten
are r
pooi
worl
sect
artis.
or in
cour
Deep concern was felt then by the health
movement and the women's movement and
is felt much more now as unsustainable,
exploitative, ecologically disastrous, self
indulgent lifestyles, products and commodities
are aggressively being marketed, to those 'with
the purchasing power'. They are seen as the
'market' that must expand and the rest without
the purchasing power, the poor majority are
the 'population', with no rights and
entitlements, and they must decrease. When
80% of the resources are consumed by 20%
of the affluent, the issue of consumption
control has to addressed as aggressively, as this
level of consumption is UNSUSTAINABLE
More so in the developing countries with a
significant % of people, below poverty line
and the national governments in debt, or in
the process of servicing debts, with further
cuts in the already inadequate social sector
budgets, in health, education and care of the
elderly, disabled etc. is further eroding
whatever little the people have had. The very
concept
of
Alma
Ata
recognises,
comprehensive health care is basic right for
all, before the privileged care for few at the
o< others.
,^^0
W6 62
V—
Con
Ivory
in th
deve
conf
and
over
1
—'A
^7
7
Chai
admi
certa
relati
orgat
man
progi
/02.
many
ed as
f the
ages,
with
'acist'
✓ictim
nding
cts of
tie or
d and
been
these
nt of
?nt of
a rds.
i and
; the
oups
iguay
i and
•n up
uties,
1995
• it or
iupra
ealth
and
ible,
self
dities
with
the
hout
/ are
and
v'hen
20%
tion
> this
BLE.
th a
line
;r in
ther
ctor
the
Jing
very
ses,
’ for
the
The 1995 World Health Report on 'Bridging the
Gap' has highlighted the increasing inequalities
betvyeen the rich and poor countries, and
within the countries. This gap of increasing
inequity is now in every sphere, and in many
institutions. The international classification of
diseases, Z595 was added as a new category
and it stands for extreme poverty. The report
says extreme poverty is on the increase (and
obviously with it are the diseases of poverty).
The Human Development Report says the
same thing, so does the ILO about the erosion
of livelihoods, erosion of the workers rights and
entitlements, devaluation of human beings in a
period where success is defined by the
possession and control of money and decisions
on the lives of others. Recent ILO report has
pointed out that 50% of the youth are
unemployed.
In such an environment devaluation of women,
elderly, disabled, and the poor is much much
more and if it has to be addressed, the question
of rapidly increasing inequities must be
addressed. It is also clear that the beneficiaries
of the greatest privileges will never want to give
them up, rather they would want more and
more. If they are in position of policy making,
programme planning, controlling resources.
Further increase in inequities is to be expected
with
greater
disempowerment
and
marginalization of the vulnerable if inequity
creating policies are promoted.
The birth of WTO — the bilateral and
multilateral pressures, lifting of quantitative
restriction, change in patent laws, agriculture,
economic industrial policies in compliance of
international trade regimes, when it is clear they
are not in the interest of the nation specially the
poor majority — laying off of thousands of
workers, closure of thousands of small scale
sector units, conversion of thousands of
artisans as daily wage labourers on the roads
or in city slums, is the economic reality of many
countries across the world.
Conflicts, wars in Iraq, Afghanistan, Sudan,
Ivory Cost for oil, diamonds have taken place
in the last decade. Peace is important for
development as the price paid for war and
conflicts is too heavy as priorities get distorted
and arms and military spending, takes priority
over medicines and health care.
Changes with the coming of the Bush
administration and its unwillingness to support
certain reproductive health programmes abortion
related, has^rcsulted in cutting of support to
organizations (like UNFPA) which has resulted in
many of the relevant reproductive health
programmes in needy places being curtailed.
National Level
At the national level post ICPD Cairo, we saw
the launching of new RCH programme in 1997
in keeping with ICPD's Programme of Action.
Against incentives disincentives and targets it
saw their removal and initiation of the Target
Free Approach (TEA). This has definitely been
a major paradigm shift. The National Population
Policy was evalued with a lot of discussions and
debate.
The National Population Policy of 2000 was
broad and incorporated issue of -
❖
Health services
❖
Girl child
❖
Male responsibility
❖
Female
literacy
empowerment
❖
Decentralised Planning and Programme
Implementation
❖
Convergence of Service Delivery at the
Village Levels
<•
Empowering Women for Improved Health
and Nutrition
and
women's
<•
Child Health and Survival
❖
Meeting the Unmet Needs for Family
Welfare Services
<•
Under Served Population Groups
<•
Diverse Health Care Providers
<•
Collaboration with and Commitments from
HEALTH FOR THE MILLIONS / August-September & October-November 2004
■
13
)o3
■>
I
Scve
an u
heah
prog
build
Ther
coer
pres
othe
Unfc
not I
of tl
are ii
The
Kee|
Corr
a nai
UNF
Non-government Organisations and the
Private Sector
❖
Mainstreaming Indian Systems of Medicine
and Homeopathy (ISMH)
❖
Contraceptive Technology and Research
on Reproductive and Child Health
•:•
❖
❖
❖
Providing for the Older Population
Information, Education and Communication
Role of TSM in RCH
Role of diverse health functionaries and
It has been a long process for building an
understanding about what constitutes
"reproductive health" within the national
government's RCH programme, and within the
women's health movement while the issue of•> Family planning
❖ Safe pregnancy and child birth
❖ Safe abortion
❖ RTI, STI, HIV/AIDS
❖ Infertility
❖ Adolescent
have also been included priority is family
planning. Unfortunately some of the other
reproductive health concerns have not received
the attention.
Sexual violence
Availability of essential medicines and their
rational use in RCH must be ensured
Male responsibility
❖ Teratogenic effect of drugs and chemicals
taken in pregnancy where congenitally
14
Q
HEALTH FOR THE MILLIONS / August-September & October-November 2004
❖
❖
❖
POP’
gove
for .
incei
case
con j
Pope
affec
vulne
- Ml
malformed babies are born to name a few
Infertility due to genito urinary tuberculosis
Abortions, still birth, low birth weight
babies or even maternal death due to
falciparum malaria
RCH in medical education and medical
practice
Due
in th<
of re
affec
tech
serv
thou
In 8 states Delhi, Punjab, Haryana, M.P., U.P.,
Karnataka, Gujarat, Tamil Nadu as part of
sensitization effort about the RCH programme,
we conducted workshops with faculty members
of Obe gyne, paediatrics paid and community
medicine on "RCH, women's health and gender
concerns". It was clear that the medical colleges
had not been involved in the process, the word
'gender' did not exist nor does it exist even today
in medical education nor does reproductive
health, or women's health, as obe gyne is not a
substitute for this. The need for gender sensitivity
in examining women patients, in not blaming them
for pregnancies often inflicted, against their will,
sensitivity in excluding possibility of pregnancy
while prescribing medicines, in treating malaria,
gender sensitivity, in treating cases of infertility,
childlessness, as it is the women who are usually
blamed and called Banjh (barren). There is a need
for inclusion of talk to husband and in-laws, about
xy chromosome, and role of 'y' chromosome
from the father in determining male sex of the
unborn foetus. This should be included in biology
books in schools to stop victim blaming and
making life of women hell for not producing a
male child, and at the same time addressing sex
selective abortion.
Non
erne
facilii
well,
mate
bloo
anen
secti
work
shor
anest
as pi
mad*
prob
prop
nurse
Med
anest
techi
Unfo
train
-t
loif
Several state level workshops were held to build
hp-,hhderSt^nding abou' RCH and women's
, gender concern, the government RCH
Qr“^ndeffor,sweremad—eS
There is no denying that in most places the
coerave population control has gone. Yet it il
t -'W;
i
present m some states and coming back in
Unfortunate y many of the state policies have
been in keeping, with the content and spirit
of the National Population Policy, infact some
are in blatant violations of NPP as well as ICPD.
The NHRC has been concerned about it
Keeping th.s the National Human Rights
Comm.ss.on declaration brought out following
UNFPA a tCOnS|Ulta"On u7 MOHFW- NHRC and
UNFPA. It notes with great concern that
population policies framed by some state
g. . emments reflect in certain aspect, respect
for a coercive approach through use of
I
few
miosis
■ight
to
cTsel r5 a"dd'slncen'ives, which in some
consistenr
? bUman riSb,s' This is
consistent with the spirit of the National
Xc " "n Po cy-.The violation of human right
v In
I
fJart,cular the marginalized and the
-tHRC^or5 °f SOCie,y'
women
al
in thenaT^’'
°f PUbl'C heal,h services
of re ,P H dccadle ,he ac«ss to and the quality
• 'P.,
Ot
ae,
ier$
fity
‘Her
■;es
ord
:ay
ze
fe^ed W'dC heal;h SerViC6S haS als° b-"
technician d S,8nif,canl ^P* in ANMs, lab
technician, doctors not in place the RCH
th^'h6^^ undoijb'edly affectedI - even
'hough the RCH budget has been increased
Non-availability
of referral services
for
emergency obstetric care and UansooH
wel''Th.”* hT 'hT WCre no' WOrked out ,o°
a
m-uo
I h S unfortunately resulted in high
maternal mortality, problems of availability of
■inemic and n
%l.°f preRnan' ^en^re
m
• til
y
section will SOrne n‘1Ve ,O under8° caesarian
work WlXhtevenf2;3sm haemoglobin and,
short J ' L"me °f del,very and resume work
irta.
anesthp t gynaecologists, paediatricians or
anesthetists are not willing to go to the
periphery. To address, the unacceptably high
maternal mortality rate, provision of emergency
obste ric care is crucial. Balance between
and access' has to be made^d
access' has to be made
Tnesth
L sur8ery. Non-availability of
as oroblemand med,c,nes have been identifier!
made
Pral a"emptS have been
riaae by the ministry to address the major
proposmi|0|ont0n-aVai';’bili,y of anesthetists by
proposal to train medical doctors MBBS or
M d ?"es,he,lsts- Resistance has come from
^edicnl Association and FOGSI, as providing
technicil'acand mOni,orin8 'he patients requires
I Inf T co™petence and adequate training
trnfoe
r^M
reali,y is ,bat ^a'ihed
amed, skilled doctors whether they are
complementing the GovernmentIn the National
RCH programme, and helping in improving the
RCH services, m selected geographical areas A
new scheme to involve private practitioners is
being made by the ministry to provide
reproductive health services.
Since ICPD in Cairo the concept of RCH
understanding wise is much clearer
unfortunately provision of quality RCH services
to the women, ,s still not a reality for various
reasons. Inadequate budget, absence of
essential reproductive health commodities e n
drugs, equipment, trained staff. Inadequate
involvement of private practitioners, absence of
clinical skills of health functionaries of public
and private sector.
’
On the whole the status of women except for
a privileged few has shown increasing
devaluation increasing discrimination and
violence. This has been a cause of g eit
concern.
JI
clcar'ba' lo ensure implementation of the
National Po icy of Empowerment of Women
was brought in to facilitate intersectoral
coordination. Several states brought out state
pohoes. Women as health care providers at the
bottom of the health hierarchy, as ANMs and
as anganwadi workers they have shouldered
the greatest work burden. Many of them face
great insecurity and inadequate support.
Patriarchal mindset has rarely thought of their
rSo|CpUsr"y
111 "’•''veiling their multiple
oles as health care providers, as mothers
wives, daughters, in-laws and their poor health
status and inadequate remuneration. As a nation
there is so much that we can do for ourselves
and in many spheres we have managed to do.'
To improve the health status of our women and
children contribution has to come besides
Health and Family Welfare from other Dr. Mira Shiva is the
minis nes, health sector and from civil society. Director. Rational
High birth rates are associated with low literacy Druf; Polic y (ROD ,lnd
and low work participation rate. Health and VVomt'n Health A
l^vvelopment (WHDI.
education budgets must be increased and VHAI. Dr. Shiva ts the
livelihoods ensured.
1Guest Editor of this
issue of the HI M.
health for the miluons z
August.sepImber &
2(XM
C
15
Reflections on ICPD and After
Ashish Bose
w
quotas
for nthe recruitment
(P
7
recrui,^ent of clients",
(l ara/.l of Programme of At lion of the United
Nations International Conference
Naums
Confercnt on Populations
and Development, reprodut ed by Ashish Bose in
Mu s Pop^ p()licv:
p
Publishers Delhi, 1996, p.279).
The theme of my presidential address at the 12th
annual conference of l,\SP at Allahabad in 1987
was -For Whom the Target lolls". I had challenged
the whole strategy of target-setting. which led to
XMly-snatchmg during the emergency (1975-77)
I also c hallenged the use of money power and cash
had the privilege of participating at the
htternational Conference on Population and
Development (ICPD) . sponsored by United
Nations at Cairo (September 5- 13, 1994), as a
member of the delegation sent by the International
Union lor the Scientitu Study on Population (IUSSP
with headquarters at Liege, Belgium and currently
a I aris). We could attend both the official United
Nations Conference as well as the Forum for
NGOs and other non-official organisations. It was
a huge conference. Suc h conferences have been
held every ten years. I c all these conferences
Kumhh Arfe/a whir h are held at sacred places in
India every 12 years and AnlhKumbhMel^nL-ry
6 years. I am happy that the United Nations is also
following this Style. There are 5 plus and 10 plus
meetings and workshops. Without being cynical
may say that Governments have got into the
mode of brahminical rituals. Even when they are
oernating, they pretend to be extremely active
and enthusiastically implementing all the
recommendations of the ten yearly conferences.
Have the objectives of ICPD 94 been attained?
Let me turn to India. 1 he Department of Family
Welfare of the Government of India was quick to
endorse the philosophy and recommendations of
me Cairo conference. It was quite hilarious for me
° observe that while the bureaucrats haa earlier
ridiculed my plea tor abandoning family planning
argets (which I had made in my presidential
address at the annual conference of the Indian
Association for the Study of Population /IASP),
r
tO accePt the recommendations
ot the ICPD conference which, inter alia, said
Demographic goals, while legitimately the
subject of government development
strategies, should not be imposed on family
planning providers in the form of targets or
HEALTH FOR THe MILLIONS / August-September & October-November 2004
incentwes to lure acceptors of sterilisation
Ccrmmenung on the target setting and incentive
sc hemes I had said: "We are opposed to the giving
ot c ash awards to different states in India for 'goocF
Mmily planning work every year"(see Ashish Bose
From Population to People. Volume I B R
,^l’PYp'’Ha.pp.ll6H7l.lha<lc|Uestioned the
me hcxlology ot rating ditterent states for giving
cash awards. I was appalled when Uttar Pradesh
Ione ot the worst states in India, got the first prize'
I wrote to Prime Minister Rajiv Gandhi on this issue
<
explainmg m a tec hnic al note why this scheme
should be abandoned and the tax payer's money
saved. I must rec ord with appreciation that at the
instance of the Prime Minister this scheme was
abandoned, d think Rs I 5 c rores were involved in
inis unproductive exercise).
According to the Government of India's order
from
April 1996 the new scheme of
Reproductive and Child Health (RCH) was
introduced all over India. The term 'Family Welfare'
was abandoned in favour of RCH. At this stage I
must pomt out that ICPD did not use the
expression RCH at all. The documents talked of
Reproductive Health (RH) and Reproductive Rights
I had pointed out to my UN friends in Cairo that
the concept of RH was nothing new to India Our
hrst Fwe Year Plan (195 1-56) had talked of
Maternal and Child Health (MCH). Perhaps our
health Ministry was aware of this and they
designated RH as RCH in India. So far so good. But
wha has been the record of RCH activities during
the last 10 years? Is the programme a grand
bhm?5 hL'S °Ur
y iplanning administrators
blaming UN agencies and academic scholars like
me for suggesting that there should be no targets
because the government cannot work without
targets. The answer to this question will depend
on the amount of fieldwork one has done in
various parts ot India to assess grassroots reality.
My brief comments below are based
on my
limited exposure to field work in states like Punjab,
I lar
Prad
heal
prog
the I
Iron'
USAI
have
I do n
the in
have
shift
sterilis
irnprj
par tic
respe
The (
prorni
tec hr
wortl
has •
progr
over. \
on thGandl
hurea
sterilis
to get
possu
depar
in gett
calls k
how h
last 2"
that f.
they b
their \
some
field v
drinks
think
grants
and m
3dequ
health
surgec
transfc
not p<
bring
It is m
wome
Muslir
Unfort
in the
in terr
operat
parts (
much I
its ene
RCH s
/o6
Haryana, Himachal Pradesh, Rajasthan Uttar
v|
Bose
Why, for example, the progress of family welfare
so appalling in the BIMARUstates (including their
three new offshoots)? Why is the infant modality
S° sh?cl<in8l>' high in Orbsarrhe i
rate so shockingly high in Orissa? The unfortunate
'i ' a' 'CPD 94 <and the ^eqi
diffl P US ‘’7' ° P'Us) have made juent rituals
healt
ei> oTl?™3 !1 d° n0‘ think the S'ate of
health or the implementation of the RCH
the hst ten year?fo spitetohel'norVmousdfUiKl,d!
* n t s ".
United
lations
Jose in
m. B.R
? 12th
1987
enged
led to
5-77).
deash
Won.
entive
giving
good'
Bose,
. B.R
‘d the
^iv'ing
•desh,
prize,
issue
heme
»oney
K the
was
■ ed in
rder,
e of
was
Hare'
•■ige I
the
•d of
s’hts.
'hat
Our
d of
our
’hey
But
” ,nK
i nd
Hors
like
rget
hout
>end
'• in
=ihty.
• rny
j.’l).
from donor agencies like World Bank UNFPA
USAID and so on. In fact, in several places thZgs
have worsened.
P
'gs
dlfference to the
the actual
actual implementor
implementation of the
programme at the grassroots level.
in Utter pUi Tr! °n‘he Sub'ect of ’terfcation
n Uttar Pradesh is both pathetic and hilariouspathetic because the scheme is an insult to human
dignity and hilarious because it exposes the idiocy
(to use a mild expression) of the District
Magistrates. I give below an excerpt fron' the
■amme
jm
shift from family welfarp r- ■
■.
°
centred around
±S^^whfo^S
and greater
respect for informed choice' of cThe Government of India is alsocontraceptives.
trying hard
I to
promote male sterilisations (in particJaAh
le
NSV
techniqiie). But I do not think this has t
made any
'XL't T'r" '-s
family planning
Mian Express, Delhi dated 23 August, 2004:
"What's the link between getting sterilisation and
wnmg a gun. Uttar Pradesh doesn't treat that as
a joke .... some district magistrates in the state are
now offering (mcentives to a person wanting a gun
’Ce ,e ' ° opts for sterilisation. The incentive
p “edu?eU COnV'nCe m°re PeOple ,O 80 in for tbe
C'-tndn'
■ ' 'U......... b
WCCdUS
Iwreaucracy which baXll™ fudged dan'on
^ny^rson
s er.lisat.ons
erusations and took recourse to unethical
unethfcal means
get asS many
is
l>ossible
The people
PeOP'e in the
,he sterilisation
s,erilisa'ten net
net as
ooint in blaminc the
....
Ipossible.
ssible. There is no point
department
8 '
-r- ....... of
w, family
,d„„,y welfare
weitare for
for —
not succeeding
/X'"ZPJ «un fcen"
0 hlS^S a,most e3cfl application that
?f'KS to my offlce 15 for J gun licence. The family
opts forsteriisMon willbe wen
15'^ging behind', Bareilly DM
^n/b‘V^/gUn' you must
that fimX'oT and 'ar8e 'conv'nced themselves
thev h
y P
8 concerns women only and
'ey have no special responsibility except to tike
^ves t° the steri|.pti.on ca;ps«Pt toteke
S work
6
SsTso mTh
(which 1 fount) during my
T Spen' by ,he men
'heir
th.nk thA° ^7„fOrIeproducti- "8b's! I do not
■ h-k that bu'ddfoV sckXs ^p-by fore^n
sKa&ssiS:s*
you^etf sterilized
eun he g
Pe.rS°n- F°r a doMe hMrel
nfle
ap,a.icanl "M’ bnng two persons. For a
nfk, the applicant shouldget three persons and for
a revolver there should be four other than the
licence seeker . He is confident that he will meet
his district s sterilisation target with his plan."
™
"3
3 CanOn? 1 ^rstand f.
rom
increased there and tire DM wants'to Control 'the
“r“s ,n
™e •
CnmC
‘1,e Obviousl
y he
crime rrate.
Obviously
he isis a genius: he wants to
™
nhol ininone
control
ooogo both the
* * crime rate and ihe
surgeons using the NSV method brine ih
-i Population
populationgrowth
growthrate!
rate!I Irecall
recallthat
thatinin 1963 on the
•ransformatio^n without whJ^dSm X
ASUn P^'i- Confed'e
adequate understanding of Indian wckX"^0
health and family planning; adStaS
cannot fsponsored
Ponsored bby
y United
United Nations
Natiomin
in New
f-fow Delhi, the
' de^Zp'
a'"^
'Uded in
Government ?of
India had inC
included
in ,he
th. '^an
delegation Prof. Amartya Sen from the Delhi School
" is my understanding based
"
"
on field work that
women themselves all over the c<
Wus|,m women) do want f ountry (including
family planning.
brought an elephant from donations collected from
ot possible? Surgical intervention
bring about social transformation.
his friends in India and USA and paraded the
elephant with a red triangle on it to impress on
illiterate Indian villagers the enormity of India's
^eS"nd m"^co'XnUated
cannm7h-PL
Amar,ya Se"'S
was: “I
cannot thmk of a more asinine solution of an
elephantine problem". After so many years, one
ITt • ,nAAkC ”e Same CGnlment -’bout the U.P
Distnc t Magistrate's gun running scheme!
health for THE MILLIONS /
Prof. Ashish Bose is
the memlx‘r of the
Indvpendont
Conimiwion oti
development and
Health in India (ICDHI).
AuguM-Sememlx., &
October-November 2004
«
17
Government of India
Ministry of Health and Family Welfare
Department of Family Welfare
lol
STRATEGY IN 150 CMP DISTRICTS
FOR FAMILY PLANNING
The Common Minimum Programme (CMP) of the United Progressive CMP Mandate
Alliance (UPA) Government states that ctthe UPA Government is committed to
replicating all over the country the success that some Southern and other States
have had in family planning. A sharply targeted Population Control Programme
will be launched in the 150 odd high fertility districts”. The Department of
Family Welfare is initiating a CMP Programme accordingly in the identified 150
high fertility districts of the country. The strategy of the Department for the CMP
Programme is as follows:
The districts were arranged in descending order of Total Fertility Rate
(TFR) as per the Census 2001 data. By excluding better performing States with
one or two districts from the list, like Haryana (Gurgaon), Uttaranchal (Hardwar),
West Bengal (Uttar Dinajpur, Maldah), Gujarat (Dohad, Banas Kantha),
Chhattisgarh (Sarguja) and Assam (Dhubri, Goalpara, Marigaon), a list of 150
districts has been arrived at. These districts belonging to the better off States will
be taken care of by improved attention of the concerned States. These 150
districts are concentrated in the 5 EAG States of Bihar (36), U.P. (58), M.P. (24),
Rajasthan (20) and Jharkhand (12), as at Annexure-I. However, since it would be
administratively inconvenient to limit the proposed initiatives to select districts
v ithin the State, it is proposed to cover all 209 districts in the 5 CMP States
under the new Strategy.
The National Population Policy aims at achieving a National Total
Fenility Rate (TFR) of 2.1 by 2010. It would still take another 35 years for the
population to stabilize by 2045 at the expected level of 160 crore. However, the
present trends indicate that if the present pace of reduction in growth rate
continues, the TFR of 2.1 may at best, be attained by 2016. The population may
touch 180 crore before stabilizing. It is, therefore, important to adopt strategy for
addressing the high order births (above two children per family) in the identified
high fertility districts, at a scale which will prevent at least 40 crore additional
births by 2045 permitting the country's population to stabilize after peaking at
about 135 crores. The plans arrived through Community Needs Assessment
Approach (CNAA) in these districts also reflect a high level of unmet needs,
basically due to weak service delivery mechanisms. Of the total 48 lakh
sterilizations being reponed in country, only around 13 lakhs are being reported in
the CMP States where as their high order births in these States are in the range of
93 lakhs per annum (of the total 170 lakh high order births in the country). It is
hoped to raise the level of sterilizations in these CMP States to 50 lakh per annum
within the next four years. In fact, we should thereafter increase the scope of our
programme and add another 150 high fertility districts to really tackle the
Selection of
Districts
The l lsion
loS
unwanted births all across the country. It is also a fact that against the average
annual growth rate of population of 1.7% in rural India, the same is 2.7% for
urban India and 4% for urban slums. The high growth rate in urban slums is also
largely due to the factor of immigration of BPL labour and families from high
fertility and poor districts to urban areas, especially the metros. It would therefore •
be necessary to cover the urban slum pockets in the CMP strategy. Then only the
systematic prevention of 40 crore unwanted births will actually happen.
Over the last 5 decades, the performance of the Family Welfare
Programme has been distinctly better in the Southern States like Kerala, Tamil
Nadu, and Karnataka as against the CMP States. Higher levels of literacy and
women empowerment in these States contributed to the success of the
programme. However, improved performance levels in these States also owe
largely to the political will, administrative commitment and good governance in
these States. A major lesson to be learnt from the Southern States is their success
in involving the private sector in service delivery. In the State of Tamil Nadu, of
the total 4 lakh sterilization being reported per annum, 1.5 lakh procedures are
being reported through the private sector. In the State of Andhra Pradesh, the
spectacular success in bringing down the growth rate of population in the last
decade has been possible, despite the low level of literacy, due to the involvement
of private sector and Self Help Groups, provision of insurance cover to family
planning acceptors, and a higher Compensation package for sterilization in the
State. Strong monitoring and the supervisory mechanisms in the Southern States
have ensured better accountability of the service providers. Under the CMP
Strategy-', the lessons from the Southern States would be replicated in select States
of L .P.. M.P., Bihar, Rajasthan and Jharkhand.
The Thrust Areas in these districts would be family planning,
immunization and safe delivery. Letters have been sent to Chief Ministers, Chief
Secretaries and Secretaries (FW) of the selected States, and also to District
Collectors of 150 CMP districts. Copies of the letters are enclosed at Annexures
II, III & IV. The strategy aims at bringing back the District Administration into
the Family Planning Programme. Detailed CMP Manual is being prepared for the
District Collectors of the CMP districts, to provide them with a roadmap and
suggested strategy. National/Regional Consultations with State Governments and
District Magistrates of 150 CMP districts shall be held.
1 he emphasis would be on targeting unmet need for family planning
sen ices in these districts. Additional funds would be provided for improved
services for sterilization and IUD insertion. The Compensation package for
sterilization is being revised, to adequately over the transaction costs of the
procedures in public and private health facilities. Additionally, an imprest fund of
Rs 10 lakhs would be provided to District Administration as a revolving fund for
family planning. Professional Indemnity Insurance cover shall be extended to
doctors conducting sterilization operations in both public sector and accredited
private health facilities, so as to cover them against legal and financial costs of
possible consumer cases. Detailed assessment of the requirement of drugs,
equipments, contraceptives and laparoscopes is being done for CMP districts, and
Lessons from
Southern States
Strategy in
CMP Districts
Emphasis on
Family Planning
senices
a strategy shall be formalized for timely procurement and appropriate logistics
arrangements.
^>4
•-
Partnerships with the private sector through accreditation, indemnity partnership with
insurance coverage and suitable higher payment nearer to basic market cost are Private Sector
the major hope for attainment of the goals in the CMP districts. A revised
Compensation package is being extended to accredited private/NGO health
facilities for conducting sterilization/IUD insertion. A package of around Rs. 1200
for sterilization in a private nursing home and Rs.600 in public health facility,
inclusive of transactional cost to the Trained Birth Attendant (TBA), and the
client to cover the expenses on travel, food, and access to the public/private
hospitals for sterilization will energize the demand and supply chain in family
planning. Availability of family planning services is thus hoped to increase
through social marketing and social franchise of such services. It is aimed to
provide quality assurance among such accredited facilities and to provide them
with a logo so as to generate publicity of the availability of such family planning
services in the private sector. Accrediting 15 to 20 private providers per district is
an attainable task. Banks are being approached to announce a special package of
loan of Rs. 5 lakhs to Rs. 10 lakhs to these accredited doctors in CMP districts to
improve their infrastructure, space, equipment. Operation Theatre etc. These
loans will be viable as an accredited clinic is expected to earn at least Rs.25,000
to Rs.30,000 extra per month and so repayment of the loan will be possible. This
itself is likely to help achieve 25-35% extra family planning procedure. In Tamil
Nadu, an average 30 to 40 private facilities have been accredited per district. In
spite of a well functioning governmental system and low levels of fertility, 35%
of all sterilization in the State are at accredited private clinics.
Promotion of
The National Maternity Benefit Scheme is being revised as the proposed
maternal
healthcare
Janani Suraksha Yojana (JSY), with the aim of promotion of institutional delivery <
to bring down the high Maternal Mortality Rate (MMR) in these districts
(Annexure-V) It is hoped that the JSY would prevent female foeticide through
raising consciousness for the girl child. It is aimed to provide an amount of
Rs.lOOO/girl child and Rs.400/male child, if delivered in a health institution, by a
BPL mother. Additionally, transport assistance upto Rs. 150. and incentive to
Dais @ Rs.200/150 for female/male child is also envisaged in lieu of appropriate
antenatal and postnatal care and referral for institutional delivery. The scheme
also aims at adoption of tubectomy by the pregnant women after the delivery. It is
aimed to operationalize First Referral Units (FRUs) at district levels to ensure 24hour service delivery for improved healthcare. Emphasis is also being laid on
provision of health infrastructure in urban slums.
It is proposed to engage around 2.6 lakh Trained Birth Attendants (TBAs)
at the rate of one per 500-1500 population aiming at one TBA for village under
one AWW in
the CMP States as the grass root level worker for the FW
programme The TBA would be the key to social mobilization in these districts.
She’would be recruited by the AWW, in consultation with the Women Self Help
Group of the village, on payment of an honorarium of Rs. 100/- per month only.
The ANM will countersign and confirm this appointment. The TBA will get IEC
material and other support from District Health administration through the .ANM.
Engagement of
TBAs
She will counsel the village women for adopting contraception, safe delivery and
institutional delivery. She would also escort the client to the hospital, whether to a
public or an accredited private facility, for family planning and institutional
deliveries and be paid a transaction cost for each such procedure. She will also
mobilize the children and expectant mothers on immunization days. She is '
expected to earn Rs. 7500 to Rs. 8000 per annum from her work. Additionally,
she will be given products such as basic medicines, contraceptives and ORS etc.
for social marketing in the village. She will also counsel for newborn care, breast
feeding and adolescent hygiene and age of marriage.
She will assist in
registration of births. All these, she will do under the supervision of AWW and
ANM among the women/girls of the community where she normally resides.
Efforts shall also be made in these districts for improved immunization,
including strengthening of cold-chain, induction of Auto Disposable Syringes and
holding of Immunization Sessions on fixed days at village/habitation level, in
convergence with the ICDS workers. A major strategy is to make the vaccine
reach the immunization site on Vaccination Day so that the ANM can carry out
longer sessions. It is proposed to bring in legislation to make it mandatory for all
medical establishments, whether public or private, to render immunization
services. Medium-term Plan for strengthening of Immunization has been moved
to World Bank through Department of Expenditure. Copy of the same is enclosed
at Aiinexiire-VI.
The work in the CMP districts is proposed to be undertaken in a Mission
mode. 1 his would necessitate organizational restructuring of the Department of
Family Welfare at the Gol level, and setting up of a National Resource Centre for
providing Technical Assistance under different components of the Reproductive
& Child Health Programme. It is also proposed to upgrade the management
capacities at State and district levels for consolidation of the Programme
Management Units through induction of key skilled professionals like MBAs,
CAs, Inter Costs, MIS Specialists etc. under the leadership of an additional IAS
Officer as Executive Director, SCOVA at State level, and ex-service men at
district levels, to steer the programme. The strengthening of the financial and
programme management would be a key input of the envisaged programme.
Improvement of financial flows, improvement in accountability through better
maintenance of accounts by induction of professional financial personnel, and use
of e-technology to handle the huge number of transactions and sites efficiently is
the management key to the CMP strategy.
Strength ening
Immunization
Programme
Management
Strengthening
A programme-specific 1EC campaign shall be launched for the CMP
Improved
districts, including wall writings, hoardings, posters, brochures, CDs and briefing con vergen ce, publicity
kit for various stakeholders, informing the key players of the new initiatives and
and programme
monitoring
the public-private institutions partnering in this activity.
Intersectoral
convergence with related Departments would be strengthened and involvement of
members of Panchayati Raj Institutions and Self Help Groups stressed to make
the programme a people’s programme. The monitoring of the Family Welfare
Programme shall be improved through e-linking with \ideo-conferencing in CMP
districts and with the 5 EAG States’ Secretaries. We also propose to use etechnology for social auditing, consumer suggestion/grievance monitoring.
1
n)
handling fund flow and other related issues. A concept note on the subject is
enclosed at Annexure-VII.
Detailed costing has been done of all the additional activities proposed
above. The Department of Family Welfare is of the view that it should be
possible to undertake the additional activities in the current year by regrouping
funds available under different Budget Heads of the Department. It should also be
possible to accommodate the additional financial requirements for the remaining
period of the 10th Plan within the Budget of the Department, if the officially
indicated Outlays for the IO11' Plan are fully funded. This would, however, require
some intersectoral adjustments within the Budget Heads of this Department, for
which orders of competent authorities would be obtained. It is possible to
continue funding these new initiatives not only in these 150 CMP districts but
also in additional 100 to 150 districts in the U11’ Plan with only a normal increase
in the Budget, by 50%. The Common Minimum Programme already states that
over a period, the Health Budget would be doubled. Also, from 9th Plan to 10°'
1 lan, our Budget increased by 80%. We are thus looking at a very practical
financial plan. The savings to the country, by way of avoiding 40 crore unwanted
births would be far more.
Financial
Implications
Population Stabilization:
The Case Against Coercion
A. K. Shiva Kumar
that women often have over ffertilityf decisions.
.L/./
Addressing these underlying causes for high
fertility rates is urgently required, not only for
advancing India's progress towards population
stabilization but also for enhancing the quality
ot people s lives, tor acc elerating economic
performance and for promoting human
development. This is the proven path for
achieving population stabilization. In contrast,
those who advocate a compulsory one-child
norm or two-child norm through use of
(. oercion and penalties show complete
disregard for human rights, for the dignity of
women and tor the sustainability ot population
policy interventions.
The Indian press and media have once again
drawn attention to the urgent need for
stabilizing India's population. That this should
happen in the current context of the
unnecessary controversy generated by the
Census ot India 2001 report giving religious
totals is unfortunate. Also, it is equally disturbing
that certain groups are calling for strict
population control' measures, the imposition of
a compulsory one-child or two-child norm, and
the use of penalties and disincentives to forcibly
restrict family size.
It is even more
disconcerting to find that a recent policy note
from the Ministry of Health and Family Welfare
outlines, as its strategy, monetary incentives and
other measures for stepping up, over the next
four years, the number of sterilization cases
from around 18 lakhs to 50 lakhs a year in five
high-fertility states.
Th^re is no doubt that India should strive for
rapid population stabilization. Apart from the
unnecessary
pressure
on
resources,
infrastructure and the environment, a large
number of unwanted births signals the lack of
access that many people (especially women)
have to basic education, family planning
services and decent conditions of child survival.
It also points significantly to the limited control
24
» HEALTH FOR THE MILLIONS / August-September & October-November 2004
This paper presents arguments in favour of a
humane approach to population stabilization
and argues against taking an alarmist position
on population especially at a time when birth
rates are progressively declining and India is
being lauded globally for some very effective
population interventions. At some level,
reiterating this position is unnecessary. India's
National Population Policy 2()()() - a document
backed by political consensus formulated after
considerable public debate and discussion advocates and prescribes precisely these
measures.
Some Common Myths
Many people tend
to oiame
blame population
populatioi per se
iviuiiy
ieno io
tor the low levels of income prevailing in
different countries across the world. Such a
perception or belief is highly misplaced. There
is no automatic or predictable association
between population size and economic well
being. China, the only country with a larger
population than India, reports a per capita
income that is almost 70 per cent higher than
India's. Within India too, Andhra Pradesh (76
million) and Madhya Pradesh (80 million)
reported similar levels of population in 2001.
Yet, most re^-'nt estimates reveal that, in 199798, the per capita Net State Domestic Product
in Madhya Pradesh was only Rs.8,1 14 - almost
30% lower than the per capita Net State
Domestic Product (Rs. 10,590) in Andhra
Pradesh.
Many also believe that a large population slows
down economic growth. Once again, there
isn't a*'
popuk.
China .
popuk
during
other
with th
bet we
rate. <
State P
I9«()s ,
rate of •
Many a
betwc.
income
popul
alleviatu
not gt
years, i
reduct*'
1975 u
to remworld.
Nadu th
levels
human
that K
properpovert
Kerala
1.000 <
Clearly,
birth r
growth
a fuiv
mtluen
factors
resour<
investr
counti
Key
What
fertility
connec
with f<
reduce
reproc
reducti
exert
birth ra
Wome
enjoy
econo
occur:
impro\
econo
emplo
/I3
Kumar
ecisions.
to- high
only for
•pulation
? quality
onomic
human
>ath for
ontrast,
ne-child
use of
■mplete
^nity of
pulation
•ur of a
ilization
position
en birth
India is
fleet ive
* level.
India's
cument
*d after
ssion —
these
per se
■ ling in
Such a
There
c iation
c welllarger
capita
.*r than
•sh (76
lillion)
2001.
1997roduct
almost
State
• ndhr.i
I slows
there
isn't any obviously predictable link between
population growth and economic expansion.
China and India, two of the world's most
populous countries, grew at a much faster rate
during the decade of the 1990s than most
other countries. Within India, Kerala, the state
with the lowest growth rate of population
between 1981-91 recorded the lowest growth
rate. On the other hand, Rajasthan's Gross
State Domestic product grew the fastest in the
1980s despite the State recording the highest
rate of population growth.
Many also wrongly interpret the association
between high birth rates with high levels of
income poverty. While a lower rate of
population growth is conducive to poverty
alleviation, reducing fertility rates by itself does
not guarantee economic prosperitv. In recent
years, Bangladesh has recorded impressive
reductions in fertility rates - from almost 7 in
1975 to 3.1 in 2001. Yet Bangladesh continues
to remain one of the poorest countries in the
world. Similarly, states like Goa, Kerala and Tamil
Nadu that have lowered fertility to replac ement
levels have not done away with problems of
human poverty. Also, it is interesting to note
that Kerala and Haryana report very similar
proportions ot population living below the*
poverty line - around 24-25 per cent. Yet
Kerala's birth rate is 18 whereas it is 27 per
1,000 population in Haryana.
Clearly, the linkages between population size,
birth rates, economic well-being and economic
growth are complex. Economic wellbeing is not
a function of population size per se but is
influenced significantly by a host of other
factors including natural endowments, human
resource capabilities, quality of governance and
investment priorities of a region, state or
(’ounti v.
Key Influences
What are some of the* fac tors that can explain
c
fertility declines across societies? Four inter
connected factors arc* commonly associated
with falhng birth rates: women's empowerment,
reduced child deaths, improved access to
reproduc tive health care* and services and a
reduction in human poverty. Tog(*ther, they
exert many time's more* intluenc e on lowering
birth rate’s than any one of them ac ting alone*.
Women get empowered when they begin to
enjoy and exerc ise greater freedoms —
economic . soc ial, politic al and cultural. This
occurs with higher levels of education,
improved health and nutritional status, greater
economic freedoms, improved access to
employment and higher earnings, and more*
meaningful participation in decision making
within and outside the family. More educated
women tend to marry late and they also enjoy
better health and nutritional status. These in
turn have a positive impact on the health and
survival of newborn babies and infants. And
improvements in child survival, as discussed
below, contribute in many ways to lowering
birth rates.
A related concern, central to population
debates, has to do with gender equality, and
particularly the freedom and ability of women
to exercise choices freely and without fear.
The subordinate position of Indian women is
well known. Most do not have the control thev
would like on their own fertility decisions. To
the extent that fertility decisions are taken b\
a family, tackling the issue of gender equality
necessarily implies addressing hard social
realities that perpetuate male dominance,
nurture unequal power relations within the
family and in society, and obviate social
constraints (or unfreedoms) that women face.
Improving child survival has a direct impact on
birth rates. Public support for improving child
survival conditions has sometimes been
inhibited by the* argument that, inasmuch as
such efforts are sue cessful, they arc* ultimatelv
self-defeating bee ausc* they serve* only to
aggravate* the* problem of rapid population
growth. Sue h an argument is not only morallv
repugnant, but it is also demographically
unsound.
Several mechanisms connect lower child death
rates to lower birth rates. First, the physiological
factor. An infant death means the end of breast
feeding, an important 'natural contraceptive'. In
the absence of any other method of birth
planning, a new pregnancy becomes more
likely. Second, the replacement factor. The
death of a child prompts many couples to
“replace" the loss by a new pregnane y sooner
than would otherwise have been the case.
Such families, which experience the' death of a
child, arc* also much less likely to use* anv
method of family planning. Third, the insurance*
factor. When child death rates arc* high, manv
parents compensate* for the' antic ipated loss ot
one or more* of their children by giving birth to
more children than they actually want
Compounded by such factors as son
preference* and the* time* lag between c hanges
in death rates and changes in perceivc’d risks,
this 'insuranc e' fac tor is a major mason for the*
persistenc e of high birth rate’s. Fourth, the*
confidence* factor. Empowc*ring parents with
today s child survival knowledge helps build
confidence* whic h is a c rue ial fac tor in the*
accc*ptancc* of family planning.
HEALTH FOR THE Mill IONS /
Augu't Scptonibcr & Octobrf-Novemtx'r 2004
Ihree ot the most important strategies tor
reducing (hild deaths - the education ot
women, the well-intorm('d timing and spacing
of births and breast feeding — also happen to
be the most direct methods of reducing ( hild
births. Reduc ing < hild deaths can help societies
move towards family building by design than by
( haiu e. I he interventions tor improving ( hild
survival are well known — better (‘ducation,
improved atc ess to health < are, belter nutrition,
higher earnings, safe drinking water, and better
sanitation. Not surprisingly, these are the same
interventions that are needed tor empowering
women, for improving standards of living, and
tor stabilizing population.
High fertility rates are often a reflection of the
extremely limited access that women have to
decent health care and reprodur five health
services. Surveys repeatedly reveal that even
poor women do not want to have many
children. However, the lack of access to family
planning interventions combined with poor
knowledge and limited freedom to make
choices leads to a situation of unwanted fertility.
It is important to enlarge the contraception mix,
expand the provisioning of quality health care
and services, and simultaneously empower
women and communities to make informed
c hoices.
Finally, reducing human poverty is another
factor that can have a direct impact on fertility
rates. In discussing poverty, we need to look
beyond income poverty to the poverty of
opportunities - economic, social, cultural and
political - that severely hampers progress. The
State must ensure that jobs are created for the
poor and that their incomes are enhanced. But
it is also equally important to simultaneously
ensure universal access to basic education and
health, safe drinking water, adequate food and
nutrition and so on — all of which are critical
components of a decent quality of life.
A Matter of Rights
In recent years, human rights activists and
women's groups have strongly influenced the
approach to policy formulation for population
stabilization. They have drawn attention to
critical ethical principles of human dignity and
women's freedoms when discussing population
policies - a perspective globally endorsed at
the 1994 International Conference on
Population and Development held in Cairo. A
rights-based approach to population policy
formulation implies accepting certain
fundamental premises about the position of
women in society that: (1) women can and do
make responsible decisions for themselves, their
families, their communities, and increasingly, for
kt>
the stair of the world; (2) women have the*
•right to determine when, whether, why, with
whom, and how to express their sexuality; ( U
women have the individual right and the soc ial
responsibility to dec ide whether, how, and
when to have* c hildren and how many to have;
and (4) sexual and soc ial relationships between
women and men must be governed by
princ iples of equity, non-c oerc ion, and mutual
respec t and responsibility. /Xdopting sue h a
perspec (ive implies requires abandoning fertility
and demographic 'targets' and focusing on the
quality of services. It entails promoting an
essential pac kage of reproduc five- and c hild
health servic es that inc luck's services for the'
prevention and management of unwanted
pregnane y, the promotion of safe motherhood
and child survival, nutritional services for
vulnt'rable grexips. service's for the prevention and
management of reprexluc live trac t infections and
sexually transmitted infec tions, as well as
rc'produc live' hc'alth services for adolescc'nts.
The Senselessness of Coercion
There are still many advocates who favour
controlling' population by forcibly limiting the
number of children a woman can have. They
argue that coercion and an authoritarian
approach will yield the quickest results. Some'
even go to the extent of advoc ating that India
should emulate China's one-child policy despite
the many problems with the coercive
approach. In China, for example, adoptions are
reported to have risen sharply in the 1980s
from around 200.000 before the one-child
policy to almost 500,000 a year in 1987. A
significantly higher proportion of girls is put up
tor adoption than boys. Others have pointed
to the practice of forced abortions that
jeopardizes the life of the mother. Some others
have expressed concerns over the state of
mental health of the population over time as
society begins to deal with the specific
problems of raising a single child - and that too
a boy. Some fear that the shrinking child
population will impose severe pressures on
children who will have to care for aging parents.
There are several other reasons why use of
coercion is not necessary or justified.'
First, using coercive policies has little appeal
especially when almost every other country in
the world (including Bangladesh and Indonesia)
has been able to lower birth rates and fertility
levels without the use of force or compulsion.
Within India, Tamil Nadu, Goa and Kerala, states
with low fertility rates, have lowered birth rates
without the use of any force or draconian
measures. Second, imposing restrictions on the
number of children violates people's freedoms
and individual rights. Third, it makes little sense
HEALTH FOR THE MILLIONS / August-September & October-November 2004
--w^*rwrK'VT
p
t<»imp< >s
have tew
most pe<
rural are.
want to
pe< >| >lc's
is also hi;
not abk
adequaU
11 mt th. (
p< )ll( v \
cquitabli rpportur
reduce p
(hild pol
< ountry
to have
dcmocr.
wounds
initiated
Indira Ga
Si\t/i, in
China,
f«,stric tio
further <
worsen
against
particula
alarming
India 20(
in the cF
a comm
policy is
speed q
There st
such a b<
not able
Kerala tF
instance.
But by
lower th
ive the
y, with
’ lity; (3)
? social
w, and
) have;
‘tween
ed by
mutual
such a
fertility
on the
ing an
i child
or the
anted
•rhood
es for
^n and
ns and
ell as
ns.
ion
avour
»g the
They
arian
Some
India
espite
reive
is are
980s
-child
7. A
ut up
n’nted
that
•thers
te of
ie as
cific
it too
child
•s on
'(‘fits.
>e of
•peal
hy in
icsia)
tility
Ision.
ktates
rates
nian
i the
toms
ense
JI*
COfAPCNfATION
HIGHEST
FOR COUPL.ES WITH
OWE
TWO CHKJJRtK
CO L.L.ECT
HERE
I
\
\*
to impose penalties when people indeed want to
have fewer (. hildren. Every survey points out that
most people - even the poorest, those living in
rural areas, and belonging to minority groups —
want to have fewer children. At the same time,
people s knowledge of family planning methods
b also high. Why penalize people if the State is
not able to fulfill its obligation of ensuring
adequate provisioning of basic social services?
fourth, (»ven in China, the coercive population
policy was accompanied by a broad and
equitable expansion <»f social and economic
opportunities for women — the proven way to
rediK e population growth, fifth, enforcing a one<h:ld policy may be possible in an authoritarian
(ountry like* China. But such measures are likely
to have disastrous political <onsequences in any
democracy. In India, the political and human
wounds of the population 'control' measures
initiated during the Emergency rule under Mrs.
Indira Gandhi, some 25 years ago, are still to heal.
^th, in (ountries of South Asia and even in
China, with a strong son preference, such
reMric tions on family size will inevitaldy promote
further discrimination against girl (hildren and
worsen the alre.idy prevalent discrimination
against the girl child in India. In fact, it is a
particularly serious concern given that the* most
alarming and disturbing result of the* Census of
India 2001 is the worsening female-to-male ratio
•n the < hild population aged 0-G years. .Severn/),
a ( ommon argument in favour of a one-c hild
polk y is that it c an quii kly lower birth rates and
speed up the process of population stabilization.
I here seems little evidenc e or justification for
•'Uc h a belief. C hina, with its one-child polk y, was
not «ible to lower its fertility rate any faster than
Kerala th.it did it without coerc ion. In 1979, for
instance, Kerala had a higher fertility than China.
But by 1991, Kerala's fertility rate of 1.9 was
<>wer than ( hin.fs 2.0. Similarly, Bangladesh has
shown that it is possible to reduce fertilitv rates
rapidly without use of any coercion - by
empowering women, educating people and
improving access to reproductive health care.
There are other serious problems associated
with the use of disincentives and penalties for
reducing birth rates. Penalties tend to get
reduced to tokenism, and they are difficult to
implement. It anything, such a move is
impractic al and is full of loopholes. Also,
imposing penalties has little ethical or moral
justification. They tend to be unfair and
inequitable in terms of how they affect different
groups of people in society. Clearly, it will
affec t more* adversely women in rural areas,
those who are illiterate and those who belong
to the disadvantaged communities. Clearly,
these communities enjoy much less access to
basic social services and opportunities than the
test of the soc iety. The proposal, therefore, to
impose* penalties on people with more* than
two children is clearly biased against rural and
tribal populations, against less educated
persons, against those* belonging to Scheduled
Castes, Sc lieduled lrib(*s and Other Backward
Castes, and the poor in general. Similarly, giving
monetary inc entives for sterilization is bound to
lead to the* exploitation of poor women. Io
begin with, fertility levels may not be* drastically
affected as many poor women, lured by the
offer of money, may agree to undergo
sterilization especially if they already have 3 or
4 or more c hildren. At another level, the
attraction of money can also force women to
undergo sterilization even if they are reluctant
to do so. In any case, the provisioning of
counseling servic es or even medical services is
so poor in many parts of the country that
making it compulsory will imply exposing
women to unnecessary health risks.-'
HEALTH I OR THE MILLIONS / Auqust-Septcmbcf & Octob«*r-Novcml>er 2CXM
u 27
•
I here.'
•ality is that population stabilization is best
at hieved ‘by
7 seeking the cooperation of people,
References
by treating women with respect, and by
Census of India (2()o | > "Provisional Population
lotals" Paper — 1 ol 200 1 Series - I. Registrar
General and ( ensus Commissioner, India
ret ognizing the human rights of individuals. It
is tntical tor sot icty to invest in its people - in
their health, m their education, in expanding
Ureze, lean and Sen, Amartya (20021 "Indir
Development .md Put,<
(>xl„nH i,„vers,lv
Press, New Delhi.
reprodut live health t hoices and in enhancing
their t apabilities.
Concluding Remarks
out
measures
to
achieve
population
stabilization. It rightly advocates and builds on
Germum. Adtienne. Nowrojee. Si.i
Su
DninUmniim^. -Setting ., new .tgend.t: Se.u.il
.tnd reprodut I,ve he.tlth .uul lights-. ,n
5,.,,
et .1 lied. 1. -I'opul.nion I’oln i.-s Reconsidered
He.tlth. Impowerment jntl Rights. - d.stributed by
a set ot twelve themes: decentralised planning
and programme implementation, convergence
Unweisity
Massach\setts. USA.
India s National Population Policy 2000 spells
ot
servite
delivery at
the
also
emphasizes
collaborations
is moo
the d'
India. .
future
assessment of family planning programs in Gita Sen
et al ied>. "Population Policies Reconsidered- Health
Empowerment and Rights." distributed bv Harvard
University Press. Cambridge. Massachusetts, USA.
proper implementation of the Action Plan.
at tent.
We r.
<. onsidt
relate
here is absolutely no justification for enforcing
Menon-Sen, Kalyani and Shiva Kumar. A K OOOI)
"Women in India: How freef How equaP" United
Nations Publication, Office of the Resident
Coordinator. New Delhi.
penaltK‘s, or tor introducing a compulsory one-
chi d or two-child norm. Such measures not
only
tend
to
punish
the poor
and
.it tribi
agree
in the
human
many *
and l
object
consequences can be quite disastrous. It is also
not true that only such draconian measures can
the population momentum generated by an
already large young age population - also
predicted to be the source of economic
buoyancy and comparative advantage in the
years to come. Government of India's newly
announced Common Minimum Programme
(CMP) reiterates once again a strong political
commitment to end human poverty. Many of
the pro-poor interventions are likely to have a
-A- K. Shiv Kumar is
a development
economist and
adviser to UNICEF
India. This paper is a
condensed and
modified version of
an earlier article on
. ... population
Hl’ Isinv
,1...
by him for the
National Human
Rights Commission
<2003 >.
28
strong impact on reducing birth rates. Apart
from these measures, any direct intervention to
India, New Delhi.
Sen, Cita. Adrienne Germain and Lincoln C Chen
advancing India's development.
HEALTH FOR THE MILLIONS / August-September & October-November 2004
sen it
empox
the be
SFn:
<’995), -Population Policy:
Authoritarianism versus Cooperation", International
Lecture Series on Population Issues, The John D. and
Catherine T MacArthur Foundation, New Delhi.
1
strengthen family planning services must be
resources and political support for these
interventions must become a national priority
born out of a genuine concern for
accelerating population stabilization and
An are
impat^
of fere
"Population Policies ReconsideredHealth. Empowerment and Rights," distributed by
H^r.ard
Umversity
Press,
Cambridge
Massachusetts, USA.
'
integrated with a more comprehensive effort to
revamp the public health and health systems
across the country.
Ensuring adequate
incider
sexi/
c ommi
probl
lain, Anrudh and Bruce. Judith ( mpg),
reproduc live health approach to the objectives and
m place. The challenge before India is to ensure
arrest India's population expansion. India's
population will continue to grow on account of
transmi
I he
A dt
International Institute for Population Sciences (UPS)
and ORC Macro (2()()0), "National Family Health
Survey (NFHS-2).
India", Mumbai.
National Population Policy 2000 outlines in
detail the many interventions that must be put
the political and
..
^pec
the
between
government
and NGOs,
research on
contraceptive technologies, and strengthening
legislation. The Action Plan accompanying the
disadvantaged,
ac tit
a< tion
of w
AIDS,
trjnsnv
International Institute tor Population Scieru e> (im/Sf,
National family Ih'alth Survey I ift)2-t) I " ///’$
Mumbai.
urban slums, remote tribal and rural areas and
It
In th“<
■ J he
services, addressing as priority the needs of
under-served groups such as those residing in
of
c.tmbr,dee
’
Government ot India (jooo^ NaOonal P^u.
Population
Pohcy. Ministry of Health and family Welfare
New
Delhi.
nutrition, promoting child health and survival,
meeting the unmet needs for family planning
importance
/>„.ss,
village level,
empowering women for improved health and
adolescents.
Dr. L.
2
have It
men, i
living
family
living,
Sen (1995) presents several philosophical and
other arguments denouncing the use of
coercion and arguing in favour of cooperation
as the preferred and only way to achieve rapid
population stabilization.
I have deliberately not referred to men as most
family planning interventions in India target
women It is worth recalling that when men got
targeted during the Emergency in India, it fuelled
enormous public protest with serious political
consequences. Sadly, women seem to have little
support even on this matter of choice and
health.
m^n f,
family
There
belief
get in
their
pertec
husba
conse
to cas
j- - i
//7
Myths about Population growth among Muslims
Tilting at Windmills
Amit Sen Gupta
The BJP’s shrill campaign, sparked off by the release of population and demographic
characteristics based on religious communities, leverages on two pet projects of the party population control and muslim bashing.
Hysteria Based on Falsehood
To be fair, the hysteria that the BJP tried to whip up, was partly fuelled by faulty presentation of
statistics by the Census Department. This was further augmented by large sections of the print
and visual media. Banner headlines in many prominent dailies “screamed” about the “huge”
growth in muslim population between 1991 and 2001. Television channels, synonymous today
with shallow and sensational reportage, joined in with gusto. Many channels had BJP and RSS
spokespersons frothing at the mouth as they declaimed about Hindus in India being deluged by a
burgeoning muslim population. Many “experts” lent their voice to this campaign — one prominent
news channel featured a well known demographer who pontificated on the possible link with
migration from Bangladesh.
Now that the Census Department has issued a clarification, and the Census data is open for
examination, let us look at what the figures really say. The initial release from the Census
Department said that the population in India had risen by 22.7% between 1991 and 2001. In this
period the rate of growth among Hindus has been 20.3% and among Muslims it has been 36%.
What the Census Department failed to highlight was the fact that in 1991, the state of J&K (the
only muslim majority state in the country) had not been part of the census operations because of
disturbed conditions. Thus, while the 2001 census figures include the population of J&K, the
1991 figures do not. In order to make any sort of comparison, the population of J&K should have
been subtracted from the 2001 figures.
The total population of J&K, according to the 2001 census, is just above a crore, of which
muslims constitute 67% of the population. Thus of the 13.8 crore muslim population in the
country reported in the 2001 census, 0.68 crore - i.e. about 5% - live in J&K. Because the 1991
Census did not include J&K we need to deduct this number from the 2001 census figures of
muslim population. If we do so, we find that the growth rate for muslims between 1991 and 2001
is actually 29.3% -- 6.7% less than originally reported! The rate of growth among the Hindu
population would also come down if we subtract the Hindu population of J&K, but marginally to
19.9% from the originally reported 20.3%. If we look at the new figures, we would see that the
rate of population growth has declined in the last decade (from the previous decade) by 5.2 %
among both Hindus and Muslims (from 25.1% and 34.5% respectively)!
The BJP and RSS owe an apology to the nation for foisting this falsehood on the country - a
transparent ploy to sow communal discord. So do the media who sought to sensationalise the
BJP’s communal canard.
Bogey of Population Control
Having failed abjectly in its designs, the BJP is now trying to shift to another plank by
resurrecting the bogey of population control. It now says that the issue is not just high growth in
muslim population, but also the larger issue of population growth. Why is the BJP saying this
now? The 2001 census figures were available almost two years back - when its NDA Govt, was
in power. The total figures for population growth between 1991 and 2001 haven’t changed since
then. The recent release by the Census Deptt. has only added disaggregated data based on
religion. How has it suddenly become such a major issue? Clearly, for all its fancy footwork,, the
BJP has emerged as an iirresponsible
” ’ party that is willing to clutch on any straw in order to sow
disharmony.
Let us, however, look a little more closely at the “population explosion” argument, not the least
because it has many adherents even within the present dispensation. Let us, in fact, look at the
reasons for the relatively high growth in muslim population. Blinkered vision, such as the BJP
possesses, never makes for rational analysis of facts — because facts often inconvenience such
bigots. The recent release by the Census Deptt. does not talk only about population growth. It
gives detailed data about other socio-economic parameters, disaggregated on the basis of
religious communities. This data is being presented by the Census Deptt. for the first time, and it
is essential that we look closely at what it says. In its introduction while releasing the data the
Census Deptt. says: In the past there has been a pressing demandfrom various agencies for the
religion data cross-classified by socio-economic characteristics of the religious communities so
as to assess the level ofdevelopment achieved by them in the social and economic spheres of life.
... The National Minority Commission has been suggesting that religion data be cross-classified
by various socio-economic characteristics of the religious minorities to assess the social and
economic status attained by these groups. Their requirement is therefore being fulfilled by the
Census Organization^.
Conditions of Living among Muslims
I his socio-economic data on the muslim community is startling — a sad commentary on the state
of the nation 57 years after Independence. The data clearly shows that Muslims in this country
area far behind in almost all socio-economic indicators. Literacy rate among muslims at 59.1% is
way below the national average of 64.8% and lower than that of all other communities listed.
Worse still, work participation rate among muslims is just 31.3%, again far below the national
average of 39,1%. In other words a Muslim in India is 25% less likely to be working than the
average citizen in the country. The picture is even more grim if we look at the disaggregated
figures for work participation. Just 20.7% of muslims are listed as cultivators, as compared to an
overall average of 31.7%. That is a muslim is 50% less likely to own and cultivate his own land,
as compared to an average citizen of India. In contrast 8.1% of muslims - almost twice the
national average of 4.2% - work in Household industries, that is in poor, ill paid, sweatshop
conditions (see Table below).
Distribution of category of workers by religious
communities, India - 2001
Calegcry
All
Hndus
Ralgcm
Musi ms
SiMa Budt?<sH
Jara
Otticra
Total
"CL
100
too
100
100
100
100
100
100
31.7
33.1
20.7
29.2
32.4
20.4
11.7
49.9
AL
26.5
27.6
22.0
15.3
16.8
37.6
3.3
TTfi
HHI
42
3.8
8.1
2.7
3.4
2.8
3.3
3.2
Others
37.6
35.5
49.1
52.8
47.3
39.2
81.7
14.3
CL: Cultivator; AL: Agricultural Labour; HHI: Household industry
What the data shows is that the average muslim in the country is more likely to be illiterate,
unemployed and landless. This is really the root cause of a relatively higher population growth
among muslims. Numerous studies and experiences across the globe have shown that socio
economic development precedes population stabilization - not the other way round. It is
foolhardy to believe that population growth can come down drastically without socio-economic
development. If any body has been singularly responsible for pushing the muslim community
further into the quagmire of poverty, unemployment and illiteracy, it is the BJP and its cohorts
(while in Govt, as well as when in opposition). The BJP is actually responsible for a major part of
the high population growth rate among muslims - by its discriminatory politics and hate
campaigns.
Sex Ratio and the BJP’s Silence
The muslim community, however, fares much better in respect to one indicator of socio
economic development. This is related to the sex ratio — both for the general population as well as
for the 0-6 year age group. Declining sex ratio in the country is clearly indicative of
discrimination towards women and girls and the prevalence of the heinous practice of sexselective abortion and infanticide of girl children. It’s a cause for national shame. Curiously Shri
Venkiah Naidu and his friends have been totally silent about the fact that in this regard the
muslim community fares better than the All India average and also better than Hindus. At 936.
the sex ratio among muslims is better than the All India average of 933 and that of Hindus at 931.
The child sex ratio (0-6 years group) which is indicative of the prevalence of female foeticide and
infanticide, is 950 for muslims, 927 for the whole population and 925 for Hindus. Is the BJP’s
silence about this explained by the fact that the manuvcidi core of the BJP’s ideology would prefer
to turn a blind eye to gender-discrimination and murder of girl children?
There are huge problems that face this country. If as a serious political party the BJP is looking
for issues, it should not require it to tilt at windmills and resurrect imaginary monsters. The BJP’s
politics of falsehood and hate has been comprehensively rejected by the people of this country.
But, as the saying goes: History repeats itself - the first time as tragedy, the second time as farce.
In the ultimate analysis that is what the BJP’s campaign is - a farce.
/.xa
Voices From The Grassroots
B-
Where have all the Services gone
?
Lindsay Barnes
I promised to write this article for Health for the
Millions, I learnt it was to be about ICPD + 10,
and reproductive health services. I started to
think, 'What services should I write about?' and
then got sidetracked. Submerged in the little
things that keep cropping up here in our village,
in a backward part of the rich, steel plant
district of Bokaro in Jharkhand.
I!
SV
i
<
Like the health camp that we'd started a couple
of months ago in Chotitanr, a village 25 kms
away. Some of the members of the 'mahila
mandals' - women's groups - there had
demanded immunisation for their children.
None of their children had ever had anything
other than polio drops in the 'Pulse Polio'
programme. They were quite happy with this
until they learnt other diseases could be
immunised against through our health training
programmes. Knowledge may be empowering,
but it also means more work.
"You are providing immunisation for < hildren of
the 'mahila mandals' near the health c entre, hut
what about us?" the group leaders had asked.
We have been providing immunisation in our
community health centre for the last five years,
but their village was only 8 kms from the big
city, couldn t they go to the government
hospital there and get their children immunised,
I tried to argue? After all less than 30% of the
district 's children are immunised, should a small
NGO like ours really be getting into this?
How to get there? There's no transport, we'd
have to walk the whole way and back. And
then they charge anyway, or they use the same
needle for all the children. Then sometimes
they don t come at all?” said one woman
speaking from experience.
But now I'm wondering whether we should
have agreed. To pick up the vacc ines from
Bokaro, and maintain the cold chain, is one big
headache. There's no generator back up in the
PHC, so we don't get our vac cines there.
There's never any ice in the ice packs, and the
voltage is too low to freeze. The vacc ines from
the PHC are picked up by the ANMs on
Tuesdays, for immunising children on
Wednesdays, without ice in the ice packs.
"What c an we do?" one of the ANM lamented,
if we pick up the vaccines on Wednesday, we
can t reach the village before midday, and we
Ra
t
A*
.■
have to leave bv 1 o'clock. It takes 2 to } hoin s
to get home."
Then last month there was no measles
vaccine, and lots of children had to be
returned unimmunised. We'd told them it
would be available this month. And it isn't.
The Jharkhand government had launched a
special measles immunisation programme*
for the welfare of the children - in some
districts of the state. So they had recalled all
the measles vaccines from all the other
districts, including Bokaro. Anticipating
villagers might not understand that the
government's measles drive was for theii
welfare, we decided to send our field
coordinators to inform villagers of the*
measles-vaccine-less programme, and I
finally started to think about
the
reproductive health programme.
But before I could pen my thoughts. Fulmoni
Devi, from Mantanr, a village around 6 kms
away, lands up in my c ourtyard. She has come
on her own, though it's rice planting season, so
it must be serious. Husbands rarely ac c ompany
their wives, having much more important social
ac tivities to do - playing cards or discussing
matters of great importance in the teashops.
HEALTH FOR THE MILLIONS /
August September R, October November 2OO<1
'
95
/i/
* - 'KE-
" Two moons ha\'“ passed," she said, "can't you
give mo some injec tion or medicine to bring on
my menses?" she asked.
At least three women a week come with such
a request. She already had three children within
five years, and she'd had enough. But hadn't
she thought about prevention, or spacing, after
all her village has a government health centre, I
asked. Hadn't she heard of pills or 'Copper-T'
or condoms?
"I ve heard of pills, but villagers told me that
it dries up the blood, and I don't have
enough anyway, and 'Copper-T' they say
causes cancer. And condoms! Don't ask
about that!"
But doesn't the ANM provide all these
services in the centre?
How do I know? I've never been there. She
comes
to
give
our
babies
polio
drops...Anyway never mind all this, what to
do now?"
What indeed. The choices are limited. It
Fulmoni agrees, she can get a safe, legal, free
abortion at Bokaro General Hospital - if she
agrees to undergo sterilisation. This hospital
has a 'family welfare' programme, or
popularly known as 'family planning' — which
are the only free services made available to
the public. Or she can get a safe, illegal,
expensive abortion in a private nursing home
in the city. Or the village 'doctor' provides a
whole range of abortion services —
injections, pills, and even conducts D&C in
the village. Or there's the old woman in
Kumirdoba who inserts medicine into the
vagina with a stick. There's no dearth of
choices. But abortion in a government health
facility isn t one of them. This service is not
available in any government hospital in the
whole district.
I explained the 'choices' available to Fulmoni.
She didn t realise that 'operations'
(sterilisation) was available in the summer.
Most villagers think that sterilisation
operations can only be had during the winter.
These operations were usually carried out in
camps, held during the winter months.
Women would be rounded up by touts,
agents or ANMs and taken to the PHC, or
Bokaro General Hospital, sterilised and taken
home. With the announcement of the Target
Free Approach (Or 'Trouble Free Approach'
the doctors had chuckled when it was
introduced) in 1997, 'operations' have not
taken place in the PHC at all. They almost did
96
HEALTH FOR THE MILLIONS / August-September & October-November 2004
this year, with the (kite being annouin ed, and
all arrangements were made. ANMs brought
women from the villages. I he gynaet ologist
turned up, ( oming all the w.iy from Dhanbad,
H) kms away, and ((inducted one operation'
Then she annouiKerl th.it she had been
transferred and refused to do more. All the
women were sent home.
So instead of operating at the P||( , during
the month of March, woinen were rounded
up and taken to the mu< h more c onveniently
located distric t hospital, just Skms away from
the dot tor's residence. Women paid a
service (barge to tin* agents that t.ike them,
tor the vehit le that took them and for the
injectable antibiotus that the doctors
prescribed. Doctors advise injections to
ensure the stitches didn't get infected, the
women were told, since the medic inos the
government provides arc* substandard.
Fulmoni decided to go tor abortion along
with sterilisation, but them she pleaded, "t low
can we go alone to the big hospital? I've
never been there* before." So I had to think
about who would ac company Fulmoni and
her husband, before I could think about
reproductive health matters. I'll think about
this tomorrow, I tell myself, and put my
notebook away.
Then, in the middle of the night Parvati Rai's
husband comes and wakes us up. He's
brought his wife on the back of his cycle. It
wasn't unexpected; she'd been coming to
our health centre for antenatal care from her
third month. This was her eighth pregnancy
— but only has three surviving children. All
her children had been breech, and all born
at home. Some survived, some didn't. The
last one was born in our health centre, after
the village 'doctor' had given huge doses of
oxytocin in her seventh month, mistaking
stomach cramps due to diarrhea for early
labour pains.
Parvati's village is only 5 kms from the PHC,
couldn't she go there? Last year the new
Jharkhand administration helped promote
'safe motherhood' by building labour rooms
in many PHCs. The government also ordered
all PHCs should have one doctor available at
all times. So nc
the doctor stays in the
labour room, since no deliveries take place.
The ANM there sometimes conducts home
deliveries, for a fee. Parvati's husband had
never seen the PHC.
In the early hours of the morning things
weren't going well. Parvati's waters broke,
and do
a < aus<
I here's
a poor
c hildbir
sec lion
governr
Hospit
breaks
mother
baby d
lakes I
()ther
think
unlimih
patient
and tin
road I.
much i
husban
oi t.
After t
and sit
start? '
service
identit \
In editt
whose
nd
:ht
112-
I
and down came a hand. A referral is always
There's nowhenCern hWhere ,O g0' and ho^
There s nowhere in the Bokaro district where
chHdbirth 3-rT “h ? f°r comPlioations of
sSonshd
hOUt
ling his land- Caesarean
sections do not take place in the district's
Kafan story of Budfuya and her slow painful
death during childbirth. What today we
would clearly recognize as obstructive
labour, which needed emergency obstetric
Hospital, I tell Parvati's husband and he
breaks out into a cold sweat. "We ^re poor
've can 1 go there. Try and save^he
mother... he pleads. He cannot say, 'let he
baby Che, but.... For Bokaro GeneraHdosp tai
Other nur iTb^
°f adSn
care to save the life of the baby and the
needed to"-many needless KafanS
Kafans are
ensure mothers right to safe
delivery. For
3 5?unt7 S'vjng high value to
matratva motherhood, with
-i MCH being an
old programme and still
a very important
component of RCH, t*
the NGOs and the government programmes
Other nursing homes take as much as thev
are giving it is NOT ENOUGH.
^vseprit?ie T t ZtaL There's Bokaro Cen-a'
unhnmiteyd°UTumn|efPtaay; thT?
'°
patients, if you have ^.500^ ^ packet"
and turn nght if you don't. 35kms down that'
much fmthy°U t0 PU.rUlla DlStric' HosPitalmuch further away, but cheaper Pareti's
husband arranges a taxi for Rs.500 and sets
After they have left I manage to get awav
start" Wl"1 my nO'eb°Ok at
Whc" to
erv ce< "w3'0
Sy 'gap^
whoteTente6
'reProd^"vg health
SerVk"
'<>
ag° Prenl Clla"d
e centenary is being celebrated wrote.
is because ot the chronic poverty and
neglect deep-rooted economic inequalitv
born out of patriarchal mindset? Or is it
because a pregnant woman is seen as
population bomb, population increase in a
demographically driven pregnancy orevention
mandate, therefore further discriminated and
denved access to proper care when it is well
known or should be well known that women
1n?nl°W.h1Ve Very 11,116 Say - in '"diction i.nAa, S.^~^
anted pregnancy. Empowerment of foi",rf<-r of '/an chetna
women for pregnancy prevention AIDS
■’ Cll(> working to
prevenbon is important but not enough.
nnat arc their entitlements? Where can thev ,r(,m INU ^nd actively
access health care services? Who nni<t
in developing the
ensure this?
health inputs for training
"omen to become primary
health < .ire providers.
HEALTH FOR the MILl,ONS , Aul(ui,^P,^,
Oao^'^lOOl
97
CONCEPT' NOTE
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♦
Primary Health Centers and subcentres with adequate staff and supplies which provides
quality curative services at the primary health center level itself with good support from
linkages;
♦ A comprehensive structure for Primary Health Care in urban areas based on urban PHCs
health posts and Community Health Workers,♦ Enhanced content of Primary Health Care to include all measures which can be provided
at the PHC level even for less common or non-communicable diseases (e.g. epilepsy,
hypertension, arthritis, pre-eclampsia, skin diseases) and integrated relevant
epidemiological and preventive measures.
♦ Surveillance centres at block level to monitor the local epedemiological situation and
tertiary care with all speciality services, availaible in every district.
i
I
Slmilarl>'' three yeafs of rural posting after post graduation be made
compulso^
X hoXi meC
r be Set UP 10 enSUre observance °f minimum standards by 2tl
pr vate hospitals, nursing/matermty homes and medical laboratories. Prevalent practice of
Xith’"fJ:0rTlrniss'0ns f°r/eferral to be made punishable by law. For this purpose a body
with statutory powers be constituted, which has due representation from oeoolel
has due representation
from peoples
organisations and professional organisations.
emation rrom
peoples
3. A comprehensive medical care programme financed by the government to the extent of at
least 5% of our GNP, of which at least half be disbursed to panchayati raj institutions to
finance primary level care. This be accompanied by transfer of responsibilities to PRIs to
run major parts of such a programme, along with measures to enhance capacities of PRIs to
undertake the tasks involved.
7' AinH,iK?1tlrdrU3 P^"Cy be formulated that
xxs1sr■d,G3s
4, The policy of gradual privatisation of government medical institutions, through mechanisms
such as introduction of user fees even for the poor, allowing private practice by Government
Doctors, giving out PHCs on contract, etc. be abandoned forthwith. Failure to provide
appropriate medical care to a citizen by public health care institutions be made punishable
5'
need’based ^manpower plan for the health sector be formulated that
a?d bask dortenrU'remer
r TtiOn °f 3 mUCh lar3er P°01 °f Paramedical functionaries
and basic doctors, in place of the present trend towards over-production of personnel
trained in super-specialities. Major portions of undergraduate medical education nursing
as well as other paramedical training be imparted in district level medical care institutions3
development and growth of a self reliant
♦
♦
♦
♦
ban all irrational and hazardous drugs;
introduce production quotas and price ceiling for essential drugspromote compulsory use of generic namescriteria; adVertiSementS' promotion and "^*"3
all medications based on ethical
♦
♦
formulate guidelines for use of old and new vaccinescontrol the activities of the multinational sector and restrict their presence only to area,
where they are willing to bring in new technology-
1
as a necessary complement to training provided in medical/nursing colleges and othe^
training Institutions. No more new medical colleges to be opened in the private sector. Steps
©
4
*
\
►
*
|
j
• .*a»w4s. .
*
*
*
I
*
*
I
I
*
*
*
*
V
fc
/
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I
12. Introduction of ecological and social measures to check resurgence of communicable
diseases. Such measures should include:
♦ integration of health impact assessment into all development projects;
♦ decentralized and effective surveillance and compulsory notification of prevalent
diseases like malaria, TB by all health care providers, including private practitioners,♦ reorientation of measures to check STDs/AIDS through universal sex education, checking
social disruption and displacement and commercialisation of sex, generating public
awareness to remove stigma and universal availability of preventive and curative services,
and special attention to empowering women and availability of gender sensitive services
in this regard.
♦
♦
16. Special measures relating to occupational and environmental health which focus on:
♦
♦
♦
♦
13. Facilities for early detection and treatment of non-communicable diseaseslike diabetes,
cancers, heart diseases, etc. to be available to all att appropriate levels of medical care.
14. Women-centered health initiatives that include:
♦ awareness generation for social change on issues of gender and health, triple work
burden, gender discrimination in nutrition and health-care,♦ preventive and curative measures to deal with health consequences of womens' work
and domestic violence;
♦ complete.maternity benefits and child care facilities to be provided in all occupations
employing women, be they in the organized or unorganized sector,♦ special support structures that focus on single, deserted, widowed women and
commercial sex workers,- gender sensitive services to deal with reproductive health
including reproductive system illnesses, maternal health, abortion, and infertility,♦ vigorous public campaign accompanied by legal and administrative action against female
feticide, infanticide and sex pre-selection.
comprehensive measures to prevent child abuse and sexual abuse;
educational, economic and legal measures to eradicate child labour, accompanied by'
measures to ensure free and compulsory elementary education for all children.
1
banning of hazardous technologies in industry and agriculture,worker centered monitoring of working conditions with the onus of ensuring a safe
workplace on the management,*
reorientation of medical services for early detection of occupational disease,special measures to reduce the likelihood of accidents and injuries in different’settings
such as traffic accidents, industrial accidents, agricultural injuries, etc.
i
17. Measures towards mental health that promote a shift away from a bio-medical model
towards a holistic model of mental health. Community support and community based
management of mental health problems be promoted. Services for early detection and
integrated management of mental health problems be integrated with Primary Health Care.
18. Measures to promote the health of the elderly by ensuring economic security, opportunities
for thTddeX6 emplOyment' sensitive health care facilities and. "'hen necessary, shelter.
19.
t0 P™"0'6‘he health of Physically and mentally disadvantaged by focussing on
15. Child centered health initiatives which include:
♦ a comprehensive child rights code, adequate budgetary allocation for universalisation
of child care services, a expanded and revitalized ICDS programme and ensuring
adequate support to working women to facilitate child care, especially breast feeding-
©
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isri
Targetted Negligence
India began its tryst with destiny half a century ago. Despite remarkable progress in many
fields, the overall development indicator, the Human Development Index, continues to be
poor with a low rank of 127 among 177 nations. One easy excuse has been the oft quoted
population problem’. Politicians of different hues and persuasions, bureaucrats and even
the middle class person in the streets finds the large number of poor an easy excuse for all
forms of problems; from electricity to traffic problems, from inflation to sluggish
economic growth. One tempting solution, has been has been the imposition of a target
driven family planning programme, where everyone from district magistrate to the lowly
anganwadi worker is given a number of sterilization cases she or he has to bring each
month or year.
Uttar Pradesh is the state with the highest number of people living within her boundaries,
and a population growth rate which is above the national average. It has also been the
focus of population control and family planning programmes for a long time. It is
interesting to examine the impact of a target oriented programme in contemporary times
by looking at the example of Uttar Pradesh.
Mauli Devi of village Lohra Ahrora in Sonbhadra district lost her life during a
sterilization operation on 7lh February 2004 Nirmala Devi of village Belaparasa of
Ambedkamagar district died in similar circumstances just a week later. These are not
isolated incidents. Women are coaxed, cajoled or coerced into agreeing for sterilization
operations because they are easy ‘targets’. However once they have signed on the dotted
line and the operation is over they are forgotten. But for women the operation is often the
beginning of a new ordeal. For many the operation table becomes the death bed. There
are hardly any recorded deaths from sterilization, but community level observations are
showing that these are not uncommon.
Parwati Devi of village Kodwari in Mirzapur district underwent her second sterilization
operation in April 2003. Four years ago she had her first operation and then after having
two more children she went in for her second sterilization operation. Failures are a
common feature of sterilization operations. According to international standards the
failure rate is roughly one in two hundred operations. However a study conducted by a
state agency indicates that the failure rate could be a very high five percent which means
that annually around 22,000 women have failed operations. But there is very little
documentation of these failures and even less is done to support these women.
Besides failures and repeat pregnancies, infection of the stitches or the operation wound
site is also common. These women hardly get any care for dressing of their wounds or
receive extra other medicines. It is hardly surprising that women suffer from various
complications after sterilization operations. The condition of sterilization camps is
abysmal in the state. There has been more than one report in recent years of bicycle
pumps being used for putting air into the abdomen before laparoscopic operations.
In addition to the hurry, and the concomitant risk of mistakes, there is hardly any
attention paid to prevention and control of infection. Tubectomy operation of women, in
contrast to the vasectomy operation of men, is a major operation. It requires that same
care in terms of infection control as any major abdominal surgery for example removal
gall bladder stones, or removal of the appendix. However such camps are found to take
place in schools where classrooms become makeshift operation theatres. Surgeons don’t
remove their gloves after completing an operation (this can also add to the risk of HIV
transmission) and instruments like the laparoscope are inadequately sterilized
In August this year five young men were drugged and then vasectomised in the district of
Lakhimpur Kheri. Two of them were under 21 and un-married. They were poor farm
laborers and their landlord needed a licence to procure a gun. More than one district
magistrate has started a scheme for giving licenses for guns against sterilization cases
They have justified it as being one easy way for meeting sterilization targets. There are
reports that state has over 5 lakh pending applications for gun licences. It is easy to
calculate the sterilization targets that can be met by applying the simple norm of two
cases for a small gun and five for a big one!
€
The case of Uttar Pradesh also highlights how ‘targeted’ population control program not
only affects women who seek sterilization but any woman who needs government health
care support. The whole health machinery in Uttar Pradesh is geared to implement the
family planning program and there are no other services available for women. Every year
nearly 40,000 women lose their lives to pregnancy or maternity. According to the last
round of the National Family Health Survey only 4% of pregnant women received all the
required check ups, immunization and tests. Nearly 80% of the five million births that
take place in the state are unsupervised and the government nurse reaches a measly 7% of
these women after her delivery within 2 months.
A little more than a quarter of a century ago a targeted and coercive approach to family
planning programmes led to the downfall of a Congress Government. The Common
Minimum Programme of the United Progressive Alliance, has once again mooted “a
sharply targeted population control programme”. The National Population Policy which
was approved in 2000, recommends a target free, community needs centred approach
which can go a long way in meeting the health needs of the community. This was also
am affirmation of the commitment made at the International Conference on Population
and Development in 1994. Experience from UP highlights the immense amount of
medical negligence and the gross human rights violations that are committed in the name
of targets. Unfortunately the impact of targets has most often been borne by women, and
once men are involved, the political cost may prove to be too high once again.
Abhijit Das
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R3 3KiYr 'Tm' -337
FROM :4Pa^8Sor.ic rnZ' -FA’. ’
NO.
: 000000
Sep7--Z4 2004 0b:5p
1. 35 years old Paso Devi, belonging to scheduled caste community contested election
for Zila Parishad Member. Paso Devi fought/ contested from ward no 5 of ZP District
Fatehabad She is an illiterate woman from Nagpui Gram Panchayat of 1 atehabad. When
she contested for ZP membership, she was with the ruling party - Indian National lok
Dal. As Fatehabad has the highest scheduled caste population amongst othet districts the
post for chairperson ZP was rese-' ed for scheduled caste woman. Out of 13 members
elected for ZP, 7 were supp<‘>rting her for the post of Chairperson.
The ruling party decided to elect Smt Kalo Devi as ('hairperson. I his R-d to Paso Devi
leaving the ruling party and joining Jk-mds with the opposition - Congress Party. As there
were only two candidates eligible for the post the members of opposition supported Paso
Devi whilst the ruling party SUDDOrtcJ Kain Di vi Thw fnnl -a drtunuu^ turn
ruling party kidnapped Paso Devi whilst Kalo Devi, supported by the ruling party* was
elected as ZP Chair.
Paso Devi cun .•'illy is iui elected ricmbcr of Zila Parishad from ward no. 5. Her
constituency had 44300 total votes at that
and covered 21 villages. Paso Devi won
by 17500 votes.
At the time of election she had h>u children. Before election her sister adopted two of
her children.
After one yem, her own brother in law (Jcth’i, filed a case against her alleging her that she
had more that t oo child which is disqualification as per Haryana Pancha^ati Raj Act. She
obtained stay Oom financial Comnmsioner and Secretary in this regard and continued as
member Zi'i i I’arish.id on the basis of 'hat a similar case is pending with supreme court.
When the judgment from Supreme Court came on 30 07.2004, Past' IX\i also hud to
leave her scat. This shows that the constitutional Provision is used as weapon fot |xditicul
rivalry'.
I
oep.
jLdti)4 do-r e
2. Mr. Devraj s/o Sh. Phalli Ram is 35 years old belongs to scheduled caste got elected
as Panthayai Samiti member. He contested from ward no.12 of Ratia Panchavut Samiti ol
Fatchabud District. He c'ontcsted first time. He is educated up to 8’1 standard. His
constituency comprised of five villages, lie won the seat by 252 xotes against her nearest
rival. He belongs to SAI INAL village. His rival candidate filed case against and
challenged his qualification for the post. Devraj has three children (2 male and one
female) I he case was pending with deputy commissioner for one year and utter one year
he had b<vn dismissed from th * post as he had been declare disqualified. His third child
was born on January 1996.
3. Mr. Sher Singh, Disqualified Sarpanch
Age 30 years. Casic-Vuhniki (SC), Chum Pancha)at- Lchariyan.
Education- Matric (10th)
Living Children- 5 (4 Femair I male) Last child was bom in 1999.
He contested election fur the post of Sarpanch from the scat reserved for scheduled caste.
Total votes in His Gram Panchayut at the time of election were 2300. Hu won the
Election by 436 voles. His father had been member Panchayat for two terms. He was also
a worker of ruling party. He was first suspended in 2001 on the basis ot disqualification
having more than two children Bui he. remained Sarpanch, as he was member of ruling
parly He second time suspended in 2003, he again escaped himself, f inally he has t>cen
giv^i notice on
tli) I'i inrili film (.UlOr CM 00.07.2004 umJ Ji.Miil.vsud
26,07.2004. He told that during his tenure of four year, administration never supported
him in his work Upper caste people (Punches) of his Panchayat influenced. Ji-.. Secretary
and BDPO. He was never provided all the funds. Development works done in his
Panchay.v. some times without asking him. In parliament election he supported congress
candidate as tie belongs to his coming.lily, ruling parly victimized him.
13
24 2224 B£.:5lBFr!
I
F'dl
4. Rajkiinu- i, i u . )ditliTied Sarp.tiK ii
l atehabad, Toiiil V^ies: 6500
Gran. - . •• out Righai, Block A. ‘.
Age- j > jr>
education- LH2
Caste Scheduled Caste
I iving t IrAj -..r 4 (2 Mule ? I'.-nr ' : n,: - ’'ild bom in 199b.
RaiVu.-. . v. as elected unan.ineo- .
Sarpanch, as the post of Sarpanch in bighar (iiam
Paia’ .y.i was reserved fo sdicduled .estc In 2002 there was -i ease of vneivnehincnl.
Some uprer caste people tried ■■■ inOuence him to take decision in their <<voar.But he
refuse-1 sf. irig that he cannot
^ms' the will of majority of people The same (x-ople
are rm tn m Cvh. ol fhey clh-rd free edueation to his children in their school. AHer
|iax ,lr .hJ'p:.. 1 of bmth of his child, they filed ease against Itaikumar. He declined
disip. -’i-'. c e.ud dismissed trum the p- •< t on 26.05 2004.
5.
BUIu, Disqualified Sarpanvli
•
Patu Lus at - Bhund;'rv;as 1< t , I Votvs: 2800 won by 63
.Age- 43 \r>. Scheduled caste, i-.ducation 9
Living, Chikhui. 5 (3 1 cinak ' ma’ic' Last Child Born in 199' Gunale); Adopted by
his biothci in law.
,r, .,-.1 si<-a1 and won by (A ’.oko fiom liis nearest rival
Billu co.ilc.slcd cle.c.iior. ui.
c»f Billu's election as Sarpanch, Mr Makhan Singh
Mi.M. '■ 'r n Singh. Atk” *9 J.
fiiC-l i. • '.'1 disq’.Kilific./.ion against him He fought the -..jsc up to B D.Dhuliya.
. ‘h’.i '
I kpHrtmcnl ol Pan; >
Govt of Haryana and Higf. ( o.ul. 11c hnuli)
disnrA.'-cJ on 28.01 ?.004
[-
IVo-'ien's experiences with the public health system
Testimony 1
40 year old smt. mangibai W/o Ambalal Meena r/o village
Manpura had tow children when she got tubectomy done 10
years ago in a sterilisation camp at Chhoti Sadri. But she
continued to conceive even after the tubecomy and has given
birth to three more children since then. In Mangibai's own words
".....conceiving after getting tubectomy done makes it difficult
to live in the village. Imagine my plight if instead of me my
husband had got the operation done and then 1 would have
conceived because of failure of his operation...
Testimony 2
28 year old Smt. Lacchibai w/o Sh. Fatehlal Meena r/o
village Lalpura, got tubectomy done earlier this year (after
being encouraged by a multi purpose worker to do so) even
though her family did not approve of it. She has been
experiencing severe problems ever since the stitches weie
opened. She has been suffering from burning sensation while
urinating, irregularity in menstruation as well as white dischaige.
Till now she has spent around 3000/- rupees in seeking tretment
from both government and private doctors but with no respite.
Since Smt lacchibai had got the operation done against the wishes
of her family. Members of family do not take any responsibility
for her situation and do not consider her problem seriously.
Testimony 3
35 year old Smt. Ruplibai w/o. Sh. Narayan Meena r/o
village Inton ka Talaab got tubectomy done in the Chhoti Sadri
camp after having three children. But she began to remain unwell
after the operation with pain in stomach and during monsoon,
season. One year after the operation she gave birth to another
child. Smt. Lacchibai has this to say about her experience,"
-/2T>———-—-—
I
tubectomies are stressed upon and women are pursued to get
tubectomies done but after that women are left on their own
with no follow-up services." Her agony is that conceiving after
tubectomy leads to ostracisation from the society
Testimony 4
In the case of 30 year old Smt. Kailashibai w/o Sh. Damn
Meena r/o village Bhura nobody ever told her about anv
method of family planning until her fifth child. After that also
s ic was given information only about tubectomy and no other
contraceptive option was given. One and a half year ago she got
the tubectomy done and since then has been suffering from
burning sensation while urinating and irregular menstruation.
Due to unavailability of government services she has been
seeking treatment from a private doctor but this has not been of
any help and her problems still persist. Smt. Kailashibai also
complains that none of her children were immunised. She feels
that if she had got timely information about family plannme
methods she would not have had so many children and her life
would have been somewhat better
—
'asfi!
76
Testimony 5
18 year old Suit. Dhaniaribai w/o Sh. Suitaram Meena r/o
village iVlahidon ki Rail conceived al the young age ol 17
years. At the time of delivery even though she went to the
government hospital yet the doctor sent her back home. At home
ANM delivered her and the child died after two days. She says
that no health care provider ever contacted her and informed
her about the complications that could happen by conceiving at
a young age. She says "...by conceiving at a young age 1 could
neither take care of myself nor of my child. 1 not only lost my
child but myself also feel very weak.
ifii
■
■8
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■III
Testimony 6
42-year-old Ratnibai w/o Sh. Laluram Meena r/o village
Harmaron ki Rail got man ied at the age of 18 years. Nobody
told her about any methods of family planning until her fifth
child. Ten years ago she got tubectomy done in a camp al Chhoti
Sadri. But 6-7 months after the operation she started
experiencing pain in abdomen, hands and feet, irregularity in
--
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■■■■—
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menstruation and while discharge. She consulted-the A\M as
well as PHC at Dhola Pani and took medication but with no
relief. She has already spent about 3000 - rupees in the
treatment so far. She says that she feels very weak after the
tubectomy and is not able to do any heavy work, both agricultural
as well as household. Having suffered so much she has lost
faith in medicines and health care services.
Testimony 7
40 vear old Smt. Babri w/o Sh. Punjiya Meena r/o Harmaron
ki Rail got tubeclomy done in a camp at Chhoti Sadri. During
the operation she was aware of what was happening, which is to
say that she had not been administered anaesthesia properly. 3
months after the operation she started experiencing pain in
abdomen, burning sesation while urinating, irregular
menstruation and white discharge. She sought treatment from
the area ANM as well as private doctor but got no relief She is
verv ti oubled by the illness and feels weak. Having spent about
800/- rupees already, she is not able to seek further treatment
due to lack of money. Smt. Babri says"... I invited the problem
on myself and am now looking upto god for some relief.
Testimony 8
27 year old Smt. Bhulki Meena w/o Sh. Harji Meena r/o
village Lavan Ki Khedi, one day stalled having pain during her
first pregnancy. Her husband called the compunder from the
Chhoti Sadri CHC. The compounder administered an injection
and a bottle of glucose which relieved her pain for a while The
compounder charged 200/- rupees and went back. After some
time the woman again stalled having pain and also stalled vomiting.
The family took her 8 kilometre away to Siyakhedi village in a
bullock cart and from there hired a tractor to take her 30
kilometres away to Chhoti Sadri. The woman was administered a
bottle of glucose in the hospital and asked to go to a private
hospital in Neemach. The family hired a jeep and took her to
_
-/24> ,
_________
J3
\ . ,v> h She underwent caesarian there and was ei\en twe
i
' \hi iod In this wax the tainilv spent about I ?00(> - napees
b0,rS 0 i ■ «em i of which 3500/- w as the doctors tees
-pitals
hem to
,'kvboni <W M »™ve and the doctors also said that Soil Bln,
Meena would not be able to conceive again.
iospnals
Testimony ?
I supply
<
. R.KHtib ii w/o Sh. Nanuram Ravat r/o village Barol
n is also
cmmonly
uibcetomy
BuJ^Bcr the operation she started expenencing pa.n m
ire never
abdomen and burning sesation wh>le urmat'ng. S’te sotg
treatment from the nearby government hospital. She was
lout, list of medicines to buy from a med.cme shop outside
the hospital As she did not have money tor the medicines
mortuagod her land for 6000Z- rupees In addition tc> this s >e
also had IO bonorv money Iron, a money lender Mean* .K
she also stalled having the problem of »h«e diseha.geW hen
.... asked the doctor the reason for
her P
rob’e”?)s^sc
h^ <.
she
toi hei
pioblems
she askcu
.
was tbe cause of her pvob|ems.
that the tubectomy procedure
cgarding
un
dignified
11 age who
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I
37
Case Study -1
Mrs. Geeta Madan Pandole
Sarpanch
Village
Panchayat
Development Block
District
Valni
Valni
Prsbhatpattan
Betul (M.P.)
Geeta Pandote was etecled to the post ot Sarpanch for the first time. She has
°O
da
am. Her fourth daughter was born on
danuary 200, and after one
and
.. months tater she came to Know about this taw. Prior to this, no one had
o
r that there had been an amendment in the Panchayat Pa, system
unexpected information staggered att. he. and the vtttagers as we«. w
d
elected he. The vtttagers thought what Kind of a democratic system was it that a
person they had chosen with their voles wouid be removed from her post ih such
a manner. They gave a written letter objecting to this step. They prom.se
er
every help, but due to economic constraints, she couldn t fight.
Geeta has received formal education up to eighth standard. The woman
representative who has replaced Geeta, happens to be illiterate.
Geetabai says that giving birth to a male child is a social demand. It is no
fault that she delivered four girls? Geetabai is a wise and active woman w
,
apart from increasing he. interaction with he. fellow villagers, has atso got ma
and a wetl constructed tn he. village. She has also brought the benefits
the
,ndi.a Awes Yojna to the eligible villagers and led in constituting a womens
group.
Case Study -2
Sarpanch
Village
Panchayat
Developmental Block
District
Mrs. Prenvati SunderSailu
Handipani
Handipani
Shahpur
Betul
Mrs. Premvati Sailu, aged 28, got elected to the post of Sarpanch for the first
time. Her husband was also a Ranch. He too has been removed. They have four
girls. Sunder Sailu is the only child (son) in his family. He is worried that his
family’s name would be wiped out if he did not have any son.
Premvatibai came to know about the law in March 2004, when she was carrying
the fourth baby in her womb. They were advised to terminate the pregnancy, but
it being the eighth month, it was not medically possible. She delivered a female
child. Premvati is carrying another baby presently and is in her ninth month.
Population control and the post of Sarpanch are secondary priorities compared to
the yearning for a male child.
Premvati Bai has undertaken several development works during her tenure. She
got a road, a pond, a school building constructed; constituted three Self-help
Groups that are still functioning with her guidance. She says politics is secondary
priority in her life. She needs a male child to carry on the family name. But she
regrets that her removal has brought to halt several development works like
issuing the children of the village caste certificates.
■We were sent a copy of the court decision in English. We’ve written to the
District Collector that we don’t know English; hence we may be sent its Hindi
translation. Changing laws so frequently affects the village community adversely.’
N.B.:- The Sarpanch can’t come to Delhi, being in the ninth month of pregnancy.
J/
Case Study - 3
Sarpanch
Village
Panchayat
Development Block
District
Mrs. Ramkali Panse
Naharpur
Kamod
Bhimpur
Betul (M.P.)
The Government talks of promoting women and yet puts them in trouble,’ says
the ex-Sarpanch, Ramkali Panse, removed from her post because of a complaint
that she has more than two children. She was removed from her post on
01/06/2004 Earlier, she was dismissed on 29/11/00 and she got a stay order on
16/01/2003. Regarding her third child, she says her family experience tells her
she must have at least two male children for looking after them in old age as the
son of her elder brother-in-law fell sick at the age of 8 and eventually died.
-Fighting this case caused us economic loss at first. We had to appear in the
SOM’s court and then, before the Collector, leaving all our other work. We did
fight It in the High Court, but that too was a costly affair. But. we do want that a
poor tribal should get justice and laws that adversely affect women and make a
poor family retrogressive in its thinking should better not be passed.
Ramkali likes her work as a Sarpanch and has undertaken several development
works during her tenure. She was responsible for getting constructed two school
buildings, three wells, five community centers, an aanganwadi budding, a road, a
check dam and a stop dam with the help of voluntary community labor 'I do want
to bring development to my village, but have no say in this matter. My opponents
made a complaint after I gave birth to my third child and I had to give up my post.
There are lots of Sarpanches whose third child was born after 26” January 2001.
but they have not been removed as no complaint has been made against them.
Such double standards confound our thinking and foster mutual hostility amongst
people.
4t>
Case Study - 4
Ranch
Village
Panchayat
Developmental Block
District
Mrs. Indravati/Lakhan Kasde
Chapra Raiyat
Pahavadi
Sahapur
Betul (M.P.)
‘The law of the Government, introduced in 2001, stipulating removal of
Panchayat representatives having more than three children is violating the rights
of the people like us belonging to the lower sections. This is a law, we don’t
endorse.
I was elected unanimously from Ward 11 and devoted myself fully to village
development. ‘During my tenure, I got roads constructed in my ward, houses for
three villagers under the Indira Awas Yojna, a chaupal and a school building. I
also got the existing roads mended.
‘The villagers elected me of their own will. I was elected unanimously. My fatherin-law is also an ex-Panch from the same ward. I’m not educated, but I do help
people in development work.
‘I encouraged women’s participation in village development work; constituted
women Self-help Group and am its member still. I didn’t know I'd be removed
from my post under this law; otherwise I’d not have been in the fray. The law has
hurt my honor. The decision of the Government is utterly wrong. Had I known it
earlier, I'd have certainly resigned from my post of my own will.’
Case Study -5
Mrs. Ramvati/Sarvan Lal Parkade
Ranch
Village
Ranchayat
Development Block
District
Rather
Rather
Ghoradongri
Betul (M.P.)
su
of nf Ranch for the first time. She has three
Ramvati Bai »as eteded >o <be pos. o< Pannbdo
chMren. The .bird gid was born <o her a«e. 26.h
had to,d be. .ba. there bad Peen an amendm
Thus, the unexpected news
200
t.n^
had
js thjs? How can the person
red rre7i"n a de^ie s,s- be .entoeed iihe « Op. eo.e has
gone waste.
=“-■"= --—- - ——«—•
wells etc.
Raroatl Bai says .be »boie .bing .s -ng. Han sbe
have contested the election. Wrong kind of persons
such laws.
Case Study - 6
Ranch
Village
Panchayat
Development Block
District
Mrs. Surgati Bai/Harishankar Aahok
Khari (Jamundhanar)
Khari
Ghoradongri
Betul (M.P.)
surgati Bai Aahok had been elected to the post of Ranch for the first time from
Ward no. 2 of Khari Panchayat. She was removed from he. post after
January 2001, when she gave birth to her third child.
‘Had I known earlier,
I wouldn't have contested the election. I came to know
pregnant. The law is all wrong. The Government is
about this law when I was
doing injustice with the Panchayat representatives.'
Surgatl Bai has done viilage deveiop-nent works like road eonstroetion and Indira
Awas Yojna etc in her ward. She is of the opinion that this law has hurt her
honor. Suragati Bai is a wise and active woman.
S'
^3
Case Study - 7
Ranch
Village
Panchayat
Development Block
District
Phoolvati Bai got elected as
Mrs. Rhoolvati/Mauzi Dhurve
Chapra
Pahawadi
Shahpur
Betul (M.P.)
Ranch for the first time and unanimously. She has
six children. The third child was bom in March 2001.
■The Sarpanch, the Up-sarpanch and the Secretary tell us nothing. I have taken
keen interest in development work since I got elected. Though. I couldn't do
much for I didn't get much information about Panchayat work. I want to learn and
do something.
I didn’t know about this rule. I was not given even
straight away.'
a notice. I was dismissed
4^
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553
Five Case Studies on Sterilization in Different District of UP
St
Case Study 1
Case: Female Sterilization
Name: Bitti
Age: 32
Caste: Cole
Children: 5
Village: Maarkundi
District: Chitrakoot-Karvi
State: Uttar Pradesh
Source: News Paper
Date: 23rd September. 03
On 23rd September a sterilization camp was organized in Community Health Centre
of Manikpur. Bitti had got first appointment and doctor called her to operation room
initially. First, doctor gave an injection to her. While operating doctor cut wrong
vein. For that her condition got complicated. She started bleeding. When doctor
realized that her condition got out of control then, CMO and doctor took her in
Rooprani Hospital
in Allahabad.
But her condition becomes more and more
complicated because of bleeding. That time she needed blood. Doctor asked her
husband and he gave one bottle blood. After receiving blood her condition got
better. In spite of this, her treatment not happened in Allahabad, she had to come
Manikpur. Her treatment was going on in CHC of Manikpur.
According to doctor
(Who came from Lucknow) "victim woman was ill, if she could not come for
operation, definitely she would be die". But victimize woman's condition proofed
that doctor statement was totally wrong.
Case identified by VANANGNA, Chitrakoot
1
Case - 2
Case: Female Sterilization
Name: Shimla Devi
Age: 35
Caste: Lohar
I
Children: 5
Village: Aidilpur
District: Azamgarh
State: Uttar Pradesh
Date: 12th February.04
Source: Grameen Punarnirman Sansthan, Bellari, Azamgarh
Shanti Devi (ANN) suggested Shimla Devi to do sterilization. ANM decided that on
12
February, she would take her in CHC, Atraulia. On that day ANM's husband
came to her (victimize) home and told her that today they cannot go CHC because
they cannot arrange any transportation. But after some time, Urai Nishad (ration
shop owner), Mahantu Nishad and Rampareet came to victimize home and told her
that they have arranged transport so come with them. When she reached at CHC,
she did not find ANM. She told that before operating, doctor did not do any check
up. First a person put an injection and after half an hour she called in operation
room. During operation, surgeon got very much irritate because he was not finding
the vein. It took half an hour of operation. Before leaving CHC, she got vomiting
four or five times. But no health worker came with her. When she came back at
home, she met with ANM, she told her everything, ANM got angered, then she
wrote a medicine and after eight days she again come and cut her stitch.
After
cutting the stitch, she did not feel any relief. She got pain and swelling. Then she
went to CHC, Atraulia, that time surgeon was not there, another doctor saw her and
told that once again she has to do operation because internally stitch got brake. For
that operation she has to pay 500/-Rs. According to her doctor's behaviour was
very bad that is why she did not go CHC again. But day by day her condition
become complicated then she went to Shahganj, Jaunpur. Firstly doctor did her
2
53
ultrasound and told her she got hernia. But she was little bit confused. She went to
another doctor, but he also told same thing. Then she had to do another operation
on 26th June 04. That time she got 14 stitches and doctor took 5000/-Rs. During all
these process she faced mental, physical and economic harassment. Now she
wanted to like that health department should reimbursement her.
Case identified by Grameen Punarnirman Sansthan, Bellari, Azamgarh
3
Case - 3
Case: Female Sterilization
Name: Sudha Singh
Age: 27
Children: 2
Address: 123/9 Shastri Nagar, Kanpur
State: Uttar Pradesh
Date: 8th June.03
Source: Local News Paper
On 28th May Mrs. Sudha Singh went to government hospital for sterilization. Her
sister-in-law was with her. Doctor told her she is pregnant of 6 week, so she has to
come tomorrow and after abortion she will do sterilization. On 23rd May, again she
went over there; firstly doctor did abortion and then did sterilization. Next day
again Shuda went there and told the nurse she has a problem. Nurse checked her
and said she has gastric. Nurse gave medicine and told everything will be all right.
But she did not get relief. Next day doctor said that once again they have to do
operation. On 1st June Sudha had one more operation but she did not fine. Next
Eight days after operation she was senseless. As a result, she died on 8th June.
Case identified by Savita Misra
4
-r
-af
m
ss
Case - 4
Case: Failure of Female Sterilization
Name: Manti Devi
Age: 30
Caste: Yadav
Children: 3
Village: Bhawanipur, Cunaar
District: Mirzapur
State: Uttar Pradesh
Date: 13th January.04
Source: Shikhar Prashikshan Sansthan, Chunaar.
Manto Devi has three children and all three are boys. So both have decided to
family planning. This case was happened in 1997.
Manto devi went to Dhorawal,
Primary Health Centre for sterilization. Initially health worker did all check-up like;
blood, urine test and pregnancy test. Then doctor did sterilization. After sterilization
again she became a mother of two children. In February 2001, again she did
sterilization. She has all evidence regarding sterilization and she wanted to file her
case.
'dentified by Sadafal, associated with Shikhar Prashikshan Sansthan,
^11 U fl 3 3 ra
'
Case - 5
SC
Case: Female Sterilization
Name: Heerawati Devi
Age: 35
Caste:
Children: 5
Village: Shobhol, Cunaar
District: Mirzapur
State: Uttar Pradesh
Date: 2003
Source: Shikhar Prashikshan Sansthan, Chunaar.
This case is based on basically temptation. One-day gram pradhan and his
supporter came to Heerawati's house and started alluring. They said to her if she
gets sterilization they would give her land on lease. So, she got sterilization but
after that her stitches become an acute condition. She did not get any facility in
government hospital then she had to go private hospital. However, gram pradhan
also ditch her and did not give anything.
Case identified by Shikhar Prashikshan Sansthan, Chunaar.
*********
6
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4
NAME OF STATE: BIHAR
Name of the Contact
Victim/member
accompanying
(please specify)
1.
Ms Geeta Kumari
2.
Ms Somi Gupta
Case description(Brief)
Accommodation
Travel (Train)
Venue / days
Arr:
Date & Time
Tubectomy done by Mary Stoves Clinic, Indian
Social 9.10.2004
in
Dak Bangla Road, Patna in the month of Institute, New- morning.
December 2002.
Delhi / 3 days
Abortion was also done along with
tubectomy.
W/o
Mr.
Rajeshwar Singh,
Hanuman Nagar,
Chemni
Chak,
Block
Phulwarisharif,
Thana
Problem faced:
Gaurichak, Patna. Septic infection, blood clotted in the
uterus. Ultrasound done and medicines
given for relief.
On May 15, 2004-the expected date of
menstruation but didn't take place. She
again became pregnant. Went to PMCH.
Patna and get aborted in the second
phase of pregnancy and again got
tubectomy in PMCH in the month of
August 2004. Treatment going on.______
W/o Mr. Ashok Did her tubectomy just after delivery of Indian
Social 9.10.2004
Gupta,
child in the year 1989. The child died Institute, New- morning.
Akhiyarpur,
within a month.
Delhi / 3 days
Thana - Bikram, In the year 1996, she conceived and she
Block - Bikram, aborted.
Patna
In the year 2001, she again conceived,
she got tubectomy as well as abortion in
the first phase of the pregnancy.
Now she got her menopause.
in
Dep:
Date & Tir
the 11.10.2004
the evening
the
11.10.2004
the evening
7^
3.
Ms. Kusum Devi
W/o
Mr.
Budhadev Dubey,
Vinampura, P.S.
Mahendei,
Jehanabad
4.
5.
6.
Got tubectomy ion the year 1995 when Indian
Social 9.10.2004
she had three children.
Institute, New morning.
After that she conceived twice after Delhi / 3 days
tubectomy and gave birth to 2-girl child.
Again tubectomy was done in the year
2000.
Indian
Social
Institute, New
Delhi
Indian
Social
Institute, New
Delhi
Indian
Social
Institute, New
Delhi
State Organisers / Experts:
Name
of
person Contact address / Accommodation
expert/organizer______ tel, no._________
Ven ue / days_______
1. Sapan Majumdar
Bihar VHA
Indian Social Institute
Sapan Majumdar (Bihar VHA)
Travel (Train)
Arrival
Date & time
Departure
Date and time
in
the
11.10.2004
the evening
77
Testimonies
Orissa, BGVS/PHA
To abhijit @ u.washington.edu
To shicdelhi @ vsnl.net
To hrlndel@ vsnl.net_______
Case in brief__________________
Detailed_________
SI. No.
Sterilization failure. 3rd child borne.
Godida
Name of the Village
01
Green
card facilities denied.
Charulata Sahu
Name of the women
Banamber Sahu
Father/Husband name
30
Age_________________ _
Non literate
Educational status
Married
Marital status__________
Good
Marital condition_______
15
years
___
Year of marriage_______
*
No. of female child
*
No. of male child
3 years
Age/month of the last
child_______________ _
yes
Whether given free
consent to be interviewed
02
03
Name of the Village____
Name of the women
Father/Husband name
Age__________ ________
Educational status
_
Marital status__________
Marital condition_______
Year of marriage_______
No. of female child_____
No. of male child______
Age/month of the last
child______________ __
Whether given free
consent to be interviewed
Name of the Village
Name of the women
Father/Husband name
Age ___________
Educational status
Marital status
Marital condition
Year of marriage
No. of female child
Garama
Mania Bhoi
Bipin Bhoi
24
Illiterate
Married
Good
8 years
2
*
7 months
Sterilization not conducted in the
pretext of prevalence of other internal
disorder with the women. Medical
personnel do not entertain. Clams
money, as they would be taking the
risk Third child borne. Deprived
from the benefits of the green card.
Yes
G a ram a
Pratima Bhoi
Prasant Bhoi
24
Literate
Married
Bad
_ 5 years
1
Sterilization not possible as doctors
returned the patient 4 times. Local
hospital not equipped with necessary
infrastructure. Doctor insists for
supply of kits by patient to make it
happen.
7®
04
05
06
No. of male child
Age/month of the last
child
Whether given free
consent to be interviewed
Name of the Village
Name of the women
Father/Husband name
Age
Educational status ____
Marital status _____
Marital condition______
Year of marriage_______
No. of female child
No. of male child_______
Age/month of the last
child
Whether given free
consent to be interviewed
1__
1 year
yes
Tarasahi
Approached for sterilization. Doctors
Swarnalata Behera denied and consumed time. Then
Ramesh Behera
found Problem in menstruation.
35
Menstruation stopped. Women
Class-II____
conceived. PHC and CHC denied for
Married
abortion. The next child came.
_____ Good_____
12 years
1
2
ves
Name of the Village
Name of the w omen
Father/Husband name
Age
Educational status
Marital status_________
Marital condition______
Year of marriage_______
No. of female child_____
No. of male child_____
Age/month of the last
child
Whether given free
consent to be interviewed
Paschimadia
Lochana Behera
Rabi Behera
35
Non I iterate
Married
Good
19 years
4
1
Name of the Village
Name of the w omen
Father/Husband name
Age______________
Educational status
Marital status_______
Marital condition
Year of marriage
No. of female child
No. of male child
Age/month of the last
Paschmadia
Kumari Behera
Kartik Behera
35
Class-II
Married
Good
12 years
*
3
~
2
I child
Nov.-2001
Sterilization unsuccessful.
Menstruation stopped.
ANM says it is usual. Woman
becomes pregnant. Approached for
abortion. Doctor demands Rs. 1000/
for that. Advice to again come so that
they can do the same after the 3rd
child.
ves
2001-Nov.
Sterilization done in camp.
Dec-2001 menstruation stopped
ANM says - it is usual!!
After 4 months approached to the
doctor.
Doctor says it is a 5 months
pregnancy case. Too late and riskful
for abortion. The woman gave birth to
a 3r child. Now she is used to take
contraceptives (oral pills) for
prevention.
7?
Whether given free
consent to be interviewed
Yes
( * ) Data unexhibited
Mr. Gourang Mohapatra
Mr. Biorin Mohanty
BGVS - Orissa
Contact Tel. No. - Mr. G.Mohapatra - 0943^0 363£5/m)
Mr. B. Mohanty -094371 11204(m)
0674 2550891 (o)
BGVS-Orissa
- Media
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