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^3:!

Population Policy

What went wrong?
Devaki Jain
18th July 1994

Reply to Dr.Ashish Bose Indian Express 17th July 1994.

The

fissue at stake is not whether Devaki Jain does not
under stand
Population Science or the English
language;
or did not have ideaaj or whether Dr.H.8.Sweminathen
le
pro poor, pro woman, and pro nature. The issues are two: .
one: the serious discriminatory effects of
legislations
which
bar entry into powerful and elite positions and
privileges
suoh
as
elected
positions,
organised
industry, official services to those who are poor,
fron
soci culturally traditional categories hemmed
in by
economic and
social
insecurity.
It will also hurt
females as
a
whole
as
as a whole as
in son-preferenoe cultures,
2child formula will lead to killing of females till a son
born .
is born.
Thus by applauding legal strictures?, as
in
40
page
is
para
13.1,the expert group
launching an
attack on the poor SC/ST women.

IJWQ By moving away fron agreed
approach which was
ethical
and
practical
the energies of a
whole
community of
organisations engaged in grassroot work
will be turned fron implenentation to resistance.
If the document
aocuimt had
naa stuck to the approach that
in ny
view was agreed upon, then all the hands - official, PRI,
grassroot could have gone into action putting it on the
ground.
Instead it has now
i
...
wasted
nine nonths August
Hay of deliberations andJ <oonsenus .building.
.. ..
Further
it
has put
the organisations working with the
_..j poor,
and
women who could have put a ''’decent” policy on the ground
into taking adversantial roles; and put poor wonen and
SCs & Sis into
a node of defending themselves, - rather
than enabling themselves.
,

It
is not only tragic, it is reprehensible. Our verbal
battles
in
newspapers are trival, against
this great
cost - namely loss of productive constructive tine.
This is my deepest anguish.
At a private
level, there is
of course anguish as
persons
like
Dr.Ashish
Bose,
and
even
nore
Dr . H.S.Swaninathan iare personal friends for about forty;
years and throughout the working of the
-- > group were the
strongest
rsupporters of the principles of justice,
and
the reasoning against
3 '
a narrow approach, the approach of
incentives/disincentives targets, legal sanctions.

1

Dr.Bose says I ceased to be ia member of the group when I
went abroad - and I am truly relieved to hear this,
We
could have completed the document before I left, if
for Dr.Bose. He and I were to bring comp 1ete drafts not
of
the final document to an
'Ak hand-Path' meeting in Delhi
2 9th
3 01. h Where
w e wore
to wrangle over
our
differences, s m o o 111 e n the corners and bring out a final
agreed draft
for the Chairman and then the group.
I
did. He didn't.

Certainly
if
I was around in April-Hay,
have agreed
to
the
inclusion
of
the
parngrap ho nor
t o the kind of analyois,
fragemented nature ofJ the documen t.

I
would not
obj ectionable
emphaiia and

The pity
is that we h&d in fact
a freshly designed,
cogent
and
enlightened draft - even
even if
if it
it was
in
the
was
in
form of inpiLtjs.
from
------- 1 neinbers.
We could have stayed with
that and given ourselves the pride of place in India and
abroad that we in India, with
— i our ability to review and
critique ourselves, can present 1to Parliament and Public
a really just and practical policy on Population?
Here are some
agreed approach;

•

of the basic elements

Of

( 1 ) that population
policy
as
a means
people s well being
is not synonymous
Planning.

our

pre-May

of
ensuring
with Family

(2 ) emphasising macro-economic policies
which ensure
public expenditures
to provide basic, social and
economic security.

(3 ) taking. a non contraceptive approach
to population
size-reducing strategies: based on the principle of
self-determinati on .
(4) making social and economic
development a community
based activity, art iculated through the PRIs.
’

(5) providing
Health
health care as a basic service through a
high quality wide spread net work of PHC's
thus
merging
the
various
health depar tmen ts
into an
integral, ed service.

t IF

2

(6) making

the birth control programme

male

i
be the single most
important effort of
nio r a 1 and material reasons.
- for niora)

addressed
that
should
the
country

And here are the noxious paras; Page 40,
Para 13.1
Rajasthan and Haryana have enacted laws
prospectively persons who do not adopt the which debar
two child
norm from contesting ejections for
Panchayats, Zilla
Par ishads and Nagarapalikas.
reflects
political
cpmml.tjnen.t..
Even
if such legislation does
r.
2
-j
not
exist,
there should be a code of^conduct which enjoin
is
on
: all
elected representatives of the people’
,
from
parliaoent
t’
to panchayat,
to adopt voluntarily the small fanily
norm . Electod peop 1 e ' s
will then becone
role
models for the representatives
public
to
emulate.
legislation
in this area at central or state Future
level
should
however safeguard the interests of
wonen
,
particularly
those Lbelonging
_1_..o
to the isocially
‘ H
and
economically underprivileged
-- 1 sections of society.

•

3

rs©.^
Devaki Jaln/26th March
to
Draft

Va ( o

HP3:2V

t-' v 11

NATIONAL POPULATION POLICY

1.

Introduction : Goals

■ A!i

■ i.

1. 1

Population

1s

populations

are fast growing or slow growing,

about people and their

/A';'.!.:

well-being. tWhether/

' S'

increasingly/
i'. ;r

i.

it is being seen as an issue that contains within it all the

ma jor

concerns

of the world today. The

sustainabi 1 ity : of.'i

growth, the relevance of life styles,

economic

V'-;

consumption !

1 eve 1s, the role of science and technology, the exercise

of

human rights; the participation of disadvantaged/subordinat- 1
ed groups in decision making and the quest for a Just

world

order. Thus a policy on population offers the best framework..
a

• •

'•

f°r peoplerled social, enyiiieejyjng for economic

advancement; i
I

1

*

I

with the strong underpinning of ecological sustainabl1ity.

T' j!

Purpose of population policies is not just family limitation

or survival but a satisfactory quality of 1tfe for all (MSS)
•

■

•

f
1.2

The

policy will be such that all three elements

j

.•

..zb.

-■Mill

t®

' -P
of.j.

a

building will be incorporated.
■7

a

Gat-tern of ecpnomi.s atQ.wth which is enabling

i

namely

A
.4. '■

provides

livelihood and food security to the poor

and

environ

safeguards the natural resources base and the

• ■AAA:

ment.

pattern o_f socia 1 deve 1 opment which

a

across

bridges

buiIds

divides based on class, caste and

-'•i -7;
. \ rA

re-

gender,

i

gionaT imbalances and urban - rural divides.

Jk

'»' i'

A :,fe

and a pattern of political management which responds to d
"
’ ’ -• '
;
- if; r
the aspirations of the neglected communities and ) un- rf
reached

groups

and

respects

our

in-grained

deeply

‘■i-

principles of democracy.

1. 3

It

women,

the character!stics of their

life

'a

1t -

will based on an understanding of poverty and within

poor

fT

vA

their deprivations and capabilities.

It

and superstition are responsible for large > fami-r.;

that the re fore the poor especially women have 4 .to

lies,

"motivated”
the

as that:

also has to shed any myths and prejudices such

ignorance

'A

' '

situation,

'

through reward and punishment, and scares

Malthusian

argument

or the population

' '’■Afi

A '’

bomb
I
5

that a small family is a happy, family
$:
*. • J1money can buy or moie aptly dry reproductive capacUy

reverse

I
- ■ .

1.4

Thus [NPP (or the Population Policy)/ or "it is"/recommended.. ;;r

that]

:XC

recommend investment in social and economic, securitMiilrrt?'<
■'

services

''

■

for the poor as the key to reach the goal of

•;

peoj*?■

pies well being, balancing people with resources.

2

t.

-A-

I A

, .

iff

■

■ i

;t

Today's concerns In Population policy recognises the econom
ic interdependence between macro and micro, and within

that

the

and

organ I sat I on

of production and trade

and

social

;!1

political organisation. Social organisation has to take note

- 1r

of individual, family, household and societal, - aspirations.

' /

and

with"’: a

political organisation support self-government

strong place for the interest of women and other subordinat-i

i"

ed groups.

1.6

ir
-t hhilife

Today’s

concern is for women's role in decision making;not,!.

■t*

within the family but also In other, arenas .of,. pubJjc.t ''
.. .I
1?
policy. Not involving women enough in
the
planning
and
’
irr
,
k
J
implementation process has been responsible for distortions

only

:/

”■T’i

•

and wastage of efforts.

It

is for method more than goal - (the Gandhtan

that means are

•
j

• r ■

J-

4
•*

1.7

-1

»■

;’Z

approach),

. i

ends,

>'r

as important as ends, means determine
•

'

t i -VM-'

■ 1

This moral approach has gained new legitimacy as .it is; being ;
•*

■ f

V'

?

‘ i h’--

V?

found to be more efficient, in that self determined and self
!

dos I gned

programmes

built

the strength for effective

in

through being

based

appropriate,. haye, 1
• ;
s
'i
implementation.; ,Thus.-

programmes, programmes

which

’

begin

local involvement, response to a locally articulated

institutions

' by’

C

'

more

;

community

•

'V. i

■

'<^1 Tr'.

with

i

issue;:-

'; :1 '4

which bring together :self ; Interest v-group,?.

v
■
'■ ■ ’
' - ir?
1 I ke rural youth In sports clubs are being found effective.;!
■

V

•;

'A
■

3

■ '': v i
R.

siip
-I
11 is for youth - especially the adolescent girls and

the i r

wel 1

being, their knowledge and

their

boys,

aspirations,

their sense of security. Following the SAARC region’s

of

the glN chi Id population policy recommends

theme

rearranging

public policy to provide the girl child with security : with
food and education, her parents with livelihoods and

Insti

tutional

whether

mechanisms to safeguard their interests -

. disadvantaged because of gender, caste or class.
•!

•

1 .9

It is for

. I,9.

'1 • tr Jr

moving out of targeting birth control , the demo~<i

wH

graphic approach to user - induced responses, to choice free;?

,i

I

of coercion.
;'

■

■

The

adoption of a small family norm with a

consequent

de-.
i

cline in total fertility should not be viewed only in

■■

demo

- -ii

graphic terms. It means that people, and particularly women,
■

are

empowered

to take control of their fertility

it

i'1 H-’-il

the

and

planning of their lives. Information and education using all ■
the

products of the information age are important for

pro-f'
■

■

■’!

moting a change in the mind set of the society. The

concept

of

to

equity has to be extended to the generations yet

born, i.e. inter-generational equity.(MSS)
I

i

■A

shi ft

integrated

from a contraceptive approach

to

concurrent

attention to services, technologies and

be *

1;

C;

and

govern-,

ment policies, with a view to providing the substrate condi
tions essential for success. Diversity in culture,
•

language
■

6

4

■

'

/

O:
!
"W •

•W: wi W
and

religion

and

national assets. It

1s

that

Important

{’W

"

■4-

• amidst this diversity, there is unity of purpose in

a

1ng

balance between population

and ’natural

achiey-

resources,

particularly land and water and equity In gender and econom
ic terms.

(MSS)

•;

1.10 It

is for’ emphasising the greater participation of mgr]

for

■

■; .-WBi

■

and

the strengthening of techniques to be available to men i
■

and male youth and not only to mothers and girls.

■'

:

■

■

'

1. 11 It emphasises linkages in delivery of development

: '’f ; A7

to other' service programmes; to social & political

insXitu-..’

t ions

not only institutions of self-government but

rate,

worker,

cooperative, technnlcal, social

1F

Impulses,

'f

’

corpo-j

culturalJ/ '

&

organisations.
■

■ r:

i

1 i .

£

■!.r .vr

• r* ; •'
■r

-y

fX-i*

i. ■

J ’.f ..

•<

41 *

4 ' .
> ..

..

■wW i

■-■'Ji

•fl. ; •■’•t

t. >n- I®

Wtlw
«»«

■

5
,■ '4^ '5;#'

y1..

2

India’s Experience - Positive aspects
i t '

2. 1

The

Indian political and development environment offers /an

unusually creative opportunity for putting on the ground the

kind of wholesome population policy that is suggested In the ‘
and regional discourse on population

global,

and

develop-^.
! j <■' •

u? •

me nt.
..

-

■

■>

■ ■ i'

2.2

•

I' '

The traditional democratic framework, multi-party system andr
freedom-' of association and speech has encouraged, free

f rank

debate

government

interest

and

on population policy and
the

public

as well

programmes
as

andf‘i!

• I;

•'

r«;!|

between^

between J various

■feafev---hi
f-.r

'■it

groups. Further from the very beginning there ,;has 1

been

freedom

right

to

for women to choose to

'•■Bl

birth — the ' • 7 ' ’
■’if'"'
programmes have -j,

intercept

abortion, HIP etc. Anti poverty

been Another feature of the development policy,

■;lel

targetted s

■

programmes of food and work especially for the below poverty
households

and further within them special

programmes

I

for 5

the women.

2.3

Ind ian

experience in improving the quality of life

people,

equity building and population

v ides

a

rich

directions/for the future.

2.4

stabilisation

basket of ideas and practices

for

the
5

pro

' ' / ;X '
new

'-iM

Between 1951-61 to 1992, there has been a dramatic, approximate 1y 50X fall in death rate (22.8 to 10); in Infant
<RPr“

6

"■W

of the

i

'

IP#

■ s !*

W-*' ■'

1
•

I

’f

taii ty

rate (IMR) a 30X fall from 110 p.1000 to

-

79.

’■’’J

Crude
I

Birth Rate (CBR) has shown a fall of 25X from 41.7 to

’

S

29.0,
■

• ■

.i

and TFR has also fallen by about 40X from 5.97 to 3,6.

i

I

j;’':

2.5

There has been a remarkable increase in life
expectancy, one
of the most widely used quality of life indices, from 32
58.6.

5-

to
;

-A

■ i ,

'

■■
.

•X

•
2.6

,n--

. Aj.

'-v . A.;
There are significant variations between States, and be tween
V .;
rural and urban areas. States like Kerala and
Tamil. Nadu J,J; 7
with crude birth rates of 17.5 and 20.7 in 1992
respective-^ ; A

f

have performed very well. On the other hand, the,-crude.
birth rates in Assam (30.6), Bihar (32.2), Haryana. ■ (31.9) H,;.

Madhya

Pradesh .(34.4), Rajasthan (34.7) and

Uttar

(36.2)

are

of

higher than the national average

thousand population in 1992. Similar Inter-State

-..r

; ...
Pradesh'.. A
■If').
- z

pert-

29.0

variations .■
■

are

Seen in respect of the infant mortality

’t?

r-. £

rates.’ Kerala

; ;h, •- J.f-

■

has an IMR of only 17 per thousand live births whereas it is|

i-

t

as

high as 104 in Madhya Pradesh and 114
114 in
in

Orissa.

'f

Aji'

Total!
■

fertility rates in Bihar (4.4), Haryana (4.0) Madhya Pradesh'
■ i >
tfri/C'i',f V'L ,
';b. ...
'
(4.6), Rajasthan (4.6) and Uttar Pradesh (5.1)
are > $1gn1f 1- ! |||
, 41
1 . i jy *
cantly higher than the all-lndia average of 3.6 (SRS 1991).TJ
? • &C1 F.is.

'J:

<1

’

' ■

" ■

i t-!
2.7

The

Ferti1i ty

Rate is lower In urban areas than. ■■ rIn-crural
pradj
■

areas.

'mi 1 1 ion,

•«

?;

In Urban India with a total population of

the

over.
■ 217.J':;tH.>^
o

total fertility rate has declined t0; 2.7

1991 .

W-'
;i
7

i -•

Kerala

State

with a population of 29 million In

1991

■■

I •

already achieved a total fertility rate of 2.0; and allowing
for mortal Ity, its fertility has dropped below the
ment

leve 1.

In other words, its NRR 1s below

b with an

bi rth

of over 70 years. The state Goa with a small

t ion

of

million 1n1991 has

also

■ AA

replace-

infant ' mortality rate of below 20 and a 1ife expectancy

1,2

\

achieved

V

at

popula-.
below-.

a

replacement level of fertility along with,low mortality.
■ •

4

I

;r

i.

Tami1

Nadu state with a population of nearly Se.myjUn

1991,

the TFR in 1990 was 2,5,> the gross reproduction

'

rate!

was 1,2 and with an infant mortality rate of 67, the NRR was

?

■

KO,.

2.9

The

long-term

achieve

a

total

rate of about 2.1, with an Infant mortality

rate

below GO and a crude birth rate of 21 and a crude

death

ferti1ity

of

goal of the country Is to

rate of- 12 per thousand.

■

I

■■

. 10 These

changes are significant achievements and reflect

effort

made in all directions : the thrust towards

removal;

investment in infrastructure economic and

the

spread of extension services, as well as

informat ion,
nomic

poverty
jy;_
soc1al,|'jmr;;'r^^-?r

diffusion

and the role of institutions, social and

and political including the role of non

the

ofT AAA ■ W.

eCGr|;.^?>;

governmenVal^rf"

• a n?

• <:A-.
8

A

. -AA^a a"

' \f

organisations.

AM

i

r

W $

.4-.?
H ■ h'A

2.11 What

this experience reveals Is that the goals

policy, .

of

I

can be reached tlirough the democratic process namely without

coerci on.
same

I

That the "routes'' of approaches need not

be

the

in every place. That a supportive environment

of

Im-

proved

social amenities, information about them,

education

and

capability to access them, a hope of economic

security

and

a sense of equality between people, especially

classes

I

■

\

’

■

! -U

• ■

and

■:

sexes 1s the critical mass
mass for
for Deoole
people tn
to vnitmt*™
voluntary

for smaller families.

opt A

7'
•'t .

.. .r;

:

’-J.

!. 12

ti

However in India there is widespread recognition that theea;T •

approaches, though legitimate in themselves have not
not

'

• ;v-l..

. -;

■■

j-

deliv-

ered the results - either In removal of poverty and 'hunger,

'S‘' i

«

■

or improving the social quality of life.
■

2. 13 The

Government and civic society in their search

effective

/

d'..-

approaches have recognised that there is need

tO j

provide 'the framework for an even more democratic method
economic
73rd

&

elected

and social development - and this has led

74th Amendment to the Constitution

which

7

more.;

for

of

to

the

mandates

■

'1

*r

'■i.

‘

bodies at the sub district and district level

with ’'I

7

■■

33-I/3X reservation of seats for women.

2.14 This administrative and political

'
•
.T ’
M.M; i?
■ ■
framework will provide the 1

Ml
• i

■'i :
■ -->r

■

7

space to reflect and accommodate the heterogeneity of Indian:
'

society

■

1

|! ;.
•

i

• ■1 ‘t■■■ '■£

•• • \

•,

and the Indian economy - regional diversity,^ apart.i»^^^

from

ethnic and religious diversity. It will

what

is

critical in any quest for Justice
9

also

provide

within

unequal

-

‘At

rF '

■

....

soc iet ies

and relationships, namely a system of

wh i ch

in turn depends on accountabi1ity. In a

system

with periodical national and

the

power

regular

multi

subnet tonal

to remove from power, that

elections

redressal,

provides the best

is

elections

offered

Instrument

party

through
for

1-

such

redressa1,
I

■

■.

;..

2.15 Indian

development

planning

has also been

concept

of

product

area as in silk, or dairy; wheat or

area

planning -

the

built on ’ the,!?

geographical

area, , the’jj

sugarcane,

•

.-.7

or

the social backwardness of area. By using area planning with?]
the

power to design, given to a locally elected body,

of

the

needs

dependence,

of

inter-sectoral

or 'integration, plus

balance,

many g

■

'•Sil

inter-sectoral

heterogeneity

of

base,

J-

>

A

■

culture and opportunity can be accommodated.
t •

&

'

2. 16 A

number

of NGOs

undertaking

innovative

community-based

}

programmes specifically targetted to the poor and’ dlsadvan- “i. 1

taged,

have demonstrated dramatic reductions

in

fertility

■ A.

j

and mortali ty.

2.17 The

experience of health service provision through NGO.s

often cited as an example of correct approaches.

to

be

L
T•

The

point .

emphasized here is that these programmes. Jiave

beep j

successful because they have had an organic growth and

not

1s r -b

been

preconceived programmes.

have

It is likely, that

'r

:

the'". J ’

specifity of each successful approach makes it.less replicab 1 e; but the lesson to be drawn is precisely that we need, a
we need . a

•r

•n

10
••

”

/

h' '

system
worth

that

permits and contains diversity.

It

also

is

emphasizing that a

programmes which 1s "handed over"
to an NGO for Implementation is missing out
on the first and
necessary condi tion, that the
programmes be developed from
bottom up.

r
• if

•

t •y

:

2• 18 An important lesson that the NGO
experience has to offer Is
that social change,
especially where it affects
gender, ■j
c 1 ass and caste groups
Is a slow process and must be
ap
i
proached gradually. While
grassroot NGO experiments have 1
not led to major monolithic
movements In people’s partlcioapartlclpa- ''
tion and self- rellance and the
voluntary sector cannot hope i' :
to play a major quantitative
foie in the national scene, the

■

by providing a test-bed for
a

sound i ng

the gulIlt.t1v,

new Ideas and methodolnaioc
methodologies

board for government

policies

and

and

program/pes

(Sundarj. 1993)

:■*

5

r

.. -W fffi
-r

■ 'till
r

-

■M.. ..

2.19 The

experience

of

NGOs has also drawn

attention .to . the T
importance of qua 1i ty of care in the design and Implement#- A

tion of programmes.

qua!i ty

implementa-

NGO experience shows that
that attend™
attention

of services, particularly from the

J

,

to T
!

. '

Perspective, of

the user, can significantly enhance
service utilization.'

T
■- ‘
of government
- it programmes has largely been on
service
delivery and on the service provider.
The user’s perspect i ve has not received much
attention in government pro- M
grammes,
Quality of care issues from
the user's perspective, have yet
to be understood, Particularly by those

focus

•u

1 1

11

-B

•i .

relative advantage or NCOS has 0a.„

. Ji?

•*-* -v-1

--

'

'■i-

'a

■

r
involved in policy formulation and programme

implementation

in the public sector (Pachauri, 1993).

2.20 NGO’s

have

recorded the fact that women generally

wish for larger families but are
and

the blind preference for sons.

^r.' ■

■'

not;?.

do

coerced by social.

• i.

custom .

Such coercion can

only .
■i

be countered when safe motherhood, child survival and gender . >

just i ce

prevai1.

Male involvement In family planning Is

a ■.

■

desideratum but remains at a low level due to attitudes, and J■. Vh •
also to the fact that there are fewer male contraceptivehl
t.i
choices.
THe popularisation of the condom may raise .thatyt
level , especially as protection against diseases and AIDS,'?
but

male

attitudes and behaviour still

remain

rooted

backward traditions and a disavowal of women as equal

><.

3.^ ■y'S-'-i.t

’'■X:

• ! •-

■V* ft'

in 1

part-.
' y..

1

ners.

<1

■■

■.’ii

■

■

•. <

:.ru O
■

.*

r
? ■

•i

.h*'
!

■■

•

■4

':f
■j-'

■

t

j !'-

<>! v p

12

3.

INDIAN EXPERIENCE - Negative Aspects

3. 1

Evaluations and studies that not only assess the

programmes

especially as they affect womens’ fertility and health - but
also analyse the links between changes in the birth rate, in

fertility and variables such as income, education,

and

so on seem to converge in the view that the

A

autonomy

approaches

and the programmes have not been able to engineer population
stabi1isation

evenly and wholesomely in a sustainable

man-

ner.

1

!*17

3.2

Reasons

for

this lack of success can be divided

classes; one, those internal to

programmes

and

Into

family planning and

two, those external to it

even

Si

two

health

If ’deeply
t .

connected to it.
3.3

Internal:

One

systems

the instruments used such as

important reason is traced to

the

delivery,
‘<5 '

the

'r

* . ;

Institutional
:

■■

arrangements at the ground level, the PHC, the MCH outposts,

the functionary, namely

' ' •' • : I,

/ '- y ■ ■<'*>.
i

the ANM and so on.

. “t

The

method: that the programme is cut off from

grammes

addressed to the same client group.

.'W-- ’■

pro-

other

That there

'-'0

SI'

,

Is
• i '

no commitment to local needs, conditions : no

of "users

participation

etc.

T

The technologies and the way they are provided and of;course ;
the
cover

basic flaw of target setting in

and

implicit coercion &

f. •j; 'i

contraceptive

corruption

in

use/and r ’ • h •••
I;*/

offering
■

••

d&l

■

incentives and disincentives

13

jj

I

3.4

Ex Lerna 1 ■ Flio inadequacy of public investment in

of ban ic aiii(?nlLins Including
such

as

prov 1 s:1 oh

food and livelihood security it

elementary education, primary health.

apart

■'W

from>

reduction in inequality of access to moving assets..

.

■

...

;

</■/

3.5

The population of India is eypected to cross the one billion:

mark

by

the

Standing

Committee of Experts on Population Projections. The

Commit-

2001 as per the projections made by

tee also estimated that the population of the country

would

■

"

be about 1082 million in 2006.
>1.6

India’s population rose from 36.1 million in 1951, i when rd the?
per

planned development effort started, to 846.3 million ns
the

1991 Census. On 2.4 per cent of the world's land .

India supports more than 16 per cent of the world’s

f-

area,c

t i on,

and the population is increasing by about 11'?mi 11 Ion

every

year. The growth of population has gathered

W ;i£

•!.h.

popula-j

momentum^
Kk. ‘ '

in

the last few decades. However,
However, the
annna]
the averaaa
average annual

, nential'

growth

’ Independence

in

rate has fallen, for the first

1947m, to 2.14 per cent,

time

expo-- after’

during

1981-91.

OaLa gathered annually on sample basis also show
a

deci ease

in

the

annual natural increase rate, to 1.90 per

st. ffl
■

cgnt • in ,

1992. The sex ratio stood at 10 79 rna.les per ,1.000 females

in

J.5_2.1... 37 per cent of the population was aged below 14 , years

i1

and G.G pur cent is <-ui i ent I y • ost imatod to be overt 60
overt 60

J '

years
years ?

of age. The death rate is estimated to be 10 and birth
rate
29. 1 he Inf ant Morta1i ty Rale
(IMR) is estimated to be 79
per thousand live births in 1992 and Total

:

n.4 ;

(TER) 3.6 in 1991.

t.

I 1

■

V-!

" •;y ^-T
;; i

<1

i®*4

■
/v- • Wr

'^4
3. 7

The

country has the dubious distinction of being the

In

the

wt'i Id In terms of the absolute

number

persons

of

added to its population each year.
3.8

The

country has also the unenviable position of

being

- MM

one

[Wrft

with a.very unfavourable sex ratio (929 females : 1000 men '

' '

1991 census).

-pjj
’ • J?.'*
■

3.9

’ /<;

’F.s

The current patterns of development are first, enhancing the-.
•’ •

ri ch-poor

divide,

with increasing marginalisation

’■

ir-fe

of

the

Shtit

• • fl

poor, second joblessness is increasing, 1.e. Jobless economr ■ • - ,

-'’t

\ ■

iS

< rf

ic growth, third, damage to the l ife support system of land, J

t-

I?

water, flora and fauna and the atmosphere is increasing

■'■•'a--;.

fourth, there is growing violence in the human.heart leading

to a situation where there is disproportionate attentfoh
the seem ity of a few than to the misery of the many.

j.'i

to
fii-‘

,

; -Tp?

3.10 The national level of IHR and female literacy and the inter.’
state

differences in them arc high and need

attention.

w

■

the

b i r Lhrat.e

doos not drop simultaneously,

the 'rate
■

natural

/•

increase in population can rise above the .1,9

cent reported for 1992.

h
l yl.
■ j /.'• ’ I?

r.-T' i: ‘ E
'
•F.
•.;<

■

• vb

■■■

-■•‘r'.’J. '' “

i

4.

Women & Population/or Women-led approach/gender .dimensions

I,

It

is now widely recogn i sed(or recognising that)

IP

the x’■wide
the

disparities between men
and women
men and
women in
in all
all the
the lev
key indices

we 1 1

being and progress - starting with

death,

to wage rates - inhibits the capability of women

to'*-

freely

make

and

access the services. It

be

to

adopt

s recommended that this gap has/ to .

bridged and this bridging requires special attention

ill®

!

'from
witli
*f
roar birth to death with

fem.a.l.es

reach

w

-

Nutrition,
Nutr11 ion thfouqh*through

the i r own reproductive choice,

■

services

the
the

specially designed and funded packages.
>

However,
ways

this is not enough. Nor it is always perceived

wh i ch

lead to autonomy. Women must

inn?'

as'^d

perceived

be

1,

-

active

agents

production

in leadership and change in the

& trade as well as social &

/;
ri

•
'

spheres^ ofas..pk,

political

■ ■

4 ?

sphe res
■ \ f

must be recognised as holding views on the

They

definitionW^^^>
; .S

:

pro-pro

;

■

and

goals of a population policy; on
on its
its practice
practice and
and

gramme

and not only as recepients of social,

'
'j?
economic and,

political services.

r

• •«.

'i• •' ■::

J.

.Poor women, as also other women, want to have

freedom,

reproductive V

the power to make their reproductive choice,

the

we I 1 bei ng

from

the

limit

the I r

women

are best equipped to determine the elements

■

;wantf ?

.-/if

of the I r families and themselves,, freedomJ

"drudgery" of child bearing (and

:
would .like

''it' •

toj '

..O,

fam i1y size). >t~stbereeog,,,s^.^H,g7||^^
and
and, the
-

i nstruments

of

a programmes that helps them

towards

7,;-.

goal.
JH

16

>>y ,.y

' :•

. » -.7

'I.

al

as in Mahila Mandals, and in Panchay' ithiri
a I s; informal as in non-governmental organisations,
wheth-

Women's groups,

er

formal

joined together’ for- economic or social purpose, are

most

effective

and

sens i t i ve

vehicles

f or

"■y:T

the

safeguarding

women’s interest in developing and implementing a

reproduc-

tive health and fertility management programmes.

1

i.

i

5.

Gender

re 1 at ions,or

the distribution of power betweeni

men

>■

and

women in a society and particularly within a family- Js . .
■i < %r‘pxuOu .r’
i
a critical factor in enabling women’s status. It is now
-I

Lt

■

is

j-

well established that women's access to decision making
capability to exercise her

strong

-Marai <

interest in the social group• , has
J
' '• H • - i tjS ’
4

links to social well being, especially

reproduct ^o.iblg,.

health and choice.

i
a-

G.

It

is

a 1 so

Ohi
•

recognised that where there' is

a

.■ ?.

of V .
•’ Tthe
equalityr ..X’. -.

measure

equality between men and women, whether because of

i

1 -r.c L •

in

education

and

income (i;erala) or ’ culture

(tribal

common i t i es)

equa 11 y

directed to the two sexes,

and

or because the programmes

custom
• ■ - and .
H
have been '■
"LVir; '■

fer t i1ity has shown

a ,

greater’ and more sustainable decline.
9 ":

7.

This reduction of the inequality between the sexes, or rome-;
lie- ‘’

L-; .... . -. ;U;

times the presence of a more equitable distribution of power th# /?
. .--T
‘
i- ’ •
k
'
between the sexes is in tur n traced to education,
-- ---------- , <•
: i ncome

ent i 11 oment
Processes

cont ro1

to r osour c»»s and also t ho
that

pi ova i1ing

1 ead t.n this situation whore women

over their lives, is cnllod empower ment.

ww

cu1 lure.
have

a

Empower:■! .\iis .
. ... . ir-il:
•

1 7

r -

i

, Of
men t

leads to reorganisation of the productive and

duct i ve

roles not only w ithin the family,- but

the society.
8.

It

is

only

repro-

also -within
t .

recognised that there is a need to address

through

heal th

extension,not only

mgrj. not

through

j

and ■■■

IEC

I
sou Iu I murkotlng of cuntrncoptI von, but to onablo mon to' and'U
4...

understand

and accommodate their role in fertility

manage- '•
■

inent,

i ts

psychological and social

h

:*

It

implications. ■

'

'i

is

-P'r* <•' :
Ji
increasingly being recognised that decisions on reproduc-

<:
j.,
impllea- ’

tion, whether taken by the male or the female have

t ions

for self image and status,accord Ing to

the

cultural

to these Implications if it wishes to

have

:•

. .:5;

and the economic context. Thus extension work has to address

i tse 1 f

- .■"I”-'

r

durable

effeet.
1.

9.

Another'

important

programmes

man)

recognition is the need to

the^l:

address

to the whole life cycle of the woman/ (and

the.

especially at the stage of child and adolescent*
'

•

:

. ■ .</; t-';

-J.

and /,.•

.J-

.

not only at the rcpr oduct Ive age.
z

Attending' to the women on ly at the MCH stage often

■‘.fl
Is

late

even from the limited goal of family size

the

more humane goal of wellbeing. For example most of

irreversible

'i. '

too

i.
. ran
apart If
the '

contraception used by women has been of. women f

:*4-. -.w.'

over 30 years with a 1 r nady 3.6 ch I 1 di on.
10.

From the conception of a girl in the womb to her death there
are

many

threats both to life itself and to

health.

This

:A
ip.

d I scr imI not i on

re 1 at i ons,

af f eels

not only health status

power’^'

but

If

the ability to take decisions, to negotiate, and J.

protect herself.

•!

.

t'
Rm.

Thus

today the concern is for the HARDSHIP that women I suf-

1 lii -

---fur,

f rom

b I rth to death,

through

•>/

f

undornutrltlon

5 O h’ •- -’Hr
marriage, unsafe child birth and inadequate health
I

’V

■

j >■ \

J j - : • AJ - ’t
addresses I ,
~
! 8 ■»’
itself to women's wellbeing of which her entitlementjtoI'^good
4’
heal th and the capability to choose her reproductive Path||:/
‘f’

to

follow

up morbidity. Population policy,

thus

>1
:

■

becomes the critical mass,
t ■

1 l.

Nutr11 ion,

but

mothers

food,

and

not only for

i '!

/•

•■

•. -t

!

pregnant

. I
•

;

and

for children, to build the base of

5
•

a

>■

Of

i

nursing f
ijhealthy^;

Bw

j'

body has been recognised as basic - whether one looks at.
/ ’.'M

as

a

basic human right or a need. Thus Food

■

has' f :

Security.

HJ ’

been closely linked to population Issues and policies. .»!;
i.0'.

■M' r-

12.

■£

. -ji

I? > 5: Afy
pointed L
>

Education is another critical element that has been

Sfs.. j';1.
out as having an impact in a variety of ways. . Less educatecti ’

•

T<' ‘
°n$<
:y&
1"!

poor and physically exhausted mothers are likely to pass

>

•

.
■

1

■

v • 'i

poverty to their children, while better educated mothers

;

one of the key factors for improving the

situation.

Stud-*'V

r
t

les have shown that women with seven years or more of edi^ca-/ :
'•
- ?!:
tion tend to marry on average four years later, and have 2.2?X i
a ; ti r
fewer children statistically than women with no schooling.
r

fA’

13.

Education

levels out power between men and women

both

in J

and outside the household (In analysing Kerala, what ,1s

not /

'{,

19

.1

' 3: r

*
.

■

®a

'■

of ton

emphasised Is the e.quaJHy

In educational

/

’/

wage,' ;

and

levo Is bolwnon mon and woman.

14.

But

educating

macro

econom1c

little girls also has major demands

system.

Poor little girls

cannot

unless

support

of creches for their younger siblings, or also

usually

‘

90 ’■•'■to*

school,

they have not only the

thei

on

Identlf 1edt%^'<

other usually identified element, that
that is,
1s, better

the;.'.

. /J?

j

household/

income

through hiaher
ho adults u..*.
higher WAao
wage fnr
for the
but

relief *

time

consuming domestic chores such as fetching

water,

' M ? It
'1

■

and

fuel for the home.
■

15.

The

gender

perspective on population policy

translated into the following

then

■

can . be'

I1: 54-

Into

recommendations, falling

t

3 categories:

a

i
■

■

1

:¥

H
Ji

(A)

Organisational

(B)

Programme content

(C)

Macro-imperat ives

■ ■c

J

1
'f-

(A)
16.

’^4

>i.U !V's .

Organisational:

h: 1

Health and Family Planning

to be seen as fins subject namely^1

th - both in Central government and in the 'new;Jnstitu|fe|

.tions of local sei f government
Health deliveries
hi gher

oriented

i ces.

qua 1 i ty

l.e - one window for health^; './'

‘•i

to be community derived and managed,' with!
of

scrv ices,

•

client

oriented,

providers}

towards integrating traditional wisdom into

serv7$

Health stations to be capable of dealing with 'niale^.

20

• >?v

■4' ■

and

females from birth to death as with

health

education,
’■H

especial 1y

informat ion on the body and its care as part

of

•I

the srtrvI co.
i:

■< :lb

This

health package to be integrated to the

Panchayat . Raj

Inst i Cut ions wi th open ended guidelines. This approach
naturally build in the sensitivity to regional diversity

India,

Differentiating both in expenditure
*

J

’•

according to the situation of life and death iO;
,

particular place.

<■

' ■ 'ft

•
.r.'

The government budget to provide the basic health serviceias

i

SWB
.Bi
Oift

$

Programme Content
- -

r

Si
i)

!r>

I

s

part of Public Expenditure.

17.

•’

'•

1

(B)

'.fW{

f
1 J . ’*

elements

iO

and j programme

’■

■

r i

will

OTs,

-

'

facilities
fj

'• 1 i

Oiienting of health providers to share Information,.;- to ?
fl

respond to clients - men & women.

• i.

.-I
r * "•ji-r-.tr..'-.

?•;

• "'ll ► . 13

IEC to strengthen knowledge base on

reproductive health and contraceptives.

Y

> .

ii)

Universalising

strengthening

females.
f rom

the

e1 ernentary
1 iteiacy

■

education

f

11

hen l.th
'/■’ 4if

3

|I'nL

and I,-.- also

drive

both

for

-C’s child care,

f rom

domestic chores

?1

r

1/

Males z
r
To enable girls to participate provide r elie|
3

’

and ; reproductive

tract including SID treatment services.

Orient ing

-J

W-W
■ it'

■'i

preventive curative

•

1

Upgrading'of primary lieajtjj centres to have
including

•

'. J

-

il

I.;
i«c

(water fuel fetching, £2okjjnat cleaning). by

infant

of

creches as a social basic

:■ - ‘i-i
•*

provision;!
i’£
making^ .

amenity;

water and fuel accessible through intense investment
investment In
iifl'
water-, wood and other’ energy provision for domestic

use 4

-j •w

on a crash programme scale.

..

.:

18.

■

Contraceptives & Birth control

i''
’r. '-

'

'"V
*;•

Women’s groups are of the view that :
a)

b)

■c

I ot

i

^-2

; < • •
ther’e should be equal emphasis' on birth control devices 1
•v •
for [1L6Q and women
in provision, promotion . and1:
research
that

a

wide

range

of

''"I

safe

contraceptives ■ to

be

available - but safety nnnured.

The safety depends

on

quality of clinical services and Information
to

recipient.

■ ‘w
■

•■‘•Tw5
• ^'•2'

i s.

key

1 r-5
VR

''

aval Table

The hea_l_th centres quality

JEfe' -.' <1

■

to

'■

• .• .

j?

contraceptive adoption

J

C'fS.

c)

that

educat ion

body,

reproductive

is to be on the understanding
processes for men and

early years.

of

the

"°"en

■

t 41SS!
i

19.

Loca 1

1 eve 1

planni ng

and

implementation

of

Employment

generation/livelihood safeguar ding district and others local 1

ri

<. 1rl

level Planning for full employment often requ1 res:

J

rt;>-

• '1'
- ’^4

22

g
a)

safeguarding existing livelihood strategies, even

more!-<

than generating ’’new” employment;

• irf

b)

skill train Ing/credit - markets.

These require both identification/advocacy and investment,

wi

!
, ’ i.

c)

Food

Secur1ty

- not only the PDS

and

the

programmes

but

policies;

land use, crop selection policies to be

har.d cgre food production

,

oriented for food security..

■

and' export

a

re«

i

v

■

■■

:

i i.

iJUT20. . (C)

Accountability and Monitoring Indices

gi

■ > It. I ■ 4

h':® :

1

The arrangements being designed for development manage^!
■*;

t

ment by the local self government bodies would

A'i
I •

provide;

. ?r

accountability if the power’s of supervision over teach-;}
ers

and

these

health and other functionaries

bodies.

themseIves
the

bas 1 s

Further

the

elected

would be accountable to the
of some performance indices.

is

given

■ 'J

tor

-4

representative^^
electorate

on?

t

1 t

i’

f

It Jias! been?^^ -A’

suggested that these indices could be

. ‘ ' Al A a ! •.
'' ■

' X;

'■ J

infant mortality especially female infant nioftali^>

■ K !

■fi.' '. j

w.u.

Z

fe'
fit
Attendance at schools of students/ and teachers,^
ty

i

<.4 I

’•

rf\

•*

especially girl students
■

■

''

I

''.’’J

l

, ,«t *'’ l!
marriage registration and other basic needs..should'
be

<— 1. -j .

. ..

-.'4

....

goaled and the auditing of progress done' both
i

23

!1

-3

it

ti

'*

1

..-lip

'll5
pub 1i c 1 y

211,1A

at the grama sabha as well at the

Par I shad and Mandal Panchayat mootings so that tho

representatIves

inent

be held responsible for

achieve-J

This means

shift

of people's well being.

V’. - .••;

from CPR, IUD insertions etc as indices to IndicMT^t^
of social progress.
21.

It is noteworthy that India’s decentralisation system J3rd,’
74th

Amendments) has recognised the crucial

women’s

do

importance ■; gfj=

they'
iifeS ....

active involvement in development. Combing as

concerns

for

equity, economy and

*
j theyj
dh

environment

■•tt’ :

’

.

constitute a much needed and indispensible social forcenofo

development. The

fact

and

constitutional Amendment has grasped, this

Zr

;!•
•i

One third of elected seats in Panchayats (which means

about

10

This

places.

them initially itself, in a vantage position (and in

fairly

social force.

22.

lakh

•’W:- T

provided for a good start to generation, pf /this

seats) have been reserved for women.

■■ r

■

good strength) to influence pattern and priorities of devel*

•>

I' - J

opment. What is need are initiatives/programmes to strength?^
7iren the capab11ity/ieso1ve of women to influence decision
making

processes

In panchayats as well

as

enhance .thejr

’’-i

i

(women’s) self-conf idence.
■d -....
■■■

■-wWww
■

/•

24

• <ZI.

i

Think Locally Act Globally

^15

Reviews

f

of population and development programmes,

•

■ ■ j

attempted

the past over three decades by the Planning Commission and independent

durable results in the future.

t--1

-

’IV
necessary
• •.f,
steps to convert past experience into capital for vastly improvedI !and

. Wil

researchers, have highlighted the following as the foremost

.:

■'A b
1.

Accountable Local Institutions

i-i

jr'iJ-ilw’®

■

. • ’I ft♦ ■.S i-L'<-' i
The establishment of democratic decentra 1 i sat ion or panchay- r ;

sjf;

t. • ■ T

at

institutions - which are accountable to the

people

Where the people have the choice to replace their

and,«l- " >&■< . t.’iiaijt ■ ■ ■

represen
•

’<5'7

tatives periodically - must be regarded as the first and the

most

important

decision-making

step. Their

establishment

will

'f ’ i J? '33
hour

centres which is the dire need of the

'

I

for stimulating equitable and sustainable rural development.

•*A‘7 “ ■ i-' 7^® 11

These institutions will provide for local participation

and, 1.

local

contribution - imagination, ideas, 1 n format
ion
•'‘about
'■< ‘Kfa.
r
’■ ’ ‘i‘j.h
5- ■ ■

local

situation,

priorities

and most of

all:

stake

in

F

E. *
v

socio-economic advancement of their own area and population,
1 I'.
A responsible role assigned to the local population ; would ■?{’
a 1 so improve the prospects of raising local resources [and

provide for better care of natural resources of soil, water.'.ft'

forests for sustainable growth.

i.

Kir.cAv’i

l .I:
'' ' r

The 73rd Amendment of the Constitution has now provided

■

the r

basis and assurance that thei o will be an orderly network of

25

■T
4;

/
■

:
'

■■

-w
■

wl
■SS--9

‘.r'f

e1ected
*

panchayats extending from village to block and

the
J

district levels with a harmonious division of functions, '•

Simultaneously, the 74th Amendment

’T??

has mandated correspond-:^

■■ i

1

ing

democrat i c

inst1 tut tonal

in

underpinning

urban*

the

r;

areas.

2.

i/
‘p.

hf

Micro-level planning and implementation

i’

The

Planning Commission’s review of the working of

and other’ development programmes has

t ion
the

also

J II

t f.

-

popula<
■
'I <
•‘li
concluded i

imperative need for micro level planning without

which;>
•t:
popu-.>

economic and social services which are vital from the

■. i •

7

lation view point cannot be made to converge in a systematic i

and fruitful manner.
• **•

"Analysis

clearly underscores the need of a

ft •

decentralised,.
•

area specific district level planning based on critical

biological indices." (Planning Commission, Dec, 1991).

"•

7.

(vi 1-

Loca 1

area development plans, starting at the

lage)

levo 1 , should be the unit and basis of planning.

micro

I

For

this, the present planning process which is top down must bQi
re-modeled to accommodate and assimilate local area plans

plans

overall State/Nationa1 plans. The integration

of

areaj

with the State/Hationa1 Plans is fundamental ■ tp

the^

t ransf e rence

of poverty alleviation from the

the core of national development

strategy.

-’f-

4?

in-depth disaggragated analysis of a constellation of socio-

the

■'

and

.

t

, .-j.

*■0,.
.
periphery a to^O

.

z.

UP 3 : 3

KITAKYUSHU FORUM ON ASIAN WOMEN
19-21 November, 1993

WOMEN--LED POPULATION POLICY

AN ASIAN APPROACH

•{.

PANEL PRESENTATION

by
Devaki Jain

7

INSTITUTE OF SOCIAL STUDIES TRUST
Kamala Devi Bhawan, 5, Deen Dayal Upadhyay Marg, New Delhi - 110002
S7, 16th Cross, Gayatri Devi Park Ext., VYALIKAVAL, Bangalore - 560003

Table of Contents
I
II
III
IV
V
VI
VII

*

INTRODUCTION
THE INDIAN POPULATION PROBLEM
INDIAN DEMOGRAPHIC DIVERSITY : ITS LESSONS
WOMEN'S AUTONOMY/STATUS
THE INDIAN DEBATE
INDIAN WOMEN'S APPROACH
THE NEED FOR SOLIDARITY

List of Tab1es
Lik

from Pravin Visaria's paper
Z
fA for. -fi 1 i tat inq d i scuss i on.

Population Pol icy of India i_ A

Figure 1
Figure 2

Crude birth and death rate, India, 1901-1990
1971- 199i°teC1100
by method’ A11 Indi* -

Figure 3
Figure 4

Age specific fertility rates for India- 1970-1990
by br°ad aQe groups in India, 1961

Annexure ~ and -"Tables f rom~TJVr Antony#
s. paper
pJWame
Lessons from Tamil Nadu"

The Family
s Experience." [—’

Annexure 1:

Table
Figure
Figure

1:
5:
68

Planning

Select indicators iinfluencing birth rate of some
major states of India.
Vital rates for Tamil Nadu.
Trend in Infant Mortality Rate in Tamil Nadu.
Trend in birth rate in Tamil Nadu.

<.!

■

INTRODUCTION

THE IMPORTANCE OF THIS MEETING

This can be a very significant meeting because :
a)

It gives Asians an opportunity to aedress the war" Id with
an Asian
approach,
i s the fastest growing economic recion in t h e wor 1 d
A^ia
is
today.
Asia
is also "cu1tura11y“ self con fioent and holds
the
1 arges t
population mass.

b)

It gives Asian w oman an oppor tun i ty to go beyond the visible cats,
infor'mat ion streams a n d analysis, and u a. el op ser-ious and
useful
policy and
prog r ammes to b as i ca 11 y rr
ma.r.e
:a►.e woinen ,
eepoc i a 1 1 ,
zh.e
ow access to - service women mc.-'s
poorer', 1low
inc -'e comfortable on what is
csi led pooij I at i or. i s a L'. e s
j ap an

1 5

die largest donor' to UNFFA.

The world confarenae on Pop a. 1 a 11 on a n d L' e v e L o p m e r v
Sepr. 94, Caira.
a:

It
" '■

gives an oppor'tun i ty for' japs n to
!
7
I d o r F'opu 1 a 11 on
ue'-e 1 opmen t ano Er
! - i

i cis

i s vei^y near :

1 a ad e ra n i □

1r

the

j n ment.

con fer'ence c a n beg i n the process
•*.L: •

)

P-'ingmg Asian » omen into a to cussed
' ^tform or colid a r11/.
. he
EAAPC
(South
A ~ i an
Assoc lav ion for
;’ec;ionai
Looper a tier•
elding a ir.-'Stin-'; on ■’ ■iCiTicn a u ~ r;,- . 1 / - a s 1 ~ h in
? tin ■•■ri'ju, 'Jc / .
- We could ”con iect " i*.- i t r i; his.
’J = mg
the
=: a I i :: a i h < to
t o influence ~he approach
o Fopulation,
E a ;■ e I '.*? p m e n ,
Er •/ ■ non men r a
att the ersna*’-?! level i . e. n o ~
cn 1 •/
• j e r d >2 r
specif ic
Ieel - and
r" cj v i : e -1 ■ Asia n
approach
ana
in
turn,

1.

Z. > f 1 u e n c i n g o 1 c b a 1 •spend as and acticns

hope,

The background
notes and p r o g r a m m e s g i v e n to us
as they were aware, focussed and brief.

g i ve

me

this

I will start by addressinoi the issues elected
for me : The Indian
Population
"Problem" ;; Women's
1
Status ~ and its link to population
but
I
will try to reach into the three other
i ssues,
addressed
by
others such as :

' North/South
Low fertility rates in Japan,
Environment and Population

Italy and Sweden and

tHE

INDIAN POPULATION "PROBLEM"?
X

In India the irate of natural j
increase has rremained
-/percent rnow for almost
—
around
2.1-2.2
- three decades
(since 1961) . However, i*'
/ sional data for 1991
(birth rate : T
t the provi—
and death rate
a decline
in
9. G)
the
rate of natural
suggest
-1 increase
to
percent.(1)
a
little
below

2

Accord ing
to the i...
_________
international
experience, we
process <of' a^ fal i_
the growth, t
expect
that
tms
C^ts will continue
the years
ahead
-J, even though the "
*nd accelerate
in
number of rcouples. i.p
ages
15-44 is r
expected,
to
increase
reproductive
I 90 m i11i on in 2000.
from about- 141 mi 14ion
in 1990
to
It is nscessary
r
to precognise that
of
the growth rate is itself
the
stability
sin important- achievement; iz is
mistake to i
w
11
m ___
i s in_ terp
re t i t s. s e i t h e r <
Qr Sl'vg
stagnation or
fami 1 y- planning proq
f
a
i
Iure Of
i ramme. (Visaria also
trie
-■ Anii'ijoh Jain. on ci
1993)(2)
•J u ci j. t n ur ij a
III

INDIAN demographic
diversity
While

the national

ITS LESSONS

birrh

r'a te r'ema ms
ble _ in-er-state differences
-fdo/e 29, soera are
sizevm
i ch n a v e n lgr~ igp.tec
me 'separately the factors
tr;e need to
5;:a»Ti f
e
r
z
1
1
1
1
v
of
1.
^.nc hid'-'za ii ■i ■-’.nderiyinc, A i :^r
□ r © x s.fnp 1 e apart
from
Kerala
VM 1
1991, TFR of 2.0
h 1CS 2u3o u 1 a t j, on
or
Z'rrm
and NRR p-:ow i there 1 s
of
Tam 11
ne=tr iy
5C millicr, ’triG
non1 ■'■ i tA * on
f-RR of 1.0. Goa w i tn Nadu wicr.
a
I--m, also NRR less than
AAuJ on
or
on 1 y
OT
Th -

di/ersiry remina s
tha-j in so its of varied his
. cultural ano
zner
-=tic= cemcgraohic "goals1torical
cnaract er—
’ can be reacnec.
For e;; a m o 1 e .
P'-edam inanely Christaxn
Ess
is
sne Roman
civcncl i c. Tam i 1
1iicaracy
i
ra'ces of .£>.’.72:; wnicn
i. IMS OU
a
i= 2=..S7\ -c^e- char,
i' a z u
n e ver'
man .’(eraia.
_n.?.c rhe
-he eaualising
am 11
(Communisb
Fcucica. cirec
i-'irec-i
3n
of
zion
rarcy
ncr the ;_ i.er nistor..,
ncr
,
Wlc.5soresa
ca.-'e system
reduced by - n e m o n a r c r ■ a - . n a e D e r„2 e n c 5 /_
neaxzr
iami^
Nacu
i
-io n a'/ e f r» w »
1 aJ a t i n g morns
o-ooramme
for
cmfloren
(An cony;
anc
woman’s starus.
•
' ''3c a cppuiar l^.aer extcllino
i

Th as
cher'e are many many
routes to reaciLng
be 1 ow 1 - Each
Nr-. R Qf
|
area nas its own impulses, ■’revsvhe
or
1
aooroach
to popu1 a 11on
to
developing
<=n
growth
and
most
of
~hess
con zraceg t ing approach.
-is outside
a

(1)

J he data for <this
1
piece has Ibeen taken
isaria prepared
f rom s paper: oy Dr.
1 or
Fravin
the E x p e r t
on
currently in process i r. India. I : group
Fopulation
Pci icy,
m also a member of this
ccrnrrii t-

<2)

V i sar i a ?
Fravin
; a FPopulation
» Folicv of India :
f ac i 1 i tating discussion.
A
craft
for
•
August
1993.
Bruce/
Judith : Objectives ana <
efficacy of Family
gramme.
Planning
for
SIDA
volume
Empowerment
and
Rights.^
016
'"opula,: lon Recons i cered Pre
Health,
srvd Rights.
Jain,A nir—
u d h> K
: Revising.the roie and
----rami 1y We 1 fare
■ ■'eapcnsio i 11 ty
of
the
programme in India
India. e-Dec. 9, 1992. 3 272^-27.R7
LRC. Foj_i_tjCr 1

(3)

In3i'h'rii^ PUnninv
enue by slnri

F-rogr^mme

T.V.Antony.

Le-.13j,Ti ,r. ••S-I.R - F4lni I

’■'aau ' s Exper i~

i- n
■

/
90 districts of a total of 452
districts in
India have been
identified as requiring focussed attention. In these .districts IMR and ’
MMR is high. (Jairam Ramesh) <4)

India wishes to launch a programme to reduce this harsh phenome
na.
It hopes to achieve a NRR of 1 by 2O0O A.D.
with
an
effective
couple protection rate of 607. and an infant mortality rate of below 60
and
this would imply a crude birth rate of 21 and a crude death
rate
of 12 per thousand (Pravin Visaria) (5). It is net the case that India
has
failed'
there
is a plateau and
various demographic
analysis
(Vasant bowariker (6) predict that there will De a strong self perpet
uated downward trend even if no harsh measures are taken.
IV

•5>

WOMEN'S AUTQNOMY/STATUS

It cannot be a simple linear .argument ’■net Kerala's literacy rate
f O r :women of 667., ana women ' s labour force par t ic ipat i on of 357.,
re
v e a 1 s that women have nigh "status" in Kerala, anc that reveals
female
benemy,
~ri i ch i n t urn yields the remarkably low TFR and
NRR
(Gita
□an) (7) is a result of nigh ii teracy.
Women ’ s autonomy cannot be seen as an incependent variable. It xs
unctior of the '.'legree of equality between men anc women in a family
o -■
gender' relation Hi a household. More education o r e v e n legal status
even "advanced
economy, does not necesss:'i Iy determine
reprcduce aecisions. If it were so then would the women of Italy
' re si st"
X >.r
domination
by refusing to provide
r' e p r o o u c s i o n '''?
Gr'
WQU1Q
'Sweaish women return tc higher fertility rates once the men begun
to
•= h a re the nuturing ro1es ?..

!

!

i s gencer balance
3 •?. lane e ot cower cnat xs the -ev
facccr
th x •=
t e.c 7O.-not only permits women tc- make eno ices out it ai.s.o ma.w:es men
zsycno 1 eg l c a 1 • y capable of accepting ” o inr ;l cec i •si'q.ns . It. also
mean s
sharec spaces ana responsib 1111 ies .in family or par tne.rsh io
of
m i la care.
’
"
'‘x

I
t

i

f

THE INDIAN DEBATE:
f epu 1 a 11 on Ro Liiy issues are Doing
i ■:
ly Debated anc formulatea in
i n India toca>.

is emerging i n □ r i a f

t rom

x11 t ans i'■/e—

Lhe Incian cisccurse I'S /

i
i

(4)

Ramesh,Jairam
:
Social backwardness : C r 11 e r i a and
•»
districts in Inaia.

(5)

Visaria,
Pravin
: A Population Policy of India :
facilitating discussion. August 1993.

(6)

Gowari ker, Vasan t :
1993.

(7)

Sen,
Gita : Women, Poverty and Population
cerned environmentalist. 1992.

The inevitable billion plus.

ranking

of
I

A

drat t

for

New Delhi.

Jul y

Issues for the

con-

.
Sympos is of "Women's Health and Famiiv wel 1 -Being
Delhi, Feb. 1-2, 1993.

Meeting.

. .
Internationa1
SYmposiurn on Research on t n e r a g u 1 a t i o n
tarti1itw . Stockholm, 3wadan. Feo. 19 '• ~ .

of

Ne?-

human

0

V.

Population Policy is not to be women cen tered
but women led.
There is a world wide tendency <— —
S
Px!
a
^
dCroS5
a11
disciplines to
over-associate womens fertility with the
make
^11
a-f-f
4birth
rate,
with
reproduction and
thus
make all efforts
at
population
management
—
-->
at
entirely womb
focussed.
or example the measure,
TFR
(Total
Fertility Rate) which is
measured from the births ^:r women of
P^r
reproductive age,
age which is widely used in demographic
discourse
tends to also focus on
women's organsonly.
ui^^ourse

(b)

Women do not hold the key to their
it
and thus it IS wrong t.o make the ferti1i ty.Men and women
measures and
focussed,
policies

hold
womb

Birth
Control,
reproductive health needs to be
equal 1 y
addressed. Male •also to be responsible for r
eproduc-'t ion and
fol lows.

ma 1 e
what

(c)

Heal th,
wel 1 Ibeing of population 1
■ • z^rto be goal and
not
control.
population
Heal th,»
Life (as different
must
important
be
the
issue which means a concern from death)
for all elements of
porting life. (ft. '<. Sen)
sup-

(d)

informat ion,
ni^n quality service, choice,
key issues in oirth control services.
to choose.
are
In Door areas the primary goal should
Maternal mortal it y and not fertility , be the reduction of IMR and
c on ro 1.

(e)

f)

'h)

VI

There’ should be no
t-aryet setting, and no incentives.
both
ihefficient
These are
and unjust.
No sma11 ramily message
□ ack up.
i
withcut
'■c oroacen
naa ftn
services, to integrate
all
de I i ve--'y
h e a 11 n
into good FHC's
service
□ r deliver'/ poinus
UDto
the vi 1 iage
: cueput5" .
I no re :<-5s in vest menu
in Health.
To
lay emohasis on
□recess rather than goal, to cive
1isten,
bui Id
space
to
self -jhfiaence, to
introduce
the
indigenous wiscorn m nealtn care.
traditional.
—.2 5 k e a 1 i f e cycle approach and deal
with men <?.nd women
wide spectrum not only in reproductive
stage.
INDIAN WOMEN'S APPROACH

It is
inc lud inc
on,
would
they would
heal th ^nd

v-/an t,

m

I

a

now widely understood and largely agreed tnat r w
those who art= noor nor cni.r- +? '
yr --d that Indian Women,
like tn n
’
Ot eaucat6o, unemoloved, rural and
like to n«ve the power to contra 1 their '
I so
like
fertility.
That
.o have few children and at th° =am«= t-mensure igood
longev.ty f,. their chlld,.e„ ana

ar ises
moves from what women

Those who work with i-especially w i th those who
living in very inadequate women,
are poor,
hab
—
-j
11
a
t
s, with
o wa , c?r o runcertai n
'san
1
1
a
11
on,
economic
base
wi th
know mat icr woni€\n
choice,
to na ve
it is now not on 1y
reoroductive
insufficient, ou t inefficient,
only a cafeteri * or
to offer
□r widn
wide range of
cone racep11ves ,

I

■from :
Their reasons for holding this view arises
to have
children
that the choice of how many
contra
Their knowledge
lability
of
external to the avai
factors
depends on many
for
the need
For example^ the survival of children,
male
cept ives.
of
the
the need for a son, the self image
hands of labour,
substantiated by the women ' s pregnancy
partner whose virility is
and so on.
new
invasive
of the dangers of some of the
understanding
malnourished
Their
implanted
into
especially when
con tracep t ivesi
to
medical
care in case □ f
access
bodies
which
have
no
the
bodies, in t-there
is
and
in health service structures where
anc
'
needles
'
trouble,
This makes them wary of'
infections.
eo
idemdanger of
view of the entry of AIDS as an
'knives' - espec ially in
i c.

1.

O'

*

function
IS not a
womens fertility is
relations
Their understanding that
itien
anc
that
gender
of >
her
body
but
the
power
bociy
also
on ly
aridi thac these relations have
choice;
freedom
of
de termine
e erc i sea .
to undergo change for choice to be
rhroug'
nhe .current
•.j.r'ren c famil-- planning services
exper
ience
>□
f
The i r
4.
incentives and tar'aets
targets have made poor woma.'
States,
where
the
and neglect.
v ic time of coercion
th 1 :
the State to tale a wnolesCiT.e view of
and
They
1
y '
needs as well a^
problem and to address tliemse 1 ves tth
the focussed needs.

the need for solidarity

VII

app ro-jd
agreed
L-s urgent need for convergence, for an
the "There
latform for advocacy
from
provice
a
broad based p
neal
'
ecu
Id
wh i ch
r.f-p rod Lie 11 ve
poor vromen anc rnow 1 ecgea'o 1
on
W
1
*7
h
i ~i'v c 1 ved
ma. t tars .
responding
to
the issues raised above, I woulo J/xke
proposal
to this conference, especial-.!'/ t- Japan
i
Japan's influence on the UNFPA.
tf
are revealing that broadly
hr
World Wide Consultations by women
South
the
it is placed in the North or
women s movement whether and the following proposals.
following concerns,
the
fc
blame
c said earlier, they are concerned that the
as
First,
poor DeoR?ie"
peogA
on "ooor
.
env i ronmentai devastation is being put
is bei.'
control numbers
that the response which is to womb or the tubes
(Shan
Second,
the women'-s
entirely on* what is called
put
■

Ghosh)
z

(8)

j

(8> .

Ghosh, Shanti :

' women and Children.
Whi tner Health Care for

■

r

■

(

I
••

-r

—■

■

1

■■

Th i rd, that due to these concerns that population somehow must be
are being
controlled and reduced, technologies which have developed
brought and with subsidies and political pressure, being put into use
especially on women in developing countries, The constructive response
to these is :

for -the lobbies of Asian women broadening
to World
wide
One,
~
T
to
show
that
the
problems
of
the
environment
are
not
necessarily
women
the problem generated by population. The problems of ^environment are
by waste generation, (DJ, Berlin/SID) (9) over consumption
generated
of natural resources, both in the production and consumption styles of
Therefore, it cannot be brought into a
what is called modern industry. Therefore,
population agenda but has to be taken into what is called- the economic
development agenda.

I
!

T wo, that decision making on birth i s taken by men and women. Men
as women,
to be brought into responsibi1ity for birth as much
have
need
to
be
dealt
with.
problem,
psycho
psychological
logical
and
material
Hen ' s
Women's decision making capability which is called reproductive choice
.eading to reproductive rights has to be strengthened
population,
of
high
are seen as the pet'pe t r a tors of
S i nee women
their rethose who are not aware of the technological devices and
techno logy
of
qu1 reman ts are often’made victims of the implantation
incenThese monetary
and often induced through monetary incentives,
It
is
tives are given both to the victims as well as the motivators.
now shown that if the money spent on what is called the propaganda,
reprois
transferred to provide more care in preparation for birth,
further
resources
are
required.
ductive choice, rep r’Oduc t i ve health no
(Sonal Desai) (10)

Ther’ef ore, they appeal that the UNFPA snould put more emphasis on
q u a 1 i t y o.f care, better facilities for broad based health, much more
who
are
sharing,
and
redressal mechanisms for
those
information
technologicontraception
than
support
mainly
the
victims of careless
cal devices.

»

to
capabi1i ty
the
that women 5 organisations v*ho have
Th r^ee,
more
and be sensitive to the needs of women need to be much
ref 1ec t
birth
for
in providing care and safeguards to women wno go
1nvo1veo
cont ro1.

!

i
!

(9)

Development
and Envi r'onmentai
Challenges.
Keynote
Sustainedle
address at
and
Engineers.
a t International Congress of Scientists
’’Challenges Science and Peace in a Rapidly Changing Environment".
Berlin 29 Nov. - Dec. 1, 1991. Published in Challenges Science
and Peace
in a Rapidly Changing Environment'. Edited
by Rainer
• Rilling and others, 1992 Volume 1.
South
AlWaste and Planet Safety : Proposal Tor North
Women,
1992.
3-11,
Rio
de
Janerio,
June
Prepared
for UNCED,
1iance.
Women
Published in the Hindu, June 7, 1992, WIDE Bulletine 1992,
in Action, No. 4/92
1/93.

(10)

Jain, Devaki and Desai,Sonal De : Maternal employment and changes
Rural
in family dynamics : The social content of women’s work in
39.
Population
Council,
1992.
43p.
South India. Working paper no.

Jl

in

r

l.

.

■

/
The
15SUeS thu are
by lhe ”“n at th« s=“‘"
.greater investment
are
-axth
care,
the
mergino
of qen«ral health
ma terns1
health,
the
with
1 i ke
t o suggest that
also
State should be responsible for would
a
bas i c service of health,.
minimal
Llnet’a?y ^nd decxsian makincr spaces?
1sa11 on
of heal tn c a r' e
Frivatcan only be on top of
that,
1 deo 1 ogy
Therefore
that all hea1th care has to be privatised'
the
control strategies
wh i le pooulation
are sent through the State Mach inerias.
•sd.
are reject-

?b'rrr'

iv h-*ith

b*s‘c

I

h-

They have shown how "disincentives"
like not Ibeing allotted land,
housing,
ration cards, electoral
positions, jobs in
because of family size tend
sector
not to be <bis incentives organised
create
inequal 11ies within
only; they tend to
social strata.
--For example very,
is
the
large masses in
often
it
ery, often
< * 11 h
a t a vp3ry ear I y aqe.India who might have many children
to
srarr
to
teem, ent.'y to va.^ious
mai i ng, cowerfu1 forums due By bar 1 i-ng f-ieiTi.
'decision
to
number
o
f
chi 1d ren t h e y in a v e □ o r n e,
hou Id
a.u coma tical ly
be
one
= n if t i no the
r h e:;' s r o r a.
oower eouation
h i s i n u a n 1 v e s of this"
to
the
elite,
k i. n d cannof be pusned
suu a 1
= ociat y.
on uO ■a very
- "ia tn

ri a v e

not ^or'i ^c.
Ind j. o
t o c ;..t s o v ini;er-ast of
c e r'/ l i ■ c
achiev i

=nift

:

1

the
he a. I th

■-/

the

Indian

r rllli 1 1

F larn i nej

’■ 3 or'Goch .

Cr.a

i;

undsr

nd

th'S«;

in

c

3

0
I

M o t-

any winery
cecausa
u r.j / 1 der ?> o . h ■:■? 9 L t h
goals.
Much
of
the

-he

•r'u

harience has

o&eri

cue

f 3./'get
fr cin

to

h. a vac
che

r

/trrv

ocor societies with a - Li l e uneiTi" ^rget •'
f3
.„,
...
.
.
snd ;;he .:,en
pepu J. a t i on
anc
Cc.n easily
i / be
oe induced
-ncU'_~d to l nd©r'take various ^•CiTien
N'1 i;
s m a u. b i irs of inoney. Tn
t ssk s
us by pr
Fnus
prcv.cmg constant casn
ne may -'.of be
incentives.
resigning appropriate
- • - Policies.
- i ■-/, i'.p-r :

•

-'rev ider-

-i r-9S-Jr-r i~jz

fij.nc 11

~ i r ■?

he
^d^_?
’I'.'he
whole issue o - Hee 1 ~r.
■ sue ;., -vj i n tegr 9 te . roe I f , J ; ;h oars to be <designed
at
the
GCns-' 03:-'^
.-.s
?
and
wi-h
local
oeen br .ughc 1 i.c
■T e Li- j 13'l ainu p •
, lost a
A c c oun 15.0 11 izy
*' u •_ > 1 •“.* o c? u o . e hho receive
3 hi e h a a 1th <cars so that-'
'■■assa
mechanisms are immediate and
the
cess;b ba,'
i n c i ?. nill be
yoir.g m-.-o
fo,.m
.>3c,,n .. ,,a ■
.. i,, f
,
eminent m the 7 3 r * g
w X 1T 1 O C Z" \ o v
b / = ■ = - i! 71' ’ ' „A c - °"d
" * ° man-ill,
qr
on 1 y
this
DJ
>J. t 33
•' ? served
“
•
- ’'ha/e
f o r women. ,Flread , ’ln J s ■ a
been
1n
Iwamen
seen
o.._. ,^= 70-y
n
alreaav
c rawn in co tl'iese Pclitic a1
aover-nxnr ecu.no
councils.
India
has
II o
-1 /en
i
Is
many of
th e ind i v idu.al
^^rur.. subjects
for
desiqnino "and
f
or
fanagement,
implementation and
monxtor:nQ to
these
local
bodies.
these
■ sal th ana family welfare i =
therefor
= . -n acenea
eoenna on
.->r-. local self
gov_
^rnment ocdies.
~ommunic.

* t is most important the.'efore,
t ht tthe world tafejes^note
mew trenc which will =oon come into
of this
many other zountrie^'. e.g (F-hill
bxnes,
Bangladesh
i in Asia, Ghana, Co ted ' .'on o etc.
in
• v.c i 1 i tate women
women
and men to goal
Africa)
and
zheir own objectives
□ □ u 1 a t i c n , size
size ana ; ,t s
in
terms of
aural i ty.
The'
JNFF'A and
' c ues
ana
to as:
>3'/e Lopino
h sa I th

Japan

could

t ake

a

" -f’ 1-,‘ * •m addressing
t hase
car's
; ty be assis ted
in
sys tems wnicn
'■.aeas,
tnat
rhl!:‘ oouie..:
,4nd
advocacy and r
c
heir
responsib i11t
1 L -• • •_ r
uomen
?.nd that 1 n S 1 u I; ; o T) 5
between
men
anc
3 are built
■ 'cd
seal in a c h a T 1 S ’ s .
' “ ■’ veccur ';ao i ■ • t v
.? n d
--.ai

w-juao

in

the

■

CI

. I

.

>r

r-i

■

■ 'twrr!j
REFERENCE LIST
- ,4'3

The data for this piece has been taken from a paper by Dr. P.ravin
on
Population Policy,
Visaria prepared
for
the Expert group>
I
am
also
a
member
of this commitcurrently in process in India. - ------tee.

1

for

draft.

A

Visaria,
Pravin
: A Population Policy of India
facilitating discussion. August 1993.

i
I
i

■

■:

Planning Pro
Judith : Objectives and efficacy of Family
Bruce,
Reconsidered
:
Prepared
for
SIDA
volume
on
Population
i
gramme.
Hea1 th, Empowerment and Rights.

T,

i
I

the
responsib i1i ty of
Jain,Anirudh K
: Revising the role and
Econom
i
c
and
Po
1
i
t
i
ca
1
Weekly
,
Family Welfare programme in India.
Dec. 9, 1992. p 2729-2737

*
CJ

The Family Planning Programme - Lessons from TamiI Nadu's Experionce by Shri T.V.Antony.

6

Ramesh,Jairam * :
Social backwardness :
districts in India.

Criteria and

: A Population Policy of
Visaria,
Pravin
facilitating discussion. August 1993.

India :

The inevitable billion plus.

8

Gowar i ker, Vasant :
1993.

?

Sen,
.Gita : Women, Poverty and Population
cerned environmentalist. 1992.

:

rank ing

of

draf t

for

A

New Delhi.

Issues for

the

July

con
'M

Meet ing,

New

C)

Symposia
of "Women's Health and Family Well-Being”
Delhi, Feb. 1-2, 1993.

11

International
SYmposium on Research on the regulation
fertility. Stockholm, Sweden. Feb. 1993.

12

Ghosh, Shan t i

13

Sustainable Development
and Environmental
Challenges.
Keynote
address at Internationa1 Congress of Scientists
and Engineers.
"Challenges Science and Peace in a Rapidly Changing Environment".
'Berlin 29 Nov. - Dec. 1, 1991. Published in Challenges Science
and Peace
in a Rapidly Changing Environment. Edited by Rainer
Rilling and others, 1992 Volume 1.

14

and Planet Safety : Proposal for North South Al
Waste
Women,
1992.
Prepared
*for UNCED, Rio de Janerio,
June 3-11,
1i ance.
Women
the
Hindu,
June
7,
1992,
WIDE
Bulletine
1992,
Published in
in Action, No. 4/92 1/93.

of

human

: Whither Health Care for Women and Children.

1

i
i

■

■

15

■■•

/

'•

■:

'

f

'

■■

Jain, Devaki and Desai,Sanai De : Maternal employment and changes
in family dynamics : The social context of women's work in Rural
South India. Working paper.no- 39. Population Council, 1992. 43p.

i

■

tii

II

>
■^5-

I
■

X .
»

<•!

■

'•.

■\.

r>

’•»

■

HP 3 : 4

REDUCI1XG POPULATION GROWTH

Dr. Devaki Jain

28 February 2000
i.

f

By a curious and perhaps auspicious coincidence, the Government of India released its
Population Policy 2000 on the same day that the Indian Association for the Study of
Population was closing a three day colloquium on Population called The Millennium
Conference on Population 2000 Oxer the three days, demographers, social scientists,
academics specialising in xarious aspects of Indian economic growth and development,
personnel from the network of Population Research Centres supported by the
goxernment, State and Centre, were taking a close look at the changes that were taking
place at the ground lex-el in the Indian dex-elopment landscape, especially as it impacted
the quality, the size and other aspects of the composition of the Indian population.

Whatever the perspective from which any individual scholar or researcher was looking at
the characteristics of the Indian population whether in relation to elements such as the
natural resource base, the economic situation, the profile of poverty and
unemployment/employment. the social relations between gender, between castes, the
disparity betw een regions and categories of people, a few propositions or findings seem to
have emerged
One. that the relationship betw een availability of food and the growing population is not
alarming In fact a couple of speakers suggested that a growing population acts as a
stimulus to growth Second that poxerty was neither on the increase nor was consumption
expenditure acro’ss different income deciles changing significantly. They were by and
large stationery across these segments Three, that every prediction or forecast of
population size made in the last 50 years had been disproved by India’s population
growth - it was in each case lower than that which was anticipated, thereby arguing that
there was a down turn across the board in the rate of growth of India’s population largely
due to a lowering of the birth rate So to some extent, the alarm bells that had been
ringing were muted.

Some of the papers broke new ground, showing that more than any other causal factor,
location, namely geographical location had been the strongest determinant of a particular
fertility rate This could be tautological in that certain areas in India have embedded,
entrenched convergence of poverty, unemployment, high rates of mortality and high rates
of fertility But the paper had gone beyond those areas which I like to call the ‘black heart
of Mother India’, and found that by and large these rates were locationally constant
despite interventions like education, better health aspects etc.
A paper from Kerala showed how the public health centres had more than half of the
posts of service providers were unfilled, apart from not having most of the hardware
including notebooks for running a private primary health centre. And this is in the
socially advanced State of Kerala a leader in social development. These says cannot be
overcome by better management, but require flow of funds. This and other papers which
described the condition of the public health system, the reasons for such large numbers in
what is called unmet needs for contraception, the papers describing birth rates as
differentiated between castes and classes revealed an alarming neglect of what can be
called the health and social development services sector. The Conference was calling
attention to the imponance of state expenditure on health sector and in mm. far great

1

attention to public health, both in terms of financial suppc ■•1 and in terms of streamlining
(he delivery.

One issue that came up during the Millennium Conference and in some sense burnt holes
m the overall debate was the reference to women, their loc 'lion in the debate and the way
data was collected and used The issue in some sense not only electrified the gathering,
but also received positive response across the diversity in ti e hall
Almost all the detailed papers, i e. the sub theme papers had to refer to what is called
gender. The difference between men and women in teri is of outcomes of literacy or
health or mortality or morbidity. Some papers had to ref r to women’s unmet need for
contraception, others to achievements in contraception in t-. rms of means towards the end.
I he issue that was raised which seemed to have a rt ;onance amongst the women
academics and researchers in the conference was that uh mately the real issue between
men and women was one of relations of pow'er. Men by .nd large still had control over
women s lives Reference was made to the study of the revalence of violence against
women where most respondents have suggested that the ;Time cause is disobedience to
male authority A study on unmet needs showed that across class, caste, location,
ditleiences in awareness, education, income levels, avail bility of contraceptes the one
agieement that was common to all categories w hen it cam., to the reason why they could
not fulfil their need or desire to contraceot
coniracepi was male autho.
autho, ,:vy.

1 his identification of power over w'oman which inhibited her from reproductive choice,
asserting her reproductive rights, but also asserting other 'orms of rights, rights against
\iolence. pointed to the importance of shifting the relation of power, giving the women
the capacity to say no. This power seemed even more rele ant given the AIDS epidemic,
where women are not able to insist on sate sex due to ihe male reluctance to use the
condom and in turn the violence that h? exhibits if she insists. This led to the
identification of an issue which had not been given sufficit »t attention, namely redressing
or rearranging the power relations between men and wome: within communities, in order
to gi\e them the opportunity to affirm their will, especially n relation to their bodies.
Dealing with this might require collective affirmation b* women of rights which can
either be translated into their presence in the panchcyati n institutions,
institutions, their
their presence
presence in
in
structures of power, structures which had control over fin? ice. Money is associated with
power and it was pointed out that in the panchayati raj insti’ itions, women hardly had any
access to spending power since all the social developn mt schemes were ultimately
delivered by functionaries of departments A suggestion was made that it might be
important to look at the administrative procedures of loca1 self government, and suggest
that women's committees are formed not only to look at women’s issues, but for
providing basic social amenities and funds such as the fur s allocated in the component
plan would be put in the hands of women led committee for spending the allocations.
I bus attention w as called for institutional arrangements or enabling women to have
power in society, power in financial and political mar. rs such that they may then
translate this power into power in the domestic theatre wh..h would enable them to have
a right over their own reproduction

Community health groups are able to bridge the various ectoral and departmental and
sub departmental divides which plague the health delivery ystem. In an exercise done in
Karnataka by a sub comminpe of the state planning »
on district level social
development, it was found that out of 75 schemes that wc rmerating in a district under

■1

different heads ot expenditure, there were 25 schemes which under the broad heading of
health and equal number under the broad heading of education. There is need to look at
such anachronisms and do what is called rationalisation of financial assistance patterns
with a greater emphasis on untied funds given with some specific outcomes as the role of
the --- against which the funds should be spent, rather than the items for which it needs to
be spent Outcomes such as reduction in female infant mortality, increase in enrolment of
girls into secondary schools, reduction of maternal mortality, percentages of marriages
where the couples are over the age ot 18 and so forth could be a much more valuable
monitoring devices than expenditure heads or targets But to put a monitoring module like
that on the ground not only requires designing of pleasuring frameworks, but also the
arrangements to collect such data at short intenals in meaningful ways, so that the district
or village level government can audit the change with data which is differentiated across
gender and caste.
Ilowever, other alarm bells were being rung throughout the conference, calling attention
to the macro economic policy and its neglect of social development as well as
enx ironment and food security, and how this would impinge on the quality of the
population and social justice The Millennium Conference revealed what a large resource
ot individuals India has. who have interest and knowledge and commitment to stabilising
India s population and to link it to the protection of environment, protection of people’s
rights, the protection of food security

Interestingly the New population policy document released by the Government of India
pays detailed attention to the need for increasing finance and the need for increasing
attention to deli\en‘ ot health senices and its convergence with other services which
could be called basic social amenities It also pays attention to devolving this power both
to deliver, manage and hold accountable to the local self government institutions and
draws attention to the need to pay attention to what is called human resource
development, enormous orientation and training to service providers, linking them to the
new approach which is target tree and underlines reproductive health.
I he new Population Policy moves away from the incentive-disincentive approach of
limiting access to leadership roles or to the goodies such as house plots or jobs according
to the two family norm Thus giving us hope that the state is not entirely deaf and blind
io the information that comes from those who are working diligently in the field of
enabling people to improve their own state of well being by having families which are
manageable, given their resources and their goals.
One ot the problems about the Indian public opinion and the Indian media is that there is
a kneejerk reaction to public statements It the policy had brought in the ugly clauses of
conditionality or ot technologies of contraception which are dangerous such as invasive
contraceptives, there would have been an uproar. On the other hand when there was a
policy statement which renegotiates the approach and excludes conditionality and
exclusion, many newspapers labelled it as a population policy without teeth, knowing
tully well that population policies with conditionalities put their teeth into the worst off
and the most powerless

Another Indian and perhaps international fallacy is that a policy statement is required on
every issue and that national structures with Prime Ministers leading them will give it the
importance, attention, money, political and social support to get it through. This had
never been the case, whether it is a policy statement on industry or on child, taking two

'\2

►

extreme ends of what can be called subjects of national interest. Poli y statements, it is
said, provide a framework within which the state and what is caller civil society, can
perform But over the bast 50 years, one has not only seen that policy st >ements remain as
pieces of good worked out knowledge, but even five year plans have h -d the same fate in
that ultimately the major portion of the government’s expenditure ever luring the heyday
of planning was outside of the plan Political interventions and other ■ rcumstances have
had often to bypass the intention
Structures which required the Prime Minister to chair have invariabls found themselves
hampered in performance or in speed of action as the Prime Minister’s time is scarce and
had to be ceremoniallv used and therefore such structures and commiv -es can only meet
once a year, if at all The National Committee on Women for example which was put in
the Prime Minister’s lap. thinking that that is where the power to tt tsform lay, never
took off. Policy on children, signed at the Children’s Summit has not oeen able to walk
longer

The one advantage of making a declaration like the national population policy is that it
might set an ethic or an approach which could be used by advocacy '.roups as a peg to
critique and deconstruct the retrogressive policy approaches taken by -ome of the States.
Since this is a State subject, the capacity of the Central government to influence the State
is limited. However, it might trigger the energy of the public opinion to remove the blots
from some other state level policies which are using ideas like restric ive entry knowing
very well that it not only discriminates between classes, but it has ’he most minimal
impact on fertility

It is detailed exercises, and skills to make such exercises come into systems of district
level governance that can enable a wise and informed approach to population
stabilisation, which is more or less reflected in the new population policy, to become a
valuable exercise The National Population Policy needs to have a deeper look at
administrative structures and procedures apart from the major issue mentioned above of
finances for public health and the attention to the devolution of power to communities and
local self government

If it has to have what can be called a dramatic impact, then the effort to lay a base of
social and economic security for the poor, to lay a base :or institutional arrangements for
women s empowerment, laying a base of auditing rameworks should be initially
undertaken in the States which are showing highest rates of reproduction. Such an
approach would enable those States and the people in them to achieve their own goals,
which they might have set in their own self interest - but it will also reduce the deep
deprivation in those districts which 1 have called the Black heart of Mother India. Instead
of once more playing foot ball with the Population Policy that has just been declared, it
would be wise for both the State and civil society to address how it can be worked out in
the detail and by joining forces to press on the natio tai and state level budgets, the
importance of investing in public health and using the c >mmunity based approach which
has worked very' well m India This would have value fur both removing the ‘pop scare’
(like the bomb scare) and the hysteria associated with th. t as well as bring a minimum of
well being to highly incarcerated social groups.

HP 3./

I Cov'j

UNFBI .

I

UniU’d Nalion*
Population Fund

r/iiHenni'Jiii Conference on Population, Development
and Environment Nexus
February H • 16, 2000

Population and Economic Development. Political Systems
and Gender Equity
A historical narrative and update

■>

Devaki Jain
Karnataka Women’s Information and Resource Centre
Bangalore

V

I

«

Theme : Population and Economic Development: Political Systems
and Gender Equity
?

Subject: Population and Gender Equality and Equity

Title of Paper : A historical narrative and update

Devaki Jain

Karnataka Women’s Information and Resource Centre
“Tharanga”, 10th Cross
R.M. Vilas Extension1, Bangalore 560 080, INDIA

I

POPULATION AND GENDER EQUALITY AND EQUITY
BY

DEVAKI JAIN

ABSTRACT

This paper basically summarises the outcome of two valuable exercises conducted by official
committees of \he Government of India oh gendering population policy. It commends these
two exercises as containing in them well debated, carefully researched women sensitive
approaches to a population policy for India. The author was a member of both these
Committees.

The paper then goes on to describing the particularly distressing if not devastating trends that
are noticeable in the demographic profile of women in India in the millennium and suggest
that white specific approaches and strategies and operational mechanisms can be designed to
enable a gender just and effective population policy for India, the crucial issue for
transforming the particularly vicious situation that exists today, is for a change in the power
relations, for a reduction in disparities - at the macro level as well as at the household level,
not only in economic and social indicators, but in indicators of power.
The paper suggests that these changes in power relations can be brought about by
strengthening the presence of women in political structures not only by arrangements like
quota, but by the affirmative, collective pressures of the women’s movement. It argues that
women as a social force, transforming power relations across the board is a crucial element in
any population policy advice.

z______ ___
2

C4

SECTIONS
First Tracings - individual events

Second Tracings - The working groups

The emerging values
Women design population policy

Retrospect

Annexures

A

3

Population and gender equality and equity

A historical narrative and update
Devaki Jain

In this presentation, I am suggesting that there is enough received wisdom on gender equity
and its links to a just and effective population stabilisation programme. However, I am also
suggesting that by itself “gender-equity” as a concept is a limited and limiting approach
towards the goal.
Valuable work has been done on probing gender-equity, and its effect on fertility. From the
flat statements that leveling of difference offers a better chance for Joint decisions if not selfdetermination ,to the detail of what needs levelling, viz., physical items like control over
resources, education, health and economic,- there has been immense analysis of data, going
over age cycles, locations, ethnicity and so on.

The Human Development Reports have added useful dimensions to this quest for equity, by
locating the disparities context of poverty 1997, growth 1996, consumption 1998
And globalisation 1999. This has has provided additional fire power for those who are
concerned with inequality - its causes and consequences. The GDI and GEM , basically
gender inequity measures, have provided useful monitoring tools for the achievement of
equality in these measures or indicators.
However, as Lady Macbeth lamented "All the perfumes of Arabia cannot wash there hands
clean” - so too all the material indicators - and the attempts to level them through measures,
evaluations, programmes have not been able to break through the embedded hard rock of
patriarchal power / further strengthened by “custom”. And hence terms like gender - and
gender equity, arranging the balance in external variables, equal shares, are not the language
and preoccupation of those working for social justice Relations of power, perhaps even
unequal relations - in the sense of women or dalits having the upper hand - has became the
idiom , born out of experience.
Hence , instead of reviewing the recent, useful technical work - on gender equity, I decided
to review the work done,- what I call a historical narrative-of the available ideas towards
woman - sensitive population policy.

4

!

The paper is in five parts
The first traces the evolution of gender sensitivity
The second traces the work of two major papers, on population policy, where women’s
knowledge and ideas were integrated.
The third points to the values that emerge from this view.
The fourth summarises how women would design policy
And the fifth is a retrospect.
Just as there has been an evolution in the last 10-15 years in the demographic trends - a
decline in several key variables, like mortality, and in some pockets the TFRs are comforting.
{Population Growth in 21st Century^' - India, Population Foundation of India, 1999) so
too there has been a healthy and comforting evolution in the consideration of the link
between Women, Population and Development in the last 15 years. The evolution in the
understanding, perspective and prescription is based on deeper analysis of the data emerging
from research on population, and greater participation by women scholars and women
activists in drawing attention to the complexity of relationship and to ground level
phenomena.
I have called my paper a historical narrative, as I hope to reveal that there have been major
achievements in building wise, wholesome approaches to enabling a decline in population
growth in which, women’s role in the crucial zones of reproduction, and advice thereof, have
been accommodated and what the arena needs now is moving forward from such platforms and not returning either to the obsolete or adversarial positions. What these are will be
spelled out in the course of the paper.

First Tracings : individual events
I remember the time 25 years ago in 1973, when I went to Dr. Ashish Bose at IEG to
persuade him to do a statistical profile of women for the book that I was editing called
"Indian Women" (Devaki Jain edit Indian Women GOI 1975 ) After strenuous efforts to
build the data (the very first time I think it was done) Ashish Bose along with his research
assistant drew up some tables, and then called me to share the shocking phenomena of
the declining sex ratio, between 1901 and \96\.(Il is this same chapter exercise that went
into the CSW1 report "Towards Equality”, that was being put together at ICSSR at that time)
The sex ratio has since been one of the most crucial and pungent variables that are being
used to determine the inequality between males and females from the womb to the tomb as
the saying goes.

5

. .1 ■1
f rom then on - in my own work and in the work and participation of a large number of
informed and skilled researchers and activists ,- and in dialogue with demographers,
statistical systems, health and family welfare departments and organisations ,there.have been
valuable forward moves.
•

For example the work of those who are probing the household , the family as a stratified
social formation, not the ideal even-handed “Safe” place for women and girls; as well as the
related work of those who were looking at gender disparities across the class and caste
categories , whether in the area of work or nutrition or hospital care1 led to pressure to
gender disaggregate the data and reject the household as the lowest unit for data collection,
among other achievements.
I remember one conference {Population Trends and Family Planning in South Asia, 1989)
where (he R-G (at that time Mr. Padmanabha) had displayed maps of India and coloured the
zones according to infant mortality disaggregated across.sex . Dr Shanthi Ghosh and I were
seeing the exhibition together and noticed that District Salem seemed unusually pink ,
indicating intense death of female infants, therefore it was decided to recommend a further
study of the district under the special studies scheme of the R-Gs office. Now we know all
about the prevalence of female foeticide and infanticide.and its special presence in Salem.
(Revaluing Women's Roles ”, Paper Presented in the Conference of Population Trends and
Family Planning in South Asia, 1989.)
The growing awareness of the difference between women’s poverty and men’s poverty,
apart trom the external characteristics of this poverty, as expressed in labour force
participation profiles , in health and nutrition and educational profiles-led to immense
changes in policy documents apart from academic discourse. The sixth plan, had a chapter on
women’s employment reflecting these “new” statistical probes: and later all plans have
chapters on women and development, insisting on gender differentiated bases for data
analysis ^nd action. {Vlth Plan, Yojana Bhavan, 1980 + all other five year plans). This type
of information and its translation into prograntmes for
/.

Banerjee, Nirmala, : "Household Dynamics and Women's Position in a Changing Economy" - Paper presented at
the International Conference on Gender Perspectives in Population, Health and Development In India, New
Delhi,! 996.
Jeejeebhoy. Shireen J "Family Sice. Outcomes for Children, and Gender Disparities - Case of Rural Maharashtra”,
Economic and Political weekly. 1993
Sen. Amartya "Population and reasoned agency, food fertility and economic development", Paper Presented at the
Population -Environment Development Seminar al the royal Academy of Sciences and the Beijer Institute, 1993.
Jam. Devaki
In equality within the household. The neglectedfactor",1977.
Jam. Devaki "Household Food Security. A Production Consumption Link', 1985.
Anant.Suchitra
Women at work m India. A Bibliography ",ISST. Sponsored by Ministry of Labour, Government of India, Sage
Publications. S'ew Delhi. 1986.
Jam. Devaki The Household Trap Report on a field Survey of Female Activity Patterns, Vikas Publication, 1985.
Jam. Devaki. Banerjee. Nirmala : "Tyranny f the Household" - Investigative Essays on Women's Work, Vikas Publication, 1985.
Jam. Devaki Are women a separate issue ”, in Populi. Journal of the United Nation's fundfor population activities, New York, Nov,
Dandekar. Kumudini
Swaminathan. Madhura

Batliwala. Srilatha

6

attention to the issue of gender inequality has been enlarged and made into a discipline of its own, by
the HDRs starting with HDR 95 ( Human Development Report - 1995, UNDP) and translated into
new indices called the GDI and GEM specifically to measure inequities between men and women
based on gender differences. GEM, relates to Power and GDI to development. This work has led to
the birth of several State Level HDRs and one which I would commend is the Karnataka HDR
brought out in 1999 where the chapter on women is somewhat different from the usual and one on
which I will be basing some of my proposals and analysis. Karnataka has also taken the District as
its unit for building GDIs and GEMs, responding to PRI (73rd Amendment).

At the same time knowledge and advocacy began to appear on the difference between men
and women in choices . The work of Anil Aggarwal CSE Ask the women first The Chipko
Movement (Anupam Mishra. GPF) and the work of many of us began to reveal that women
had a different perspective and preferences in development priorities even within a class of
caste or location. This kind of information is becoming vivid in the written and spoken
information that is now emerging from the PRI system. Books and articles are emerging
which reveal that women have different priorities methods and capabilities in their role in
governance from men.
Therefore a crucial milestone that we passed was moving the difference between men and
women from merely the physiological , biological to the area of choice which could be called
mental or Intellectual

For my presentation flagging these milestones is important because what I would be making
a case for is that the focus on women , in the approach to any policy, especially population '
policy ,which is so embedded in body parts, shifts from the body to the mind, to the political
, social and economic presence of women in the overall system .
2. Devaki Jain. finds Not'Bodies - Expanding the notion of gender in development”, Bradford Morse Memorial Lecture,
UNDP. Bering. September S'*. 1995
Jain. Devaki " Leadership Gap J Challenge to Feminists. Indian Association for women's Studies sixth National Conference
Lecture .Mysore, 1993
Jam. Devaki ' li'omen and Governance ". UNDP. September 1996.
Human Development in Karnataka . 1999 "Human development and the second sex", Planning Department, Government of
Karnataka. Bangalore
Jain. Devaki "India in the new Millennium: the Challenges Ahead -Challenges for women in India in the new Millennium". January
I9,h. I99S. Publisher.Dr Bruce P Corna. Associated Prof of Economics. Managing Director, International Policy Review.
Jam. Devaki
Women s Quest for Power - five Indian case studies”, 1980. Vikas Publication, Ghaziabad..

7

Updates

ere has been much progress in India in the detailed analysis of the links between fertility
.nd external variables in the last 5 years which also needs mention and attention Many of
these studies would like to argue that the factors influencing fertility are not linear Jfox
example that an input of education will deliver an out put of lower fertility . Land rights
ownership of assets, work status, location of housing apart from broader “macro” elements
i -e the overall level of satisfaction of basic needs, the prevalence of gross disparities
mcludmg the embeddedness of patriarchy and tradition the existence of women’s coKve
S rcngth either as in mass based women s organisations or struggles, are only some of the
items that are being pointed to in analysis. Most of these ultimately land in the area of
hei 7t P°Wter i t>'We? gr°l,P1S and ,ndividuals: how much Power have women to control
then lik, to control their lives, to lead in a particular situation?

sell as tor reducing the TFR. tor demographic transition as well as the partnership and
advise of women’s organisations,
H

SSSESSSS
ultimately is a relations of power. The power to have self determination or autonomy or
reproductive freedom or reproductive rights.
"

This is why in the elements or the pillars or the analysis framework that was evolved by the
waminathgn Committee in its deliberations, an element was added called “social force”. We
recogmsed that since demographic transitions requires transformation, transformation cannot
be brought about merely by delivery of a programme as a scheme or an extension service
trans omtation requires a movement ethic and at one time we even coined the term ‘the
population movement just as during the more idealistic days of the panchayti raj system we
wanted to call it a panchayati raj movement” or a movement for devolution of power.
is not uncommon to find that idealism that was present during the birthing of an idea tends
to wear off and a movement approach gets corrupted into a delivery of development
approach. This is quite a normal and natural phenomena. Even so, it is important in my

I

Desat. Sana Ide Land Distribution and fertility-' EPW

^^Ln'rv^fNo^O Command

A m',ca' Gap m

Aganval. Bma -Gender and Legal R,ghu ,n Agr.adrural Land ,n India', in Economic and Political Weekly
Gulan.leela ■•Women's role infertility decline m Kerala State.1995
y’

8

papa on Wodd
25 03 1995
"

j

Other findings are being highlighted almost every week revealing to us that the perspective
on population have to change from one of panic as is being shown in the ads by Sahara India
Pari war . For example, Prof C H Hanumantha Rao in a recent (January 22-28, 2000 Vol
XXXVNo4, article in EPW )says "‘Demand for foodgrains in India has been declining and
some of this decline indicates an increase in consumer welfare. The decline has been sharper
in the rural areas where improvements in infrastructure make other food items and non-food
commodities available. Though cereals (used here as proxy for foodgrains) consumption has
increased among the poorest 30 percent of the population, even this group is near the
saturation”

In the pages that follow, I would have spent quite a good deal of time in quoting passages
from the sub committee of the National Committee towards preparing India’s country paper
for Cairo, and some time in putting forward the framework that was being built up as drafts
for the Swaminthan Committee.
I could as well have taken these ideas out of those processes and presented them as a list of
important findings generated from data as well as ideas generated from practise which would
be the core of a paper on gender equality', gender equity and population.
But the reason I am opting for the recall approach rather than the recycle approach is
because 1 am overwhelmed by the wastage that is being generated and will be generated, by
our not using milestones both for information and for prescription. During the course of my
research for providing an input both to the sub committee and the Swaminathan Committee, I
was overwhelmed by the depth of analysis and understanding that had been generated by the
many “powerful” technically competent meetings that the U.N. Population office had called
prior to Cairo. There was a meeting at Botswana, a meeting in Bangalore and each was of
different categories of those working in the field of population. It could be demographers, it
could be scientists, it could be academic, it could be health officials. In each of these
meetingsjxapers were generated, which scanned the available experience and put it forward.

One paper which I refer to again and again in my paper and which I will quote, and which
was written in 1993 could have been written today.

It is particularly pertinent, as it refers to the dangers of what I call a women focussed policy
in relation to HIV/AIDS. It talks of the trap that awaits women who will be having to bear
the burden of the number of sick as well as the number of orphans that would be generated
by the AIDS epidemic. She said this in 1993, whoever is the author, and it was a stark reality
that was faced by the communities in South Africa, whose conferences on AIDS I attended in
1998, who, as you would have seen in the papers, are being faced with 3 million AIDS
generated orphans as of today and more to come with no capacity to absorb the orphans into
orphanages. But a further burden or stress on already over stressed women led households
because of the culture in South Africa as in India, of families taking the burdens of social
displacement. South Africa will also have a new demographic profile with life expectations
as well as other variables showing extra ordinary disjunctions, and retrogression in an era of
millennium progress hype.

9

It is this same wastage that I wish to avoid by pointing to processes and committees which in
fact drew on the most radical at that time ‘new information’ the articulation of those who are
protecting and expanding the horizon of women’s rights. To say that there has been this kind
of process which has not just built consensus, but which has integrated knowledge to come
out with a wholesome policy, - and it would be wasteful and retrogressive not to take
ourselves forward from there.

With each day bringing out new punitive and careless and therefore inefficient proposals on
population policy, it is crucial that this Conference takes note of the fresh water that has
passed under the bridge and pick up from there. There is a possibility that the 2001 census
would probably reveal another 'missing women’ phenomena because of the prevalence of
female infanticide and foeticide. Therefore it is not Malthus, who stalks populations, but it
would be discrimination against women patriarchy and custom and AIDS which might be a
significant factor in demographic change in India.
Working groups

1. The report of the sub group of the National Committee set up by the Govt, of India in 9394 , in preparation tor the Cairo Conference. I was the Convenor of this sub committee
(as a member of the National Committee) and worked with a team of ten person; each
representing a different track record ; an ideal group with an academic, an official of
H&FW, a grassroot activist, an ngo, UNFPA, (see Annexe for coverage of report and
membership).

2. The Expert Group on Population Policy chaired by Dr M.S Swaminathan 94
Excersise I, (the subcommittee called its report Beyond Family Planning: Towards Social
Policy
and I quote some of its paras
Traditionally, population programmes have been influenced by the basic demographic
variables, birth, migration and death. These have tended to be treated separately and, in
view of the impact the rate of population growth can have on development in general,
priority has been given to the issues surrounding fertility. This has meant that, after
studying the more immediate relationships, efforts have spread to the exploration of more
abstract relationships and therefore to identifying possible linkages between fertility and the
status of women defined by variables such as level of education and salaried employment

However of late more importance is being given to just, humane and effective development
policies which have at their centre the well-being of all people. This has led to advice that
population policies, designed and implemented under this overall objective, should take into
account a wide range of phenomena including access to and distribution of resources; health
status; gender relations and sexuality; aging; urbanisation and migration; political; racial,
ethnic, religious, class and other societal factors that directly affect women’s and men’s
ability to exercise their reproductive health.
Each of these phenomena has significant gender dimensions reflecting not only biological
differences between males and females, but also power imbalances between women and
10

nen. Thus, to assure human well-being, in particular women’s well-being population
policies and programs must be framed within and implemented as a part of broader
development strategies that will redress the unequal distribution of resources and power
between and within countries, between racial and ethnic groups, and between women and
men,
n

Historically, however, population policies and programs have been driven more by
demographic goals than by quality of life goals. Women's fertility has been the primary
object oj both pro-natalist and anti-natahst population policies. Women’s behaviour rather
than men s has been the focus of attention. Women have been expected to carry most of the
responsibility and risks of birth control, but have been largely excluded from decision
making.

There needs to be fundamental revision in the design, structure and implementation of
population policies, so that focus is on the empowerment and well-being of all women. This
implies that changes are needed in the design offamily planning and health services and
information; the ways in which these are provided; the technologies they promote; the
biomedical and social research that is done; and the process for involving women in all
levels of decision making and implementation, (Extract from Women's voices '94 Januarv
15, 1992.)
'
z
It is also recognised that where there is a. measure of equality between men and women,
whether because of equality in education and income (Kerala) or culture and custom (Tribal
communities, (Survival Strategies of the Poor - the role of traditional wisdom” Sreenivasan
Foundation. 1986, Bangalore) or because the programme has been equally directed to the two
sexes, - fertility has shown a greater and more sustainable decline.

This reduction of the inequality between the sexes, or sometimes the presence of a more
equitable distribution of power between the sexes is traced to education, income, entitlement
to resources and also the prevailing culture. Processes that lead to this situation where
women hdVe a control over their lives, is called empowerment.
Empowerment leads to reorganisation of the productive and reproductive roles not only
within the family, but also within the society. To simply recommend more equal sharing
within the family is to a large extent illusory if the society is not organised in a way which
permits it: for example, in developing countries, sharing has a cost which is luxury when the
strategy is focussed on survival. It is thus apparent that the “advancement” of women cannot
be added dimension to other development activities as is often believed, but a process at the
core of society that has an impact on all development activities”. {Extracts from gender
perspective on population issues, United Nations Office at Vienna. Gaborone, 22-26 June
1992.

It is recognised that there is need to address men “the forgotten 50 percent of family
planning not only through health extension, not only through IEC and social marketing of
contraceptives, but to enable men to understand and accommodate their role in fertility
management, its psychological and social implications. It is increasingly being recognised
that decisions on reproduction, whether taken by the male or the female have implications for

11

self image and status, according to the cultural and the economic context, thus extension
work has to address itself to these implications if it wishes to have durable affect.

•'Men have always been involved”. "They were the key element in the demographic
transitions in many developed countries to smaller families, using condoms and coitus
interrupts prior to the widespread use of the’ pill in the 1960’s.” {Extract from Getting More
Men Involved. Network, published by Family Health International VI3(1), Aug. 1992)..In the last generation, however, a female orientation has been at the forefront of family
planning. The introduction of “modem” female methods - the pill, IUDs, injectables, and
recently Norplant, among others - coincided with the establishment and growth of family
planning programs in developing countries. “We know how to provide family planning
services to women better than men, and there’s been limited funding for male-only
programs.”
Three factors in the 1980s triggered more focus on the male role in the population equation.
1 he coming of AIDS and its rapid spread through heterosexual contact has caused new
attention and resources to be devoted to the condom and to understanding sexual health.
Another important recognition is the need to address the programme to the whole lifecycle of
the woman, (and the man) especially at the stage of child and adolescent - and not only at the
reproductive age. Some of the issues family planning programmes need to look into are: how
to intervene at all stages of a woman’s life cycle; how to improve the status of women, in a
life-course approach; how to proved sex education and girls / women’s higher level of
economic dependence. These, and other questions need to be looked into from a gender
perspective.
A common criticism to health efforts for women is that they are mostly centred on “MCH”
i.e. mother, child health. Operationally, such a package has made good sense, often
corresponding to existing reality and, furthermore, integration with family planning has given
important-results. Motherhood however, although fundamental, is but one aspect of a
women’s health. A greater concern for the health of women throughout their life might lead
one to explore the possibility of breaking down the concept “child” into its gender
dimensions in order to avoid families later on reacting differently to the sickness of daughters
compared to that of sons and limiting the expectations for girls to their reproductive role.
Attending to her only at the MCH stage often is too late even from the limited goal of family
size apart from the more humane goal of wellbeing. For example most of the irreversible
■contraception used by women has been of women over 30 years with already 3.6 children
(Anirudh Jam)

From the arrival of a girl in the womb to her death there are many threats both to life itself
and to health. This discrimination affects not only health status but power relations, the
ability to take decisions, to negotiate and protect herself.
Another example can be provided in relation to the AIDS epidemic. Models have shown that
variables such as the difference of age between partners can play a significant role in
increasing the risk of infection of the women. The difference of age between partners is a
typical expression of differences in wealth and power. In such circumstances, traditional
12

r

mtoimation education and communication (IEC.) campaigns and the provision of condoms
although indispensable, might not be sufficient for women to insist on “safer” sex if they are
npt suiticiently empowered. Responses to the epidemic tend to rediscover the “caring” role
of women, thus increasing their burden and endangering any advance in their status. Worse
the future of the daughters of overburdened or sick mothers can be definitively mortgaged by
enrolling their assistance, rather than that of boys. One has therefore to be careful that
community responses to the epidemic do not turn out to be gender traps for women' These
tew examples illustrate the fact that a gender analysis could have important organizational
consequences on existing programmes as well as considerable positive impact on their
outcome^(Extract from A Gender perspective on Population Issues, United Nations Office at
Vienna. Gaborone, 22-26 June 1992.)
|La'rr°f °pPortuLnities earl-v in life wil1 mortgage a woman’s potential through all stages of
rer hie. When that happens to a generation, this could mortgage future national development
tor several decades. Early pregnancies and continued births throughout the productive years
with or without emotional, practical and financial support from the father, leave many
women in an economically dependent position, from youth to old age. Family planning but
a'so the age perspective; the different stages of a woman’s life which determine her
possibilities to make decisions related to fertility.

Thus today concern is for the HARDSHIP that women suffer, from birth to death,
through under nutrition, early marriage, unsafe child birth and inadequate health
services to follow up morbidity. Population policy thus has to address itself to women’s
wellbeing, of which her entitlement to good health and the capability to choose her
reproductive path becomes the critical mass.
^utntl°n’
and not only for pregnant and nursing mothers but for children, to build the
base of a healthy body has been recognised as basic - whether one looks at it as a basic
human right and need .or from a narrow point of view of introduction of contraception (the
md, norplant another technologies work better on a well nourished body sic) Thus Food
security has been closely linked to population issues and policies (T.N. Krishnan)

This in turn, is dependent on may macro policies and programmes - for example, (land use
and export import policies determine availability of food at the aggregate level. At the local
level, prices, the food distribution system (PDS), purchasing power to buy the food, which in
turn depends on availability of employment, and then the distribution of power between the
sexes which will determine division of food within the household. (A.K. Sen) Agricultural
production programmes, land use (food or cash crops) which in turn is dependent on prices,
and these on turn on the trading policies, international food prices, export compulsions, or
import compulsions, will affect food availability to vulnerable groups (IFPRI)

Thus a simple input like nutritional justice to children would need the back up of macro
policy - both food security and employment, or livelihood. Safeguarding these two
securities it is found would affect population growth as deeply and strongly as providing
contraceptive incentives; and perhaps with a more durable impact.

Education is another critical element that has been pointed out as having an impact in a
variety of ways,
13

Less educated, poor and physically exhausted mothers are likely to pass on poverty to their
children, while better educated mothers is one of the key factors for improving the situation.
Studies have shown that women with seven years of more of education tend to marry on
average four years later, and have 2.2 fewer children statistically than women with no
schooling. (*)Sadik, Nafis: State of World Population Report, New York, United Nations
Population Fund, 1990. P 15
'
Education raises the age of marriage of girls which has a very strong impact on birthrate
(Anirudh Jain), It levels out power between men and women both in and outside the
household. The other links that education gives knowledge on health and opportunity and
thus impacts fertility is well knowri.

But educating little girls also has major demands on the macro economic system. Poor little
girls cannot go to school, unless they have (not only the usually identified support of creches
for their younger siblings, or also the other usually identified element better household
income through higher wage for the adults very but relief from time consuming domestic
chores such as fetching water and fuel for the home. In a national seminar on the new
education policy (NIEPA) the final consensus recommendation was that piped water and gas
were as important, as much a necessary condition for girls to go to school as a black board
was for the school. (Extract from National Seminar on Education in an integrated planning
framework. March 2-4 1992.)

The paper from the sub committee then gave the following proposals as a response to the
review:
The Action plan for revamping the Family Welfare Programme in India addresses these
issues and the approach suggested is consistent with many of the recommendations emerging
from a women’s perspective. These include for example, a consolidation of existing
infrastructure, more attention to practical problems of field workers, and an ending of the
"target” approach.
A holistic approach to women’s health is needed, and not one that limits itself to reproductive
health. This means we need a system that responds to all the following: occupational health;
reproductive health; maternal health; mental health; nutrition.
Close attention needs to be given to the quality of service and follow up.
ensuring this is to give primacy to the ‘perspective of the client’ (1 )

One way of

Looking at population issues from this perspective, it becomes clearer that demographic
questions cannot be understood without going beyond the boundaries of family welfare and
structure and of facilities, in particular drinking water, sanitation and education is a pre
condition for sensible population decisions. This is well borne out by theories of the
demographic transition and in the Indian context Kerala provides an illuminating example (S.
Pachauri, "A reproductive health approach to the population problem”, Demography India,
Vol 20, No 2 (1991) ppi55* 162).

The experience of health sendee provision through NGOs is often cited as an example of the
correct approaches. The point to be emphasized here is that these programmes have been
14

■

successful because they have had an organic growth and have not been pre conceived
programmes. It is likely that the specifity of each successful approach makes it less
replicable; but the lesson to be drawn is precisely that we need a system that permits and
contains diversity. It is also worth emphasizing that a programme which is “handed over” to
an NGO for implementation is missing out. on the first and necessary condition, that the
programme developed from bottom up.
The essence of the NGO approach has been to mobilize, empower and conscientization, the
people. Through their work on conscientization, struggle and protest, NGOs have taught the
disadvantaged to put pressure on the government and have complied the system to become
more responsive to their needs.

The Working group (II)

The Swaminathan group Exercise 2

The second milestone was the work done by the expert group on population policy set up
under the Chairmanship of Dr. M.S.Swaminathan. This group also had the benefit of by a
remarkably skilled group of diverse professionals from scientists to civil servants,
demographers and officials. As well as interaction with experiences both of grassroot
feminist organisations, evolved experts in this field such as Dr. Sundari Ravindran, Dr.
Shanti Ghosh, and many others. The dialogue and discussions between the proponents and
this team during the process of preparing the report brought in almost all the insights on
women's role and'participation, in responding to a population policy, as well as designing
and implementing the population policy. Naturally, the valuable diverse streams that enabled
the earlier subcommittee’s work flowed into the process also.
The Expert Group on National Policy reviewed the experience of India’s 45 years of Family
Planning interventions, and made a turn about from the old approach. Unanimously. Some
of its key recommendations were:
(i)

Scrap all incentives, disincentives, target orientation - including legal conditionalities
like making individual or institutional benefits dependent on family size or birth rate
performance - from the approach.

(ii)

At the structural level merge the Family Welfare department with the Health
Department and make it one line of administration all the way down to the village. In
other words, to remove the Family planning Department so that the emphasis on
health does not get deflected to “family planning”. This is a “Revolutionary” change
of approach for India as she has prided herself on being a pioneer, first in the world to
have an FP intervention. In fact the group decided not to even use the word “FP” any
more but call it contraceptive services.

(iii)

To change the IEC from (as Avabai Wadia put it) bombarding and exhorting people
to limit their families to one of giving information on the body, on various aspects of
health.

15

•

.

(iv) 'To set up a National committee to review the ethics of introducing drugs especially
' ’1 satisfaction of the
the new high tech contraceptives - especially the transparency and’ full
trials before introduction.

The reasons the Group were so strong and clear in rejection of the old was the fact that in a
Context of deprivation and also insecurity, in a context of diversity and difference (pluralism)
appeals on family size were un-receivable- or to put it another way could not be landed safely
on the ground. It was necessary even for efficiency to respond to poor communities on the
basis of their pre-occupations. This led to a strong support for local self government, to
decentralized management of health systems.
However, since we recognised that the number of people and their rate of growth was a
serious mater and needed to be restrained and established, (towards a goal of TFR in the rage
2.0 to 2.1; we decided to abandon the NRR as a measure) we the group, decided that at the
macro level we should pressurise the leadership to make investment, resource allocation
choices, and administrative choices which otherwise they would find difficult in die current
Structural Adjustment Atmosphere (SAP) of resource shortage - arguing that this is the most
effective intervention for a sustained lowering of TFR.
In one of its earlier drafts the Swaminathan Committee on population policy, had crystallised
the main pillars of a policy as
First the provisioning of basic economic and social security to all sections of Indian society
especially the poverty sets; - which meant universally available high quality elementary
education alongside with schemes for provisioning of creches, clean drinking water,
sanitation and maternity care. Eminent scientists had given simple solutions to ensure that
pregnant mothers do not suffer from anemia which in turn reduces the survival rate as well as
the capacity of children and so forth.

The second pillar was to use the existing institutions of governance namely the Panchayati
Raj system to advantage, to facilitate the design implementation and monitoring of high
quality social development services. The idea of locally designed and implemented and
monitored services with accountability provided by the elected body was to ensure that
delivery is proximate to users. Words like user oriented, locally designed, women designed
have all been enshrined as the second pillar of that expert group s proposal.
Third the expert group also had negated the idea of incentives and disincentives, the utility
of what was called the propaganda machinery of supporting the two family norm but instead
asked for more effort on involving young men especially in community based activities
which also give them information on not merely birth control but reproduction. So rather
than propaganda on the two family norm, it was suggested that information be given on
reproductive organs, which would both facilitate their understanding of fertility but also
enable them to protect themselves from sexually transmitted diseases etc.

Fourth, the enormous rich experience of non-governmental organisations in enabling
communities to exercise restraint on birth rate, in fact to exercise their own preference to
have a few children was also flagged. And it was suggested that if the quality of service and

16

Ihe user oriented approach of many of rhe suceessM non-govemmenul organisations was

widely disseminated and prompted there would be a far greater impac .
We felt that it was possible, even within the
financial support to a crash programmes o ™
■•adrenaline”, or feverish energy and
fX^pXd —the Population bomb t and that this would

be a more effective way of ushering in a "quality Population.
This would require very strong political wi'l in
Z'oS'aird'regmnsm ticcX m.Zi benefits shifting and allocations of resources and

pin pointing users, also requires political strength.
j great deal from the technical experts
In both these processes I had the opportunity to learn
a
analysis
and propositions which has been
and an opportunity to draw their attention to facts,
women especially women in poverty,
the experience of those who have done research on
especially women in the economy and politics.

Emerging Values:

The reason I elaborate on this experience is two fold.
all the elements of the Indian approach and strategy exactly match what the
Almost a
in fact the international women s movement
Indian
Indian women
women’’ss movementmovemen - and in tact the gr0Unds of justice and efficacy. (See
recommend and has been high-lighting on i
Afinex-l).

i)

ii)

To show rhar rhe anicularion of rhe
alone, it translates itself to practical elements of a National Policy.

The crucia! aspecr of .hose experiences

X”? m2X

10 speak io a national population policy for '"Zd uncmojoved rural and so on. would like
women, mcludmg those who are poor no. ed«m d unempk, ed,
*

The problem arises only when the discussion moves from wW woureu wu, to,

<ta

desires or need is met.
Another very important aspect of women s advice or

much as, it not more than the goal.
17

facts which

;x=;::'-s“-ss'T-=i.ZSFS-2
manipulation.
poor, living
living invery
in very inadequate
Those who work wirh women, especially with those who are poor

but inefficient to offer only a

cafeteria or wide range of contraceptives.
Their reasons for holding this view rises from:
1.

Their knowledge that the choice of how many children to have depends on many
";2 <0 rhe aeaiUhihry of contraeeprives. For examp

0

in view of the entry of AIDS as an epidemic.

2

relations have also to undergo change for choice to be exercised.

4.

Their experience of the current family planning services through die State, where
incentives and targets have made poor woman victims of coercion and neglect

ask Society and the State to take a wholesome view of this problem and to address
They
themselves to the broader needs as well as the focussed needs.

Women design population policy:
In several meetings whose localion moves from Nj, 1993)
advisory Committee meeting « Women P’P “d ° C4 Women
ftom a M6eting

D’Xpme'n'smdi™approach and the thmsts coming on from
f.-.- the
i: womens
- -

organisations are the same.
18

technologies, on power generating technologies, irrigation systems and so on.

When women recommend education for girls, they recommend piped watei’and gas to be

collected form the bush, girls cannot go t

against even little girls as thev walk to school across fields. So to reach low fertility rates
XTskrt with security from wolence. investment in soc.ai infrastructure go on to piped
water and gas to be available like black boards and teachers; and then on to school hours to
su‘it climatic and occupational needs of poor working families, then on tc'
village teachers teach and village nurses, nurse by wanting local accountability for the gras

root functionaries.
.
(-J use AK Sen’s words) as subjects
Consulting women, treating themi as reasoned agency (to
all sectors, and in institutions - what is called a
leads to another kind of public policy across a..----- ,
paradigm shift.
United Nanons Population Fund, New York.

Project for Consultations with poor women towards “Evolving a
A P^^l'adon'pohc^for the Twenty Fir^ Century - perspective from the

Statement on Population Policy - Centre for
Women’s Development Studies Dated 17.01 1993
Council for Social Development

Women's Movement.
PohcT - fX^^rsXTedcaZ,l for Soc.ai Development, New

The Hindu dated II 1 1994
The Pioneer on Sunday dated 16 January . 1994
Devaki Jam

Delhi on 14 January, 1994
Is population the real problem?
Women as guinea-pigs
Women Led Population Policy Kitakyushu Forum on Asian Women
November, 1993

When it comes .0 heal* they see health, especially reproductiee.health <
to start being attended to from earliest age of people and of both sexes, to level up meir
knowledge and responsibility. They recommend that the “departmental approach to soctal
inputs be8changed to a one line, one window and multiple services across age and gende .

Women all over the world are emphasizing participation in decision rn^ng
In our consultations with poor rural women in India, in a project funded by the UNrrA we
X iZS to find that they identify capability to make dectsions as key to therr

advancement, and of course key. to making informed reproductive choice.refs

Rm decision making to them does not emerge form literacy or income alone but from a
X;? of balanceHn power or what can be called equality between themselves and titetr mem
Taking us back to the old concept of equality between men and women not at the mac
statistical level but at the household and community level - a very different kettle of fish.

19

The -omens Groups rhar worked on rhese

£STS:w

Anrendmea to our Constitution which turves

33-1/3 % seats for women in local self government.

i

fitnrR” / resource crunch, they recommend choice between

contraceptive.
kirerarure is fr.ii of ease studies

7“" =^£7 Mo«
Most of these endeavors indicate
—challenge the theories of —
and

social change.

forms of resource. The method is usually one
1 attach the summarized version of the proposals that erne,rged from the wide range of
consultations listed along with the proposals

20

Macro Chari
MACRO SUPPORT
SOCIAL SUPPORT

literacy
EDUCATION
4 L TH

(especially towards the GIRU CHILD)
ECONOMIC POLICY

•*

FOOD SECURITY
EMPLOYMENT

(especially towards the poorest people)

RESOURCE ALLOCATION

ON SOCIAL AMENITIES
’ WATER
COOKING ENERGY
SANITATION

Cooking. Cleaning and Child Care.
FORM OF ADMINISTRATION

LOCAL SELF GOVERNMENT

Accoumable elected bodies vilh representation ensured for
women and other subordinate sections.

Based on binding categories especially youth
LOCAL INSTITUTIONS

COOPERA TION WITH NGO S
FOCUS

Girls and boys but especially girls
YOUTH

21

Going into the details, to the elements requiring
over the existing systems, they would suggest.

attention and which

Long-Term Elements^

I.

Investing in health:
GNP to 5% of GNP•

The percentage of GNP needs to

can be superimposed

increase from current 2% of
As

h0USeh°ldS'

aCCeSS ,0

- give more to public investment... -

■ on the girl child in the health system Stren^e^
base to include health servtces across age
,4 life-cycle approach - with baroade^r
focus
the primary health centres. I----and gender.
health and reproduction.
S'“S‘S “
4
• community-defined health
in local .government as well as
- other
5 “
f. „J pro^ng ^„le«l
,....
forms of local commualry leadership on health.
Ijnmedigldfomzulsion^

u.^aet into health budget -. so that the flow of funds
be used for better and under health

' tTe^^

'

.0 he par. of heahh ser.ee sys,em. name, .he PHC. to p^
2. Recasting the MCH to oe par. uj
Malting available <«

;

“ ff'^fgaal^

r ah a componem on reprodacme health.

ffr^l^

4

i

as well as adults

,

„ schemes to postpone the age of marriage ofgirls offering Dianol .raining
5

savings, income earning etc.

6.

a .ide network of agencies, for the community health

The raise the status, through
’specially the mid-wife.
worker and health providers <_

on reproductive health mallei s.

22

The above lisle are offered only as a skeleion on which more opinions and Ideas need
be boil ^e Urgency no, only because population especially Us control has cow up
(0
ihe Asendo of !he Stare bo, becaose there is also a dominant ..ew point that the
high on
factors which are most influential in reducing fertility he outside
Retrospect
The horrors of rhe MiUe^ium: The new ^lenninnr- rhe

“S

X.ISte/oZ^'Z^al se6me'„rs like women onro cioud seven or
a grand future.

The miilennium has teen anr.o.pa.ed and oharaorenzedmany ways
Information technology has crosse over
increase in
emprres. inrelleerual empires So in a sense .< has eveM. It has also ^'“^epU1Ke.

social fragmenrauon apan from

are the key words.
“uennium which are homif.c and iook » if ^ey

cannot be contained. What are these horrors?

of society and its old foundations - family, community,
S Sre ovdrpowedng economic mHoence of unaecoum^

hence an abrogation in national sovereignty and hence a

warlords -

S

wars arojittle and local.
In such a situation where disparities and conflictsi are^mcreasing,
are under assault; and where power has move in
f0n0w up mechanisms have made
MNC’s; and two women’s decades with action p
WOmen’s situation cannot be
attempts to usher in justice to
""^e, “hem up with men. In fact
redressed merely by social inputs mer y y y g
worldwide forums are taken as
women themselves ■ if their voice
„ well as the nature of the world

Why this shift even in the aspirations of the World Wide Women’s Movemem? Why

this shift from ‘demands’, to power ?
Any review of progress made in

23

partial. The UNDP/HDR-1995

xs:

“d

-—s

still ignored - as indeed their voice in governance.

“

Thi, review ar rhe globa> ievei is —eh
3-4 years as reeondary and
pXipation in decision& females in everything T"\S“X ds o ar he Sal level, many researcher, were
making . whether within the househ<;'J “
Xure it. give the measures a hierarchy
engaged both in trying to detine status of worn >
WOmen’s quest for equality and
importance and then try to asses, ■ y'^TSs ' f=™“s ar’e under assault, with
feeide on one handle of gi imo <1* sex trade on the other, and the tnfenstftcauon o

domestic violence against women.
It is anticipated that the infant
“e^a^dit^ZsXr -

reflect
andhold
female
CdT foeticide
IPPS^The
of

the humane economic interventions.

h is here therefore that the Imh betwee^dere^
and the introduction of the rights language her reproduction, a human rights v.olation seems to offer hope.
The language of rights has always been a Pr°ble^ in
instruments to enforce legal safeguards are muted^ alQng

unequal countries where
™
very p0Verty and
inequality
inequality hurts
hurts harder,
harder, -

- people are i----

—

rights even in developing countries.
newly formed National Alliance of People s
A recent example of this mobilisation is^the iorganisations
1
J
' 3. The alliance has
Movement (N APM) which is an alliance of 9 struggle oascu g
S declaration from which I quote only their slogan:

-HAM ARA BEEJ. HAM ARI BHOOMI
HAMARA KHAD, HAMARA PANI
These responses can be traced to the
a free public utility - namely rivers, oceans fo

.g

In another area
agendas, ngtts and

of Xn’in fndi. »d Soud> Asia. The

l>X”’Ue

S

which

resources
once removed

n,u™onBof wXn mSdi. and Souih Ada where rhe household aurhonty and convenuo
h-h - developnreni- An

.=TTTTTX o^.. in
NCAER Seminar. UC, 1997.
24

fighting there millions of battles m millions of homes.
Another extension of the use of rights initiated through 73rdrd and 74th Amendment is the right
local politics talk of their rights,

in po>i<i“>

? *' WOm'n m

■■haq” to be in larger and larger access of politics.
4 ,■ riohtc ■ the effective expression of reproductive rights is
And so we come to reproductive
,
f ri
in a broader set of areas such as

£nus orc,,y to no'ions of
rights, to the rights of the poor to livelihoods, tood and so on.

Again ground swell movements

w ‘v“
from the market ot course.
Some of the older institutions such as tradeand rules are
language of rights. Being rePresent^
Qn ri hts of the members. The reasons these
based on elections, on voting and
g
greater
institutions like cooperatives and tradei unions
d
ause of their represenUtive nature
landscape of globalisation and liberals anonus not^
t
which engages itself in nghts (ec
context of large corpora tions, large scale
scenario of these instimnons) but because >n^^h^^
pMsWe source of

^“g'Zr S — economic organisations, federate them.
In drawing attention to this Pi’e"om'”°J ^“^^he fteld'of
and
the purpose is to argue that it i ea
current cruelty, discrimination and assault on
development have to be shaken out of
representative institutions, are key

policy, or more programmes by government.
U i;„v bptween nolitical structures, economic
Thus 1 come back to where 1 be8“
“s self determination, - a woman's right to
development and gender equit). The
“capability” - circumstances which
ehoosZa reproductive path This emu «ent^i;as well as the collective
mdiaOT'lhis requires’a sttone

if p’f"-s
presence of women - not gender equity.

25

ANNEX 1
Draft for discussion
Section E 4.
Country Paper (India)
(Cairo Conference, 1994)

CONTENTS:
I.

Introduction (Approach).

II.

Main Elements.

III.

Towards Social Policy.

IV.

Indian Facts and Experience.

V.

Future Strategy and Summary' Package.

ANNEXURES:

1. From Vineeta Rai.(data)
2. TablesT.N. Krishnan
Anuradh Jain
3. Rural Health Infrastructure
4. Distribution of Contraceptives

REFERENCES:

References on PG
Newspaper articles

w

approach contributed by Ena
Including a monitoring framework for a non target
Singh and supplemented by Dr. Chitra Naik
i

Members of Group
Convenor: DevakiJain
Members
Ms. Avabai B. Wadia, FPAI
Dr. Alaka Basu, IEG
Ms Vineeta Rai, MHFW
Dr. Saroj Pachauri, Population Council
Dr. Mukul Mukherjee, Calcutta University

Ms. Mirai Chatetjee, SEW A
Ms. C.P. Sujaya, GOI, WCD
Ms. Ratna Sudarshan, ISST
Ms. Ena Singh, UNFPA

26

Some additional references

Ja,, DeMk, ;

,

of wo™ .0 Siaiisiics and « M

July 3-7 1989, Paper on housework.
2. Jain, Devaki : "The investigator, the respondent and the survey - the estrmate of keeping
good data on Women”, 198?.
Jai„, Devaki : “Enriching Indies with
Building a Framework for measunng gender equtty ,15 17 May

4

EPW Research Foundation,: "Social Indicators
Economic and Political Weekly, 1994.

“

of Development for India - I & U",

5 jeejeebhoy, Shireen J. : -Women's Srams and
Evidenee ftom Tamil Nadu, 1970-S0", Studres in Family Plannmg,

I 1,

■ a: "Family Size, Outcomes for Children,. mid Gender Disparities
Shireen
J.,
io Jeejeebhoy,
f kural
Mahar'ash.ra',
Economic and Political weekly, 1993
- Case ot---Ka.pagam. U"Gender in Economics - The mdian Ezperrenee", Economic and PohtlC
a

Weekly. 1986.
..,s Population .he real Problem-. The Hindu dated H* January,1994.

12

-Women as guinea-pigs". The Pioneer on Sunday,16"' January,1994.
13

Some Papers on Population Policy by Devaki Jam:

V

Si iXK

Fo"“

on Asian Women, 19-21
, populati„„ Policy)", august 27,1997.
J *'Sj1'" pXP an?P^a.ion\ Paper presented in Expert group on

5

- CXn“Z. Ptesemed in Meeting of Eminent persons,
Tokyo, Sb01-27th, 1994.

27

Reproductive Health, Empowerment and Population Policy

file:///D|/INFO FROM INTERNET/npp-reprod...lth, empowerment & population policy.htm

tional-SID Programs

7

.s

Reproductive Rights, Gender and Empowerment Programme
anc* Popuiation Policy

Project Background
This project is undertaken by SID in collaboration with its partner organizations in Brazil, El
Salvador, Ghana, India, Kenya, Morocco, Pakistan, Tanzania and Thailand.

The project investigates the resources and communication tools through which three ages of women adolescent, reproductive and third age - acquire knowledge of their reproductive health needs in the
context of their local community and to identity what type of sendees are needed to enhance their
capacity to make self-defined choices. It follows broadly the framework of the ICPD Programme of
Action’s stated aims to shift population policies away from an exclusive focus on demographic
concerns and targets to one that puts the well-being of women at the centre of human sustainable
development.
In each national context, local women’s groups act as a focal point to help formulate activities which,
through participatory research, advocacy and dissemination of ideas, would best ensure the provision
of quality reproductive health services for the three ages of women as defined by the women
themsel ves, thus acting as subjects and not objects of population programmes.

The project examines three questions:
1. How women of different ages and social positions contribute to the knowledge and practice of
reproductive health and how women and men interrelate according to the particular
configuration of gender relations;
1. How women’s reproductive choices also change according to their different stages of the life
cycle as they assume different roles and status levels through adolescence to old age, daughter
to grandmother;
2. How to take global decisions on reproductive health back to the local level through a dynamic
process of interaction between understanding local conditions and interpreting policy decisions
and activities which meet local needs while reflecting the broad principles reached.
Achievements to date
To date partners have:

* reviewed the ICPD Programme of Action in consultation with other women’s groups,
government, education and health authorities;
* undertaken the case studies (the case studies have been completed in eight countries) with
NGOs and local community groups;
«* presented and discussed the results of the project’s first phase in a workshop held in Santiago
de Compostela (Spain) on May 20, 1997 on the occasion of 22nd SID World Conference;

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Reproductive Health, Empowerment and Population Policy

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® initiated a process of local consultations with women’s groups, civil society groups,
intergovernmental and government departments in order to drawz up strategy plans which will
identify, at the community and national level, the services and resources required to meet
different ages of women’s reproductive health needs.
Future activities

® Advocacy
For advocacy purposes, by May 1998, in each local context the partners will organize a
national workshop where women’s groups leading the projects and SID Chapters will
activate their contacts with civil society groups, the private sector, media,
parliamentarians and UN agencies, to bring broader awareness of reproductive needs as
defined by the community women and the ICPD Programme of Action.

® Dissemination

The findings of the project will be disseminated at the local level as well as at the
international level in print and through electronic communication. A special issue of SID
Quarterly Journal Development will be published in 1999, on the occasion of the
ICPD+5, and will be translated in local languages in order to serve as an educational and
awareness building tool for distribution to education, health and NGO institutions
working at the community and national level as well as to the international community.
Local Activities

Brazil
Research coordinator:
Jacqueline Pitanguy - Citadania, Estudo, Pesquisa, Informagao e A^ao (CEPIA)

Special focus:
The Brazilian case study focuses on women domestic workers living in Rio de Janeiro and on their
relation to media . Specifically the research team has investigated: bow media deals with issues such
as gender, reproductive health, sexuality and environment, and how women domestic workers are
pictured by TV and Radio programmes.
For information on local activities contact;
Jacqueline Pitanguy
CEPIA ~ Rio de Janeiro - Brazil
Tel: -^55-21-558 6115
Fax: +55-21-205 2136
E-mail:

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El Salvador
Research coordinator:
Ilja Luciak - Virginia Polytechnic Institute and State University

Special focus:
The Salvadorian case study focuses on poor women living in 31 marginal households located in San
Marcos and Antiguo Cuscatlan (neighbourhoods in the capital city San Salvador) as well as in
Panchimalco (a marginal area in Quezaltepeque).
For information on local activities contact:
Hja Luciak
Department of Political Science, Virginia Polytechnic Institute and State. University
Blacksburg - USA
Tel: +]-540-231 5246
Fax: +1-540-231 6078
E-mail: ihiciak(a)vL edu

Ghana
Research coordinator:
Miranda Greenstreet - Institute of Adult Education, University of Accra

Special focus:
The Ghanaian case study focuses on adolescent women living in three regions of Greater Accra and
women of different ages living in the Eastern Regions of Ghana.
For information on local activities contact;
Miranda Greenstreet
Institute ofAdult Education, University ofAccra
Accra, Ghana
Tel: +233-21-775 430
Fax: +233-21-232 866
E-mail:

India
Research coordinator:
Ashok Bapna - SID Rajasthan Chapter
Special focus:
The Indian case study focuses on young married women living in a slum area of Jaipur and in a
village from the Alwar district of Rajasthan.

For information on local activities contact;
Ashok Bapna
SID Rajasthan Chapter
Jaipur, India
Tel: +91-141-511 574/511 577/511 326/381109
Fax: +91-141-383 978

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Kenya
Research coordinator:
Cecilia Kinuthia-Njenga - Environment Liaison Centre International (ELCI)

Special focus:
The Kenyan case study focuses on women of different ages living in Kibera, Korogocho and KM,
three urban poor neighbourhoods of the capital city Nairobi.

For information on local activities contact:
Cecilia Kinuthia-Njenga
WEDNET-ELCI
Nairobi, Kenya
Tel: ^-254-2-562 015
Fax: +254-2-562 175
E-mail:

Pakistan
Research coordinator:
Khawar Mumtaz - Shirkat Gah

Special focus:
The Pakistani case study focuses on women of three age groups living in Baja Lines, a low income
neighbourhood of the capital city Lahore.

For information on local activities contact:
Khawar Mumtaz
Shirkat Gah
Lahore, Pakistan
Tel: -92-42-576 0764
Fax: +92-42-571 3714
E-mail: sgcilF^gpJLhTQPLT^i^pk

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Tanzania

Research coordinator:
Leila Sheikh Hashim - Tanzania Media Women’s Association (TAMWA)

Special focus:
The Tanzanian case study focuses on women and men of different ages living in Uala, Temeke and
Kinondoni, three districs of the capital city Dar-es-Salaam.
For information on local activities contact:
Leila Sheikh Hashim
TARAWA
Dar-es-Salaam, Tanzania
Tel: -255-51-32 181
Fax: +255-51-290 89/116 749/113 619
E-mail: T^lWA(^lm^

Thailand

: .I

Research coordinators:
Supang Chantavanich - The Asian Research Centre for Migration, Chulalongkorn University

Special focus:
The Thai case study focuses on migrant women from Myanmar living in the fishing community of
Ranong, in the South of Thailand.
For information on local activities contact:
Supang Chantavanich or Shakti Paul
The Asian Research Centerfor Migration, Institute of Asian Studies
Chulalongkorn University
Bangkok, Thailand
Tel: ^66-2-218 7462
Fax: -i- 66-2-255 1124
E-mail: fiassct^hulkn.car.chula.ac.th orpauls(a^Ma.ac.th

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Morocco

Research Coordinator:
Fenneke Reysoo - Department of Social Sciences, Catholic University of Nijmegen,

Special focus:
The Moroccan case study focuses on unmarried young mothers who, after having left the rural
areas, live in a poor area of Casablanca.
For information local on activities contact:
Fenrieke Reysoo
Depar tment of Social Sciences
Research Methodology Division, Catholic University of Nijmegen
Nijmegen, The Netherlands
Tel: +31-24-361 5743
Fax: +31-24-361 2351
E-mail: f. reysoo(d):maw. kun, nl

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F

POPULATION AND FAMILY PLANNING POUCY

A CRITIQUE AND A PERSPECTIVE

I

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RAVI DUGGAL

CEHAT
CENTRE FOR ENQUIRY INTO HEALTH ANO ALLIED THEMES

SI*. PRABHU DAMHAM, SX KAOAR. AMBOU AMDHERKW^.
BOMBAY- 400 OSS. HOA. PHOME : 22 <23 02 17.

AUOUCT WH

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O' «SM>

POPUl ATTON and family PLANNING POUCY :
Critique and a Perspective

Ravi Duggal
Th« Oepa fl med of Family
Ocih« says 'The Family Welfare Program in India is being premofed
0/1 voluntary basis as a peof** ' nxn^emcn! in keeping with the democratic traditions of the country The
Pf<agram seeks to promote rruon^atble parenthood, with a two child norm - male, female or both thrcK^h independent choice
•jamily planning method best sorted to the acceptor For conveying
fnvauge of small family nonr
tn«r masses motivational educational and persuas^e efforts are made
^^KXrt any resort to any fevzjucrcion’ (Family Welfare Program in India ■ Year book 1909 90
C^t-<»rtmenl of Family Welfarr ‘O’ ^ew Delhi (>g 40)

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Th« its how the government v»** '
ftarmly planning program, which it never tires highlighting that rt was
the fur^t official’ program of px^ai»«om control in the world’ I have deliberately begun with the above
Quu^c because not only is rt
ot ‘Hr5, 1,01
H,so ^nves :n many home truths about the governments'
P®‘<*ptions

RETROSPECT
Th© Official Population Policy •nd ^ogram is based on the Malthusian belief that poverty in the 3rd
works countries ts due to the larv** pop’Jiat'on of these countries Each Frve Year Plan (5 YP) in India has
thus never failed to comment that Ir-dia's development or growth has been the besl possible with the
given resources but uncontrolled i>op*>«Hon growth has acted js a retrogressive force. Thus, each 5 YP
raised substantially allocations tof
Family Planning program in the hope that the fruits of
development were not eaten r*ey
unchecked population growth. (Note : In India the term family
ptarwwsg has the same meaning
peculation control.)

t

Further, India's Family Plannirg (wograrfl has been almost wholly directed by international pressures In
the wwuai years (Fifties and early aud-eJ) when the program was truly voluntary in nature it operatod
mauuy through FPAI with sutwtarttof assistance and influence from IPPF, FPA of Britain and the
Population Council.
When these efforts failed to elicit any significant acceptance of Family Planning, pressures wore exerted
on the Government of India to take a
interest in checking population growth Ford Foundation look
the maiative and helped the Goverr»menl of India in changing the approach from a ciuucar and
Volunory one to a camp approach wdh a more aggressive attitude and the introduebon of incentives
Thus from an expenditure of R*
million in the second 5 YP the allocation was enhanced to a
whoppuig Rs.270 millron (actual ©Aper»d4ure Rs 249 million) in the third 5 YP to accommodate this new
approach which continues upto the preMint And today the eighth 5 YP has ailocaled Rs 65.000 million
for the Family Planning program
(

Table Mfives plan-wise expendrtu<e on lhe Family Planning program and the actuevements made The
achievements have definrtely not been worth rt considenng the last column in the Table Today the cost
of impioving the Couple Proteaton
one
« abou1 ^ 3
(w us > 100 rndl/on) The
yield from an attematrve investment
befter ma!ernai heaWh services in rural areas, social seconty for
school going children, etc. will be more ixodudtve

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Table 1 : Expenditure and Achievement in Family Planning
F»mth Planning EipendWorr

C PR

Cuircnl

1990-91

Mcnii/Jt"***

Pnoo

Prices

(I jkhi)

(Rt millMo)

-

<

(. Pfe r. r. 4

<1

current nu- c*

(R> milh«*i)

Five Ye*r PIm»

First
Scvond
I Turd
Plan llolida)
(3 )cars)

249
705

HAh
Sixth
Seventh
I'jghlh

2^4
5)66
11952
33292
(»5(XX)
(lludgcl)

Note : 1

The 1900 price* Iwve

llMlTth

!

2
22

2U

I 53

220
2075
3920
I24IX)
B600
27‘XX)
45KX5

M H
;tr 57

|3 73

4 3 72

p W

•X> 0-1
147 |7
I 74 44

237 44

71 V
2f» 51

02
27
7

14 7
22 4
32 I
4) 3

7<» U

H5*
4 1X2

670 *
I41X ’

2972 5

6 SIXX)

calculated try using the purchasing pw*er mde*

tw *»«*•rrom

CMIE'b Base Slaiistc*

1
Sourc

i:
F«nrfy W^flr. V-' Boo* 1080-00 »nd Do™ Fw Ymi Pl»n

e^XJ

Further ft .3 wef. Known that the Coupfe Protection Rate (OPR)

CPR with fertility rates clearly shows that something rs wrong.
doesn't necessarily mean that fertility is declining Many stud.es .nJ
For instance, an increase In sterilizations does not

8mpiy demonstrated
, ^piJied family size of 4- w «

well established that acceptors of sterilization have on an ave^
living children, with at least 2 sons This only makes a mockeryJ*

program1

oMenfed Family Plae^ng
have computed

Thus, the cost of raising the CPR could be much more

Th)S lirnilalion ol xtonlizahon was .eal.zod al the end of thud 5
the largest accepted method of Family Plannmg At the end of tr-e
m a| |n<) cos| Ql
pressurized the Indian government into .mtiahrvg a very l.uge
responsrtxlrbes ^n
health programs 'The Directorate of Family Planning should Oe
XTtr^^annX
as maternal and child health (MCH) and nutrition It is unrlouMedlv *"<
no
held, pa/licularty m view ne 'a<j
Integrated (rt had been integrated with MCH in 1963) with MCH .rr th*
arw^^ehtum and made real
loop’ program, but until trie family planning carnp.ngn has pt< ked u<5 '
—
Family Planning only
**»is
in the states the Director General concerned should be res^>n<^cae» r,w
1
r^h^wise used m some slat***. r.u
recommendation is reinforced by the fear that the progr.im may — -.’•ices- (UN Advisory Mis-v-.. m.
expand the much needed and neglected Maternal and Child </Veif*e •>
Report of the FP Program in India NY 1966)

j failure Mainly because
The IUD campaign did not shape up as anticipated and was imore ar ***
social backup scjpport
prime concern was fulfilling targets and lhaf me necessary
r
the
Lok Sabha (Parham-ir^;
facJ—an
Eilimdleb CorMnsOe*
followup was not availaWe lo women in
l..----- ------carets
lo note that the ,IL" o
was critical of the Mmd acceptance of fore»gn advise 'The

-I..-.,-

'5

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omUhsi)

<r

the advise of foreign advisors without analyzing its pros
program was formulated and implemented on
and cons and without exercising an independent judgement on its suitability in Indian conditions and
The Committee suggests that a cntical
without establishing any proper infrastructure for the same
far
be
undertaken
’ (Thirteenth Report of the Estimates
evaluation of the foreign assistance rendered so l_.----------Committee of the Lok Sabha. 1971-72 pg 191)
Since the third 5 YR Family Planning has occupied a central place within the public health sector

Volunteer (CHV) Scheme, though garbed as a barefoot docfof scheme uthmately became an adjunct of
the Family Planning program In the 6th and 7th 5 YP the child survival and safe motherhood programs
undertaken with imemXnal support and gurdance. intended for reduction tn IMP and MMR. had the

objective of Family Planning as got demonstrated in implementation of this program whereby al women
getting registered for antenatal (ANC) and postnatal care (PNC) were subjected to a hard sell of Family
Planning leadtng to declining acceptance of ANC and PNC by mothers and newborns I Th.s obse^
with the Family Planning program has discredited the entire effort put into building up a network for
primary health care in the underserved rural areas All the investment in the health s^tor m rural areas,
thus remained grossly underp.ovided and underutilised because of the pushing of F P target, by the

health and other staff
The above historical brief Is important to understand how Family Planning as a program was built up and
how it's obsession with target has led to the destruction in the credibility of the rural health services

A NEW PERSPECTIVE

It Is Important to note that the official Family Planning program is directed largely at the rural population
In the urban areas the State does not have to exert pressure on the people to pursue a small family
norm. The pressures of urban living induce higher acceptance of contraception

Basically the rural-urban difference arises out of the fact that children among agncuttural families are
assets whereas for urban dwellers a liability

Why Fertility Remains High?

The small and marginal peasant and the landless laborer constitute 80% of the rural population and most
of which exists at the subsistence level In rural India, employment is largely confined to the months
beginning with monsoon and ending with Drwali - this is the kharrf season on which most of our
agriculture is dependent These five to six months hold the maximum employment potential. The more
working hands that a household has the greater its chance to avail of employment opportunities that are
limited seasonally. The greater the number of family members who are able to seek gainful employment
the larger the amount of savings a household will be able to generate to tide them over lean
(employment) seasons. Secondly, family labor is an important means of saving costs of production for
subsistence farmers. Even children make their contribution to household productivity by

contributing their labor to household maintenance that frees adults (the working age-groups). especially
women, to participate more in income generating activities Children contnbute not only to housework
and in caring of younger siblings but also as a helping hand in home-crafts, cattle rearing, fetching fuel
and water, as farm labor on family holdings and quite often as paid workers
Therefore, m •

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predominantly subsistence agricultural economy family labor assumes a highly significant place if
advantages from production are to be maximized for the household, and as a consequence high fertility
becomes a necessary associate.

With the household still as the main production unit In India the family bonds and traditional socio
cultural practices have remained intact. Extended family households or extended family relations make
the cost of raising children negligible because the down payment (cost of pregnancy, child birth,
upbringing etc) of having children is very low as the cost and responsibility of raising children is most
often shared in such families.
Further, such a family structure invariably encourages early marriages because the newly weds do not
have to set up a separate home nor have they to bear the responsibility of rearing children on their own
Thus, an early age of entry into marriage and an absence of contraception practice ( a practice which
such a family structure discourages) results in an extended fertile period for the woman leading to high
fertility. Also, in such families the status of women is low. Women are not allowed to take advantage of
educational and employment opportunities outside the home and village. As a consequence they are
married at a younger age; the gap between their age and their husbands’ is wide, resulting in a
relationship of total subservience, one of which is an uninterrupted series of births for which the only
regulating mechanism are socio-cultural practices that may exercise some control over coital frequency
Another reason for low age at marriage in India is that the female child is considered a burden as long as
she remains unmarried and. therefore, parents seek an early mamage Also in such a family system
women are sought at an early age as daughter-in-law so that they can be moulded easily into the new
family and share its burden of drudgery and family maintenance with other women folk of the household.

The role of education In raising consciousness of a people, and especially of women is undisputable.
The subsistence nature of the economy prevents the majority from seeking education, especially at the
secondary level and beyond When women do not receive education they are married early, and that too
to someone eight or ten years older, and have to take on household responsibilities without adequate
development of a mind of their own As a consequence they become a cog of the patnarchai social
structure alienating themselves from their own self as well as from the colleclive woman, thetr sexual
and reproductive function being outside their control. Education liberates women from this vicious circle
to a large extent and consequently they can also seek productive employment (non-dgmestic). Working
women find child bearing a burden as It has serious economic consequences eroding their independence
by engaging them in child-raising The end result of this (when the woman has the choice) is a greater
willingness to accept contraception and a small family norm In fad our interviews with rural and tnbal
women in various studies have brought forth the fad that these women desire to control their own bodies
and roprodudion but the social strudure prevents it. In a patnarchai strvdure (and especially so in ■
backward society) the control of womens* sexual and reproductive function vest with males for whom
produdion of children, especially sons, is viewed as a reaffirmation of their superionty and control
Therefore fertility control becomes the fundion of the social structure itself It is ironical that insprte of
this women constitute the main target in population control programs.
Another reason for high fertility in India is the nature and structure of the workforce itself As indicated
earlier agriculture Involves a very large majority of the workforce and we have seen how thts within the
given setting contributes to a high fertility rate Related to this is the fad that opporturubes for nonagricultural work are not growing at a fast enough pace A runaway development of the non-agrarian
sector generates population mobility and displacement, denting and eventually spfantering family lies and
traditional bonds. But this has not happened in India Infad, the industrial labor force even in a
metropolis like Bombay has organic links with the countryside that helps retain tradAxwt and aiongwth I
values supportive of high fertility The living conditions in urt>an-irx>ustnal centers (shxn and street
(hveWing) fndiredfy contribute to reterrtion of old value systems because they (Wving condaxjns) deni
provide a security and sense of permanancy to the migrant. As a resut he seeks comfort and securfy
back in his village, the city becoming only an extension of hts rural-scape Therefore, even the nonagricultural worker In India does not. mod often, have a small family

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Swsides. overall poverty,
i-k* of non-famrly based soc^
r^Hinterparts in rest of the third

mortalrty Poof heatth. education and housino facilities and a total
security makes an overwhelming majority of Indians, and their
opt for a family size that in the long run is beneficial for the family’s

**frvrval and growth

policy makers fail to see u>ese basic socio-economic fads and continue to be influenced by Father
to-althus and his descendan! ■
'mm the West and des.gn programs and allocate resources which
not produce expected resu«^
tbis case reduced birth rales

»* there a Population Problem ?

T>i. Mafthusians believe in the resource constraint theory and hence are obsessed with the exploding

p»«pulation bomb in the Snl We'id

Lines reality support this ?

If viewed superficially one can near the bomb tick (to make it visible every major city has a population
Ct.xik on which millions of rupees nave been spent, the PMs office has a clock donated by UNFPA and
r>*x)rdarshan every morning aiong^wrth Vande Mataram reminds us of this growing menace.)

T*h- startr poverty, malnutntion ifimeracy. high infant and maternal mortality all tend to Indicate that we
OWHII have enough resources to grve basic amenities to all Hence wrth a smaller population the given

resources would have been better drstnbuled Sounds pretty convincing1
th., question here is what is a smaller population ? What is the quantum of resources that each person
wvuuld consume ? How should ttwe population size be measured - in terms of land : person ratio. In
1f>-ms of agricultural production in terms of energy / resource consumpfion etc ?

developed countries hate these dirt/ questions because if we start answering them the population
b*nmb myth is exploded

Fw. instance, if resource avaiiabriny is a constraint then population should be measured in terms of
resource consumption Vasant Pethe an eminent Indian economist has constructed a paradigm which
shHwvs that population growth is not the cause but rather the effect of poverty the blame of which he puts
or the inequitous international economic order
He has calculated that if population size must be
rr-Misured in terms of resource consumption then USA s population will not be 250 million as measured
by the census but 25,000 million because the average U S consumer uses resources 100 times that of
th* average world consumer Hence by this measure India’s population would be about one-third of rts
count or just about 300 rnilbof* '
Or* IS not arguing here that resou>ces are not limited One is aware of that but what we want to
ewamlish is that the numencaliy larger 3rd world population is not the one responsive for deletion of
especially the non-renewable resources Intact, this question was surreptitiously glossed over at the Rio
EiMir. Summit held in 1992 It i» time that we said NO to this number* mama and demand that people
in »le under developed countnes be viewed as a resource for devetopment If the West must insist on
counting numbers in under developed countned then they should not object to counting of their
co.isumption volume (by saying mat lonsumption is a personal matter) The United Nations in that case
mu*i complement the population policy initiatives in countnes wtuch the west regards as population
borMtos. with a policy for consumphon in the wasteful West Like targetted growth rates for fertility and
ret-edudion there must be targetted ceilings for consumption of goods and services m the West In the
global context both (the population policy and comsumption policy) must go together
If thia
cr.o.plementarity is not acceptable then the entire focus on the population issue must be shifted
to investing in people
If jieopies basic needs and aspirations - employment, housing,

5

education,health, old age security, etc. are provided for people will naturally become more
socially responsible. If people are given a stake in the system they will have a stake m
system.

So, now we know where the population problem lies 1
Can We Change this Perspective ?

The Indian state is sold over to the population bomb perspective
do we bnng about a chang*- n trus
? What follows is not a prescription for change but only issues that if highlighted, could contn
efforts to bring about a new perspective

Firstly the population problem’ should not be viewed in a single country's context alone Odp
place it in the context of the global economic order Resource generation, distnbution and use shr -uKj oe
the focus of such a perspective. It is not a simple economic question but a strongly political one
Secondly, one must question the aggressive and imposing stance of agencies from the West to cb-Y^ out
population policies and design FP programs in 3rd World countne*
The West views the lanj* a.x!
growing population of the unerdeveloped countries as a threat to LTieir own survival. For instance tner
own technologies are Capital intensive which cannot be adopted on a large scale in under dev*»»opec
countries because it would exacerbate the unemployment problems Therefore the only way th** Aes;
can dominate is by reducing numbers in these countnes so that tnoir (West's) technological dom*nance
stays intact and the vicious cycle of dependence is perpetuated Hence the West is obssess**?
population control. But their ideas emerge from an understanding from within their ov/n socio-c^r’ura?
and politico-economic system and hence are doomed to failure .n societies which are very differ***n
r.
India most rural development, health and FP programs have been designed with foreign assistance one
almost all have either failed or have generated contradictions with a now senes of problems

Thirdly, following from the above mentioned, the local socio-cultt^ai economic and political conaiti<xi$
are important determinants of peoples' actions Why they accept of
accept a small family norm nest
often has very sound reasons, as we discussed in an earlier secticn One cannot impose a FP program
from above If it conflicts with peoples' reasoning Only changes n their socio-economic conditions for
instance, the professional middle class in India) which change ifieir objective reality will ultimate^
change their reasoning vis-a-vis family size India's flirtation with
coercion dunng the "Emerg cy*
demonstrates how no amount of hard sell or force can change hurnjbn behaviour The focus should
be on changing the objective reality

Fourthly the ultimate determinant of change m reproductive beh#w*our is acceptance of con(raceL*;f«.'v
Only a radically c/ianged objective reality will bung about this ac-c^xance Until then the State's emwts
with regard to reproductive behaviour should be* limited to assunng that tafe contraception is
available to those who feel the need to control their reproduction Thrt changed perspective will g/?**nv
improve the image of the public health sector especially in the n-rai areas and restore the faith of
people in primary health care services whose credibility has oeer, thoroughly damaged due to
obssession with the numbers mania under the family planning progzcam
To conclude, we would like to emphasise that there is an
need to evotve a new gxxx.
understanding on the issue of population and development Lal us ibof count paopia. Let us inva«r n
them.
CEHAT.
519. Pidbtiu Darstian,
S S Nagar. Amboli.
Andhen(W).
BOMBAY - 400 058

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INDIA’S ‘FAMILY WELFARE’ PROGRAM IN CONTEXT OF THE WORLD
BANK ENGINEERED REPRODUCTIVE & CHILDTrEALTH APPROACH

A Critique and a Viewpoint

Ravi Duggal, CEHAT

This note was presented at a meeting in Washington in December 1995 where a review
of India's family welfare program was done in the context of the 'new' reproductive and
child health approach which is being promoted by the World Bank. At the meeting were
present representatives of the Government of India from the Department of Family
Welfare, experts from the World Bank, from a number of US NG Os, afew from Indian
NG Os and some from other international agencies concerned with health and population
issues At the meeting the World Bank document Report No. 14644-IN titled 'India's
Family Welfare Program : Towards a Reproductive and Child Health Aprroach' was the
main agenda item to be debated. The meeting was organised by the Health and
Development Policy Project of the Tides Foundation and the Population Council.
I

During thr
'st decade or so the women’s movements the world over, and
especially .
the west, have brought to centrestage womens’ reproductive health
concerns, the origins possibly being the abortion debate in the United States of
America. Add to this the threat from Acquired Immuno Deficiency Syndrome (AIDS)
and the population control lobby’s supposed population bomb ticking away in third
world countries and you have a new health policy prescription for countries who
are seemingly endangering the world with their high fertility. India is one such
country whose health policy is being reshaped in this new global context.

i

Another set of global programming for the third world countries is the cutting down
of state expenditures for welafre like health, education, social- Rpr.iirify etr. The
prescription here for'fRe'‘state isTiTnarrow down its focus to providing essential
services only and that too for a select population of the extremely poor. Thus, in
the health sector there has been a descaling of goals from basic health care for all
in fifties and sixties to primary health care for all in the seventies and eighties and
now in the nineties it is selective essential health care for a selective population.
The consequence has been that the health policy in the third world countries is
increasingly being narrowed down to fertility reduction.
This development and its consequences are of crucial concern because even in
India adverse affects are very visible. Health care investment and expenditures in
the public sphere are declining and people are increasingly being pushed into
seeking c
n the private sector even if they can’t afford it.

India’s Family Welfare Program

At the outset it must be stated that ’family welfare1 as a title is highly misleading
because the entire effort of the concerned department is family planning, and That
too mostly tubectomies. Other concerns of this department like child immunisation,
antenatal care, abortions, deliveries, postnatal care etc., are only marginal -

occasional spurts of activity like universal immunisation using a mission approach
did change things temporarily but as routine set in it could not be sustained and is
again marginalised. One doesn’t have to give the gory details of statistics to show
how miserab'e health care in general and specifically for women and children is. It
should suffice: .o mention that access to basic services like basic medical care,
facilities for child birth, abortion services, contraceptive services, pregnancy care,
immunisation etc., are just not there when clients visit the primary health centres or
other provider units.

__

While in the nineteen fiftiesdhe state did put in efforts at building an infrastructure
to deliver basic health care, these were abandoned sometime in the sixties when
population control started to become the cornerstone of India’s health policy. The
first casualty of this new approach was the maternal and child health program with
which the family planning program was integrated on the advise of a United
Nations Advisory Mission to accomodate the loop program (the first ever IUCD
program). The meh program had at that time just taken off in the rural areas with
the setting up of subcentres and a large scale appointment of auxiallary nurse
midwives but both were hijacked by the newly created family planning department.
From then on there was no looking back and population control kept getting an
ever increasing share of attention of health policy, planning and resource
allocations. This might appear to be an exaggeration because ‘only’ about 15% of
the budget of the ministries of health goes to family planning, and hospitals and
medical care get about ’as much as’ 40% of the budget share. But it is not,
because 80% of the 15% on family planning is spent in the rural areas and 85% of
the 40% on medical services goes to the urban areas which have only one-fourth
of the cou’-'. -’s population. Further, the entire health team working in the rural
health infra?. jeture (as also those from other government departments who have
FP targets to fulfil) spend an overwhelming proportion of their time on family
planning related activities - this means they are forced to encroach on their time for
other health care tasks.
The fate of all subsequent programs, like the minimum needs program and
integration of health workers under the multipurpose worker scheme, the child
survival and safe motherhood program, the community health volunteer scheme,
universal immunisation program etc... was the same - all ended up serving more
the interests of the population control program than adhering to its own objectives.
And it is this that makes up the misery and tragedy of health care, and specifically
womens’ health, in India. If each of these programs had been implemented
genuinely as vertical programs like the small pox eradication program or the
malaria control program of the sixties (even though I am against the concept of
vertical programs) some significant achievements in women and child health care
would have taken place.-1 fear that the fate of the proposed reproductive and child
health approach will not be different and it will end up being a mere change in
nomenclature Also, given the fact that it will be directed largely at women it is in all
likelihood going to further strengthen the targetting of women for fertility reduction
and again keep men outside the frame of responsibility for reproduction.

Further, i‘
- aid by many supporters of the familiy planning program that if it were
not for the agressive family planning program fertility would have been much

.

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higher tn India. While one reemgnises the contribution of the family planning
departement in promoting coniraspption and increasing people's awareness aboutthem < is too far fetched to give the credit of fertility reduction to the program
Fertlity reduction has its own topic and worldwide it has come about only with
change in people’s objective reafifty, that is improved conditions of living, livelihood
and so»cial security. Conditions off poverty and large-scale inequities will normally
not leaikti to the desired demograptaic transition. History bears witness to this I

Saying 110 to a Separate Reprodluctive Health Approach

While :the elements defined in She package for reproductive and child health
services are essential and must he provided it cannot by itself be an essential
program. It must of necessity be part of a basic health and medical care program.
Good duality basic health and medical care must be the starting point for meeting
health .care needs of a population and it must be made available universally and
not lirfeed in anyway to the ability io pay for it. One must also move away from the
tendency of romanticising health care as was done with the community health
approach (demystification, peoples health in peoples hand, non-medical model
etc. ) A basic medical model is essential and desireable (not over-medicalised as
in the uJSA) and its social components must be constructed on such a base doctors and nurses must form the base and paramedics and others must provide
the support to give it a social and people-centred character, that is standing the
classical community health modef on its head I I will come back to this later.
Thus, wvhile recognising the importance of reproductive health, especially in a
country like India which still has relatively high fertility, an overwhelming proportion
of delu-eries being conducted at home, often under unhygienic conditions, a
supposed unconcern for gynaecological morbidities, an embarrasingly high
proportion of abortions being done outside the legal framework, etc... it becomes
even n>»ore important to emphasise the need for making available comprehensive
health services to all, and especially to women as a group for their special needs.
And as mentioned earlier the danger of beginning with reproductive health (as a
separate or special program) Is narrowing down the focus to the uterus, precisely
what tbwe women’s health movement wants to avoid. Thus the demand must begin
with provision of easily accessible and free of cost (at the point of care)
compr&iiensive health care for all, with a clear recognition and provision for special
needs of women, as well as of other vulnerable groups like children, the aged,
tribals «tc...
Thus, fitting the suggested reproductive health services, which have been well
though) out, within a comprehensive basic health system should be the essential
goal arwj not fitting it into the current family welfare framework. Hence one cannot
but agree with the recommendations in the report about five specific actions to be'
taken
define a package of essential services; improve access to good quality
services make services more responsive to client needs; make sure that the
frontline workers have the skills, support and supplies they need; and strengthen
the referral system. But such a package, we emphasise again, must be one of

comprehensive basic health care in which the package suggested by the
eport
becomes an essential part.

i
I

I

I

It is important to emphasise a comprehensive package of total health and medical
care because India’s experience with separate programs for each major ar&a of
health problem has not only shown major failures but also resulted in wastage of
the already small amount of resources which the public health sector is allocated
from the state finances. Hence, its time that structural changes are matte in
provision and financing of health care and not by adding another set of social
programs for a select group of population. We have done the latter for too lorn? and
wasted public money on programs which have been not only unable to fulfill their
objectives but also have alienated people from the public health system esoeviallv
in the rural areas.
’
y

Basic Health Care
While this is not the forum to discuss a detailed plan of action we can atteast
define the provisions which should go into this comprehensive package in- the
context of
five specific actions stated in the Report under review. First, a IM of
services wri.uh a comprehensive primary (or basic ) care should include :
-general practitioner / family physician services for personal health care
-first level referral hospital care and basic specialist services - paediatrics
gynaecology and obstetrics, general medicine, general surgery, dental
services and opthalmology, including special diagnostics
-immunisation services for vaccine preventable diseases
-maternity services for safe pregnancy, abortion, delivery and postnatal care
-pharmaceutical services - supply of only rational and essential drugs an opr
accepted standards
*
-epidemiological services, including laboratory services, surveillance ant?
control of major diseases with the aid of continuous surveys, information
management and public health measures
-contraceptive services
-health education and information
-ambulance services
The above must be viewed as a single package of minimum care which must Ha
available universally and without any direct payment They must be supportetr hu
secondary and tertiary levels of care which are already quite well developed- in
India and only need to be reorganised in the new context. The provision of such
care of necessity has to be a public-private mix (given the fact that India prob^oiv
has the world's largest private health sector), with monopoly buyer/s which nw^d
not be th • ate alone. This also means regulation, control and audit nontr of
which presently exist vis-a-vis the private health secror And it goes without sav no
that special needs of women, including their recxoductive health needs
discussed In the World Bank document will be an integral part of this packaae
each service available at the appropriate level.
9
th

c»

Alternate : Drop Family Planning as a separate program and strengthen prevrsjon
for basic health care under a universal organised hgoJip. care system to meet
needs and demands of people (in which reproductive and child health
and
contraception will be important components).
dr
policy Recommendation*

World Bank : Eliminate method specific contraceptive targets and incentives
Replace them with" broad reproductive and child health goals and measures
Increase the emphasis on male contraceptive methods and broaden the
contraceptive method mix.
Alternate . Restructure and organise the public health system to provide universal
basic health care with supportive referral services in basic specialities, which would
be sensitive to special needs of vulnerable groups like children, women, elderly,
tribals etc.. Remove targets from all health programs and introduce measures of
social audit and accountability.

Public Sector Recommendations

World Bank : Improve access to reproductive and child health services. Respond
more effectively to client needs, for example, by listening to clients’ preferences,
and by Imroving service quality. Increase support for the frontline workers, for
example, by enhancing the quality of training, and providing adequate supplies.
Improve the referral system, especially for essential obstetric care, by
strengthening the Primary Health Centres and First Referral Units.
Alternate : Improve access to basic health care by strengthening profusion
especially of non-salary inputs. Respond more effectively to client needs by making
available bucc services which they need and by improving service qm&hty
Strengthen basic medical humanpower in primary care and increase support for
them and other frontline workers through provision of adequate supplies, improved
training, better working conditions, removal of targets etc., provide opportunities for
staff to upgrade their skills, for example, ANMs coufd undertake intensive courses
to become full fledged nurses, and nurses similarly could become doctors, which m
the long run would help women to get both better access to health care and better
attention of their health needs as women. Improve the referral system by
strengthening the Primary Health Centres as above, as well as strengthening the
basic specialities at the First Referral Unit (Rural Hospital or Community Health
Centre).

Private Sector Recommendations
World Bank : Increase the role of the private sector, especially by : a) revitalising
the social marketing program and adding health- and nutrition products, b)
expanding the use of private medical practitioners in lhe provision of reproductive
and child health services, and c) continuing to encourage experimentation with an

o

-

-

<

Thw Private Health Sector

a- mau~

T)he private health sector as it exists today
•
_ 'a— _ I —
vewiture but IU>
----------r---.ts imcui
, —fJ
8nd- involvin0 _ Health
private■aHnr
heatth sector

^n’nXS

in^ie same'rnanndr in w^ch .« does wHh regard to many areas of economc
activities The myth of the private health sector being more
providing better quality care
"has already
beenf_adequa
e y exp
carejftas
afready L-u
8nd audi|
tf^- time is ripe now to start She overdue need for Ha regulation, control endI au*t
In «n organised public-povaae mix of health care services the private sector
secto will
—- •level
----- 1 ■*<
a domtaant bJt re’g^atesd role at the- *•
first
of care, that is family physician
services, as also participate an terms of its capacity at other levels.

Fmumcing

orientation of health services, resources from other sub-sectors of the public hea.th
system are also used for tf»e family planning program, especially human resources^
It « understandable that th* amount is far less than what is required for the
suggested reproductive heatUh approach, but what is worse is la
health
budaet is far far more inadequate than what is needed to meet
Spies’ basic health care demands. We have to demand the 0V®^IHncrease of

resources for the public heatth sector close to the WH re<?°n]2Ijl of this ratio can
the WP. And we must remember that any provision wHhm the lim. of th s rabojcan
in mo way be termed as high cost. And we must also emp asi
financino
th.4 cannot come from tax .revenues and hence other avenues of f'na^i 9.
esjjaecially from the organised sector (employers and
" °^cia
the middle and rich peasntry etc., need to be tapped through '7ura^ s°c'al
insurance, health care taxes and cesses etc., and no user c
g
now an ancient concept. Thus the role of the state in orgamsi 9
penpciallv
such a system will be crucial and its responsibility of prime importance especially

for the poor.

Alternate Recommendations Vis-a-Vis 1 he World Bank

To sum
sum up
discussion above
above we
To
up the
the discussion
we list
list out
out our recommendations as against those
of r>ie World Bank being pedalled with the government of India.

Overall Recommendations
-3 quickly as possible, to a
WoHd Bank : Reorient the Family Welfare 7
Program, as
reproductive and child health approach that
t—meets
-------- individual client health needs
and provides high quality services.

4

; ”

'Z"’!

'

r-Tr

•

'

',r:
'-’r

exepanded role for the pnv»e sector in implementing publicly funded programs;
«^^«UT*onitoring the experiments and identifying best-practice for dissemination.system
wide.

Alternate : Involve the private sector by : a) organising them under a single
uenbrella t > ovide baste h&alth care under a public-private mix system, b) Unking
ttnem with various preventMe and promotive public health programs in a socially
mtfiQningful way, and c) cremating mechanisms to regulate them as a measure for
sixeial accountability and put^c benefit.
"I

Finance Recommendation*

World Bank : Increase the budget for reproductive and child health, to meet the
staffing and other critical gaps, to enhance service quality, and to offer an essential
reproductive health packaoe; and use funding as a performance incentive to
reorient the program towarcs a reproductive and child health approach by taking
steps to improve state level finances.
Alternate .* Incre3se the ov&rBll budget for bssic heQlth CQre to meet bdsic hedlth
n&eds / demands of people zmd use monopoly financing as a tool to both regulate
tf*e system as well as integrate the public and private provision of health care, fhe
avocations to various progrstm heads should be based on expressed demands of
thx^ people, especially thos^ in presently undorserved areas. Using innovative
methods to enhance resources by targetting indirectly people with capacities to pay
and doing away with all forms of user-charges at the point of seeking care.

kj * i inNAl POPULATION TOLICY.
"".•koLlems AM> rOSSIBILITlK

By Lmrana Qadeer

indicates
unccd bv the government
coercive and a voluntary approach
c0
that it strives for
.............

‘^‘au’dwhh key components
of economic «"<'
to enhance
.............

society”

felines, the present

repealed

Looking

wl,iC"

necessarily because
whcn tbe vely
aS i‘ C0,nCS tLTarc being dismantled by rapidly
to be integrated aic ocing u
’S

i c-ition by 2045. It envisages that
range ol
T»
'

receding State initiatives.
'Ibe popoMon

chM oaro se^iees .o seduce 1^

>

’ xS* '*,cs- r1 ", al fcn,"ly ralcs’

■ education up to secondary leve ,
■ delay in age of marriage,
■ registration of vital statistics, z- with a special focus on AIDS; and
■ control of communicable diseases,
f social sector programmes.
Z a commitment to convergence of-

f twelve strategies

? x or

planning f<

s„^es.

: of women, insuring; chi d
welfare services, empowerment
1 for the basic needs of
need for family welfare andof diverse health care Pr0^S (
adolescents and men, use c.
mainstreaming Indian system
and commumcauoo
t •
infonnation education i-.
_
...... No,.bl. — '
c|i,
population are also
not new.
;d medical
practitioners to fill m the gap
system of licensee

«

1

SpeciaJ needs
privale sectOi
tive research, eflect.

for t„c

proposal1 to revive i
and to conve;
„„ a..

services at the village level. While these are welcome strategies, their content leaves much
to be desired.
The policy document raises two sets of questions. Firstly, how consistent is the
content of the policy document with its overall perspective? Secondly, how will the
challenge of convergence (of the welfare sectors) be interpreted by the States, which will
actually be implementing the policy? This paper attempts to explore these questions. It is
our belief that if the inherent contradictions within the NPP and the potential of coercion
in the implementation of this policy are not corrected right at the beginning, anu stnci
guidelines not provided, the policy will fail to realise its potential.

INTERNAL IN CONSISTENCY OF THE POPULATION POLICY
There are some very obvious inconsistencies in the NPP, which need to be
addressed if the policy has to acquire a positive edge. Some key areas for consideration lie
in the dissonance between the NPP’s welfarist approach and the reality of the government's
disinvestment plans, between primary health and reproductive health, between
convergence of welfare services and the available structures, and between voluntarism and
coercion.

Conflicting Population and Development Policies:

If the population policy's expressed concern for quality of life and well being is
genuine, then structural issues cannot be under-emphasised, even when it is accepted that
population number is an important factor in development. The NPP document, however,
neither talks of land reforms or strategic;* for employment generation and food secuiity
systems, nor of ensuring the celebrated ‘safety net’. But it does reiterate that, “stable
population is an essential requirement for promoting sustainable development with more
equitable distribution”, thus making it a one-way process. It warns, “if current trends
continue” India's population may overtake China's by 2045! And it adds that, “at the
current growth rate, the additions ‘neutralise’ efforts to conserve resources and
environment!”

fhese demographic fears are not new. They reflect a mind-set rather than a real
new threat - a mind set that is unable to accept the complexity of the problem and that
must hide behind these linear projections In India, for example, despite the perpetual
failure of the family planning programme for population control, birth rates have steadily
fallen over the 20th century (1) Interestingly enough, in 50 years of planning, the
programme targets have never been achieved at the end of a Plan period (except during
the Emergency!) As things stand, there is nothing different as far as the present
projections go But over the later half oi the 00s, the rale of decline of infant mortality rate
(IMR) has slowed down and, over 1990-98, the Sample Registration Scheme shows its
reversal in at least eight major States (2) I hus, the not-so-improbable danger that
population growth rate may come down, but because of the added factor of rising
mortality rather than declining fertility rates, has not been taken note of by the NPP

2

-U*

„d

zzxtzs? XuXd'X

pAulaXn growth fo. .be -neutralisation ofenorts to conserve the resource endowmen
Ltd enviroSnenf the Policy, al best, protects processes such as liberalisation and
StiueX Xustmem th., ensure a kind of development which sustains only eetotm
Structural Adjust.
(u accept tha, pOpU|a(1on
sectmns at the cost ‘ °“ ^Scrcatc
ing wlllth 1S a necessary prerequisite of, or

“XXm fZ.m^t™ «**->*

"" CXC"i“

•»-

fiaxing’

example
patu
)t ()f- wofkcis, in a way that the worsening employment
pnvausanon, a nd
-l ‘ J
i(c (ld
lalc gmwth rates, poverty levels have
situation aHects then vvcii .oikva
>
... There
- -=,r' ;:v

•SXiem «e..ed

or

:Xi.: s

» ...d Lu..,™ disploee.nen. W » «!.

»e

become key contribunons of development projects in independent Ind.a (7). I hest
y
i -adiuzst” Third Woild economies to suit the hi-tech markets and for
projects are meant to aujust umu
the promotion of distmted development

Even when »•' look at those above the poverty, llieie is sulliacnt evidence Io
show that maiority ol the"' •'« "'S’1"'1!' ’I1“lcd by
o"Eoi"B S“’al
““"T
processes For examples in laic 90s, total employment lias declined - especially anione ic
Etc and 0 c ede'.«d - win, seek employment other than manual (8) .Similarly, the
conuaet on o the nnmgamsed sector in the late 90s has pushed a large number of rural
Xie imo °e i'ely lot productivity areas Added to this is the shnnkmg social sector

XXes emploti en. oppo.tunrt.es (9). and makes services maecess.ble as pnv.te
sector hikes prices of health, education and other necessit.es

These examples illustrate that the conOict is not simply between the “population
added" ae' oss c set and .he resources generated by those classes, but between sections
Xopu at o Av t rmpee. 'o control over resources, irrespective of the population added.
TheAssue iTmore of b'
for the poor, and their basic
o

auainst the rights of other classes to further enrich themselves. The inabdity of the Ni l to
,1 t
t . linkages is also reflected in its narrow approach to under- nutrition.
lAeXA CMd Develotinien. Services (ICDS) alone and to dislribmion of
c mgs o
snulies in llic past have shown Hie inadequate coveiage and the
micfo-nutnents when uuuiv^
i

3

inability of the feeding programmes to impact nutritional status of the population < luj
These programmes were actually short-term strategics, initiated in the 60s and
is to
tackle a crisis situation. The assumption was that with long term planning, these 4ould
become redundant.

As it is now, the NPP does not mention any concern either about the failures I the
Public Distribution System (PDS), nor of the process of commercialisation of agriculture
that is undermining the food security system (11). Employment opportunities f< f the
unemployed, ensuring minimum iwages, public distribution system for food
“
grain* and
electrification are not important issues for the NPP. By avoiding a review of the native of
the developmental process that burdens the weak and forces them to wait for relief and
not defining concrete shifts in structure for the benefit ot the marginalised, the NPP
creates a myth of perfect choices and opportunities This fits the demographic
requirements of the globalisation process that demands the profitable use of hi-teeb but
not of human labour.
ConHictifig RCJI and Primary Health Care Policies

While the NPP proposes an integrated approach to basic health care, it in tact
reduces basic health to RCH. I his is at the cost of general health care, especially tor
women. In the absence of an explicit health policy, the NPP sends a clear message a^out
the priority being placed on population control as against Primary Health Care (PHC) I he
previous health policy, that had committed itself to achieving PHC by 2000 AD, has not
merited even a reference in the NPP document. It talks only of “primary level care” I he
supportive secondary and tertiary care essential for PHC is ignored, as is the notion of
comprehensive development of communities. The result is that Priftiary Health Cedrics
and Sub-Centres have been totally identified with the Family Welfare Programme in the
N1 P. 1 his will only further alienate people from the pcnchcral institutions.
I he NPP, instead of stiengthening PH(’, appemrs to initiate a quiet proces< of'
appiopiiation of the basic infi asti ucluie for RCH, while snnultaneously condemning I he
existing infrastructure for lacking ‘supetvision’ and ‘moL’vath'if and for being limited ind
over buidenedl I he policy, in fact, goes out of its way to declare that the last 50 y^ms
have demonstrated the unsuitability of these yaidstucks" for assessing health uue
infrastructure, particularly for remote, inaccessible, or sparsely populated regn ns
According to the NPP we need to promote, “a more flexible approach, by extending b»xic
RCH care through mobile clinics and counselling services” In other words, experim* n
such as mobile clinics that were proven to be costly and t failme in the 70s (12) are be (lg
revived al the cost of that very infiastructure that neetbs resources for its rejuvenat:. -u
I here is not a word to explain why RCH cannot remain i component of PHC and why hc
available infrastructure (among the best in South Asia) cannot provide comprehen- r
I HC (i e including R( H), fully supported by secondary anid tritiary level care

I here is much
i
talk of partnerships ’ and mol (listing a variety of service providets
to overcome the need for infrastructure However,. whan w< »uld be the Slate's share -t

i_

. tT- x .7' —

.

xxx;

.'l

t

in the areas identified and how much would the partners contribute, remain^
anv one’s guess The “partners” seem to be free to bargain with the government on this
issue At the same time, with cuts in subsidies and plans to privatise welfare sector
services, the access of those who need the services most will necessariljrbe marginalised
further.

While the NPP emphasises quality of RCH care, it also proposes, “elimination of
the current cumbersome procedures for registration of abortion clinics”! This is counter to
all notions of strengthening and enforcing mechanisms for standardised services, v
Registration is a means to assess the adequacy of the institutional infrastructure and its
quality. Any dilution of conditions for registration will have a direct effect on the quality
of services provided by institutions. Laxity in registration will ensure only proCteenng by
unscrupulous providers and not add to expansion of effective services in the real sense.
As a part of its integrated strategy, NPP does mention control of communicable
diseases but docs not comment on their vertical structures, their incffiaency and
inappropriatencss (13). With their exclusive single purpose workers, who travel to the
same places and multiply travel costs as well as waste people’s time by increasing the
number of visits per family, the present vertical programmes enhance inefficiency. Tins
was recognised by the government itself in early 1970s when the Ministry of Health and
Family Welfare introduced the concept of multipurpose workers (14).

The NPP’s exclusive focus on AIDS control programme is due to the perception
of a shared interest in promoting condoms and treating reproductive tract infections and
sexually transmitted diseases. The policy docs not recognise the dangers of poor
infrastructure for PHC that makes the population vulnerable to contacting AIDS through
the use of inadequate facilities such as unsterilised syringes. The programme records 24%
of the AIDS cases come from among professional blood donors, drug users, recipients of
blood transfusion and others (15), which arc indicative of laxity of services. Yet, there is
no accurate assessment of the implications of the inadequacy of the PHC services for
AIDS It is evident that improving the quality of PHC (including blood banks) will
contribute to AIDS control. An aid amount of Rs 1425 crores from the international
funders for the second phase of the programme seems only to enhance its vertical nature
(16) The NPP ignores the social situation that was conducive to the spread of AIDS. As a
result people remain victims of their conditions, as well as of the very system of health

care that was to protect them.
This deliberate undermining of PHC services and the NPP’s linear approach to
RCH is damaging to the cause of reproductive health itself, fhe problems of maternity and
infant health are the outcome of a continuum of ill health for women. Over 40% of deaths
among girls under 14 years of age arc caused by communicable disease (17), and anaemia
and malnutrition are prevalent in about 60-70% of the women (18). Therefore, no amount
of reproductive health services alone can be effective. The reproductive system is a part of
the body and a sick woman can hardly sustain a healthy reproductive system. It is well
known that a significant part of maternal mortality is due to sickness. Any isolated

5

! J

I

1
Conflicts Between Conceptual and Structural Needs of Convergence

pr°feSSed P°licy for integration of RCH, the stated strategies for

converoino

novelet thT YVh^1063 * s'™8111611 RCH

iU defined- 11 » also

VagUe’ Weak’

not clear that, if the presenbed services (such as primary and secondary education
hous^ dnuhHg water etc.) are to be provided to the needy, then how are the respective
epartments going to define their tasks and restructure themselves so as to be able to
eiver these services. A policy of inter-sectoral convergence can be successful only when
the: ministries have clear guidelines and mechanisms for delivery of the required services
These gudehnes are missmg in the NPP. In which case simply putting bureaucrats from
the concerned mimstnes on to the Population Commission may not help. These services
can be supportive of RCH only when they are operative in the field and cover both the
Zanr |d
f°7h,S the resPective departments need to undertake very clear-cut
nnancial and structural reforms.

I

I
I

hey may be imbued w.th excellence in their own area of expertise but they are bound to
ranTZV^Pr^f3 ,n assess,ng issucs of implementation of the NPP. These issue?
range from technological, administrative, financial, organisational, to social and ethical
ones. At best the Commission can work towards evolving a consensus on issues To
see implementation a more cohesive group will be required, with clearly set evaluation
mechamsms and working on a continuous
r
• • The
— policy does not visualise any such
basis.
* assessment mechanism within the
™Crhanism'.11 ne.itller SCts ••up “ internal
-.
•llWliGUUOlIl VYilfUll UlC
M.mstry, nor an independent external monitoring mechanism through the Planning
sCeXUsfornthenfthe|PaSl IP16
Cornmission has Provided excellent monitoring
services for the family welfare programme (20). But the NPP only proposes to use the
Planning Commission as a co-ordinating unit.

The hpJh6 TT f°r rie abSenCe of ri«orous mechanisms are not difficult to identify
the tSle 'f?'
‘0
t,On “ 3 SOP ,O 8et S°ft l0anS and inlemational aid to keep up
au Jb < , . [e'8n CUrTe',Cy ,O COrreC, t,,e balance of Paymentsl As a result the tags
th wel^
haVC ,0 bC aCCCP'Cd Consequently, the distortions
de P.te SO

,han ren,cdied H >» not surprising then that,

,8n°red

h

,he deTO“°" °r

Rai-

.

Bank
,h,at P’3"5 evolved by international funding agencies like the World
ank cannot be over-ru.ed, despite all the wisdom buried in the shelves of the Ministry of

6

MmRmMMMHMHRMM

........................................................... i’

w

'■

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.

.'..a.-;'*-..

:

....

-j .

-l.
--

11
I I
i

'll
|

,.

y,

•

-..-z-

.

.r:

.....

X<-

^.b and Family
F«nuy Welfa'e
Wdr« .-»•
S-enunen, insd^
«n»d government.
h»mn8Co>nmiM.ons
of ^pulilion Babilisaxion as a function
:hc offirdal understanding of populationrtabilisation
PHC (22), reflected the offiucud under
gimpIc
-J
was
seen
as
1
M well-being. PHC for the undterp vd ged ,
restructuring was envisaged
— An£ for all this, major restructuring
ttorrectives in the delivery system
a,
J
f. appears to
today, all thatt b»
has bec^
become .a -ng
tthing of the put. “
The NPP,X
on
.
^•^
striving
for
a
broad
comprehensive
approach
brt
is
—
rcduccs
rathcr than
than
Mtriving for a broad comprehensive app
, policy that reduces, rather
impulsion,
for pupulndon con.ro.)
wmpuisio„s of
»f .be
“-■<"> .nd
“d force,
mtcieases, investments ift the welfare sector
H
r
Larkssts for the planned benefit of a handful.
restructuring to promote m---------support the policy is yet another aspect of the
The lack of legal stnuclurcs to ----- The NPP’s treatment of women s
conflict between strategies andlack
structures
of sensitivity towards the issue but also a poor
empowerment reveals net omiy a -----* is to improve ‘ nutrition related
understanding of it. For esample,
empowerment
i.
to a woman
’s well being,
and through her, to the wellcapabilities that become crucual t_
unnriPn1 iis not clear except that Panchayats
toeing of children”. How this empowennent wall JaPP®n
of rcsources witliin the
In the absence of resources witliin the
are expected to provide them emptoyment. In the acm
is clear: according to
rnnchayals, ibis remains • bypolbcucal
.
evollclj or miligaled
W1.. women'. be^.b .4
X” no., wMconei.no.

f

iXXXSX.nen^es.in, .o ...y in "low income grouP." i. ...med,

*l*e states may fearlessly and ellccuv y p
ortive of womcn. The legislative
other
provision is
X-on. property rigb.., polM
requirements for ensunng
Women’s empowerment is thus seen as a
participation, and safety etc dl
tha(8 omotes fertiiity control rather than creates
programmatic intervention from
P
enabling conditions for tbenr

J

Conflict of Voluntary Acceptance and Coercion
rejects force and coercion. It is therefore critical that the
The NPP couXloX e thmuglr the back door of motivational strateg.eSi
same does not re-enter the progra
the policy proposals. There is a proposal
This is imminent in threoJ
for
<^5 for children below 5
to start national health insuram
8 )ce of lcrrainal methods of contraception and
years of age It is however ,»«Jed
HP thus propoSes to deny help to a child for the
small family norm by^the> fam^ I
Y
do sQ> wh tl t chlid

“SS:

ibo i. dispensable in f-ies wahing for .be

o.a son,

■ ' line. A health insurance
The second proposal is for those below the poverty
exceeding Rs. 5000, and again linked to acceptance
scheme, again for hospitalisation not l ipting sterilisation is also given a personal accident
of the two-child norm. 1 he spouse acce|
7

■
I

insurance cover. Shouldn’t those below the poverty line be given assured service, and
better coverage without arm-twisting, so that well being mduces acceptance of a wall
family and population stability, rather than denying basic amenities? The third propwal >s
to honour and award the Panchayats and Zila Parishad for successful performance w the
basis of services provided, excluding sterilisation and harmfill contraceptives. However,
such incentives may induce pressure for achievement and we have the experience to

foresee which section will bear the brunt of this pressure.
The NPP lacks trust in the people. It assumes that they do not think of their
welfare and hence a certain amount of pressure and conditional mcentive are reqwed
This is dangerous because the limits of these pressure* arc very ill defined. Perhaps this
attitude is bom out of the knowledge that, in the present policy for overall1 development,
there is no scope for well being of the poor. They have to bear the burden
the
Structural Adjustment Policies and hence must be coerced, coaxed and pushed., not
through well-being and expanding opportunities, but through pressure and coercion.

Interestingly, the lack of trust in people is not fimited to the common people •lune
- it extends beyond. The NPP proposes to set up two technology missions outsit the
purview of the existing national research institutions. One 0,
of the
these
j®^is
is for neonatal car* and
I
the other for the assessment of new contraceptives. While the first is to be composed of
Indian obstetricians and paediatricians, and is called the National Technical Comnrtttee,
Comnwttee, I I
the second is called the Technology Mission and will have international experts mi it! 1
ThLrin
thekm
’rof
Thus, in ’the
name
of hi^
high-powered commissions the
t... NPP brings
_ in international interest '
groups on national planning commissions. This Technology Mission will be witlw the ■
department of Family Welfare itself and will work towards the incorporation of advances
in contraceptive technologies”. This is an extremely retrogressive step. It undermine our
own scientific community that has worked with diligence within research institutions like
1CMR, and saved the programme from incorporating harmful contraceptives sutdi as
Depo-Provera and Quinacrine pellets. All of these were proven to be damaging to vromen
in India and elsewhere (23,24,25), but were being pushed by corporate experts. h» also
unnecessarily duplicates institutions while there is rcsouxrce scarcity.
The case of Quinacrine is particularly alarmnng, where ethical concerns have
collapsed altogether. Despite WHO’s advice to stop ail’ trials, unscrupulous doctors
taking advantage of weak control systems and free market mechanisms - promoted thw use
of this unapproved contraceptive among unsuspecting women. This drug has not even
cleared the required stages of testing necessary before a human trial and yet First World
academic journals have chosen to publish the unelhitcal human trials on Third Worid
women as scientific research (26).
We therefore need to ask, why do we need! foreign experts in our Naeronal
Technology Missions? What role did the foreign expertts play in the past; be it the Family
Welfare Programme, the National Malaria Programme, the Tuberculosis Cawitrol
Programme or the AIDS Control Programme? In the Family Welfare Programme they
advised to keep maternity and child health services ouE of the scope of the programmw, as

8

i-.-

..-’.7."

,c:

- -

the poor state of health of women and children would exhaust all resources (27). Indi,
pushed into accepting a National Ma.aria Eradication
preparatory phase, a necessary component of the programme deagn (28h and pa^a
heavy price for it when hit by resurgence of the disease Similarly Directly Observed

.

another means for expansion of foreign markets in technology and dependence of the
Third World What role are the technical experts in the mission going to p ay
whose interest will they represent?

Hints of vested interests arc visible in the pressure on the Third World to do.away
with strinoent safety guidelines in research and take up more of the so-called essential
research” This research will be funded by international agencies but will be conducted in
the Third World for the benefit of humanity (31). There is a view that life is cheap in the
Third World, hence it can be used as a dumping ground (32). The increasing use ol 1 bird
World populations as cheap human material for expenmentmg with new technologies (33)
are indications of a trend It is, therefore, extremely critical to understand who provides
the technical expertise and for whose benefit.

I

PROBLEMS OF IMPLEMENTATION
The implications of these contradictions are evident in the State Population Policy
documents circulated by Uttar Pradesh and Madhya Pradesh. Both these states join
Maharashtra Haryana and Rajasthan in enacting laws that debar people from elections to
the local bodies (but not to Parliament!). The thrust of their Populat.on Pohcy is fcrtihty
control through the RCH approach. The two policies barely articulate their broade
•*»is said about enhancing opportunities, capabilities, or
developmental strategies. Also, •*little
.at

■

f inter-sectoral
development.
convergence ol
----- -----

(')

(ii)
(iii)

(iv)

Refuse government services to those who many before the legal age of mamage.
Sterilisation will continue to play a critical role in its strategy.
.
„
.
Hold sterilisation and RCH camps! It does mention “periodic reviews and
“follow ups” to diffuse the damaging image the word ‘ camps elicits (35). At the
same time it confesses that camps are not the best way to provide hIgh quality
services on a regular basis. Yet it hopes to “improve access to and quality of
Performance appraisal of medical ofiicers will be based on their “contribution to
meeting RCH needs”! This means that if they do not perform other duties it does

not matter!

i

I.

9

(V)

(Vi)

f

People will be “encouraged to utilise services of the private institutions” at all
evels of the district. These will be identified by the State and given support both. in terms of equipment and resources. This not only means that the tax payer's
money is dtverted into the private sector, but also that those 36% people who are
beiow the poverty line (36) may not get any secondary or tertiary level care even
tor KCH.

Tram its workers & upgrade their skills and knowledge in modem research with
newer technologies. However, there is not a word of caution about the use of
contraceptives that are not suitable for Indian conditions. In fact, the State '
proposes to incorporate material on injectable contraceptives in its training and
hopes to conduct operations research to assess the possibility of introducing
injectables and other new technologies in family planning services. It needs to be
pointed out that operations research helps optimise a system. The choice of
technology should depend upon epidemiological studies. The fact that the
Ministry has not included injectable contraceptives in the National Family Welfare >
Programme, and ep.demiological studies have shown that they are inappropriate
js totally ignored (37).

(vii)

Despite the fact that the Centre has created a special fund for population
stabilisation and the NPP considers RCH a basic service, Uttar Pradesh proposes
to mtroduce user fee even for RCH. This is proposed despite the evidence that
user fee excludes the poorest from services (38).

main c

51316 Of Madhya Pradesh (39), chooses education and Panchayati Raj as itj

Se.ptOr Pro8rarnnies that will support its population stabilisation strategy The
rest of the welfare sector does not enter the debate nor does the document state the share
witMhOeUseCethtO r
P0?'’6 Panchayats for tlie sociai s<*tor programmes. Along
with these, the policy proposes that:
°
(<)
PcrsionsJ’avmg more than two children afier January 26th, 2001 would not be
c igible for contesting elections to Panchayats. local bodies, or co-operatives in the
•3luiC.

(i>)

Legal age of marriage will be made a criterion for employment.

policies?® the »hC °'ie ,13nd “i6"? ,aJk °f eniPowerin8 women, and on the other hand
po icies ike the above negafively aflect women. The majority of women are hardly in a
be^ T he6
r 6 386 31 Which ,hey afe mafried or
momber of children they
bear. If these State pohcies are any indication of future possibilities, then it is clear that
coercion is there to stay. Child marriage, for which the social and economic conditions of

Lfu"hcr <,epri''e *" ‘"“dy

yo-1’

In addition to these two Stales, the Maliarashtra government is reported to have
with m3 T’ draCOni,ain)bi" for ",e aPProval o'"'he Governor It not only Suses families

with more than two children all welfare facilities (housing, land for housing or agriculture

lt>

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studentship, loans etc). b«i! also denies the third child rationed food grains and even
teoith care for the mother imd tbtc infantl Even the poorest arc not spared the wrath o ns
,^^(40) and the Minister oFFood and Civil Supplies is reported to have jusltfied the

decision as being “in the natioaail interest (41).
Thus we see that, m the interpretation of the national policy, the States reflect a
aMigle-minded pursuit of .be d«=mographic goal. Whatever was left of the public sector
lM>alth services is going to be fiully appropriated and penpheral health institutions will be
liansformed into RCH sendee csutlels. As a result, the workers may not have time for the
of the services for "-ch they were earlier responsible The poor will be further
sucked into tine vortex of a free market for health care being formally
piomoted by the States bv prowiding space and formal financial assistance to the private
xuetor. What then, is diffeent snout tliis NPP except its liberal camouflage?
It is evident that the NPP yet again falls short of striking a balance between well
tuung, through increased human pioductivity, and population numbers The latter by itself
makes little sense unless seen is> terms of integration into or alienation from the economic
luid social processes The NPT, unfortunately, is too preoccupied with demographic
targets to provide that balance The States have taken their cue and are going to alienate a
big chunk of the population from the mainstream socio-economic process, labeling them
a* undesirable and an obsliuctrnm to development. We seem to be losing sight of the fact
that the level of poverty m tine country is stagnating. Even those who are above the
poverty line are increasingly lacing greater insecurities due to shrinking employment
opportunities, under cmploynaent and a failing service sector. I he IMP. is not only
Magnating but also giving hints of a rise in some of the major States (42). In such a
Mtuation, should demographic achievements of fertility control alone be considered the
noed of the hour?
References:
1

Government of India, (1997): “Ninth Five Year Plan, 1997-2000", Vol. II, pp.205.
New Delhi, Planning Commission.

2

Government of India: Office of the Registrar General (2000): SUS Bulletin, Vol. 33,

No. 1, April, pp. 1.
i

Noronha, Ernesto and Sharma, R.N. (1999): “Displaced Workers and Withering of
Welfare State”, Economic and Bohtical Weekly, Vol 34, No.23, June 5-11, pp. 1454.

4

Datt, Gaurav (1999): Economic and Political Weekly, Vol. 34, No. 50, December 1117, pp. 1516-1518.

Prasad C Shambu (1Q99) “Suicide Death and Quality of Indian Cotton- Perspectives
from History of Technology and Khadi Movement”, Economic and Political Weekly.

Vol. 34,No.5, pp. PE 12'21

11

,
i
Il
‘.

i

i

I1
6. Caufiel C. (1997): “Masters of Illness: ’flic World Bank and the Poverty of hrthons”,|
New York, Macmillan, pp.25.
I

7. Water Fernandis (2000): “Pawns in the ‘Development Game’ India. Disaster IteportTowards a Policy Initiative” In Parasurasuraman and Unikishnan, P.V., (H ), New
Delhi, Oxford University Press, pp. 276-279.

l
I

I
'I

li

8. Kamla Prasad, (2000): “Rural Economy”, in Alternative Economic Survey 19982000, Two Years of Market Fundamentaling, Alternative Survey Group, New Delhi,
Rainbow Publishers Limited, Lokayan, Azadi Bachao Andolan, pp 91-94.

I
I
i

9. Keshab Das, (2000): “Informal Sector”, in Alternative Economic Survey 199H 2000,
Two Years of Market Fundamentaling, Alternative Survey Group, New Delhi,
Rainbow Publishers Limited, Lokayan, Azadi Bachao Andolan, pp. 122-124.

i
f

10. Central Technical Committee, Integrated Mother and Child Development fl996).
“Integrated Child Development Services - Survey, Evaluation and Research. New
Delhi, Control, Technical Committee, pp 179.

li.Patnaik, Utsa (1998) : “Export-oriented Agriczdturc and Food Security”, in. The
Great Grain Drain. Bangalore, Books for Change, pp 36
12. Government of India (1974): “ Annual Report 1973-74”, New Delhi, Department of
Health and Department of Family Planning, pp 45
13. Imrana, Qadeer (2000): Health Care Systems in Transition HI. India, Part I The
Indian Experience. Journal of Public Heahh-Mcdiicinc Vol. 22 (I), pp. 25-32, U K

14. Government of India (1973). “Report of the CcMnmittee on Multipurpose W ikers
Under Health and Family Planning Programme”, (Chairman Kartar Singh), New Delhi,
Ministry of Health and Family Planning.

15. National AIDS Control Organisation (1999): “ National Aids Control PrognmnieIndia’s Country Scenario-an Update”, New Delhi, NACO, DGHS.

16. Government of India (2000). Annual Report 19W-2(X)0”, New Delhi, Ministry of
Health and Family Welfare, pp 135.
17. Qadeer, Imarana (1988): “Reproductive Health - A Public Health Perspective”
Economic and Political Weekly, Vol 30, No 41, pjpZS?' 84
18. Reddy, Vinodini et al (1993). Anaemia in Female
Hyderabad, National Institute of Nutrition, pp 37.

Nutrition Trends in India,

12
I

'

I

AJ

- —

' - .

J..Ii

19 Government of I*** ((1993) “Draft National Population Policy . (Ch^nD^: M. S.
Swaminatlian), New Dtdlii. Minify of I Icalth and Pamdy WcUare.
-

• i

.

20 Government of InA* (31965) “Evaluation of Family Planning Programme", New DdhL
Planning Comnu»»»on. Programme Evaluation Organisation

;
I

21 Government of !**•■ fHIMO) “Report of the Working Group on Population Policy”,
New Delhi. Pianreng Crommission

(

22 1CSSR and ICMR (I9W0) “ Health for All An Alternative Strategy Report of the
Study Group Set up Jointly by ICSSR and ICMR”. New Delhi. ICSSR
23 ICMR Task Fok* on iHurmonal Contraception. (1980): Return of fertility following

. feeble
200 mg dose

- No....... ..

E^.ta.o (NET-EN)

Vol 34 No 6. pp 573-82

24 Ritchcr. J., (1996) Vaccination against Pregnancy: Miracle or Menace. London and
New Jersey, Zed Press
25. Sahcli (1997): “QutnaOTnc: The Sordid Story of Chemical Sterilisations of Women. A
Sahcli Report, July I99T\ New Delhi. Sahcli
26. Do Trong Hicw cl al (*993): "31781 Cases of Non-Surgical Female Sterilization with

Quinacrine", Lancft. Vol 342. July 24.
27. United Nations Advisory Mission (1966): “Report on the Family Planning Programme
in India”, New York. Uwled Nations.

28 Bancrii D. (1985) Health and Family Planning Services in Indra - An
Epidemiological, Socio-Cultural and Political, Analysis and a Perspcctrve , New Delhi,
Lok Paksh pp. 96
29 Banerii D (1997) “Serious Implications of the World Bank’s Revised National
Tuberculosis Control Programme for India” Mimeograph, New Delhi, Nucleus for

Health Policies and Programmes
30. Panos Institute (2000): “Beyond Our Means?" The cost of treating H1V/AIDS in the
developing world. London U.K. Panos Institute, pp 19-27.

,

31. World Bank (1993) “World Development Report (1993). Investing in Health, New
York, Oxford University Press, pp. 148-55.
32 PRIG (1994) Unhealthy Trends: The World Bank of Structural Adjustment-and the
Health Sector in India. New Delhi. Public Interest Research Group, pp 26.

i
13

!

33. Richter. Judith (1993): “Vaccination Against Pregnancy; Miracle or Menace?” Lon*m , j
and New Jersey, Zed Press
1

34. Government of Uttar Pradesh. (2000): M Population Policy of Uttar Pradesh* DeptOf Health and Family Welfare.

35. National Institute of Family Planning (1973). “Vasectomy Camps - A Study”, New
Deiiii, National Institute of Family Planning

I

36. Government of India (1999) 9** Five Year Plan. 1997-2002 Development Goak.
Strategy and Policies, Vol 1. pp 27. New Delhi, Planning Commission
37. Sathyamala. C, ( 2000). “ An Epidemiological Review of the Injectable Contraceptive
Depo-Provera”, Pune, Medico Friends Circle.

38 Krishnan, T N, (1999). “Access to Health and The Burden of Treatment in India An
Inter -Stale Comparison, In. Rao. Mohan (cd ): Disinvesting in Health. The WorW
Banks’ Prescription for Health, New Delhi. Sage, pp 212-230.
39. Government of Madhya Pradesh (2000): “Population Policy of Madhya Pradesh
Department of Health and Family Wclfaie.
40. The Hindu (2000): September 6, p. I, col.6.

41. The Hindu (2000): September 7, p. 11, col.3.

42. Sagar, A. ct al (2000). Health in Alternative Economic Survey 1928-2000. Two Years
of Market Fundamentalism, New Delhi, Rainbow Publishers Limited, Lokayan, Azadi
Dachao Andolan, 2000.

I

I

I

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11

vPRRWl i

Tnnr nnf
*nf fiScvfl• iioooi
rRTtl 7T'

1 SHNA > ingh

,J 0 \o. \.| ioi I/25/200U-NCP
•<Jear

3710051, Mnm : 3717M1
Government of India
National Commiieion on Population
Yojina Bhavan, Parliament Street
New Delhi-110001
Tel. : 3710051. Fax : 3717631

October 4, 2000 ■

yv. ,k

»’«« been conV, ,,,?,/

w°'l‘i»s Croups as dwehbed in

Order acloccj

hive

•
The firsi

“ “te

meeting ol >vur Working Group(s) is likely to be convened shortly.

With regards.
Yours sincerely,

(Krishna Singh )
y* Devaki Jam
^aninia Sreenn .is3n Found.i(w>
IMranga" IO:n Cross.
■<-M^iahal Vilas Extension
•-’3»galore

I

,'. S',
: -st:

V •- ;■ ■

\o N.| ioi I/25/2OOO-NCP
>utiondl Cpinmiition on Population

Room No.243, Yoj&na Bh&v&ny
Sansad Marg, New Delhi - 1.

Dated 4th October, 2000.
i.

■ •

ORDER
Subjevf:

Groups

'be Nmtiopal Comminion on Population-

(1)
In ]pursuance of the. decision taken in the first Meeting of the National
Commission on Population heldI on 22 July, 2000, the following Working Prpupa.aro
eonsti luted:
I)

working GROUP qn strategies TO ADDRESS UNMET NEFDS
u)
b)
c)

d)

Sub-group on strategics to address unmet needs for contraception
healthr°UP °D ,,r“IC8‘es ,0 addre,,» unmet needs for maternal and .^d

Sub-group on strategics to address unmet needs for public health,
drinking water, sanitation and nutrition
F
Sub-group on strategies to address unmet
needi for empowerm<At of
women and development of children

Subgroup on stracvgi^s |u addros
i)
‘

:

unmet pegds for copfrpccptioq

Mr. K. Srinivasan, Ex. Health Secretary • Chairman

'in)

Members:
Dr. Nina Pun , President, FPIa
CouSl°j PaChaUri' Rtfgional Dir^tor, South and South East Asia Pppuhuion

iv)

Socia^Medicine ’

v)
vi)

Shri K. Gopalakrishna, President, JANANI
In'diaJFOGSI) Chaneoee« President. Federation of Obst. & Gyna. Society of

vii)
viiO
ix)

R u Cboufdhna,% Sc'entist, National Institute of Immunology^ —
Dr. D. Takkar, Head of Department. Depn. Of Gynaecology, AIIMS,
•>
|Ot Birla
Corporation Ltd’i Community Initiatives
’Development, Mumbai.
7

h)

MedlCaJ CoUe«e> ^dian Association of Preventive and

I

I ■

Z -. .S'>

Representaiivc from Hindustan Latex
Representative of National Commission on Population
Secretao, Family WeHoze. Government of Bihir
ecretary, Family Welfare, Government of Rajasthan
epresentanvc of Department of Family Welfare - Convenor.

•1

Xi)
xii)
xiii)

xiv)

UJU i<».t

*wcciaJ Invi(^^5

■

•|X*,

1

0
H)

iii)
iv)

Dr (Ms.) Banti Coyaji. Director, KEM Hospital, Rastapet
CJ, .
Dr. Sharud Iyengar, aRTH, Udaipur
KcpreseniiKive of Department c.
...M<
°nj.h
dian SysWms 0^Wc<Jicine & Homeoptuhy
Sudha Tiwari, Pariuar Seva Sanstha.
‘er..

•)

To identity- gaps and

.

1

•

innovations with durreg^^coTt cSvcncH^d8
dcvclofnicnt3
•
with the obiective
rAnX,k .■
cne«tlYcnc»s ^d optimization of resources. '■>
National Population Policy. U
10 **
of the1’objectives of the
^consider arty other maner related with or incidental to tbc.^vc.^ of "

'A

>)
)

i)
ii)
v)
•')
)

ub-grou

op strategics tp address unmet need, for matemni

and chjlld health

MeS Hea,th’ Govenunent °^dia, Chairman

S Abhay
SCP Bang,
?UnWSEARCH,
' Indian Nursin
8 Co^il
Gadchiroli

(t

Ur. LN. Mehrotra . President, IMA

■

•

•

i)
ii)
■ lii)

...

x)
■)

a)

•ii)
iii)
lv)
V)

vi)

epresvntattve ol Department of Family Welfare
Representative of Department of Women & Child
Representative of Department of Social Justice
SeTretZ?^^ IJT31 Conunission oa Population
y Wclfare’ Government of Madhya Pradesh
Welftre. 0»wn™e„. of uSS

« (Xcto '

Commissi°"

Department of Heal th • Convenor

Al.

.

...
)

: ■

.

..dbul/

- WF

,V

J
♦

2

' '

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• -

k■ /
Lgnns of

b;

fcrenc

I o identify gaps and
Io examine and sug^ese ahemarive strategics, intcraiia recent developments and
innovations with cue regard to cost effectiveness and oprimiyanon of resources, /
with the objective of contributing to the ftiJfdlmcnt of the. objectives of the •* .
National Population Poiury.
’
.
To consider any other anaticr related with or incidental to the above tenns of •
reference.
.....
• •r:• \ . • ,
.»v «.

. ■

••

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.

j.j
C)

i)
ii)
iii)
iv)
v)
vi)
vii)
Vljiy

ix)
X)

xi)
xii)
xiii j

Sub-group on Sub’gra>up on strategies (q address
pppiyi
hcultbt drinking v <|cr» ntion god pMfrjjfiQP

fvr pubUff
•• .

9

•! <

Iscms ot Reference
a)
b)

.) I

f)r. H. Sundcrasan, Fx-Vice Chancellor (Madras University) ..ChainnanroT,k:; (d
.■>
Members:
Ms. Imrana Qadir, Professor, Population Studies, JNU •
' ■ ■■
■
a ••
Dr. B.K. Tiwari, Nutrition Adviser, DGHS 1
Lr°fnK'^ Nath’ A11
institute of of Hygiene APublic Health, Calcutta ''H
•
Mr. Bindeshwar Paihak,
Sulabh
International!
.........................................................
Representative of Department of Rural Drinking Water
Representative of Department of Urban Drinking water
Representative of Department of Women &;Qhild development..
Representative of Department of Environment
Representative of Department of Health
Representative of National Commission on Population
■'■ ‘
Dr. Prema Ramachandran, Adviser (Health), Planning Commission •••••■
Adviser or Representative. Drinking Water/Sanitalion/Planning Cnmm^inn .

<l .

•J*. ■

•

To identify gaps and
■■• ■/.
- J \
To examine and suggest alternative strategies, intcraJia recent developments and
•.* •■
r
.
innovations with due regard to cost effectiveness
and
op
timization
of
resources,,
cvuvcdcss ana opumizauon or resources,, uj >x^_ x
with the objective of contributing to Tthe, fiUfillmcnx
*
,of. the>objectives! .of the
National Population Policy.
L/Yfll or I incidental
r»z51n t«1 »7«
- ■ ■ . — of
To consider any other matter related with
to the above Atenns
<., 1
reference.
'f:

d)

■U-.;-'f i

Uli
: /;

!L.

i)

s^b-grpup OP vrmfgic, for empowerment pf yvQPlfn, dmldPmPBf ftf ■
children and issuea relating to adoleicenu1
■ ■
(dZW
rdZ^’*
..
'■
■-•••'M
Mrs. Margaret Alva, Member of Parliament - Chairperson
• •••■
’i-'T?'

ii)
i‘0

-• Ela Bhatt, SEWa, Ahmedabad
lx. Swapna Mukhopadhyay, IEG, Institute of Social Studies Trust

----

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/

iv)
v)
vi)
vii)
viii)
ix)
x) '
xii)
xiii)

Ms. Devtki Jam, Sangamma Foundation
Ms. Aaditti Mehtta, Rashtriya Mahila Kosh
Dr Saroj Pachaun, Regional Director. Population Council

On sT2 mZ M amt7

1 »f t"'

Representative of Department of Women and Child development .
Representative of Department of Youth Affairs
. |-<
Representative of National Commission on Population
i •••’
Representative from 1GNOU
Adviser or Representative, Social Welfare, Planning Commission

ffims of Reference
a)
b)

ahms
dj

.rfnOI/.*, .-1
z/'.-'nt/:'.-.

• Convenor.
’>

•L

To identity gaps and
To examine tand suggest alternative strategies, interalia recent dcvelopmcnu and (i ’-.A
k 1/1 t Fl rii u
zi n
(
/'/'___ - '
•
*
.
innovations wth
due'regard
to cost effectiveness
and■ optimization
of rwotm^T '• 'S
a

the fulfillment of the .objectives of the
C)

'^cr “y odBr ma""

1

.pjrz/iT .X.G >CJ

— ,j the ’above tenns

'ID
i)

ii)
iii)
iv)
v)
vi)
vii)
viu)
ix)
x)
xi )

Dr k' V I
L
’ ■ ‘’'i'nnwMi. A
IZ.
r. K. Venkatasubramanian. Member (Education), Planning Conuniwionw>H '
■ ■ ' S 4.
Chairman.
Ex
••>E7or>j-A5zV.-_:(
Dr. (Mrs.) Usha Nayyar, NCERT
.ugw/icD '
Prof. Mohd. Amin, Ex- Vice Chancellor, Jamia Hamdard
Dr. Ketan Desai, President (MCI)
Dr. Digvijay Singh, Ex-M.P.
Ms. Jaya Jaitley, President, Samata Party
"’
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__
Mr. B.G. Dcshmukh, Ex-Cabinet Secretary/Pr. Secretary to PM ■
•JwZJrOl;
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Principal Adviser (Education), Planning Commission
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Representative of Department of Family Welfare
•
ic
Representative of National Commission on Population
Representative ol Department of Education
------------ . Convenor .-i
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Terms of Reference

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a)

b)

c)

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To identify gaps and
c;.?
b
To examine and suggest alternative strategics, interalia recent dgyelopm^nta and
innovations...
with due regard
to cost effectiveness and opumiyation. of resources
with the < ‘J ‘ _
■opu'X ?ou£
National Population
Policy.“rib““n8 “
any other matter related with or incidental to the above’'terma of

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vii)

REC*$TRATION of BIRTHS, deaths and

M^^A^GhS RQlT

Registrar General of India - Chairman
Members:

Dr. Pai Panandiker. Centre for Policy Research
Shri K.Srinivasan, President, Indian Association for Study of Pppulauonj
Shn Ashish Bose,
Representative of DeptHmeni of Statistics
Representative of Department of Family Welfare
Representative of National Commission on Population
-I
Adviser, Healih/Planmng Commission - Convenor.
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Nauonal Population Policy.
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io consider any other maner related with;or incidental, to the above 'tamt of
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Both legislative and implemcntaiiortaJ issues should be addressed
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GRgUP ON MgDiA FOR INFORMATION

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MOTIVATION
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iv)
v)
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vii)
viii)
ix)
x)
xi)
xii)
xiii)
xiv)

a

i>hri H. K. Dun, Press Adviser to PM - Chairman
Members:
Nhri Alyque Padamsce, President. AP Associates,
ihri Rajiv Shukla - M.P. (Rajya Sabha)
'•'r-J.K. Jain, Jain TV
Ms. Sharmila Tagore. MP
-’fin Ajit Bhaoacharya, Press Institute of India
Ms. Rami Chhabra, Member NCP
- ’r. Mahip Singh Member NCP
•'f- K. Jaipal, Principal, Siddha Medical College, Chennai, Tamil Nadu
i>hn Narendra Mohan, MP
Nts. Usha Rai, Editors Guild of India
^1x1 Qari M. M. Majari, Urdu Secular Qayadat
■rpresentative of Department of Family Welfare
>/!?rCS':ntal*vc Department of Ministry of IB
■ •auonal Commission on Populition - Convenor.

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To identify gaps and
To examine and suggest alternative strategies, interalia recent development! and t
innovations with due regard to cost effectiveness and optimization of r^fourcea, 4
with the objective of contributing to the fulfillment of the .objective! of the U
National Population Policy.
J n j. f
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To consider any other matter related with or incidental to the above* tenns of
reference.
(/
Aspects of inter-sectoral co-ordination should be given special attentioi^
f •

a)

b)

T
c)

d)

2.

1 he Working Groups may co-opt any official or non-official as a special invitee *
to one or more sittings of the Group.
•-

3.

1 he expenditure on Ta/Da of the non- official members, in connection w^th the .7 :
meeting of the Working Group will be borne bv
by the National 'Co
"Commissi
mij
on on
Population, as per rules and regulations of TWA applicable5io/Orade ^officers
of Government of India or as otherwise decided by the Vice JChmm^n NCR
expenditure on TA/DA of the official members, in connectinn^with tju^ryu^ting pf
’
- DeparunenU/Mi^lstries^
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the.................................................................
Working Group will be home by their respective

4.

Ail the Working Groups will submit their final ireports to ‘ the ‘National
lafA zxF tool
Commission on Population within six months from the date
of issue zx#*
of this o.(der.. ft i ' V

-

(R-K'jParnptr) —
'■■•Und«r-S«cretary,i"^
National CommiMipn?pn!Pppu^tion('^^

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All Members ot the National Commission on Population
All Members of the Working Groups.

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Copy to :
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3.
4.

JS, Prime Minister’s Office.

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PS to Deputy Chairman (Planning Commission)
PS to Member Secretary (National Commission ion Population)'
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PS to Joint Secretary (National Commiwion on Population)

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3 ‘
http://www.maharashtra.gov.in7en3lfsh/grnent/policyfr.htrn.
MAHARASHTRA STATE POPULATION POLICY

An Extract
Maharashtra is one of the Progressive States in the country. The State however, has not been
able to control its population as per expectabons. The first doubling of the populabon occurred in
60 years between 1901-1961. The next doubling occurred only in 30 years. The present birth rate
of the State is 22.3 and we rank Sth in the country. The State is declaring its population policy with
an intention to bring down the rate of population growth.

The objectives of this policy are:
(1) Reducing Total Fertility Rate to 2.1 by year 2004;
(2) Reducing Birth Rate to 18 by year 2004;
(3) Reducing the Infant Mortality Rate to 25 by year 2004;
(4) Reducing the Neonatal Mortality Rate to 2- by year 2004.
Following schemes will be introduced under this population policy: -

1.. Accepting concept of two child norm as "Small Family Norm";
2.. For obtaining subsidies under various Government schemes acceptance of "Small Family
Norm" would be considered essential.
3.. In order to propagate the concept of Small Family Norm amongst the Government and semi
Government employees this condition will be included in the service rule. Schemes such
as House Building Advance, Vehicle Advance and Medical Reimbursement will be
admissible those who limit their family to two children;
4.. Performance in Family Welfare to be part of assessment of officers at various levels;
5.. Strict implementation of existing acts and policies such as Child Marriage Act, Prenatal Sex
Determination Act, Birth and Death Registration Act etc.;
6.. Organisation of Family Welfare Camps with the financial assistance from Cooperative
Societies, Sugar factories and other industrial establishments;
7.. Acceptance of small policy norm as a condition for qualifying for elections to various bodies
such as Zilla Parishad, Panchayat Samiti, Corporation, Co-operative Societies etc.;
8.. Constitution of Mahila Vikas Group under the Chairmanship of Hon. Chief Minister's wife at
State level and under the Chairmanship of Minister or Guardian Minister's wife at District
level;
9.. Enhancing involvement of Panchayat Raj Institutions in implementation and monitoring;
10.. Village Level Scheme based on achievements in various Family Welfare Indicators;
11.. Schemes for motivating the health infrastructure for improving quality of care;
12.. Training of Dais to ensure self delivery practices;
13.. A population council under the Chairmanship of Chief Minister and a Coordination Committee
under the Chairmanship of Chief Secretary to monitor the implementation of policy; and,
14.. An incentive of Rs. 10,000/- in the form of fixed deposit for 18 years to Below Poverty Line
couples accepting terminal method after one or two daughters (with no male child) (If two
daughters an amount of Rs.5000/- for each daughter). This daughter(s) will be given an
additional incentive of Rs.5000/- each as fixed deposit for 5 years when she completes her
schooling unto 10th standard and does not get married before completing the 20 years of
the age.

HP' 3-

Men's involvement in population

SuDlbjectt: Menu’s involvement nun popuuHatioini
Dates Thu, 23 Mar 2000 20:28:13 +0530
Fromms "DOLKE" <aaasn@nagpur.dotnet.in>
Tos "Medico Friend Circle" <mfriendcircle@netscape.net>
http://www.timesofIndia.com/140300/14inbom8.htm

Experts attempt to rope in men to defuse population bomb
By Rupa China!
The Times of India News Service

MUMBAI: With India’s population poised to cross the one-billion mark,
desperate policy-makers and programme managers have now hit upon a new
formula to approach the vexed problem of population control.
Realisation has now dawned that Indian male involvement is crucial for
change, because they are the prime decision-makers within all relationships.

While admitting that this half of the species has been ignored in five
decades of the planning process, experts are now trying to understand how
men can be sensitised to become responsible sexual partners, husbands and
fathers; how they can be made to value women and see them as equal partners
in the decision making process; and how to involve their help in the
country’s reproductive and child health programme.
At a workshop on 'Reaching out to men as supportive partners in reproductive
and sexual health’, held in Mumbai recently, secretary level health
officials from Rajasthan, Madhya Pradesh, Gujarat and Maharashtra,
academics, researchers and NGOs struggled to formulate strategies that might
work double-quick in creating such enormous societal and mindset changes.
The need for this new approach is also highlighted in the recent 'Population
Policy of India’ that was announced a week ago. The workshop was organised
by the Population Council and International Institute for Population
Studies.

Emerging from the workshop was the recognition that men also have health
needs, and in particular sexual health needs, that are not being met through
the current emphasis on programmes geared at women and children. In the
absence of a ''basket of curative services’’ being offered at primary health
centres, government health workers have no way of reaching out to men and
talking to them about preventive health issues. Personalised counselling at
this level is vital, along with generalised information campaigns.
(Studies show that 70 per cent of India’s population seek curative services
from the private sector, because they do not get the services they require
from the government system.)

In fact, during informal discussions, senior bureaucrats bluntly criticised
the continued circumvention of the comprehensive primary health care
__J
approach. ''Family planning is not a technology issue. Delhi’s failure in
understanding this complexity is leading to the same mistakes being made
again and again,’’ a senior health official said.

Referring to government claims of having sought the 'community’s perception
and participation ’ in health planning, officials said that in reality it is
doctored by a questionnaire that refers to the government's set agenda.

'When a person cannot get treatment for a disease, he has no confidence in
the health worker. Perception of health needs are based on individual
experience and priority, and when the villager is only asked about safe
delivery or maternal death, it may not be a major issue he sees, because so
many women are delivering their babies safely at home through the

1 of2

)O

/Z/H

k.

To
Co

3/23/00 9:27 PM

$7^3

Men's involvement in population

traditional 'dai' (midwife). At the grassroots, health cannot be divided
into compartments, and has to be wholistic. If this verticalisation of
programmes does not stop we will do more damage,’' a senior secretary of
health said.
NGOs from Gujarat presented studies showing that men readily respond to
having small and healthy families, and are supportive when sensitised. The
'entry point’ to men’s involvement, however, started with the NGO offering
them a package of curative services that established channels of
communication on issues of preventive health. Now the men accompany their
wives for pre and post natal check-up, makes sure she rests and consumes her
iron folic tablets during pregnancy. Antenatal clinics now see 85 per cent
attendance, says Anupa Mehta of Deepak Charitable Trust, Vadodara.

Cultural constraints were recognised as being a major deterrent in the
decision making process between husband and wife and the attainment of the
latter’s health. For instance, in a Rajput village community of Vadodara
district, there is no communication between couples on such issues, and
health seeking decisions are often made by elders in the family. Couples
cannot go out alone. Consequently, when women do come for referral services,
they often come too late.
According to Ramachandran Kaza of Maulana Azad Hospital, Delhi, the
successful outcome of the 'No scalpel vasectomy’ (NSV) campaign in several
states, was restricted elsewhere. ''Its not because men are not coming
forward, but because service providers are not providing the services,’’ he
says. In Karim Nagar, Andhra Pradesh, 40,000 cases treated with NSV in seven
months, was achieved because of the strong commitment of the district
administration who assured them good quality services and follow-up of each
case.

Arun Dolke
Tel. : (91-712) 260709
Email : aaasn@nagpur.dot.net.in
Medico Friend Circle (MFC) - eForum
http://www.geocities.com/Paris/2893/mfc/mfc.htm
Send email at mfriendcircle@netscape.net to unsubscribe MFC eForum.

2 of 2

3/23/00 9:27 PM

0.

RECOMMENDATIONS
Following the essence of the recommendations of NDC Committee on Population &
Implementation, the Family Welfare Programme has undergone a paradigm shift from 1996-97.
The Centrally fixed methods specific targets have been replaced by a system of assessing needs

at grassroot level which will take into accounts local needs, ensure community participation and

close monitoring implementation through Panchayati Raj Instituitions and other local bodies.
Approach during the X Plan
The objective during the X Plan period should be:

a)

to ensure that the all the felt need for contraception is fully met;.

b)

reduce the infant and maternal mortality and morbidity so that there is a reduction in the
desired level of fertility and the consequent increased felt need for contraception,

especially by birth order based approach.
The programme will be directed towards

a)

bridging the gaps in essential infrastructure and manpower through a flexible approach

and improving operational efficiency through investment in social, behavioral and
operational research.

b)

providing additional assistance to poorly performing districts identified on the basis of
the 1991 census and RCH Surveys.

c)

ensuring uninterrupted supply of essential drugs, vaccines and contraceptives of

appropriate quality and quantity.
d)

promoting male participation in the planned parenthood movement and increasing the
level of acceptance of vasectomy, particularly through no scalpel vasectomy techniques.

41

v-

Attempts will be made to enhance quality and coverage of Family Welfare services
through:

0

participation of general medical practitioners engaged in voluntary, private and joint
sector and active cooperation of the practitioners of ISM&H;

ii)

involvement of Panchayti Raj Institutions for ensuring intersectoral coordination,
community participationat at grassroot level in planning, monitoring and management;

iii)

involvement of corporate sectors, agriculture workers and labour representatives.

The Programme will take up the following initiatives during the Tenth Plan period:
1)

Assess the needs for Reproductive and Child health Services at PHC/CHC/FRU level.

.2)

Undertake area specific need assessment at the grassroot level to fulfill the felt needs for
Reproductive and Child Health Services.

3)

Provide- need based, client centred, demand driven, integrated Reproductive and ChL
Health Service so that there is:

i. improvement in the maternal and child health indicators.

ii. increased contraceptive acceptance to prevent unwanted pregnancies; and
iii. reduction in the birth rates.
4)

Provide essential infrastructure through a flexible approach, strengthen the existing

manpower and provide key personnel required, provide essential drugs, devices and other
consumables essential for running the programme
5)

Increase the operational efficiency of the Programme through training, improved

utilisation of the Management Information System (NUS), improved first line supervision,

increase in involvement of the state Govt public health infrastructure in the sub distric1
level and improved integration of different sectors at village level.

6)

Improve community participation in implementation and monitoring of the programme

through

involvement

of the

Panchayati

Raj

institutions

and

other

local

bodies/institutions.

7)

Improve the existing mechanisms for concurrent and independent monitoring and
evaluation of the ongoing programme and initiating appropriate mid course corrections.

42

1
1

V

8)

Undertake IEC programme through all channels of communication so that the population

understands the paradigm shift and makes optimum utilisation of the available facilities.
9)

Components of the RCH Services to be implemented include:

I

Increased access to effective Contraception

a) Balanced presentation of the contraceptive options and enabling the couple to choose the

method most appropriate to them;
b) Improving availability of family planning services to prevent unwanted pregnancies .

c) Improving male participation in the Family welfare programme, popularisation of
vasectomy including newer techniques like no scalpel vasectomy.

II. Increased access to safe legal abortion facilities under MTP Act for management of unwanted
.

pregnancies.

DI. Universal screening of all pregnant women for risk factors and appropriate management of

problems detected in pregnancy, labour and post natal period so that there is reduction in the
maternal, perinatal and neonatal morbidity and mortality.

IV. Effective nutritional services to vulnerable groups.

V. Improved child health care through detection and management of the health problems in child
hood and adolescence.

VI. Proper treatment of reproductive tract infections and sexually transmitted infections in men
and women.

VH.

Prevention and treatment of gynaecological problems including infertility, menstrual

disorders and prolapse uterus, malignancies including cancer cervix and breast.

To review the present status of involvement of organised and unorganized sectors of

Industry and trade/labour unions in the Family Welfare Programmes and

recommend ways and means for increasing their participation in the Programmes.
Managerial capability of corporate bodies will go a long way in improving efficiency in

the field of social marketing of contraceptives.

The problem solving approach of corporate

sector can be of use in improving operational efficiency of the health care infrastructure.

43

I

Possibilities may be explored to deliver health care services in unserved urban acea- •_

through public, private and/or joint sector as the case may be.

Other issues and recommendations
To make the CNA approach a success, role of each person in the health care system has
to be clearly defined. A holistic thinking has to be developed for appreciating this approach.

Both administrative structure and professional culture have to be integrated and internalised in
such a manner that the functionaries are made to learn the modus operandi of what is to be done.
SRS has provided reliable and useful information for planning as well as impact

assessment in Health and Family Welfare. • The SRS needs further strengthening for rapid
collection and reporting of vital indices according to felt needs.

Now that three-tier local self-government has come into being, the letter and spirit of self

governance has to be inculcated in the sub-centres as well as Primary Health Centres. The
decentralised approach would require sharing of responsibility at various stages - PHC being th
unit of micro-planning of the Panchayati Raj System.
The doctors and other functionaries of the health care delivery system have to know their

role and activities as well as explain it to the Panchayats for effective planning and

implementation of the ongoing programmes and a well increased community participation at
grassroot level.
The Family Welfare Programme has to meet the requirements of contraception for

spacing in the younger age couple and permanent methods - vasectomy, tubectomy for those
who have completed their families.

Villages with small population size, which are generally backward in basic infrastructural
facilities, poor literacy and poor utilisation of existing services, need special attention.

Additional staff, if necessary, may be provided.

It is estimated that a large number o.

paramedical staff may be required to meet the MCH/FP needs specially in urban slums and

poorly performing districts.
Even during Tenth Plan, some Sub-Centres may have to be established to serve needs of
remote rural and tribal areas which are underserved. For establishing new sub-centres, it is

desirable to take into consideration a distance criteria (say, a sub- centre within a radius of 10
kms) besides size of population, in the inaccessible areas. Population, distance and access to
44

V

Family Welfare needs of the population will be used as criteria for determining the manpower as
well as infrastructural needs. The Family Welfare Programmes will utilize differential areas

specific micro planning to assess the needs for family welfare services.

■" -

The content, quality of services for antenatal, natal, and neonatal and post natal care will

be improved.

Necessary equipment for identification of risk of mothers, neonates will be

provided (e.g BP apparatus, weighing scales, urine testing kits). Universal serving of all pregnant
women and neonates at birth will be the goal for 2001.
The success of the programme depends upon the personnel operating it, who shall be
provided with the necessary knowledge, skills to meet the requirements of the population at

Primary Health Care Institutions. Periodic inservice training utilising multi-professional

approach has to be taken up to update their knowledge and skills.
Distance education and multi-professional education should be the focus for training the

lower level functionaries like ANMs, Male Health Workers, and Anganwadi workers etc. in
order to attain optimum utilisation of resource.

The Departments of FW, WCD and Human

Resource Development may have to join hands for discharging this onerous task.

Tenth Plan strategy in FW programme would be to meet the unmet need for MCH & FP

Services to enable the couples to achieve their reproductive goal so that the national goal of
reduction in under 5 mortality and birth rate are achieved through adequate primary, secondary

and tertiary care with appropriate linkages.

Urban Migration over the last decade has resulted in rapid growth of urban slums. There
has not been any well planned and organised effort to provide primary, secondary and tertiary

care services in geographically delineated urban areas. In some cities, the health status of urban

slum dwellers is worse than that of rural population. During the Tenth Plan period, the initiatives

taken in Ninth Plan will be further strengthened by a well structured organisation of urban

primary health care services to all inhabitants within 1 - 2 Kms of their dwellings. Appropriate
referral linkages between primary, secondary and tertiary care facilities in defined geographic
area will be established to promote optimal utilisation of Nagar Palikas in the implementation of
health, water supply and sanitation programmes.

45

Following the essence of the recommendations of NDC Committee on Population, the'
Implementation of Family Welfare'Programme has undergone a paradigm shift in 1996-97. ^e

Centrally fixed methods specific targets have been replaced by need assessment at grassroot
level which will take into accounts local needs, ensure community participation and close
monitoring through Panchayati Raj Instituitions and other local bodies. The RCH approach will
address the reproductive needs of the population.

The family welfare programme during the

Tenth plan is to be geared up to meet the un-met need for contraception and achieve rapid
reduction in IMR, maternal mortality and undeif 5 mortality.

If these programmes are fully

implemented specially in the States/ Districts which currently have high IMR and high fertility,
rate, there may be substantial reduction in IMR, CBR, TFR and population growth rate.

Strengthening and operationalisation of the FW infrastructure
The focus since the Sth Plan has been on strengthening and operationalising existin

infrastructure for delivering of . primary health care through improvement in physical
facility,fiiling up of vacant posts, ensuring supply of essential drugs and improving referral

services. To some extent this has been possible; however, there are still some key posts like

specialists at CHC, lab technicians at PHC/CHC and male multipurpose worker at the sub centre

which are either not sanctioned or continue to remain vacant, which, to some extent was
overcome through RCH initiatives.

The main approach of the Family Welfare programme during the Tenth Plan should be:

i)

To assess the needs for reproductive and child health at PHC/CHC/FRU etc. level and
undertake area specific microplanning.

ii)

To provide need based, client centered, demand driven integrated Reproductive and chil

health care.

46

TABLE-1

TOTAL FERTILITY RATE (TFR) - PROJECTED LEVEL 2007
Estimated
TFR
2007

No. of eligible
couples
2001
in 000's

Total Fertility Rat

INDIA__________
MAJOR STATES

176,647

3.2

2.3

Andhra Pr
Assam_____
Bihar______
Gujarat
Haryana
Karnataka
Kerala_____
Madhya Pr
Maharashtra
Orissa_____
Punjab
Rajasthan
Tamil Nadu
Uttar Pr__________
West Bengal
|
SMALLER STATES

14,161
4,049
14,752
8,854
3,563
8,912
5,190
10,749
16,641
6,130
3,886
10,052
10,807
27,897
13,557

2.4
3.2
4.3
3.0
3.3
2.4
1.8
3.9
2.7
2.9
2.6
4,1
2.0
4.6
2.4

1.8
2.3
2.8
2.1
2.2
2.0
1.6
2.6
2.1
2.4
2.1
2.7
1.7
2.7
2.1

Arunachal Pr
Chattisgarh
Delhi_______
Goa________
Himachal Pr
Jharkhand
J &K
Manipur
Meghalaya
Mizoram
Nagaland
Sikkim_____ _
Tripura
' Utts/"
III; 'UNION TERRITORIES

169
3,702
2,343
194
1,015
4,790
1,571
315
332
117
233
78
501
T425

2.8
NA
1.6
1.0
2.4
NA
NA
2.4
4.0
NA
1.5
2.5
3.9
NA

2.4
3.0
1.8
1.6
2.0
3.0
2.3
2.2
2.6
2.4
2.3
2.2
2.6
2.4

59
155
39
24
165
165

1.9
2.1
3.5
2.5
2.8
1.8

1.7
1.9
2.8
2.1
2.4
1.6

Sl.
No.

I.
1
2
3
4
5
6

IF
9
10
11
12
13
14
15
II.

State/UT

1
2
3
4
5
6
7
8
9
10
11
12
13

2
3
_4
5_
6

A&N Islands
Chandigarh
D&N Haveli
Daman & Diu
Lakshadweep
Pondicherry
47-

SRS
(98)

I

I

•
I

©
TABLE-11

% of Girls Marrying Below 18 Years - NFHS and Rapid Household Survey(98-99)
and Literacy Rate(% Female)2001 Census

SI.
No.

State/UT

% of Women Ages
% of Girls Marrying
20-24 Married
Below 18 Years
Before Age 18
of Age proceeding
NFHS (98-99)
3 Yrs. Of survey(98/99)

Literacy Rate
% Female
(7 years & above)
2001 Census

INDIA________

50.0

36.9

54.2

I. MAJOR STATES
1 [Andhra Pr______
2_ Assam________ _
_3 Bihar__________ _
_4 Guiarat________
£ Haryana________
£ Karnataka______
Kerala__________
Madhya Pr-_____
9 I Maharashtra
10 Orissa________ _
11 Punjab_________
12 Rajasthan_______
13 Tamil Nadu______
14 Uttar Pr________ _
15 West Bengal

64,3
40.7
71.0
40,7
41,5
46.3
17.0
64.7
47.7
37,6
11.6
68.3
24.9
62.4
45.9

37.3
28.7
58.2
25.2
31,6
35,4
9.1
58.6
30,9
32.2
11.2
57,1
19.1
49.3
51.1

32.7
43.0
33.6
58.6
56.3
57.5
87.9
50.3
67.5
51.0
63.6
44,3
64.6
43.0
60.2

27.6
NA
19.8
10.1
10.7
NA
22.1
9.9
25.5
11.6
22.9
22.3
NA
NA

32.8
41,9
6.4
3.5
3.0
50.8
1.5
10.2
9.1
16.0
29.5
15.7
34.5
12.4

44.2
52.4
75.0
75.5
68.1
39.4
41.8
59.7
60.4
86.1
61.9
61.5
65.4
60.3

NA’
NA
NA
NA
NA
NA

20,6
0.0
50,6
17,6
18.2
5.0

65.5
75.3
43.0
70.4
81.6
74.1

II. SMALLER STATES
1 Arunachal Pr______
2 Chattisgarh_______
2 ' Delhi___________ _
Goa_____________

5 Himachal Pr_______
6 Jharkhand________
7 J& K_____________
8 Maniour__________ _
9 Meghalaya________
10 Mizoram__________
11 'Nagaland_________ _
12 Sikkim____________
13 Tripura___________
14 Uttaranchal
111. UNION TERRITORIES
A&N Islands

2 Chandigarh
2 D&N Haveli
£ Daman & Diu
5 Lakshadweep
6

I

Pondicherry

4/

i

TABLE-III
Fertility and Contraceptive Preferences NFHS-I & NFHS-II

(7-

India/states

Ideal No. of
Children

% of couple with two
children want
no more child
(including Str.)
1998-99
1992-93

% of couple with three % couple not using
any method
children want '
no more child
(including Str.)
1992-93 1998-99
1998-99
1992-93

1992-93

1998-99

1992-93

1998-99

1992-93

1998-99

% who
discussed
FP during
Home visit
1998-99

0.7

58.6

65.2

29.0

22.4

14.4

1.0

0.5

34.0
61.7
59.4
62.1
55.4
79.6

78.1

45.3
20.8
26.7
18.3
25.9
13.6

Preferred Method for future use
Female Str.
Male Str.

Spacing Method

1992-93

1998-99

INDIA

2.9

2.7

59.8

72.3

76.9

84.2

59.4

51.8

0.9

North______
Delhi_______
|Haryana
Himachal Pr.
J&k
Punjab
[Rajasthan

2.5
2.6~
2.4
2.8
2.6
3.0

2.4
25
22
2.7
2.3
2.8

78.2
63.4
77.1
60.0
75.4
44.2

85.3
81.4
91.5
65.6
89.0
61.1

89.4
86.8
90.8
49.2
89.1

39.7
50.3
41.6
50.6
41.3
68.2

36.2
37,6

1.0
0.7
3.8
0.2

71.2

94,7
88.2
94.7
87.5
96.4
79.4

Central
Madhya Pr.
|Uttar Pr.

3.1
3.4

2.9
3.1

47.4
32.3

59.6
47.9

70.2
57.2

83.6
70.5

63.5
80.2

55.7
71.9

1.7
0.9

1.0
0.5

64.3
25.5

78.4
33.5

3.4

3.3

3.0
2.6

2.7

35.1
60.7
74.2

44.4
70.9
87.7

38.5
79.5
86.8

69.5
88.6
93.0

76.9
63.7

75.5
53.2

1.1
1.4

33.4

60.5
46.1
43.0

68.0
67.3

42.6

0.9
1.3
0.3

4.7
3.2
3.7
46
4.3
4,0

32
2.9

29.0
53.4
36.5
21.9
500
31.6
74,5
NA

48.0

34,7
76.3
63.3
34,1

76.4
57.2
65.1
79.3
46.2
87.0
43.9
NA

64,6
56.7
61.3
79.8
42.3
69.7
NA

1.3
0.2
3.0
0.7
0.8
3.6

94,5
NA

59.4
82.4
65.9
50.6
77.5
57.8
NA
94.4

46.2

76.4
75.9
81.7

87.7
81.3
85.9

86.4
85.7
91.9

52.2
50.7
46.3

83.9
80.1
86.5
86.4

84,2

92J_

83.9
90.2

89.8
88.7
93.6

530
50.9
36.7
50.2

East_______
Bihar_______
| Orissa_____
|West Bengal

Northeast
(Arunachal Pr.
Assam_____
I Manipur
Meghalaya
[Mizoram
Nagaland
Tripura____

2.4

3.6
4.7
4.0
40

[Sikkim

2.6
NA

NA
2.2

West
[Goa_______
Gujarat
[Maharashtra

2.7
2.6
2.5

2.3

2^
2.3

70.2
71.9
70.9

South
iAndhra Pr.
Karnataka
iKer^fh ~
[Tamilnadu

2.7
25
_2 6
2.1

2.4
2.2
2.5
2.0

64 8
67.3
84.0.,
79.4

‘ Less than 0 O5’/c

I

66.3
47.2
26.8
38.5
51.2
NA
90.0

66,9
40.6

91.9

32.3
50.9
33.3
59.7

1.3

23.1
17 4
17.8
8.0

15.8

22.0

27.3
58.2

15.5

26.5
25.4

32.3
39.3
32.0

26.3
22.6

35.6

20 8
12.2
14.2

NA

34,8
32.1
NA

41,7
50.8
40,2
36.6
NA

20.9
11.0
18.5
23.3
6.9
32.4
NA
33.9

52.5
41.0
39.1

0.9
0.5

44,5
79.4
68.3

30.8
12.3
25.7

17 9
14.2
10 2

40,4
41.7
36.3
47.9

22
03
0.5
0.4

45.0

36.9

23.9

38.5
66.7

14.5
21.6

47,6

1.8

88.5
81,9
76.3
78.8

87.0

7,2
13.7
15.1
15.4

58

14.0
_6_4_
12 2
152

. (?•
TABLE-IV

©Status of IMP,TFR & Higher Order of Birth - SRS, NFHS & District Rapid Household Survey
SI.
No.

I.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

State/UT

INDIA
|
MAJOR STATES
Andhra Pr______
Assam_________
Bihar__________
Gujarat________
Haryana________
Karnataka______
Kerala________ _
Madhya Pr_____
Maharashtra __
Orissa_________
Punjab_________
Rajasthan______
Tamil Nadu_____
Uttar Pr________
West Bengal

SRS
(99)
70

NFHS-ll
(98-99)
67.8

SRS
(98)
3.2

66
76
66
63
68
58
14
91
48
97
53
81
52
84
52

65.8
69.5
72.9
62,6
56.8
51.5
16.3
86.1
43.7
81.0
57.1
80.4
48.2
86.7
48.7

2.4
3.2
4.3
3.0
3.3
2.4
1.8
3.9
2.7
2.9
2.6
4,1
2.0
4.6
2.4

3.3
2.5
3.5
2.2
3.8
2.2
4.0
2.3

43

63.1

2.8

2.5

NA

NA

NA

NA

31
21
62

46.8
36.7
34.4

1.6
1.0
2.4

2.4
1.8
2.1

NA

NA

NA

NA

2.7

NA

NA
2.4
4.0
NA
1.5
2.5
3.9

NA

NA

NA
NA
NA
NA
NA
NA

1.9
2.1

IL SMALLER STATES

_i_ Arunachal Pr
2_ Chattisgarh
3 Delhi________
4 I Goa________
5 [Himachal Pr I
6 [Jharkhand
I
7 U&K
I
8 [Manipur_____
9 [Meghalaya
10 [Mizoram_____
11 [Nagaland
12 [Sikkim_______
13 [Tripura
14 Uttaranchal

NA
25
56
19
NA

49
42
NA

111. UNION TERR TORIES
25
1 A&N Islands
28
2 Chandigarh
4 |Daman & Diu
5 j Lakshadweep
6 IPondicherr/
Source -

Districts with more than 40%
Contribution
birth order 3 and above
of higher
_______
(RHS, 98-99)_______
order of births
Total
No.
3 & above (%)
Distt.
NFHS-ll RHS NFHS
Covered
(98-99) (98-99) (98-99)
504
312
45.8
45.2
2.9

TFR

1MR

56
35"
32
22

65.0
37.0
89.0
37.0
42.1
43.9

3 5

^.5
2.8
1.8

28.8
45.6
57.1
37
40.9
35.3
17.1
53.6
34.5
45.3
35.8
51.9
23.6
59.4
38.9

31.5
43.8
54.6
41,1
41.6
33.6
21.1
52.8
39.2
42.9
39.6
52.9
23.2
58.1
36.5

0
16
30
8
5
5
0
36
7
26
4
30
0
58
7

• 23
23
30
19
17
20
14
38
30
30
17
30
23
58
19

56.7
47,0
32.3
21.4
31.4
54.2
50.6
46.2
57.1
40.0
61.1
43.3
34.7
50.8

46.0

NA

13
5
0
0
2
13
8
7
7
2
6
3
1
10

13
7
1
2
12
13
13
8
7
3
6
4
3
10

20,3
20.2

NA

£

NA

0

1

'.._44.9_'

NA

1

1

|
I
|

NA

2.3
2.3
3.5
2.7

2.9
2.1
2.0

3.0
4,6
2.9
3.8
2.8
NA
NA

NA
NA
NA
NA
NA
NA

35.4 I
44.6 I
21.1 |

NA

39.3
24.9
33.3
NA

50.3
47.1
60.1
46.0
59.6
42.1
NA

NA
NA

Registrar General, India, NFHS and Rapid Household Survey

i

7
o

I
T
T
T

T

I

T
I

2

1
4

r-.
TABLE-V
Status of Maternal Care - Rapid Household Survey (98-99) and N.F.H.S.(98-99)

SI.
No.

INDIA
I.: MAJOR STATES
1 Andhra Pr______
2 Assam _______
3 Bihar__________
4 Gujarat________
5 Haryana
6 Karnataka______
7 Kerala_________
8 Madhya Pr_____
9 Maharashtra
10 Orissa_________
11 | Punjab________ I
12 I Rajasthan______ I
13 Tamil Nadu_____
14 Uttar Pr
15 West Bengal

T

r

Districts with less than 40%
Full ANC Visits
(RHS, 98-99)
Total
No.of districts
Distt
Covered

RHS

NFHS

40.4

42.3

267

504

80.1
30.8
17.8
60.2
37.4
71.4
98.3
28.1
65.4
47.3
57.0
22.9
91.4
14,9
57.0

60
31.1
18.8
56.3
32.8
60
97.4
27.5
61.4
32.9
55.0
32.5
82.5
21.9
45.6

65.2
21.4
23.4
53.5
42.0
59.1
94.0
29.7
59.4
33.4
62.6
35.8
83.8
22.4
44.2

0
18
30
3
7
0
0
31
0
23
5
30
0
55
10

23
23
30
19
17
20
14
38
30
30
17
30
23
58
19

19.8
27.1
73.1
80.3
52.7
18.9
23.8
30.9
30.9
43.7
15.6
31.9
34.8
17.5

40.5

28.2
22.4
73.8
95.1
36.4
19.9
46.8
50.0
35.7
62.9
25.1
36.8
48.4
22.3

84.4
62.9
62.0
71.1

NA

NA

|
|
I
[

NA

T

9E4

NA

NA

I

83.8

NA

NFHS-ll |
3
or More
3 check-up
TT+IFA checkup
43.8
31.8
RHS

RHS

NFHS-ll

65.3

65.4

94.2
56
26.4
79.1
77.7
88.9
84.5
53.9
87,8
72.9
87.2
62
98.4
48.0
84.1

92.7
60.1
36.3
86.4
58.1
86.3
98.8
61.0
90.4
79.5
74.0
47.5
98.5
34,6
90.0

63.4
24,8
10.1
42.7
23.9
60.1
86.1
20.2
54.8
32.5
24.5
16.6
75.3
11.2
33.4

61.6

II. SMALLER STATES
44,4
1 Arunachal Pr
'
Chattisgarh~
52.2 T
2
89.5
Delhi
______
3
98.3 ~T
4 ' Goa_______
87.1 I
5 Himachal Pr
42.8 I
6 ’ Jharkhand
58.0 I
7 1J&K
77.0 I
8 | Manipur
55.0 7
9 | Meghalaya
|
80.3
J
[ 10 [Mizoram ~
I 45.7 |
| 11 Nagaland
| 63.1
12 | Sikkim
| 69.1
_13_ iTripura
T 40.6 ~
Uttarancnai
14

Safe
Delivery

Full ANC

Any ANC

State/UT

NA

83.5
99.0
86.8
NA

83.2
80.2
53.6
91.8
60.4
69.9
NA
NA

■

NA

68.2
95.7
60.9
NA

66.0
54,4
31.3
75.8
23.1
42.6
NA

NA

31.9
NA

65.9
90.8
40.2

;
|
|
i
I
I
|
I

na

42.4'

53.9
2£6
67.5
32.8
35.1

I

T
I

12
5
0
0
0
10
5
4

. 13
7

I

T
T
7

12
13
13
8
7
3
6
4
3
10

NA

5
3
1
3

NA

0_

2

_0
_0

_1_
2_
1
4

NA

I

I

—

III. UNION TERRITORIES,

|a&N Islands
Chandigarh
__3 D&N Haveli
4 Daman & Diu
Lakshadweep
5_____
6 [Pondicherry

~ 1

V

|

95.9
79.6
90.6
95.1
99.4
99.8

NA
NA
NA

NA

NA
NA

|
T

67.2
71.6
27.9
70.7
74,1
93.5

NA

NA
NA

£

NA

£

NA

0

TABLE’VI
Status of Immunisation - Rapid Household Sun/ey(98-99) and NFHS(98-99)

SI.
No.

State/UT

INDIA
I. MAJOR STATES
Andhra Pr______
_2_ Assam_________
_3_ Bihar__________
4 Gujarat_________
5 Haryana________
Karnataka______
_7_ Kerala_________
_8_ Madhya Pr_____
_£_ Maharashtra
_1£ Orissa_________
11 Punjab_________
1£ Rajasthan______
_1£ Tamil Nadu
14 I Uttar Pr
15 [West Bengal

11.2

26.8

151

Total Distt.
Covered
504

4,5
33.2
16.8
6.6
9.9
7,7
2.2
13.9
2.0
9.4
8.7
22.5
0.3
29.5
13.6

25.2
17,1
8.6
13,8
4.8
15,0
24.3
7.9
10.4
24.8
2.4
4.7
16.6
4.9
23.5

39.6
37.1
15.4
28.9
25.7
34,3
47.9
29.8
33.2
35.1
42.3
20.3
27.9
15.8
40.5

0
9
30
2
0
2
0
16
Q
2
0
19
0
26
6

23
23
30
19
17
20
14
38
30
30
17
30
23
58
19

28.7

13.7

40.2

NA

NA

NA

5.1
0.0
2.8

NA
13,8
17.2
NA
12.0
13.6
10.4
23.5
30.9
40.3
14.1

39.1
55.6
45.6

10
1
0
0
1
9
2
4
5
1
5
0
1
0

13
7
1
2
12
13
13
8
7
3
6
4
3
10

2.

NA

£
£
£
£

NA

0

RHS

NFHS-II

54.2

42.0

18.7

14.4

74,7
46.7
20.1
58.2
66
71,6
83.8
47.3
79.5
57,4
72.6
36.9
91.5
44.5
51.3

58.7
17.0
11.0

2.4
11.6
53.1
10.2
10.4
5.7
1.8
13.3
1.9
10.0
9.7
33.6
0.4
27.3
14.0

22.9
7.8
2.4
0.0
2.4
34,1
1.0
20.5
18.0
5.7
8.8
4.2
16.9
19.4

I
I
I

20.5
NA

69.8
82.6
83.4
NA

56.7
42.3
14,3
59.6
14,1
47,4

I
T
1
T
T

NA

NA

T

111.

UNION TERRITORIES

_1_
2

A&N Islands
Chandigarh
D&N Haveli
Daman & Diu

53.0
62.7
60.0
79.7
22.4
78.4
43.7
72.1
17.3
88.8
21.2
43.8

I
|
I

NA

10.4
17.2
42.3
10.4
32.7
17,6
NA
NA

I

4.
5 Lakshadweep
c ironoiunerry

I 77.4

NA

61.6
77,3
72.0
94.8__ '

^□.3

|

NA
NA
NA
NA

1.8
1.8
2.7
4.2
0.3

Districts with Full
Immunisation less than 40%
(RHS, 98-99)

No.

NFHS-II

I
|

ORS packets
for Diahhorea

RHS @ NFHS 3

RHS

||. |SMALLER STATES
30,4
1 lArunachal Pr
59.1
2 Chattisgarh
84,8
3 Delhi_______
88.3
4 Goa________
80.5
Himachal
Pr
5
30.8
Jharkhand
6
I 52,8
J & K
50.6
Manipur
32.7
Meghaiava
9
66.7
10 Mizoram
26.2
Nagaland
11
65.4
12 Sikkim
45.4
13 Tripura
62.8
14 Uttaranchal

£

No
Immunisation

Full
Immunisation

NA

NA
NA
NA
NA
NA

29.8
35.7
7.9
17,3
3.1

■\A

. o.

I
I

NA

I
I

47.5
50.7
22.4
44.7
29.7
27.0
NA
NA

NA

NA
NA

@ Parentage mothers whoes children got ORS packets as treatment of diahhorea
3 Percentage of children who suffered diahhorea and got
ORS packets as treatment.

2

1

TABLE-VII
CRUDE BIRTH RATE (CBR) & DEATH RATE(CDR) - PROJECTED LEVEL 2007

SI.
No.

I.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

State/UT

population
Census
2,001

CBR
SRS
(99)

CDR
SRS
(99)

Exp.
Level
of CBR
2007

INDIA__________
MAJOR STATES
Andhra Pr______
Assam______ __
Bihar__________
Gujarat______ __
Haryana
Karnataka_____ _
Kerala_________
Madhya Pr
Maharashtra
Orissa________ _
Punjab________ _
Rajasthan_____
Tamil Nadu
' Uttar Pr_______
West Bengal

1,027,015,2471

26.1

8.7

21

75,727,541
26,638,407
82,878,7961
50,596,9921
21,082,989 _
~ 52.733,958?

21.7
27.0
30.4
25.4
26.8
22.3
18.0
30.7
21.1
24.1
21.5
31.1
19.3
32.1
20.7

8.2
9.7
8.9
7.9
7.7
7.7
6.4
10.4
7.5
10.7
7.4
8.4
8.0
10.5
7.1

17
22
23
20
22
20
15
23
17
21
18
22
16
24
22

22.3

6.0

20_____

NA

9.6

22______

19.4
14.3
23.8

4.8
7.2
7.3
8.9
NA
5.4
9.1
5.5
2.3
5.8
5.7
6.5

16_____
12_____
20_____

5.5
3.9
6.6
7.1
4.7
6.9

15
14
23
16
20
16

31,838,619?
60,385,118?
96,752,247?
36,706,920
24,289,2961
x 56,473,122
62,110.8391
166,052,859

II. SMALLER STATES
Arunachal Pr
1
Chattisgarh
2
Delhi______
3
Goa_______
4
Himachal Pr
5
Jharkhand
6
J & K
7
Manipur
8
Meghalaya
9
10 Mizoram
11 Nagaland
12 Sikkim
13 Tripura
14 Uttaranchal

III.

-X

1,091,117
20,795,956?
13,782,976
1,343,998
' 6,077,248?
26,909,428?

NA

10,069,9171
2,388,6341
2,306,0691
891,058
1,988,636
540,493
3,191,168
8,479,562

18.6
28.7
17.0
NA
21.6
17.0

356,265
900,914
220,451
158,059
60,595
973.829

18.1
17.9
32.4
26.9
25.1
17.7

NA

NA

T

22______

22 _____

16___ J
23 _____
16 _____
15 _____
17 ____
16 ____
23___

UNION TERRITORIES

1 ' • A&N Islands
Chandigarh
2
D&N Haveli
3
4
Daman & Diu
5~ Lakshadweep
Pondicherry
6

*

80,221,171

?

TABLE-VIII
INFANT MORTALITY RATE - PROJECTED LEVEL 2007

SI.
No.

State/UT

2001 census

NFHS-II

SRS

[INDIA
__ 157,863,145
I. [MAJOR STATES
9,673,274|
|
1 Andhra Pr
4,350.248
2 Assam_______ I
16,234,539
3 Bihar________ I
6,867,958
4 Gujarat_________
3,259,080
5 Haryana________
6,826,168
6 Karnataka______
3,653,578
7 Kerala_________
10,618,323
8 Madhya Pr_____
13,187,087
9 [Maharashtra
5,180,551
10 [Orissa
3,055,492
11 Punjab_________
10,451,103
12 Rajasthan______
6,817,669
13 [Tamil Nadu
30,472,042
14 [Uttar Pr________
11,132,824
15 West Bengal

____ I

SMALLER STATES
IL Arunachal
Pr______

_i_
_2
_3_
_4
5

IMR

Children 0-6

200.055
3,469,7747
Chattisgarh_______
1,923,995?
Delhi________ _____

142,152 ~

Goa__________ _____
769,424
Himachal Pr______
6 [Jharkhand________ 4,796,188

7 |J & K

I ~ 1,431,182'

312,691 '
457'4427
141,537'
280,1721
77,170
13 Tripura___________ 427,012
14 Uttaranchal___ 1,319,393

8 [Manipur__________
9 Meghalaya________
10 Mizoram__________
11 Nagaland_________
~~
12 Sikkim

IMR 99
(Average
SRS &
NFHS-II)
1998

Estimated
IMR
2007

(99)

(98-99)

70

67.8

68.9

42

66
76
66
63
68
58
14
91
48
97
53
81
52
84
52

65.8
69.5'
72.9
62.6
56.8
51.5
16.3
86.1
43.7
81.0
57.1
80.4
48.2
86.7
48.7

65.9
72.8
69.5
62.8
62.4
54.8
15.2
88.6
45.9
89.0
55.1
80.7
50.1
85.4
50.4

40
45
40
35
40
40
9
55
36
60
35
45
35
55
35

43
NA
31
21
62
NA
NA
25
56
19
NA
49
42
NA

63.1
NA

53.1

46.8
36.7
34.4
NA
65.0
37.0
89.0
37.0
42.1

38.9
28.9
48.2

43.9
NA
NA

NA
46.5
3.9
NA

40
50
20
9
30
35
40
30
35
20
30
30
30
35

25
28
56
35
32
22

NA
NA
NA
NA
NA
NA

1.9
2.1
3.5
2.5
2.8
1.8

20
30
35
25
25
16

I
T

NA

NA

2.7
31.0
72.5
2.9

III. UNION TERRITORIES

1 IA&N Islands
2 IChandigarh ~
D&N Haveli
|~

2
4

2
6

Daman & Diu I
Lakshadweep
Pondicherry

44,674
109,293
39,173
20,012
8,860
113,010

I ABL E - IX
COUPLE PROTECTION RATE - PROJECTED LEVEL 2007

SI.
No.

State/UT

No. of eligible
couples
2001
in 000’s

INDIA
176,647
I. MAJOR STATES
1 Andhra Pr
14,161
2 Assam_____
4,049
3 Dihar_______
14,752
4 Gujafat_____
8,854
5 I laiy.ma
3,563
6 Karnataka
___ 8,912
_7_ Kerala_____
5,190
A Madhya Pr
10,749
9 Maharashtra
_ 16,641
10 Orissa
6,130
11 Punjab
3,886
12 Rajasthan
__ 10,052
13 'Tamil Nadu
10,807
14 Uttar Pr
27,897
15 West Bengal
13,557
II. SMALLER STATES
1 Arunachal Pr______ 169
2 Chattisgarh
3,702
3 Delhi_____________ 2,343
4 Goa______________ 194
5 Himachal Pr_______ 1,015
6 Jharkhand________ •4,790
7 J & K_____________ 1,571
8 Manipur___________ 315
_9 Meghalaya________ 332
10 Mizoram__________ 117
11 Nagaland_________ 233
12 Sikkim____________ 78
13 Tripura___________ 501
14 Uttaranchal
1,425

Couple Protection Rate
as per programme data

Contraceptive Prevalence Rato
NFHS (98-99)

Total
March,2000

Dy Sier.

Spacing
(Modern)

Total

Dy Sier.

46.2

29.0

17.2

48.2

36.0

52 8
15.2
21.2
52.8
49 4
56.3
39.6
45,9
49 3
37.6
65.5
36,1
50,4
38
32.2

44.5
12.3
16.7
35.4
32.3
44.8

8.3
29
4.5

59.6
43.3
24.5
59.0
62.4
58.3
63.7
44.3
60.9
46.8
66.7
40.3
52.1
28.1
66.6

34,5
28.0

220.
26.5
35.2
22.9
39,3
17.3
27.2

17.4
17.1
11.5
5.1
17,9
9.3
11.1
30.3
13.2
11.1
20.7
5.0

14.0
NA
27.0
23,9
46 9
NA
14 4
17 8
47
34 6
8.2
21,5
23,4
NA

9.7
NA
17.0
21.1
34.8
NA
12.1
11.3
2.8
28.9
6.3
14.8
17.0
NA

4.3
NA
10.0
2.8
12.1
NA
2.3
6.5
1.9
5.7
1.9 •
6.7

NA

35.4
NA
63.8
47,5
67,7
NA
49,1
38.7
20.2
57.7
30.3
53.8
NA
NA

38 4
33,5
37,5
29,3
7.2
58 4

32.2
23 3
25.8
23.0
3.3
51.2

6.2
10.2
11.7
6.3
3.9
7.2

MA
NA
NA
_NA^
NA
NA

6.4

Contraceptive Prevalence Rato
Any (%)
__________ RUS (98-99)
Spacing All Method
By Ster.
Spacing
(Modern)
(Modern)

I

8.3

42.5

34.9

57,0
16,7
20.2
45.3
40.8
52.2
51.0
37.9
52.2
35.6
30.9
41.8
46.0
15.6
33.8

1.8
10.0
2.2
8.1
12.5
4.4
5.1
4.7
7.6
4.7
23.0
5.8
4.3
6.4
13.5

58.7
28.5

20.7
NA
28.6
28.2
52.4
NA
30,7
15.5
10.7
45.3
12.3
24.8
NA
NA

12.2
NA

33.8
40.1
68.3
38.9
62.4

NA
NA
NA
NA
NA
NA

27.7
7.7
8.4
NA
11.1
10.3
9.1
11.7
12.0
26.6
22.8
NA

I

CPR
(Average Prograrne,
NFHS RUS)
Dy Ster.
Spacing
(Modern)

Expected Level
2007
;

Permanent

Spacing
(Modem)

7.6

33.3

11.0

49.3

15.9

57.7
13.5
21.1
42.6
39.4
52 8
50,3
38.0
50.6
34.0
310
32,4
45.5
14.1
31.9

1.0
15.0
2.2
9.4
13.3
5.1
74
5.4
7,7
5.5
22.6
66
4.4
7.5
13.5

53.1
14,2
19 3
411
37.5
49 9
45 3
34 6
47,6
320
32 4
32 4
43 6
15,7
31 0

37
9.3
30
11.6
14 3
70
59
93
~8 2

j55_0_
35 0
30 0
60 0
56 3
60 0
60 0
55 0
60 0
55 0
55 0
45 0
65.4
35 0
50 0

10 0
16 9
10 0

17.8
NA
39.5

15,5
380
24 8
26.1
45.9
21.0
24.2
12 3
6.6
37.8
10.3
20 8
20.0
30.0

114
50
257
68

47.0
19.4
13.2
47.5
21 6
36.7
40,4
39.9

160
NA
28.8
28.9
50.6
NA
29.9
10.1
6,4
39.3
12.3
22.9
NA
NA

58.2
57.0
35 4_
50.7
11.5
56.8

44.7
21.1
29.7
44 4
7.4
50.6

136
35.9
5,7
6.3
4.1
6.2

23.3
52 0
52 7
57.9
57.7
43.4
58.3
39.5
53.6
39.0
49.9
21 6
45.4

10.0
11.8
NA
17.1
9.3
6.8
82
9.3
13.8
NA
39.9

7,1
25 3
85
66
115
10 7

____ i
.19A

30 0
45£
40 0
45.0
65 0
30 0
36 4
30 0
30 0
56 8
30 0
31.3
30.0
40 0

Ii

9n
20

_IO_2_
87
59
85
7,7
15 7
20 0
10 0

I

2J_2_
26 0
_I22_
JO 7_
17 0
14 9
12 9
30 0
15 5
12 0

_2LP.
19 4

20 8
100
30 0

J2_£
19 6
36
18 5
15 8

.IP A
15 5
14 1
28 5
36 4
18 2

III. UNION TERRITORIES

1

A&H Islands

2_ Chandigarh

2. D&N Haveli
4

2
6

Daman & Diu
Lakshadweep
Pondicherry

59
155
39
24
165
165

NA
NA
NA
NA
NA
NA

i
I

.L

50 0
40 0
35 0
50 0
30 0
65 0

15 0
35 0
10 0
JO 0
10 0
10 0

( I.IWLJUill IHUIIIU Jjy

i I u Ji UIIIIIIC

31.3.2000

By Ster.

By Ster.

spacing

By Ster.

spacing

All Methods

spacing

By All Meth.

By Ster.

46.2

29.0

17.2

30.8

5.5

36.0

8.3

34.9

7.6

42.5

52A_

8.3
2.9
4.5
17.4
17.1
11.5
5.1
17,9
9.3
11.1
30.3
13.2
11.1
20.7
5.0

44.7
146
17,7
41.0
34.8
42.7
48.3
31.7
46.5
31.6
34.0
26.2
39.6
13.1
30.6

1.8
5.4
3.2
5.8
9.6
4.8
6.1
4.0
6.4
10.0
17.4
3.3
5.8
5.3
7.0

57.0
16.7
20.2
45.3
40.8
52.2
51.0
37.9
52.2
35.6

50.4
38
32.2

44.5
12.3
16.7
35.4
32.3
44.8
34,5
28.0
40.0
26.5
35.2
22.9
39.3
17.3
27.2

41.8
46.0
15.6
33.8

1.8
10.0
2.2
8.1
12.5
4.4
5.1
4.7
7,6
4.7
23.0
5.8
4.3
6.4
13.5

577
13 5_
2T1_
_42j6_
39.4
52.8
50.3
38.0
50.6
34.0
31.0
32.4
45.5
14,1
31.9

1.0
v 15.0
2.2
9.4
13.3
5.1
7.4
5.4
7.7
5.5
22,6
6.6
4.4
7.5
13.5

58 7
28.5
23 3_
52 0
52.7
57.9
57,7
43.4
58.3
39.5
53.6
' 39 0
49.9
21.6
45.4

14,0

9.7

4,3

10.7

8.5

20.7

12.2

NA

NA

NA

NA

HA

NA

27,0
23.9
46.9

17.0
21.1
34,8

23.2
30.5
45.8

31.2
7.3
•8.5

28 6

2^

27,7
7.7
8.4

33 8
40.1
68.3
38.9
62.4

NA _

NA

NA

NA

NA

NA

NA

NA

14.4
17,8
4.7 ■
34.6
8.2
21.5
23.4

12.1
11.3
2.8
28.9
6.3
14.8
17.0

10.0
2.8
12.1
NA
2.3
6.5
1.9
5.7
1.9
6.7
6.4

16.0
NA
28.8
28.9
50.6

17,8

NA

29.7
13.8
10.0
44.6
6.4
NA

10.0
10.3
5.1
8.3
6.2
NA

30.7
15.5
_107
45.3
12.3
24 8

29.9
10.1
6.4
39.3
12.3
22,9

17.1'
9.3
6.8
8.2
9,3
13.8

NA

NA

NA

NA
NA

NA
NA

NA
NA

11.1
10.3
9,1
11.7
12.0
26.6
22.8
NA

NA
NA

39.9

47.0
19.4
J3.2_
47.5
21.6
36.7
40.4
39.9

3JT4_
33.5
37.5

32.2
23.3
25.8
23.0
3.3
51.2

6.2
10.2
11.7
6.3
3.9
7.2

NA

HA

NA

NA

NA

NA

HA

HA

NA

NA

NA

HA

NA
NA
NA
NA
NA
HA

HA
NA
HA
IIA
HA
NA

44,7
21.1
29.7
44.4
7.4
50.6

13.6
35.9
5.7
6.3
4.1
62

58.2
57.0
35 4'
JO.7
11.5
56.8

INDIA
MAJOR STATES
I.
Andhra Pr______
1
2_ Assam_________
3_ Bihar__________
4
Gujarat________
Haryana_______
5
Karnataka______
6
7
Kerala_________
8
Madhya Pr_____
Maharashtra
9
10 Orissa_________
11 _ Punjab
12 Rajasthan______
13 Tamil Nadu
14 Uttar Pr_______
15 West Ben gal

15.2
21.2
52.8
49.4
56.3
39.6
45.9
49.3
_3L6
65.5

_36/L

II. SMALLER STATES
Arunachal Pr______
1
2 Chattisqarh_______
3 Delhi____________
4 Goa______________
_
5 Himachal Pr
6 Jharkhand
7 J & K____________
8 Manipur__________
9 Meghalaya________
10 Mizoram__________
11 Nagaland_________
12 Sikkim___________

J3_

spacing

’J’

CPR Any (in %)
RHS (98-99)

CPR(in /o)
NFHS 11(98-99)

CPR(in %)
NFHS I (92-93)

CPR(in %)

Slate/UT

SI.
No.

14"

Tripura___________
Uttaranchal

III.

UNION TERRITORIES

1
2
3
4
5
6

A&N Islands
Chandigarh
D&N I taveli
Daman & Diu
Lakshadweep
Pondicherry

7,2
~58.4-

I

52,4

NA

39.5
10.0
11.8

NA

I’

•

■

table - ;</

SI.
No.

State/UT

Total Population)
(in ’000)
2001

No. of
I Accepted
Eligible
Couples
Programme
in 000’s
i March.2001

I

I

I
India
i.

.

major states

1 Andhra Pr
2 [Assam
3 I Bihar
~~
4 I Gujarat
5 I Haryana
6 I Karnataka
T I Kerala
8 I Madhya Pr
9 I Maharashtra

I

10 I Orissa_____
11 I Punjab
12 ) Rajasthan
13 (Tamil Nadu
I 14 (Uttar Pr
I 15 (West BennaI

1
1
T

r

II. SMALLER states
LjArunachal_Pr
J
2 Chattisgarh
3 Delhi_______
4 (Goa
5 I Himachal Pr
I 6 Jharkhand

I
_L
T

Tt

±

£k

I

T

3 (Manipur
9 (Meghalaya
10 (Mizoram
11 (Nagaland
12 I Sikkim
~
13 (Tripura
~~
14 (Uttaranchal

in.

i_
i

J.
T
I

1,027,015

75,728
26,638
82,879
50,597
21,083
52,734
31,839
60,385
96,752
36,707
24,289
56,473
62,111
166,053
80.221

1.091
20,796
13,783
1,344
6,077
26,909
10.070
2,389
2,306

891
1,989 •
540
3,191
8,480

176647

1
L

i
T

169
3702
2343
194
1015
4790
1571
315
332
117
233
78
501
1425

I

I
I
I
I

RHS
98-99

36.0

34.9

44,5
12,3
16,7
35.4
32.3
44.8
34,5
28.0
40,0
26.5
35.2
22.9
39.3
17,3
27.2

57,0
57.7
I 16,7 | 13.5 iI
| 20,2
21.1 I
45.3 ~~42.6 I
~| 40.8
39.4 |
( 52.2 I 52.8 |
51,0 | 50.3 |
37,9
38.0 |
T 52.2
50.6 I
( 35.6
34.0 |
T 30,9
31.0 |
I 41,8
32.4 I
I 46.0
45.5 I
I 15.6
14.1 |
I 33.8
31,9 I

9.7

| 20,7 | 16.0 I
I
NA |_______
NA
|
l~ 28.6 | 23.8 I

NA

I

98-99

30% Couples Sterilised
(RHS, 93-99)
No.
Total
Distt.
Covered
223
504

_ 0_
22
29
_ 1
2
0
0
7
0
7

T

17.0
21,1
34.8

28.2 |
52.4 |

I

T
J.

TT"

II

0
57
8

T
i_
I

11

12
0
1
1
0
11

28.9 I
50.6 I

NA

NA

|

NA

12,1
11.3
2.8
28.9
6,3
14,8
17,0

~ 30,7 |
~l 15,5 |

29.9

|

10.1

|

I10.7
_______
I 6.4 |
I 45.3
T 12.3

NA

|
I

39.3 |
12.3 I

23
23
30
19
17
20
14
38
30
30
17
30
23
58
19

I

■I

I

I
I
I
. I

NFHS I

29.0

14161
4049
14752
8854
I
3563
J
8912
I
5190
10749
16641
6130
3886
I 10052 1
I 10807 I
I 27897 T
13557

Districts with less than-

i erminal Method

13
7
1
2
12
13
13
8
7
3
6
4

±

riI

7
1
6

I

24.8

|

22.9 I

I
I

A

NA

|

NA j

~3

.NA

|

na

|

4

i

I

I

UNION TERRITORIES

I
I

1 lA&N Islands
I 2 I Chandigarh
| 3 |d&N Haveli
4 lOaman&Diu
5 I Lakshadweep

i

I
i

356
901
220
158
61
974

59
155
39

J.
1
I

32.2
23,3
25.8
23,0

TV2

I

0

I

2

I
I

44.7 |
21.1 |

_0
1

NA

r 29.7 |

NA

44.4 |
50.6 |

0

NA

o -?

165

2

J_

J.
1

NA

NA

I

4

J

1
J

10“

i

J

J

TABLE‘XII

Rate of Contraceptive Acceptance

State/UT

SI.
No.

I
I

3

1

7,859
3,551
12.288
5,720
2,412
4,919
3,399
7,739
9,985
4,506
2,518
7,750
6,560
23,071
9,869

I

1

I

27,897.
13,557

14 I Uttar Pr
15 [West Bengal I

1 lArunachal Pr I
2 IChattisaarh I
3 I Delhi_______ 1

1

5 [Himachal Pr I
I
6, Jharkhand
J & K_______ I!
Manipur_____ I
9 Meghaiava
10 | Mizoram
I
11 Nagaland
12 Sikkim_______
13 Tripura______
14 ’ Uttaranchal
_________ _

t

169—
3,702
2,343
194
1,015
4,790
1,571
315
O
ooZ
117
233
78
501
1 .^25

I
I

260,251
157,231

NA

1,945
153
662
NA

I

1
I

1

NA

I
I.

1
2
3
-i
5
o

1
I

I

I

111?
159|

729.111

|A£N Islands T
[Chandigarh I
|D&N Haveii I
i Daman >3
;
I Lakshadweep
| Pondicherry

59
155
39
24
10
165

I

T

1250
255
180
2349
2159
1440
-- -

__e

27Uul
~ 1100l
12381
^30971
2306
1166
1656
739

I

303
4,617|
__ 671
1,028.
NA____
NA
I
NA
NA
I
1233
142
_
239.8471
27.556I
356_
280
4,2921
5,4431
1761,
341
22~533~i~~ 116,5111
NA
NA
NA
I__________
_
NA
I
. 3
33.5741______ 2ZL
10,5781
207
5,7721
18L
4961
162
itl
1,7271
382
3.1771
3061
2.5451
NA____
7 NA
I
NNA
ftNA
I
428
2,8461_______ _§8
538
771
32,0681
124
5,151
NA
NA
I
N-A------NA

"^I

ZZZIS

UNION TizRRI i ORI-S.

I
|
j
|
■
|
j

6211
25
441
3501
320.
704l
3651
315
531
1351
269?
250?
473?

487,8831
90,493?
8.8441
220.77?
54,6221
200.042 1,343,368 _
520.753 _
77,212
708,528 _
346,234
~ 218,5157
124,200
243.6161 2.089,34|7
530.040 1.098,5921
557,8201.
60,624
779,90lT
67,613
193,901_ 7787.^551
764,967
310.352
3,821,37?

|

153

1,381
279
323
• 83
218
66
416

__ L

EZZZLZZ3
982,1771

11. [SMALLER STATES

HI

- Performance of States

Performance Rate per
Performance
Estimated Estimated No.
10,000 unsterilised
(2000-01
of Unsteriiised
No. of
coucles_____
lictoJan.) _
Couples
Eligible
Terminal Spacing
Terminal Spacing
March,2001
Couples
method
method
(in 000's)
March,2001
(in 000's)
1922
2581
!__________
| 3 235,5551 24,109,615.
125.419
176.647

[INDIA
MAJOR STATES
Andhra Pr
I _ 14,161
4,049
2 Assam
14,752
I
3 Bihar
8,854
Gujarat
4
3,563
5 lHaryana
_
6 I Karnataka
I 8,912
5,190
7 I Kerala
10,749
8 iMadhya Pr
16,641
| 9 | Maharashtra
7i
6,130
10 Orissa_____
3,886
11 Punjab
10,052
12 | Rajasthan
10,807
13 Tamil Nad?

4 |Goa

*

23374T
J6,146T~

40
119
29

7348?
2.069I
2671

10
31

__ 3Sj
9.552114.5381

^ToiT

2T602L
4421
^2^5!"

3371
1741
921
2391
S9l
11S6I

843
1358
139
867.
699
1805

•f

4

1

Table XIII
'■

J-

1

... ;
'' '

-•

NFHS-I
(1992-93)

Indicators

t

35.4

Children fully immunized ( /«)
(BCG, Polio 3, DPT 3, Measles)
1
of Individual Antigens
3(a) Coverage
BCG
Polio 3
DPT
Measles
Infant
Mortality Rate
4.
3 or more Ante Natal
5.
Check up for women.
2 or More doses of TT
6.

i
I

■ i

?

62.2
53.4

51.7
42.2
78.5
44.0
55.0

7.
8.
9.

Iron Folic Acid Supplementation
% Safe Delivery
Percentage of births of
order 3 and above.

52.0
34.2
48.5

10.
11.

Contraceptive Prevalence Rate
Sterilisation
Spacing Methods (Modern)
Spacing Methods (Traditional)

40.6
31.0

12.

13.
14.

15.

Total Fertility Rate
% of Women with any anaemia
% of Children with any anaemia

n
‘-I
’

I

•J

• • .1

•;T5

1

6V

(199S-99)

51.4
50.0

43.3
54.2

1. Female Literacy.
2. Percentage of Girls
married below 18

nfhs-ii

6.0

4.0
3.4
NA
NA

42.0
|

72.0
63.0
55.0

■

51.0
67.6
44.0
67.0

■

'

; .;.

58.0
42.3
45.2

48.2
36.0

7.0
5.0
2.9
52.0
~4.0

All

' -5*

I
n.
Table-XIV
Position of Districts - Acceptance of RCH - District Surveys-I and il

Very
Good

Good

Satisfactory

Poor

Status(%)

<10

10-20

20-40

>40

No. of districts

6

21

164

313

Pregnant women who Status(%)
had IFA tablets
No. of districts

>75

50-75

30-49

<30

41

88

109

266

Status(%) .

>75

60-75

40-59

<40

No. of districts

95

42

102

265

>75

50-75

30-49

<30

No. of districts

46

62

109

287

Status(%)

>75

50-75

25-49

<25

S.No. Characteristics

1'

2

2

4

5

Contribution to birth
by birth order 3 &
above

Three ANC
check-ups

Institutional deliveries Status(%)

Safe deliveries

___

6

7

Children diarrohea
treated by ORS

Children fully
immunised

No. of districts

97

128

137

142

Status(%)

>75

50-75

25-49

<25

No. of districts

0

9

82

413 •

Status(%)

>75

60-75

40-59

<40

No. of districts

144

90’

118

152

________

8

Sterilisation

Status(%)

>50

40-50

30-39

<30

No. of districts

75

101

105

223

Z*
K-------

population stabilization, the indicators of maternal & child care should be 100% by the the

terminal year.

Unless this is achieved, the indicators of fertility above can’t show any

improvement.Matemal mortality rate in India is 540 per 100,000 live births (NFHS-98).Post

Partum Hamorrhage (PPH) and severe anemia are among the important causes of high maternal
mortality. As per NFHS-98,35% of pregnant women did not receive antenatal care,67% received

2 dosesT.T and 58% received Iron and folic acid and two-thirds dehveries took place at
home.Even though the infant mortality rate has declined from 146 in 1950s to 72 per 1000 live

births in 1998;it has remained static since early 90sand neonatel mortality continues to be high.

Maternal and Child Health target should be 100% without which population stabilization

cannot be achieved.
$M

a.;

r

27
I

r

Vv

!

fI
I

CHAPTER. -7
current staUts and future recent (si,art,

Terms of reference- To assess

^lum and long tern,) of dentograpkie, bio-medical, social and beltavtoura

research aimed at meeting the felt needs for health

cure of

G.7td children

and contraception during the Tenth Plan:
e Programme. Major focus of
Research is an important component of the Family Welfan
the research activities during the last three decades include:
Basie research aimed at better understanding of the physiology of reproduction in women

X, d^op^te™^

1)

newerdnsd^^-

couples in the 2lst century will have wider choice of contraceptives.
ChrWtegmg of newerdmgsand demees to dete^ne them -"r

2)

in the

National F-y Weifare ^8™-■=. “XX ««=d

efficacy of available contraceptives m p

3)

4)

opX »—*

----

r

st
===--'*■

contraceptive methods.
e .$ ^etter
Socio-demographic, psycho-social and commun.cat.on researc
■
understanding of the behavior, factors governing comraceptrve » “’j “

of me s- «y norm, and

“ ^ Xlment in

knowledge, promote attitudes and practices

acceptability and continued use of contraception.

3

• ;S

- * >n Stabilisation are being carried out by
Research studies in Family Planning and Populate
permanent institutes, its eoll=bora:mS centres; and
Council
of
Medical
Research,
its
the Indian
28

•>!

a

■'•.J

J.

V

v-

academic and Research Institutions supported by research grants from the ICMR, DBT, DST and

UGC. The National Institute for Health and Family Welfare carries out operational research
studies; the UPS Bombay and the network of Population Research Centres also carry out

research and evaluation studies in Family Planning and allied fields. Many of these institutions
are undertaking collaborative studies funded by National Agencies and by International agencies

such as WHO, UNFPA, UNICEF, etc.

Research studies in India have shown that:
1. Puerperal sterilisation is safe and effective contraception in lactating women.
2. IUD insertion in the immediate post partum period is associated with high expulsion rates.

Insertion of IUD in the hyper involuted uterus during lactational amenorrhea might be

associated with a increased risk of perforation of uterus. Taking these factors into
consideration it would appear that the optimal time for IUD insertion migS be soon after
return of menstruation in lactating women.
3. IUDs and sterilisation have no adverse effect on lactation and hence are the contraceptives of

choice in lactating women.
4. There may be women who find that these methods are not suitable and opt for hormonal

contraceptives. Available data indicate that progestogens only contraceptives are free from

any adverse effect on lactation. Combination of pills containing low dose estrogens have
been shown to reduce the duration of lactation and milk output when initiated early in

lactation. However, if low dose of Oral Contraceptive use is begun after 6 month of lactation,
there was no adverse effect on duration of lactation, milk output, infant growth or

development. It is well known that contraceptive steroids are excreted in breast milk. So far
there are no reports about any adverse effect attributable to steroid ingestion through breast

milk. Taking all these into account and as a measure of abundant precaution. Government of
India has issued a guideline that hormonal contraceptives use in the Family Planning

Programme should initiate only after 6 months of lactation.

Demographic research studies should include testing and validation of relationship
between reduction of infant mortality rate and the parameters in the States at different levels of
demographic transition.
29

Population Policy
PoUcy and
Population
and Family
Family Planning
Planning Paradigm
Paradigm has shifted in the recent past fr.ln
demographic issues to quality of life issues. Emphasis has been put on the reproductive r.gh_ of
women, adolescent care, gender equity and greater male participation in family life and family

planning. These are closely linked with women’s health and status of their development. In order

to provide conceptual clarity on researchable issues on reproductive issues on reproductive anc
child health care, several research projects are being undertaken in the category of bio medical

research studies, as well as fertility regulation, infertility, safe abortion, rep:reductive tract

infections (RTIs)and sexually transmitted diseases(STCs), adolescent reprodum.ve health, old
age problems etc.
The Division of Reproductive Health and Nutrition of the ICMR has been engaged ir.
promoting, conducting and coordinating research and development activities in the nationally

important area of reproductive health and related nutritional issues. The activities of the Division
in reproductive health have a major focus on program relevant operational researches as ’ ’! ai

on applied clinical and basic research. This is being carried out through its intramural set uf
namely Institute for Research in Reproduction (IRR), Mumbai, National Institute of Nutrition
Hyderabad and through extramural research largely being conducted by a nation-wide networl

of Human Reproduction research Centre (HRRCs), National Nutrition Monitoring Bureau am
other non ICMR collaborating institutions/medical colleges.

Interstate/ intrastate differences in fertility and mortality
There are marked differences in the performance under the Family Welfare Prograr

between states Some of these attributable to the differences in the availability and access t
services- socioeconomic factors including educational especially of v/ome., also play

important role. Even though the norm for expenditure is uniform there are substantial difference
between States both in terms of utilization of the funds and impact as assessed by IMI

B.

and CPR. States like Kerala have achieved low CBR and IMR at relatively low cost . On th

other hand states like Haryana and Punjab have not achieved substantial reduction in IMR ar.
CBR in spite of higher expenditure per eligible couple. In states like Bihar, the expenditure

low and performance is poor.
District data on higher order births available from district surveys shows that there a:
marked differences in these indices not only between States but also between districts tn .1
30

!
I

Vv

hi
1

’

:

same state..

The Family Welfare Program, therefore, has been re-oriented to (a) remove or

minimise the inter and intra- State differences (b) undertake realistic PHC based decentralised

area specific microplanning tailored to meet the local needs and (c) involve Panchayati Raj
institutions in the programme development and monitoring at local level to ensure effective

implementation of the programme and effective community participation.

Kerala, the first State to achieve TFR of 2.1 did so in spite of relatively low per capita

income; in spite of having substantial higher per capita income Punjab and Haryana are yet to
achieve TFR of 2.1. Obviously in Indian context, economic development and increase in per

capita income are not essential prerequisites for achieving reduction in fertility. Tamil Nadu was

the next State to achieve TFR of 2.1. The State did so in spite of higher IMR and lower female

literacy rate than Kerala; Maharashtra, which has similar IMR and is yet to reach substantial

decline in TFR. This shows that in some States decline in IMR is not also a critical determinant
$

of decline in fertility. Andhra Pradesh is the State which has shown lower growth as per census

2001.

The State has shown a steep decline in fertility in spite of relatively lower age at

marriage, low literacy and poorer out-reach of primaiy health care infrastructure. The States of

Haryana and Punjab, have a comparatively higher age at marriage, higher literacy rate and better

outreach of primary health care infrastructure have not succeeded in achieving a parallel decline
in fertility rates.
Both Tamil Nadu and Kerala achieved TFR of 2.1 long before the CPR of 60 was
reached. In both these states, sterilisation was the major mode of contraception, suggesting that

under conditions prevailing in these states, the low utilization of spacing methods was not a

hindrance for achievement of replacement level fertility. Health professional believe that

availability and access to family welfare services is one of the critical determinant of decline in
fertility. In the North-eastern States of Tripura, Manipur, Mizoram and Himachal Pradesh, there
is substantial difficulty in access in primary health care facilities; these states have achieved not
only low fertility rates but low infant mortality suggesting thereby that a literate and aware

population can successfully overcome deficiency in access and availability of primary health

care infrastructure.
In spite of infrastructural manpower and financial resource constraints, high illiteracy

31

and marked diversity between States, the Family Welfare Programme has during the last fr")

decades succeeded in achieving substantial reduction in

infant mortality and

fertility i.-es

within the framework of democratic set up. In this process, the Family Welfare Programme has

shown that factors such as economic status, educational status, access to health services which
were thought to be pre-requisite for achieving sustained decline in birth rates are not essential
prerequisites for reduction in birth rate in the Indian context. The experience of different
States, while implementing FW programmes clearly show, that the programme can succeed

despite limitations in several States. The need for identifying local problems and also methods by

which these could be overcome from within the resources available is therefore, of paramount
importance in rapidly bringing down infant mortality and high fertility. Under the Reproductive

and Child Health care, the emphasis on area specific need assessment and micro-planning is
expected to provide the policy direction for achieving this.

r

The fact that perinatal and neonatal mortality have not shown substantial decline over the

't

two decades is a cause for concern. Improvement in the quality of antenatal, intranatal and

neonatal care is urgently needed.
Monitoring of Family Welfare Services
Monitoring and evaluation form' an essential component of FW Programme. Indicators

used for monitoring and evaluation, include process indicators and impact indicators. Process

indicators are used to monitor the progress of implementation of the programme through
monthly progress reports as compared to the annual targets. The existing service statistics do
provide an inbuilt rapid and ready method for assessment of performance in Family Welfare

Programme in terms of process indicators for ANC and for immunisation and FP acceptance.
These data are used for mid-course corrections in the States that are not achieving the expected

level of performance. However, these indicators do not provide any information on the qualii

f

care or appropriateness of the services. During the Tenth Plan, efforts will be made to collate

and analyse Service data collected at the district level and respond rapidly to the evolving
situations. Available data will be analysed and utilised at the local level for area-specific micro

planning. Efforts will be made to incorporate the district-level information from other sectors and
optimally utilise the local resources including human resources in the implementation of the
Family Welfare Programme, through inter-sectoral coordination. Efforts will also be made to

32

I.

h

generate district- level data on all the related sectors and the Department of Family Welfare has
constituted regional evaluation teams which carry out regular regular sample verification of
family welfare and RCH Programme and utilise them for programme planning , monitoring and

evaluation.
The Office of the Registrar General of India (RGI) works out the annual estimates of

crude birth rate (CBR), crude death rate CDR) and infant mortality rate (IMR) through their

scheme of Sample Registration System. The system provides an independent evaluation of the
impact of the Family Welfare Programme in the country. The vital indices and decennial growth
rate estimated by the Office of the Registrar General of India on the basis of the census, also
provides indirect evaluation of impact of the Family Welfare programme.

The Department of Family Welfare, in collaboration with RGI, has set a target of 100%
registration of births and deaths by the end of the Ninth Plan. Steps to collect, collate and report

these data at PHC/District level on a yearly basis have also been initiated.
“However, at the State and District level, IEC efforts have to be multiplied by roping in

ail departments and securing the services of private ad agencies to improve the quality of the
messages. The EEC message today has to cover areas such as Age at marriage, preservation of

the child and* even the management of infertility.”
Monitoring and Evaluation
Monitoring and Evaluation is essential for any ongoing program so that appropriate

midcourse corrections can be made. Monitoring is an in-built component of Family Welfare
Programme and should be carried out by the existing personnel involved in implementing

the

programme. Concurrent and periodical evaluation of the programme currently being earned out
by a variety of organization under variety of schemes by Governmental, Non-govemmental

organizations and Research institutions utilizing different study designs and coverage making it

difficult to have a comparative assessment of the implementation of the total programme^The

devaluation^of the programmejjieed be clearly brought under one head, while monitoring of the
activities should be through the functionaries of the Dept; if necessary by independent agencies.

These should be funded adequately but duplication should be avoided.

I

.w,..

To assess the current status,and fiiture requirements

(short, medium and long

term) of basic, clinical, applied and operational research in reproductive health and
family welfare.
of research in contraceptive technology and demography and conducting
For purpose
evaluation studies, grants-in-aid are being provided to Indian Conned of Medical Research,

National Institute of Health and Family Welfare. Central Drugs Research Institute, Lucknow,
Central Council for Research in Ayurvedha and Siddha and Central Counml for Research m
Unani Medicines under the programme. A net work of IS Population Research Centres are

operational ii various Universities and Institutions of national repute to conduct stud.es on
various aspects of the Family Welfare Programme, demographic and other related subjects so as

to brin. about modification in the ongoing programmes. A small provision has also been kept m

the budget for ad-hoc research/ evaluation studies, experimental research projects, and for

printin'1 of Eligible Couple Registers (ECRs). In order to ensure that quality sernces/ equ.pmem
are utilised in the programme, a National Centre for Technological Evaluation of IUDs and

Tubal Rings has been set up at nT, New Delhi. The ongoing research acnvtfes were revmwe
and the Following recommendations were made. Research on eradication of Polio & prevalence
of Hepatitis B, including future course of research is an area to be excelled m Tenth Plan.

Basic and Clinical Research
e
Basic Research studies in the priority areas identified earlier will be continued. These me u e:
Immunological methods for fertility control ofB-hCG, FSH. inhibit and ribofiavin carrier
1)

protein immunization. The projects need to be continued until the logtcal conclusion .s
reached.

2) New drug delivery systems for the delivery of contraceptive

steroids need to be

developed and tested.

occlusive methods, efforts to develop spermicides based on
3) Trails to test the newer vasoplant products such as neem oil and sapomns need to be continued. Vao
such as
contraceptives including those using plantbased substances need to be teste
systematically for their safety and efficacy.
34

I
i

4) Testing contraceptives, which are considered to be effective in Indian System of
4

Medicine and among tribals is another rather difficult task that should be continued.

5) In the field of male contraceptives, the concept of injecting a bio-active compound into

the lumen of the vas deferens to obtain potentially reversible long term contraceptive
effect is a new dimension in the male contraceptive field. The animal model studies and

phase I and phase II clinical trials with injectable contraceptive RISUG, a specific
copolymer of Styrene with Maleic Anhydride dissolved in 60mg sovent of.dimethyl

sulphoxide, have indicated that the new technique is safe and efficacious. It is necessary
to take steps to bring the technique to a level where it can serve the family welfare needs.
A phase IH Clinical Trial with this preparation has been initiated to evaluate the safety

and efficacy of the drug in a large number of subjects.

6) Emergency contraception is useful in a situation where prevalence of regular
contraceptive is' low, in couples using barrier methods or oral pills or in couples having

infrequent sex. The knowledge and availability of emergency contraception is very
limited in India.

7) The study has been initiated to assess the knowledge and demand of these methods.

Newer non-surgical methods of MTP are currently under clinical trials in India and
elsewhere. These studies need to be supported and the potential role of these in reducing

illegal abortion and health hazards associated, if need be, explored.
8) The Central Drug Research Institute has developed once-a-week, non-steroidal
contraceptive, Centchroman, which is undergoing post marketing surveillance. These

studies need be completed so that information on the safety, efficacy and side effects are

available under the Programme conditions in the country.

Operational Research
The group emphasised the need for providing adequate funds for operational and

socio-behaviourial research. During the last year of the Eighth Plan, the Dept, of Family Welfare
______ /

has adopted the target free decentralised PHC based area specific micro planning,

implementation and monitoring approach for the implementation of the Family Welfare Services.
35

v>

This is in line with the recommendations of the NDC Committee on Population. Effective 1

change over to this system would require that all service providers, in the Govt., Voluntary ^id
private sector understand and participate in the process and the population understands and

appropriately utilises the available facilities. Reproductive and Child Health Programme under
target free approach have been introduced in the last year of the Eighth Plan in the National
Family Welfare Programme along with detailed guidelines for operationalising these through

existing infrastructure.

In order to rapidly translate these written guidelines to actual

implementation and smooth out operational problems, it is imperative that operational research

studies are set up in different setting in the States. Operational research studies on a massive

scale would be required for this. The term operational research-has been used to cover a wide
variety of formal research studies of varying scale carried out by research workers belonging to

different disciplines. In addition to strengthening these types of formal research .studies, it might
become necessary to encourage local population, health service providers and others who wantf

try innovative methods to tackle local problems.
Demographic research studies should include testing and validation or relationship

between couple protection rate and crude birth rate and relationship between reduction of infant
mortality rate and reduction in birth rate in the States in different levels of demographic
transition. Focussed studies on continuation rates, use effectiveness under the programme condi
tions should be undertaken so that these could be used for computing effective couple protection

rates.
Research is also required in operationalising integrated delivery of RCH services,

nutrition, education, women and child development, rural development and family welfare
services at village level utilising available infrastructure under the various programmes.

To review the present status of involvement of organised and unorganized sectors of
Industry and trade/labour unions in the Family Welfare Programmes and
recommend ways and means for increasing their participation in the Programmes.
Managerial capability of corporate bodies will go a long way in improving efEciency in

the field of social marketing of contraceptives. The problem solving approach of corporate

sector can be of use in improving operational efficiency of the health care infrastructure.
36

ii

•

Possibilities may be explored to deliver health care services in unserved urban area

U through public, private and/or joint sector as the case may be.
The Steering Committee endorsed the recommendations of the Working Groups on

Reproductive & Child Health and Population Stabilisation regarding ways and means for
increasing involvement and participation of organised and unorganised sectors of industry,
agriculture, trade/labour unions and agriculturists in family welfare programme.

Twelve strategic: themes have been identified in the national Population Policy,2000
which must be simultaneously pursued in order to achieve the national socio demographic goals

for 2010. Department of Family Welfare wiU take care of the strategies Eke Child Health and

Survival, Meeting the unmet needs for Family Welfare Services, convergence of service delivery
at village levels, underserved population groups, etc.. In addition, the Department of Women and
Child Development will also take care for the strategies Eke empowering w^men f°r improved

health and nutrition; programs for safe motherhood etc.

37

J

CHAPTER -8
Terms of reference -To project financial implications for implementation of the

family welfare programme during the X Plan including the plan and non-plan
requirements and the Centre-State participation in the funding.
The Parliamentary Standing Committee on Human Resource Developgjent m its 20th
Report for grants of Deptt. Of Family Welfare recommended that at least/3% of the total plan,
X,—

allocation should be provided for the Family Welfare Programme^
Planning Commission supports the idea that within the available resources more funds

should be provided for the programmes under family welfare.

At the same time State

Governments must be convinced and persuaded to provide funds for the family welfare

programme from their own resources and share the expenditure which is of non-plan in nature.
The NDC Committee on Population has also recommended that allocations for Family Welfare
Programme should be gradually increased to about 3% of the total public sector Plan outlay. The

NDC Committee has further recommended that the States should meet at least 10% of their
family welfare expenditure which are non-Plan in nature from within their own budget. The

expenditure on Health as proportion of GDP has been low to the extent of about 1% only. In
USA, public expenditure on health is 4% of GDP. Hence some attention is to be given to
increase the proportion of GDP in India.
The activities, which were in operation in the Ninth Plan would be continued in Tenth Plan

also. However, in some cases there would be a marginal increase in the outlay

wh

ich stress on the following points:
(i)

(ii)

Special focus will be given to Districts identified on the basis of child mortality, IMR,
CBR. & under 5 mortality.
States which have already achieved the expected level, will be assisted to have other
facilities like blood bank and other better facilities like RTI/STI screening.
38

The allocation for the Panuly We.fare
outlay has ranged between t06 pet cent and 1.76 per ce^un^

the ^nations under

emphasis given to hnproventen. of these
implications for raptd popeiadon .ah t^n. ihe^

this criterion so as to motivate the

-

importance of IEC campaign m

programme may have to be eonstderec

md Akashvani will be

improving utilisation of avatlable servtces or
.
persuaded to.provide specific ume slots on a iarger scale etther

concessional rates for

IECeffortSu
cid?rable escalation in the cost of drugs. Supply
Over the last 40 years, there has een con
essential pre-requisite for
of adequate quantities of drugs, vaccines and con
P
bem adequate supply of
ensuring adequate coverage. In the Eighth

an pe^

Contraceptive supplies have

vaccines for pregnant women and vaccines to e giv

in the supply of

by and large been adequate. However, there <ave^

imperative that the

IF A and Vitamin A for achieving 100/o covera0

the target groups On

requirement of drugs, vaccines and contraceptives

the basis of the projected population is provi

of these

.

„Kds to be made available so that coverage w. >mpr

°

the

hems are contmued See of charge to ^'^
e reluctance to meet the expenses for
population above the poverty line, there is often consider^
women and children especially for preventive progr

(o pay

Family Welfare Programme should continue to e p

acceptance of Family

for preventive and promotive services does not eco
and the achievement of the desired farm y siz
Welfare Programme and the acmeven
Financing Family Welfare Programme:
Over the last 45 years there had been a

•<

Family Welfare
the fact that primary

39

i

■■

V
• •*?

ex];pansion, the investments have been far from adequate. It is noteworthy that Health and
Welfare outlay as proportion of overall Plan outlay has essentially remained unalteredI over the
last 45 years.
Realizing the importance of Family Welfare Programme for the overall development of
the country, the programme was initiated as a Centrally Sponsored 100% Centrally Funded

activity in 1971.

A small provision has also been kept in the budget for ad-hoc research/ evaluation
studies, experimental research projects, and for printing of Eligible Couple Registers (ECRs)

MCH registers, immunization cards, etc. In order to ensure that quality services/equipments are
utilised in the programme, a National Centre for Technological Evaluation of IUDs and Tubal
• Rings has been set up at ITT, New Delhi. The ongoing research activities were reviewed and the
Following recommendations were made.
Basic and clinical Research studies have already been included in the earlier chapter

However, the financial implication for their implementation of the projects on the ground is

dependent on the financial support.
Basic essential records maintained in respect of eligible couples, maternal and child care

should be available with all the Primary level workers. The forms in respect of civil registration
which helps Tn family welfare planning is also in short supply.

CNAA forms, which are the

basic records of micro-planning are not available. The Tenth Plan needs to provide for the same.

Training of personnel in family welfare including medical & para-medical
Personnel in a continuing manner, is a prerequisite. Necessary infrastructure, including vehicles,

computers, etc. is also to be in place for efficient delivery of services.

40

1

*

Hf-3-

TFYP WORKING GROUP Sr. No.

26/2001

CD Cj

REPORT OF

THE WORKING GROUP ON '
mplementation of Population Policy and Achieving Rapid Population
Stabilization

FOR

THE TENTH FIVE YEAR PLAN

GOVERNMENT OF INDIA
PLANNING COMMISSION
JUNE - 2001

I

Ot-

■}

No.2 (12)/2000-H£FW
Government of India
Planning Commission
(Health. Nutrition & Family Welfare Division)

Yojana Bhavan,
Sansad Marg,
New Delhi-i 10001
Dated: 4-12-2000
ORDER
Subject: Constitution of Working Group on Implementation of Population Policy and A-y v . .->■
Rapid Population Stabilization
In the context of formulation of the Tenth Five Year Plan (2002-2007) it has
been decided to set up a Working Group on Implementation of Population Policy and
Rapid Population stabilisation. The composition of the Working Group is asunder: -

1. Secretary,
Department of Family Welfare,
Ministry of Health &, Family! Welfare
Nirman Bhavan, New Delhi.

Chairman

2. Member Secretary/Representative,
National Commission on Population,
Yojana Bhavan,
Parliament Street,
New Delhi-110011

Member

3.Secretary/ Representative,
Deptt. of Health,
Ministry of Health & Family Welfare
Nirman Bhavan, New Delhi.

-do-

4. Secretary/ Representative,
Deptt. of ISM &H,
Ministry of Health &. Family Welfare
Red Cross Building, New Delhi.

-do-

5. Secretary/ Representative,
Department of Elementary Education & Literacy,
Ministry of Human Resource Development,
Shastri Bhavan, New Delhi.

-do-

6. Secretary'/ Representative.
Ministry of Rural Development,
Shastri Bhavan, New Delhi.

-do-

1

7. Secretary/ Representative,
Deptt. of Women and Child Development,
Ministry of Human Resource Development,
Shastri Bhavan, New Delhi
8. Director General/ Representative,
Director General Health Sendees,
Ministry of Health & Family Welfare,
Nirman Bhavan, New Delhi.

-do-

9. Director/ Representative
International Institute for Population Sciences,
Govandi Station Road,
Deonar, Mumbai

-do-

10. Director,
National Institute of Health & Family Welfare
Munirka,
New Delhi

-do-

11. Dr. (Mrs.) Prema Ramachandran,
Adviser (Health),
Planning Commission,
Parliament Street,
New Delhi-110001

-do-

12.Registrar General of India/ Representative,
Office of RGI,
2-A, Man Singh Road,
New Delhi

-do-

13. Dr. Parveen Visaria,
Director,
Institute of Economic Growth,
Delhi University,
Delhi-7.

-do-

14. The President/Representative,
Federation of Indian Chamber of Commerce
&, Industry,
Federation House, Tanscn Marg,
New Delhi-110001

-do-

15. General Secretary/Representative,
Indian National Trade Union Congress,
Sharmik Kendra,
4, Bhai Veer Singh Marg,
New Delhi-110001

-do

1

2

I__

-do-

7

i

the felt needs for health care of women and children and contraception during the
Tenth Plan.
4. To project financial implications for implementation of the family welfare
programme during the X Plan including the plan and non-plan requirements and
the Cenrtre-State participation in the funding.

The Chairman may form sub-groups and co-opt official or non-official members
as needed.
The TA/DA of non-official members of the Committee will be paid by the
Department of Family Welfare as admissible under Govt, rules. The TA/DA of the
official members would be paid by the respective Govt. Departments/Institutions to
which they belong.
The Working Group may submit its report by 30th April, 2001.

(T.R.Meena)
Deputy Secretary (Administration)

Copy forwarded to the Chairman and the Members of the Working Group
Copy also forwarded to:

1. PS to Deputy Chairman, Planning Commission
2. PS to Minister of State for Planning &
Implementation
3. PS to Member (Health)
4. PS to Member Secretary
5. PS to Special Secretary
6. Advisors, Planning Commission
7. Pay and Accounts Officer, Planning Commission
8. Under Secretary (Admn.)
9. PA to DS (Admn.)

Programmes

(T.R.Meena)
Deputy Secretary (Administration)

.A-

Q"*!

4

16. President/Representative,
Bhartiya Mazdoor Sangh,
Ram Naresh Bhavan,
Tilak Gali, Chuna Mandi,
Pahar Ganj,
New Delhi-110055

-do

17. DG/ Representative
Central Statistical Organization,
Sardar Patel Bhavan,
Parliament Street,
New Delhi-110001

-do-

18.Secretary (Health^/Representative,
Govt, of Punjab,
Punjab Civil Secretariat,
Chandigarh-160019

-do-

19. Secretary (H&FW)/Representative,
Govt, of Madhya Pradesh,
Vallabh Bhavan,
Bhopal-462004

-do-

20.Dr. Joseph Abraham,
Joint Adviser (FR),
Planning Commission
New Delhi.

-do-

21. Dr. K.V. Rao,
Chief Director (DRS),
Deptt. of Family Welfare,
Nirman Bhavan, New’ Delhi.

Member-Secretary

. TERMS OF REFERENCE

To review:
(a) the current demographic projections for the Tenth Plan (2002-2007) and
beyond and the time by which the country’s population is likely to
stabilize;
(b) goals indicated in the National Population Policy (NPP) 2000.
2.
Keeping in view the current Mortality, Fertility and Couple Protection Rate
prevailing at present in different states to suggest
(a) future strategy for achieving population stabilization as early as possible;
(b) fixation of targets for the Tenth Plan i.e. by the terminal year 2007 and
individual years for birth rate and IMR statewise;
(c) fixation of targets statewise for couple protection rates, immunization/ante
natal, intrapartum neonatal and child health sendees;
3. To assess the current status and future requirement (short, medium and long-term)
of demographic, bio-medical, social and behavioural research aimed at meeting
1.

3

, 1

0
Report of the Working Group on Implementation of Population Policy
and achievement of Rapid Population Stabilisation

CHAPTER 1

Introduction
Population pressure is an' underlying cause of over-exploitation of natural resources like land,
water, forests etc. Spiral linkages amongst excess, ve population growth, extremes of poverty and

prosperity, and environmental degradation have

;wn increasing attention of Indian planners,

population scientists, ecologists, and environs

talists over the recent past. Stabilizing

population has been enshrined as an essent

requirement for promoting sustainable

development with equitable distribution in the F

.onal Population Policy,2000 (NPP-2000)

document released by the Department of Famii

Welfare, Ministry of Health and Family

Welfare(MoHFW), Govt, of India at the beginnir

of New Millenium. The NPP document

affirms the commitment of government towards stab :. dng population by 2045, as it’s long -term

objective, which would facilitate economically, environmentally and socially sustainable
•

•

development.

•

-•**

•

Working Group’s Terms of Reference
In the context of the formulation of the Tenth Five Year Plan 2002 -2007, the Planning
Commission has set up a Working Group under the Chairmanship of Secretary (FW) for

implementation of Population Policy and achievement of rapid population stabilization.The

Terms of Reference of the Committee are as under:
1.

To review:

(a) the current demographic projections for the Tenth Plan (2002-2007) and beyond and the
time by which the country’s population is likely to stabilize;
(b) goals indicated in the National Population Policy (NPP) 2000.

1

P

2. Keeping in view the current Mortality, Fertility and Couple Protection 3ate prevailing

at present in different States to suggest;
future strategy for achieving population stabilization as early as possible;

(a)

fixation of targets for the Tenth Plan i.e. by the terminal year 2007 and

(b)

individual years for birth rate and IMR state wise,
fixation of targets state wise for couple protection rates, immunization/ antenatal,

(0)

intrapartum neonatal and child health services.

To assess the current status and future requirement (short, medium and long term) of
3.
demographic, bio-medical, social and behavioural research aimed1 at meeting the felt needs for

of women and children and contraception during the Tenth Plan.
health care c.------

To project financial implications for implementation of the family welfare progra. ie
during the X Plan including 'the plan and non-plan requirements and the Centre-State

■4

participation in the funding.
1 I

Ld to examine and suggest
The group also has the responsibilities, tojdentify_ga;
alternative strategies^interalia recent developments and innovations, with due regard to cost
and optimization of resources, with the objective of contnbuttns to the Mm
——

■

i

■

of the objectives of the National Population Policy and to consider any other matter relate w.
or incidental to the above terms of reference Moding aspects of inter-sectoral co-ordmatton.

►
i

•

The working group intends to review the implementation of Populafon Pol.cv strategtes

and achievement of rapid population stabilization objective within the term or reference m . e

Bght of the recently released Census-2001 results and other National Level Survey based resu from District Level Rapid Household Survey - Reproductive and Child Health m 1 98-9Xs-RCH). Nation. FaMy He.tb Surveys (NFHS) conducted m 1992 and 1997, and other
studies sponsored by the MoHFW.

2

i.

CHAPTER 2
Terms of Reference- To review the current demographic projections

for the Tenth Plan (2002-2007) and beyond and the time by which the
country’s population is likely to stabilize:
Population Growth in India Since Independence:
India’s population at the time of Independence in 1947 was estimated to be around 345

million and the eighth decennial census of 1951 counted 357 million people (excluding the State
of Jammu and Kashmir, where the Census had not been conducted). India figured out to be the
second largest country in the world and which has not changed till date? Since then India s
population has become almost three-fold to nearly 1027 million by 2001.
Thee accelerated pace of population growth in each successive decade uptill 1981 had

witnessed a marginal decline in the growth or deceleration during 11981-91. The accelerated

pace of population growth during 11951-81 is evidenced by increasing decadal growth of
.

population in each successive decade. However, a marginal decline in 1981-91 was witnessed as

the decadal growth from 24.66 in 1971-81' to 23.86 during 1981-91. Further deceleration in the
population growth process is evidenced by the decadal growth of 21.34 percent during 1991-

2001.
The growth of population,

as brought out by the population census since Independence is as

under:

1961

1971

1981

1991

2001

Year

1951

Population

36.11 43.92 54.82 68.33 . 84.63 102.7

(in crores)

■i

Average growth rate

1.24

1.95

2.20

2.22

2.14

1.93

Crude birth rate

39.9

41.7

41.2

37.2

32.5

26.1 (SRS-99)

ih
Crude death rate
The evolution of the programme right from the First Plan in 1950’s, wit.

emphasis on the family welfare programme has been innovatively changing, the stress of th

programme continued to be on population stabilization by providing necessary maternal am
child care and other services. The strategies of approach remained to be contraceptive oriented ii

1950’s, while it was changed to immunization and maternal care later in 1960’s and 7C’s. Mor
interventions were added to the programme over the decade.
The National Health Policy brought out in the year 1983 has also earmarked certaii

indicators of family welfare programme, to be achieved in a time specified manner. Accordingly
the concept of two-child norm in 1985 and a targeted approach has been continued in the family
welfare. .In order to meet this goal of Health Policy, the Primary Health Care infrastructure wa:
extended during the Seventh Plan by involving PP Centres, enlargening the scope of uni—ri>a

immunizations etc.
Magnitude of the Problem:

India was the first to launch the official Family Welfare Program in 1951. Paradign

shiftsjn India’s population policies from earlier contraceptives-mix-target oriented to target-free
approach in-April,1996 and thereby client-centred-demand driven community needs assessmen
.

(CNAA) approach during 1997 have brought forth focused attention on the reproductive anc

child health (RCH) services package. The comprehensive definition of RCH was dehberated a

length and adopted at ICPD conference at Cairo in September, 1994 and got globa
acknowledgement since then. India was also a signatory to the UN s resolution at Cairc
conference. The Govt, of India’s (GOI’s) switchover to the community’s need assessment (CAN

approach in 1997 necessitates decentralization of planning, monitoring and evaluation

the

RCH services at micro and meso levels _yiz. states, districts, blocks and villages. The paradigm
shifts in the Family Welfare Program over the period has brought focused attention towards

provision of on quality RCH services to people in general. Program efforts and interventions has
been mainly responsible for averting more than 200 million births over the period and has

generated health infrastructure comprising Sub-Centres, PHCs^CHCs etc.

4

V.

■.

*

As has been brought out in the Sub Group on Ninth Plan, the share of unwanted fertility

and high wanted fertility continue to be 20% each, while the momentum of growth of population

contribute 60%. While the country has minimum choice regarding the quantum of contribution

by the momentum of growth of population, except by a staggering them a little, which could be

achieved by reducing early marriages and spacing of births It is seen from the NFHS-2 results
that as much as 72% of the couples (including sterilised) having 2 living children do not want to
have any more. Similarly, the percentage of couples with parity 3 wanting no more children is

84%. The similar type of ratios as per the NFHS-1 report 1992-93 shows a positive trend of
more and more people coming to favour small family norms.

Census count of 1027 million people as of 1st March,2001 has exceeded the population
projection figure of 1012 million by the Technical Group on Population Projections constituted
by the Planning Commission in 1996. This could be due to inbuilt assumptions of either

mortality being improved faster than expected or fertility decline being bit slower than assumed.

Another possibility could be that base population assumed in the projections exercise needed a
revision (p.65. Census 2001). However, fertility decline in most parts to India are well evidenced
through the pace of decline may be little less than the assumed levels in the projections exercises.
Nevertheless, India is expected to surpass China, the most populous country in the world in the

near future.
The magnitude of the problem of early population stabilization as per the information

available through various surveys is quite substantial. The program has made a dent in the family

welfare indicators and has been responsible for a TFR of 3.2(1998 SRS). The estimate of TFR

stands at 3 as per NFHS-II (1998-1999). However, a TFR of 3 can be taken for 2000 also. (Table
-1) The population stabilization approach will have to address the issue of higher order births, in
different States, with however, high state differentials. The contribution of birth order 3 and

above at national level stands at 45% as per SRS-97 and also district surveys 1998 & 1999. The
NFHS-2 also brings out the same magnitude of higher order births during 3 years preceding

1998-99. The differentials of States show that the southern States have made a dent in almost
accepting a two-child norm, with almost less than 30% contribution to higher order of births cut
5

total births.

The contribution of'a higher order births is nearly 60% in Bihar and UP. The

pattern should be reversed if the population stabilization is to be achieved, especially when the

total number of eligible couples are likely to grow continuously for about four decades from
now.

The approach of girls getting married and having their first child after 20 is a matter to be given

utmost importance. The States of Andhra Pradesh, Uttar Pradesh, Rajasthan, Madhya Pradesh are
having more than 50% of the girls married below the legal age at marriage. This causes not only
the early pregnancy and hence more prone to- maternal deaths and higher mortality with risks of

infant mortality.

The strategy for increased age at mamage needs the patronage of thg_

community, which r^quiresjhg_backing jpf the opinion and community leaders. The NFHS -1 &
2 have clearly brought out that the teenage pregnancy is of the order of .5j5 (the age specific

fertility rate between the age of 15 to 19 being 0.107). The NFHS -2 has also shown resuh_ of
age specific fertihty rate of 15 to 19 age group has come down marginally. The mean children

ever bom in the district survey 1998 & 99 also shows that .55 children are bom for teenage
mothers. The trend needs to be totally reversed, and this could be achieved only by delaying the
age at marriage.

A strong component^£fj^_and^,socialjnobilizatioi^xequfred to achieve

adherence to the minimum legal age at marriage by all states and communities. (Table-II)

As per the Terms of Reference, the Sub Group is to review the current demographic

projections for the Tenth Plan 2002-2007 and beyond by which the country’s population is likely
to stabilize. The official projections available up to the year 2016 as prepared by the Technical

Group on population projection gives the population of the country at the end of each Plan
period, which are as under: -

Year

1997

2002

2007

. 2012

Population

95.118

102.893

111.286

119.641

(In crores)
Adjusted population as per the 2001 census for the above year is as follows:
104.418
112.935
121.414
96.528

6

Population Projections by Age clearly indicates that proportionate population would grow
faster in the working and reproductive age groups largely because of demographic momentum.
Thus an increase of population from 520 million to 800 million in the working age group of 1559 years which would generate increased demand for the family planning program. In spite of

massive investment in training, the quality of care available to the population specially in remote

and rural urban slums are sub-optimal. The monitoring mechanism at district and State level are
often inadequate. It is important that a sense of urgency to achieve the goals stated in NPP-2000
is imparted to all the functionaries so that there is a serious attempt made to achieve these goals.

It is very clear and evident from two major surveys that the people in general would like
two/three children fTaWe-mj.

The results show that the percentage of couples with two

children do not want any more is above 75% in the states of A.P., Karnataka, Kerala,

Tamilnadu., Delhi, Punjab, Haryana, West Bengal, H.P., Maharashtra, Gujarat, Goa, Srkkim,.
In all the states except' Bihar, U.P., Arunachal Pradesh, Manipur, Meghalaya & Nagaland,
couples with iee children want no more is more than 75%. 'Hie high wanted fertility^

basically for the high infant mortality, which still remains a problem to be tackled fully, with

high priority.
(a) Another major factor is increasing the level of contraceptive acceptance both spacing

and limiting. The demand of unmet need needs to be viewed from the angle of population

stabilization. Considering the fact that the 2-child norm is to be considered by the couples
for early population stabilization, contraceptive needs should be targeted in this direction.

(b) If the family welfare programme is to be successful, there is a need to have
spectrum of Services with better quality and also meet the felt needs of MCH and FP
The Technical Group on Projections also estimated the year in which TFR of 2.1 would

be achieved for each major State. The country was projected to have a TFR of 2.1 by 2026, while
the States of Bihar, Haryana, Madhya Pradesh, Rajasthan and Uttar Pradesh were projected to •
have this level beyond 2026. ~

7

1 v

CHAPTER 3

'I

Terms of Reference -To review the goals indicated in National Population

Policy (NPP) 2000:
The demographic goals, which need to be achieved, by 2010 as per the goals &

objectives contained in the Population Policy are as below: -

i)

ii)

Address the unmet needs for basic reproductive and child health services, supplies and
infrastructure.
Make school education up to age 14 free and compulsory, and reduce drop outs at

primary and secondary school levels to below 20 percent for both boys and girls.
iii)

iv)
v)

vi)

Reduce infant mortality rate to below 30 per 1000 live births.
Reduce maternal mortality rate to below 100 per 100,000 live births.
Achieve universal immunization of children against all vaccine preventable diseases.

Promote delayed marriage for girls, not earlier than age 18 and preferably after 20
years of age.

vii)

viii)

Achieve 80 percent institutional deliveries and 100 percent deliveries by trained
persons.
Achieve universal access to information/counseling and services for fertility regulation

and contraception with a wide basket of choices.
ix)

Achieve 100 per cent registration of births, deaths, marriage and pregnancy.

Contain the spread of Acquired Immunodeficiency Syndrome (AIDS), and promote
x)

greater integration between the management of reproductive tract infection (RTI) and
sexually transmitted infections (STI) and the National AIDS Control Organization.

xi)
xii)

xiii)
xiv)

Prevent and control communicable diseases.
Integrate Indian Systems of Medicine (ISM) in the provision of reproductive and child

• health services, and in reaching out to households.
Promote vigorously the small family norm to achieve replacement levels of TER.

Bring about convergence in implementation of related social sector programs so that

family welfare becomes a people centered program.
8

it
’f

J

These are four demographic goals among other goals involving maternal care, child

,

health and related, social indicators to be brought about in order to have early population

stabilization. The trends in infant mortality for the last decade normally show that the infant
mortality at the national level is staggering at 70 (Table-IV).' The sample registration system,

which is a continuous flow of information on infant mortality, also shows that the major States
are not showing a tangible decline afler 90’,s.

The infant mortality rate as shown-both by

NFHS & SRS in 90’s are given below:

SRS

1991

1992

IMR

80

79

■ ■ NFHS-

IMR

■

1993

1992-93

1994 .1995' 1996 1997 1998 1999
74
74
74
72
7T'
72
70
1998-99

78.5

67.8

-

3

1

• This only
at siaie
state level
level or
or national
national level
level will
will not
/ shows that spealdhg
r
o of infant mortality’ di
d0’ The districtsfteIoW district levels'iare to be tackled in order to contain the infant mortality.

■ The basic cause of death for the infants'is revealed by the' NFHS and SRS are ARI, Diarrohoea’^B*^
and under weight children. The district level survey shows that the percentage of episodes of ’
diarrohea who were administered ORS is only to the tune of 11.2% of cases. Out of all the

districts surveyed, the episodes of diarrhea who were admimstered ORS is less than 25% in

about 413 districts of the country (82%),. Similarly, the children who were fully immunized in
the districts are less than 40% in 152 districts constituting about 30% of the districts in the

country: . The related problems like underweight that could be controlled by Ante Natal Care

i

(ANC), as well as safe delivery, which do not show a better picture at district level(Table-V)
t'y.

Though the provision of three ante natal care check up is made, 265 districts (53%) reported less

than 40% pregnant women who had three ANC checkups.

Similarly, 142 districts (28.2%)

reported less than 30% safe deliveries. These are factors of prevention of infant mortality. The
death in infant is more in the first week, followed by first month as compared to the remaining

period of the infancy.

The newborn care has to be properly undertaken, which requires

Mia;

involvement of local practitioners, etc. since the extent of availability of institutions is on the
lower side in most of the States. The maternal mortality ratio, which stands at a level of 400, for

the country as a whole is stagnant over the last decade. The NFHS-1 showed the maternal

9

K;'

I
B

,

of 437 (424 as corrected for comparison with
. difference is not substantial, the fact that the
1 mortality
dermined. The National Population Policy has-ttuge^
, statistically the

f®
1
1
Q
f 540 in NFHS-2). Though I
continuous to be around 400 ;
io J
100
-1 obvlo„s

cannot be unu.
ff, order to achieve the goals o
an
in a span of 10 years.
- , mortalities have to be controlled. In or
that the causes leading to
need to be introduced in the Register an I
maternal death cause !
of such deaths The possible mdtcators .
to prevent recurrence
NFHS, the maternal care (Ml ante haul can> tog« e^

¥
;■

of maternal deaths, a
lead t0 phm
amoQg pregMIfl

&
I

women and children as per
for mothers, safe debveoes, ^d treatment of dtarro
natal care

,toes ame
chM

cadre Y

immu:
\\

jn order_tp_bnni

ofmidydyes '.htuaaildJaioui^^
those
serviceS-tQ,
• TarT^/rHCs to -----------------------------------niidwivcs_and
midwivesare ffOTLtheJsffilUM^

& resources ttet are .heady in place-

^je X Plan has to address the issues in addition to the supplies
!

.

The systems to be put in place are:
Basic record maintenance in order to ensure
a)
BW1 -based approach to provide surubl^co

b)
c)

d)

community involvement;
under CRS.

Ensuing O registration

at
.
— to monitor
monitor all indicators
This is the only system

i

be continue in a

Community mvolvemen
Panchayat Raj- This ensures particp
500, which normally are deprived of som

f

PtOb'emS

s “menno
rate (TFR) needs to be done.

full fledged manner, im

in'

fess than a population c
smaller villages,
Obvious
logistic a inftastructur
for c
_

e, tance of maternal and child h^'^SStoet

It may be seen

4

piogralimes t0 have

the Panclrayal Ra, rnsutuuorrs more

Panchayat&beloxv.

e)

& services;

CHAPTER- 4

Terms of reference - Keeping in vieyv the current Mortality, Fertility and
Couple Protection Rate prevailing at present in different States to suggest
future strategy for achieving population stabilization as early as possible:
There has been substantial improvement in the availability of utilization to the access to

Family Welfare Services and a progressive increase in the acceptance of contraception and
couple protection rates. Percentage distribution of birth order in major States shows that in

most of the poorly performing States over half of the women have two or more children and

are likely to require permanent methods of contraception sooner or later, the number of
sterilization per 10,000 unsterilized couples with two or’more children is low in Bihar (110),
UP(188), Rajasthan(447) and MP (523) as compared to TN(934), Kamataka(1297) and

AP(1230). There is an urgent need to improve access to contraceptives care including -

sterilization in the States like Bihar and Uttar Pradesh. On the other hand in some of the better
performing states, increasing number of women may desire to postpone the first or second
pregnancy 'and there may be a progressive increase in the need for sgacingjnethods.

Contraceptive need assessment, counseling, improved quality of initial and follow up care

would go a long way in meeting the felt needs of contraception in the population and accelerate
the decline in fertility. In UP and Bihar, there has been decline in acceptance of sterilization

and spacing methods as compared to the past performance. In Madhya Pradesh, the decline is
marginal while in Rajasthan, there has been improvement in both permanent and temporary

methods used. The poorly performing States thus have to evolve implementing a two pronged
strategy for trying to improve acceptance of appropriate contraception in districts.
The census results of southern and western states have shown that the birth based

approach and also acceptance of sterilization have yielded jresults showing a much lower
growth rate as compared to some of the northern states.

The target of a crude death rate of 9

has already been achieved as may be seen from the information available from SRS as well as
from the National Family Health Survey (NFHS). The matter of concern is only the infant and
12

of IMR and MMR there is a need to improve the status of the indicators mentioned
7
above. A sustained effort to reduce the tdtal fertility rate (TFR) needs to be done.

li

/V

I

hi
I .

J

....

t

The strategy to be adopted in controlling the related issues are discussed below.

Anaemia prophylaxis programme
India is one of the countries with highest prevalence of anaemia in the general
population. Prevalence of anaemia in pregnant women ranges between 50-90%. This is mainly

due to low intake and poor bioavailability of iron from the diets consumed in India; poor intake

of folic acid and coexisting foliate deficiency also contributes to the problem. Anaemia present
from childhood through adolescence antedates pregnancy; it gets aggravated during pregnancy

and perpetuated by blood loss during labour. Anaemia continues to be responsible for substantial
proportion of the perinatal and maternal morbidity and maternal mortality.

Child Survival Programme
The fact that perinatal and neonatal mortality have not shown substantiafdecline over the

last two decades is a'cause for concern. Improvement in the quality and coverage of antenatal,
'

intranatal and neonatal care is urgently needed. Initiatives for detection and management of low

birth weight babies; detection and management of birth asphyxia and essential newborn care

have to be added in a phased manner to the existing package of services. Improving utilization of
nutritional supplementation programmes under the ICDS, massive dose of Vitamin A

prophylaxis programme and1 anaemia prophylaxis programme need priority.
- - -ims at reduction of infant and child morbidity and mortality through:
The ongoing programme aims
sustaining and strengthening of ongoing programmes of uniyer^immunization, ORT,

i)
massive dose of Vitamin A, Iron & Folic Acid supplementation programmes.

ii)
iii)

expanding the coverage of ARI control'Programme.
Coverage under the anaemia and Vit A prophylaxis programme showed substantial

improvement but is still way below the target of 100%.

Immunisation
During the Eighth and Ninth Plan period, the coverage under the immunisation
programme was maintained (Table-VI). However, the target of 100% coverage by 2002 is

unlikely to be achieved for all the six Vaccine Preventable Diseases CVPD). There has. been
substantial improvement in the quality of the programme but even now, there are slippages in the
14

maternal mortality, where about 7 % of the infants do not see their first birthday, while more

.

than a lakh of maternal deaths takes place every year.

,

7

The key component for the success of the population program is to have an integrated
approach and address the whole gamut of related issues, instead of tackling the single problem

of population growth. There is a need to focus on causes responsible for adult mortality and
initiate interventions.

There is an urgent need to improve availability of transport to tajce

patients who are having emergency obst. problems to first referral units. In areas where NGO

hospitals are available to provide emergency obstetric care they should be included in the

network of FRUs providing emergency care. India is in the midst of demographic transition
and there is a need to pay attention to old women and their health problems. Urban slum areas
represent a high risk area where health indices are poorer than rural_Populatio.TL The key

elements to have early population stabilization are, provision of health care to women and
children, together with the provision of contraceptive services. In India, the contribution to

health services is*done both by the public and private sectors, especially in rural areas

e

access to health services have been hitherto provided by the private providers in various kinds
of health systems existing in the country over ages, along with organized public health system.
The contribution by the practitioners of Indian System of Medicines to the far-flung villages,

numbering 6 lakhs in the country cannot be undermined.
The main recommendations of the NDC on population as well as the ICPD is to have

decentralized area specific approach, based on the needs assessment and provision of qualitative

services to be given to women and children and the accelerated pace of implementation of family
welfare programme, which is in vogue. The acceptance of the family welfare programme is a
factor of many extraneous variables like education, community intervention & involvement, and
policy support by opinion & political leaders and commitment of the implementing agencies of

the programme in a given area.

The current high population growth is due to three factors

a)

b)

c)

the large size of the population in the reproductive age group (estimated contribution

60%)
higher fertility due to unmet need for contraception (estimated contribution 20%)
high wanted fertility due to prevailing high IMR ( estimated contribution about 20% )
13

v
i:

V

programme resulting in occasional morbidity and rare mortality. It is a matter of serious concern
that coverage was lower in high-risk group of children from poorer communities in rural areas,
urban slums and in poorly performing districts.

MTP Services

Efforts to improve access to family planning services to reduce number of unwanted
pregnancies and abortion will continue to receive attention as a part of RCH services.

In

addition, there is a need to provide improved access to safe abortion services. There is also a
need to train and recognise practitioners and institutions that are capable of providing safe

abortion services during the first trimester. Provision of first trimester abortion should be coupled

with appropriate contraceptive care so that these women do not incur the risk of yet another

unwanted1 pregnancy and induced abortion.

The role of private sector needs to'be defined and-

utilized. It is important to modernize regulatory system in health care so that individuals and
institutions who are performing their assigned roles efficiently can prosper. There is a need for

area specific programs not only between states but also in different districts.

!

RTIANDSTT

•

Sexually transmitted infections had been and continue to be major public health

problems in developing countries such as India. HIV is the most recent addition to the already
long list of RTI/STL So far there had been no major initiative for detection and management of

STIZRTI in women. The major constraint in effective STI/RTI control is the absence of simple,

inexpensive, accurate methods of detecting the infecting organism so that appropriate treatment

could be provided.

Adolescent Health
In India early age at marriage is still the rule in many parts of the country and adolescent

pregnancies are very common. However, till such time as adolescent marriages decrease, one of
the major problems to be tackled is care of adolescent girls during^pregnancy^)Adolescent girls
are at high risk of anemia, toxemia and infections. They require appropriate care throughout
15

,v

pregnancy and institutional delivery to ensure safety of both the mother ana the caby, m orde^to

reduce maternal mortality.
Male participation in Planned Parenthood Movement
Vasectomy which is safer and simpler than tubectomy was wtdely accepted m . e

sixties However, after 1977 there had been a steep and continuous decline in vasectom.es; m t e

nineties vasectomy forms less than 2.5% of all sterilisations. There is a need

to find out an

address the needs and conveniences of men seeking vasectomy and prov.de ready access to
vasectomy services both in urban and rural areas. In Institutions with adequate -mmed .expe

surgeons, No^soalpel vasectomy might provide a useful technique for populansahon

vasectomy among some segments of the population.
The village ievel functionaries - namely Anganwadi workers, Mahha Swasth Smtgi
(MSS) Traditional Birth Attendant (TEA), Krishi Vigyan Kendra (KVK)-Volunteers, c oo
teachers need to work together and achieve optimal utilisation of a.adable servrces. The Opinion leaders at the National, State and local levels will parrieipat m commumr

education efforts regarding the Family Welfare Programme so that commumt,
.
rfu:c nrnoramme is improved. Simultaneously, the Dept wu
involvement vital to the success of this programme is impiu
.

iaunch an intensive drive to promote health education so that Indi, budds a sound fbundauon 0
a successful health programme. IBC on basic principles of hygiene, sanitation, nutnuon. an.

prevention of illnesses and disease wiU be promoted through not only die educaho^ msh u .on

and the adult education programme but also through the ICDS programme,
offered by the health workers at all levels, and the mass media.

To establish ntale welfare eeaters to address health problem and speetal needs Or men.
.

The present Fatrily Welfare Program is mostly geared to the needs of women s iieak
care. There are no Contres at present where men eon.d go to address the

. Reproductive Health Problems.

.

Male Family Welfare Centres to address the
RTI/STI/HIV/AIDS, impotency, infertiliy ai
Reproductive Health problems like

Establishment of comprehensive

other sexual disorders.
16

• -.i

i.

Ji

•L.

This will help men’s involvement in the FW program.

•

Components of male Reproductive Health care needs including that of adolescent .
boys are:
i)

Male involvement in maternal care and care of the child

ii)
iii)

Adolescent reproductive health and premarital counseling
Education on gender discrimination and gender based violence

iv)

Prevention and control of reproductive tract infections, including HIV and AIDS.

V)

. Treatment of infertility, impotency and other sexual disorders.

vi)

Responsible parenthood and male involvement in acceptance of FP methods -

vii)

NSV etc.
Treatment of Reproductive tract malignancies

viii)

Treatment of Reproductive health cares for elderly males

$

Private Sector participation
Involvement of Non-Govemment Voluntary Organisations for Promotion of Family
Welfare would bring the programme nearer to the people in remote/inaccessible areas. It is
estimated that the private sector accounts for more than (three quarterpof all health care
expenditure in India. It is increasingly recognised that the private sector represents an untapped

potential for increasing coverage and improving the quality of reproductive and child health
services in the country.

(a)

Measurement of Indicators
Monitoring and evaluation form an essential component for any on going programme.

Monitoring of on going programme process is important so that it becomes possible to quickly

identify the problems at implementation level in order to effect mid course corrections for
achieving the pre-defined goals.
Process indicators are used to monitor the progress of implementation of the programme

and a sound data-collecting base is essential for scientific planning, monitoring and evaluation of
the programme. Service Statistics are useful for monitoring of the programme against the
assessed needs.The impact evaluation parameters currently used by the Deptt. of Family Welfare
17

-•

Urban Health and Family Welfare Services

1
•V

in urban areas. Urban migration over the last

Nearly 30% of India’s population lives
decade has resulted in rapid growh of people living in urban slums. The massive inflow of the

population has also resuited in the defeneration of living conditions in the ernes. In many towns
and cities the health status of urban slum dwellers is worse than that of the rural pop anon

e

available urban health care infrastructure is insufficient to meet the health care needs o

e

growing urban population.

Involvement of Tanchayati Raj Institutions/ Local Self-Govehtment Institutions

With the 73rd and 74th Constitutional amendments the Nagar Paltkas ano Panchaya i aj

Institutions, are becoming operational in many States. These institutions will pkty increasntg role
in ensuring planning, implementation and monitoring of heahh and famtly welfare smytees a
Jocal level Involvement of voluntary organizations and improved Information Educatron and
Communication (IEC) activities are essential to ensure adequate commumty panrcrpauon and

!

improved utilization of the available health facilities.
At the current level, the demand of 20% of eligible couples are to be met by spacm,
permanent methods. Assuming the similar ratio of acceptance, 4% of the coupes n^ls tube
' provided review of spacing method and 16% of permanent methods, rn add

acceptance prevailing.

Hence the total couples currently protected need to be 13 /. modern

methods) by spacing methods and 51% by permanent method. Thrs ratio is use 0 0
X ~ protected. Sterilization is, the most appropriate method for reducmg hrgher
repr0(Juctive needs of the population. Ample

order

eras, to clearly indicate that there is a substantial un-met need for tally planning estrmated to e
around 20%. Efforts to reduce IMP. can create more acceptors for F.P.m d.stncts havmg hrgh
fertility The family welfare programme during the Tenth Plan is to be geared up to meet the

un-met need for contraception and achieve rapid reduction in IMR,
underS mortality.

If these programmes are fully implemented in the

18

V

J

maternal mortality and

States/ Districts which

currently have high IMR and high fertUity, there may be substantial reduction in IMR, CBR,
TFR and population growth rate.

Strengthening and operationalisation of the FW infrastructure
The focus of the Sth Plan was on strengthening and operat
ogeratiionalising
onabsmg posting

infrastructure for delivering__ of primary health care throughjmprovenient^_m_
Mk^filhiTg up_ofvacant posts, ensuring supply of essentjd drugs and improving referral
Prices. To some extent this has been possible; however, there are still some key posts like
Specialists at CHC, lab technicians at PHC/CHC and male multipurpose worker at the sub centre

which are either not sanctioned or continue to remain vacant, resulting in suboptimal
performance.

Assistance to poorly performing states/ districts
In view of the substantial difference in performance not only between States but also
between districts in the same state and the fact that lack of infrastrucmrea^anpow^jya^one

of the factors responsible^-poor performancejhe NDC Sub- committee recommendedthat the

focus should h^onproyiding special assistance to poorly performing district^ Data available
from the Districts surveys may be used to identify districts for specific programmes. ------

Legislation pertaining to population stabilisation:
In order to ensure stronger political commitment to the small family norm, the 79th

Constitution Amendment Bill has been introduced in 1992 in the Rajya Sabha. The BUI seeks to
incorporate promotion of population control and small famUy norm in Art. 47 dealing with

. Directive Principles of State Policy and annexing it in the list of fundamental duties (Article 51

(A)) a clause of enjoining citizens of India to promote and adopt a small family norm. The Bill
proposes to add an additional schedule under which a person shall be disqualified prospectively
from being elected or holding office as Member of either House of Parliament or legislature of

the State if he/she has more than two children. The Parliamentary Standing Committee on

Human Resource Development has recommended the bill for passage in the Parliament.

19

i

|

Rajasthan, Orissa, Delhi, Haryana and Andhra Pradesh have passed this Bill to

elected representatives to Panchayats and Nagar Palikas.

The programmes needs to be directed towards bridging the gaps in essential infrastructt
and manpower through a flexible approach and improving operational efficiency.
a) providing additional implementational assistance to poorly performing districts identifi

in order to have a full coverage services for the target population.
b) ensuring uninterrupted supply of essential drugs, vaccines, contraceptives of approprL
quality and quantity to the nearest point.

d) participation of general medical practitioners working in voluntary, private, joint sectc

and the active cooperation of practitioners of ISM&H,
e) involvement of the Panchayati raj institutions for ensuring intersectoral coordmatic
community participation, in the planning, monitoring and management,

f) involvement "of the industries, organised and unorganised sectors, agriculture workers a
• labour representatives, through local specific interventions.
To sum up:
Family Welfare programme has made considerable progress during the last four decad

Major lessons learnt while providing family planning services during these four decades are:

a)

b)

adequate financial inputs and . health infrastructure are essential pre-requisites f
success of the programme.
providing integrated Reproductive and child care through CNAA ensures not o:

efficient and effective delivery of services but also helps in building up rapport with :
community, so essential to sustain the FW programme, which include.

i)

ii)

Safe Motherhood interventions e.g. ante-natal check up, immunisation for Tetanus, st
delivery, anaemia control programme.
Counseling and education are powerful tools to overcome the barriers of pover

illiteracy and conservative social norms for achieving the small family norm.
iii)

The population is conservative but responsible, responsive and mature; their respor

to rapidly changing attitude positively towards population stabilization is to be encash
by providing necessary services, which is rational and sustained.

20

V

The 9th Five Year Plan had identified the need to increase the strength of nurses and
^paramedical. In addition,. women -from a particular village may be trained to render health
education, talk about small family and guide women for CNAA etc. This strategy adopted in the

IPP8 at Calcutta, Hyderabad and Bangalore seems to be effective and we can try to replicate.

Health Manpower Development
,

-phe training of doctors and the paramedicals continues to be grossly unsatis.actory,^both

initially during the professional course and during the reorientation program, x he focus is
on theory and there is hardly an attempt to provide ‘hands on’ training. As suggested m

both the 9th and the 10th Five year Plans, SKILLS TRAINTNG is of tremendous

importance, in order to render proper RCH care.
. The training in skills requires special knowledge, planning ariH appropnate
operationalisation of the training programs. Therefore, it is suggested that TOTprograms

should be organized for ail the training of RCH.
• The TOT programs should focus on list of essential skills, development of standard
management protocols for common problems, development of checklists for the j L

■ identified skills.
Population Stabilization

.

In order to provide QUALITY services in FW program, we need to train health care

providers in COUNSELLING and spacing methods.
•

The male paramedical worker must be given the task of counseling the men. Currently,
the whole burden of family welfare program is on the female worker.

21

1

CHAPTER- 5

Terms of Reference -Keeping in view the current Mortality, Fertility and Couj

Protection Rate prevailing at present in different states, and to suggest fixati
of targets for the Tenth Plan Le. by the terminal year 2007 and individual yei
for birth rate and IMR state wise.
The Ninth Plan had two level targets for the demographic indicators like birth rate, E

and other family welfare services. The two areas have been specifically given with the idea
achieving the enhanced targets as the additional inputs in the family welfare programme.

RCH is one of such inputs covering the whole aspects of family welfare services as envisagec
*

ICPD Cairo Conference in 1994.

Registration of Birth and Death
The use of civil registration data has been limited because of the substantial amount
under-registration. In states, where 90% of registeration of all births & deaths have b

achieved, data may be used at district level for PHC based planning. In districts where c
registration is over 70%, efforts may be stepped up to ensure that over 90% of birth and death
reported so that independent data base is available for planning.

Expected levels of achievement (ELA) for the Ninth Plan

The performance under the Family Welfare Programme will depend upon.
1. programme initiatives during the Ninth Plan;

2. financial resources available;
capability and effectiveness of the infrastructure and manpower to carry out the programm
3.

4. literacy and economic status of the families particularly of the women,
5. policy support by opinion leaders and the society.

Health indices and demographic targets for the Ninth Plan
22

-I

J
I

4

I
I

Table

Indicator

If

current

continues

trend If

acceleration

envisaged

Approach Paper to the

in

Ninth

Five Year Plan is achieved
CBR

24/1000

23/1000

IMR

56/1000

50/1000

TFR

2.9

2.6

CPR

51%

60%

NNMR

35/1000

MMR

3/1000

Even though method specific family planning targets have been abolished since 1.4.96, it
is essential that at the central level some figures indicating the expected achievement is available
for procurement of contraceptive and making necessary budget provisions.
The impact evaluation parameters currently being used, by the Deptt. of Family Welfare

and O/o Registrar General, India should continue. In addition, a target of 100% registration of
births and deaths by the end of 9th Plan has been set. These data will be collected, collated and

reported at district level to assist the district based planning as well as momtonng of the
program.
The current birth rates and infant mortality rate available and expected level by 2007 are
at Table-VII & VTH.

5.3

v

\ •

to be considered. The latest status of tne indicator

The targets for the Tenth Plan have

are as under at all India level:

Indicator

Latest

Expected

level I Expected

information

by 2002

by 2007

26.1 (1999 SRS)

23/24

21/20

70 (1999 SRS))

50/56 .

45/40

level i
I

available
Birth Rate

IMR

I

program was

!

* tW»wW> ®

o'"***

momliW assoela.ed
Vaadpe P— r—
UNICEF 1998, RCH 1998-99) indicate that only about 50/o of infan 3

“
6

VPD in the first year.
j

•4

Contribution of higher order

Of birth to be reduced, contraceptive acceptance

(Terminal/Spacing) to go up.
•7

Maternal Care/Child Health, ORS/AARI

B:

Immunization to improve.
■iven for the terminal year of Tenth Plan
Statewise estimates of Birth Rate and IMR is given

1

period.
Irfenility is to be given due consideration since it i^. very ^°'Xcentr«

..C;

about 10% of all couples. A provision for managentent of tnfe

■

y

essential and a beginning should be made tn the Tenth Plan..

9

24
■•i

r

pi

: ■'J■i!

A-

' CHAPTER -6

Terms of reference- Keeping in view the current Mortality, Fertility and Couple

Protection Rate prevailing at present in different States to suggest fixation of
targets state wise for couple protection rates, immunization/ antenatal,

intrapartum neonatal and child health services:
The Ninth Plan initiatives have been in the direction of providing Reproductive and Child

Health services at peripheral level and to undertake micro planning with the provision of demand

driven for high quality maternal and child care services. This Plan was specifically diverted to
bridge the gap in essential infrastructure, manpower, through a flexible approach to improve the

operational efficiency. The Reproductive and Child Health Project, which coincides with the
Ninth Plan period, have also taken up the strategies to fill in the gaps in the infrastructure,

involvement of the Panchayat Raj institutions and voluntary private and un-organised sectors in
the family welfare services.
■4>

Couple Protection Rate
Couples currently protected under the various methods of the Family Welfare Programme

include, all those who accepted the programme thus for, leaving out those who have dropped out

because of mortality or widowhood and attribution due to aging or discontinuation of the method

in case of IUD and Conventional Contraceptives. In the case of sterilisation, attrition takes place
due to death of either spouse or the wife attaining the age of 45 years. (Table-IX & Table-X)
The Ninth Plan initiatives have been in the direction of providing Reproductive and Child

Health services at peripheral level and to undertake micro planning with the provision of demand
driven high quality, maternal and child care services. This Plan was specifically diverted to

bridge the gap in essential infrastructure, manpower, through a flexible approach to improve the

operational efficiency. The Reproductive and Child Health Project, which coincides with the
Ninth Plan period, have also taken up the strategies to fill in the gaps in the infrastructure.

25

Vr

4

involvement of the Panchayat Raj institutions and voluntary private and un-organised sectors i j
the family welfare services.
The ratio of spacing and permanent method as per the current use by NFHS 1998-99,

and the CPR as reported by the Department of Family Welfare (Table-X to XU) are as follows.

NFHS

98-99

(9:36)

CPR March 2000
(17:29)
To a large extent the performance of the family welfare program depends upon the
effective functioning of The primary health care facilities. Though the infrastructure for tug
provision of primary health care exists in all States, it is no~t'fimctioning optimally. By ensuring

that they function affectively and efficiently, and holding them accountable for performance
gainst set goals, it will be possible to achieve the goals set in the NPP 2000 including birth rate

of 21 and total fertility rate of 2.1 by 2010,
Over the last four decades, there has been substantial improvement m the availability and

utilization of and access to FW services and a progressive increase in the acceptance of
contraception and couple protection rates. In the last decades, the rise in CPR is less steep but for

the fall in CBR has been steeper and sustained than in the earlier decades. The trend in CPR and
CBR over the last 30 years suggest that over the years, there has been an improvement in the
acceptance of appropriate contraception at appropriate time. By the end of March,2000, we had
46% of couple protection rate.
At the current level, the demand of 20% of eligible couples are to be met by spacing or

permanent methods. Assuming the similar ratio of acceptance, 4% of the couples needs to be
provided review of spacing method and 16% of permanent methods, in addition tc

he

acceptance prevailing. Hence the total couples currently protected need to be 13% (modem

methods) by spacing methods and 51% by permanent method. This ratio is used to obtain the
couples , effectively protected. Sterilization is the most appropriate method for reducing higher

order of births.
While projecting a minimum level of 30%

specified and a

minimum level of 10% spacing have been specified.

26

Vv

contributing Terminal methods has been
In order to have the

<cr

Hp- 3http://www.maharashtfa.gov.in/english/gment/policyfr.htm

«*- —»hbT

MAHARASHTRA STATE POPULATION POLICY
An Extract
Maharashtra is one of the Progressive States in the country The State however, has not been
able to control its population as per expectations The first doubling of the population occurred in
60 years between 1901-1961 The next doubling occurred only in 30 years. The present birth rate
of the State is 22.3 and we rank Sth in the country. The State is declaring its population policy with
an intention to bring down the rate of population growth

The objectives of this policy are
(1) Reducing Total Fertility Rate to 2.1 by year 2004;
(2) Reducing Birth Rate to 18 by year 2004;
(3) Reducing the Infant Mortality Rate to 25 by year 2004;
(4) Reducing the Neonatal Mortality Rate to 2- by year 2004
Following schemes will be introduced under this population policy. -

1.. Accepting concept of two child norm as "Small Family Norm";
2.. For obtaining subsidies under various Government schemes acceptance of "Small Family
Norm" would be considered essential.
3.. In order to propagate the concept of Small Family Norm amongst the Government and semi
Government employees this cor dition will be included in the service rule. Schemes such
as House Building Advance, Vehicle Advance and Medical Reimbursement will be
admissible those who limit their family to two children;
4.. Performance in Family Welfare to be part of assessment of officers at various levels;
5.. Strict implementation of existing acts and policies such as Child Marriage Act, Prenatal Sex
Determination Act, Birth and Death Registration Act etc.;
6.. Organisation of Family Welfare Camps with the financial assistance from Cooperative
Societies, Sugar factories and other industrial establishments;
7.. Acceptance of small policy norm as a condition for qualifying for elections to various bodies
such as Zilla Parishad, Panchayat Samiti, Corporation, Co-operative Societies etc.;
8.. Constitution of Mahila Vikas Group under the Chairmanship of Hon. Chief Minister’s wife at
State level and under the Chairmanship of Minister or Guardian Minister's wife at District
level;
9.. Enhancing involvement of Panchayat Raj Institutions in implementation and momtonng;
10.. Village Level Scheme based on achievements in various Family Welfare Indicators;
11.. Schemes for motivating the health infrastructure for improving quality of care;
12.. Training of Dais to ensure self delivery practices;
13 A population council under the Chairmanship of Chief Minister and a Coordination Committee
under the Chairmanship of Chief Secretary to monitor the implementation of policy; and,
14 An incentive of Rs. 10,000/- in the form of fixed deposit for 18 years to Below Poverty Line
couples accepting ferminal method after one or two daughters (with no male child) (If two
daughters an amount of Rs.5000/- for each daughter). This daughter(s) will be given an
additional incentive of Rs.5000/- each as fixed deposit for 5 years when she completes her
schooling unto 10th standard and does not get married before completing the 20 years of
the age.

H P" 3

t

THE NATIONAL POPULATION POLICY:
PROBLEMS AND POSSIBILITIES

By Imrana Qadeer

r

The National Population Policy (NPP) announced by the government indicates
that, at least on paper, the oscillation between a coercive and a voluntary approach has
been settled in favour of the latter. The document unambiguously states that it strives for a
welfare strategy that is voluntary, target-free, and integrated with key components of the
welfare sector. It also states that the “overriding objective of economic and social
development is to improve the quality of lives that people lead, to enhance their well
being, and to provide them with opportunities and choices to become productive assets in
society”.

Looking at past population policy guidelines, the present policy appears to be a
step forward. The policy makers have arrived at tliis public position only after repeated
failures of earlier strategies, and not necessarily because of their enlightened collective
assertion. It is therefore problematic as it comes at a point of time when the very
components with which the strategy is to be integrated are being dismantled by rapidly
receding State initiatives.
The population policy fixes a goal of population stabilisation by 2045. It envisages that
population replacement levels will be achieved by 2010. To achieve these goals a range of
objectives have been set up. These include:
S effective coverage with reproductive and child care services to reduce infant mortality
rates, maternal mortality rates, and total fertility rates;
■ education up to secondary level;
■ delay in age of marriage;
■ registration of vital statistics;
■ control of communicable diseases, with a special focus on AIDS; and
■ a commitment to convergence of social sector programmes.
To achieve these objectives a set of twelve strategies is spelt out. Many of these are a
continuation of previously accepted strategies. Such as decentralised planning for
reproductive and child health (RCH), education up to 14 years of age, convergence of
welfare services, empowerment of women, insuring child health, providing for the unmet
need for family welfare and for the basic needs of the under-served. Special needs of
adolescents and men, use of diverse health care providers (NGOs and private sector),
mainstreaming Indian system of medicine, strengthening contraceptive research, effective b
information education and communication strategies, and providing for the older
population are also not new. Notable among the new steps is the proposal to revive the
system of licensed medical practitioners to fill in the gaps in clinical care and to converge
1

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services at the village level. While these are welcome strategies, their content leaves much
to be desired.
The policy document raises two sets of questions. Firstly, how consistent is the
content of the policy document with its overall perspective? Secondly, how will the
challenge of convergence (of the welfare sectors) be interpreted by the States, which will
actually be implementing the policy? This paper attempts to explore these questions. It is
our belief that if the inherent contradictions within the NPP and the potential of coercion
in the implementation of this policy are not corrected right at the beginning, and strict
guidelines not provided, the policy will fail to realise its potential.

INTERNAL IN CONSISTENCY OF THE POPULATION POLICY

f

There are some very obvious inconsistencies in the NPP, which need to be
addressed if the policy has to acquire a positive edge. Some key areas for consideration lie
in the dissonance between the NPP’s welfarist approach and the reality of the government's
disinvestment plans, between primary health and reproductive health, between
convergence of welfare services and the available structures, and between voluntarism and
coercion.
Conflicting Population and Development Policies:

I

If the population policy’s expressed concern for quality of life and well being is
genuine, then structural issues cannot be under-emphasised, even when it is accepted that
population number is an important factor in development. The NPP document, however,
neither talks of land reforms or strategies for employment generation and food security
systems, nor of ensuring the celebrated ‘safety net’. But it does reiterate that, stable
population is an essential requirement for promoting sustainable development with more
equitable distribution”, thus making it a one-way process. It warns, if current trends
continue” India's population may overtake China's by 2045! And it adds that, “at the
current growth rate, the additions ‘neutralise’ efforts to conserve resources and
environment!”
These demographic fears are not new. They reflect a mind-set rather than a real
new threat - a mind set that is unable to accept the complexity of the problem and that
must hide behind these linear projections. In India, for example, despite the perpetual |
failure of the family planning programme for population control, birth rates have steadily i
fallen over the 20th century (1). Interestingly enough, in 50 years of planning, the ;
programme targets have never been achieved at the end of a Plan period (except during
the Emergency!). As things stand, there is nothing different as far as the present
projections go. But over the later half of the 90s, the rate of decline of infant mortality rate
(1MR) has slowed down and, over 1996-98, the Sample Registration Scheme shows its
reversal in at least eight major States (2). Thus, the not-so-improbable danger that
population growth rate may come down, but because of the added factor of rising
mortality rather than declining fertility rates, has not been taken note of by the NPP

2

I

The above trends, along with the increasing pressure on land, ensuing migration,
and the unmet need for contraception, indicate that, instead of using hypothetical
situations to justify the so called ‘dangers’ inherent in India's demographic status, there is
an urgent need to look at the processes behind demographic shifts. By blaming future
population growth for the “neutralisation of efforts to conserve the resource endowment
and environment”, the policy, at best, protects processes such as liberalisation and
Structural Adjustment that ensure a kind of development which sustains only certain
sections at the cost of others. The NPP. yet again refuses to accept that population
stabilisation requires efforts to create well-being, which is a necessary prerequisite of, or
an instrument for, population stabilisation, rather than the exercise of demographic goal
fixing!
Just the issue of utilisation of natural resources shows that it is the international
market-oriented model of development and its strategies that cause mindless destruction
and waste and certainly not population numbers, even when they are increasing. For
example, the pattern of industrial growth is characterised by large-scale closure,
privatisation, and displacement of workers, in a way that the worsening employment
situation affects their well-being (3). Despite adequate growth rates, poverty levels have
not changed much. Rural poverty, in particular, shows stagnation over the 90s (4). There
is also evidence of severe destruction of life and livelihood. In Andhra, 300 cotton
growers committed suicide, as they could not sustain their livelihood within the shifting
policies that generated a systemic crisis (5). At the Narmada Dam site, the so-called
development created death traps of malaria and human displacement (6), which have
become key contributions of development projects in independent India (7). These
projects are meant to “adjust” Third World economies to suit the hi-tech markets and for
the promotion of distorted development.

Even when we look at those above the poverty, there is sufficient evidence to
show that majority of them are negatively affected by the ongoing social and economic
processes. For examples in late 90s, total employment has declined - especially among the
literate and the educated - who seek employment other than manual (8). Similarly, the
contraction of the unorganised sector in the late 90s has pushed a large number of rural
people into relatively low productivity areas. Added to this is the shrinking social sector
that reduces employment opportunities (9), and makes services inaccessible as private
sector hikes prices of health, education and other necessities.
These examples illustrate that the conflict is not simply between the “population
added” across classes and the resources generated by those classes, but between sections
of population with respect to control over resources, irrespective of the population added.
The issue is more of livelihoods for the poor, and their basic rights to survival with dignity,
against the rights of other classes to further enrich themselves. The inability of the NPP to
focus on the broader linkages is also reflected in its narrow approach to under- nutrition.
It clings to Integrated Child Development Services (ICDS) alone and to distribution of
micro-nutrients when studies in the past have shown the inadequate coverage and the

3

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inability of the feeding programmes to impact nutritional status of the population (10).
These programmes were actually short-tenn strategies, initiated in the 60s and 70s to
tackle a crisis situation. The assumption was that with long term planning, these would
become redundant.

As it is now, the NPP does not mention any concern either about the failures of the
Public Distribution System (PDS), nor of the process of commercialisation of agriculture
that is undermining the food security system (11). Employment opportunities for the
unemployed, ensuring minimum wages, public distribution system for food grains and
electrification are not important issues for the NPP. By avoiding a review of the nature of
the developmental process that burdens the weak and forces them to wait for relief, and
not defining concrete shifts in structure for the benefit of the marginalised, the NPP
creates a myth of perfect choices and opportunities. This fits the demographic
requirements of the globalisation process that demands the profitable use of hi-tech but
not of human labour.
f

Conflicting RCH and Primaiy Health Care Policies
While the NPP proposes an integrated approach to basic health care, it in fact
reduces basic health to RCH. This is at the cost of general health care, especially for
women. In the absence of an explicit health policy, the NPP sends a clear message about
the priority being placed on population control as against Primary Health Care (PHC). The
previous health policy, that had committed itself to achieving PHC by 2000 AD, has not
merited even a reference in the NPP document. It talks only of “primaiy level care” The
supportive secondary and tertiary care essential for PHC is ignored, as is the notion of
comprehensive development of communities. The result is that Primary Health Centres
and Sub-Centres have been totally identified with the Family Welfare Programme in the
NPP. This will only further alienate people from the peripheral institutions.
1 he NPP, instead of strengthening PHC, appears to initiate a quiet process of !
appropriation of the basic infrastructure for RCH, while simultaneously condemning the j
existing infrastructure for lacking ‘supervision’ and ‘motivation’ and for being limited and
over burdened! The policy, in fact, goes out of its way to declare that the last 50 years
have demonstrated “the unsuitability of these yardsticks” for assessing health care i
infrastructure, particularly for remote, inaccessible, or sparsely populated regions.
According to the NPP we need to promote, “a more flexible approach, by extending basic
RCH care through mobile clinics and counselling services”. In other words, experiments
such as mobile clinics that were proven to be costly and a failure in the 70s (12) are being
revived at the cost of that very infrastructure that needs resources for its rejuvenation.
There is not a word to explain why RCH cannot remain a component of PHC and why the
available infrastructure (among the best in South Asia) cannot provide comprehensive
PHC (i.e. including RCH), fully supported by secondary and tertiary level care.

There is much talk of “partnerships” and mobilising a variety of service providers
to overcome the need for infrastructure. However, what would be the State's share of

4

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responsibility in the areas identified and how much would the partners contribute, remain
any one’s guess. The “partners” seem to be free to bargain with the government on this
issue. At the same time, with cuts in subsidies and plans to privatise welfare sector
services, the access of those who need the services most will necessarily be marginalised
further.
While the NPP emphasises quality of RCH care, it also proposes, “elimination of
the current cumbersome procedures for registration of abortion clinics 1 This is counter to
all notions of strengthening and enforcing mechanisms for standardised services, v
Registration is a means to assess the adequacy of the institutional infrastructure and its
quality. Any dilution of conditions for registration will have a direct effect on the quality
of services provided by institutions. Laxity in registration will ensure only profiteering by
unscrupulous providers and not add to expansion of effective services in the real sense.

As a part of its integrated strategy, NPP does mention control of communicable
diseases but does not comment on their vertical structures, their inefficiency and
inappropriateness (13). With their exclusive single purpose workers, who travel to the
same places and multiply travel costs as well as waste people's time by increasing the
number of visits per family, the present vertical programmes enhance inefficiency. This
was recognised by the government itself in early 1970s when the Ministry of Health and
Family Welfare introduced the concept of multipurpose workers (14).
The NPP’s exclusive focus on AIDS control programme is due to the perception
of a shared interest in promoting condoms and treating reproductive tract infections and
sexually transmitted diseases. The policy does not recognise the dangers of poor
infrastructure for PHC that makes the population vulnerable to contacting AIDS through
the use of inadequate facilities such as unsterilised syringes. The programme records 24%
of the AIDS cases come from among professional blood donors, drug users, recipients of
blood transfusion and others (15), which are indicative of laxity of services. Yet, there is
no accurate assessment of the implications of the inadequacy of the PHC services for
AIDS. It is evident that improving the quality of PHC (including blood banks) will
contribute to AIDS control. An aid amount of Rs. 1425 crores from the international
funders for the second phase of the programme seems only to enhance its vertical nature
(16). The NPP ignores the social situation that was conducive to the spread of AIDS. As a
result people remain victims of their conditions, as well as of the very system of health
care that was to protect them.

This deliberate undermining of PHC services and the NPP’s linear approach to
RCH is damaging to the cause of reproductive health itself. The problems of maternity and
infant health are the outcome of a continuum of ill health for women. Over 40% of deaths
among girls under 14 years of age are caused by communicable disease (17), and anaemia
and malnutrition are prevalent in about 60-70% of the women (18). Therefore, no amount
of reproductive health services alone can be effective. The reproductive system is a part of
the body and a sick woman can hardly sustain a healthy reproductive system. It is well
known that a significant part of maternal mortality is due to sickness. Any isolated

5

1

approach to RCH can, therefore, only be self-defeating. Thus, it is very significant that the
NPP rejects the positive ideas evolved by an earlier draft that had called for “a
restructuring of the ministry”, in a manner that its two departments are actually merged
and vertical programmes are integrated into the general health services (19).

Conflicts Between Conceptual and Structural Needs of Convergence

f

Just like the professed policy for integration of RCH, the stated strategies for
converging welfare services to strengthen RCH are vague, weak, and ill defined. It is also
not clear that, if the prescribed services (such as primary and secondary education,
housing, drinking water etc.) are to be provided to the needy, then how are the respective
departments going to define their tasks and restructure themselves so as to be able to
deliver these services. A policy of inter-sectoral convergence can be successful only when
the ministries have clear guidelines and mechanisms for delivery of the required services.
These guidelines are missing in the NPP. In which case simply putting bureaucrats from
the concerned ministries on to the Population Commission may not help. These services
can be supportive of RCH only when they are operative in the field and cover both the
rural and urban poor. For this the respective departments need to undertake very clear-cut
financial and structural reforms.

By adding a hundred member National Population Commission to oversee the
implementation, the policy does not actually set up an efficient mechanism for
implementation of policies. The Commission's members are from different walks of life.
They may be imbued with excellence in their own area of expertise but they are bound to
have varying competencies in assessing issues of implementation of the NPP. These issue?
range from technological, administrative, financial, organisational, to social and ethical
ones. At best the Commission can work towards evolving a consensus on issues. To
oversee implementation a more cohesive group will be required, with clearly set evaluation
mechanisms and working on a continuous basis. The policy does not visualise any such
rigorous mechanism. It neither sets up an internal assessment mechanism within the
Ministry, nor an independent external monitoring mechanism through the Planning
Commission. In the past the Planning Commission has provided excellent monitoring
services for the family welfare programme (20). But the NPP only proposes to use the
Planning Commission as a co-ordinating unit.
The reasons for the absence of rigorous mechanisms are not difficult to identify.
The health sector has to function as a sop to get soft loans and international aid to keep up
the trickle of foreign currency to correct the balance of payments! As a result, the tags
attached to developmental programmes have to be accepted. Consequently, the distortions
in the welfare sector have to be ignored rather than remedied. It is not surprising then that
despite so much emphasis on Panchayati Raj, both the devolution of power and
disbursement of funds remain inadequate.
It is apparent that plans evolved by international funding agencies like the World
Bank cannot be over-ruled, despite all the wisdom buried in the shelves of the Ministry of

6

II''

Health and Family Welfare and government institutions. The forgotten report of the
Planning
Planning Commission's
Commission's Working
Working Group
Group on Population (21), and the ICMR-1CSSR Report
on PHC (22), reflected the official understanding of population stabilisation as a function
iderprivileged was seen as much more than simple mid-way
of well-being. PHC for the underprivileged
correctives in the dehvery system. And, for all this, major restructuring was envisaged.
to be
Today, all that has become a thing of the past. The NPP, on the
1 face .of it, appears
-striving for a broad comprehensive approach, but is actually trapped in the demographic
compulsions of the prevailing economic policy. A policy that reduces, rather than
increases, investments in the welfare sector (except for population control) and forces
restructuring to promote markets for the planned benefit of a handful.

'r

I.

The lack of legal structures to support the policy is yet another aspect of the
conflict between strategies and structures. The NPP’s treatment of women’s
empowerment reveals not only a lack of sensitivity towards the issue but also a poor
understanding of it. For example, empowerment is to improve “nutrition related
capabilities that become crucial to a woman’s well being, and through her, to the well
being of children”. How this empowerment will happen is not clear except that Panchayats
are expected to provide them employment. In the absence of resources within the
Panchayats, this remains a hypothetical proposition. Only one thing is clear: according to
NPP, women's health and nutrition problems can be largely prevented or mitigated
through “low cost interventions designed for low income settings”. Thus, while one is not
sure of their empowerment, women’s destiny to stay in “low income groups is assured.
i

Except for extending the legal freeze on the 42nd Amendment to 2026 AD, so that
the states may “fearlessly and effectively pursue the agenda of population stabilisation”, no
other legal provision is offered that might be supportive of women. The legislative
requirements for ensuring women’s right to information, property rights, political
participation, and safety etc. all are missing. Women’s empowerment is thus seen as a
programmatic intervention from above that promotes fertility control rather than creates
enabling conditions for them.

Conflict of Voluntary Acceptance and Coercion
The NPP courageously rejects force and coercion. It is therefore critical that the
same does not re-enter the programme through the back door of motivational strategies.
This is imminent in three steps being included in the policy proposals. There is a proposal
to start national health insurance coverage for hospitalisation costs for children below 5
years of age. It is however linked to acceptance of terminal methods of contraception and
small family norm by the family. The policy thus proposes to deny help to a child for the
acts of its parents! Should a NPP working towards well being do so, when that child
invariably will be a little girl who is dispensable in families waiting for the arrival of a son?

The second proposal is for those below the poverty line. A health insurance
scheme, again for hospitalisation not exceeding Rs. 5000, and again linked to acceptance
of the two-child norm. The spouse accepting sterilisation is also given a personal accident

7

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;

insurance cover. Shouldn’t those below the poverty line be given assured services and
better coverage without arm-twisting, so that well being induces acceptance of a small
family and population stability, rather than denying basic amenities? The third proposal is
to honour and award the Panchayats and Zila Parishad for successful performance on the
basis of services provided, excluding sterilisation and harmful contraceptives. However,
such incentives may induce pressure for achievement and we have the experience to
foresee which section will bear the brunt of this pressure.

The NPP lacks trust in the people. It assumes that they do not think of their
welfare and hence a certain amount of pressure and conditional incentive are required.
This is dangerous because the limits of these pressures are very ill defined. Perhaps this
attitude is bom out of the knowledge that, in the present policy for overall development,
there is no scope for well being of the poor. They have to bear the burden of the
Structural Adjustment Policies and hence must be coerced, coaxed and pushed; not
through well-being and expanding opportunities, but through pressure and coercion.
»f

Interestingly, the lack of trust in people is not limited to the common people alone
- it extends beyond. The NPP proposes to set up two technology missions outside the
purview of the existing national research institutions. One of these is for neonatal care and
the other for the assessment of new contraceptives. While the first is to be composed of
Indian obstetricians and paediatricians, and is called the National Technical Committee,
the second is called the Technology Mission and will have international experts on it!
Thus, in the name of high-powered commissions the NPP brings in international interest
groups on national planning commissions. This Technology Mission will be within the
department of Family Welfare itself and will work towards the incorporation of “advances
in contraceptive technologies”. This is an extremely retrogressive step. It undermines our
own scientific community that has worked with diligence within research institutions like
ICMR, and saved the programme from incorporating harmful contraceptives such as
Depo-Provera and Quinacrine pellets. All of these were proven to be damaging to women
in India and elsewhere (23,24,25), but were being pushed by corporate experts. It also
unnecessarily duplicates institutions while there is resource scarcity.
The case of Quinacrine is particularly alarming, where ethical concerns have
collapsed altogether. Despite WFIO’s advice to stop all trials, unscrupulous doctors have taking advantage of weak control systems and free market mechanisms - promoted the use
of this unapproved contraceptive among unsuspecting women. This drug has not even
cleared the required stages of testing necessary before a human trial and yet First World
academic journals have chosen to publish the unethical human trials on Third World
women as scientific research (26).
We therefore need to ask, why do we need foreign experts in our National
Technology Missions? What role did the foreign experts play in the past; be it the Family
Welfare Programme, the National Malaria Programme, the Tuberculosis Control
Programme or the AIDS Control Programme? In the Family Welfare Programme they
advised to keep maternity and child health services out of the scope of the programme, as

8

the poor state of health of women and children would exhaust all resources (27). India
was pushed into accepting a National Malaria Eradication Programme without any
preparatory phase, a necessary component of the programme design (28), and paid, a
heavy price for it when hit by resurgence of the disease. Similarly, Directly Observed
Treatment Schedule (DOTS) has been thrust on the Tuberculosis Control Programme
against the advice of national experts who had clearly outlined a more economic and
context specific alternative strategy (29). “Experts” have also made projections of AIDS
for India that promoted panic and ignored the specificity of the Indian population. They
ARE also sliifling attention towards treatment OF AIDS without at all considering the
problem of its control (30). Without a rational strategy for control, AIDS becomes yet
another means for expansion of foreign markets in technology and dependence of the
Third World. What role are the technical experts in the mission going to play now and
whose interest will they represent?
Hints of vested interests are visible in the pressure on the Third World to do away
with stringent safety guidelines in research and take up more of the so-called essential
research”. This research will be funded by international agencies but will be conducted in
the Third World for the benefit of humanity (31). There is a view that life is cheap in the
Third World, hence it can be used as a dumping ground (32). The increasing use of Third
World populations as cheap human material for experimenting with new technologies (33)
are indications of a trend. It is, therefore, extremely critical to understand who provides
the technical expertise and for whose benefit.

PROBLEMS OF IMPLEMENTATION
The implications of these contradictions are evident in the State Population Policy
documents circulated by Uttar Pradesh and Madhya Pradesh. Both these states join
Maharashtra, Haryana and Rajasthan in enacting laws that debar people from elections to
the local bodies (but not to Parliament!). The thrust of their Population Policy is fertility
control through the RCH approach. The two policies barely articulate their broader
developmental strategies. Also, little is said about enhancing opportunities, capabilities, or
convergence of inter-sectoral development.

Uttar Pradesh (34) for example, proposes to:
Refuse government services to those who marry before the legal age of marriage.
(0
Sterilisation will continue to play a critical role in its strategy.
(ii)
Hold sterilisation and RCH camps! It does mention “periodic reviews” and
(iii)
“follow ups” to diffuse the damaging image the word “camps” elicits (35). At the
same time, it confesses that camps are not the best way to provide high quality
services on a regular basis. Yet it hopes to “improve access to and quality of
services”.
Performance appraisal of medical officers will be based on their “contribution to
(iv)
meeting RCH needs”! This means that if they do not perform other duties it does
not matter!

9

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(V)

People will be “encouraged to utilise services of the private institutions” at all
levels of the district. These will be identified by the State and given support both
. in terms of equipment and resources. This not only means that the tax payer's
money is diverted into the private sector, but also that those 36% people who are
below the poverty line (36) may not get any secondary or tertiary level care even
for RCH.

(Vi)

Train its workers & upgrade their skills and knowledge in modem research with
newer technologies. However, there is not a word of caution about the use of
contraceptives that are not suitable for Indian conditions. In fact, the State
proposes to incorporate material on injectable contraceptives in its training and
hopes to conduct operations research to assess the possibility of introducing
injectables and other new technologies in family planning services. It needs to be
pointed out that operations research helps optimise a system. The choice of
technology should depend upon epidemiological studies. The fact that the
Ministry has not included injectable contraceptives in the National Family Welfare
Programme, and epidemiological studies have shown that they are inappropriate
is totally ignored (37).

f

(vii)

f

Despite the fact that the Centre has created a special fund for population
stabihsation and the NPP considers RCH a basic service, Uttar Pradesh proposes
to introduce user fee even for RCH. This is proposed despite the evidence that
user fee excludes the poorest from services (38).

The State of Madhya Pradesh (39), chooses education and Panchayati Raj as its
main social sector programmes that will support its population stabilisation strategy. The
rest of the welfare sector does not enter the debate nor does the document state the share
of resources to be provided for the Panchayats for the social sector programmes. Along
with these, the policy proposes that:
(i)
Persons having more than two children after January 26th, 2001 would not be
eligible for contesting elections to Panchayats, local bodies, or co-operatives in the
State.
(ii)
Legal age of marriage will be made a criterion for employment.

Thus, on the one hand there is talk of empowering women, and on the other hand
policies like the above negatively affect women. The majority of women are hardly in a
position to either decide the age at which they are married or the number of children they
bear. If these State policies are any indication of future possibilities, then it is clear that
coercion is there to stay. Child marriage, for which the social and economic conditions of
parents are responsible, will further deprive an already hopeless youth (especially girls)
from seeking opportunities.
In addition to these two States, the Maharashtra government is reported to have
put up a most draconian bill for the approval of the Governor. It not only refuses families
with more than two children all welfare facilities (housing, land for housing or agriculture

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■1

free studentship, loans etc.), but also denies the third child rationed food grains and even
health care for the mother and the infant! Even the poorest are not spared the wrath of this
policy (40) and the Minister of Food and Civil Supplies is reported to have justified the
decision as being “in the national interest” (41).
Thus we see that, in the interpretation of the national policy, the States reflect a
single-minded pursuit of the demographic goal. Whatever was left of the public sector
health services is going to be fully appropriated and peripheral health institutions will be
transformed into RCH service outlets. As a result, the workers may not have time for the
rest of the services for which they were earlier responsible. The poor will be further
marginalised and sucked into the vortex of a free market for health care being formally
promoted by the States by providing space and formal financial assistance to the private
sector. What then, is different about this NPP except its liberal camouflage?
It is evident that the NPP yet again falls short of striking a balance between well
being, through increased human productivity, and population numbers. The latter by itself
makes little sense unless seen in terms of integration into or alienation from the economic
and social processes. The NPP, unfortunately, is too preoccupied with demographic
targets to provide that balance. The States have taken their cue and are going to alienate a
big chunk of the population from the mainstream socio-economic process, labeling them
as undesirable and an obstruction to development. We seem to be losing sight of the fact
that the level of poverty in the country is stagnating. Even those who are above the
poverty line are increasingly facing greater insecurities due to shrinking employment
opportunities, under employment and a failing service sector. The IMR is not only
stagnating but also giving hints of a rise in some of the major States (42). In such a
situation, should demographic achievements of fertility control alone be considered the
need of the hour?

References:

1. Government of India, (1997): “Ninth Five Year Plan, 1997-2000 , Vol. 11, pp.205.
New Delhi, Planning Commission.
2. Government of India: Office of the Registrar General (2000): SRS Bulletin, Vol. 33,
No. 1, April, pp.l.

3. Noronha, Ernesto and Sharma, R.N. (1999): “Displaced Workers and Withering of
Welfare State”, Economic and Political Weekly, Vol. 34, No.23, June 5-11, pp. 1454.

4. Datt, Gaurav (1999): Economic and Political Weekly, Vol. 34, No. 50, December 1117, pp. 1516-1518.
5. Prasad, C. Shambu (1999): “Suicide Death and Quality of Indian Cotton- Perspectives
from History of Technology and Khadi Movement”, Economic and Political Weekly.
Vol. 34,No.5, pp. PE 12-21

11

:i

6.

Caufiel C. (1997): “Masters of Illness: The World Bank and the Poverty of Nations”,,
New York, Macmillan, pp.25.

7. Water Fernandis (2000): “Pawns in the ‘Development Game’ India. Disaster Report-

Towards a Policy Initiative” In Parasurasuraman and Unikishnan, P.V., (ed.), New
Delhi, Oxford University Press, pp. 276-279.
i

8. Kamla Prasad, (2000): “Rural Economy”, in Alternative Economic Survey 19982000, Two Years of Market Fundamentaling, Alternative Survey Group, New Delhi,
Rainbow Publishers Limited, Lokayan, Azadi Bachao Andolan, pp 91-94.
9. Keshab Das, (2000): “Informal Sector”, in Alternative Economic Survey 1998-2000,

Two Years of Market Fundamentaling, Alternative Survey Group, New Delhi,
Rainbow Publishers Limited, Lokayan, Azadi Bachao Andolan, pp. 122-124.
t

10. Central Technical Committee, Integrated Mother and Child Development (1996):
“Integrated Child Development Services - Survey, Evaluation and Research, New
Delhi, Control, Technical Committee, pp 179.

ll.Patnaik, Utsa (1998) : “Export-oriented Agriculture and Food Security”, in. The
Great Grain Drain. Bangalore, Books for Change, pp.36.
12. Government of India (1974): “ Annual Report 1973-74”, New Delhi, Department of
Health and Department of Family Planning, pp 45.
13. Imrana, Qadeer (2000): Health Care Systems in Transition III. India, Part I. The
Indian Experience. Journal of Public Health-Medicine Vol. 22 (I), pp. 25-32, U.K.
14. Government of India (1973): “Report of the Committee on Multipurpose Workers
Under Health and Family Planning Programme”, (Chairman Kartar Singh), New Delhi,
Ministry of Health and Family Planning.
15. National AIDS Control Organisation (1999): “ National Aids Control ProgrammeIndia’s Country Scenario-an Update”, New Delhi, NACO, DGHS.

16. Government of India (2000): Annual Report 1999-2000”, New Delhi, Ministry of
Health and Family Welfare, pp 135.
17. Qadeer, Imarana (1988): “Reproductive Health - A Public Health Perspective”,
Economic and Political Weekly, Vol. 30, No.41, pp 2675-84.
18. Reddy, Vinodini et al (1993): Anaemia in Female - Nutrition Trends in India,
Hyderabad, National Institute of Nutrition, pp 37.

12

h
4

19. Government of India (1993): “Draft National Population Policy”, (Chairman: M. S.
Swaminathan), New Delhi, Ministry of Health and Family Welfare.

20. Government of India (1965): “Evaluation of Family Planning Programme”, New Delhi.
Planning Commission, Programme Evaluation Organisation.

21. Government of India (1980): “Report of the Working Group on Population Policy”,
New Delhi, Planning Commission.
22. ICSSR and ICMR (1980): “ Health for All: An Alternative Strategy: Report of the
Study Group Set up Jointly by ICSSR and ICMR”, New Delhi, ICSSR.
23. ICMR, Task Force on Hormonal Contraception, (1986): Return of fertility following
this continuation of a injectable contraceptive - Norethisterone Enanthate (NET-EN)
200 mg. dose. Contraception’, Vol. 34 No. 6, pp 573-82.
f

24. Ritcher, J., (1996): Vaccination against Pregnancy: Miracle or Menace. London and
New Jersey, Zed Press.
25. Saheli (1997): “Quinacrine: The Sordid Story of Chemical Sterilisations of Women: A
Saheli Report, July 1997”, New Delhi, Saheli.

26. Do Trong Hiew et.al. (1993): “31781 Cases of Non-Surgical Female Sterilization with
Quinacrine”, Lancet, Vol. 342, July 24.
27. United Nations Advisory Mission (1966): “Report on the Family Planning Programme
in India”, New York, United Nations.

28. Baneiji, D. (1985): “Health and Family Planning Services in India - An
Epidemiological, Socio-Cultural and Political, Analysis and a Perspective”, New Delhi,
Lok Paksh pp. 96.
29. Baneiji, D. (1997): “Serious Implications of the World Bank’s Revised National
Tuberculosis Control Programme for India” Mimeograph, New Delhi, Nucleus for
Health Policies and Programmes

30. Panos Institute (2000): “Beyond Our Means?” The cost of treating HIV/AIDS in the
developing world, London U.K, Panos Institute, pp 19-27.
31. World Bank (1993): “World Development Report (1993): Investing in Health, New
York, Oxford University Press, pp. 148-55.
i

32. PRIG (1994): Unhealthy Trends: The World Bank of Structural Adjustment-and the
Health Sector in India, New Delhi, Public Interest Research Group, pp 26.

13

: I

I

33. Richter, Judith (1993): “Vaccination Against Pregnancy: Miracle or Menace?” London
and New Jersey, Zed Press.

34. Government of Uttar Pradesh, (2000): “ Population Policy of Uttar Pradesh”, Deptt.
Of Health and Family Welfare.
35. National Institute of Family Planning (1973): “Vasectomy Camps - A Study”, New
Delhi, National Institute of Family Planning.

36. Government of India (1999): g01 Five Year Plan, 1997-2002 Development Goals,
Strategy and Policies, Vol. I, pp. 27. New Delhi, Planning Commission
37. Sathyamala, C, ( 2000): “ An Epidemiological Review of the Injectable Contraceptive,
Depo-Provera”, Pune, Medico Friends Circle.
r

38. Krishnan, T.N, (1999): “Access to Health and The Burden of Treatment in India: An
Inter -State Comparison, In, Rao, Mohan (ed.): Disinvesting in Health. The World
Banks’ Prescription for Health, New Delhi. Sage, pp. 212-230.
39. Government of Madhya Pradesh (2000): “Population Policy of Madhya Pradesh”,
Department of Health and Family Welfare.
40. The Hindu (2000): September 6, p. 1, col.6.
41. The Hindu (2000): September 7, p. 11, col.3.

I

42. Sagar, A. et al (2000): Health in Alternative Economic Survey 1998-2000: Two Years
of Market Fundamentalism, New Delhi, Rainbow Publishers Limited, Lokayan, Azadi
Bachao Andolan, 2000.

i

■

•

Hp-;
The

role

of

the Language of

in

Rights

population,

health and development : An exploratory paper
Devaki Jain
Summary

I

’1

i

i

The
poor

language of rights has always been a

unequal

safeguards

countries

are

muted

where

or

blunted

inequality of the situation.
But

hurts

instruments

by

very

people

are

legal

poverty

along - and

almost as hard if not harder

deprivation

enforce

in

and

(ref)

as globalisation strides

harder

the

to

problem

mobilising

than

around

inequality

poverty

rights

even

and
in

developing countries.
A

recent

example of this mobilisation is

the

newly

formed National Alliance of People's Movement (NAPM) which is

alliance

of

Bachaon

Andolan, Himalaya Bachaon Andolan, National

Forum,

Bhopal Gad Peedit Mahila Udyog Sangathan,

Parishad,

9 struggle based organisations such as

Manav

Vahini, Ganga Mukti

Andolan,

the

an

Azadi

Fishworkers

Samajwadi

Chilika

Jan

Bachaon

Andolan and Narmada Bachaon Andolan and number of other
movements
are part of this process.

1

i>n I1 nilywmnin

i!

p
The

alliance

has drafted a declaration from

I'

%

position

' *

which

quote only their slogan:

If
of

the members

" HAMARA BEEJ, hamari bhoomi
HAMARA KHAD, HAMARA PANI"
the
a few sentences
I could summarise in
from
of this alliance it is "Bachao us

Badlao",

Conference on»
argued at the Jaipur
Medha
Patkar
who
to quote
advocated in the name of
is
being
Women Studies that everything
changes are
change. But all these
transformation,
Badlao
number of
an increasing
livelihoods
and
and
damaging lives
from this
asking for Bachao, save us,
are
formations
groups,
become so
further to say that it has
She
went
transformation.
of transformation that "we
of this new type
pressure
the
bad,
in the misery
are left alone even
be
left
where
we
just want to
enough is
The spirit is to say:
situation
.
of the current
pull
development. Object, obstruct it,
Say
no
to
enough, stop.
similar
that are encroaching. Very
the
existing
structures
down
50 years of Bretton
global pressures:
to
to feminist responses
woods is enough and so on.

the gradual reduction
be
traced
to
can
These responses
free public utility
rights to what was earlier a
people
'
s
of
land etc. These natural
forests,
gracing
namely rivers, oceans,
for
for production,
be
contracted
resources are beginning to
not many times
which are once removed if
agencies
trade by
them.
in these areas who used to access
I
from
the
people
removed

2

■•i

I
This crunch or squeeze to use the language of today is
J

deeply

to

hurt

movement

for

affirming people's rights

'J

to

right

the NAPM itself has moved from a call to support the

Thus

work.

a

resources.

natural

to

with

to

responded

enough to be

beginning

to

to a call for the right to resources as even prior

the right to work.
Groups

J

J
T

being

responsible for the devastation and taking a

stand

against

people's

consciousness

J

dissociation

on

25 and ending

January

from

to their

total

from the macro policy.

India

awakening

15,

March

as

unqualified

through

They propose to have a march

starting

pointing

process

liberalisation

finger

J

if

to the globalisation,

their

it.

in

like the NAPM have no hesitation

resistance,

objection,

way

They propose this as a

of voter education prior to the elections.

(Annex.)

0

'I

In
J

if
’.'xi

’i'i

which

women,

condition
their protection has come to be accepted as a necessary
beginning to turn around the terrible situation of women

for

?

India and South Asia.
Asia

The situation of women in India and

where the house-hold authority and conventional

&
■

women's

P

to

roles and behaviour is so deeply embedded that

the Language and instrument of right, it is

provide

1

at

least

one

enabling

mechanism

millions of battles in millions of homes.

hl
3

1LF *i

and

rights

is now at the top of all the agendas,

0
V

against

violence

another area namely the area of

for

in

South

models

of

recourse

believed,

fighting

might
this

I

€

extension

Another

of

the use

of

structures.

political

While

it is nobody's

that

claim

this

expression

is as wholesome in either its feminist

participation

in

participate^

73rd and 74th Amendment is the right to

through

initiated

rights

or

sex

female

visibility

in

governance is beginning to be felt in local areas.

According

to

or

its consequence of improved gender relations, agency

the

ratio,

those

numbers

sheer

working

in terms

of

at the Panchayat Raj level,
into

a larger right

translating

presence

actually

have the information, the skill, the autonomy

decision

on local development has become a challenge

feminist who ar working with these institutions.

women's

right

to

to

take

for

those

the

namely

political

a

part of the orientation.

rights,

" haq"

taste

of honey.

of

t
€
€

t
t
4
4
€

'V
<

Again awareness

of laws and how to access them using the language of rights is

Many

t
t

the women in local politics

of

talk

to be in larger and larger aces of

their

politics.

But even though to many including

A

t
€
t
t
t
t
t

like

people

Medha Patkar - entering political parties as they are shaped,

as

€
ft

they are ideologically bound are not palatable nor desirable; the

quest

and

and aspiration is to transform these structure

through

flooding them with women -

ideology

both

through

greater attention to enhancing the feminist

leadership.

their

well

as

aspects

of

as

€
t

I

t

I

■

■1

I
I

1

The

rights is dependent

on

reproductive

effective

broader

a

expression

of

acceptance

of the language of rights, in a broader set of

areas

the

such

as

mentioned above - the right to natural

resources,

right

to

protest, the right to leadership and

to

information.

concept of reproductive health

to

include

Expanding

9

And so we come to reproductive rights:

the

bring

of social and economical security for women would

concept

the

us directly to notions of development rights to the rights of the

poor to livelihoods, food and so on.
Again

ground

swell movements in

parts of the women's movements,
links

India

including

are adopting this language as it
seem

them to constitutional and judicial mechanisms which

$

to have more potential to provide justice than the government

or

even civic society - apart from the market of course.
Some
9

of the older institutions such as trade

unions

and cooperatives have always used the language of rights.

Being

representative
9

based

on

9

members.

4•'7

trade

bodies most of their "procedures" and

rules

are

elections, on voting and therefore on

rights

of

the

The reasons these institutions like

cooperatives

and

in

the

unions

need

to

be seen with

greater

interest

landscape of globalisation and liberalisation is not only because
9
9

9

of

their

(even

if

scenario

II
a

9

9
9
9

A

large

representative nature which engages itself
women

of

are

not yet visibly

present

in

in

right’s

the

current

these institutions) but because in the

corporations,

large scale financial

context

institutions

coming

into to play in the fields of India, the only possible source

countervailing
organisations,

power

is

to

build

alternative

of

of

economic

federate them.
5

I

■

I
such

One
that

Labour

emerged in India as

has

various unions of unorganised workers.

a

Centre

for

of

the

confederation

is

act

cooperative

being re-designed to free itself from government control, thereby
bringing

greater place for membership rights, and

through

that;

process

of liberation from government control and bringing

more

representative

cooperative

a

self-managed process develop into

k •

taking

A similar move is

the cooperative sector where the

in

place

National

new coalition is the

ft.
©
t
©
ft

movement which can challenge with corporate movement.

r

In making this presentation and drawing attention

to

modes

of

resistance, the purpose is to argue that if ideas and actions

in

to

be

shaken

economic

and

institutions,

of population and health and development have

field

the

on

of

phenomenon

this

out of their current cruelty, discrimination and
the

women,

language

of rights

and

the

assault

building

up

ft
ft
ft

of

representative institutions are key instruments, perhaps more key
or

policy

more valuable than more research, or more advocacy on

or more programmes by government.

notion

of

what emerges as one strong phenomenon in South Asia

is

Whether
activism

■(

it is a notion of research or the

discrimination

the

intense oppression of women and

unqualified

apart

from lack of escape routes.

It appears like a

" no

exit”

a

small

Re-valuing women is critical and would require

very

except

situation

proportion.

for

some categories who

are

still

t

c
i

deep disruption of perceptions and a replacement of 'new'. Such a

transformation may be beyond development and may be only possible
through

cultural

revolutions
6

as

well

as

psychological

t
t

'LL

Uli

S
o. •
1
• >

1'*
I •

1

deschooling

of men and society.

That job certainly needs to

be

done.

Further, in the frame of the theme of this conference.
it

is necessary to draw out the

current preoccupations

of

women's movement which is in political consciousness, in

over

resources

structures

of

and

social arenas through

an

entry

power, an interest in the process of

the

control

into

the

social

and

economic transformation and an interest in poverty.

The language

of

with

rights

concerns.

has

been found to be ideal

in

dealing

these

... -

j.

UNNIKRISHNAN P.V.(D, 06:46 20/10/00 *0, for Dr. Devaki Jain

HP -

Delivered-To lcjain@bgl vsnl net irT*
From “UNNIKRISHNAN P V (Dr f <unnikru@vsnl com>
To “LCJain" <1cjain@vsn! com>
Subject for Dr Devaki Jain

Date Fri, 20 Oct 2000 (X> 46 57 40530
X-MSMail-Priority Normal

X-Mailer Microsoft Outlook Express 5 00 23 14 1300
X-MimcOLE Produced By Microsoft MimcOLE V5.OO.2314 13(X?
Dear Dr Devaki Jam

Thanks for inviting me for the colloquium on Population Policy It was very informative to listen to
the
presentations I am attaching the draft note I prepared along with this
Regards and in solidarity
L'nni

Dr. Unnikrishnan PV
Oxfam Fellow: Emergencies, INDIA
unnikru@vsnl.com
;9 Phone : (Mobile) +91 (0) 98450 91319
Visit htq?://www.thchungcfsitc.com

Attachment Converted. ''cA^dora'attach\populatien policyJWS : Dan 19th oclQbarjQc"

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Rough notes/ draft PLfEA$E EDIK
Colloquium on popuiettion policy
19-20 October 20Q£ Bangalore.

Dr. Mohan Rao:

Good to see peop*« frorm various background and we have a very flexible agenda
Our key concerns are ®n gender, health and rights issues. The inter-linkages
between them are wnporrtant and the social context in which the new policy
document has to be located has to be looked at.
When I met Dr. Devakj ^am several months ago. we were looking at the policy
related issues The new policy document has to be placed in the context of
recent developments like panchayati raj and other local self-govemance
initiatives.

My concerns : To re-ennphasise on the need to have a holistic view and
approach.
Two basic questions: Is this a population policy or a family planning policy?
If it is a population policy, what should be the elements ?

We need to place reproductive health in the context of larger public health issues.

There is a need to look at epidemiological and mortality data as it often gives a
different picture/ signal. Reproductive morbidity is*high. But it is not
epidemiologically correct io delink mortality with morbidity. There is a need to link
mortality and morbidity.
Most of the studies have focussed on ill designed strategies and symptomatic
variables. White discharge is a case. This need NOT be related to reproductive
issues. We must look at one larger context.

On the absence of reliable data : We don’t have death data since 1990. (
explain the OH sheet on female deaths in India (1992-93).

please

Death related to childbirth and pregnancy is only 2.4. This proportion has
increased between 1982 and 1993, despite all commitments.
Age specific deaths Communicable diseases double or even triple amongst all
women irresptive of age groups. Deaths due to reproductive reasons are
comparatively minimum.

There has NOT been a drop in
contraceptives.

in India and Indonesia despite the over use of

We are not concerned about maternal mortality, but family planning.
Maternal mortality has been increasing from... .to
But the death due
to communicable diseases has changed and is showing a reverse trend.
Level of hunger is increasing / high in the country. Anaemia is an indicator. But we
get concerned only when women are pregnant and lactating. But half the
deaths is anaemia induced.
C:\eudora\attach\populflHon policy WS - D on 19th october.docCreated on 19/10/00 10:33- 1 -

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Reproductive health care is being discussed as a vertical programme despite all
expenence IMR data is extremely worrying. Still, we have misplaced priorities
In a recent WS. there was one paper on malaria, one on IMR but 40 on sexuality

10 states have shown an increase in the IMR rates MOHFW has made a statement
to the supreme court that they are planning to introduce Neten
Dr. Devaki Jain:

This is the best time for me to off load my burden on NPP.
The policy is already out, but we need to look at the strategic avenues and
opportunities available to influence its implementation. Any opportunity to link
policy with practice and influence policy its implementation is a moral responsibility
Tlie initiatives and the ground level realities should be listed.

Some of the key concerns:
1) Many of us are in different working groups. We need to co-ordinate
between ourselves.
2) Our role in state level commissions may be defined and strengthened.
Thelma and me managed to name it as a policy for population
and social
development. I, Thelma and Geetha sen are members (edit)
3) Thelma and Dr. Sudershan are part of the National commission/ Working
group (?) So they could bring in their experience to the state.
4) Investement in social sector is low and it is not ok.
•

5 things that bother me:
NPR16^
assault on rights — rights perspective is missing in the

b. Conditionalities of the 2 child -norms should be resisted and rejected.
Lobbying and advocacy is needed to block the private member
bill that aims for restrictive practices.
c. Delivery and availability of health services. 4 stake holders in
Karnataka- the govt, academicians, demographers and
.................. Can we wrok on the details that will help.
d. We had documents in the past. How do we build public opinion is
the challenge. We need to work on a policy.
e. Narmada - The need to make alliances and the need to extent
solidarity on the rights issues.
f. Private member bill: If this group can come up with guidelines
and strategies, we may be able to block the bill.
Interest generated within NHRC, RBI, MOHFW: My meeting with Justice Verma of
NHRC... .This is a rights issue. NHRC may join hands with us for the delhi
meeting. Health ministry will fund. Bimal Jalan of RBI may fund the Delhi meet.

I thank all of my people-at the foundation,

from UNFPA, etc. etc.

We want to make this as your colloquium.
Let me brief you about the conflict between NPP and MO Health. The
representatives from Health Ministry are coming because they would like to
listen and equip themselves to lobby for a pro-people and humane policy. This
is a good occasion to influence their thinking and understanding.
2
C.\eudora\attach\population policy WS - D on 19th october.docCreated on 19/10/00 10:33- 2 -

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■

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■

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Explained programme for today and tomorrow
I am NOT a great beM^/ertthat the government will be the only service delivery
people The crux is that tints should transform into a peoples' movement, like the
Narmada struggle

Mechanics I thank the Gowt. of Karnataka and . . . for the hall.
|We have invited mocha tomorrow. But if you don't want, we skip that.;

Comparison between the state and central population policies are required to
develop linkages and evwn develop a monitoring matrix. TOR for the WG to be
redrafted as it is not uniform and inappropriate.

Padmini:
How do we read the docunnent, where do we go from there? What actions evolve
from this?

Sheela Prasad Sec of
I got the document just now' But I will focus on the AP state policy, the first state to
come up with a state population policy in 1997. Shared the lessons learnt.
AP has been aggressive antd has come out with reforms of aggressive nature. The
1997 document was based x>n the recent results in TN. The political commitment in
TN, facilitated the AP policy

Women’s health is talked in big way. The girl child is the main focus and not
adults. Women and children are the key factors
The other pressures used
as justification was pressure on land, agriculture etc. But the there is no
reference about how this will be dealt with this.
In last March, there wa» a target of 20,000 sterilisation. Groups Against Targeted
Sterilisation stepped up a campaign. But even the media didn’t interpret the way in
which we wanted it to do Then the WB asked the question how could the govt,
pressurise and
jncen&ve and target oriented sterilisation in the post Cairo
situation. WB was forced to back track. WB made clear that they were NOT keen
on targeted oriented camps The CM said that the women were coming on their own.
But this year nothing of that sort has happened, by design or by default.

Donna: I work on domestic issues.
Ravi:

CEHAT Co-ordinator, into research on health issues of women, finance etc.
We have a perspective on population policy.
Demographic targets are a concern. It is good to reduce IMR, but it is done in the
context of demographic issues. This needs to be confronted. National policy is
more progressive, compared with the Maharashtra state policy. There was lot of
involvement of NGOs, grassroots etc. in the national policy formulation. But the state
policies are more blunt- UP » AP and Rajasthan is a good indication. In all these

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z. -S'>

3 states, an Amencan consultancy group. FUTURES has bagged the contract The
group is an US based consultancy group.
We are worried about the common elements, mostly on the nature of incentive
elements this consultancy group has been able to place as a policy. The
element of cohersion is coming back. After emergency, cohersion have moved
^re important0001*0^
*° 3
W3y
0)6 riflhts perspective becomes

We need to look at why we have separate family planning and population
policies and why it is not based in the larger context of primary health care.
Padma Prakash.

This document is a beautiful patchwork. It is frustrating because it is an extreme note.
Impoverishment is central issue, but this document doesn't deal with it. We
must be concerned why there is no mention about the nutritional programmes On
the one hand, impoverish people through big dams and impoverish through other
means and then talk about a population policy that misses the realities.
Why there is a women oriented pop policies. This would target women and it puts the
burden and responsibility on women. If it is health or nutrition policy we can
understand. But not this.

Fathima All Khan from Osmania University:
never g65^ ^00k

6

but

Panning policy. The language is right, but

*

Targetting women again are the model. Story of the women that sums up the need
to empower women and give choices. The case of the fight for the abortion rights
Rights issues should be our focus.

Eliamma Vijayan:

lam not an expert on policies. Sighted a section that mentions about sustainable
development In the absence of a sustainable development policies, how would
we achieve long term results by 2045.

Even in Kerala is not an exception. Privatisation and cost is going up for medical
care. Self help groups are formed and this is not sustainable. The self help groups
are asked to takecare of the health needs as well. This is dangerous.
Lija Shibhu, elected member of Panchayat :

I am an advocate, a very new member. I will speak tomorrow.
from Achutha Menon Centre for health

We don’t see it as a complete policy. I am a demographer. This policy is biased.
Feasibility of the stabilisation is questionable. Stabilisation is never stable.
Stabilisation process can never be a reality. This could be a statistical wonder. It may
be noted here that if we look at only statistical indicators , Kerala may NOT
need a policy because the it is already below the stability level.

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1 '

K-

But if we focus on the ngmts issues, the population policy doesn’t reflect the
individual rights This dmesn t mention anything about the individual needs We
should go back to the ngmts perspective This is a wish list and not a policy in total

Sangamitra acharya frown JNU:
Stabilisation is a questionable concept. The policy has been successful in
giving a cosmetic touch-to numbers that is away from realities. It is not possible
to have death rates and fertility rates falling in the same pace The inter linkages
between pop and health and other holistic issues related to redistribution is
not addressed. Case of ^P, Bihar and
with all the natural resources but the
least development indicators

Rather than making rt as a <clinic
* ’ oriented (case of surgeons), can we involve
other needs including psycho social issues.
Thelma Narayan:

(1) We need to look at assumptions like why we need a pop policy ? The
assumption that if we cut Tie numbers, we make the world better is wrong
(2) Can we look at the policy as a process that evolved over a period of time and its
dynamics..
(3) The context in which thts doc has been developed. The influence of agencies
(external and internal) on this process and the final doc. The lobbying has not
been adequate.

The pressure of the WB and others to stress on family planning. But the cost of the
“women’s rights and choices “ needs to be questioned.
Some of the practices in the form of camps must be resisted. We have stopped
many basic/ survival programmes like ANM training and distribution of folic
acid etc. It is in this context we need to look at the aggressive way in which the pop
policy is pushed.

Gender equity:
In the absence of birth registration, we rely on unreliable data and thus improper
policies. We must insist on data collection.

Sudershan:
I share the same concerns as Thelma. The positive thing was that PM was there
from 10 to 5.

My main concern is whether we will be able to implement at least 10 % of the
doc.
Karnataka Task force has the responsibility to make concrete
recommendations and monitor the implementation. The system is bad, but some
improvement is in the pipeline Decentralised demographic calculation is what is
happening. Non availability of iron folic acids for ordinary anaemic patients is
worrisome. It is available only for pregnant women.

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a
... X

.

z'. -S'>

I am against the pop policy if it is away from the health policy. I think that
implementation is the key issues. The issue issue and policy needs better inter
sectoral co-ordination

Prakash Rao: OAF
Role of drugs in national pop policy. It is a distorted view to think that
contraceptives will help to bong down the numbers We have taken it for granted that
drugs will help Use of drugs is in a sorry state. Western drugs, sold over the counter,
can create problems There is a very ambiguous statement on use of drugs. With
the issue of patents in olace, the situation becomes more complicated as it may allow
a free entry

Ina Sen, UNFPA:
The historical context is important. Birth control is missing and this is a positive
element. The gender is not taken as such, but is integrated. There is a progress
here, even on decentralisation. It has NOT come out loudly on the issue of
cohersion. It should have been more vocal. If there was more dialogue, some of the
controversial things in the draft would NOT have found its way.
Out side (and govt level) action is required in state level policy formulation It is
good that people from different backgrounds and ideologies are there in the working
groups.

State actions aje not consistent with policies. Some of the state policy documents
are good, but not when it gets implemented when they close political
participation. CMs may have to listen to grassroots. A strategy to amplify the
voices of the grass roots is required.
Documentation has to come in about the field experience. Earlier the cohersion was
based on family planning. Now it is based on fertility. We move from pressures on
contraceptives to the fertility issue itself.

Role of donors- USAID has said that they don’t like what Maharashtra does. No
agency is a monolith. They have said that the trend is worrying.

We must try to use the existing windows of opportunities and develop
indicators and monitoring systems. I am a believer in indicators and monitoring
systems.
It may be a good idea to suggest to the working group what could be the indicators
and monitoring systems/ indicators.
Looking at a transition from where we were 10 years ago, this a good step.
Dr. KR Nair:

I will focus on decentralisation. What is happening in the name of decentralisation ?
What is happening is deconcentration and not really decentralisation. We need
to focus on what is happening to places like PHCs and sub centres who has to
bear the brunt.
In Rajasthan, they are not filling the vacancies and even abolishing male multi
purpose workers. They are not filling the vacancies. This is worrisome.

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....

..

u., ..

z. .&■>

The second area i> rewworch. Research is required Historically social research is
done when the programme fails, as a post mortem. What we need is a process
oriented research Social differences are important I am shocked at the recent
observations in the hearth research sector It is mostly donor driven The results
are evident in the language they use
Ashish Sen , VOICES

Media for social change
Does this document toueh the rights issues ? Does rights link with representation
It is good to talk about women, but if we don't touch the issues related to survival and
livelihood, we miss the zjoint
Shyama Narayan

Jaya :

I am here to react on the pop policy. We don’t need a pop policy. Constant
reassurances at Cairo and other forums didn’t work. They said doors are
opening. But after 6 years, we are convinced that all the fear is coming back with full
force. I differ with Ina Targets are there. It is there in print. They talk about women’s
health, empowerment eflto But If you look at the Maharashtra pop policy, it says
that no ration for the third child. It is cohersion. If so, how will the third child
will live.

This is anti poor and not anti poverty. Maharashtra government is planning to
focus on child mamage. but not from their rights but the number issue. There is
nothing on male responsibility. We must stop camp approach as it is violation of
rights Denying the rigtit to context in elections (in the context of more than 2
children).
In Maharashtra the number one reason for women’s death is accident. Stoves burst
only when young bndes turn it on. The Maharashtra govt is moving away from MMR
to IMR. Without bringing down MMR, you can’t bring IMR.

Botn National and Maharashtra state policy stresses the role and responsibility of
panchayats. It is worrying to note that the funding pattern will be based on the
performance of the panchayats on pop control programmes.
The most disturbing factors of these documents are the underlying philosophy and
language is disturbing. If the state can’t assure the survival, it can’t limit the
number. The national document says “states are persuaded to fearlessly pursue...”.
We can demand consumption policy.

Mira , HSt.

Rights perspective missing Approach of having Non- negotiables to implement a
policy is questionable. Women have no assurance for survival medicines like for
snake bites or ...etc
Eg: During a field visit to Raichur, a lady asked me to write a note to so that he could
go for a surgical stenlisation. After the surgery she had to do everything.

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c>

,/z A ,

Years later, rt was found that she had senous reproductive health problems*There
are linkages

Recent initiative of the ISST on conducting panchayats

Capacity building needs to be looked at
NOT to wnte the numbers

has come down to equipping them

Janaki nair:

Arya Bhat :
Sample registration system doesn t work Population policy needs a holistic
approach.
Sabu George:

(Sabu will fill... .)
stressed on female infanticide

3 Panchayat members spoke in Kannada, please fill
Last speaker spoke about the initiative to federate elected members. Didn’t get
into the details.

Padmini Swaminathan, MIDS:
My analysis found that increased participation alone
TN govt’s explanations about 4 (symbolic) indicators are in place and so we
are in good shape. Explanations were not conclusive and final.
How do we go about sustainable development. Linkage between poverty and
population policy is important. It is more important in the context of increasing
inequality levels. The argument that we are over populated to deal with
development. We are loosing track of the lessons learnt by developed
countries. The nature of economic development has made is extremely difficult
to bring up a child in the west. The working hours have made it extremely difficult
to share the responsibility between parents. Sweden gives three years of leave to
bring up a new bom child. We need to look what we can learn and what we need
to be careful from the experiences of these developed countries.

The recent move to develop social development indicators in TN: Concerns
raised in the concept note are.
Exceptionally high MMR
Existence of anaemia, malnutrition
Omissions of men’s role in contraception.
Excess female child malnutrition is appalling.

Structures of governance are not explained and understood. To locate the
implementing and monitoring aspect.
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it.

z' - .S'»

'

Post-lunch:
Ravi
Thelma

Sanjay Kaul: (pk»«se pick up the notes from Sabu. I am sorry , I missed this)
No more incentives for sterilisation in Kranataka

Targets for sterilisation tias been given up but not the target for immunisation
Case of Bijapur

GOI is promoting male responsibility. We need to tap the potential strengths of
TSMs.
We need to involve NOOs as well. If it was not for the financial strengths of these
NGOs, the system would have collapsed
Lot of money is available for AIDS and TB.

I EC needs revamping
In the health system, there is lot of resistance to look at things differently. One is
scepticism that if we don’t keep targets , number will go up.

Challenge is to develop documentation that will prove that targets alone don’t
help.

Ravi: Small family Vs healthy family.
Suman:

Shyama:
I work with IVF clinics.
No govt, clinic give* services. So ordinary people are left out. There is no work being
done to tackle infertility
The Maharashtra policy will enable structural discrimination against female
embryos.

The negative side of the technology was stressed.
Ravi: On amniocentesis
Sabu:

The recent moves of the task force , let us hope they come with something new.

Mala:
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.r:-

. ,s->

Complications related to sterilisation and not just the loss of child is why women
move away from sterilisation

We must be careful when we quote Kerala and TN In fact, Punjab and Haryana has
better male responsibility in contraception
Devaki Jain:
Population policy is more to
No stress on individual and social well being
Use birth control term instead of family planning

Panchayati Raj and decentralisation is to be looked at
Critique of Sanjay’s presentation and critique of macro economic policies

Ina :
3 suggestions

Possibility of recommending one more working group to safe guard cohersion.
If not central, why not in states

For strategic reasons, I oppose the NHRC angle. No decision maker wants a
right’s angle.
On vertical programmes: In Orissa, local level Swasthya committees.
Central-State fund flow patterns.
Target free approach and its impact.
It may be important to move away from the contraceptive targets.

Mohan:

No country has been able to achieve health care without state responsibilities.
Groups like ours we could remind the govt, of its duties.

Lady speaker: Stress on birth data and other statistics. The comment that
Govt, can’t be blamed for the notion that number is the problem, who else is
strengthening this notion.
Observation: By default or by design, there was a single ideology / tonej
throughout discussions barring two exceptions.)
The conceptual clarity exists. It may become easier for the group to move)
forward tomorrow.)
»
Ravi:
India has the largest unregulated private sector. In India less than 20 percent comes
from govt, where as in US it is 40 %. I would like to look at this in the context of
primary health care.

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, -• • -

..

. ............

To train a doctor ind« spends one million rupees Despite expanstons. 75 % of the~~
students are coming ouitfrom the private sector

pharmaceuticals are strong 40 % of our products go as exports We are NOT sure
what will happen after $ years when the patent regime comes to an end.
Medical insurance »s stnll small
come in a big way

Private medical insurance companies are going to

Groups:
Please add who is tn wrhtch groups

*

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Hp-3♦

NATIONALPOPULATION POLICY

2000

FACT SHEET ON NATIONAL POPULATION POLICY-2000
DEMOGRAPHIC PROFILE OF INDIA

a. Adverse sex ratio- The sex ratio has decreased from 972 in 1901 to 927
females to 1000 males, in 1991.
b. Inter state disparities- Despite uniform norms for health care, infra
structure and funding substantial differences have emerged between
states in the achievement of basic socio-demographic indices.

c. Demographic projections in 5 States if present trends continue- From
1991-2016, the increase in numbers is projected to be 410 million.
55% of this increase is taking place in 5 States : Bihar, Rajasthan,
Madhya Pradesh, Uttar Pradesh, and Orissa..
d. IMR of India is 72
e. MMR of India is 437
> INTERSECTORAL AGENDA FOR STABILISING POPULATION

1. Making reproductive health accessible and affordable.
2. Increasing the coverage and outreach of primary and secondary
education.
3. Extending basic amenities like sanitation, safe drinking water and
housing.
4. Empowering women with enhanced access to education and emplayment
5. Providing roads, transportation and communication.
> OBJECTIVE

C.
a) LONG TERM OBJECTIVE

"

1. To bring about popiilationjjtabilization by 2045_consistent with the
requirements of sustainable economic growth, social development and
environmental protection.
b) MEDIUM TERM OBJECTIVES

1. To bring the total fertility rates to replacement levels country -wide by
2010.
2. To implement multi-sectoral operational strategies.

U

2.1

Chandigarh
2

Tamil Nadu

1.9

A&Nislands
1.8

Pondichery

1.8

kerala
1.6

Delhi

1.5

Nagaland

1

GOA

2.5

2

1.5

1

0.5

0

equalwith
to 2.1
9orstates
TFR of less than

Growth in population(millions)
1200

1000 z

1100-

800

™

600 '

400-h

_

900——

700

"

238 — 250_300_420

200

o-l^

I

1000

■•.■■•■■■•■•■■■•J

1901

WWWMt

1921

1941

WWW?

1961

1981

1996 2001

2011

States with TFR more than 2.1
4.8
4.8

UP
M EG H.ALAYA -

4.4
4.2

BIHAR RAJASTHAN -

4
3.9

MP TRIPURA -

3.5

D& HAVELI -

3.4

HARYANA -

3.2

ASS.AM -

GUJRAT -

3

ORISSA -

■3
2.8
2.8

LAKSHDEEPARI NACHAL -

2.7
2.7
2.6
2.5
2.5
2.5
2.5
2.5

PUNJAB -

MAHARASHTRA ■
WEST BENGAL -I
SIKKIM -

HIMACHAL ANDHRA -

KARNATAKA DAMAN DILI -

2-4

M.AN I PUR -

0

1

2

3

4

5

6

INTERSTATE DISPARITIES IN INFANT MORTALITY

100-fl

90-

I !

80-

70-

60-

50403020-

10-

0

98

.iiiill
x

z

<

sCQ

GO
GO

<

X

F
co

<

GO

F Q
<

< X

> co

x H

<
co

GO

2
o

CL

g j

INTER STATE DIFFERENCES IN MATERNAL MORTALITY RATIOS
800-|

700-

600500498

400-

300200-

87

XWWWWS ■

a

5?

LIFE EXPECTANCY
70n
60'

50.5

50-

63 4L

68.8

40

30-

□ male
female

20-

100.

ss
1901-10

1981-85

1996-2001 (p)

2011-16(p)

IMMEDIATE OBJECTIVES

C)

1. To address the unmet needs of contraception, health infrastructure and
trained health care personnel.
2. To provide integrated service delivery for basic reproductive and child
health care.
> STRATEGIC TH EMES-

Decentralised planning and program implementation.
Convergence of service delivery at village levels
Empower women for health and nutrition.
Mainstream Indian systems of medicine.
Upscale information education and communication.
Provide for the older population
Meet the unmet needs for contraception and trained health care
providers.
8. Facilitate diverse health care providers.
9. Target under-served population groups.
10. Include specific good management practices from South East AsiaMalaysia, Indonesia and Sri Lanka.

1.
2.
3.
4.
5.
6.
7.

> ACTION PLAN FOR DIFFERENT GROUPS

(a)

WOMEN’S HEALTH AND NUTRITION

“ The complex socio-cultural determinants of womens health and nutrition
have cumulative effects over a life time. Impaired health and nutrition is
compounded by earlly or frequent child bearing, serious complications, unsafe
abortions, RTI and STI premature death or disability_______________________

1. Cluster services for women and children at the same place and time.
2. Lower service delivery costs and positive interactions in health benefits.
3. Expand the availability of safe abortion care and post abortion
counselling.
4. Maternity hut in every village
5 More child care centres in rural areas and urban slums to facilitate
participation in the labor force.
(b) CHILD HEALTH SURVIVAL

“Infant mortality is the most sensitive indicator of human development’^

A National Technical Committee to review programs and interventions
for reducing infant mortality.
current advances in perinatology
2. Align program implementation with
and neonatology.
.
Improve
capacities
at
health
centres
for
essential
neonatal care,
3.
including the management of childhood illness.
4. A national health insurance : hospitalisation costs for children below 5
years.
,
Expand
the
ICDS
program
to
include
children
up
to
age
9,
in
order
to
5.
promote 100% retention up-to primary school.
6, Sub-groups like street children and chid labourers should get focussed
attention.

1.

(c) URBAN SLUMS

1.

2.

A comprehensive urban health carestrategy and inter-sectoral
coordination with municipal bodies, water, sanitation and housing,
education and nutrition.
A network of health care providers in the urban slums, incusive of para
medical personnel, retired doctors, NGOs.

(d) TRIBAL COMMUNITIES/ HILL AREA / MIGRANT POPULATIONS

1.
2.

A system of preventive and curative health cares, responding to
seasonal variations in work and income.
Mobile clinics to widen and expand regular coverage/outreach with a
burden of disease approach to provide for their special needs.

(e) ADOLESCENTS
“ Improvement in the health status of adolescents has an intergenrational
impact. It reduces the risk of low birth weight amd minimizes neo-natal
mortality.__________________

1.
2.

_______ _______________

Provide the package of nutritional services available under ICDS
program.
Ensure access to information, counselling and affordable reproductive
health services.

(f) MALE PARTICIPATION

1.

Inform, educate and counsel men to plan smal families, support
deliveries, be responsible
contraceptives use, arrange skilled care during
<
fathers and educate the girl child.

(g) HEALTH CARE PROVIDERS

I.
2.
3.

Revive the earlier system of licensed medical practioners who could
become eligible for providing clinical services.
Involve non-medical fraternity in Counselling and advocacy, in order to
demystify the national family planing effort.
Create a national network of voluntary, public, private and non
government health centres identified by a common logo delivering RCH
services free to any client.

(h) NON-GOVERNEMNT ORGANISATIONS
“Where government interventions or capacities are insufficient: private sector
participation unviable; focussed sendee dellivery by NGOs effectively
complements governments efforts. ”1

NGOs should augment information, education, communication,
motivation, training. Counselling, advocacy, clinical services and
innovative social marketing schemes.
2. NGOs should facilitate efficient service delivery to viollage levels,
increased clinical; outlets and mobile clinics.
3. NGOs should provide efficient service delivery to village levels,
increased clinical outlets and mobile clinics.
4. NGO should pursue and strengthen activities where there are acute
deficiencies in supplies and services.
5. Commence activities in States and pockets with under-served segments
of population.
6. There should be a genuine long-term collaboration between the
government sectors.
1.

FACT SHEET ON RECOMMENDATIONS OF NATIONAL WORKSHOP OF
NGOs HELD ON 28™ June ‘2000 ON NATIONAL POPULATION POLICY’2000

Participants of the Workshop - 140 NGOs from different parts of the
Country
Chairperson
- Dr C.P.Thakur
Co-Chairperson - Prof Rita Verma
Presentations made by
> Tagore Society for Rural Development, Calcutta
> Chetna, Ahmedabad
> SOSVA, Delhi, Punjab, Haryana and Chandigarh
> Adithi, Bihar
> Health WatchTrustee, IIM, Ahmedabad

The budget allocation to the MNGOs need to be made flexible so as to accommodate
the difficulties of local terrain and sometimes the widely differing capabilities of the
FNGOs funded by the MNGOs.
2. The financial allocations to the NGO sector must increase and the range of activities
entrusted by the NGO sector must expand beyond the current limited set of activities.
3. The department of Family Welfare should examine whether MNGOs can maintain a
common bank account for the grants received from different departments of the same
Ministry.
4. The limitation of 2 days imposed upon the MNGOs for evaluating 2 FNGOs should
be modified.
5. Mobile clinics should be sanctioned at least to those MNGOs who monitor NGOs in
hilly remote and inaccessible areas.
6 The MNGOs should be allowed to operationalise in direct manner in certain in certain
areas.
7. Districts should be reallocated between MNGOs for better monitoring.
8. Terminal family planning methods should be implemented additionally through
MNGOs that have clinical facilities.
9. MNGOs must observe transparency in financial dealings with the FNGOs.
10. The Ministry must provide copies of the entire schemes and projects run by them that
directly impact the empowerment of women.
11. Wherever reaching the household level is essential, self help groups must be formed
in villages and should be trained in health related activities.
12. Department of family welfare should reconsider the 6 bedded hospital scheme.
13. The services of the already existing health sub-centres, PHC and CHC should be
improved before constructing the new ones.
14. Public sector organizations should be involved in operationalizing the agenda for
population and development.
_________________________________________
I

«

FACT SHEET ON RECOMMENDATIONS OF NATIONAL WORKSHOP OF
PROFESSIONAL ASSOCIATIONS AND EXPERTS HELD ON 27th June ‘2000
ON NATIONAL POPULATION POLICY^OOO

Participants of the Workshop Experts from the Indian Systems of Medicine.
Presidents and delegates from the following all India level professional
organizations
> Federation of Obstetrical and Gynecological Societies of India(FOGSI)
> Indian Academy of Padiatrics(IAP)
> National Neonatology Forum(NNF)
> Indian Association of Preventive and Social Medicine(lAPSM)
> Indian Medical Association(IMA)
> Indian Society of Anesthesiologists(ISA)
> Indian Ayurvedic Conference(IAC)
- Dr C.P.Thakur
Chairperson
Co-Chairperson - Prof Rita Verma
1. The current level of government’s direct expenditure on health is too small to permit
a significant improvement in the health status of the Indian people.
2. The gaps and deficiencies in primary and secondary level health care infrastructure
and the delivery systems are the major cause of high IMR and high MMR. Bridging
this gap is essential to fulfill the unmet needs of contraceptive services and basic
health care.
3. Quality and the coverage of routine public health activities should be improved by
providing equipped and trained manpower in hospitals.
4. The staff and official in charge of the operation of health facilities have to be made
accountable.
5. ISM Practitioners, after suitable orientation, should be involved in the basic health
care delivery.
6. Nutritional Support should be provided not only to mothers during pregnancy but also
to adolescent girls and children of the age group of6mths-2yrs. Awareness generation
in this area is also recommended.
7. Crash courses in disciplines like Anesthesia should be introduced so that emergency
obstetric care services become available in referral hospitals and rural hospitals.
8. Supervisory powers with respect to the MTP Act, 1972 should be transferred from the
State to the district.
9. The anganwadi workers in the ICDS program should be trained in the techniques and
management of ARI. They should be allowed to distribute Cotrimoxazole tablets.
10. The members of different Associations should be motivated to provide consultancy
services at the PHC or CHC level in the RCH program.
11 At the block level blood storage facilities have to be made available.
12. Those contraceptives, which have already been tested and found safe and used
elsewhere with considerable success, should be introduced in the country.
13 . In States with high Birth Rate and total fertility rate, Centchroman ( once in a week
pill) should be introduced for the uneducated women, who cannot have the oral pill
daily.
_________________________________

' "V\p- 3 '

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i

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vT-mwi i
^'■'’11 HZR. mm Hni
fecvfl - 110001
3710051, tjnrn : qtizmi
Government of India
National Commission on Population
Yojana Bhavan, Parliamant SUaat
New Delhi-110001

' skua' b.lNGH

Tel. : 37100^1, Fgx : 3717631

3 0 \'o. \-| id l,-25/2OOV-\CP

October 4, 2000- .

Oear

,v

"aee been cone,

u/nl'

'

Or°“ps “ dt“nb«l ta ihe Order enclosed

^ns'deradon^opnons /

The

meecng or >o^r Workl„g Oroup(s) is |ikdy „ be

With regards.

Yours sincerely,

(Krishna Singh )

Ms Devaki Jam
iii’^amnia Sreemvasan Foundanon
'Mranga" IO1" Cross.
K^iahal Vilas Extension
Bangalore

—

■ ;«r--

No N-J1011/25/2OOO-NCP
Govtrnrneot of India
National C Ptnnjissioo on Populaijpo
Room No.243, Yojana Bhav&n,
Sanjad Marg, New Delhi - I,
Dated 4th October, 2000.
' •

I .

./

ORDER
S u bj i e L forking Groups of the Nhuqdh) Comtpjttipp pp PbPUliilioni

I)

WORKING GROUP ON STRATEGIES TQ ADDRESS UNMET NEEDS
u)
b)

Sub-group on strategics to address unmet needs for contraception
healthr0UP °D ’,riUC8'CSi 10 “ddres* unmet need* for maternal and fhiW

c)

Sub-group on strategics to address unmet need* for public health,
drinking water, sanitation and nutrition
Sub-group on strategies to address unmet
need* for empowerment of. .
women and development of children

d)

a) Suh-group

0
• <0
iii)

ou strategics |u address unmet pepds fpr contraception

Mr-K. Srinivasan, Ex. Health Secretary - Chairman
Members:
Dr. Nina Pun , President, PP1A
Co
PaChaUri' Regional Doctor, South and South East Asia Population

iv)

Socia^Medicine ’

v)

Shri K. Gopalakrishna, President, JANANI
India,^FOGS!) ChatlC':’CC' President- Federation of Obst. & Gyna. Society of

vi)
vii)
viii)
ix)

Mtfd‘CaJ Coile«e’ ^dian Association of Preventive and

Dr0DRT^iCvC‘ R u C50udhryy' Scienust, National Institute of Immunology
Dr. D. Takkar, Head of Department. Depn. Of Gynaecology, AUMS
■.'■/TCTnVC !Of B,rla Mana«emcn' Corporation Ltd’i Community Initiative*
’ :•? Ku:-’! Development, Mumbai.
“«‘umiy uuuauvc*
)

’

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•

■I

r

x)
xi)
xii)
xiii)
xiv)

Representative front Hindustan Latex.
Representative o! National Commission on Population
Secretary, Family Welfare, Government of Bihar
Secretary, Family Welfare, Government of Rajasthan
Representative of Department of Family Welfare • Convenor.

i)
ii)
iii)
iv)

i

‘‘x?,

•

Special Invitees

*«

Dr.(Ms.) Banu Coyaji. Director, KEM Hospital, Rastapet
Dr, Shared Iyengar, ARTH, Udaipur

u. ..

SyHem‘of Medld"'&

L
yr.;
IsniiSjOtli’iEDw
*)

To identify gaps and
HU8fiCS‘ aJ‘Crnativc straI^«. intcraJia recent development and
with th. ak— ducr«8ard 'o cost effectiveness and optimization of resource- ■'>

0-

N.^%xx
o
p
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b
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n
8
,
o
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wilh O'

or

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))

)

i)
ii)
v)
')
)

i)
ii)
• iii)
x)
■)

a)
;ii)
iii)
iv)

ub-grou

on s(ratci?i^ fp address unmet need? foy ma
- • •»J- ' It

Secretary, Health, Government of India, Chairman
Members
■ ti:?: \f
^Umar' ,ndian Nursin8 Co^cil
Shrt, Abhay Bang, SEARCH, Gadchiroli
•/ i • ft
Dr. T.N. Mehrotra, President, IMA
S^AlniMan0har
Hospital
Shrt Alok Mukhopadhyay .Chairman, VHAI
DrrSHNHeld£nUcd
President, Naga Mothers
Association
Dr. Badri N. Saxena, Centre for Policy Research
Representattvc ol Department of Family Welfare
Representative of Department of Women & Child
Representative of Department of Social Justice
u.
Representative of National Commission on Population
Secretary, Family Welfare, Government of Madhya Pradesh
Secretary Family Welfare, Government of Uttar Pradesh
.

V)

JS (FWCH)

Comm,'’*io"

vi)

Department of Health .

Convenor

H;

...

)

■

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)

i

2

i

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li. ■,

t-;. *"?

/

•)
bj

C)

I g identify gap* and
Io examine and
ahemdiive strategics, intcralia recent devclopmenu and
itinovations with cue regard to cost eflectiyeness and optimiyArinn of rcaourcea, /
with the objective of contributing to the fulfillment of the. objodivea of the »•
National Population Poihcy.‘
To consider any ether matter related with or incidental to the above terms of ■
reference.
ri

y. ■

r
C)

i)
ii)
iii)
iv)

v)
vi)
vii)
viiij)

ix)
x)
xi)
xii)
xiii)

Sub-group on Sul’-gro>up on strategies (o address yppift Pfcdl for Public i.’
heultb, drinking w«(er, sanitation and pufrifiop
,
■ " . ••>•••1.^1
i •*,Ci -j
.j ii

:_i»

b)

c)

d)

0
ii)
iii)

r*’

j

Dr. H. Sunderasan. Ex-Vice Chancellor (Madras University) ChairmanpoT •-'■■■ (d J
Members:
’
■'
Ms. knrana Qadir, Professor, Population Studies, JNU i >
Dr. B.K. Tiwari, Nutrition Adviser, DGHS !
■•m.
Prof. KJ. Nath, All India Institute of of Hygiene APublic Health, Calcutta ‘Tt
Mr. Bindeshwar Pathak, Sulabh International!
Representative of Department of Rural Drinking Water
Representative of Department of Urban Drinking water
Representative of Department of Women &: Child development.
Representative of Department of Environment
i
Representative of Department of Health
~
Representative of National Commission on Population
■' "■
‘
Dr. Prema Ramachandran. Adviser (Health), Planning Commission
-X’t ■
■
Adviser or Representative, Drinking Water/Sanitation/Planning Commission Convenor.
-7.
...
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Term s o f Re fc re nee
a)

j

•<?’ 'iT'

To identify gaps and
• -t
.fTo examine and suggest alternative strategies, intcralia recent developments and
innovations with due regard to cost effectiveness and optimization of-fieflourcefl, ;*.*
with the objective of contributing to the/fulfillment ,of the>objectivef'X>f the f/j
National Population Policy.
*■
• *
To consider any other matter related with or incidental to the above, tenxu of <
reference.
v

■u

Sub-group on »r*irg»C> for emppwerm^pt of yvQfflfn, tlmlPPmfBt Of
children and i$3ue» rtbitiflg to adokicentj1
-~
Mrs. Margaret Alva, Member of•Parliament - Chairperson
■
Members:
z_____ ’
- Ela Bhau, SEWa, Ahmedabad
i>r. Swapna Mdkhopadhya>. IEG, Institute of Social Studies Trust

'
'

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/

iv)

Ms. Deviki Jam, Sangamma Foundation
jr
Ms. Aaditti Mchtia, Rashtriya Mahila Kosh
Dr Saroj Pachaun, Regional Director, Population Council
Dr. Tyagi, Indian Academy of Paediatrics, Department of Tele Medicine, AHMS
Dr. Sunil Mehra, MAMTA
..
Representative of Depanmem of Women and Child development
. di
Representative of Department of Youth Affain
.'e y
••ft
Representative of National Commission on Population
Representative from IGNOU
Adviser or Representative, Social Welfare, Planning Commission - Convenor.

v)
vi)
vii)
viii)
ix) '
x) ;
xii)
xiii)

Terms of Reference
•h • i
dj<;
(•jr
......
& >.d.a)
i o identify gaps and
’
” ' .
b)
To examine and suggest alternative strategics, interalia recent developments and
innovations with due regard to cost effectiveness and optimization of resources, •' rcSc
with the objective of contributing to the: fulfillment of the-.objectives of the ('Ti O
National Population Policy.
. rjiwiT .Xfl ,<J
lo consider any other maner related with or incidental to tha-ahnve terms of<7*^vtf
c)
«f««nce.
•»
tv^

4

H)

i)

Dr. K. Venkaiasubramanian, Member (Education), Planning ComraiwionM^H'
•. <
chairman.
./ tTUiX pfG.’iVI /.□
i:x
Members .
•
7<. i^jvb/V .’J<
Dr. (Mrs.) Usha Nayyar, NCERT
iuii>vno*> .
Prof. Mohd. Amin, Ex- Vice Chancellor, Jamia Hamdard
Dr. Ketan Desai, President (MCI)
Dr. Digvijay Singh, Ex-M.P.
Ms. Jaya Jaitley, President, Samata Party
(z
Mr. B.G. Deshmukh, Ex-Cabinet Secretary/Pr. Secretary to PM
id
Principal Adviser (Education), Planning Commission
Representative of Department of Family Welfare
• .us ;d- N
Representative of National Commission on Population
Representative ot Department of Education '• Convenor
I

ii)
iii)
iv)
v)
vi)
vii)
viii)
ix)
x)
xi )

I .f

.SS
r> o i

si m

•

■

■

•»;..?

a) •

.<• ’Il'/JCGO 'H

• i'.:
<

To identify gaps and
•.
To examine and suggest alternative strategies, interalia recent deyelonmpnta and
innovations with due regard to cost effectiveness and optimization of resources

•;

>

NX%X,1o'n0/»l“;,rib“,i", “
c)

’M:

*•

Isms of Reference
b)

3

re°ferenncedCr any other matter rtflated
related With
with orincidentaI
or incidental »
to «be
the above'tenns
ihnv? form* of .;i<
-’i

4

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u., ...

fc W

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5 -

UI.
i).

WQRKJNG CROir 0^ REGISTRATION OF BIRTHS, PEATHS ANP
Marriages
._r <

^*1
,3 . ! v

Registrar General of India - Chairman
Members:

->i)
ii>)
iv)
iv)

v) '
vi)
vii)

Dr. Pai Panandiker, Centre for Policy Research
Shri A h’t^’ Prcildcnl’ ,nd,3-° Association for Study of Pppulauonj

’ I
$ •'' ’

)

Representative of Department of Statistics
Representative of Department of Family Welfare
Representative of National Commission on Population
Adviser, Health/Planning Commission • Convenor.

’’i C !r'-'-fOy',.

!hf

Reference

a).
b\

C)

d)
IV.

ii)
ii)
iii)

iv)
v)
■ vi)

vii)
X)

xi)
xii)
xiii)
xiv)

!I

If /

4iriiX
■

lo identify gaps and
.
• <
fo examine and suggest aliemative strategies, interalia recent developments and
innovations with due regard to cost effcctiyeness and optimization of myrarn™

z -M ft

Fzi

• ‘

A*' ’•

•

‘ '>

L' - •

'o6erta“‘,rM?^

National Population Policy.
*
To consider any other maner related with; or incidental to the above-'tams of
reference.
:“■«i
Both legislative and implementational issues,should be addressed.-.,
/

- ^/4

WORKING GRQUP QN MEDIA FOR INFORMATION
COMMUNICATION (1ECI and motivation :

Shri H. K. Dua, Press Adviser to PM - Chairman
Members:
•rShri Alyque Padamsce, President, AP Associates,
Shri Rajiv Shukla • M.P. (Rajya Sabha)
. .
'. .. . ;/C ■^r. J.K, Jam, Jain TV
Ms. Sharmila Tagore, MP
Snri Ajit Bhanacharya, Press Institute of India
Ms. Ranu Chhabra, Member NCP
&r. Mahip Singh Member NCP
JaipaJ’
Siddh# Medical College, Chennai, Tamil Nadu '
inn
Narendra
Mohan.
MP
• - ■
,:.1
'
Ms. Usha Rai, Editors Guild of India
Snri Qari M. M. Majari, Urdu Secular Qayadat
Representative of Department of Family Welfare
Representative of Department of Ministty of IB
National Commission on Population • Convenor,

, TH-

%

I

z.

‘z.rr

•

,r:

t--

•

_ ■«-»

»»• < “J- T?.--,r •

Term? ef Reference
•)

w
'V
>•
c)

To identify gaps and
To examine and suggest ahemative strategies, interaha recent devcJopmcuts and
innovations with due regard to cost effectiveness and optimization of r^aources,
with the objective of contributing to the ftilfillment of
‘j
National Population Policy
/ ,
*
To consider any other matter related with or incidental to thej|bove^krpis.of^ J

re,CrCnCC.
Aspects of inter-sectonil co-ordination should be given special attention;^

.

• . <>:.. ..4' : vs
2.

The Working Groups ma> co-opt any official or non-offtcial as a special invitee *
to one or more sittings of the Group.
'

3.

The expenditure on TA/DA of the non- official members, in connection*w^th the .1 •
meeting of the Working Group will be borne by the' National zComm^sion on^^
Population, as per rules and regulations of T^VDA applicable’fo/Or^cT^fficen

’ '

’ ii

1

of Government of India or as otherwise^decided by'the VicejChalqi^Lil NfP. The •03.
expenditure on TA/DA of the official memben, in connection with tnejipoe^ng of.
the Working Group will be borne by their respective DepanmcnU/Mi^lj^e<j • VAll the Working Groups will submit their final reports ' to Jtho ^National

4.

Commission on Population within six months from (he dale of issue of this order.
•?

■ /J

•: H ;!■».>

11W.(Y) r . ,Z ;{

■ (R-r4Pirmah
CXKSWWG

I

- • "■•Under-SeCTetaiy,^.^
National CommiMipn?pu!PppuIation<77^

1

.... •'? ,..iz •• .\;'u
. 1.

2.

All Members of the National Commission on Population
All Members of the Working Groups.

Copy co :

1.
2.
3.

4.

ti
IV/ • *•£>
uiv
rf

i? ./ :/.•

? .> ;
•;;;

j.e:-

•'|/»

./• * '• Jlt.d

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JS, Prime Minister’s Office.

PS to Deputy Chairman (Planning Commission)
' *’**' " ttJ
PS to Member Secretary (National Commission on Population)'i
PS to Joint Secretary (National Commission on Population)

(/iix

A
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6

NATIONAL COMMISSION ON POPULATION :
LIST OF THE MEMBERS

Chairman:
Prime Minister of India

Vice Chairman:
Deputy Chairman, Planning Commission.
Members:

Union Minister incharge of Education
Union Minister incharge of Environment and Forests

Union Minister incharge of Finance
Union Minister incharge of Health and Family Welfare
Union Minister incharge of Information and Broadcasting

Union Minister incharge of Rural Development
Union Minister incharge of Social Justice and Empowerment
Union Minister incharge of Urban Development

Union Minister incharge of Women and Child Development
Leader of the Opposition in the Lok Sabha

Leader of the Opposition in the Rajya Sabha
Chief Ministers of All States/Union Territories

Dr.(Smt-) Najma Heptulla, Deputy Chairman, Rajya Sabha
Leader of Bharatiya Janata Party (Shri Kusha Bhau Thakre)
Leader of Communist Party of India (Shri A.B. Bardhan)

Leader of Indian National Congress (Smt. Sonia Gandhi, M.P.)

Leader of Nationalist Congress Party (Shri Sharad Pawar, M.P.)

Leader of Janata Dal (United) (Shri Sharad Yadav, M.P.)
Mrs. Margaret Alva, Member of Parliament
Shri Pumo Sangma, Member of Parliament

Smt. Shabana Azmi, Member of Parliament
Shri Vinod Khanna, Member of Parliament

President, Associated Chamber of Commerce and Industry of India

President, Confederation of Indian Industries
President, Editors Guild of India
President, Federation of Indian Chambers of Commerce and Industry
President, Federation ofObst. & Gyna. Society of India, FOGSI
President, Indian Medical Association

President, Indian Newspapers Society
President, Indian Nursing Council
Representative, Jain T V. (Dr. J.K. Jain)

President, Medical Council of India
Representative, STAR T V. (Shri Prannoy Roy)
Representative, SUN T V.

Representative, ZEE T V. (Shri Subhash Chandra)

Professor Abad Ahmed
Mr. Abhay Bang, SEARCH, Gadchiroli

Shri A C. Muthiah

Shri Alok Mukhopadhyay, Chairman, VHAI
Shri Alyque Padamsee

Dr A. Vaidyanathan, Madras Institute of Development Studies

Shri Aveek Sarkar, Telegraph
Dr. Banoo Coyaji, Director, KEM Hospital, Rastapet
Shri Barun Sengupta, Bartman

Dr. Darshan Shankar (ISM), President, Foundation for Revitalisation of Local
Health Traditions.

Dr. E.K. Iqbal, KSSP

Smt. Ela Bhatt, SEW A, Ahmedabad

Smt. Imrana Qadir, Professor, Population Studies, JNU, New Delhi

Ms. Jay a Jaitley
Ms. Jayanti Natarajan
Shri K. Gopalakrishna, President, JANANI

Dr. K. Srinivasan, President, Indian Association for Study of Population

Dr. Mahip Singh
Shri Mammen Mathew, Malayalam Manorama

Professor Mohd. Amin, Ex. V.C., Jamia Hamdard

Ms. Mohsina Kidwai
Shri Narayana Murthy
Shri Narendra Mohan, Dainik Jagaran

Dr. Neena Puri, President, FPIA
Mrs. Neidonud Angami, President, Naga Mothers' Association

Shri N. Ravi, The Hindu

Dr. N.S. Deodhar, Pune

Ms. Padma Sachdeva

Shri Prabhash Joshi, Jansatta

Dr. Pravin Visaria, Director, LEG, Delhi

Shri P N Tripathi, AV ARD
Shri Qari M.M. Majari, Urdu, Secular Qayadat

Ms. Quatarlain Haider

Ms. Ragni Ben Banwari, Seva Ashram, UP
Dr. Rajnikant Arole, Jamkhed Project, Ahmednagar

Ms. Rami Chhabra

Shri Ramoji Rao, ENNADU
Ms. Rani Bang, SEARCH, Gadchiroli

Shri Ratan Tata
Shri R. Srinivasan, Ex Health Secretary

Dr Saroj Pachauri, Regional Dir., South and South East Asia Population Council

Ms. Sharmila Tagore
Ms. Sheema Rizvi, MLC, UP
Dr. Sudarshan (Right Livelihood Awardee), Mysore

Prof. Sundar Lal, Rohtak Medical College, Indian Association of Preventive and
Social Medicine
Dr. Susheela Nayyar, Gandhi Medical College, Wardha Prof. Swapna
Mukhopadhyay, IEG, Institute of Social Studies Trust Smt. Thelma Narayan,
International Health Network of WHO Dr. Trilochan Singh
Dr. V.H. Pai Panandhikar, Centre for Policy Research

Member -Secretary:
Smt. Krishna Singh, Planning Commission

In addition to the above composition, the following shall be Permanent Invitees
to the Commission:Principal Secretary to the Prime Minister
Cabinet Secretary
Secretary to the Prime Minister

Secretary, Department of Elementary Education
Secretary, Department of Family Welfare
Secretary, Finance
Secretary, Department of Health

Secretary, Department of Higher and Technical Education
Secretary/ Member-Secretary, Planning Commission

Secretary, Department of Social Justice and Empowerment
Secretary, Department of Women and Child Development

Joint Secretary to the Prime Minister (Incharge of Health and Family Welfare)

Position: 1205 (4 views)