A Discussion Paper on "Targets and Coercion in the Family Planning Campaign"
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- Title
- A Discussion Paper on "Targets and Coercion in the Family Planning Campaign"
- Creator
- Manisha Gupte
- Date
- 1987
- extracted text
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A Discussion Paper on
"Targets and Coercion in the Family Planning Campaign
il
Manisha Gupte
Target planning and coercion (directly during the
period of Emergency and indirectly through motivational
strategies) are integral components of the Indian Family
Planning Campaign. What needs discussion is whether target
planning or motivation for the 'voluntary acceptance' of
the small family norm are well intentioned strategies of a
government that truly believes in its own goodness or
whether coercion in Family Planning (FP) is a reflection of
more basic maladies in society. Though Mamdani (1972)
conclusively proved that motivation and coercion are not even
practically able to reduce population numbers, the Indian
Government has continued to base its FP programme through the
setting of targets(conveniently glossing over the socio
economic factors that are responsible for population grwwth.
Coercion, whether explicit or implicit, is .
riddled with prejudicial biases, be they of gender,
nationality, class or ethnicity. This explains why the
targets of population control programmes are the poor, the
coloured, the tribals, the dalits and their women. Dumping
of dangerous contraceptives in Third World countries and their
testing on poor women without proper informed consent, the
selection of Puerto Ricans or Mexicans for sterilisation in
the United States or the distribution of a chicken alongwith
each shot of Depo provera in the Phillipines are examples.
The result of such biases can be genocidal when for instance,
tribals who are already a persecuted section are tricked into
mass sterilisations (FRCH 1987X-.
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I incentives and disincentives?
Explicit coercion in the Family Planning programme
in India can be seen in the form of incentives and disincen
tives to assure that the required targets are achieved.
Incentives, be they an extra portion of rations, a few
hundred rupees or a pair of new clothes can work wonders in
impoverished societies. Ironically the leanest agricultural
period coincides with the financial year ending (the month
of March) when FP activity at the Primary Health Centre (PHC)
level has reached to hysterical proportions.
An incentive based FP programme can understandably
create distortions. In North Arc cJt' 20,000 government
employees signed a pledge to observe 1985 as a 'childless
year'. They pledged to register one lakh sterilisations'in
1984-85, doubling the number of operations from the previous
year
(The Hindu, Sept. 25,1984). The Punjab government
introduced a raffle for a lakh of rupees as well as the
slogan 'Get sterilised and win'
(Indian Express,Jan. 1,1985).
Laparoscopes and their accesories have been exempted from
customs duty 'in view of the growing popularity (sic) of
laparoscopic sterilisation among women1
During 1983-84,
80% of those sterilised were women (Hindustan Times,
Nov.25,1984). There was also a proposal by Mr.Krishna Kumar,Ex
Minister of State for Family Welfare, to give income tax
concessions to private sector companies who offered to set
up PHCs and who showed significant results in the FW
programme (The Times of India, June 26,1986).
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The ridiculous emphasis on. incentives not
surprisingly has also led to malpractice., A Bangalore
based doctor teas arrested in 1985 for issuing bogus
sterilisation certificates to 220 employees <5f the New
Government Electric Factory (NGEF). The cash incentives
offered by the NGEF for vasectomies was P.s.1700 per
person (Deccan Herald, Jan.12,1985). Dr.Khandwala,
General Secretary of the Indian Association of Gynaecolo
gical En'd^copists criticised surgeons in mass
sterilisation camps and doubted as to how they could
perform 300-500 laparoscopies in a single day when the
maximum possible was only 50 (The Daily, Dec.1,1984).
The depressing results of such callous operations is only
too well known through the.case of the eighteen deaths
in the Solapur PHC following laparoscopic sterilisations
and similar such reports. The pressure of completing
targets can be seen through incredible figures of
acceptors shooting up at-.yeac.. ending by 4.4 million
(only for the period of the mon£h'~o^~M3‘f57T7i t*J86) when
the average monthly figure of acceptors is 1.33 million
(The Daily, May 5,1986). The Copper-T fraud of the
Maharashtra Government is only too well known.
/tribals
Disincentives for motivators in the form of
humiliation, punishment transfers, delays in salaries
as well as promotion, and sexual harassment can reach
dangerous limits when motivators as single women, sometimes
sole financial supporters for their families and living
in alien villages cannot fulfil the prescribed targets.
In March 1986, Manda Padwal, a female health functionary
(an ANM) in the Talasari PHC of Thane district committed
suicide after a reprimand and order from the doctor in
charge to sterilise twenty/(Barse,1986). In November 1986,
thousands of primary school teachers from rural
Maharashtra gathered fdr two days in Nagpur and while
voicing other grievances clearly demanded for a withdrawal
of FP work (Date, 1986). Doctors attending the first
national conference on 'medico legal and social problems
in professional services associated with infertility and
fertility control' were critical of the government for
setting targets in the FP programme (TOI, Nov.10,1986) .
Hundreds of Haryana government employees are fighting
orddrs that force them' to arrange voluntary sterilisations.
The new monthly target for a woman worker in Haryana is
four vasectomies, twenty IUDs and forty nirodhs. For
males the target is four vasectomies and a hundred
nirodhs each (IE, Jan. 16,19r86")'."'jThe--protests are
numerous.
The government has introduced the concept of
Net Reproduction Rate Unity (NRR-1) in its Family
Welfare Programme 11
after considerable experience
in this regard (need to control population growth, the
country has set before itself the long term demographic
goal of achieving NRR unity by 2000 AD, with a birth rate
of 21.0, death rate of 9.0 (life expentancy at birth
beina 64.0 years) and infant mortality rate less than
6C5.O1” (GOI, 1985, p.164).
Implicit forms of coercion;
The official acceptance of NRR-1 by the
government is especially sinister because in lay persons'
terms it spells that only one daughter should replace her
mother. Whereas the concept of NRR-1, is explicitly
coercive, the implicit meaning is dangerous for women
especially. Female foeticide through sex determination r
sex selection is inbuilt in this strategy.
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The government makes no bones about the fact
that inspite of Dr.Karan Singh's lofty slogan of 'Development
is the Best Contraceptive' at Bucharest in 1984, population
control is seen as a substitute for development. Sarla
Grewal, che then Additional Secretary, Ministry of Health
and Family Welfare writes that "..... A reduction in human
fertility per se has to be regarded as an important component
of, if not an essential prerequisite f or, socio economic
development. To assume that socioeconomic development will
automatically bring about a reduction in fertility is perhaps
too optjmistic to hope. In any case, the country cannot
afford to wait for socio economic development to take its
course and show up its impact"(emphasis mine) (Grewal, 1984).
Against this background it is not surprising
thdt maternal and child health services, female literacy
and employment opportunity, or child-survival are seen by
the State as the means to reduce population. MCH and child
survival therefore get reduced to 'spacing methods' and
therefore most basic services such as ante, peri and post
natal care, immunisation or for that matter even primary
health care are covertly and overtly used as a screen to
achieve fertility control. The Centre in an attempt to
create the Neighbourhood Big Brother decided to finance the
raising of 1.5 million strong corps of women volunteers to
catalyse the FP programme at grass roots. The volunteers
would be mothers above 30 years of age with not more than
two children each and would themselves be acceptors of FP.
To achieve NRR-1 by 2000 AD, each woman would, in rural and
urban areas, monitor sixty families (TOI, June 4,1986).
Targets and Primary Health Care
The integration of FP with primary health care
has had an adverse effect on the utilisation of the latter.
A substantial majority of the rural population utilises the
private practitioner in times of illness and the major
reason for nonutilisation of government services is the
absurd emphasis of the latter on FP (FRCH, 1987). Women
still prefer to be delivered at home by traditional dais or
relatives one reason being that any contact with a woman in
peurperum is seized for FP. For the same reason, many
children stay without immunisations.
The overshadow of the population control
programme over all other essential public health services is
naturally resented and feared by the poor. With low access
to health services, the public health services are the only
ones that most people can really afford for utilise. Through
a worsening of access and utilisation to these essential
services, a double crime against the rural working class is
committed by those in power. Those sections who require
health care most and who have little choice in choosing health
care facilities are prevented from utilising basic he.alth
services that are in principle provided by the government for
the people. They are denied what is rightfully theirs.
It is angering that public health services,
especially maternal and child services are used as a bait
to lure people towards reducing population growth. K.K.
Pooviah, a member of the Central Council of Health and FW,
while writing about enforcing the two child norm, states
that the-fourth Pay Commission had suggested a discontinuance
of maternity benefits to employees after the second child.
It had also been suggested to the various ministries that
while selecting beneficiaries under the poverty alleviation
schemes, preference be given to those who accept the small
family norm. For instance, the agriculture ministry was
required to give FP acceptors preference in loans for buying
agricultural employment. In all schemes of employment only
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those who accepted the two child norm wore to get training
or jobs (Pooviah, 1986).
•Coercion and human relations?
The entire fabric <tf human relations is eroddd,
especially in rural areas due to motivational strategies.
Since health workers, petty bureaucrats and all government
employees are burdened with the completion of targets
throughout the year, most of their conversation with any
human being ends with FP motivation. It is not a rare
scene when motivators pay from their own meagre salaries
or honoraria to escort 'eligible' individuals to the PHC
and on some occasions there are fist fights among
motivators over potential cases (FRCH, 1937). Human
relations of motivators vis a vis the targets and amongst
motivators themselves are full of mutual mistrust and
contempt.
This hatred that the working class harbours for
their own kind helps the real oppressors to escape without
being questioned. To the rural masses the only visible
oppressors are helpless motivators such as Manda Padwal,
and it then becomes easy to forget that she too is a victim
of the entire design of a coercive population control
programme. This anger directed towards each other helps
the ruling classes through a divide and rule strategy.
Coercion thrives on the helplessness and the inability of
the unorganised oppressed sections to rebel and further it
breaks working class solidarity.
Choice versus coercion:
The concept of coercion is by definition based
on the concept of choice. It is implicitly understood that
if coercion as we understand it, is absent, then people
are free to choose what they want. It is therefore
necessary to discuss and debate whether choice in the form
that it exists today, allows for most people, even in the
absence of overt coercion, to make decisions regarding
‘their own lives.
The working class today have no choice except to
live in subeistance, they have no choice today to produce
those commodities which they need most, and neither do they
have the choice to decide in a socio economic vaccum as
to how many children they will have.
Working class women as a gender also suffer from
the unavailability of the above mentioned choices, but in
addition they have no choice regarding their own sexuality,
reproduction, child rearing and other family labour. For
instance, a woman does net have the choice to mother a
child outside of marriage and conversely, she does not have
the choice to stay childless within marriage. Her choice
is snatched«way from her at either end: infact within
marriage a woman's control over her own sexuality,is
markedly reduced.
Similarly, she does not have the choice to use or
not to use contraceptives or the type of contraceptive she
desires, nor does she universally have the choice to
undergo abortion. These decisions are often made through
the top down political structure.
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The concept of 'choice' as we understand today
Sherefore is a capitalist concept, where in a 1cafetaria
approach' one can 'choose' from amongst the available limited
options. These options are seen as commodities and not as
active decisions to be taken. Thus we have the choice of
birth control which really means that women choose the lesser
evil among the available contraceptives when the family or
the state decides that she must not have a child. The
tussle between the wage market and the family leave the
couple and especially the woman on a constant tight rope
walk about child bearing and on that shaky ground she makes
her 'choice' of pregnancy, contraception and abortion. In
the same context, with an enforced small family norm and in
a woman hating environment the woman 'chooses' to abort a
female foetus.
In the absence of the true freedom for the majority
of the people of the world to be able to make decisions
regarding their own lives, it is possible to narrow down the
horizon of choices in the very name of giving the right to
choose. Thus along with the freedom of child survival come
motivations to use spacing methods for birth control. In the
same manner, sex preselection replaces sex determination
techniques under the guise of giving a woman the ‘choice1
of pre-selecting the sex of her unborn child to 'avoid
bloodshed through the abortion that follows sex determination'.
In the absence of a thoughtful definition of choice, coercion
and choice do not as expected, stand poles apart from each
other, but ironically are separated from each other only by a
thin line.
*•*••*• ',*< A' **********
References:
1. Barse Sheela; The Afternoon Despatch and Courier,(A Report),
April 21, 1986.
2. Date vidyadhar; The Times of India (A Report), Nov.10,1986.
3 . The Foundation for Research in Community Healths NGOs in
Rural Health Care, Vol.II (under publication), Jesani
Amar, Gupte Manisha and Duggal Ravi, 1987.
4. Government of India; Ministry of Health and Family
Welfare, Annual Report, 1984-85 (1985).
5. Grewal Sarla; In ‘Population Policy in India1, Compiled
by Gandotra M.M. and Narayan Das, Population Research
Centre, Baroda, pp.3-7 (1984).
6 . Pooviah, K.K.: The Times of India, Dec.13,1986.
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