family planning under the emergency

Felrrr,y Pr,*NNrnc UNDER rua EuencsNcy

FAMILY PLANNINGUNDER

THE EMERGENCYPolicy Implications of Incentives anl Disincentives

VA PAI PANANDIKERR N BISHNOIO P SHARMA

under the auspices ofCentre for Policy Resear ch

and. Family Planning Foundation

nRADIANT PUBLISHERS

Copyrtght A) ff78 by Cente for Policy Research and FamilvP lanning Foundation

All rights reserved. No part of this book maybe reproduced or transmitted in any form orby any means, electronic or mechanical, includingphotocopying, recording or by any informationstorage and retrieval system, without permissionin writing from the Publishers.

First Published 1978 byRadiant PublishersE-155 Kalkaji, New Delhi-I10019

Printed in India by iDhawan Printing l orks26-4 Mayapuri, New Delhi-I10064

Contents

List of Appendices

List of Tables

List of Abbreviatio!s

Preface

I A Perspective

2 Our Research Problem

3 The New Policy Measures

4 Organization and Administration

5 The People-Their Atiitudes and Reactions

6 Overview and Policy Implications

Appendices

Index

vllixxi

xiiiI

t524

50

87

144

152

175

I,ist of Appendices

I List of Selected Units

2 Guide Points for Discussion with Officials

3 Selection of Acceptors and Non-Acceptors-SamplingDesign

4 Incentives Formulated by State Governments forPromoting FamilY Planning

5, Disincentives Formulated by State Governments forPromoting FamilY Planning

6 Composition of StateJevel Committees

7 Distribution of Respondents by Religion

8 Distribution of Respondents by Age Group

9 Distribution of Respondent Cultivators by the Size

of their Land Holdings

152

153

163

166

168

170

r72l'13

174

List of Tables

1.1 Percentage Distribution of Population of Develop-

ing Countries by Official Population Policies and

Programme, 1971

1.2 Selected Demographic Indicators by Country'

1970-75

3.1 Classification of New Policy Measures by the

Nature of Their ImPact

3.2 Break-up of Compensation Money for Sterilization

in Madhya Pradesh

5.1 Sample of Persons Selected

5.2 Distribution of Respondents by Level of Education

5.3 Percentage Distribution of Acceptors and Non-

AccePtors bY LrteracY GrouPs

5.4 Distribution of Respondents by Occupation

.5.5 Distribution of Respondents by Their Economic

Status

5.6 Percentage Distribution of Acceptors and .Non-

AccePtors bY Income GrouP

5.7 Distribution of Respondents by the Number of

Living Children

5.8 Distribution of Acceptors by Their Awareness ofFamily Planning Methods

5.9 Distribution of Non-Accepto$ by Their Awareness

of Family Planning Methods

l4

lo

43

88

90

91

92

94

95

96

99

102

Family Planning in India

5.10 Distribution of Respondents by Their primarySource of Awareness

5. i I Distribution of Acceptors by Methods of FamilyPlanning Adopted

5.12 Distribution of Acceptors by Reasons of Adoptionof Family Planning

5.13 Distribution of Acceptors by Their Primary Sourceof Motivation

5.14 Distribution of Non-Acceptors by Reasons of Non-adoption of Family Planning

5.15 Distribution of Acceptors by Their Knowledge ofNew Measures Being Taken by the Government forPromoting Family Plannin g

5.16 Distribution of Non-Acceptors by Their Knowledgeof New Measures Being Taken by the Governmenrfor Promoting Family Planning

5.17 Distribution of Respondents by Their Opinion onHigher Monetary Compensation for Sterilization

5.18 Distribution of Respondents by Their Opinion onthe Raising of the Age of Marriage

103

107

109

112

il6

122

130

136

138

List of Abbreviations

A.N. Auxiliary NurseA.N.M. Auxiliary Nurse l\{idwifeC.M.O. Chief Medical OfficerF.P. FamilY PlanningLU.D. Intra-uterine Device

K.A.P. Knowledge Attitude and PracticeL.H.V. Lady Health VisitorM.C. Medical CareM.C.H. Maternity and Child HealthM.P. Madhya PradeshM.T.P. Medical Termination of Pregnancy

P.H. Public HealthP.H.C. Primary Health CentreP.H.P. Pregnancy Health ProgrammeSte. SterilizationT.A. Travelling A,llowanceT.B. TuberculosisU.P. Uttar PradeshVol. Orgns. Voluntary Organisations

Preface

It is a rare research experience specially in social sciences

where within the short span of a few months that the study is

completed, its findings become dated' This is p' ecisely what has

happened to our present study. When the Family Planning

Foundation suggested a study of the policy implications of the

incentives and disincentives of the New Population Policy inApril 1976, it looked too premature to undertake the study. Atthe time we moved to do the field work, the States were still inthe process of gearing themselves for the implementation of the

new policy package. We conducted our field studies in the

summer months of June-August 1976.

By thb time we completed the first draft of the study in early

March 1977 , just before the 1977 Lok Sabha Elections, the

political events had already overtaken the new populationpolicy. The virtual rejection of the new policy package and the

decision of the new Government to convert the Family Planning

into Family Welfare Programme and put the entire populationprogramme on a voluntary basis, made our conclusions a matter

of history. This was iirdeed an unusual experience and indicates

the extent to which the family planning programme had become

a political issue.We tried to undertake this study in only four States. These

four States were critical both politically and in terms of the

programme. When we bele-cted the four States we had not quite

realised how important these States rvould be to the future

political developments in India. We selected Uttar Pradesh,

Bihar, Madhya Pradesh and Punjab' In our classification the

xrv Family planning in India

first three States were relatively backward and the last Staterelatively progressive in the field of family planning.

Our field visits were conducted during the months of June,July and August 1976. Nature posed many a handicap to ourresearchers who had to weather difficult and scorchins temDera-ture in the plains ol northern lndia. Besides, *h.r, our .tudyproceeded into Punjab we ran into heavy weather, almostliterally. The floods virtually flooded out our study in theAmritsar District.

We faced several difficulties in the conduct of the study.There was an intense fear of the Government orevailine in

the country at that time, particularly with regard to fainilyplanning. This made many a respondent try to avoid meeting us,The non.acceptors among them feared that we might haul themup for sterilization. The acceptors felt that we might involvethem iu some further complications. It was some task to getthem round to talk to us and even then many of them did nottalk with us freely.

The fear psychosis was so widespread that it even made manyofthe officers talk evasively and cautiously.

We also noticed that most of the records on family planningwere not maintained properly. In many cases they wereincomplete, sometimes grossly incomplete, and in some casesinaccurate.

To add to our problems, the women in the rural areas,except in Punjab, were generally reluctant to talk to us. Thosein Bihar considered it taboo to talk on a subject like familyplanning to male investigators.

The occurrence of heavy floods in Amritsar district ofPunjab made it impossible for us to reach the villages in thatdistrict inspite of successive attempts to reach there in Augustand September 1976. Even in Amritsar city many localitieswere flooded and it was with considerable difficultv that wecould get some respondents.

As we look back, the study might provide a useful docu-mentation of the policy measures which were jmplemented inthe family planning field during 1976. lt is unlikely that suchpolicy measures will ever be undertaken again. From thatpoint of view this documentation wi.ll provide us some clues tothe kinds of issues which emerged in the implementation of

Preface

family planning programme. We did not, admittedly, visit

States when the heat of the family planning programme was at its

peak later in the winter of 19'76. Even so: we were able togather the mood of the people by the time we made our field

visits.There are obviously many limitations of a study which was

rushed through the way we did. Besides, as stated earlier, the

nation did not have enough experience with this policy to make

a very thorough assessment. Some of the limitations which are

in the study, apart from those of the authors', were inherent inthe situation.

We are very grateful to the Family Planning Foundation fortheir generous grant which made this study possible. In parti-cular, we are grateful to Prof J.C. Kavoori for his initiative and

support given to us for carrying out this study. We wouldalso like to express our deep gratitude to all the State Govem-

ments who provided us full cooperation and every assistance we

demanded of them.We record our appreciation of Sarvashri Y.L. Nangia,

Kamal Jit Kumar, Trimbak Rao and P.K. Yegneswaran whoprovided a great deal of staffsupport at various stages in the

completion of this studY.

the

Centre for Policy ResearchNew DelhiJuly 1978

VA Pai PanandikerRN BishnoiOP Sharma

Cseprrn I

A Perspective.

Never before in the history of the world has the populationincrease been at such a high rate as in tle present half of thetwentieth century. There is a wide consensus of opinion that thecurrent level ofgrowth cannot be sustained for long withoutserious detriment to the welfare ofthe people. The growth ofthe world population which, on an average, had been 0.5 percent per annum in the nineteenth century increased to 0.8 percent in the first half of this century and further rose to analarming 1.9 per cent per annum during the period l95l to1975. As of mid-year 1975, the world population stood atabout 4 billion and at the current rate of growth is expected torise to about 6.5 billion by the turn of the century.This has, for good reasons, caused considerable alarm and

more so in many of the developing countries where the bulk ofthe world population is located and the growth of the economyis relatively inadequate to support such population growth.There has, therefore, been a growing realization in thesecountries that econonic development cannot make muchheadway unless the population is more effectively planned. Fora long time, however, it was believed that not much could bedone to stem a high growth of population in these countrieseven if it was desirable to do so. Many people felt that a highdegree of economic and social development must be awaitedwhich will automatically lead to a fall in the birth rate.

In the last few years, since after 1971 generally, there hasbeen a marked change in this attitude. A growing body ofpublic opinion has been arguing that for economic, social and


environmental reasons, governments must not regard thepopulation question as outside their concern and that theymust adopt a population policy. Several factors have bean res-ponsible for bringing about this change ofperspective. First ofall, there is the realization that parents, especially the motherswho have to bear the brunt of rearing children, want smallfamilies. Secondly, there has been an advancement in cheap,effective and acceptable contraceptive technology. And last,but not the least, the easy and ready availability of variousbirth control methods, including facilities for legalised abortionin several countries, have created an atmosphere conducive tofamily planning and birth control.

Nevertheless, the governments of all the developingcountries have not yet adopted a national population policy.While a large number of them have launched a full-fledgednational programme for curbing the growth of population as a

part of their national policy, there are some which are stillvacillating on the issue. A third group has adopted a middlecourse. They have accepted the need to curi-r the growth ofpopulation but prefer to do so by encouraging and assistingprivateiy sponsored programmes. Even where populationcontrol has been adopted as a national policy, it has notushered in a revolutionary change or brought about a radicaldeparture from the previous position. Such a decision has

generally been a culmination of a long-drawn process duringwhich family planning evolved from a small to a large prog-ramme with the support of the government. The adoption of anational population policy or the absence of it, therefore,represents essentially the degree of emphasis in the realizationof the problem of a high growth rate of population. Measureshave generally been taken to resolve the problem in accordancewith the degree of this realization.

Developing countries can be divided into three categories onthe .basis of the status population policy and family planningobtain there. These categories are as follows:

a) Countries which have adopted a national population policy:.rid an official family planning programme.

b) Cor.rntries which. have not adopted such a policy but inwhich the government gives material and technical assistance

A Perspective

to privately sponsored family planning programme.c) Countries which do not have official population policy

do not give support to fanily planning activities,and

More often than not the population policy adopted by adeveloping country was an antinatalist policy rather than acomprehensive population policy covering ai1 aspects ofhumanlife. This was because the more direct and immediate concernof these countries was to reduce the erolvth rate of theirpopulation and relieve its pressure on ih.i, economies. Theargumetrt seems to be that if this could be achieved, ihe resul-tant higher growth rate of the econorry and per capita incomewill in due course lead to a better standard of living of thepeople and improve their quality of life.

By 1971, 72 per cent of the population of developingcountries lived in countries which had adopted an antinatalistpolicy and were running an official family planning programme,9 per cent in countries which had not adopted any policy butsupported privately organised family planning activities, and19 percentin countries which had neither adopted a policynor lent any worthwhile support to family planning. Thetable on page 4 shows the position region-wise.

A comprehensive population policy is virtually the core ofsocial policy of a country and covers tbe whole gamut ofgovernment actions pertaining to human life. The areas towhich it relates range from the birth of children, their upbring-ing, education, employment, marriage, social security, etc., toindustrialisation, urbannisation, migration and even thedistribution of national income and wealth. Obviously, it isbeyondthe pale ofcompetence of any developing country tocoordinate and corelate action on such a rvide front in orderto bring about the desired demographic results. Therefore, theyhave to opt for a narrolver policy of regulating the birth ofchildren. Strictly speaking, this is only an antinatalist or lowfertility policy. However, this is what most of the developingcountries have generally adopted and seems to constitute theirpopulation policy.

Even in that sense there is nothing like a universal popula-tion policy applicable to tJl countries or even to all thedeveloping countries. It varies from country to cowttry and


Tlst,r 1.1

Prncrurlcp DtsrntsufloN oF PoPULATIoN op DpvrroplNcCouNrRIEs nv Orprclel Popur-lrrox Potrclrs lNo

Pnocne urs. 1971

Positiott All deve- Africa Lati,t East Rest ofIoPing America Asia Asia

counlries

Official antinatalist policyand family planning pro-grammeNo official policy butsupport to privately or-ganised farnily planningactivitiesNo official policy andlittle or no support tofamily planning activities 19.0 45.0 63.0 4.O 13.0

Source: Gavin Jolaes, Populqtion Grotth and Educational Planni S in Dew'loping NationE (New York, N.Y., 1975), p. 14.

has to be in corformity with the economic and social situationobtaining in a country. There are, however, certain measures

which have, by experience, proved to be effective in curbing thegrowth ofpopulation in many developing countries. These are

as foilows:

1) Spread of education among the populalion.2) Participation of women in gainful employment outside

the home.3) Abolition of or reduction in the economic value of

child labour.4) Reduction in infant mortality.5) Restraint on early marriage.6) Decline in traditionai religious beliefs which support

high fertility norms.7) Attenuation of the extended family.8) Adoption of social security measures like old age pension,

unemployment reiief, etc.

72.O 4t.0 4.0 96.0 86.0

9.0 i4.0 33.0 0.1 1.0

A Perspective

. 9) Provisicn of different birth contror methods as alterna-native choices and as close to the homes ofthe people as

possible.l0) Increase in the per capita income of the econcmically

weaker sections of societY.

This is by no means an erhaustive list' There are a number

of other measures which have been taken by the different coun-

tries to meet the exigencies of their situation. But the above, inour opinion, represent the largest common denominator- How-ever, not all the developing countries have adopted all these

measures. These have been adopted in varying numbers by the

different countries. There is also no evidence to suggest that these

measures have been adopted only as an integral part of itspopulation policy by any country. Almost invariably, only some

of these form part of the population policy, while some other

are being pursued as independent policy measures Besides, a

varying degree of emphasis is being placed on the di{ferent

measures by the different countries. Nevertheless, each ofthesemeasures has stood the test of time by proving its efficacy and

earned a world-wide recognition as a restraining influence on

the growth of poPulation.The most common form of the population policy adopted by

the developing countries in general and those in Asia in particu-

lar is the formulation of a time-bound plan for the reduction ofthe growth rate ofthe population. Quantitative targets are set

and are sought to be achieved through the operation c'f a

national family planning programme. The programme isorganised and run wholly or largely by the government. The

people are sought to be motivated mainly through the process

of extension education and in some cases also by the offer ofcertain incentives to those who accept the programme and

disincentives to those who do not. The larger social good and

welfare ofthe people are kept iri view both while formulatingthe plan and implementing the programme but are seldom

ilcorporated in the plan in the form. of direct, concrete schemes

or action programmes other than family planning. This is the

form and the setting in which the population policy is conceived

and operated by most developing countries aod in which our

own policy should be viewed.


Whether such a policy will achieve the desired goal is amatter of continuous debate among the social scientists and thepolicy makers. While the family planning programme isdesigned mainly to give immediate results, it is the broadersocial policy which will go a long way in shaping the future ofthe generations to come. Therefore, side by side with thefamily planning programme, whatever the constraints oftime and resources, efforts should be made to evolve a long-term policy in which there should be a proper synthesis of thedesired pattern of growth of the population and the social andeconomic development. Thus, a population policy, in a broadperspective, must include both a solution to the immediateproblem and a plan for the realization of the ultimate objective,i.e., the creation of a reasonable physical quality of life forevery citizen.

As shown in the table given above in this chapter, an over-whelming majority of the people of Asia reside in countrieswhich have adopted an official population policy and areoperating a national family planning progr:)mme. 96 per cent ofthe population ofEast Asian countries, in which India has alsobeen categorized, and 86 per cent of therestof Asia falls inthiscategory. It is, therefore, worthwhile to discuss the course ofaction being followed by some of these countries. A briefaccount of their activities is given below.

INpoNnste

Indonesia has adopted an official population policy. The mainaims of the policy are as follows:

1) To raise the standard of living ofthe people by decreasingthe birth-rate to a level where the increase in populationdoes not exceed their ability to step up the gross nationalproduct.

2) To improve the health and general welfare ofthe motler,the child, the family and the nation.

The policy is sought to be implemented through the practiceof family planning. The government runs an official familyplanning programme and provides the necessary funds,

A Perspeclive

accommodation, equipment and manpower for it' The

pr.tt*t*" f , propuguttd by the use of -extension

techniques

iu"t u, tr-r. creation of an as'areness of the irnportance of

i"*irt- pr""ti"g for welfare of the family among the people'

;;;ril;;;iopt familv planning in their own.and in the

nation's interest, ,.pu.,'o! of instructions on the use of the

nurior, -"tflods of - famil-y planning and provision of the

n...r.ury facilities for practising family planning' No compul-

.i* or-.o.r"ion of any kintl is used in implementing the

programme.

Mlr-eYsll

Malaysiahasformulatedapopulationpolicy.lviththeprincipal;tr;i;; of reducing tn" tititt rate through the practice of

f"tltfiv pf^i"*g. Tie aim is to reduce the growth rate of the

;;;i",";;;;"; about 3 per cent per annum prevailing in

1965 to 2 Per cent Per annum bY 1985'

fne family planning programme has been made an integral

part of the planning process since the introduction ofthe very

t.riri"" Y""i rtuo Jfttautuy'iacovering the period 1966-70'

Orr" of the salient features of the programme is that it is being

*.ri.a-oot in phases, beginning with large metropolitan areas

; il; t and graduaily extending it to rural areas.in phases

li, ill anC lV, with areas of high density of population being

taken first. Another notable ieature of the programme isthe

high degree of acceptance of thc oral pill as a contraceptive

rnirt"al In fact' oral pill has been the mainstay of the

;;;;;;;-.. upto Julv 1970 about 92 per cent of the total

iOOiOOO acceptors had accepted oral pills and only 4. per cent

had taken to sterilization, Z p" cent to intrauterine device'

and 2 per cent to conventional contraceptrves'

The Federation of Family Planning Associations of Malaysia

carries out the programme throughout the country' lt,aa"iua, large annual grants from the government as well as the

facility to use government clinics and health centres for

"p..Jl"g the famiiy planning programme' The Federation as

tilt u, lts constituent units follow closely the government's

policy and instructions on family planning'


Parrsr.rN

. lu*1tY planning activitr'es were started in pakistan rn 1953by the Family planning Association "f

p"tirt.r," " voluntaryorganization. The Association initially op.nud ,orn.

"linics andbegan with some publicity and educarionat work,-mainly in theurban areas, with a view to propagate the idea ofand the needfor family planning. The Governmeot

"f p"tiriuo itso .eutizingtheimportance of famirypranning, made u rJuiiprouirion ro, itin the First Five_year plan covering the perioJ isjj_oo. Ho*_ever, very little work was done during the early -vears of thePlan. It was only in 1959.60 ttrut tt" -Cou..nnient

O."lar.dfamily planning a national poiicy and d."id"J;o;;;;ch a com_prehensive family planning programme throughout the country.Late r, the progralnme was integiated with tfr"-S..onj f,l*-V*,Plan ( 1960.65) and the Government undertook to make it anofficial activity.

The aim ofthe national policy was to regulate and controlthe growth of population through voluntu.v iurrl"ip.liion of thepeople in _

famity planning. The basic id";*;, ih;;;e peopleshould voluntarily limit the size of their famities anJ space ttrebirth of children. The programme was administered throughthe existing health services by making f"ritt;;;;;a normalfunction of the government hospitals, airp.ninri"r'-""d ruralhealth clinics. Reatizing that flmity ph;;i;; ';;r'viral

toachieve economic viability, the Governme ni'asrigned u highpriority to the programmeand also incorporated it uiu r.prror"secticn in the Third Five-year ptan, tgdS_70.The programme has since gathered momentum. It aims atmaking planned, limited fani.lies a way of tife. Consequentty,

great emphasis is laid on educational and motivational work,particularly arnong the younger and lower-parity women.Ef:i1s a:leing made to popularize conv."tiooui.oni.uceprivesand the IUD among them. One ofthe metfrods teing used is tosupply conventiona.l contraceptives at the very Aoor-'step of tnepeople and to provide facirities lbr other forms oi

"ont."""pfionat all clinics.

PgrLrpprlrs

The Philippines has an offcial population poJicy. Its princi_

A Perspective 9

pal objective is to strike a balance between the famiry size andthe social and economic goals of the governnent. part of thepolicy is being implemented through tlre operation of the natio-nal family planning programme which aims at reducing thegrowth rate ofthe population. Thisis sought to be achieved byeducating and motivating people on the desirability of a smallfamily and by the advocacy of voluntary control of conception.The programme does not set any norms and even allows thecouptres to have the desired number of children but expects themto exercise restraint on having any more children.

A voluntary organisation called the Responsible ParenthoodCouncil plays an important part in promoting family planning.It utilizes the services of Christian missionaries and barrio schoolteachers for visiting all eligible families in the provinces, citiesand municipalities and propagating the cult of family planningamong them. The rnethod jt advocates generally is the rhythmmethod.

In addition to voluntarism, the Government of philippines isthinking in tenns ofintroducing a scheme of incentives and disin-centives for promoting family planning. In fact, the populationpolicy itselfl makes it possible to evolve such a schenre by provi-ding for an examination of the legal and adrrinistrative policiesand measures of the government with a v.iew to bring about aharmonious balance between the size of the family and the socialand economic goals set for the country.

SrNceponp

Family planning was initiated in Singapore in 1949 by theSingapore Family Planning Association, a voluntary organisa-tion. The Association used to offer all the recognised methodsof contraception, with a choice to the client to accepl any. C)neof the salient features of the Association's programme was thatit was not free but operated on a fee-for-service basis. Neverthe-less, it was quite popular.

In August 1965, Singapore dissolved its affiliation rvithMalaysia and became an independent nation. Soon after, the newGovernment announced a five-year national programme offamily planning. It also constituted a body called the SingapoieFamily Planning and Population Board. The Board was given

l0 FamilY Planning in India

full responsibility for implementing the five-year programme

as well as the responsibility for directing and coordinating all

family planning work in the country. In November 1968, the

functions of the Singapore Family Planning Association as a

voluntary family planning organisation were taken over by the

Family Planning and Population Board. Since then the Board

has been the sole body responsible for running the familyplanning programme in SingaPore.

The programme aims at reaching all the people in the repro-

ductive age-group. Inter-personal communication is the most

important method being flollowed in propagating the programme

and motivating the people. Special attention is given to women

attending the matemity and child health clinics and to mothers

Iying in bed in maternity hospitals. Family planning wolkers

contact expectant mothers both in the hospitals and at home and

give them direct personal advice on tbe need for family planning

and the availability of the service. Such advice is also given inpost-partum visits to individual homes. A public address system

regularly explains the benefits of family planning and as to

where the necessary information and services could be obtained.

Men's clinics and individual consultation facilities are also

available.Of all the developing countries, Singapore is one where the

national family planning proglamme has been the most success-

ful. The programme owes its success to a number of factors such

as an efficient administrative structure, high standards of mater-

nal and child health care programmes, a competent extension

and communication system and the responsiveness ofthe people.

In addition, certain changes in the social policy have given an

impetus to the programme. These include the cance'llation ofmatemity leave and defraying of hospital charges for the fourthand subsequent pregnancies and no discrimination against

married couples without children in the allocation of public

housing. Unlike other developing countries the question before

the government of Singapore is not whether the target set forreducing the growth rate of population will be achieved or not,

but what would follow after the programme is successfully

completed.

A Perspectirc

TAIWAN

A modest beginning was made in family planning in Taiwanin 1954 by the Family Planning Association of China. The mainactivities of the Association were publicity and education onfamily planning and popularising the use of traditional methodsof contraception. In 1959, family planning programme wasrnade an integral part ofthe matemal and child health servjcesof the Government. Later on, the programme was designatedas the 'Pregnancy Health Programme' (PHP). PHP clinics wereset up in all the Government general and maternity hospitalsand PHP workers appointed at township health stations. Themain functions of the PHP clinics were to render advice andguidance on family planning and provide the necessary services.The PHP workers would make home visits and conduct groupmeetings to educate and motivate women towards family plan-ning. The family planning services being provided, however,only related to the distribution of conventional contraceptivesand later on, from 1964 onwards, also included the insertion ofthe Lippe's loop.

Inspite of its moral support to and participation in the prog-ramme, the Government of Taiwan, horvever, did not declare aformal policy on population or family planning until 1969. Itwas only on l lth May 1969 that the Government announced itspopulation policy. The policy envisaged the limiting of thegrowth of population through the practice of family planningand for the first time legalised sterilization and therapeutic abor-tion under certain medical conditions. It also provided for theintroduction of population studies in the curriculum of schoolsand colleges. Consequartly, population dynamics and familyplanning are being taught in medical, nursing, health and alliedinstitutions in Taiwan. An important factor operating in favourof the policy is the high level of literacy prevalent in the country.E7.l per cent of themales and 64.4 per cent of the females above1 5 years of age are literate. This has helped in spreading cons-ciousness about the problem facing the country and the signifi-cance of family planning in meeting the challenge.

TIIIILANo

Until 1959 Thailand's official stance on population was pre-

ll

12 Familr Planning in India

dominantly pro-natalist. It was in 1959 that on the basis of aWorld Bank Report/the attention of the Thai Government was

drawn to the high growth rate of its populatio!. However,until 1962 no serious notice was taken ofthis issue. Seriousthought about population contlol appears to have begun inThailand with the holding of a National Population Seminar inBangkok in March 1963. The high growth rate of the popula-tion ofthe country which was about 3 per cent per annumand its implications were examined at length. Opinion was divi-ded among the participants of the Seminar on the desirabilityof introducing family planning in Thailand. Nevertheless, themajority agreed that a family planning pilot project should bestarted to investigate the response of the people to family plan-

nitg services. As a first step to the project a survey was con-ducted to obtain information useful to an action programme.

The main findings of the survey were as follows:

l) The size ofthe family considered ideal by the people was

3.8 children.2) About 72 per cent of women wanted to have no more

children but did not know how to prevent pregnancy.

3) Not even I per cent of the women had the vaguest ideaof birth control, but over'70 per cent wanted to learn theuse of contraceptive methods and practise family planning.

Towards the end of 1964 the pilot project was set up in Potha-ram district. It met with a very favourable response from thepeople. Starting from almost no contraceptive practice in the

district, the proportion of eligible women who adopted birthcontrol methods in the very first year of the project grew toabout 20 per cent. Being encouraged by this response, the pro-gramme was further strengthened in the district and gradually

extended to other parts ofthe country. The main features ofthe programme were that it was entirely voluntary. No notmswe re laid down with regard to the number of children. Each

couple could decide for itself at what stage they wanted tocommence practising family planning. A number of methods

were offered simultaneously as alternative choices, such as the

loop, the pill, the condom and the foam tablet.

A Perspective

It was not until March 7970 that the Government adopted anational policy on population control. The policy aims at redu-cing the birth rate through the propagation of family planningamong the people. Targets have been laid down but it is leftto the choice ofeach individual couple whether to adopt familyplanning ornot and what tnethod to use and at what stage. TheGovernment supplies all the information on the subject andmakes the necessary services available to the people. TheMaternal and Child Health Division of the Departnrent ofPublic Health runs the programrne.

The above account indicates that most ofthe developingcountries in South and South East Asia, in order to cope upwith the problem ofa large growth ofpopulation, have adopteda policy to reduce the growth rate through family planning.The programme of family planning is the mainstay of these poli-cies and is run largely or wholly by the governments themselvesor with a large support from the government by voluntaryorganisations ofstanding. The reduction in the growth rate issought to be achieved by voluntary participation of the peoplein family planning and no coercion or compulsion of any kindis used. Consequently, education and publicity are the principalmeans for propagating the programme and the provision ofa number of contraceptive methods simultaneously as alterna-tive choices the most common practice in making family plan-ing services available in these countries. By and large, this is thepattern which obtains throughout the region, including lndia-some temporary aberral ions notwithstanding.

Selected demographic indicators in respect ofthe above couu-tries for the quinquennium 1970-75, except for Taiwan forwhich the corresponding data is not available, are given in thefollowing table. Government of India's estimates for the quioq-uennium l97l-76 are also given below the table.

TJ

l4 Family Planning in India

Tlsrn 1.2

Srrnctno DEuocnapslc INntcarons lv CouNrnv, 1970-7 5

Name ofthe

Country

Populqtiotl Grottlh(Mid-year Rate

1975) 1970-',7 5(Percentage)

Crucle Life Expec-Death tancy 1970-Rate 75 (years)

t 970-7 5(per 1000)

CrudeBirthRate

1970-75(per 1000)

IndonesiaMalaysiaPakistanPhilippinesSingaporeThailandIndia

13,60,44,0001,20,91,0007,05,60,0004,M,37,000

22,48,0004,20,93,000

61,32,17,000

2.602.893.093.341.6 r3.272.43

42.93 8.747.443.821.243.439.9

16.9qq

16.510.55.1

10.8

15.7

47.559.449.858.469.5

58.049.5

Soarce.' Population Bulletin of the United Nations, No' 8, 1976, Data

Sheet.

GovERr.rltBNr oF INDIA Estlu,lrrs

Population* as

on 1.3.1976

Crude Birth Rate+1971-76 per 10C0

Crude Death Rate+1971-76 per i000

- 60,62,03,000

- 36.6

- 15.2

Growth Rate+197 r-76(Percentage) - 2.L4

Life Expectancy+197i-75 (Years) - 49.5

*Fanrily Welfare Programme Year Book, 1975-76' p. l7-+Draft Five-Year Plan 1978-83, Vol. lI, Page 34. The Draft Flan esti'

mates birth rate in 1978 at 33 per thousand and death rate at 13.3'

giving a growth rate ot 1'971'.

Cgeprsn Il

Our Research Problem

At the time of independence in 1947,India had a populationof 345 million people. At the end of 1977 Ihe population wasestimated at 629 million. This marks an increase or'284 millionor a rise a over 82 per cent in the population in 30 years.Never in the history of India has there been such a largeincrease as during the post-independence period. From a growthrate of 13.3 per cent in the decade 1941-50, it had risen to21.6 per cent in 1951-60 and further to 24.8 per cent in l96l-70.This steep rise in the growth rale has not only added largenumbers to our population but built a growth potential whicheven with a declining rate of growth has the capacity to generatea large population increase. Thus, even with a growth rate of2 per cent pet annum, which is stated to have been reachednow, as many as 12 million people are being added to the popu-lation per year.

The mechanism of the growth of population is such thatpercentages do not always present a correct picture. Forinstance, with a growth rate of2 48 per cent per annum in thelast decade, 196l-70, the average increase in the population wasof the order of 11 million persons per year, whereas a growthrute of 2.2 psr cent per annum in the last quinquennium, l97l-76, has been adding 12 million people to our population peryear. A decline in the growth rate does not necessarily mean afall in the net addition to the population. It is, therefore, moreappropriate to take into account the absolute numbers ratherthan percentage points in an analysis of the populationproblem.

16 Family Planning in India

Judgecl in the light of this interpretation, the growth of our

18 Fwnily Planning in lndia

74 at 1972-7 3 prices. The share ofthese 30 per cent, or 173rnillion people, in the total priva.te consumption in 19j3-74 wasestimated to have been 13.46 per cent, i.e., even less tban halfof their legitimate sirare in the national consumption expendi-tufe.

The above analysis shows that not only has the pace ofeconomic development been low but the gains of this develop-ment, however small, have been very unevenly spread. For theIowest 40 per cent of the population in the urban areas, povertyhasin fact deepened and for their counterparts in the ruralareas it has largely been stationary. A large proportion of thepopulation has to go without even the most essential necessitiesof life because the income in their case is too small relative totheir needs.

There are three main causes of poverty in India-(i) mder-development of the economy, (ii) inequality in the distributionof national income and wealth, and (iii) a large growth of thepopulation. Our efforts to neutralize these causes have so farbeen indadequate and to a certain extent unimaginative. Inspiteof the measures taken in the successive five-year plans toaccelerate the growth of the economy, the tempo of develop-ment has been slow and halting, land reforms and fiscalmeasures have failed to make any major impact on the reduc-tion of inequality in income and wealth and the family planningprogramme has not been able to check the high growth of thepopulation.

The combined effect has been to create a kind of a syndromeof poverty and large population growth: Experience has shownthat it is rather difficult to eradicate this malaise. Consequently,public policies have been under review from tjme to time with aview to reorient them in the light of the emerging situation andimpart a measure of new dynamism to their implementation forthe purpose of breaking this vicious combination of factorsmaking for poverty. One such review which was recently under-taken was that of the population policy.

The population problem of India is essentially that ofthephysical quality of life-how to make the people lead a better,fuller and richer life, a life that will enable them to have reasona-ble economic comforts, a certain measure of social security andsufficient leisure and means for the pursuit of cultural values.

Our Research Problem

The central theme and objective of planning have also been thesame but the low margin between the grorvth rate of theeconomy and that ofthe population has thwarted the nationfrom realising that objective. Instead, the nation has beenponcentrating on survival and has just been able to keep itshead above water.

On 17 April 1976 the Union Minister of Health and FamilyPlanning announced a new population policy for India to theParliament. The main features of this policy were (1) thedecision to raise the minimum legal age of marriage from I 5 to18 years for girls and from 18 to 2l years for boys, (2) increas-ing the amount of monetary compensation for sterilization to asubstantial amount both for male and female acceptors, (3)freezing of people's representation in the Lok Sabha and theState Legislatures on the basis of the 1971 census until 2001, (4)allocation of Central assistance to State Plans. devolution oftaxes and duties and sanction of grants-in-aid on the basis ofpopulation figures of l97l till the year 2001, (5) 8 per cent ofthe Central assistance to State Plans to be specifically earmark-ed against performance in family planning, and (6) the intro-duction of compulsory sterilization and specific measures ofincentive and disincentive to family planning to be left to thechoice of State Governments. lt was also envisaged in the newpolicy that it would be the responsibility of all the Ministriesand Departments of the Government of India as well as of theState Governments to take up as an integral part oftheir normalprogramme and budgets the motivation of the citizens towardsresponsible reproductive behaviour.

The principal thrust of the new population policy was togive a boost to the family planning programme and therebybring down the birth rate from an estimated 35 per thousandat the beginning of the Fifth Five Year Plan in 1974 to 25 petthousand at the end ofthe Sixth in 1984. It is also anticipatedthat if thjs can be brought about, the growth rate of populationwill come down from the present about 2 per cent per annumto 1.4 per cent by 1984,

We considered it worthwhile to study the policy implicationsof the various measures incorporated in the new package andto assess the nature of the effect they are likely to produce onthe different classes of people. With this aim in view it was

l9


decided to undertake a study ofthe new population policy, Thdspecific obiectives of the study were as follows:

l) To examine the contents of the new policy with a view tosee how far it serves as a viable population policy for thecountry, and more specifically the policy implications ofthe scheme of incentives and disincentives incorporatedin the new package.

2) To explore the thinking and motivation of the StateGovernments towards the new policy, including themeasures taken by them on their own initiative.

3) To assess the capability of the administration, includingthe family planning infrastructure, for putting the newmeasures through effectively.

4) To find out the understanding and attitude of the differentclasses of people towards the family planning programmein general and the new measures in particular and to assess

the nature of the effect these measures are likely to produceon them.

The preparatory work on the study was commenced in May1976. Four States were purposrvely selected for study, three ofthese were those where the family planning programme had notmade much headway and the fourth where it had been relativelysuccessful. In each State, twb districts were selected mainly onthe basis of their performance in family planning. One of thedistricts was to be comparatively good and the other poor. Otherfactors which were taken into account in selecting the districtswere their accessibility, size of population and location. Thedistricts which were difficult of access, thinly populated or situatedin a remote corner ofthe State were excluded from the selection.The latest available all-India data on districtwise performance infamily planningwas taken into account for selecting the districts.The selection was made on the basis of the compilation for theyear 1973-74.

In each selected district, one urban Family Planning Centreand one Prirnary Health Centre were selected for an intensiveobservation of the working ofthe programme at the ground:level. The selection of these centres was made in consultationwith District Family Planning Officers or Chief Medical Officers

Our Research Problem 2l

where District Family Planning Officers did not hold indepen-

dent charge and was based on their performance rating for the

latest year, the average being the criterion of selection.

Further down, three villages were selected from each Primary

Health Centre-one each from among those rated good, medium

and poor for their performance in family planning in the latest

year. In the urban areas one ward was selected from each Family

Welfare Planning Centre from among those rated average fortheir performance in the latest year. The selection was made in

consultation with the Medieal Officer-in'Charge of the Primary

Health Centre/the Family Welfare Planning Centre. The names

ofthe States, districts, family planning/primary health centres

and villages selected for the study are given in Appendix I'The study was conducted mainly through two processes-

discussion with the oflicials and non-ofrcials associated withthe working of the family planning programme and associated

. or likely to be associated with the implementation of the new

population policy at the State, district and local levels, and

interview of the acceptors and non-acceptors of the programme.

These methods were suitably supplemented by a personal

observation of the working of the programme in the field' The

discussion was held with the help of pre-planned guide points

appropriately <lrawn up for each level and keeping in view the

objectives ofthe study. The guide-points adopted for a discus-

sion with the officials are given in Appendix II.At the State ievel a discussion was held with the Secretary,

Department of Health and Family Planning and such other

officers as the Secretary considered necessary to call to the meet-

ing. The discussion. with him related mainly to policy matters'

For matters pertaining to the implementation of the familyplanning programme and the new population policy, a discus-

sion was held with the officers of the State Family Planning

Bureau. As certain items of the new policy fell in the jurisdic-

tion of other departments, such as introduction of population

studies in the educational system or administration of child

nutrition programmes, a discussion was held with the Directors

of Education and Social Welfare or their representatives or

special officers-in-charge of such programmes. In addition to

these officials, office bearers of such organisations as have been

working in the field of family planning and operating at the


State level, such as the Family Planning Association of Indiaand the Red Cross, were also contacted and a discussion heldwith them.

At the district level a discussion was held with the DistrictFamily Planning Officer, the District Health Officer and wherethey did not hold independent charge, with the Chief MedicalOftcer or Civil Surgeon also. Besides them, a discussion washeld with other officers of the District Fam ily planning Bureau.Attempts were also made to contact District Education Officer,District Social Welfare Offcer and the District planningOftcer at some places, but it was found that the measuresincorporated in the new population policy pertaining to theirrespective fields had not yet reached the district level. How-ever, voluntary organisations and statutory bodies whereveractive were contacted and a discussion held with their officebearers.

At the local level, a discussion was held with the medical andpara-medical staff executing the public health and family plan-ning programmes and with school teachers, Gran Sewaks,Patwaris, Sanitary Inspectors, etc. wherevex they were involvedin motivating or mobilizing people for the programme and wereavailable for discussion. Office bearers of local bodies andvoluntary organisations, taking an active part or otherwisesupporting the programme, were also approached and theirviews obtained. However, the major focus of attention at thelocal level was the person who had accepted the family planningprogramme as well as that who had been approached or other-wise informed of the programrae but had not adopted it. Fairlyintensive, but unstructured, interviews were held with suchpersons for eliciting both factual information about their familylife and views on family planning and the new population policy.The beneficiaries and non-beneficiaries ofthe programme wereselected for interview both from the urban and rural areas andin general constituted a proportion of about 28 urbanto 72rural respondents. Care was also taken to give a fair representa-tion to women in the sample through stratified random sampl-ing. Except in the rural areas of Bihar where no woman waswilling to be interviewed, a good number of them were inter-viewed in the other States as well as in the urban family plan-ning centres of Bihar.

Ow Researth Problem

The selection of respondents was further diversified by takinginto account their occupation. In the rural areas, abroadclassification of cultivators and non-cultivators was made forthe sample selection whereas in the urban a three-way classi-fication of shop-keepers and businessmen; servicemen andprofessionals; and others was adopted for the purpose. However,in the final sample that emerged marginal and small farmers,

medium and big cultivators, landless agricultural labourers,industrial workers, artisans, big, medium and small shopkeepersand servicemen were all represented. 'Ihe sample thus covered

a cross section of people and we made an attempt to collectfrom them as authentic an information as possible on theirknowledge, experience and views on family planning and aware-ness and understanding of the new population policy. A noteon the rnethod of sampling followed in the study is given inAppendix III.

Basically, the new policy was an extension of the principleof family planning, !'A small family is a happy family." It sought

to intensily the operation of this principle by a series of newmeasures. These measures are ofa diverse nature and relate todifferent fields such as education, social reform, public finance,etc. To these have been added a number of incentives anddisincentives formulated by the State Governments on their owninitiative.

The present study has tried to examine the various issues

involved in this effort. It has analysed first the new policymeasures with a view to assess their efficacy in promotingfamiiy planning. This is followed by an appraisal of the capabi-lity ofthe adninistration in delivering the goods. It has thenproceeded to find out how far the cherished principle of a smallfamily had percolated down to the lives of the people throughthe existing programme of family planning and finally toinvestigate to what extent and in what manner the new policyhad reached the people and influenced their,thinking,

Cseprrn III

The New Policy Measures

The measures incorporated in the new population policy can bebroadly divided into three categories: (l) those wliich are ofsocial import, (2) those which are ofan administrative nature,and (3) those which afect the individual citizens directly. Ofthe 16 measures enunciated in the new policy, half fallinthecategory of social programnes. The important ones amangthese are introduction of population studies in schools andcolleges, expanding and improving the quality of female educa-tion, associating voluntary organizations more closelv with thefamily planning programme, and providing group incentives topopular institutions like the Zilla parishads, the cooperativesocieties and the labour unions through their all_India levelorganizations.

The next largest category of measures relates to administra_tive action, including financial arrangements. The princioalones are freezing ofpeople's representation in the Loi Sabhaand the State Legislatures on the basis of l97l population until2001, allocation of financial assistance from the Centre to theStates, where population is a criterion, to be made as per 1971census figures tilt 2001, 8 per cent of Central assistance to StatePlans to be earmarked against performance in family planningand the cho.ice of introduction of compulsory sterilizalion andsuch other measures as would help promote family planning tobe left to the discretion of the State Governments.

The measures which are of direct applicability and conse_quence to the individual are, however, only two. One is theraising of the age of marriage to a minimum of l g years for

' The New PolicY Measures 25

girls and 21 years for boys and the other is the increase in

iloo.tuty compensation for sterilization, both male and female'

," nt. iio for person. with two living children or less' Rs' 100

for persons having three living children, and Rs 70 for persons

*ith fout or -oi. children' Besides the compensation to be

ouiA in cash to individual acceptors, these amouts include the

i"oloOitut. incurred on items such as medicines and dressing'

transport and diet.The above classification is, however, not exclusive' For

instance, the provision relating to the raising of the age of marri-

age is both a matter of social import and individual consequence'

Simltarty, the intensive use of mass media for motivation con-

stitutes toth social action and individual appeal' In making the

classification we have been guided by the consideration whether

u prtri."f* measure wili have an impact more on the social

ftuo. o. the individual plane and have classified it accordingly'

ih, r.u.urr, *hich neid only administrative action to get going

and do not involve setting in b process of any long-term social

change or effect have been placed in the category oI measures

oi Siut" import. This cldssification has been done mainly for

the convenience of analysis of the new policy' The table on

page 26 presents this classification'

Mresunrs rAKEN BY Stltn GovrnNusl'tts

In addition to the above measures, the State Governments

have introduced a number ofincentives and disincentives which

apply to public servants in all States and to private citizens in

some. These measures were taken by the States at their own

initiative and naturally differed from State to State' The posi-

tion in the four States selected for this study was as follows'

Comparative statements of incentives and disincentives formu'

lateiby the'State Governments are given in Appendix lV and

Appendix V'

Bihar

The Government of Bihar have introduced the following

measures:- f . ef f employees of the Department of Health and Family

Planning have been allotted targets separately for motivating

Family Planning in India26

als;EE,iF,fEii;se;;;F!I ;f3EgIEffFiSFg;;F:

giisffiffiEisF;€€:E!ii,; a.t .?r soo.i Y L

rr= =ts:: _bP

u'I !B tro & ! r-.9Y-d$.dE'3 EES*1g7 E E-r.o tr!t[iptiI €5:d

.=6 -^ ($ i t:FI H 3 E€F(,Y;,tr:g-i 6i

.EE Ef:i,E.g .E m,g :E=€; *€fEit€g e ;B*'i:;

=39 iE!;;E:f ;;t€,:-;s ;; E

s*Ei€€i g ;lf: FE5. ge:giEgfi ;$i FcsECgs;;si 6i ..i d ,.i \D r- od

sllq

r'i

't

F

E

L!

Ftr

!Q

pF

zF

ao ql

=a?#F:c)

z

zFO

!Q

The New PolicY Measures

eligible people for sterilization. Those employees who achievb

fro-m Z5-to iess than 100 per cent of the target will be censured;

those who acbieve between 50 and less lhan 75 per cent will

not be allowed to draw one increment; and those whose achieve-

ment is even less than 50 per cent will be discharged from

tttlloou teachers of Government primary, upper primary and

middte schools have been allotted a target of one motivation for

sterilization every two months or 6 in a year, failing which

departmental action witl be taken against the defaulters'

i. Similurly, all Panchayat ernployees (Panchayat Sewak)'

Village Level Workers (Jan Sewak), Circle employees (Halka

Karichari), Anchal Inspectors (Anchal Nireekshak), Extension

Officers (Piasar Paryavekshak) and Supply Inspecto-rs - (Apoorti

Nireekshak) have been allotted an annual target of 6 motiva-

tions each ior sterilization. In case of default in fulfilling the

target, departmental action will be taken'+. fn. n.ta staff of municipatties and notified area commi-

ttees etc. have been given a tatget of motivating at least one

eligible person per month for sterilization' Departmental action

will be taken against thosb not fulfilling the target'

5. All medical officers and health staff of the Zilla Parishads

will also be allotted appropriate targets for motivation for steri-

lization by the Chiei Medical Officer of the district concerned'

Failing thi fulfilment of the target, departmental aclion will be

taken against the defaulters.6. All other field staff of the

allotted a targ€t of one motivationzation, failing which departmental

Zilla Parishads have been

per month each for sterili'action will be taken against

'them.7. All Government and semi-Government employees will be

given transfer T A. for three living children only' -

8 All Government and semi-Government employees will be

entitled to reimbursement of medical expenses for treatment of

upto three living children onlY.

9. All eligible Government and semi-Government employees

will be entitled to reimbursement of educational fees for three

living children onlY.10. All such persons as have more than three children shall

be debarred from appointment to any Government and semi-


Government servic e.ll. All the selected candidates shall be required to sign

a declaration before appointment to any Government or sem!Government service that they will get themselves or their wivessterilized aftdr the birth of two childrea or otherwise stop anyfurrher child-birth.

_- 12. All public employees who fulfil the quota of motivations

allotted to them will be given a certjficate oi commendation anda medal. Those who achieve 50 per cent more of their quotawill be given a cash reward and the employees of the HealthDepartment who fulfil double their quot; will be given oneadvance increment.

13. Such Government and semi-Government servants whohave upto three children will get priority in:

(a) allotment of residential accommodation;(b) grant of house-building loan; and(c) sanction ofioan for the purchase of motor_car. scooter.

14. Such Government employees as have got themselves ortheir wives sterilized afrer two living children will get priority inthe allotment of motor-car, scooter, etc.

15. Such candi.dates as have got themselves or their wivessterilized after the birth of two chjldren shall be given priorityin appointment to Government or semi-Government service.

16. Such persons as have got themselves or their wivessterilized after two living children will get priority in allotmentof house-sites and house-building loans in the urban areas.

17. Such persons as have got themselves or their wives steri-lized after two living children will be given priority in the grantof loan from Government or semi-Government sources forestabJishitrg an industry or construction of buildings for suchindustry.

There are two important provisos to the above measures.These are as follorvs:

1. The aforesaid disincentives shall not apply to:

(a) Males above 45 years of age and females above 40 years. of age;

The New PolicY Mealsures 29

(b) Males less than 45 years of age who have got themselves

or their wives steri.lized;(c) Females less than 40 years ofage who have gotthem-

selves or their busbands sterilized;(d) Such couples as have not got a child born to them for at

least ten years before the above measures become

applicable.2. All the above measures shall apply only in case where

children are born henceforth and not to cases where three

or more children have already been born'

Madhya Pradeslt

The Director of Public Health and Family Planning, Govern-

ment of Madhya Pradesh, issued a circular in June 1976 infor-ming all Divisional Commissioners, District Collectors and

Heads of Departments of the Gove?nment's decision to intro-duce certain incentives and disincentives with regard to familyplanning. These measures applied only to Government servants

and employees of Government-aided institutions, local self-government bodies and public sector undertakings and establish'ments. The measures were as follows:

All such employees of the aforesaid organisations who are inthe reproductive age-group and have more than three children:

1. if they do not get themselves or theix wives/husbands

sterilized within six months, will lose their eligibility for theallotment of government residential accommodation, and ifthey already occupy government accommodation, will be

charged 50 per cent more than the present rent;2. if they do not get themselves or their wives/husbands

sterilized within one year, will lose their eligibility for house

rent allowance from the government in case they reside inprivatg houses;

3. if they do not get themselves or their wives/husbandssterilized, will not receive facilities of festival advance, foodadvance, loan for house-building, purchase of car, scooter, etc.and other advances and loans admissible from the administra-tion except the T.A. advance;

4. if they do not get themselves or their wives/husbands steri-lized, will not be entitled to convert their earned leave into cash

payment or to avail of honte travel concession;


5. if they do not get themselves or their wives/husbandssterilized, will be entitled to transfer T.A. for three childrenonly, but if they get sterilized, this facility will be available forall ch ildren;

6. if they get themselves or their wivesihusbands steriljzedwithin one year, will continue to receive reimbursement oftuition fees of their children as provided for in the rules. Other-wise, this facility will be available only for three children;

7. if they do not get themselves or their wives/husbandssterilized within six months, will not get their annual gradeincrement. Those who get sterilized within six months rvillget their grade increments from the due date but those whoget sterilized after six months will get the increment only fromthe first day of the month following the date of sterilization.

The circular explained that only such persons will be consi-dered to be in the reproductive age-group whose wives are inthe range of 15 to 45 years of age. For purposes of monitoringand record-keeping it has also been provided for that all sucheligible employees as have either already got themselves (ortheir wives/husbands) sterilized or get subsequently sterilizedwill be issued a certificate in lieu thereof by the contperenrauthority.

A special provision made by the Government of MadhyaPradesh relates to the enhancement of compensation money tobe paid for sterilization to the last category of acceptors, i.e.,those with four or more living children. A sum of Rs. 25 wasearmarked to be paid in cash to each such acceptor under theCentral Scheme. Subsequently, this amout was raised to Rs. 50 bythe Government of Madhya Pradesh. The extra amount sanc-tioned was stated to be an additional outlay by the StateGovernment from its own funds.

Uttar Pradesh

The Government of Uttar Pradesh also introduced a numberof incentives and disincentives for promoting family planning.These were as follows:

l. Farmers who come in the category oftaiget couples andopt for sterilization will be entitled to 50 per cent rebate intheir land revenue for a period of three years.

2. Families which have adopted family planning will be

The New policy Measures 31

givcn priority in maternity ald child health programmes and willbe issued identity cards to avail ofthese facilities. Such familieswill also be given priority over other families in the facilitiesgiven by other departments, other fabtors being the same.

3. For individuals in general (who are in the reproductiveage group and volunteer for sterilization) priority shall begiven in the allotment ofhouses and plots and grants of loans.

4. Whole-time family planning staff will be entitled to amotivation "bonus" of Rs 6 per case of sterilization motivatedby them in excess of their quota of 2 motivations for steriliza-tion per month per worker or 24 in

5. lfa person of the eligiblesterilization even after the birthnot be

a year.category does not undergoof the third child, he will

(a) given any loan,(b) granted a license for fire arms.(c) allowed the renewal of license for fire arms,(d) allotted a fair price shop,(e) allotted a house or plot,(f) entitled to free medical treatmedt at government hospitals,(g) given educational concessions and scholarships except

merit scholarships, and(h) granted facilities offered by the Harijan and Social Wel-

fare Department.

6. For government servants, if the number of children bornto them exceeded three after 1969 or exceeds 2 after a stipu_lated date inl977, the foliowing facilities will be withdrawnfrom them:

(a) free treatment in government hospitals,(b) all kinds of loans,(c) allottment of government accommodation,(d) allottment of houses under the Rent Control Act or those

built by the Housing Board or other simi.lar bodies,(e) facility of payment of rent for government accommoda-

tion at 10 per cent of salaries. In such cases, the rentcharged witl be at market rates.

(f) travelling allowance on transferformore than3l2 children,

32 FamilY Planning in India

(g) encashment of leave and all rewards and honoraria,(h) allotment of houses under the middle income group and

Life Insurance Corporation Schemes, and(i) maternity leave.

The instruclions on the subject also mention that similar pro-visions were being made for the employees of government

industrial undertakings, autonomous bodies, local self-govern-

ment bodies and government-aided institutions as were applicable to governnent servants. It is also provided for that grants-

in-aid to voluntary organizations for medical and health work willin future be linked with the fulfilment of family planning targetsallotted to them.

Punjab

Recognising the fact that family planning was vital to rapideconomic progress, the Government of Punjab introduced the

following incentives and disincentives. These were however,applicable only to government servants:

1. All loans and advances will in future be given by thegovernment only to those of its employees who liniit the number

of their children to two. Other government employees will be

allowed these loans and advances provided they (husband orwife) undergo vasectory or tubectomy and furnish a certifrcateto that effect, or if they guarantee the use ofother methods o[family planning so as not to have any more children born tothem.

2. Women employees will be granted maternity leave for thebirth of the first two children only. Leave entitlement will,however. be raised to five months.

3. A government employee shall not be allowed to drawtravelling allowance on transfer for more than two children,unless he or she (husband/wife) undergoes vasectomy or tubec-tomy or guarantees that he/she shall keep the number of his/herchildren limited to two, as on the date of transfer, with the helpof other family planning methods.

4. In respect of all such government employees to whomindividual targets for family planning work have been allottedby the government, the following criteria for disciplinary actionshall apply in case of non-achievement of the allotted targets:


(a) Performance up to 20 per cent of the allotted target:Termination of service or reversion to .the lowerpost, if the official concerned has a lien on such a post.

(b) Performance between 21 and 30 per cent of the target:Stoppage of two increments with cumulative effect.

(c) Performance between 3l and 50 per cent of the target:Stoppage of one increment with cumulative effect.

(d) Performance between 51 end 70 per c€nt of the target:Censure.

(e) Performance between 71 and90 per cent of the target:Warning.

5. Similarly, the following criteria shall apply for apprecia-tiol ofgood work done by the employees:

(a) Performance between 101 and 125 per cent of the target:Issue of a "Letter of Appreciation."

(b) Performance above 125 per cent of the target: Grant ofan "Award" keeping in view the performance of theemployee and the recomnendations of the Civil Surgeonconcerned.

Gnoup Incrsrrvrs

Besides the above measures which are applicable to indivi-duals, the State Governments thought of introducing groupincentives with a view to encourage local self-governing bodiesand other institutions like the cooperative societies and labourunions, which have a close and direct ccntact with the people,to take a more active interest and make a more earnest effortin promoting family planning. At the time of our visit 1o theselected States, only Uttar Pradesh had introduced some ofthese incentives. These consisted ofthe institution of an awardof Rs I lakh for the ZiIla Parishad adjudged to be the best inthe State in performance in lamily planning in a year, tenawards of Rs 25,00C each for the best Kshetra Sarniti in everyDivision and fifty-five awards of Rs 10,000 each for the bestGram Sabha in every District. These amounts were intendedfor being used by these bodies for creating public utility servicesof a capital-intensive nature like setting up of hospitals, con-

JJ

34 Family planning in India

struction of school buildings or water supply.Other States were also thinking in this directiontaken any concrete step until we visited them in1976.

schemes, etc.but had notJuly-August,

Mresunns oF SocrAL Iuponr

The schemes relating to raising the level of female education,improving the standard of nutrition of children. introducinepopulation studies at appropriate levels in schools anicolleges, associating voluntary organizations more closely withthe family planning programme and similar schemes areundoubtedly steps in the right direction. But in tbe implemen_tation of these nleasures, two things were particularly notice-able. First of all, there was no sense of urgency at any levelin implementing these measures. Except for framing some incen-tives-for Panchyayati Raj institutions in U.p. and preparing sometext.book lessons of an elementary nature on the -populationproblem in Madhya Pradesh, no concrete step had been takenso far in implementing any of these *rurur., in any State.

Secondly, there was a lack of commitment on the part ofgovernment officials towards implernenting these measures.This could be because there was nothing in their tradition ortraining to attune them to a process of solial change throughthe medium of education and persuasion. the bulk of thegovernment machinery seemed to regard these measures moreas talking points or an afable propaganda Iine than real reme_dies to the problem. This was reflected in their attitude ofnagging and procrastination towards, for instance, the childnutrition programme, the female literacy programme, the exten_sion education and mass contact programme, etc. with theresult that these programmes, which by their very nature are ofa long-gestation period, suffer all the more deiay in showingresults owing to an attitude ofindifference and negligence inimplementing t-hem by the bureaucracy. Similarly, tlie govern_ment officials showed considerable indiference, and sometimeseven hostility, towards the voluntary organizaiions engaged infamily planning work. This was reflected in their attempts towitbhold grants, delay supplies and prevaricate sanctions ofvarious kinds.

The New Policy Measures 35

Mresunrs oF INDTvTDUAL IMPoRT

Among the measures likely to have an individual import, theprovision relating to the payment of a higher amount of mone-tary compensation for sterilization had been put into effect inall the States at the time of our visit. ln fact, the only pro-gramme which had been released with a great deal of force inthe wake of the announcement ofthe new population policywas the sterilization progranrrne. Targets for the current year(197 6-77) were drawn up in the light of the new policy andquickly transmitted to the States. There was a great deal ofemphasis on their fulfilment and they were backed by a sub-stantially higher amount of monetary incentive to the acceptorstnd a sizeable amount of Cenlral assistance to State Plansbeing made contingent on their performaace in the field offamily planning.

The top leadership of the country extended its full support tothe new population policy as well as the specific programme setforth for the year in the light of this policy. The Prime Ministeraddressed a personal letter to all the Chief Ministers in thisregard. The Members of Parliament were advised to tour theirconstituencies and exhort the people to adopt family planningand help realize the targets set forth by the government. Afull-scale propaganda campaign was opened in support of bring-ing down the birth-rate as quickly as possible and, therefore,realizing the targets set for sterilization and other forms offamily planning. Although other forms of family planing werementioned, all the emphasis was laid on sterilization.

It was in this background that the States, being the imple-menting agency, received instructions or advice from the Cdrtreto launch a massive campaign fbr sterilization, In the thenprevailing state of emergency in the country, any adv.ice orinstruction given by the Centre was generally taken as a man-date by the States. These instructions were taken in the samelight and as if to prove their credentials to the Centre as beingcapable of carrying out the mandate, the States mounted amassive effort to sterilize as large a number of people aspossible. The States which were labelled backward in familyplanning on the basis of their past performance made all themore vigorous efforts in order to wipe out the stigma attached


to them. Therefore, they allowed a free hand to the adminstra-tion to scoop as large a number of people as possible andsterilize them. This is how U.P. and Madhya Pradesh exceededthe targets allotted to them in less tharr six months of the year(197 6-77) and Bihar was well on rhe way to performing thesame feat.

. This was possible by organising a large number of steriliza-tion camps and pressing into service the field staff of variousgovernment departments for bringing people to the campsunder the quota system or otherwise mobilizing them for lendinga helping hand to the government in its special efforts to pro-mote family planning. But all those who were brought to thecamps were not willing acceptors of the programme. A goodmany of them came because of official pressure ofvariouskinds-a threat of prosecution tothe shopkeepers, of delay inthe sanction of loans or grant ofsubsidy to the cultivators, ofdifficulty in the allotment of house-sites or surplus land to land-less agricultural labourers and so on. After being operatedupon these persons were handed over a cash award which theyaccepted in the spirit of 'hush' money. Those who were trulymotivated, in fact, needed no cash award. But even they accept-ed the money, but in a diflbrent spirit-in the spirit of a gift fromthe government. To a large extent, this has been the role ofthe monetaxy compensation for sterilization.

The provision relating to the raising ofthe age of marriagehas not been implemented in any part ofthe country yet. TheStates were looking to the Centre to enact a law on the subjector suitably amend the provisions of the Child MarriageRestraint Act of 1929.1 In theory, however, this is a goodmeasure. If fostering responsible parenthood is one of the aimsof the new policy, the marriages of girls and boys of lower agesthan stipulated should in no case be allowed. However, itsefficacy, like that of other measures, will depend on how it is.

implemented.

MEesunrs oF SrATE IMPoRT

The measures of State import incorporated in the new policy,such as freezing ofpeople's representation in the Central and

r This hls b:en done by the Gcvernment of InJia only in March 1978.

The New PolicY Measures 37

State legislatures and devolution oitaxes' duties and grants-in-

aid to State Governrnents on the basis of 1971 population tillthe year 2001 seemed to have had an impact on the States' Alack of perspective and/or effort in restraining population

growth on the part of some of the States like U.P. and Bihar

was unwittingly earning them a bonus in the form ollargerfinancial assistance from the Centre and increased representa-

tion in the Lok Sabha and the State Assemblies. On the other

hand, States like Maharashtra and Tamil Nadu, which were

doing very well in limiting population growth, were getting a

reduced representation and share. With the incorporation ofthe new provisions the imbalance belween effort and gain willno longer continue and a measure of stebility and firmness willhold good in the matter of allocation of legislative seats and

financial assistance among the different States.

The provision relating to 8 per celt of the Central assistance

to State Plans being contingent on the performance of the

States in the field of family planning has had a very salutary

effect on the States, particularly those which had a rather poor

record of performance in this field' On the formulation of this

provision, they had rather to sit up and think seriously how to

accelerate the pace of progress so as to, at least, achieve the

targets allotted to them by the Centre. This would not only save

them the loss of sizeable revenue from the Centre but also the

odium ofbeing called backward. The States which already had

a good record of performance felt all the more encouraged to

register a good achievement so as to win a larger share in the

Central assistance as well as earn the approbation of the Centre.

Although this measure has yet to show results in terms of the

assistance the various St.ates will get from the Centre, it has

already made a mark in shaking off the inertia of many of the

State Governments and mobilising them all for a much greater

effort than before.The provision allowing for full rebate in income-tax on all

amounts donated for family planning purposes to Government,

local bodips or registered voluntary organisations approved forthis purpose by the Central Ministry of Health is a measure ofminor significance. As it is, donations for family planning are

not very large nor do donors appear very much influenced by


the fact that their donations will be excluded from the assess_ment of income tax, Exemption from income tax did not seemto count much in their calculations. The provision is, therefore,only an innocuous one without any significant impact.

The other two provisions falling in this category, i.e., leavingthe introduction of compulsory sterrlization and such othermeasures as the State Governments considered necessary anddesirable for promoting family planning to the discretion of theState Governments, were only enabling provisions, not involv-int _uoy

action on the part of the Centre, but granting thefreedom to the States to do so. None of the States in oursample had, however, introduced compulsory sterilizationformally. U.P. and Punjab were reported to have made certainproposals in this regard to the Centre but the details of theseproposals were not known. All the four States have, however,introduced a series of other measures for promoting familyplanning. These measures were in the nature of inceniives anddisincentives and were directed towards public servants in allthe States and in a limited way to the general citizens in U.p.and Bihar. These measures are discussed State by State.

Bnnn GovrnnMrNr Msnsunrs

The Government ofBihar had allotted targets separately form,otivating eligible people for sterilization to different categoriesof employees of the Department of Health and Family plan_ning, teachers of Government primary and middle schools,employees of Panchayati Raj institutions and field statr ofmunicipal and notified area committees. It was provided for inthis measure that those employees who did not fulfil the quotaallotted to them would be liable to disciplinary action includingdischarge from service. This measure cast a gloom over alarge majority of the employees affected by this piovision. Theymade no secret of the fact that they were feeliag highly demora-lized on account of this measure. Not only had it placed themunder the Sword of Democles but also lowered their prestigegreatly in the eyes of the public who now regard them, forthe purpose of continuance in service, dependent on the good-will of the people to ofer themselves for sterilization.

The lower category of staff especially the primary school

The New PolicY Measures 39

teacher, vaccinator, auxiliary nurse-midwife, etc', felt parti-

cularly concerned as they wielded very little authority otherwiseto influence people to agree for sterilization. Cases came toour notice where more than one employee of the sane depart-

ment or office were canvassing the same person or group ofpersons for sterilization, thereby causing an unnecessary rivalryamong colleagues, and also whete a person motivated by ajunior employee was grabbed by his senior to be registered as a

case motivated by him.There were three measures which specifically applied to

prospective public employees. One stated that all such persons

who had more than three children shall be debarred fromappoinrment to any government or senri'gove rnment service.

This kind of a blanket ban caused serious practical problems,

For senior appointments, particularly on technical posts, bothin the government and semi-government organizations, naturally,such a ban was difficult to be applied. Persons of the requisitequalifications and experience cannot always be found among

the ranks ofthose who have restricted their families to three

children only. Secondly, if expertise was the criterion, h.ow

could it be correlated w.ith the fam:ly size of the candidates.The second measure stated that before appointment to any

government or semi-government service, all the selected candi-

dates will be required to sign a declaration that they will get

themselves or their wives sterilized after the birth of twochildren or otherwise stop any further child-birth. This measureallowed a wider choice of the family planning methods thanmerely sterilization and also indirectly cautioned a prospective

employee that the birth of more than two children to him willentail a breach of contract and may invite penalties. Thiscould have the effect generally of restraining the future publicemployees from having a family of more than two children.

The third measure applicable to prospective public employeesstated that such candidates as have got themselves or theirwives sterilized after the birth of two children shall be givenpreference in appointrnent to government or semi-governmentservice..This was a good measure, but the insistence on steri-lization had caused much resentment. It would have perhaps

been adequate if it was provided for that preference will be


given to those who have restricred the birth of children to twoonly.Of about seventeen measures of incentives and disincentivesframed and introduced by the Governm""i"isilr"r, only two

applied -to

the €eleral public and that too largely in the urbanareas. One of these measures stated that su& p"rsons as hauegot themselves or their wives sterirized afrer th'; rivl;; childrenwould get priority in allotment ofhouse-sites uod hourl-UuildingIoans in the urban areas. The other measure urJgn.A ,o"f,persons a priority in the grant of loan from gon.Lrn.o, o.semi-government sources for establishing un iniurtry o.

"oo_structing a building or buildings lor eslablishing an industry.These measures however sound, caused nuch adierse reactiondue to undue emphasis on sterilization.

^ There are also certain provisos to the aforesaid scheme. Oneof these stated that males above 45 years ofageanA females

over 40 shali not attract any of the disincentives incorporatedin this scheme. This proviso is perhaps based on the beliefthatmen above 45 and women above 40 had already completed theirreproductive span, and therefore, need not go in for or besubjected to any kind of birth control. This is tJchnically not acorlect basis.

Another proviso stated that such coriples as have not got a'child born to them for at least ten years before the aforesaidmeasures become operative shall be exempt from the applica-tion of any of the disincentives. This was considered an appro_priate measure for it did not unnecessarily insist on steriiizationor any other fornr of family planning from those who hadalready stopped child births for ten years or more.

Taking an overall view of the incentives and disincentivesintroduced by the Governntent of Bihar, it isseen thattheoverwhelming majority of them appliecl to public servants,inch'ding the prospective employees.

- Th. -.uuu*, applicable

to the general public were only two and that too only to certainspecified classes of people. These sections, both puOiic servantsand specified classes of general public, constituted only a sniallfraction of the total population. On a rough estimate, notmore than 10 per cent of the people, in terms of family units,were covered by the scheme. The rest of the population was noraffected by these lneasures in any manner.

The New Policy Measures 4l

Most of the public servants were educated and many of them'were self-motivated tov ards family planning and actually

practised it. Many of the private citizers residing in the urban

areas, particularly the educated ones' were also self-motivated

and practised family planning in some form or the other' In any

case. this was not the hard core of the population which needed

to be converted to family planning. The hard core consisted ofthe large masses of people living in the rural areas who wete

illiterate, poor, underemployed and largely ignorant both ofthe need for and practices of family planning. For this large

mass of people no incentives and disincentives were framed by

the government. Of all the States in India, Bihar is one ol the

most rural. 90 per cent of its population lives in the villages'

The scheme of incentives and disincentives formulated by the

Government of Bihar, which is largely urban- educated-oriented,

therefore, remained highly circumscribed in its appeal or

application.

MADHYA PnaopsH GovmrMENr MEASURES

The Government of Madhya Pradesh introduced a scheme

which was more a scheme of disincentives for there were hardly

any incentives therein. The scheme applied to employees oftheState Government, local self'governing bodies, public under-

takings in the State sector and institutions aided by the State

Government. There was no scheme for the general public or

private citizens. lt was provided for in the measures incorpo-

rafed in this scheme that such employees of the aforesaid

organisalions as are of the reproductive age and have more

than three children, unless they get themselves or their wivesi

husbands sterilized, *ill be denied facilities and conveniences

like the allotment of government residential accommodation;

house rent allowance if they reside in private houses; loans forhouse building, purchase of car, scooter, etc. transfer T'A' and

reimbursehmeni of tution fees for more than three children;

home travel concession and the annual grade increment.

Here. as in Bihar, the insistence was on sterilization' Apart

from the fear of the unknown whicb is common to all surgical

operations, there was an apprehension among a sizeable

section of people that vasectomy leads to impotency or at least

42 Familv Planning in India

causes a weakening of the. sexual urge and that tubectomycauses sickness of some kind or the o-ther and a weakening ofthe stamina of the woman. There was u g., ut d.; of- resistenceto sterilization among a large majority oi people and consiCer_able hostility to the measure among many. The sterilizalioncamps, and campaigns were being conducted in a manner as ifthese fears djd not exist and even if tfrey Oia, li"V Ola ,,o,matter. This kind of an approach led to many untoward inci_dents including violence in different pa.ts of ttre itate,

The Government of Madhya piadesh h"d ;i;; allouedtargels to certain categories of government servants. Thetargets were of two kinds_one for aclual sterilization operationor loop inserrion and the other for motivatlon fo. sierlfi"ation orloop insertion. The former ciass of targets were allotted to dis_trict level medical officers only such as ihe Civit Su*geons, trreAdditional Civil Surgeon and the District Healrh an"O FamilvPlanning

_Oflicer. The purpose of allotting th;r; t"rg;r^;;;;;involve these officers directly in professlonal medical workrather than leave them to exercise superv;sion alone.

The targefs for tnotivation werc allotted to specified cate_gories of employees of the public Health and fu_ity ftann;ngDepatment from the district level downwards uoJ

"".tuin otfr..categories of public servants such as the primarv School

Teacher and the patwari. While such ta.gets wer" liotred tothe employees of the public Health alnd nu*it/'irtunniogDepartment in previous years arso, the other depurtments'emproyees were involved in this kind of work duriig 1976_77for the first time. However, both the cut.gori., if puUfcservants showed considerable annoyan., *ilh this kind oftarget-setting. What irked them particularly was that if, theywere nct able to fulfil their quota, they would be proceededagainst departmentally for disciplinary action. Sinci motiva-lion was interpreted in terms ofactua

""r., tr""gl, for and

handed over for sterilizationed it wourd resurt in *.,".";;;::T,iffi:fi,.t1i;tff:T:;the employees and frustration in tire

'ottrei. iin.. t.i. o*ncareer was at stake, naturally all conceivable means would beadopted to fulfil their quora. This will oritt., U.looa fo, tfr"development of their career nor for rendering an unbiasedservice to the people,

'' The New Policv Measures

The Government of Madhya Pradesh had increased the

quantum of money to be paid for sterilization to the last cate'gory of acceptors, i.e., those who had four or more children.Under the Central Scheme a sum of Rs 70 was earmarked tobe spenl on an acceptor falling in this category. This amount

included the money payable to the acceptor directly as well as

the expenditure incurred on items such as drugs and dressing'

diet, transport, etc. On a bifurcation of this amount among the

several sub-heads, only a sum of Rs. 25 was left for direct cash

paynent to the acceptor. Later on, the Government of MadhyaPradesh added another Rs 25 to this sum and made it a total ofRs.50. The extra amount being spent on this item, it was

claimed, was met by the State Government from its own budget.The following table illustrates the point.

T.nsru 3.2

Bnr.tr-up oF CoMPENsATIoN MoNEY FoR STERILIzATIoN IN

Me.onve PR,lorsn(in rupees)

Perconswitlt 2 or Persons with 3 Persons v'ith 4 orItem less living children living children more living children

' Vasec- Tubec- Vasec' Tubec' Vasec' Tubectomy

tomi tomY tomY tomY tomY

43

Cash paymentm accepror

Drugs and DressingDietTransportMiscellaneous

Purposes Fund**

100l055

30

100IJ205

50105

5

5015

205

t<Jrs+ ,{ J rs*tA 15

< 'tns{

2510

Torer 70 70

* This amount is being additionally spent and met by the State

Government from its own budget.ri Expenditure on the following items will be met from this fund:

(l) Community awards, (2) Group Incentives, (3) Equipment, (4) Special

Campaigns.

1001001s0


It was felt by the State Government that Rs. 25 was too smallan amounl to enthuse anyone for sterilization. Moreover in theirview the persons with four or more livl'ng clildren constituted acategory more an:enable to accept sterilization than others. It,therefore, decided to raise the amount to Rs. 50 and to brinsthiscategoryonparwiththathavingthreechildren.

Urran Pnaorsg GovERNMENT MEesunEs

The Government of Uttar pradesh introduced a n umber ofincentives and disincentives. Sonie of them applied to the gene-ral public, including the government servants if they quuiifi.Afor them, and some to the government servants only. AmonEthe incentives, two were parricularly notable. One ,tut.d rhaifarmers ofthe eligible category who opt for sterilization will geta rebate of 50 per cent in their land revenue for a period ofthree years. Although the quantum of land revenue paid hy mar_ginal and small farmers was so small that a rebate of 50 per centwould not amount to more than a few rupees, yet this gesture didnot fail to attract the attention of the cultivators owing to theiremotional attachment to land and all interests and rights therein.Not so much in terms of money as an expression oigoodwill ofthe Government towards the farming community, this measureseemed to appeal and influence the thinking of the cultivators.However, the insistence on the part of the Government thatsterilization was the only methotl acceptable to it to allow thisconcession created strong controversy and hostility to themeasure.

The other incentive related to the payment of a motivation"bonus" of Rs. 6 per person motivated for sterilization by thewhole-time family planning staff in excess of their quota of twomotivations per month per worker or 24 in u y.ur. Th" bonrrsor incentive money was to be paid to such members of staf asexceeded their targets. While the feelings of ali government staffwho were allotted individual targets were hurt by being made todo a kind of contractual work. tlie work which supposedly im_pinged on their pride and prestige, this jncentive assuaged theirfeelings to some extent-at least in the sense th at it made themrealise that the government is not all for punitive action but alsohas a reward to offer to those who make a determined effort not

7 he New Policy Measures 45

only to fulfil but to exceed their quotas. In other words, likethose who fail to fulni their quotas attract some punishment,those who exceed then att'act some reward. It was, however,not clear as to why this incentive was being ofered only towhole-time employees of the Family Planning Department. Theprovision should have beea extended to all such public servantsas were allotted a quota for motivation for sterilization

Conceptually it was also a good measure that such familiesas have adopted family planning will be given priority in mater-nity and child health programmes and will be issued identitycards to avail of these facilities. Other things being common,such families will also be given priority over other families inthe facilities offered by other departments of the government.However, the implementation of this measure bristles withserious difficulties. It obviously suggests that those families whichhave adopted some form of family planning or the other willhave to register themselves with the primary health centre orthe urban family planning clinic. On an average, a primaryhealth centre citers to a population of one lakh persons or20,000 families, The population is scattered over a hundredvillages, many of which lie in the interior or far-flung areas notconnected by all-weather roads or regular public transport. Formost of the families residing in distant villages or for that matterin villages other than those on the peliphery of the PHC,even if they have adopted family planning, it will be quite sometask to reach the PHC either for registration or for availing ofany facilities ofered. Still more difficult, if not impossible, will bethe job for the PHC staffto verify the claims of such familiesthat they have really adopted lamily planning in a regular wayand to continue to oversee the position periodically. The so-called sub-centres were so ill-equipped both in respect of man-power and medical aid that to depend on them for the executionof this nreasure will amount to court failwe ab initio.

In the urban areas the position was none the better. Theurban family planning clinics were generally attached to Iargehospitals and depended on the clientele ofthe hospitals for theirwork. Very little independent work was done by thenr by way ofextension, motivation or follow-up action. They also covered alarge population, 50 000 each on an average, and the majorityof the lower strata of society, where the intensity of work really


lies, was either a floating population or resides in slum areaswhere the family planning staf generally did not visit. While itwas not difficult for such people to reach.the clinic to avail ofany facilities ofered, it was a difficutt task, fraught wrth risk insome cases, for the staf to verify the claims of such familiesthat they had adopted family planning and to continue to checkthis from time to time.

The U.P. Government did not insist on steri.lization in ap-plying certain disincentives to government servants. What waslaid down was simply that if the number of children born to agovernment servant exceeded three after 1969 or exceeded twoafter a stipulated date in 1977, facilities like allotment of govern-ment accommedation, different kinds of loans, free medicaltreatment, etc., will be withdrawn. The rationale of the conditionthat the number ofchildren born after 1969 should not exceedthree was difficult to understand. To apply this measure withretrospective effect and that too with reference to a period as farback as seven years was considered harsh

The disincentives being applied to the general public, however,made sterilization necessary. It is laid down that if a person ofthe reproductive age does not undergo sterilization even after thebirth of the third child, he will not be given any loan, allotted ahouse or plot or entitled to free medical ffeatment at govern-ment hospitals and dipensaries etc. There was a great deal ofhostility among the peopie against these measures. They feltaggrieved that they were being subjected to an unwarranted denialofeven their most basic rights such as the right to free medi-cal treatment at government hospitals, allotment of a plot ofland or grant ofa loan, including the crop ioan without whicha large majority of the small and marginal farmers could not doeven for a single season. They were also sore on the point thatsterilization was the only method prescribed by the Governmentto let people avail ofthese facilities. So strong was the reactionof the people against these disincentives that the governmentwas compelled to withdraw them in December 1976, i.e. inabout six moths of their announcement.

Tbe U. P. Government was allotted a target of 4 lakh sterili-zations for theyear 1916.77 by the Centre. The State Govern-ment increased it to l5 lakhs on its own and distributed themto three categories of departments-5 lakhs to the Department


of Health and Family planning. 5 lakhs to the Department ofEducation, and 5 lakhs to other departments excluding the policeand the judiciary.

The departments, in turn, allotted monthly quotas for moti_vation for sterilization to their field staff, p-uiding for certainpenalties for not fulfilling them and cirtain iicentives forex(eeding them. The employees of all the departments, who wereallotted a quota, were very unha"ppy with this kino of workhaving been assigned to them and felt apprehensive of some kindof disciplinary action being taken a_sainit them in the event oftheir not being able to fulfil their quota. Apparently, they werevery shaken and depressed and going aboui their

-work in amanner as if they were already awarded some kind of apunishment.

The field staff of the Department of Health and FamilyP.lanning were particularly agitated. In the first place, the quotaallotted to them was much higher than that allotied to the em-ployees of other departments. Secondly, the penal provisionswere so strictly enforced in their case that over 24,000 employe-es of the Department were not paid their salary for the monthof June 1976 for their failure to complete their quota for thequarter April-June 1976, Besides this, the State Government con-veyed its displeasure to the District Collectors and Chief MedicalOficers concerned. The demoralization was ,o g.."t in th"ranks of the employees of this department at thai time thatmany of them felt the need to resign their jobs. Only the wantof a: alternative livelihood restrained them from doing so. Theactions taken by the State Government had hurt their"pride andthey still nurse a feeling of deep grievance.

PuNlas GovBnllrrrrnr MeAsunBs

The Government of punjab had introduced a scbeme of incen-tives and disincentives which was applicable to Governmentservants only. There was no scheme for the general public. Anyscheme which applies only to a select class of peopie

-like thegovernment servants who are generally better informed, more

educated, largely urban and predisposed to family planning, andnot to the masses where the real problem lies, tenOs to besymboiic. At best, it can be said to be a pace_setter provided it

54 Farnily Planning in India

Planning Programme in the District. Both are independent ofeach other. The 'M.P. Model' has an advantage over the .Bihar

Model' in the sense that here functions haie been clearlydemarcated and assigned and an independent officer is in-chargeof family planning at the district level. This is, however, againstthe basic assumption that public health, medical care and familyplanning are inter.related and that best results are achievedwhen they are integrated.

Between the Punjab and the U.P. Models, the latter seemsto have an edge. The Punjab Modol provides for a number ofpersonnel to look after various components of the public health,medical care and family planning programmes. The largenumber of personnel raises the problem of coordination. TheU.P, Model provides for only three officials to look after publichealth, medical care and family planniug programmes. Thus,the C.M.O. of U.P. may not face the problems of coordinationto the degree which his counterpart in punjab may have to.Besides, the shortage ofqualified manporver also tilts the balancein favour of the U.P. Model.

As mefitioned above, the head of the family planning pro-gramme at the district level has a challenging role. In order toenable him to play his role effectively, it is desirable to providehim with necessary resources, both material and manpower.Whereas the districts of Punjab and U.P. are comparativelybetter equipped personnel-wise, there were lesser number ofsenior medical officers at the district level in Bihar and MadhyaPradesh.

UnsaNr AnEes

In the urban areas, urban family welfare planning centreshave been organized by the Government as well as by localbodies and voluntary organizations. The Government of Indiaprovides assistance to urban centres on an approved pattern tothe extent of meeting their full cost. The stafing pattern ofthese centres is based on the population which a Centre isrequired to serve.

A11 the eight urban centres which we visited in Bihar, M.P.,Punjab and U.P. were being run by the respective State Govern-ments. All these centres were attached to district or other

O r gani zati on and Administr at ion

UnnaN Feltlrv Wnpens Pr,e.rlxtltc CENTRE wITEe PoputlrroN BrrwnrN 25,000 ro 50,000

f,f

hospitals. The urban unit of Aruritsar was, however, making

referrals to District Family Planning Bureau and Government

Women's Hospital, Amritsar. These centres can be divided into

two categories on the basis of the population which they were

serving, viz. those serving a population between 25,000 and

50,000 and those serving 50,000 and above' The urban centres

of Hoshangabad, Datia, Ropar and Amritsar belonged to the

first category. The urban centres of Gaya, Dhanbad' Rampur

and Allahabad belonged to the second category' The prescribed

stamng pattern for these categories is as under:

Part-time Medical Officer(One male and one female)

F.P. Extension Educator (Male)F.P. Field Worker (Male)A.N.M.Attendant

UnnlN F.turrv Werrenn Pr.eNNtl'tc

HevrNc Popuretlots oF 50,000 AND

Full-time/Part-time Medical Offi cer(One mate and one female)

F.P. Extension Educator (Male)Lady Health VisitorF.P. Welfare Worker (Male)A,N,M.Attendan tSweeper (Part-time)

No. of postsz

CBllrnsABOVE

No. of postst

In order to cater to the needs of male and female population,provision has been made for one male and one female medical

officer at each urban family planning centre. However, the urban

centres of Dhanbad and Ropar did not have any medical officeron their rolls. Urban centres of Hoshangabad, Amritsar andRampur had one medical ofticer each on their rolls. Urbancentres of Gaya, Datia and Allahabad each had two medical

officers on their rolls. All the medical officers, however, were

female. The situation being as it is, it is doubtful whether a

56 Famly Planning in India

Medical Officer (Preferably female)Lady Health Visitor

female medical oficer can effectively cover the male population,and also whether male population can approach and discussfreely with female medical officers. It is, therefore, essentialthat for effective coverage of poupulation each urban centreshould have two medical officers in position, one male and onefemale.

Secondly, whereas an urban centre which covers a populationof 50,000 and above was provided with a Lady Health

^Visitor,

the urban centre which covers the population between 25,000and 50,000 has not been provided with a Lady Health Visitor.One possible justification for this could be that since the formercaters to the need of a large population its staff should be morethan that of the latter which covers a smaller population.However, this numerical justification does not *..- L Le soundand, in our opinion, adversely affects the performance of thelatter. Let us list briefly the functions of a Lady Health Visitor.A Lady Health Visitor is responsibie for providing familyplanning infornration and clinical and supply services to womenon selected days. On other days of the week she has towork in the field as community educator. She is also responsiblefor insertion of the I.U.D. She supervises and supDlements thework of the A.N.M. Thus, a lady healrh visiior plays animportant role in family planning work. This highlights theimportance of staffing each urban centre with a iadv HealthVisitor.

Since lst April 1976, a new pattern of staf was proposed tobe introduced at Urban Family Welfare planning Centres. Therevised pattern provides the following staff.

UnneN Fevrr,y WrrranE prlNNrnc CENTRE wrrg APopurerroN BErwrrr 25,000 to 50,000

F.p. Extension Educator/Lady Health visitor No' of posts

F.P. Field Worker (Male) IAuxiliary Nurse or Midwife I

Uns.aN FaruLy W runr PLANNTNG CENrnn HevrNcA PoPULATIoN oF 5O,OOO AND ABovE

No. of postsI1

Organization and Administration 57

Auxiliary Nurse or {idwife Z

F.P. Field Worker (Male) IStorekeeper-cum-Clerk 1

(N.B. An additional Medical Officer to be provided in the Centres

wbich function under the post-partum programme)

It was too early to have a feel of this change because at most

places the revised pattem of stamng had not reached' Many ofihe local authorities were not even aware of this change' We'

however, felt that this change was likely to affect the perform-

ance of the programme adversely. Taking first the category

which caters to a population between 25,000 and 50,000' the

revised pattern does not provide for any Medical Officer' In the

absence ofany doctor, we do not know how the centres are

going to function, who will check the eligibility of persons

iro"gnt for sterilization or for IUD or for that matter any other

famiiy planning method: who is going to perform operations and

in caie of any complications who is going to look after the

patients? In short, we cannot think of a clinic without a doctor'

if th. pu.por. of the Government was that these centres would

provide only referral services (this is also irrational) than that

should have been made clear. Perhaps the Government felt that

since the urban centres were generally attached to the nearby

hospitals functioning in the area, medical officers working there

wili look after the urban centres in addition to their normal

duties. If this was so, we are afraid it was rather impractical

because they alteady have sufficient work at their clinics which

keeps them busy. Thus, to expect these persons to do family

planning work in addition 1o their own duties seems to be too

much especially when no doctor is enthusiastic about doing

family planning work. It may, therefore, affect the performaace

of the programme both quantitatively and qualitatively'

Secondly, provision has been made either for a F'P' Extension

Educator or a l,.H.V. Instead of providing a choice between

these two. it would have been better if the Government had made

a provision for both of them' If there is no F'P' Extension

Eiucator, then who is going to look after extension education'

The shortcomings of extension education in the family planning

programme are well known and need not be emphasized' Ifixtension education is properly carried out, then we will not

have to offer inducements or resolt to coercion in family planning'


It is, however, not to suggest that a L.H.V. has no useful role toplay or when the question of a choice comes she should bedropped. A L.H.V. has an important role to play whicn a F.p.Extension Educator, or for that nratter an! other field staff,cannot play. It would have been better if ihe revised patternhad made a separate provision for a L_H.V. for each clinic.This would have gone a long way in providing an efficient andeffective service to the clients.

Some significant changes have also been made in the staffingpattern of that category ofurban centres which serve the popula-tion of 50,000 and above. Whereas earlier it had two MedicalOfficers (one male and one female), now it has only one MedicalOfficer, preferably a female. The absence of a male MedicalO^fiicer is-going to pose serious problems, such as, a heavy loadof work for the female medical officer and a neglect of the maleclients. Moreover, as the Government wants to-popularize malesterilization more than female, the uppointmeni of a femaleMedical Officer seems to be rather odd.

Secondly, the post of rnale F.p. Extension Etlucator has beenabolished. It is an established fact that urban people as com_pared to the rural are more easily amenabie ti accept newthings and are somewhat more easily motivated. This, however,does not mean that urban people do not need any type ofextension education which might help them in making up theirminds for acceptance or otherwis; of a new p.oiru--" o,policy. Unfortunately, from the recent changes maie Uy tneGovernment of India in the staffing pattern, it appears as ifthere is no need of educating the urban people

'about the

acceptance of the small family norm. Surely, there would havebeen no need for this, had orr.p.ogru--" been based not onpersuasion but compulsion. Since it is based on a persuasiveapproach and its educational and motivational aspect is one ofthe weakest parts of the programme, we feel that extensioneducation needs to be strengthened considerably. Thirdly,whereas earlier there was a provision for only oo" A.N.M., th"new pattern provides for two. This will make a good impacton the performance of the programme,

Since the problems faced by the field staff of the urbancentres are more or less the sarne as those faced by the fieldstatr of the PHCS, they have been discussed together ut u ,.purut"


place later in this chaPter.

Runer- Annas

In the rural areas of the districts, the family planning pro-

gramme has been integrated with public health and maternity

and child health programmes at the Primary Health Centre

(PHC). Generally, one PHC is located in each community

development block. The PHC has a number of sub-centres

which operate as the primary functional units' These sub'

centres have been organized on the basis of population cover-

age. Each sub-centre generally covers a population of about

10,000.The PHC is headed by a medical officer' Besides him, there

are one or two other doctors to assist him. In M.P', Punjab and

U.P.. the re are two doctors in each PHC-one is the Medical

Officer Incharge and the other the Second Medical Officer' InBihar, each PHC has three doctors. One is Medical Officer

Incharge and the other two are designated as Medical Officers'

In the rural areas, as stated above, the family planning

service has been made an integral part of public health and

MCH services. Hence, family planning units have been

attached to PHCs and additional staff have been sanctioned for

this purpose. The additional staff besides others includes one

medical officer. Thus, out of two or three' asthe case may be'

one medical officer is paid from the family planning budget'

However, no medical officer is exclusively reserved either for

family planning or public health or MCH service' All look

after these services jointlY'The rationale behind providing two medical ofrcers at each

PHC is understandable. First of all, the work relating to all the

three services, viz., public health, MCH ar:d family planning is

very heavy. Secondly, the area covered by each PHC is very

larie. Thirdly, in case of any emergency or otherwise if a

medical oficer has to proceed on leave, there is another doctor

to look after the work. And lastly. out of the two medical

officers, one ought to be a lady. This will enable the PHC to

cover satisfactorily both the male and the female population'

However, we are not in a position to appreciate the Bihar

Model which provides for three medical officers in each PHC'


It was explained by the authorities that three officers wereprovided for the three services but since all of them workedjointly for each service, this argument did not appear to us tobe very convincing.

Since a PHC covers the entire population in its area forfamily planning, it is desirable that it should have a ladymedical omcer to look after the female population. lndia stillbeing an orthodox and conservative society, especially in thenorthern parts like Bihar, M.p., and U.p., it is essential thatthese parts must have a lady medical officer with whom theconservative women can talk and discuss their problemsfreely. However, none of the pHCs which we visited in Bihar.M.P., Punjab and U.P. had a lady medical officer on its staf.

Before discussing field staff's position, problems etc. perhapsa few words about sub-centres may not be out of place. Thesub-centres of the PHCs are generally manned Uy e.N.U.s. Atthe peripheral level, they are not only health units but alsodepot holders. They take the message of family planning to theinterior areas hnd as mentioned earlier they generally cover apopulation of about 10,000.

In this connection, it may be mentioned that the workload ofthe A.N.M. i.e., to cover a population of about 10,000 is muchto.o heavy. It is not possible for her to discharge her respon-sibilities effectively and efficiently over such a large area. Theproblem of workload becomes particularly serious when viewedin the light of the facilities provided to the A.N.M. at thesubcentre. Since the buildings housing the sub-centres aregenerally located outside the village, ihe A.N.M.s do not feelsecure. They have generally to live there alone. Besides. thecondition ofthe buildings is hardly satisfactory. The buildingsof a few sub-centres, which we visited, were in such a conditionthat one cannot live safely in them. Thus the A.N.M.s areprovided with a place to live and work which is not only out-side the village but also not safe to live in. Besides this, forobvious reasons the A.N.M.s flnd it difficult to cover the malepopulation.

With regard to staffing of the sub-centres, we were informedthat there were two types of sub-centres in a pHC. Onecategory of sub-centres belong to MCH side and the other tofamily planning side. This distinction is made on the basis

O r gan i zal ion and Admini st r ation

whether expenditure of the sub-centre is met out of MCH fundsor family planning funds. Whereas the family planningprogramme provides for only one A.N.M. for each sub-centre,

the MCH programme provides for one A.N.M and one Dai foreach sub-centre.

In order to improve the performance of the family planningprogramme, especially in rural areas, it is essential that sub-centres should be strengthened. There is a good case to havetwo persons at each sub-centre. In addition to the A.N.M, theother person should preferably be a male. This will not onlyprovide security to the A.N.M but also help in covering themale population in a much more effective way. Immediatemeasures to improve the buildings ofthe sub-centres are alsonecessary. Moreover, while opening new sub-centres ofconstructing buildings of sub-centres, the Government shouldsee that they are within, or at least near, to villages.

FrEro Sr.lrp

The field staff occupy an important position in the implementa-tion of the family planning programme. The success of theprogramme depends upon the efforts put in by the staff ineducating the people. To a certain extent this also reflects theinter-state or even inter-district differences in the performance

of the programme.During our field work we tried to find out from the eligible

couples, whom we met, whether any family planning workerhad visited them and talked about fanily planning. Themajority of the persons stated that nobody from the familyplanning centres had ever contacted them.

Out of those persons who had been contacted by the fieldworkers, we tried to find out as to how many times they hadbeen contacted in a year. The frequency of home visits bytheworkers came to once or twice per year on an average.l

t This 6gure is calculated on the basis of our discussions with theeligible persons and the field workers. In mary cases, official figurescould not be relied upon because during our home visits we found ihatfield workers often failed t0 trace those persons who, as per theirstatement, had been contacted by them several times, Hence, the abovefigure was arrived at on the basis of visits confirmed by both theeligible persons and the field workers.

61


There are two main factors which are responsible for thelow level of contacts between the clients and the family plan-ning field workers. First of all, the worker-client ratio is notsatisfactory. For example, an urban centre which covers apopulation of 25,000 to 50,000, has a sanctioned strength ofthree persons to look after field work. Thus, one worker isresponsible for covering a minimum population ofg,333 to amaximum of 16,666. In an urban centre covering a populatiouof 50,000 and above, four persons ..are responsible for fieldwork. One worker has therefore to look after a minimumpopulation of 12,500. The situation is equally bad in the ruralareas. A primary health centrc covers a population of aboutone lakh and is responsible for public health, medical care andfamily planning altogether. It has normally a sanctioned staffof about 18 persons (about l0 for family planning and about8 for the other two services). It may, however, be mentionedthat the staff, other than family planning staf, have onlymarginal responsibilities for family planning. One worker ison an average responsible for about 10,000 poputation. Thus,the client-worker ratio is very low and makes it extremelydifficult for a worker to cover the entire population falling inhis charge.

Secondiy, the performance offield workers is generally notsatisfactory. All the concerned authorities at the state, districta"trd local levels invariably pointed out the problem of low workinput. Workers were working neither in the spirit nor to the

' extent it was expected of them. For a programme like familyplanning, the interaction between ciients and workers is crucial.The success of the programme is directly related to the eflective-ness of the workers' contacts with the clients. This leadustoinvestigate as to why the family planning field workers often failto fulfil their responsibilities.

Among the different government departments, health depart.,ment occupies, comparatively speaking, a low status. Andwithin rhe health department, family planning occupies thelowest position. Not only in governmental.bureaucracy but alsoin the society, family planning is not looked upon as a veryrespectable work. Thus, enjoying a low status, the familyplanning department with its emphasis on rural field work,makes itselfthe least desirable place for posting.


Secondly, the effOctiveness of the role performance is co-related wirh awareness of role-perception:

Awareness-+Motivation+Action

Almost all the field staff, whom we met, did not possess thenecessary background which could enable them to be aware oftheir role. Most ofthem had taken up their occupation becauseof economic necessity rather than by professional calling.2Besides, they were not suitable to work in the rural areas.Leaving aside some who had an exposure to rural life, the rest.were essentially used to life in urban areas. They were not ableto adjust themselves for living in rural areas. Everyone wastrying for his or her transfer to urban areas or a place nearthem. A substantial amount of time of the field workers wasthus being used for an unproductive activjty, nanely, seekinga transfer.

When the field staff do not possess the necessary backgroundwhich will enable them to be aware of their role and to work inthe rural areas, the training cannot help much, particularlywhen training is given for a short duration. All the fieldworkers at the urban centres and the PHCs which we visited,were trained in family planning work. The training had,however, not helped them in any meaningful way in carryingout their duties efficiently. In fact, while talking with the fieldstaffwe got an impression that none of them had taken up thetraining seriously. This is the reason why they were not able todistinguish between "Family Planning" and .,Family WelfarePlanning." What they meant by "Family Planning" was sterili-zation generally. If a person is not sterilized and is using, forinstance, condorus for the last three-four years aad did not haveany child during this period, still according to them rhisperson is a "Non-acceptor" of this family planning programme.Though we did not study the nature, contents, etc. of the

? We were surprised to learn from some female field staff thatinspite of the fact that they were unmarri€d they had to put on all themarks of a married woman. Otherwise women, especially rural, wouldnot take them seriously and would not like to listen about familyplanning programme from them. Thus, they were doing this becausethey did not want to lose their job-economic necessity and not theirinterest in the programme was the main motive force.


training being given to the field staff, yet it looks that thistraining does not necessarily prepare them to be aware oftheir role and motivate them lbr their work.

When the social ..background, job expectation and thetraining do not motivate the field worker to discharge hisduties effectively, then the higher level bureaucracy has to comeforward and take up the responsibility of inducing the workerto carry out his duties. The bureaucracy can induce workers towork either by providing necessary physical facilities or byproviding guidance and supervision or by introducing ascheme of incentives and disincentives. However, during ourdiscussions with ofrcials and workers at different levels, wefound thai very little effort had been made for a properorientation of the staff towards the programme.

The officers of District Family Planning Bureaus w€re requir-ed to make supervisory visits to urban and rural service units.Similarly, the officers of the PHCs were required to make suchvisits to sub-centres in their area. We found that these visits were

neither regular nor intensive. Those centres which were easilyaccessible or near the headquarters were visited most. Thepurpose ofl these visits was mainly to check accomplishments.

The visiting oflicials seldom tried to study and analyse problems

or ofer guidance to field staffwith regard to problems faced

by them in the implementation of the programme. During ourdiscussions the visiting ofrcials also gave us the impression thatthey were only interested in the fulfilment of the targets and didnot bother to resolve any local problems or difrculties.

With a view to review the progress of the programme and toremove bottlenecks, monthly meetings are required to be heldat district and PHC levels. Though in every district and at each

PHC, visited by us, these meetings were being held but discus-

sions were only confined to a review of achievements. Difficul-ties and problems faced by the field staff were not properlyattended to, Assignment of work to field staflwas being donewithout keeping in view the conditions prevailing in differentareas. In short, at these meetings, there was no two-way com-munication. This had created uneasiness in the mind of the fieldstaf.

Another way of motivating the field staff is to provide certainincentives and disincentives to them. The schemes of incentives

Organization and Adminisftation 65

and disincentives have however been introduced by the fourStates in our sample only after the announcement of the newpopulation policy by the Centre.s These schemes apply to allpublic servants, including those who were allotted individualtargets for motivation for sterilization and other forms of familyplanning. For such public servants incentives are few and farbetweeo and generally weak, whereas disincentives are morenumerous and hard. These kind of schemes are not going to be

very effective in motivating the field staff. In fact, these have

caused more demoralisation than inspiration among them. Oneway of making these schemes efiective is to incorporate measu-

res for opening further avenues of promotion for the stafl. Atpresent, the staff does not have any career mobility. If specific

schemes of career development are adopted as incentives to thefield staff, these will go a long way in motivating them towardsrendering an efficient and dedicated service.

Family planning programme administration, like other bran'ches of Indian administration, is no exception to the general

rule of political interference. During our discussions with offi-

cials at various levels, we were told about frequent politicalinterference in the programme, especially in relation to appoint-

ment, transfer and promotion of staff and disciplinary actionagainst them. In one ofthe states, a very senior ofrcial confes'sed that he was not in a position to devote much of his time tothe family planning programme as most of his time was being

taken up by the politicians who came to him with a "request"relating to someone's appointment or transfer or promotion orabout disciplinary action. This had resulted in appointing anumber of persons among the field staff of his department who

otherwise would not have been appointed. Since these persons

were not qualified but had political backing, they were not muchinterested in doing any work. Supervisory officials were findingit difficult to get work done by them. In fact, in some cases

where officials tried to take some disciplinary action against suchpersons, they were harassed by the politicians and made to ret-race their steps by their seniors. Very often, they themselves

0 The schemes of incentives and disinectives, as worked out by the State

Governments of Bihar, M.P., Punjab and U.P, have been discussed indetail in Chapter Il I.


were transferred from that place. Under such circumstances,most of the officials expressed their inability to take any correc-tive action against such staf.

URBAN-RURAL Drpnrnrxcrs

Because of the restrictions inrposed by the nature of the studywewerenot able to make an in-depth study ofthe organisa-tional structure of the urban and rural ciinics, but we did comeacross certain factors which highlighted the differences betweenthem. Urban areas are generally associated with all the charac-teristics which we call modern. Literacy, education, employ-ment and media of communication like radio and newspaperare all present in a larger rneasure in urban than in rural areas.All these characteristics of urbanism in turn make for a greateracceptance of the norms of small family.

Ifwe accept this thesis, we find that urban and rural familyplanning clinics face different problems and probably requiredifferent forms of organization to deal with them. The urbanclinics generally attract more acceptors simply because the urbanpeople as a class are not only densely populated but also bettereducated and betttr motivated. On the other hand, the ruralclinics are faced with the problem of dispersed populationwhich is also less educated and less inclined to accept thefamily planning programme. This means that to conracrand recruit the acceptors, the rural clinic would require anextension capacity much greater than that of the urban clinic.This in turn requires more technical competence in the fieldstaff and better organizational efforts to motivate the people.Rural ciinics therefore require additional incentives to recruitand retain the qualified and experienced staff as well as moreresources and better working conditions to utilize their services.

This highlights the usefulness of establishing different types ofclinics in urban and rural areas. We are, however, not sugges-ting that at present there are no differences between the two.Wbat we want to say is that the criteria which were kept inruind while developing the organizational sttucture of the twotypes have now become obsolete. In order to identify and meetthe needs of these rwo types it is desirable that some in-depthcomparative studies of urban and rural clinics be undertaken.


OnceuzartouAr- PATTERN

For administrative convenience, the Govemment has pres-

cribed a uniform pattern of staffing' While this system mighthave served the purpose of bureaucracy for sanctioning ofgrants, prescribirrg educational qualifications for the staff, etc.,

it has certainly not served the interests of the family planning

programme. This is because it is not possible to enforce uniformstandards all over the country which is known for its diversity.The rigidity of the staffing pattern has in fact affected the

performance of the programme in many areas. For example,

in U.P. there is an acute shortage of A.N.M.s. and as a result a

large number ofthe posts are lying vacant. Had there been no

rigidity, the U.P. Government would have made use of male

health workers who are available with them in good number.

Thus, the present rigidity of the staffing pattern needs a change.

While the Government of India may prescribe the staffing

pattern, there is a need to allow the State Governments to make

the necessary changes therein in the light of the local condi-

tions.

CoMMITTEES

The vigorous and effective implementation of the familyplanning programme calls for the setting up of governmental

machinery which will provide for adequate policy making.and administrative and financial control. For this purpose, a

number of committees have been set up at the state and districtlevels. These committees aim at reviewing the performance

of the programme, enlisting cooperation between offcials and

non-offcia1s; and, seeking co-ordination amongst government

departments; and, government departments and non-officialagencies. Their details are as under.

CABTNET Sun-Couurttrr

At the apex, there was a Cabinet Sub-Committee on FamilyPlanning in each of the four States, viz. Bihar, M.P., Punjab.and U.P. This Committee gave policy directions and reviewed

the progress ofthe programme periodically.


Whereas in M.P. it was headed by the Minister of PublicHealt} and Family Planning, in Bihar, Punj ab and U.P. it washeaded by the Chief Minister. The M.P. and Punjab Commit-tees consisted of 7 officials each and that of Bihar of 5. The U.P.Committee consisted of 6 ofticials and 5 non-officials as reportedby the State Family Planning Bureau. During 1974-75, theM.P. Committee did not meet at all and the Bihar and U.P.Committees met only once. In Punjab it was only in 197 5-76 thatthis Committee was constituted,

Femr,y PLANNTNG CouNcrr.iBoenn

The Family Planning Council/Board provides a forum foreffective communication amongst government departments andnon-officia(s associated with the programme. It also lays downbroad guidelines for the implementation of the programme.

Out ofthe four States, Punjab is the only State which hasnot constituted this Council. The M.P. Council consists of l0officials and 21 non-officials and is headed by the Minister ofPublic Health and Family Planning. The U.P. Council consistsof 23 officials and 15 non-officials and is headed by the Ministerof Health. The Bihar Council has a membership of 22 of whom6 are officials and 16 non-oficials. In M.P. and U.P. thisCouncil had not met at all during 1974-75, whereas in Bihar itmet only once,

SrArB-LrvsL Co-onorNlrroN Coulrlrrrrt

The State-level Co-ordination Committee aims at securingco-ordination amongst the various government departments andalso with the non-official agencies.

All the four States have set up this Committee. In M.p., it isheaded by the State Family Planning Officer, and in Bihar,Punjab and U.P. by the Chief Secretary. Whereas the M.p. andU.P. Committees consist of both officials and non-oficials (7officials and 5 non-officials in M.P., and 13 officials and I non-official in U.P.), the Punjab Committee consists of l4 officialsand that of Bihar of 12 officials only, During lg74-7 5,the M.P. Committee did not meet at all, the U.p. Committeemet twice and that of Bihar thrice. The puniab Committee

Organization and Adminislration 69

was constituted only in 1975-76.

Gnet.lrs Cotrltulrrrn

The State Grants Committee advises the government about

the disbursement of funds amongst voluntary and local bodies

engaged in the family planning work. It also advises about

undertaking ofnew schemes and starting ofnew centres of familyplanning.

Grants Committees were in existence in all the four States.

The M.P., Punjab and U.P. Grants Committees were headed by

their respective Health Secretary and that of Bihar by the

Director of Health Services. Whereas the M.P. and U.P. Grants

Committees consisted of 4 offcials each the Grants Committee

of Punjab cousists of 4-5 officials, and that of Bihar of 3 officials.

During 1974-75, tbe Grants Comrnittees of M.P. and Punjab met

once and those of U.P. and Bihar twice.In addition to these Committees, U.P., unlike other three

States, has a Publicity Co-ordination Committee comprising 20

officials and 5 non officials. It was headed by the HealthSecretary. This Committee reviews the work done with regard

to publicity of the family planning programme. During 1974-75,

it met only once.A statement on the composition of State-level Committees in

the four States is given in Appendix VI.At the district level, each district, which we visited in Bihar'

M.P., Punjab and U.P., had an Action/Implementation Commit-tee. It consisted of heads of development departments of the

government in the district. The Collector/Deputy Commissionerwas its Chairman and the Civil Surgeon/District Family Plan'ning Officer its Member-Secretary. This Committee co'ordina-tes, supervises and reviews all mattets pefraining to the imple-mentation of the family planning programme in the District.

In all the eight districts, visited by us, we found that thisCommittee was not functioning property' It was not meeting

regularly. Besides, attendance in its meetings was generally

poor. Ithas actually failed to serve the purpose for which itwas consttiuted.

In Punjab, a District Co-ordination Committee was also fun-ctioning in each district. The Deputy Commissioner was its


Chairman and the District Mass Education Officer (FamilyPlanning) its Convenor. Besides them, it consisted of represen-tatives of those official and non-official agencies which are fun-ctioning in the district in the fleld of mass education. Its mainfunction was to ensure that mass education activities concerningfamily planning are effectively carried out. Like the DistrictAction/Implementation Committee, this Committee was also notfunctioning properly. We did not find such a committee inBihar, M.P. and U.P.

In conformity with the directives of the Central Government,the State Governments had constituted these committees at theState and the district levels to help the implementation of theprogramme. However, during our discussions with officials andnon-officials in the States at various levels, we discovered thatthese Committees had not been functioning properly. Generally,these Committees did not oreet regularly or frequently, More-over, the attendance in their meetings was not satisfactory. Thisshows a lack of interest on the part of the members constitutingthese Committees

StArrsrrcer, SysrEu

For monitoring the progress ofthe programme each serviceunit keeps the records of various activities undertaken duringthe course of implementation of the programme. These recordsrange from the information on potential acceptors to the budgetand expenditure of the unit. Since it was not within our obje-ctives to look into the entire records ofthe service units, werestricted our enquiry to only those records which were directlyrelated to our study. These were as follows:

(a) Records pertaining to the potential acceptor.(b) Records of motivational activities of the field staff.(c) Records of services rendered by the clinic.

Rrcono PmrelttNc ro rnE PorENTrlr. Accspton

This record is maintained in respect of the persons who arein the reproductive age-group and are considered eligible forpractising family planning. Through surveys data is collected on

Organization and Administration 7l

the eligible couples and maintained in a register called "Target

Couple Register" at each sefiice unit' The quality of these

regi;ters and the extent to which they were kept upto date varied

from State to State. In Bihar, these registers were not only

generally incomplete with regard to the record of statistics but

io ro-. cases misleading. The position in the States of M'P' and

U.P. was bettor but by no means satisfactory' In all these three

States supervisory personnel were also not paying proper atten-

tion tothe maintenance of records. In Punjab, however, the

registers were generally complete and periodically updated'

Atthough the Central Government have specified the contents

ofthe "Target Couple Register," yet at certain places the speci-

fications laid down by the Centre were not being followed' lfproperly maintained, these registers can supply vital information

which can be helpful to the planners in identifyittg the weak

spots of the programme and the possible ways for improvement'

We feel that the "Target Couple Register" must, inter alia,

contain information on the socio'economic background oftheprospective acceptors, whether they already follow any method

and if so what and the reason and source of their motivation'

REcoRD oF MoTIVATIONAL AcrlvrrlEs oF THE FIELD STAFF

The main function of the field staf at the service units is the

motivation of eligible couples for family planning. For thispurpose, each field worker has been allotted an area in which

he/she has to cover all eligible couples not only at the pre-

acceptanqe stage but also at the acceptance and follow-up

stages.In most of the service units in Bihar, M.P., Punjab and U.P.

the records pertaining to motivational activities of the field staff

have not been maintained. At other units such records werekeptbut were not satisfactory. Although the field staff has the respon-

sibility to keep adiary of their work, yet we found that they

were not properly instructed by their superiors in this respect.

Many ofthem did not even know that they were required to keep

such a recotd. Thus, the responsibility for this state ofaflairsrested mainly with the officers incharge of the se ice units.

Acceptance and use of family planning methods depend on

the motivi,tion to regulate fertility. In order to assess these


motives and bring about the necessary changes therein a syste-matic effort has to be made by the field statr A record ofthese efforts is a valuable source of information about the know-ledge, attitude and practice of family planning among the eligi_ble couples, both acceptor and non-acceptor. lt i, heie that therecord of motivational activities of the fielcl staff assumes consi-derable importance.

Reconos oE Srnvlcrs RENDERED gy tuE Crturc

Each service unit is required to maintain a record of familvplanning methods serviced by it. On the basis of this recordservice statistics are consolidated and supplied to the higherlevels. This data gives an idea of the family planning methods,relative acceptance by the people and ofthe performance_targetratio. Consequently, this record receives a greater attention ofthe officers incharge of the service units and is more regularlymaintained than other records.

. Since the family planning programme is target_oriented, theimportance of this record need not be emphasised. With theatrnouncement ofthe new population policy the family planningprogramme has assumed considerable importance. The incen_tive of 8 per centof assistance offered by the Central Govern-ment to all those States which achieve their annual target haschanged the outlook of the State Governments ol Bihar, M.p.and U.P. In these States we noticed that there was a heavyconcentration of attention on the farnily planning programmeand the State Governments were lying a great emphasis onthe fulfilment of their targets. This .,mad', rush for achievingthe targets had led to a raanipulation of the records at a numberofservice centres. False cases of sterilization were registeredmany of which on verification were found to relate to personswho were non.existent. Cases a.lso came to our notice in whichfake certificates of sterilization had been issued.

Rrponrrlc

The family planning programme has a prescribed format forperiodical reporting to the Central Evaluation Unit of the

Organization and Administration IJ

Ministry of Health and Family Planning'a The reporls origina-

ting from the Primary Health Centres are consolidated at

.uJh high.t administrative level, i.e. the District and the State'

until they reach the Central Government. A number of reports

-monthly, quarterly and annual-are called for and consoli-

dated at itt. Stut" level by the State Family Planning Bureau in

all the States. Th€se reports usually are extracted from the

record kept at the service units and contain information on

various aspects of the programme. The data supplied by the ser-

vice units raises the problems of deliberate misreporting and

incomleteness. The Central Government has prescribed a mec-

hanism for improving the reliability and validity of the data' The

mechanism consists of spot checks and sample checking' With

regard to delayed and incomplete reporting, even salary disbur-

sements have been made contingent on tle complete and timely

submission of rePorts.Almost in all the centres we visited in Bihar, M P' and U'P'

we found that thg officers incharge of the programme were not

aware of the ntechanism for ensuring the reliability and validity

ofthe statistics. The position was better inPunjab where this

mechanism was more effectively used'

Ev.lLu.{rIoN

The importance of evaluation of family planning programme'

or for thai matter of any programme' needs hardly be emphasiz-

ed, but we ditl not find any effective system at the State level

for evaluating the reports collected from the service units in

any State in our sample except Punjab' It was only in Punjab

that these reports were first discussed every month in the

Directorate of Health and Family Planning, and subsequently

at the Secretariat level amongst the Secretary (Health & Family

Planning), the Regional Deputy Directors of Health and

Family Flanning, the Regional Director (Family Planning) of

the Government of India and the officers of the Directorate'

The purpose of these discussions was two-fold: to review the

progress and to chalk out the programme for the future'

4 For details see, India, Department of Family Planning, Manual ofFamily Planning Records and lRelartts (New Delhi, 1968)'


We have also noticed the problem posed by the proliferationofthe reports. This is one of the reasons for the non_submis_sion of reports in time. Moreover, preparation of these reportstakes a considerable amount of time of the staffwhich is at thecost of clinical and extension work. Since the service statisticssystem is primarily meant for the evaluation of the programme,it should not hinder the service efforts themselves. Further_more, not all the reports are analysed and used for the purposefor which they are called. There is, therefore, both scope andthe need for rationalizing the system.

Vor,uNreny OncrNrzArroNs

As discussed in Chapter I, voluntary family planning associa-tions have played a crucial role in initiating the family planningmovement in many developing countries. Voluntary organiza-tions in a country often begin their activities by offiring familyplanning services through private clinics. They also direct theirefforts towards creating a wider base of public support forfanily

_planning through a mass communication campaign.Gradually, they start lobbying the Governments to enact apolicy with regard to family planning. Thus, presence ofvoluntary organizations in a country is a positive foice for theadoption of a national family planning policy or programme.

While voluntary organizations were responiible for theinitiation or adoption of an official policy/programme on familyplanning and in facl welconed the government's acceDtance ofthe responsibility, with the passage of time they became uneasy,if not unhappy, about this development because of the unhelp_ful attitude, generally, of the government towards them. Inwhat follows we have made an attempt to examine briefly theexisting relationship between the government and the voluntaryorganizations in the States of Bihar, M.p., punjab and U.p.

Family Planning Association of India and the Red Cross arethe two main voluntary organizations which run family plan-ning clinics in many parts of India including Bihar, M.p., punjaband U.P. Besides, there are a few voluntary organizationswhich are of a local nature and either run family planningclinics or provide relerral services for family ptanning.Voluntary organizations' clinics have been made responsible for

Organization and Admtniitration '15

providing family planning services in the area undel theirjurisdicti,on. They have also been made responsible for educa- 'iional and .motivational work in their area' The State Govern-

ments allot them yearly targets for sterilization and IUDinsertion. It is worth examining how far these clinics have

been equipped for discharging successfully their responsibilities'

The- Government of India have a scheme of assisting

voluntary organizations' clinics. The scheme envisages grants-

in-aid for approved pattern of staff and free medical supplies'

Government grants are smaller than needed because with fullgrants there is a danger of taking away the sense ofparticipationif voluntary organisations and of inviting criticism for inade-

'quate coniol of what essentiaily would amount to a fullgovernment commitment.

The Government had prescribed a staffing paltern for the

clinics of voluntary organizalions on the basis of which each

ciinic was given grant-in-aid, but from lst April 1976 a new

pattern has been introduced by the Government for these

clinics. Under the revised pattern, a post of part-time female

Medical Officer, two posts of Extension Educalors, one post offemale Family Planning Field Worker and the post of the

Attendant have been abolished. Instead a post of Lady Health

Visitor and two posts of A.N.M.s. have been created'D

Whereas the old pattern provided for two Medical Officers'

one male and one female, the new pattern provides for only one

Medical Officer, preferably male. This change is going to affect

the performance ofthe clinics, because, firstly, the reduction in

the number of Medical Officers is bound to affect adversely

both the quantity and quality ofthe services being rendered to

the clients. Now one Medical Officer has to do the work which

Old Pattern1, Medical Officer (Male) I2. Medical Offcer (Female) I

(Part-time)3. Extension Educator (Male) I4. Extension Educator (Female) I5. F.P. Field Worker (Male) I6. F.P. Field Worker (Female) I7. Clerk-cum-StorekeePer I8. Attendant I

New Patlet1, Medical Officer

(Preferably male)2. Lady Health Visitor3. F.P. Field Worker (Male)4. A.N.Ms,5. Clerk-cum-StorekeePer

I

I1

2I


was being done earlier by two Medical Officers. Secondly, theeligible population comprises both males and females. In asociety like India's which is very traditional, consenative andorthodox, it is difficult, and in some parts impossible, for womento come out to discuss their problems and to get themselvessterilized by a male surgeon. Thus, this step would act as adisincentive to female clients.

Earlier, there were two Extension Educators, one male andone female, who were responsible for education and motivationofthe people in their jurisdiction. But under the ne\ry patternthere was no one to look after this part of the programme. Theproblem of education and motivation of the people is importantand becomes serious when viewed in the context of, first, ourprogramme being based on a persuasive approach, and second,that the educational and motivational part of tbe programmehas not been attended to regularly and sytematically so far.Moreover, at least part of the population covered so far by theprogramme was ..self-motivated', and needed only slightpersuasion. Henceforth, we have to contend largely with thehard core of the population which is quite resistant to andagainst the family planning programme. This section of thepopulation needs much more educational and motivationaleflort than the earlier one. This underlines the need for anintensive mass media programme. Thus, when there is a needfor strengthening the mass media efforts, the new pattern hasnot only not made any provision for it, but has reduced thestatr already provided for.

Some of the voluntary agencies which we visited also pointedout the problems faced by them on account of low pav scalesprescribed for the staff. These agencies were therefoi- not ableto recruit well qualified persons and if recruited, they were notable to retain them for long.6

6 For example, Matra Sadan, a voluntary organization doing familyplanning work in Jharia (District Dhanbad, Bihar) since t958, hasthe following pay scales prescribed by the Government for FamilvPlanning staff:

a) Medical Officerb) Lady Health Visirorc) F.P. Welfare Worker.r') Clerk-cum-Storekeeper

Rs. 350 p.m. (fixed)Rs. 250 p.m. (fixed)Rs. 135 p.m. (fixed)Rs. 150 p.m. (fixed)


Besides these difficulties, voluntary organizations' clinics

were facing serious problems with regard to the receipt ofgrants-in-aid and medical supplies' So far as the grants-in-aid

were concerned the situation was very disheartening in the

sense that the State Governments of Bihar, M.P. and U.P. were

not giving grants in time. Medical supplies were also not onlyirregurar but often insufficient. However, in Punj ab these

agencies were receiving a better deal than in the other three

States. The representatives of these agencies were of the

opinion that the attitude of the concerned State Governments

was not at all helpful. Grants were sometimes delayed for years.

In such circumstances, it becomes very dimcult for them tocarry on their work. On the other hand, the government feltthat these agencies were not doing good work. They did notsupply the necessary information and returns in time to enable

the Government to review their performance and take necessary

action for sanctioning the grants and supply of medicines, etc.

Unfortunately, this problem of non-cooperation has eropped

up because ofa misunderstanding ofthe role of the voluntaryagencies. During our discussions with government officials at

various levels, we found that they considered the voluntary

organisations as their competitors. Inspite ofthe announcement

of the New Population Policy which envisages a greater

involvement of the voluntary agencies in family planning work,

there has not.been any change in the attitude of the State

Governments. In none of the four States, the Governments had

drawn up or were seriously thinking of drawing up a strategy

to associate these agencies more intimately with the familyplanning programme.

The review of existing relationship between the government

and the voluntary agencies points out three factors that hamper

a harmonious relationship, viz., communication, coordinationand attitude. It is evident frorn the above review that there

was a lack of effective communication between the government

and the voluntary agencies. At the national level, communica-

tion was sought by the inclusion of representatives of voluntary

Everybody, inclutling the authorities of Matra Sadan and the CivilSurgeon, Dhanbad, felt that with these pay scales no one can afford to

live in Jharia town,


agencies in the Central Family Planning Council, which advisesthe Union Government on broad policy issues connected withfamily planning. The etrectiveness of this communication canbe gauged from the fact that this Council meets once a year.

The importance of communication at the lower levels,especially in a federal structure where considerable autonomyprevails at the provincial and local levels, needs hardly beemphasized. Although voluntary agencies are operatingmainly in urban areas yet wherever they were operating therewas no institutional arrangement to associate them with theformulation and implementation of the family planningprogramme. Efforts should, have been made to include themin the family planning committees and where such committeesdid not exist, by holding periodic meet.ings between theopposite numbers.

With the adoption of the offcial family planning programme,the role of voluntary organizations has changed. Though theyare continuing to co-exist with the government organizationsit is necessary to define their role in the context of increasedparticipation of the government in the programme. Thepossible changes that can occur in their role can be one or acombination of the following:

1. The voluntary organizations may carry on their usualactivities in areas where they have a base, without over-lapping or duplicating government-ron services;

2. Therc may be a division between governmental andvoluntary agencies' activities by demarcating areas ofwork and/or services to be carried out by each;

3. The voluntary agency may be allotted only certain typesof work to feed the government services;

4. The voluntary agency may fill, wherever it can, the inter-stices of the main programme run by the government;

5. The regular programae may be run entirely by thegovernment. The voluntary agency may undertake onlyselected items, such as running ,'model clinics" or impart-ing population education.

6. The voluntary organization may withdraw altogether.

Whatever be the future arrangement, it seems certain that

O r ganizat i on and Admini s t r ation '79

voluntary activities would only be small in volume as comparedwith government-run programme. These would be generallysupplementary and complementary to the national programme.Voluntary agencies should however be given a chance to decide,in consultation with the government, what they could do bestinstead of being made to accept the decisions of the governmentblindly. There should be a forum for joint consultation andcoordination of the activities of the two. With mutual consulta_tions, functions could be delineated between them. Some ofthe areas in which they can play an important part are publicityand propaganda, extension and community education, evaluationand social research and service demonstrations by organisingand running model clinics.

Attitude is the other factor responsible for the lack ofharmony between goverument and voluntary agencies. There isa marked difference between the professed and the .,felt,'attitudes, which creates misunderstanding between them. Forexample, voluntary agencies see the government as full ofredtape, requiring too much paper work especially where moneyis involved; wanting to take over the clinics which they havebuilt at the cost of years of effort; making the programmeimpersonal; aad providing services during government workinchours only.

On the other hand, government officials regard voluntaryagencies as the ones which demand action from officials whichis contrary to rules and regulations; possessive about theirclinics when reorganization is needed; wanting help withoutany strings; and, too informal about their working and book_keeping. Thoughthe role of voluntary organizations and thegovernment is complementary, the respective status of eachpartner has not been clearlv defined. The Government in theirattempt to implement the family planning programme havetried to involve the voluntary organizations as a partner, but inactual practice the latter have been assigned, over a period oftime, the role of an .'associate," i.e., a member of ,less thanequal status'. Thus, in a situation where one pa ner getsrelegated to a lower position and the other limits its role. bvand large, to finding loopholes in the modus operandi oftheformer, a mutually satisfying relationship is very difrcult tobuild up.

80 FamilY Planning in India

The problem of population control is a very difficult one

and the job ahead is very challenging. It is, therefore, necessary

that the combined eforts ofthe government and the voluntaryagencies be harnessed to a much greater extent than what theyare today. Voluntary agencies have, therefore, to play a greater

role. Fortunately, both the government and the voluntaryagencies have recognised this fact. But no concrete steps were

taken by the Government in enlisting the cooperation of the

voluntary agencies in a greater measure or reorganizing the

working ofthe clinics run by them in a fruitful manner.

EDUcATIoN ANo MortverloN

The basic assumption underlying the family planning

programme seems to be that individuals, on their own, willcontrol fertility provided the rationality ofdoing so is properly

communicated to them and/or they are offered a package ofincentives and disincentives to do so. This highlights the

importance of the role of communication in making individualsfavourably disposed to the idea of family planning and to the

acceptance of a method of family planning. In order to develop

a Javourable disposition on thepart ofpotential acceptors, the

family planning programme relies on a variety of interpersonal

and media presentations. Adoption of an innovation or new

practice follows the sequence of awareness, interest, evaluation,

trial and acceptance. While the media campaigns help in creat-

ing awareness and providing information, the interpersonal

communication involving family planning field workers friends,

relatives and community and religious leaders helps in provid-

ing a favourable evaluation prior to the trial and acceptance ola new practice. In India both media and interpersonal presenta-

tions are said to be used. In what follows we have made an

attempt to analyse how they are being actually used in the

States in our samPle'The media and interpersonal communication used to put

across the family planning programme include:

(a) Film Shows(b) Mass Meetings(c) Group Meetings

O r gani zat ion an d A dmini st r at ion

(d) Camps(e) Home Visits(/) Exhibitions(g) Posters(ft) Pamphlets/Folders(i) Puppet Shows

While the mass media have considerable potential forinfluencing the thinking of the people, it is diftcult to establisha direct correlation between the intensity of mass communica-tion and the performance in the field of family planning. Withregard to the working of the important components of thecommunication system we offer our comments as follows.

Auoro.vrsuel Mrrpnrel

The district bureaus of family planning were provided withthe necessary basic audio-visual material such as films, filmstrips, film projector, and audio-visual van. The districtbureaus were required to arrange film shows, etc. in the urbanand rural areas in their jurisdiction.

The position of films was very unsatisfactory in the sensethat there were only a few films available and that too were veryold. People had seen them several times and as such they didnot have the desired impact. There is need for well-producedfilms relating to family planning. The Government should alsoexplore the possibility of promoting the idea of family planningthrough regular commercial films. With regard to filmprojecror it may be mentioned that at most of the places it wasnot in a working condition over a number of months. The samewas the position of audio-visual vans. They were standing idleeither for want of repairs or for petrol. Besides. these vehiclescannot be used extensively in Bihar, M.P. and U.p. where manyof the villages are not connected with all-weather roads.

As regards the urban family planning centres and primaryHealth Centres the only equipment available with them werea few charts and n"odels ofthe reproductive system. They hadno other equipment and depended on the District Bureau forarranging any film show, slide show or any other mass show.Such shows organised by the District Bureau were few and far

8t


between particularly in the rural areas.

ExrrusroN Wonr

Mass and group meetings, home visits, exhibitions, posters

and pamphlets were the other methods reported to have been

used in both urban and rural areas to motivate people towardsfamily planning. However, no accuracy can be vouchsafed forany data on these activities as no systematic and correct recordwas maintained in respitt of them nor was there any check-up

or scrlrtiny of this data. Ii is, therefore, difficult to have even

an approximate idea ofthe amount of extension work beingdone b/ the family planning centres. Although it was claimedthat a good deal of such work was being organised, we foundit very much wanting when verified from the people whom we

met and interviewed during the course of our study both in theurban and the rural areas. This was mainly beqause the familyplanning field workers, generally were neither adequately

trained nor much interested in extension work for it involvedconsiderable touring in the interior areas or remote villages towhich they were averse. Moreover, the number of familyplanning field workers at the PHC and sub-centre levels was

grosly inadequate for the task assigned to and expected ofthem.

Virtually no family planning field worker had a clear concqrtion of his role as an extension agent. Almost invariably theyperceived it to be a job to "persuade" people to accept steriliza-tion. Inter-personal communication through home visits isrecognised as one of the most effective methods to persuadepeople to adopt family planning. But in the areas covered byour study, such visits, although stated to be quite numerous,were actually few and far between. Instead, summary methodswere generally employed to "induce" people either by the otrerofmoney or the use of coercion to go in for sterilization.Immediate steps should, therefore, be taken to reorient theentire field staff so as to improve their competence and instil abetter sense of service in them.

All officers whom we met at the various service centres andat the State and the district headquarters, were optimistic aboutthe efficacy of the mass publicity programme in creating a

Organization and Administration. 83-. .

favourable climate for family planning. They were, however,not satisfied with the way in which. it was being carried out.They wanted to intensify it but were not in a position to do sofor a number of reasons, the nost important being..the lack offinance. Everyone pointed out the inadequacy of funds for rna$spublicity purposes. We were told that a sum of Rs 3000 , only.was provided in the budget of a District Family PlanningBureau for publicity. This was hardly suficient; even tomaintain the equipment in a state of good repaiq. B"esides., this,no new posters, pamphlets and hand-bills had been issued, for along time. The old literature was still in use but had lost rnuchof its appeal. Even this was in short supply. Whiie the impor-tance of publicity in popularising the family planning pro-gramme was recognised on all hand.s, no positive steps have ,

been taken for a long time either to. augment the funds forpublicity or otherwise strengthen the working ofthe publicityproglamme.

Besides this, specific techniques of_ communication for.motivation were not evolved keeping.in view the differences of.geographical location, income, education and socio-cultural .

background of the people. For example, persuasion approachmay have to be different for rural and urban populations,.While social adjustment is relatively. an impprtant factor ig..determining the family planning behaviour of the people in the.rural areas, rational object-appraisal is a more important.determinant of such behaviour in the urban areas, There should..be a periodical assessment of the family planning beliefs,andattitudes of the different classes of people through standardizedKAP surveys. Such surveys, would provide useful guidelinesfor designing a suitable communication strategy for familyplanning.

Popularrorv EoucerIoN

With regard to the introduction of population value.s in. the.'educational system, very little work had been done.until the,time ofour visit to the different States for the present study in,1976. U.P. was considering to introduce populatiotr studies: at'the higher secondary stage, i.e., for classes 9 to 12. They.intended to make it a part of either the biology or the geueral -


science or social studies course but not an independent subject.

For students up to the middle school stage they did not favourthe idea of incorporating population studies in their syllabuses.

For them, they wanted to train the teachers so that they couldgive some general lessons to the students. The Governmentof Punjab was thinking of introducing population studies in the

curriculum of classes sixth to eleventh but they felt that itwould not be possible to do this before the academic year

1979-80. In Madhya Pradesh, some elementary literature hadbeen prepared for both students and teachers. It was beingsent to training colleges for a trial on an experimental basis

in selected schools in their areas. On an experimental basis,population study and health education had also been introducedlately in the curriculum of B.Ed. and M.Ed. courses at theGovernment College of Education, Jabalpur. We did not findany thinking being given to this subject in Bihar.

CoNcr,uorNc OBSERVATIoNS

For every programme which strives to meet the needs of thenation within limited resources, both human and material,improved organization and administration are a necessity. Forplanners who aim at maximum utilization of available resources,organization and administrative structure must become apriority concern. Though the extent to which the Governmenthad recognized its importance cannot be documented, yet it wasfound that the situation was not quite satisfactory.

In fact, the failure of organizational structure and administra-tion essentially reflects the lack of symbiotic relationshipbetween the process of planning and administrative change. Inother words, there is a lack of effective dialogue between theplanners and the administrators.

The basic conclusion on the administrative side whichemerges is that the new programme was undertaken rvithoutcreating the necessary organisational and administrative under-pinnings. In particular, the administrative infrastructure fortranslating the programme into efective action was inadequateand incapable of delivering tbe services.

Urban family welfare planning centres were generally


attached to district and other hospitals where primary attentionis devoted to medical work and family planning work generally

receives only secondary attention. Moreover, the supervision

and control over the family planning field staff was very lax'In the revised pattern, the post of medical officer has been

abolished at the urban centres covering a population of 25,000

to 50.000. This will create further problem for these centres tocarry out the programme effectively.

The area of operation of a primary health centre was toolarge. It comprises on an average about 100 villages and one

lakh of population. The resources, both human and physical'

at its disposal for handling the tasks were very limited. Forexample, provision lor indoor beds for tubectomy cases is

extremely limited and in most cases the tubectomy operations

are done atthe sub-divisional or district hospitals, which again

have a limited capacity. Besides this, it involves sending cases

far away from their homes.

Secondly, the PHC is ill-equipped for extension work forfamily planning. Most of the audio-visual equipment such as aprojector, publicity van, films, etc. are located at the districtheadquarters and are available to PHCs once in a while.

Thirdly, the sub-centres were particularly under-staffed and

ill-equipped for the job. There was generally one A.N.M' and at

some places one Dai or attendant was also provided. But being

women, their movements were generally confined to their head'

quarter village and the closeby villages where they can easily

reach. The interior and distant villages were generally neglect'

ed. Moreover, they were generally not able to reach the

menfolk of the villages.The attitude of the State Governments towards voluntary

organizations was generally indifferent and these organizations

often found it difficult even to get the assistance normallyadmissible to them in time or regularly. A review of their

relationship is urgently called for.Educational and motivational aspect of the programme was

one of the weakest parts of the family planning programme'

Since the progtamme is supposed to be based on persuasive

approach, the importance of it need not be over-efirphasized'

However, it had not received adequate attention from the

.186 Family Planning in India

concerned authorities. Though some attempts to improve the'situation was being made in some of these States, they wercfar from satisfactory. In fact, all these were piecemeal effo rts

i and there was no coordinated effort in this regard.

Cneprrn V

The People-TheirAttitudes and Reactions

With a view to find out the people's attitudes and reaction to

the family planning programme in general and the new popula-

tion policy in particular we made a sample selection of a cross

section of the people an{ interviewed them intensively' The

sample consisted of a total of35l persons and included both

rural and urban, beneficiary and non-beneficiary, and male and

female respondents. Through stratified random sampling we

tried to strike a reasonable proportion between these diflerent

and contending groups. For details on our sampling design

please refer to APPendix III.Certain factors, however, militated against our sample selec-

tion. One was the widespread fear of the Government ilithregard to family planning prevailing in the selected States at

the time our study was made. Our investigating team was often

suspect in the eyes ofthe people, particularly in the rural areas,

who thought that it was part of the governmental set-up out

to "motivate" people for sterilization. This made many a

respondent try to avoid meeting our team altogether. Conse-

quently, we had to resort to take some substitutes in some areas

and make do with such number of respondents as were avail-

able in the other areas. The second was the occurrence offloods in Amritsar District, Punjab in August'September of 1976

on account of which we could not visit any village and select

any respondents there. The third was the unwillingness ofwomen respondents in the rural areas of Bihar to give us an

88 Family Ftanning in India

interview. Therefore, we did not get any female respondentfrom the villages ofBihar. Nevertheless, the sample was fairlyrepresentative of the different classes of people iesiding in theselected areas. The broad features of the samfte ate given in thefollowing table.

TABLE 5. 1

SaruPLn on PnnsoNs Ssr,rcrro

State and Acceptors Non_Acceptors4District Rural Urban Rural (hban TotalMale Femsle Male Female Male Female Male Female

Bihar

Gaya 18Dhanbad 24

M.P.

Hoshangabad IDatia 9

Punjab

RoparAmritsar

U.P.

AllahabadRampur

,l

62

I

10

2

f,

^3

3

4

17

19

t2IJ

:

7o

o

)J

3

3

2

4750

d

49

4r5a2353

i

3

414

13 13

11 1022

22

Torar, 8735124l63750 29

Of the 351 respondents, 196 had accepted the programmeand were following one or the other of the family planningm€thods and .155 were those who had not, Thus, there were55.8 per cent acceptors aad,44.2 per cent non_acceptors in the$ample. The rural-urbim composition was 252 to 99 or 7l .gper cent rural and,28.2 pef cent urban respondents. The male_female ratio was 3: 2, i.e., 60 per cent and 40 per cent, or 2ll!o 140 in absolute numbers, It is significant to note in this con-text that wt ereas .the number of female respondents in the

The People-Their Attitudes and Reactions 89

aggregate fell much short of the male in the rural areas, theyexceeded the males in the urban areas both among the acceptorsand the non-acceptors. This was partly due to the fact that wegot no representation of women in our sample from the ruralareas of Bihar owing to the prudishness of women there totalkto male investigators and partly explained by the reason that 6 ofthe 8 urban family planning centres in our sample being exclusi'vely maned by lady doctors, women naturally had a prepon-

derence over men in their clientele.Of the 140 women respondents in the sample, 87 or 62.1 per

cent were acceptors and 53 or 37.9 per cent non'acceptors.Among men, 51.7 per cent were acceptors and 48.3 per cent

non-acceptors. As between town and village, 59.6 per cent ofthe urban respondents were acceptors as against 54.4 per €ent

ofthe rural and proportionately there was the same difference

between the non-acceptors from the two areas.

Although religion was no criterion for selection, it reflected

itself in the sample as shown in Appendix VII. The age compo-sition of the sample is given in Appendix VIII.

LrrERAcy

The educational level of the respondents is shown in Table

5.2 on page 90.As expected, the level of education was low both among the

acceptors and the non-acceptors. About 59'7 per cent oftheformer and 63.2 per cent of the latter were illiterate, 18.4 per

cent of the former and 20 per cent ofthe latter were literate

only upto the Primary level and 12.8 per cent and 9.7 per cent

in the two categories respectively had their education up to the

Middle Pass level. The number of those who had their educa'

tion up to the Matriculation standard or above was very small,

being 18 and l1 respectively in the two categories. Proportiona-

lely more of the urban than rural and more of the male thanfemale respondents were educated. As between the acceptors and

the non-acceptors the level of literacy was as given in Table 5.3

on page 9 1.

OccupArroNThe occupational structure of the sample was as given in

Table 5.4 on page 92.


Tasr,B 5.2

Drst sutrox oF REspoNDENTs By LEvEL oF EDUCATToN

Acceptors Non-Acceptors

IIlite-Stale and rate'District

Middle Matri lllite-Pass cula- rate

tionand

above

Lite- Middle Moti-rate Pass cula-

t rcrland

above

Lite-rate

up toPri-

maryPass

up toPri-maryPass

533431

2364218533

1373217432

105413 4 5

21I

BiharGayaDhanbad

M.P.

HoshangabadDatia

Panjab

RoparAmritsar

U.P.

AllahabadRampur

4I

l2l6

J

2

21

IJ Ja1

1633111

19531772

Tor,cr 3t 15 11

Cultivation and agricultural labour were the main occupa-tions of the respondents in the countryside and shop-keepingand service in the towns. 49 per cent of all respondents followedcultivation as their main occupation. Their proportion in theacceptors was 46.9 per cent and in the non-acceptors 51.6 percent. Agricultural labour was followed by 14.2 per cent ofall respondents as their main occupation-l3.8 per cent of theacceptors and 14.8 per cent of the non-acceptors. Ssrviceaccounted for 14.5 per cent of all employment. l5.g per centof the acceptors and 12.9 per cent of the non-acceptors were inservice ofone kind or the other. l2 per cent of the- respondentswere in business, usually running small shops. Their proportion

The People* Their Attitudes ond Reactions 9l

Test-r 5.3

PEtcerrecn DtsrntguuoN or AccsProns ,c.l'lo NoN'AccEPToRs gv LrrsRlcY GnouPs

Literacy GrouPs

Category of IlliterateRespondent s

Upto PrimarYPass

MiddlePass

Maticula-tion and

above

a.l37.9

62.537.5

53.746.3

54.445.6

AcceptorsNon-acceptors

100.0Tor,nr

among the acceptoff and non-acceptors was l2'7 and 11'0 per

cent r;spectively. The other occupations accounted for a very

small number of respondents. Among these were industrial

labourers, artisans and the miscellaneous workers like mecha-

nics, bicycle repairers, rickshaw pullers, etc. It may also be

explained in this context that of the 140 women respondents'

onty Z were employed-3 as agricultural labourers. and 4 inservice. For the rest the occupations followed by their husbands

were taken as their occupations.The cultivator class being the most important both among

the acceptors and non'acceptors, it was considered necessary

to identify them by the size of their holding' Consequently, data: was collected on the land held by each cultivator and theni classified into four categories. Holdings of upto 2 acres of land' constituted the first category, of above 2 to 5 acres the second,

of above 5 to l0 acres the third and above 10 acres the fourth'

The first categoiy signified marginal farmers, the second small

farmers, the third medium farners and tle foruth big farmers': The data on this classification is presented in Appendix IX'

EcoNot{tc Sr,lrus

With a view to find out whether economic status of a person

had any correlation with his attitude and response to family

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planning, we tried to collect data on the income of the respon-dents. Income is a sensitive matter and any direct investigationinto it is almost immposible. We, therefore, tried to assess theincome of the respondent by a number of indirect questions andinferences such as the quantum and quality ofland held by him(by quality we meant whether it was irrigated or unirrigatedand if irrigated by what source) and the kind of crops grown;the average wage rate prevailing in a village for agriculturallabour; the nature of goods handled or services rendered by ashopkeeper and his probable monthly or annual trade turn-over;and length of service and pay scales of the servicemen, etc. Onthe basis of information thus collected we figured out the incomemost likely to accrue to a respondent and placed him in theapporpriate incomegroup.

The four broad economic groups commonly in use in theadministration for extending certain facilites to the people onthe basis of their economic status such as the allotment ofhouses or house sites or grant of house building loans etc., wereadopted by us for the classification of our respondents. Thesegroups or categories were .economically weaker section', low-income group, middle income group and the high incomegroup. Persons with an income of upto Rs. 300 per month wereclassified as belonging to the economically weaker section.Those with an income of Rs. 301 to Rs. 600 per month wereplaced in the Iow income group, those with an income of Rs.601 to Rs. 1500 per month in the middle income group, andthose with an income of above Rs. 1500 per month in the highincome group. On this score the data turned out to be asgiven in Table 5.5 on page 94.

The economically weaker section constituted the largest singlegroup both among the acceptors and the non-acceptors, but pro-portionately there was a big diference between the two cate-gories. Whereas among the acceptors the weaker section formed39.3 per cent of the total, among the non-acceptors its propor-tion was 56.1 per cent, signifying that the majority of the non-a€ceptors belonged to the economically weaker section ofthesociety. The low income group was almost on par with theeconomically weaker section among the acceptors, being 36.2per c€nt of the !ot&l, but among the non-acceptors it was at alower level, 26,4 per cent. This shows that more of the Dersons


T,{srr 5.5

DrsrRrBUTroN op RrsponorNTs By THEIR EcoNourc Srarus

State andDistrict


E.W.S. L.I.G. M.I.G. H.I.G. E.W.S. L.I.G. M.I.G. H.I.G.

Bihar

GayaDhanbad

M.P.

HoshangabadDatia

Punjab

RoparAmriisar

U.P.

AllahabadRampur

1373195-

614-

17

14

1St651

1l11

8

10

12

I

5

t

l)16

ll 11

lJ -

I

I

7I

I 61

l1r2

7I

54

5

2

5

2f,*31

Torar,

E.W.S. - Economically Weaker Section.L.I.G. - Low Income Group.M.LG. - Middle Income GrouP.H.I.G. - High Income Group.

in the low income group accepted the programme than those

who rejected it. The same trend is visible in the other twoincome groups, i.e. the middle income group and the highincome group. In both, the proportion of the acceptors was

higher than that ofthe non-acceptors.Analysing the data income-group-wise, the position emerges

as given in Table 5.6 on page 95.

NulaeER oF CHILDREN PER FAMILY

In order to find out at what stage the respondents stood inthe matter of their family size when they decided to accept orreject the family planning programme, information was collected

t0


T.lsI-r 5.6

PsRcrl.rtecs DtstntsutloN or Accrprons eNo NoN-eccrpronssy INcoras Gnour

Category ofRespondents

Income-Group sE.Iry.S. L.I.G. M.I.G. H,I.G.

AcceptorsNon-acceptors

47.O

5 3.0 36.663.336.7

66.7

ToTAL 100.0 100.0 100.0 100.0

Nota; Abbreviations same as in Table 5.5.

on the number of living children they had. The position was

as given in Table 5.7 on page 96.It may be seen from the above table that the number and

proportion ofthe acceptors increased with the increase in theirfamily size. The largest number of acceptors were those whohad six or more children already born to them. They constitu-ted 30.6 per cent of the total acceptors. The next Iargest groupwas of those who had five living children each before they optedfor family planning. They formed 24 per cent of the acceptors.The next group of 42 or 2I.4 per cent was of those who had 4children each. Thus, 76 per cent ofthe acceptors had adoptedfamily planning only after they had four or more children each.Only 24 per cent had adopted it when they had 2 to 3 childreneach. Even in this group the acceptors with 3 children consti-tuted 16.3 per cent and those with 2 only 7.7 per cent of thetotal. Thus, those who fell in line with the current slogan "HumDo Hamare Do" constituted less than 8 per cent of the totalacceptors.

On the other hand, the trend was quite different among thenon-acceptors. Here the largest single majority was of thosewho had four children each, followed by those who had three.The two together constituted 60.6 per cent of the non-acceptors.This signifies that the majority of the non-acceptors consistedof those who did not consider having three to four childrengood enough for practising family planning. The two highergroups of non-acceptors with five and six or more children

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each, constituti ag 17 .4 and 13.5 per cent of the total respective-ly, were obviously more amenable to family planning than thetwo lower groups. This was because of two reasons. First ofall, the more the number ofchildren one has above a certainminimum (in the present case four, which incidentally alsoallows for the occurrence ofa certain amount of balance bet-ween sons and daughters), the more amenable he is to adoptfamily planning. Secondly, the more the number of children aperson has, the greater, generally, is the attention and effortdevoted to him by the family planning staf and other agenciesconcerned for bringing him round to adopt family planning.This is why there were more of acceptors and less of non-accep-tors in the higher size-groups of family (5 or more children) inour sample. These reasoris also explain as to why those respon-dents, both acceptor and non-acceptor, who had only twochildren each could not be considered to be more anenable tofamily planning than the other size-groups,

MEN-WoMEN RArro

One significant fact which emerges from an analysis of thesample is that proportionately more women were inclined toadopt family planning thao men. Taking all the women in thesample together, we find that as inaJry as 62. I per cent of themwere acceptors and only 37.9 per cent non-acceptors. On theother hand, the proportion of acceptors to non.acceptors amongmen was about half and half. More precisely, the acceptorsamong men were 51.7 per cent and the non-acceptors 48.3 percent. Among the non-acceptors, women were far less than men.Roughly, they constituted a proportion of l:2, i.e. whereas only34.2 per cent ofthe non-acceptors were women, 65.8 per centof them were men. Among the acceptors, however, the propor-tion of men was somewhat higher than that of the women. 55.6per cent of them were men and 44.4 per cent wonen. Thedifference was of the order of 11 per cent, and was mainly dueto two reasons. First, men were more easily and directly accessi-ble to the family planning agencies for canvassing than women.Secondly, more facilities were generally available for vasectomythan tubectomy, particularly in the camps. Over and above

98 Fatnily Planning in India

these reasons, women have almost invariably to take the permis-sion of their husbands for adopting family planning, whereasmen generally do not have to depend on the consent of or even

consultation with their wives in the matter. In the final analysis,therefore, it appears that subject to the removal ofthe handicapsm€ntioned above, more.women were likely to opt for familyplanning than men. In other words, more of the women werepsychologically prepared for practising family planning thanmen. This is a hopeful sign.

AwenrNnss oF FAMTLY PLANNTNG

A1l the acceptors of the family planning programme wereasked as to what they knew of family planning. Interestinglyenough, all of them named sterilization. Some were aware ofsome other methods of family planning as well but there wasnone who did not know of sterilization. What was more.they spoke of sterilization in a manner as if sterilization wasfamily planning and family planning was sterilization. None ofthem knew anything at all ofspacing ofchildren for better healthof the mother and more careful and attentive upbringing of thechild or had any definite knowledge ofthe various methods offamily planning and their relative effcacy. Their awareness of thefamily planning methods was as given in Table 5.8 on page 99.

The majority ofthe acceptors knew of sterilization only as

a method of family planning. They constituted 52.6 per centofthe total. Another 24.5 per cent knew of sterilization andthe loop, and 9.7 per cent of sterilization and the condom.The former group i.e. those who knew of sterilization and loopconsisted mainly of women located in rural areas and the latter,i.e. those who knew of sterilization and condom were mainlymen located in urban areas. The accepto$ who knew of all thethree methods were only 15 or 7.6 per cent ofthe total. Thosewho knew of four methods, i.e. sterilization, loop, condom andthe contraceptive pill, were only 8 or 4.1 per cent of the accept-ors. The last two groups ,consisted largely of men and womenwho were educated upto the matriculation or above standardand were mostly in service. They were better informed mainlybecause the avenues available to them for acquiring knowledgewere more than mere family planning sta.ff or other

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100 ' Family Planning in India

agencies propagating family planning. Being educated andmostly in service, their contacts were more than those of anordinary man .or woman and many of them possessed a radioor transistor and read newspapers and other literatue. Of theother methods known to the acceptors, two were aware ofcoitusinterruptus or the withdrawal method and one of the rythm.However, none .of them was quite sure that these would beabsolutely foolproof in stopping a pregnancy.

The above findings indicate that extension education was notevenly balanced as between the different methods. There was aconcentration of effort on propagating sterilization and a com-parative neglect of the other methods. The family planningfield staff admitted that this was so and advanced three reasons.One was that as a matter of policy the State Governmentsfavoured the propagation of sterilization more than of anyother method because being the terminal method it ensured apermanent achievement and could be counted solidly in theprogress of the family planning programme. Secondly, the per-lbrmance of the family planning field staff was judged largely,if not wholly, in terms of the cases canvassed and brought forrhfor sterilization. Therefore, in the interest of their own careers,they had to devote a much greater attention to sterilization thanother methods. Thirdly, monetary backing in the form of incen-tive money was available only for sterilization and for no othermethod. Although by itsetf the incentive money would hardlybring round a person to accept sterilization, yet coupled withcanvassing (which often included a good deal of ofrcial pres-sure) the money did play a supporting role.

However., the main disadvantage of concentrating on sterili-zation to the point of neglect of the other methods, is that manyof those who would like to practise family planning short ofsterilization often find themselves in a dilemma. The dilemmais which other method will give them equally satisfactory results.The family planning staff hardly did anything to resolve thisdilemma. On the contrary, they often seized this opportunityto hammer in with greater force the inevitability of sterilization.This repelled many of the prospective acceptors from acceptingsterilization and often made them resign altogether from prac-tising family planning.

The awareness of the family p'lanning methods among the

The People-The.b Attitudes and Reactions

non-acceptors was as given in Table 5;9 on page 102.

The most striking thing about the non-acceptors was that 41

or 26.5 per cent of them were not aware of any 'method offamily planning. Obviously, nobody had contacted them tosuggest any. While we were informed by the family planningstaff at the time of selecting the sample that all non-acieptors

had been approached and tried to be persuaded to accept familyplanning but when actually contacted by us about a quarter ofthem categorically stated that nobody had approached themand askedlhem to practise family planning. This wds corro-borated by the fact that when we sought the assistance of the

family planning staffin locating the non-acceptors who were

not easily tracable, the staffwas found equally wanting in theirknowledge of their whereabouts. A large majority ofthe res-

pondents who had no knowledge of any method of familyplanning belonged to the economically weaker section and the

low incorne group of people, most of them lived in urban slum

areas or the Harijan and poor bustees in the villages and

occupationally constituted petty peasants, landless labourers,casfral workers and wayside shopkeepers.

'The rest of the non-acceptors were all aware of ster.ilizationbut only a quarter of the total knew of other methods' This.again goes to show that there has been a concentration ofattention on sterilization and neglect of other methods in the

spread of knowledge about family planning. The second best

known method was the loop'and the third lhe condom. Onlyan insignificant number of two knew of the pill. No othermethod was known to any of the non-acceptors.

SouRces oF AwARLNESS

' In ord", to find out to what extent the diferent agencies were

responsible for spreading the knowledge of family planning,

ilata was collected from the respondents about the primary

source of their information. The position was as given in-Table

5.10 on page 103.

The above table indicates that the role of the family planning

personnel in making people aware of family planning was notvery large. Only 47.3 per cent ofall respondents came to knowof it through them,41 per cent were informed by other sources

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and 11.7 per cent were totally ignorant. Being aware is not beinginformed, in the real sense, mucb less being eciucateJ. what waslacking in number was further .on po.nd;;;;-;;;;";d; ""jthe manner in which it was told. The term ,.."t.orion .Ou.ution,,can be almost wholly ruled out so far as ttre iamiiy planningpersonnel or for that matter any other government agencypropagating family planning *u,

"on...n-.d. Wf-l "t has beengoing on for a number of years ty "o* *u, merely Ueinginformed to get ready for.sterilization unA U.ing l;led up foran operation. The family planning programme wis largety beingconcentrated in camps and campaigns. Every year two to threecampaigns were launched by the government in what aregenerally called family planning fortnights or months. It wasduring rhese periods tha-t rhe famili plarnjng'p.rrono.r unOsome other government ofrcials lte tle patwar"is ,oO tU. fto"tstaff went round, usuallvp;;;i"';;';#H:f ;i.fr j."J'f;lllllil',i';'il,11"fr:0,,f

:being held and exhorted them to undergo steriiization. This wasthe manner in which the so_called exlension education wasbeing largety carried out or the people ;.r; ;;;;;;i"rmed offamily planning, i.e. during particular periods, iith a snow ofauthority, in a brusque man_ner and through quick campaigning.what was often rold was rhat steriliz"ti;, ";;;;;;; or tubec-

19m-V, ls a simple, quick and safe operation wfricf, ,Lp.

"f,labirth permanently and that it carries a reward from thegovernment in the form of incentive money. To ,h. _o.":fflTrry of the prospectiveclients it wu" ui* qiietry aadeornar rn case ofneed for a child_birth later it could be reversedalso. Nobody explained how an .p.."ri", ir'"peitrmeo, inwhat mannerit stops the conception;nd what its consequencesare to the health of a person. More often tlan

-no-t -

,h. "ua-paigners themselves did not know of the mechanism of asteritization operation nor did they h""" th;;;l;;;;io ."pruinit to the peopre even if they knew. ;d;;;;;;;mme wasgenerally time and rarsef bound. their mission i,ul ,.qu;"L

Catch" rather than tocarry conviction. For this ihe f.amilyplanning personnel or other government offcials were not toblame primarily but rhe cou.rn-.niitr.ii.'iju"i"g lrnp".r.aan urgency to the programme to show quick resuiis and inno less a tangible form than steriljzation, i1 was the Govern-


ment which had reduced extension education to such straits.In the above circumstances, it was not surprising that the

family planning programme came to be known in the commonparlance as "Nasbandi Programme" and a large number ofpeople, to the best of their ability, tried to avoid being caughtfor sterilization. Whenever a campaign was launched or campheld, even for other forms of family planning than only steriliza-tion which was indeed rare, a scare spread through word ofmouth to distant places and among a large number of people"Nasbandi-wale earahe hein. Hoshiyar rahura, Bhai." (Theoperators of sterilization are coming. Beware.) This is how thecategory consisting of friends, relatives and neighbours becamethe second largest source of information on family planning,the word information being used only in the sense of being madeaware that something was going on about I'amily planning, moreprobably that a sterilization drive was on. This group waslargely a rumour group and, therefore, still less specific inimparting knowledge about family planning than the familyplanning staff. Nevetheless, 21.9 per cent of acceptors and34.2 per cent of non-acceptors got their first wind of familyplanning through this group.

The persons who were really informed, or rather betterinformed, were those who had as their source of knowledge theradio, the newspaper or other literature, more often a combina-tion of ali the three. They were mostly educated, urban andeconomically better off. However, their proportion was verysmall, being only 8.7 per cent among acceptors and 5.8 per centamong non-acceptors, or 7.4 per cent in the total. Their know-ledge was self-acquired, more specific and varied.

A word about the role ofvoluntary agencies in disseminatinginformation about family planoing is also necessary. Iu noneof the villages falling in our sample was there any voluntaryorganization working nor was any youth, women's, social orcultural organization associating itself actively with the propa-gation of family planning. In fact, none of the kinds of organi-"ation mentioned above existed in any of the villages. There-fore, we drew a complete blank on the part played by voluntaryorganizations in our sample villages.

However, in two of the eight cities in our sample thexe werevoluntary organizations which were propagating the family


planning programme and running family planning services.These were at Allahabad aud Amritsar. But as the institutionsselected by us for intensive study at these places were otherthan those run by voluntary organizations, their role in dissemi-nating knowledge about family planning does not get reflectedin the above table. Even otherwise, their role would have been

very small.We visited these institutions and found that owing to lack

of funds and staffthey were not engaging themselves in any kindof outdoor extension work, but were confining themselves tocommunicating only with such persons as came to theit clinicsfor health or maternity reasons. This was confirmed by ourvisits to three other institutions located at Lucknow, Patna andJharia. There too theirworkwas confined to rendering advice

on family planning only to those who came to their clinics andproviding clinical services to them.

Pnecucr oF FAMTLY PlauNtrc

We now go over to the actual practice of family planningamong the acceptors. They were asked as to which method offamily planning they had adopted. The result was as given inTable 5.11on page 107.

It will be seen from the above table that only three methodswere adopted by the acceptors-the sterilization, the loop andthe condom. Although some of them were aware of the pill as

well, none had used it. Any other method than the threenamed above had also not been used by any acceptor. Steriliza'tion was way ahead and towered over the other two methods

used. 175 or 89.3 per cent of the acceptors had gone forsterilization, only 12 or 6.1 per cent for the IUD and 9 or 4.6

per cent for the condom. This is as was expected. With a highconcenffation ofattention and effort on sterilization and a neglect

of the other methods, the result could not be any different'During our investigations, we carne across some very interest-

ing cases which are worth narrating. Two of the respondents

told us that although they were using the condom for a numberof years, they were not recorded as acceptors by the familyplanning staff on the plea that they were not taking delivery ofthc condom from any recognised agency. As there was no


TlsrE 5.1 |

DrsrnrrutroN oF AccEPToRs BY METHoDS oF

Feltr,v PIINNTNG Anoprro

Stale andDislrict

Method Adopted

Yaseclomy Tubectony IUD Condom Pill Any other

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HoshangabadDatia

Punjab

RoParAmritsar

U.P,

AllahabadRampur

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Tor,c,L 100

record to substantantiate their claim that they were regularusers of condom, they could not be treated as acceptors.

Although there was no such rule or instruction, the over-zealous

staff was applying its own rule aud goading these persons to get

themselves or their wives sterilized. Ultimately, one got him-self and the other his wife sterilized. The entry then made

against their names read as follows, "Earlier us'ing condom butnow (the date) got himself/his wife-sterilized. "

In another case, both husband and wife were sterilized with'out the kuowledge of the other and both were recorded as

acceptors separately. The woman was sterilized during a cam-paign when the husband had gone on a pilgrimage andthervro was sterilized later on in a camp. Both did not informeach other for different reasons-the woman for fear of beingreprimanded and the man for fear of being considered sexually

IJ

108 Family Planntng in India

incapacitated. In yet another case, a man had got himselfsterilized but still his wife became pregnant. When he offeredhimself for a check-up and a second operation if necessary, hewas quietly advised to get his wife sterilized this time to make itdoubly sure, He dutifully followed the advice.

After ascertaining what methods of family planning werefollowed by the acceptors, we naturally enquired why they hadadopted fan:rily planning. Their responses are presented in table5.12 on page 109.

To find out the real motive of the people for adopting familyplanning was one of the most difficult tasks of our investiga-tion. This was largely because of the prevalence of a wide-spread fear of the government with regard to family planningat the time our investigations were conducted. Consequentlymany people did not want to disclose their mind to us andsome deliberately tried to put us of the track. We had, there-fore, to employ some supplementary questions to arrive at thetruth. One such question was at whose instance they hadadopted family planning. Another was where they were operat-ed upon for sterilization. Taking the supplementary questionsfirst for analysis, we found that as many as 115 ofthe acceptorshad adopted family planning at the bidding of the family plan-ning staff and 27 at the instance of other government offcials.Together they constituted 72.5 per cent ofthe acceptors. Thus,oficial counsel or advice was the largest source of motivationo[people towards fa"r:rily planning. Of the rest, 37 or 1g.g percent were self-motivated and 17 or 8.7 per cent were motivatedby friends or relatives.

It was, however, a different story as to why the counsel oradvice of the officials prevailed. It came out in answer to thesecond question-',Where were you operated upon for steriliza-tion?"-that 137 or 69.9 per cent ofthe acceptors had beensterilized in camps specially organised for the purpose. Thecommon sites for the camps in the rural areas were big villages,locations where village festivals and fairs were held, includingweekly markets, and sometimes the primary health centresthemselves. In the towns the camps were generally held nearthe crowded localities inhabited by the lower middle andpoor class people. Preparations for tho camps were made wellin advance. Mobile units of medical staff were deputed to peiform

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il0 Family Planning in India

the operations. Family planning field staff would go round the

neighbouring villages or localities usually in government vehicles

to exhort and "persuade" people to come forward for steriliza-tion. Revenue offcials, block staff and school teachets were

also often pressed into service for mobilizing people for opera-tion at the camps and generally free trasport-trucks, pick-ups,

etc.-were provided to carry people to camp-sites. At the

camps, the assembled people were given refreshments, usuallytea and snacks, before operation, and care was taken thatnobody slipped away. Where camps were held jointly orseparately for tubectomy, women patients were kept in impro-vised wards for 4 or 5 days and, besides free dreessing and

medicine, were given free meals. Every acceptor, whether ofvasectomy or tubectomy, was also given a cash award at thetime of his or her discharge from the camp.

Broadly, this was the scenario in which a large majority ofacceptors had undergone sterilization. In such a situation,obviously, a large majority ofthe acceptors were unwilling orinvoluntary participants. They had been brought to campsthrough the exercise of ofrcial influence and display of authorityand were made to sign onthe dotted line. They had no escape,

€xcept at the risk of incurring the displeasure of the officiald

which very few of them could afford. While 27 or 13.8 per centcf the acceptors were bold enough to admit that they hadundergone sterilisation because of pressure brought to bear on

them by the family planning staff or other government oficials,as many as 1 18 or 60.2 per cent gave us only an omnibus replythat they had adopted family planning in order to limit thefamily size. Actually, limiting the family size was not the reason,not the real reason at least, but the consequence ol practisingfamily planning.

We pointedly asked this group to tell us why they wanted tolimit the size of their families and the result we got was quite

interesting. A large majority ofthem looked askance at us andcould not immediately hit upon a reason to justify their action.Some said, "The officials visiting our village had told us that itwas not good to have too many children and those who hadthree or more must undergo sterilization. So, we did." Some

told us, "We have had no children born to us for the last manyyears but we were advised by the officials to make it 'pucca' by

The People-Their Attitudes and Reactions I I I

undergoing sterilization. Hence, we did." A few looked obvi-ously too old and long past their youth to need sterilization butstill they had it. Perhaps, their answers were nearer the truth.They revealed that they had gone in for sterilization primarilybecause of the pressure or influence of the offcials rather than .

of their own free wiil. The muted look of the many revealedeven more. While they knew their mind, they were not willingto disclose it to us. In all probability this was because they didnot want to antagonise the officials, at whose instance they had

adopted the programme, by telling us the truth.In order to find out further whether there had been any pro-

longed orientation of the people on family planning by theofficials we addressed one more question to them. The questionwas, "How many times had the offcials propagating familyplanning met you before you adopted the programme?" Theanswers gave us an average of L6 meetings. In other words, theofficials had met them only once or twice before adoption.Thus piecing together the inf<rrmation we collected throughdifferent questions, one fact which stood out clearly was that a

large majority of the acceptors in this group had adopted theprogramme not because of the exercise of a free will exposed toa process of thinking, reasoning and deliberative decision-making but due to the pressure or influence of the ofrcialsbrought to bear on them through quick campaigning and snap

decisions. In this context table 5.13 on page 112 may also be

seen. It shows the primary source of motivation of the acceptors.Going back to Table 5.12, we find that 1 I or 5.6 per cent of

the acceptors had opted for family planning in order to protectthe health ofthe women bearing children and 8 or 4.1 per centbecause they found it difrcult to maintain a large family. Thetwo together constituted a group in which the number ofchildren already born was large enough and discretion suggested

to them to restrain themselves frorn bearing any more. Sorne ofthem considered it necessary so as not to expose women to anyfurther hazards of child-birth and others so as not to add any

more burden to supporting an already large family. This was agroup which wanted to stem the rot which had already set inand did not want any more rotting. The merit in their case

lies in the fact that they had perceived the rot and wanted tostop it.

112 Family Ptanning in India

TABLE 5. l3

DISTRIBUTIoN oF AccEPToRs BY THEIR PRMARY

Souncr or Morrverrou

State andDislrict

Influence ofofrcials

Owninitiative

Advice of friendsand rclatives

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On the other hand, there was a group which had a morepositive approach to family life. 18 of them had adoptedfamily planning in order to provide a good upbringing to theirchildren and 14 were actuated by a desire to improve theirstandard of living. The two together constituted only 16.3 percent of all acceptors. Although the group was small, it was

enlightened and largely self-motivated. These were the people

who had realized early in their married lives the necessity offamily planning and acted upon it. They were all educated, gene-

rally above the middle school standard. A good number of themwere high school graduates and some had received still highereducation. They were both from the urban and the rural areas

but the majority of them belonged to towns. It was in thisgroup that the methods like the condom and the IUD wereIargely used.

The People-Their Attitudes and Reactions ll3

Those who admitted that they had adopted family planningbecause ofthe pressure exercised on them by the family planningsta.ff or other government ofrcia.ls were a mixed group whichhad no particular identity of interest or affinity of outlook.They came both from the rural and the urban areas. Althoughthe majority of them were men, yet there were some women tooamong them. Most of them were illiterate but there were somewho were literate upto the primary pass level. They belongedto different age-groups and diftbrent communities other thanChristian. Some were residents ofa rehabilitation colony wherecertain facilities being extended to them were made contingentupon their adopting family planning (which virually meantsterilization), some were shop-keepers who were threatenedwith a "Challan" (prosecution), somb were small cultivators towhom grant ofcrop loans was "delayed" and sorne landlessagricultural labourers to whom allotment of land under thescheme of redistribution of surplus land was withheld "for thetime being." It may, however, be added in fairness to thefamily planning programme that they all had four or morechildren each. This does not mean that they were fit subjects

for the exercise of pressure but only that they were highlyeligible for practising family planning. This should have beenbrought home to them through a process of education, persua-tion and motivation rather than coercion.

It is also clear from Table 5.12 above that nobody hadadopted family planning for the lure of money. We asked bothdirectly and indirectly whether money had played any part ininducing a person for undergoing sterilization. Even the mostindigent of the acceptors in our sample denied that money wasany consideration. Whereas the amount of incentive or compen-sation money being paid earlier to an acceptor was Rs. 10 forvasectomy and Rs. 20 for tubectcmy, it had been raised in thewake of and formed an important plank ofthe new populationpolicy. The revised amount varied from Rs. 25 to Rs. 100 a-s adirect cash award to an acceptor, depending upon the numberof children he or she had immediately before undergoing steri-lization. While these were the rates adopted by the Governmentsof Bihar, Punjab and Uttar Pradesh, the Government ofMadhya Pradesh had gone a step further and raised theminimum amount to Rs. 50 in order to make the incentive still


more attractive. Of the 175 persons among our respondents whohad gonein for sterilization (vide Table 5..11), 39 or 22.3 percent had done so after the introduction ofthe revised rates. Theywere, therefore, exposed to a much greater temptation toaccept sterilization than those who had gone in for it earlier.Nevertheless, none of them admitted that he had been actualedby a desire for money. They cited other reasons asgiven inTable 5.12 but not the lure of money. Judged in the light olour own observation that there were strong feelings againststerilization, both explicit and muted, among a large number ofpeople, their denial that money was a motivating factor doesnot appear to us to be implausible. The policy behind the offerof a higher amount of incentive money, therefore, does notseem to have any basis in peoples' motivation.

Inthe final analysis, we find that 13.8 per cent oftho accep-tors had adopted family planning because of the pressureexercised on them by government offcials. Another 58.7 percent can also be legitimately counted to have adopted feunilyplanning because ofthe pressure ofofficials. Although there isno direct evidence to support this contention, all the circum-stantial evidence leads to this conclusion. A small number of3 or 1.5 per cent of the acceptors were unable to identify as towhy they had adopted family planning,9.1 per cent had per-ceived the baneful eff€ct ofa large family and decided not tobeget any more children and 16.3 per cent felt the necessity oflimiting the family size so as to have a better standard ofliving or provide a decent upbringing to their children. Nobodyhad adopted family planning for the lure of money, not exclu-sively at least.

NoN-eooprroN or F.q.N{rry PrlnNrNc

Equally important with reasons of adoption were the reasonsfor non-adoption of the family planning practices. We enquiredfrom the non-acceptors as to why they had not adoptedfamily planning. Their answers are summarised in Table 5.14 onpages I 16- 17.

As the above table indicates, 4l or 26.5 per cent of the non-acceptoru had not adopted family planning because they did not_know of any method. While it is true that they had no definite

The People-Their Attitudes and Reactions 1r5

knowledge of any method of family planning, it does not neces-sarily mean that they would have adopted the programme ifthey had the knowledge. What the reply indicates is that eventhe first step of informing them what family planning meantand what the different methods rtrere to practise it had notbeen taken in their case. This points to a serious lacuna in the€xtension effort.

Nevertheless, we asked this group a direct question, .,If youhave the knowledge of or are imparted knowledge on the useof various methods of family planning, will you adopt any ofthese?" Nobody gave a ready consent. They gave differentanswers but the consensus of opinion was that they would haveto consider the matter and then only they could decide whetherthey would adopt any. Quite a number of them, l7 out of 41 tobe exact, also added, "Sir, iif you are hinting at 'Nasbandi', thenwe will not accept it. It is very harmful." Apart from expressingtheir opposition to sterilization, perhaps unwittingly they gavethemselves out by their answer that they were not quite as

ignorant of family planning as they were presenting them-selves to be.

The second largest group of non-acceptors, 36 or 23.2per centwas of those who felt that children were gifts of God or thatfamily planning was anti-religion or anti-God. This shows tbatthey had a very tradilional outlook on family life. They certainlyneeded some amount of "brainwashing" before they could beexpected to adopt family planning. Obviously, thistoo had notbeen done.

There was another group which felt that if they adoptedfamily planning, by which they meant largely sterilization andto some extent loop insertion and no other method, they wouldsuffer from ill-health or weakness. Some men among them alsofelt that sterilization would lead to impotency. Together theyconstituted a group of 35 or 22.6 per cent of non-acceptors. Thisfeeling had occurred largely because ofthe negligence ofthe familyplanning field statr in taking even the most elementary afler-care of the loop insertees and the persons sterilized. Once aperson was sterilized and discharged from the camp or hospitalor fitted with loop and allowed to go home, he or she wasgenerally forgotten and lefr to fend for himself or herself incase any complications arose. This allowed a free scope

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for the rumours to spread and they did a considerable damageto the programme. While the loop did cause bleeding andbackache in many cases, the near absence of any follow-upaction or even of precaution helped the rumours to blow its illeffects out of all proportion. One such rumour which we heardquite often was that if the loop was allowed to stay in the wombfor a long period it would cause cancer ofthe uterus.

Equally harmful were the rumours about sterilization. Allkinds of illnesses and weaknesses, including impotency, werebeing blamed on sterilization. Very little had been done to scotchthe rumours or disprove the accusations. This has allowed aprejudice to grow in the minds of many people against familyplanning,

Among the rest of the non-acceptors there were 8 whowanted to have one or more sons and 3 who desired to have atleast one daughter before they would agree to adopt familyplanning. The desire ofthose who had no son and wanted tohave one is understandable and can be readily conceded. Butwhether they would stop at that and would not like to havemore sons is a moot point. Similarly in the case of those whoalready had one or more sons but wanted to have some more itwas difficult to say where the process would end, or at whatlevel their desire for sons would dry up. Those who wanted tohave at least one daughter might not have one until anothercouple of sons are born or might like to have another son

following the birth of a daughter. As there is no scientific basisto determine in what order girls or boys will be born and thereis a lot of soothsaying in these matters in the rural areas, the

chances are that the desired balance may not be struck until itis already late in the day, i.e. about half a dozen children arealready born. At that stage, family planning has no particularsignificance. It looks nore like an act of despair than a measure

of practical policy, Why we have emphasized this point parti-cularly is that we did not find any ofthese non-acceptors havingless than four children alreadY.

There was a group of 18 women, constituting 1 1.6 per cent ofthe non-acceptors, who wanted to practise family planning butwere helpless because their husbands or mothers-in-law were

opposed to it. Each of them had 3 to 4 children already born tothem and had realized that an indefinite child-bearing would be

The People-Their Attitudes dnd Reactions u9

detrimental to their health. They were, therefore, keen to adoptfamily planning but tleir husbands, or mothers.in.law, wherethey were strong enough to exercise a decisive influence, wouldnot permit them to do this on ideological grounds. They wereorthodox people and felt that child-birth was an act of God andan attempi to stop it by artificial means would be an interferencein the act of God and, therefore, irreligious or immoral.

About half the women in this group y'rere Muslim and a largemajority of them belonged to urban areas. The realization thattoo many child births were detrimental to health was the resultof their frequent contact with the medical staff of the hospitalsand dispensaries which they used to visit for their ailments.Many of their ailments were traced to their weak health andthey were advised to avoid further child births. Primarily, theadvice was in favour of sterilization, but failing that the loopwas suggested. Since the sterilization could not be undergonev'ithout the consent or at least the knowledge of the husbandand other family members, it was summarily ruled out. The loopwas acceptable but the fear ofrhe husband and/or the mother-in-law, in the eveJrt ofdetection, gripped them so much thatthey finally opted out of the loop as well. Nevertheless, itshowed that they were convinced ofthe utility of family plan-ning and had they been allowed to exercise a free will, they wouldhave adopted it, but the circumstances beyond their controlprevented them from doing so.

The two groups in the sample, i.e. the one of women whowanted to practise fanrily planning but could not do so because

of the opposition to it by their husbands or mothers-in-law andthe other ofthose who had tried a method but forsaken it forits failure to give them the necessary satisfaction, appeared tous to be the only persons among the non-acceptors who wereearnest and keen on practising family planning. In fact, theywere only technically non-acceptors but were actually willingto adopt family planning if they were given a chance, or properknowledge, to do so. They were mentally prepared for it butonly circumstantially handicapped. It is significant to note inthis context that of lhe 26 non-acceptors who were earnest aboutpractising family planning as n)any as 2l were women and onlyfive men. The women constituted as high a proportion as 39.2per cent of all female non-acceptors, whereas men formed


only 4.9 per cent of their total. The big dr'ference between thetwo indicates, again, that many more women were willing topractise family planning than men. However, altogether thisgroup constituted only 16.8 per cent of the non-acceptors. Theremaining 83.2 per cent were not willing to adopt family plan-ning. They were not mentally prepared for it and most of themneeded considerable amount of reorientation in their outlookand attitude before they could be expected to fall in line.

Although a wide variety of reasons was given by the respon-dents for not accepting the programme, going deeper into thequestion, we found that their non-acceptance stemmed mainlyfrom a life slyle which is really hard for them to chage. Centuriesoid, deeply ingrained values, which glorify motherhood, mas-culinity and raising of large families; highlight the importanceof having sons for a variety of reasons, not the least of which isfor the performance of after-death oblations; confer socialprestige inter alia on the basis ofthe family size and denigratesterility, are not easy to supplant, particularly when no serious,systematic and sustained effort has been made to reform thesystem and reorient the values.. Coupled with this, in many cases,are the economic compulsions to have a large family whichalone ensures a better income to meet even the most modestneeds of daily life in an otherwise grim situation ofgross under-employnent and low returns.

Klrowreocr oF NEw Porrcy Measunrs

With a view to find out whether the knowledge of the variousincentives and disincentives and other measures being introduc-ed by the government to promote family planning had reachedthe local levels and if so in what form, we enquired from theacceptors and the non-acceptors separately whether they knewof any such measures and if so what. The result was as given inTable 5. l5 on pages 122-23.

We did not put a direct question to the respondents whetherthey knew of the new population policy because we thought itwould be appropriate to ask them first of things which weremore immediate and closer to them than the distant Dationalpolicy and the answers we received justified our approach. Ofthe 196 acceptors, as many as 128 or 65.3 per centhad no


knowledge of any of the measures introduced lately by the

respective State Governments for promoting family planning'

This was not surprising. With the extension efort being so

limited and thinly spread as we have seen above, the result

'could not be much different. Moreover, the new measures had

been introduced only a short while before we made our enqui-

ries. Only a few weeks to a few months h3d elapsed betw€en

the introduction of these measures and our investigations'

During such a short time it was not likely that they would be

known to many people unless an effort was made to publicise

them expeditiously and widely. This was not done.

Consiquently, news was trickling down slowly and gradually

and only those people came to know of these measures who-were either reading newspapers or were in more frequent

contact with the staff of the primary health centres or of the

hospitals and dispensaries in the towns or had a direct personal

experience of any of the measures. Of the 68 persons who

knew ofthese measures, 38 or more than half knew ofonly one

item, i.e. a higher amount of incentive money or compensation

being paid for sterilization now than before. The major source

of information was their own experience. 29 of these persons

had undergone sterilization after the amount of compensation

money had been increased and had received the higher amount''They were, therefore, aware of this measure' The other t had

€ome to know of it from other sources' mainly through casual

talk with the staff of the primary health centres or city hospitals

and dispensaries which they had visited in the meantime'

Howevei, both the groups had only a vague knowledge ofthe

rew measure. By andlarge, they knew either of the amount

which a person had himself received or that a certain higher

amount was being paid now than earlier, but did not know what

amount exactly was admissible 1o which category or what the

different categories of acceptors were under the new scheme'

They also did not know whether any payment was made for

food or transport. This was the state of knowledge of those

'who knew ofonly one measute in a package of incentives and

.disincentives introduced by the State Governments in the wake

of the new Population Policy.Another '14 or7'1per cent of the acceptors knew of two

items, the higher incentive mon€y for sterilisation and the

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raising of the age of marriage. Although they knew of twomeasures, one already introduced and one proposed, the exact-ness ol their knowledge of the former r,vas no bitter than that ofJh9 S^toul of 38 acceptors discussed above. They were quite asindefinite about the amout of money being payaLle to diferentcategories of acceptors and other facilities being available underthe scheme as the other group. The ,ou..., o1 tieir informa-tion about this measure were also the same as those of the othergroup. 8 ofthem had known it from their own experience and6 through their contact with the staf of primary iealth centresor the city hospitals and clinics vjsited by them. In addition,3 of them had also read about it from the handbilts issued bythe District Family Planning Officers of two districts, Gaya andHoshangabad, but did not rem€mber what was mentionedtherein except that some higher amount of monev was beinsoffered for sterilization. As regards the other measure, i.e. thiproposal to raise the age of marriage, 9 of them had read aboutiJ in the local papers and 5 had heard of it fronr friends andneighbours. When asked to state exactly what they knew aboutit, surprisingly 8 of them did not even know whetLer the mea_sure bad already been introduced or was in the proposal stage.Their reply was ofthekind ..we had read/heard about it quitesometime back. We do not know exactly whether it has beenintroduced or not. Perhaps, it rright have been by now ormight come soon." In addition to these g, another 3 did notknow what the proposed ages were. Only 3 of the group hada definite information both about its still being a proposal andwhat the proposed ages of marriage were. Alf thl : wereeducated-2 matriculates and one middle pass. Two of themwere in service and one was a businessmen,

The remaining 16 respondents who knew ofthese measureswere better informed than others both in respect of the numberof items and the contents thereof. Four of them knew of hieherincentive money for sterilization, raising of rhe age of marrlgeand certain other incentives being offered to the acceotors.Among the other incentives known to them were the grani of arebate of50per cent in land revenue to those farriers whoagreed to be sterilized and the assignment of priority in theallotment ofhouses and plots and grant of loans to those indi_viduals who volunteered for sterilization. These incentives were

The People-Their Attitudes and Reactions t2s

being offered by the U.P. Government and were known to three

of the respondents in this category who belonged to U'P'

Surprisingly enough, even an important incentive like grant of50 per cent remission in land revenue was not widely publicised

and only an insignificant number of cultivators knew of it' The

other respondent in this category belonged to Bihar. He knew

of only one other incentive, i.e. grant of priority in the allot-

ment ofhouse-sites and house-building loans to persons who

had undergone sterilization after two living children.

All four ofthem knew that the cash award being offered for

sterilization ranged from Rs. 25 to Rs. 100, depending upon the

number of children one had before undergoing steriiization'

Those with two children or less got Rs. 100, those with three

Rs. 50, and those with four or ntore children Rs' 25. They also

knew that the raising of the age of matiage was not yet enacted

into a law but that it would be enacted soon and that the pro-

posed minimum legal age of marriage was 18 years for girls

and 2l years for boys. However, only one of them knew that

the remission in land revenue was admissible for a period of3 years only after sterilization, while the other two were under

thi impression that it would be available for life' None ofthem linew in what manner exactly the priority would be

given in the allotment of houses and house-sites ald grant ofl,oans to those who opted for sterilization. All the four of them

were middle pass or above in education. Three ofthem were

cultivators from the tural areas and one a shopkeeper from an

urban area. Two of them were in the middle income group

and two in the low'There was another group of five who knew of the higher

incentive money for sterilization, raising of the age of marri4ge

and ofthe disincentives or disadvantages that applied to those

who did not undergo sterilization or otherwise limit the number

of children to two or three. It is significant to note that aU

these five respondents were public servants. Three of them

belonged to Madhya Pradesh and two to Punjab and that none

ofthem had any knowledge or stated to have any knowledge

of any incentive other than the cash award for sterilization'

Since the Governments of Madhya Pradesh and Punjab had

introduced schemes which consisted largely of disincentives and

since these were applicable only to public servants, it was natu-


ral that they alone would know of them and not the commonman to whom these were not applicable. The Government ofMadhya Pradesh had not provided any incentives to publicservants as such, which were not available to the generalpublic. On the other hand, there wasa set of disincentiveswhich were exclusively applicable to public servants. In fact,the only incentive applicable to the general public itself wasthe payment of a cash award for undergoing sterilization andnone other. It was, therefore, not surprising that the respon-dents from Madhya Pradesh falling in this category knew ofonly disincentives which applied to them and ofno incentivesfor there were none which existed.

In the case of Punjab, there were a few incentives as well,besides the disincentives, which were applicable to governmentservants. But tbese were ofsuch a flimsy nature, compared tothe disincentives which were very hard and fast, that most ofthe government servants did not consider them incentives at all.When their attention was drawn xo the provision of theissuance ofa letter of appreciation or the grant of an award tothose employees who exceeded the achievement of the targetallotted to them by a certain percentage and the increase inthequantum of maternity leave from three to five months to suchfemale employees as restricted the birth of children to two only,the respondents reacted with the remark that these were hardlythe incentives which would enthuse anyone. They refused torecognise these as incentives on the ground that these were notat all material to the career of a government servant, whereasthe disincentives were very harsh, definite and far-reaching intheir consequences.

Being educated andin public service, all the respondents inthis category were well informed of the provisions of the variousmeasures. It was, however, interesting that despite beingacceptors themselves, they were very exercised about the disin-centives. Their general attitude was that although they werenot affected by such measures as ineligibility for allotment ofgovernment accommodation or grant of loans, they were stillcovered by the provisions of disciplinary action for not beingable to fulfil the quotas of motivation for sterilization or loop-insertion allotted to them. Further, the penalties provided forunder this measure were unduiy severe and would adversely


affect their careers permanently. They, therefore, felt greatlyagitated, resentful and apprehensive about the operation of thismeasure. Moreover, they felt that the scheme of dis-incentives,being applicable to public servants only and to no other classof citizens, was highly discriminatory and partisan in itsapproach. In their opinion, this was not good for the morale ofthe public servants.

The most knowledgeable among the acceptors was a group ofseven who knew of four items and knew them fairly well. Thefour items were higher incentive money for steri.lization, raisingofthe age of marriage, other incentives and disincentives. Fiveofthem were public servants agaiu, and two private citizens.All of them were fairly well educated. Four of them belongedto urban ateas and three to rural. Among the rural respondents,one was a village level wo.ker, one a school teacher and one abig cultivator and local leader. Two of the respondents werervomen and five men. The major sources of their informationwere their contact with public authorities and the newspapers.Three of them belonged to Bihar, three to U.P., and one toPunjab. None of them belonged to Madhya Pradesh becausein Madhya Pradesh there was no scheme of incentives (otherthan higher incentive money for sterilization which constituteda separate category in our classification) in operation either forpublic servants or private citizens.

Of the three respondenls from Bihar, two were publicservants. They had a good knowledge ofthe various measures ofincentives and disincentives introduced by the Government ofBihar as well as of the proposal to raise the minimum age ofmarriage. They, however, did not know of all the incentivesand disincentives incorporated in the scheme because the listthereof was too long for anyone to remember. Nevertheless,they were quite familiar with the various provisions affectingpublic servants. The third one was a businessman of goodstanding and an under-graduate. He too was well informed onthe various measures but not quite so on those affecting publicservants as on those pertaining to the general public.

The lone respondent from Punjab was a lady teacher. Sheknew of the various measures fairly well. Although she feltsore on the point that the Government of Punjab had singledout public servants for the application ofincentives and dis-


incentives introduced by it, she did not make a sharp distinctionbetween the severity of the disincentives and the mildness of theincentives as had been done by the other two governmentservants discussed above in the analysis of the previous category.She, however, added that the enhancement of the period ofmaternity leave to five months was of no particular use to womanemployees. It would only result in idling away time. Instead,some other suitable incentive, like the grant of an advanceincrement, should have been introduced by the Government.

The three respondents from Uttar Pradesh were, again,well informed of the various measures announced by theGovernment for promoting family planning and of the proposedrevision in the minimum legal age of marriage. Two of them -were government servants and one was a big cultivator, in facta landlord. The two government servants were among thosewho had been given targets for motivation for sterilization.They, thereforc, knew the various measures fairly well, boththose which were applicable to the general public and thosewhich were applicable to public servants. The landlord was abenign type ofperson of olden days who would hold court everyevening of bis proteges and admirers over a'hookah'and the

'pandan'. While he would tell the assembly of the incentivesand di"incentives being otrered by the government, he also toldthem of the ill-effects of sterilization which he and some ofhis acquaintances had experienced. The result generally was togenerate a disinclination rather than an inclination for familyplanning (which for all intents and purposes meant only sterili-zation) among his audience.

In sum, of the 196 acceptors 128 or 65.3 per cent wereentirely ignorant ofthe new measures introduced by the Govern-ment for promoting family planning, 38 or 19.4 per cent hadonly a vague knowledge that a certain higher amount of incen-tive money was now being paid for undergoing sterilization.11 or 5.6 per cent knew of the higher incentive money as wellas ofthe proposal to raise the age of marriage but had nodefinite idea ofthe provisions of any of these measures and only19 or 9.7 per cent had some definite knowledge of one or moreof the measures introduced or proposed to be introduced by thegovernment. Thus, about 90 per cent ofthe acceptors amongthe respondents were either uninformed or very little informed

The People -Their Attitudes and Reactions I29

and only 10 per cent rather well informed of the new measures.

Ofthese 10 per cent, 6 per cent were again public servants whowere informed of these measures more as a part of their duty tomotivate people than otherwise. Only 7 or 4 per cent of theacceptorsfrom among the general public had a fairly good and

definite knowledge ofthe new measures.

The knowledge of the various incentives and disincentivesand other measures among the non-acceptors was as given inTable 5.16 on pages 130-31.

The non-acceptors were less informed of the new measures

adopted and proposed to be adopted by the government forpromoting family planning than the acceptors. This was

expected. They had less contact with the family planning andhealth staff which was the main source of information to thepeople on these measures. In many cases they deliberatelyavoided meeting the staff for fear of being caught for steriliza-tion. The incidence of literacy was also lower among them thanin the acceptors. Economically also they had a lower status,generally, within comparable groups. It is, therefore, notsur-prising that proportionately there were more of the ignorantand less ofthe informed in their ranks

Of the 155 non:acceptors, ll4 or 73.5 per cent had no know-ledge of the new measures, 27 or 17 .4 per cent knew of only oneitem, i.e. higher incentive money being ofered for sterilizationand 8 or 5.2 per cent of two items, i.e. the higher incentivemoney and the raising of the age of marriage. Of the latter twocategories, 32 persons had only a vague knowledge of one orthe other item. Only 3 had a definite knowledge-2 of the actualamount being admissible to the different categories of acceptorsofsterilization and one ofboththe actuai amount andthe specificminimum ages of marriage proposed to be enforced for boysand girls. All the three were educated, 2 belonged to the ruralareas and one to the urban. One of them was a serviceman andtwo cultivators but both had good urban coniacts. One ofthemwas a regular subscriber ofa newspaper also. The major sourceoftheir information was their urban contact.

Of the rest, two knew of the higher incentive money forsterilization, raising of the age of marriage and certain otherincentives being offered to the acceptors of family planning.One of them belongedto the urban and the other to the rural

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area. Both were educated above the middle school standard.One was a business man and the other a cultivator. While bothof them had a fairly good knowledge of the first two items,they had only apartial knowledge of the third, i.e. the otherincentives being oflered by the respective State Governments.The businessman respondent knew of priority being given in theallotment of house sites and grant ofhouse building loanstopersons who had got themselves or their wives sterilized afterthe birth of two children. The cultivator respondent knew ofthe grant of a rebate of 50 per cent in land revenue to suchfarmer couples of the eligible category as had undergone orwere willing to undergo sterilization. In both the cases theknowledge was incomplete. The former did not know that thepriority for house sites and house-building loans was admissibleonly in urban areas and the latter that the rebate in landrevenue was being granted for a period ofthree years only.Both the respondents had no knowledge of any other incentiveeither.

The only respondent who had a knowledge ofthe higherincentive money for sterilization, the raising of the age of marri-age and the disincentives introduced by the State Governmentwas a public servant in Madhya Pradesh. He was a matriculateand well informed of the various measures but was very criticalof the scheme of disincentives. His complaint was that theState Government had unnecessarily made sterilization compul-sory for all public servants who had more than three children,failing which the various disincentives would apply to themirrespective of whether any ofthem followed any other methodof family planning or not. In his view, by de-recognising othermethods of family planning and making the disincentives hard,punishments, the State Governmeut had taken a very harshmeasure.

The number of non-acceptor respondents who had a know-ledge of four items, viz. higher incentive money for sterilization,raising of the age of marriage, other incentives and the disincen-tives, were only three. All ofthem were public servants and welleducated. They had a fairly good knowledge ofrhe variousmeasures but were particularly well informed about the incen-tives and disincentives applicable to public servants. They allfelt that whereas the incentives being offered to public ssrvants

The People-Their Attitudes and Reactions I33

varied from negligible to small, the disincentives were uniformlysevere.

In the final analysis of the knowledge ofthe non-acceptorsabout the new nreasures, we find that only 4l or 26.5 per centknew ofone or more of them. Of the knowledgeable persons,as many as 27 or two-thirds knew of only one item, i.e. the pay-ment of higher incentive money for sterilization. They consti-tuted 17.4 per cent of the total non-acceptors. Those who knewof two or more items, vide Table 5. 16 above, were only 14 or9 per cent of the total. In the depth of the knowledge of thevarious measures, all those who knew of only one item and 5of those wbo kne w of two were only vaguely informed. Theyconstituted 20.7 per cent ofthe non-acceptors. Only 9 or 5.8per cent had a fairly good knowledge of one or more measures.All of them were educated, middle pass and above, had goodurban contacts, and were economically better offthan mo$trespondents among the non-acceptors. Five of them were inservice, three cultivators and one a businessman,

After enquiring into the state ofknowledge ofthe respondents,both acceptor and non-acceptor, about the new measuresadopted and proposed to be taken by the respective StateGovernments for promoting family planning, we pointedly askedthose who had a knowledge ofthese measures whether they knewthat these measures were being taken in pursuance of a newnational policy on population control announced by the Govern-ment of India in April 1976. Ofthe63 acceptor respondentswho had a knowledge of one or more of these measures, 45 or.

66.3 per cent did not know that these were a part of a newnational policy. In fact, they did not know that anything likea national population policy had been announced or was afootor what its aims and objectives were. Their whole idea of thesemeasures was very vague and woolly and none of them couldcorrelate these with a policy adopted at the national level witha definite aim and perspective.

Only 23 or I1.7 per cent of the acceptors knew that a newnational policy on population control had been adopted by theGovernment of Irdia and that the various measures of incentivesand disincentives introduced or proposed to be introduced bytheir State Goverrunents were a part of that policy. Althoughsome ofthem didnot know exactly or definitely the provisions

t34 Family Planning in India

of these measures, they all were aware of the fact that a newpolicy had been launched by the Government of India some

time back with a view to control and regulate the growth ofpopulation over the whole country. Most of them had a fairlygood knowledge of the various measures. All ofthem weieeducated and about half ofthem belonged to the service class.

The main source of their information were frequent contactswith the officials including the health and family planning staff,contacts in urban areas and reading of newspaper s.

Among the non-aqceptors, only 41 had a knowledge of these

measures but as many as 30 or 73.2 per cent of them did notknow that a new national population policy had been announcedby the Government of India and that these measures were beingtaken in pursuance thereof. Most of them. knew ofonly one

measure, i.e. the payment of higher incentive money and thoughtthat this was a kind of compensation or fee being paid to thosewho were williog to undergo sterilization. None of them hadany idea that this was one of the several measures of a nationalpolicy designed to control the growth of population. Only 11

or 7.1 per cent of the non-acceptors knew that a new populationpolicy had been adopted by the Government of India and thatthese measures were a part thereof. AII these persons wereeducated and about half of them were, again, servicemen,indicating thereby that both among the acceptors and the non-acceptors the educated ones in general and those in service inparticular were better informed on the national populationpolicy.

OprrroN oN NEw Polrcv Mr.lsunss

Of the various measutes introduced or proposed to beintroduced by the Government in pursuance of the new popula-tion policy, only two were commonly known. These were thepayment of a higher incentive money for sterilization and theproposal to raise the age of marriage. These were applicable tothe general public, whereas most of the other measures appliedto public servants and were known to them only. We therefore,decided to ask the opinion of our respondents on these twomeasures. Naturally, we put the question only to those whohad a knowledge of these measures. We have seen above that

The People- Theit Attitudes and Reactions 135

68 of the acceptors and 41 of the non-acceptots knew of the

measure providing for the payment of a higher amount of

monetary incentive fo r sterilization. We asked them two questions

on this issue: one, whether they regarded the increase in

the quantum of money being paid for sterilization to-the accep-

tor good aud, second, whethel the higher amount being offered

noliwould attract or induce more people to undergo steriliza-

tion. The answers we received are presented in Table 5'17 on

page 136.' it -igttt appear somewhat paradoxical that whereas 97 or 89

per cent of the respondents, both acceptor and non-acceptor'

*ho w.r. aware of this measure considered the increase in the

quantum of compensation or incentive money good, almost an

equal number thought that the h:gher amount would not attract

mtre people to sterilization. This clearly shows as stated earlier

that contrary to the belief of the policy makers, the financial

incentive of cash reward for sterilization was no motivating

factor. But having been accustomed to receive a cash award

for sterilization for a pretty long time, a feeling had grown inthe rninds ofthe people that sterilization was some kind of a

sacrifice or service rendered to the government or society

which merited a reward, and if it was so, it was better that the

reward was adequate rather than meagre. It was in this context

that a large majority of our respondents felt that the payment

of a higher amount of compensation money for sterilization was

good.It was, however, another matter whether the higher amount

would induce more people to come forward for sterilization' As

many as 9l or 83.3 per cent ofthe respondents, who were aware

of this measure of higher incentive money, felt that it would

not induce more people to take to sterilization. They opined that

however keen the people might be to avail of a financial benefit,

they were not willing to barter their reproductive capacity for amonetary gain. This is corroborated by the fact that not a single

respondent from our sample admitted that he had undergone

sterilizatiorr for the sake of money as may be seen from Table

5.12 supra.Five respondents from among the acceptors and seven from

the non-acceptors thought that the increase in the qu artum ofmoney being paid for sterilization was not a good step' They

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The People-Their Attitudes and Reactions 13:l

stated that the main purpose of the government in increasing the

amount was to attract more people to undergo sterilization but

this objective would notbe fulfilled because a large majority ofthe

people had a fatalistic outlook on the birth of children and many

of tn.to also felt that a large family, particularly the one con-

sisting of a good number of sons, wastheirbest asset for

economic security and raised their social prestige' Since very

little had been done to educate the masses on the virtue ofasmall family, the old ideas still persisted among them to a large

exrcnl.Coupled with this was also the fear that sterilizati on involved

some risk to their health or caused sexual inadequacy' These

respondents further said that although many people might not

be vocal about it, there was a general apprehension that steri-

lization was harmful in some way or the other' It was their con-

sidered opinion that the new measure would not achieve the

desired result, i.e. to attract more people to sterilization' Itwas, therefore, a wasteful expenditure and was not a good

measure in that sense. Although numerically small, this was a

group oi persons which was fairiy well educated and well

informed on the various issues involved in the implementation

ofthe new policY measures.

While none of the respondents from among the non-acceptors

thought that the new measure would induce more people to

undeigo sterilization, a group of eight from among the

u.."piorc felt that it would. Ali the eight had undergone sterili-

zation themselves but when asked whether any of them had

done so for the sake of noney, all ofthem denied nor could

they cite the example of anyone else whom they had. known to

have done so for the sake of money' Nevertheless, they main-

tained that because of wide-spread poverty, and extreme poverty

in some cases, some people might have accepted or might

accept sterilization for monetary benefit' However' our survey

did not find any supportive evidence to this view'

While nothing can bi said with certainty about the future'

none ofthe li5 respondents in our sample who had undergone

sterilization had admitted that he or she had done so for the

sake of money.Lastly, we asked the respondents their views,on the proposal

to raise tire age of marriage. Here too we put the question only


TABLE 5.18

Dtst sutroN op RrspoNorNts By THErR OprNroN oN THERersrNc on rue Aor or.M*nrecp

to those respondents who were aware of this measure. It may berecalled in this context that only 30 ofthe acceptors and 14 ofthe non-acceptors knew ofthis measure. We asked them whetherthey considered the proposal to raise the minimum legal age ofmarriage from the present I 5 years to 1g years for girls and fromthe present 18 years to 21 years for boys good. their answersare presented in the following table.

State andDistrict

Acceptors

Whether raising the ageof marri, ge was good

Yes No Cannot say

Non-Acceptors

lYhether raising the age ofmarriage was good

Yes Na Cannol say

Bihar

Gay^ 3Dhanbad I

M.P,

Hoshangabad 4Datia 3

Punjab

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U.P.

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While analysing the data compiled in the above table it mustbe remembered that it relates to a class of respondents. bothacceptor and non-acceptor, who were largely educated, about40 per cent of whom were in services, many of whorn. weremedium to big cultivators and some in good, flourishinE

The People-Their Attitudes and Reactions t39

business. Many of them had frequent contact with government

om.iuft, including the health and family planning personnel'

and some had other good urban contacts' A11 told' they as a

group *".. better informed and more enlightened than the

leneral tun of respondents in our sample'- Wi ft this proviso, we found that 23 ot '16'7 per cent of the

acceptors who were aware of the measure considered it good'

The consensus of opinion among them was that this would pro-

uid. b.tt., scope for the young men and women. .to develop

their personality und u gr.ut"i t"n'" of responsibility before

iirv g"t -^tri.i. only 4 or 13.3 per cent ol them thought that

it wai not agood measure. They felt that soon after boys and

girls Xtainei puberty, they should be married so as to keep

it"*in proper discipline. They further argued that even the

pr.r.nt ug" ii-its foi marriage were not being observed by manY

'pt"pr. i"?. "illages

and thi new measure providing for still

;i;h". ;g" limits would be a totally impractical proposition for

th! rurai areas. Three or 10 per cent of the acceptors did not

e*press th"m.elves on this measure one way or the other' They

simply said only time would show whether it was a good

-.uro.". They could not say at this stage whether it was good

or not.Of the non-acceptors who knew of this measure' 10 or 7l'4

p., ."ni uguin considered it to be good and cited more or less

il; ;." reason for its being good as the one given by

u.""prort who subscribed to this view' Only two or l4'3 per

cent'ofthem thought that it was not a good measure' Although

both were oppor.d to the proposed measure' their arguments

*"i. Oi"..tti"a1ly opposite to each other' One ofthem argued

that there should be no restriction on the age of marriage' The

other was an orthodox Hindu who thought it proper that boys

uiO girrc be married early. He said this was the tradition of

our Jountry and societv and was ordained by the scriptures'

Anong the non-acceptors also there were two respondents who

did not express any opinion onthe new measure'

Taking all the respondents, both acceptor and non-acceptor'

together, who were aware of this measure 33 or 75 per cent

"oitiO"r"A the proposition to raise the age of marriage good'

e o, f:.0 per cent thought that it was not good' and 5 or 11'4

per cent did not express ariy opinin' Apart from the number of

140 Family Plannhtg in India

respondents, who had a knowledge of this measure and weretherefore asked to express their opinion on it, being very small(only 44 out of 351 in rhe sample), the fact that thJy compriseda group which was better educated and better informed than thegeneral run of respondents conditioned their response to a con_siderable, extent. They did not constitute a cross-section ofpeopJe. Therefore, no general inference can be drawn from theopinion expressed by them.

CoNcLUDINc OssrnverroNs

As a general conclusion the study has revealed that althoughfamily planning was intended to enlist un u.tiu" puiii.ipation ofthe people, the motivatioa of the people towa.As tl" ,,"w popu_lation policy was simply not of the requisite level. ny anO tu.g"the programme had remained official_led

"ra u fu.g.'_";ority ofpeople had adopted it because official pressure wis brought to

bear on them.

^ The ways of exercising pressure were many and varied_threat

of a prosecution to shopkeepers, delay in the grant of croploans to cultivators, withholding of ailotment o?-iunO to funa_less agricultural labourers, denial of certain facilities to a clarsof people to whom they were normally admissible, and ofl.er ofinducement of certain benefits to ceitain p.opf" to *fri"f, tfr.ywere not normally entitled. These tactics had caused bothintense fear and acute resentment among the people.

The fear was so intense that many oflhe acceptors who hadadopted the prograrmme at the bidding of ttre otrc;als would notadmit that they had done so under thi pressure of the oflicials.They parried the question and gave oniy round-aboui *rr..r.By a series of supplementary questions the fact was broughtout that as many as Il5 or 5g.7 per cent of the acceptors hadldopted the programme because of the pressure of the officjals.Only 27 or 13.8 per cent of the acceptori were bold enough toadmit this openly. The two together constituted u totil of tqZ o,72.5 pet cent of the acceptors.

There was a high concentration of effbrt and attention onsterilization and a neglect of the other methods, so much sothat the family planning programme had come to be known incomrnon parlance as ..Nasbandi programme.,, This is evidenced


by the fact that as many as 175 or 89.3 per cent of the accep-

tors in our sample had gone in for sterilization and only 2l or10.7 per cent for the other methods. This high concentration ofattention on sterilization was due to the fact that the Govern-nlent as a matter of policy favoured sterilization to any othermethod. Consequently, a large number of sterilization camps

were held every year in each State and a cash reward was offer-ed for sterilization only.

The identification of family planning with sterilization haddone a great harm to the programme as a whole, On the one

hand, coercive methods were used extensively to acheive thetargets set for sterilization and, on the other, wild rumoursspread about the baneful effects of sterilization. Both caused

considerable resentment among the people and shook thefoundations of the programme.

Very little effort had been made to educate the people onfamily planning. Extension education was virtually non-existent,the extension staff being largely busy in canvassing people forsterilization under the quota system. Consequently, people hadremained largely ignorant about the various methods of familyplanning and their relative efficacy and a sizeable numbermaintained a traditional outlook on family l1te. 26.5 per cent

of the non-acceptors in our sample had no knowledge of any

method of family planning, 23.2 per cent considered children agift oI God and another 22.6 per cent did not adopt family plan-ning for a variety of misconceptions.

There were however some hopeful signs. Wherever the

family planning services were provided within the reach of thepeople, there was a beiter response indicating that family plan-

ning adoption is largely supply led. That is to say that morepeople tend to adopt family planning if the services are closer

to them.The second hopeful trend was that women were becoming

more concious ofthe need for family planning. Inspite of strongreligious taboos, even Muslim women \,vete becoming moreconscious. 34 per cent of the lemale non-acceptors in our sample

wanted to practice family planning but for opposition to it froartheir husbands and relatives. About half of these women were

Muslim.The number of respondents who had a knowledge of the oew

l4l


policy measures adopted by the government, both Central andState, was very small. Only 68 or 34.7 per cent of the acceptorsand 4l or 26.5 per cent of the non-acceptors knew of some ofthese measures and that too not very deeply or precisely. Amajority among both the informed acceptors and non-acceptorsknew of only one measure, i. e. the offer ofa higher amount ofmonetary incentive for sterilization. A distant second numberwas of those who knew of two measures, i. e., ofhigher monetaryincentive and the proposition to raise the age of marriage. Theother measures were known only to a very small number ofpeople, a large majority of whom were urban educated andservice class people. Such little knowledge ofthe new measureswas partly due to the fact that only a few weeks to a fewmonthshad elapsed since these measures were introduced wlen ourinvestigations began and pa-rtly because very little publicity andextension work had been done on the new measures.

There was very little r'mpact of these measures on thepeople. Even the higher amount of incentive money by whicha great store had been set by the policy makers, failed toattract people to undergo sterilization. Noi a single respondentadmitted that he had undergone sterilization for the sake ofmoney nor anyone cited any case where money had played amotivating part.

The provision to raise the age of marrige was still aproposal and, therefore, did not affect any one. Othermeasures related to the scheme of incentives and disincentivesintroduced by the State Governments on their own initiative.By and large, these schemes were highly restricted in theirscope. In two of the four States in our sample these appliedonly to public servants and in the other two largely to publicservants. Public servants were generally educated and self-motivated towards famiiy planning and needed no particularincentive or disincentive to motivate them. Further, the incen-tives offered were generally of a weak and minor nature butthe disincentives were harsh and definite. Whereas theincentives hardly enthused any public servant, the disincen-tives did definitely generate a sense of cynicism and demora-lisation among a large majority of them.

Where the disincentives applied to the general public, theyalso did not take kindly to them. So strong was the reaction of


the people against them in U.P., where these applied most tothem, that the Government was forced to withdraw the scheme

within a few months of its introduction. It was clear thereforethat the scheme had not been based on any study ofthe people'smotivation.

CHAPTER VI

Overview and Policy Implications

The policy of incentives and disinoentives, which constitutedan important part of the new population policy of theGovernment of India announced in April 1976 was accordingto the findings of the present study a prime example of non-policy. If therewere any sound basis for formulating the policy,the Government has succeeded in concealing it effectively, forthe deficiencies in the policy are so glaring and ttre damagedone to the programme so extensive that it would have beenmore advisable if the policy was not formulated.

The most important limitation of the policy seems to bethat it was not based on any serious examination of themotivations and preparedness either of the people or of theadntinistralive machinery. The extensive experience of theGovernment with other policy areas would have normally ledone to assume that major policy measures are preceded by anintensive and indepth analysis of the various factors whichmake for the success or failure of the policy measures.

Of all the factors, the factor of people's motivation is themost decisive one in a measure of this kind. Experieuce inIndia as well as abroad has repeatedly shown that in ademocratic system the use of any kind of force is counter-productive. There is therefore no option to education andpersuasion, processes which are complex in their character andundoubtedly exasperating 1o a Government bent on quickresults. Even so, there is no demonstrable case that suchschemes ofincentives and disincentives can be sold to citizens

Overview and Policy Implications 145

without a massive campaign of bringing about mass cons-

ciousness and preparedness.

If the Government of India had any data to the contrarysuggesting a level of motivation of the people to accept the

new package, neither the policy pronouncement nor any ofthe ofrcial publications reveal what the basis in fact was'

There is, therefore, ample ground to feel that there was no

sufficient study of the basic data.

The findings of the present study do however indicate thatcertain ofthe measures, such as freezing of people's represen-

tation in the Lok Sabha and the State Legislatures on the

basis of the 19?l census until 2001 A.D.' did make for asizeable impact on the State Governments. The same cannot

be said as far as the scheme of incentives and disincentives as

applied to the citizens and a whole class of civil servants is

concetned.In other words, the study shows that the new policy of

incentives and disincentives was based on totally erroneous

data, if any, in terms of the motivations of the people' Forinstance, the incentive of additional financial reward was

based on the assumption that it would provide an importantincentive to the people to accept sterilization. The evidence

collected during the. present study showed that this was in fact

not so. Not a single person admitted having been influenced

by the lure of higher incentive money to undergo sterilization.The financial incentives, at any rate the ones visualized in the

programme, thus meant nothing to the people inspite of the

much advertised poverty of the Indian masses.

Similarly, other parts of the package were based on avariety of assumptions regarding how the people, and even the

civil servants, would react to the prescribed measures. All these

assumptions were essentially invalid and demonstrated thatpublic policy which in a real sense is not based on essential

requisites of the policy process but on the hunches and

predilections of officials, however exalted, is foredoomed tofailure.

Indeed it is now quite apparert that the policy implications

of the new package were utterly disastrous to its objectives.

Instead of supporting the reasonable popular response tofamily planning progranme which had been forthcoming over

t46 Family Planning in India

the years, the new package of incentives and disincentives hasled to profound hostility both of the citizens and even moreimportantly ofthe State instrument, viz., civil service engaged

in the implementation of this package.

Undoubtedly the matters were made highly complicated bythe seeningly innocuous provision inthe new package ofthescheme of compulsory sterilization to be implemented at theoption of the State Governments. In the process of implemen-tation ofthe new package, this option virtually became thepopulation policy in all the four States under study which tookto it with a vengeance resulting ultimately in the total collapseof the policy itself.

It is also very important to record that despite all thefanfare, the instrumentalities for implementation of the newpolicy package did not exist in adequate measure. The infra-structure necessary for carrying out the programme,especially in the rural areas, was exceedingly poor and where-ever it existed it was too deficient to perform the necessary

tasks. As a result, ad hoc arrangements had to be made andsterilization camps had to be established in the countryside ina haphazard fashion which led to many clinical complications.This created further scare amongst the population andaroused their hostility to the programme.

During our study we also found that the figures of steriliza-tion were inflated in the records ofa nunber of service centres.Upon investigation it was revealed that in many cases thepersons who were reported to have sterilized simply did notexist. Such fictitious adopters of sterilization created all kindsof problems to organisational discipline. Also in many cases

we found that false certificates were issued about sterilizationto keep to the prescribed quotas for the officials.

In sheer organisational terms, we found above all that thePrimary Health Centres were, to put it mildly, grossly under-equipped and understaffed. Not only was there an acuteshortage of properly trained medical personnel to undertakefamily planning work in these centres but they also were quiteoften poorly supplied with the various family planning devices.

This indicated an odd feature of the programme that thepolicy was made without giving adequate thought or attentionto the question of organisation for implementation. This

Overtiew and Policy Implications 147

inadequacy in organisational infrastructure was not lessdisastrous to the programme than its inability to mobilisepeople's motivations.

Ofno less negative consequence was the manner of use ofthe civil service in the implementation of the programme. Notonly did the harsh measures create severe dilemmas for thisentire class, but they also turned one ofthe major adversariesof the scheme. Besides they also became victims of many ofthe harsh measures leading to their severe demoralization.

In retrospect, the new policy brought about a severe deva-Iuation ofthe government and the governmental apparatus inthe eyes of not only the people but even the civil service itself.In that sense, the implications of the programme were farreaching. This was in many ways the first major programmesince independence where the people wsre pitted against thegovernment. Everything the latter did was suspect and createda credibility gap in the government's relationship u'ith thepeople going far beyond the confines of the populationprogramme. No wonder therefore that this became the biggestpolitical issue in the history of independent India, and playedperhaps a decisive role in the Lok Sabha elections of 1977.

The new population policy package, especially the scheme

of incentives and disincentives, thus illustrates severe deficienciesof the public policy making process in India. Above all it shows

trow poor the information base of the policy was. None of thefour State Governments which we studied had made any effortsto develop the necessary information base before starting theimplementation ofthe new policy. Instead, they issued a series

of orders without any qualms as to what impact they wouldhave on the citizens or the civil servants or on the policy itself.In that sense the programme showed a massive political failure.The emergency prevailing in the country no doubtplaledanimportant role in the failure of political comnunication.

The deficiencies in the ihfornation base were compoundeddown the line in all the facets of policy making. Indeed, thepolicy implication of the implementation of incentives and dis-

incentives truly suggest the need fbr a more organised publicpolicy process and its implementation.

The immediate adverse implications of .the new policy to


the overall family planning programme have by now become

widdly known. To put it mildly, the programme has been badlydiscredited in the eyes of the people in all the States where

forcible sterilizations were made.For a nation which has faced severe stresses and strains of

inadequate food supplies and low per capita income for thelast thirty years or so, it needs hardiy be emphasised that Indianeeds to planand control its population. From that point ofview it was unfortunate that the new population policy package

was not made an integral part of the overall plan of develop-ment and programme of the State Governments. One of theimportant findings of the study is that none of the StateGovernments have yet conceived of a population policy forItself in terms of its economic development, manpower needs,population distribution, etc. The new population policy withaccent on sterilization was clearly a Central Government pro-gramme directed from the top. From every count, this has beenanother maj or limitation of the programme. The events of theperiod from April 1976 to about January 1977 have only con-firmed the experience from many other areas, how a sociallysensitive programme pushed from the top without a carefulstudy and planning especially at the grassroots can be counter-productive and almost destructive of its objectives. There is nodoubt that it will take years before the family planning pro-gramme in India, by whatever name it is called, recovers at leastin these four'States and perhaps in many others.

This is not to say that the situation on the ground is bereftof hope for the dissemination and acceptance of family planning.It is an important finding of the present study that, like manyother crucial services, the adoption of family planning practices.

is supply-led. In other words. whenever a progranme and theservices are taken closer to the people, there is a greater degree'

of their acceptance and adoption. With additional effort on theextension and educational dimension of the programme, theprocess could be accelerated and made considerably speedier.

The most important positive fiinding of the study is tbereforeto take education, family planning technology and the infra-structure as close to the people and in as quick a time as possible.

All the three dimensions are crucial for the future of the pro*gramme of population planning in India.

Overview and Policy Implications 149

Of no less significance is the finding that women, even fromthe minority communities, were keen to leam and practise familyplanning. The reasons for their motivations differ. The religioussanctions which many of them fear are also to be reckonedwith. Nonetheless, larger and larger number of women seem tobe more wiliing to adopt family planning measures which arenow available, Several other studies have already shown howwomen's education is an important pre-requisite for theiracceptance of famiiy planning. The present one only confirmsthis trend and reinforces the need for a more concerted effortin the direction of providing every possible assislance to womenfor adopting the family planning devices.

It is also an important finding about family planningorganisation that whenever a clinic or a Health Centre is headedby a medical practitioner who has an aptitude for and dedica-tion to family planning work rather than to general medicine,people's response has been more systematic and more extensive.

Organisationally speaking therefore it will be far more effectiveand desirable to create specialised family planning services inthe primary health centres and as close to the grassroots aspossible with medical practitioners who are genuinely orientedto family planning located in them.

These hopeful findings suggest some important policyoptions. First of all, there is a need for an extensive programmefor developing mass consciousness of the people about thefamily planning programme and the various techniques ofdoing so. The traditional programmes of education and exten-

sion have been largely based on official media and bureaucraticapparatus. This is good as far as it goes. But it is not good

enough. The coverage by these instruments is still very limited.The problem is aggravated by the serious erosion of people'sfaith in the governmentai machinery arising out of the disastrousprogramme of forced sterilization in family planning during1976-77. It will be years before this instrument becomeseffective again.

What then are the options in this direction? Ideally speakingfamily planning should be made a major public issue and inthat sense a political one so that all political institulions areinvolved in promoting the requisite level of mass consciousness.

The unfortunate events of 1976 and 19'17 may not make this


immediately feasible.Nonetheless, overthe coming years the ideals of a broader

programme of family welfare, including not only family plan-ning measures but also maternity and child care, public health,etc., should be brought closer to the people in their day to daylives. In this process, first of all, the political organisationsincluding the Panchayati Raj system should be greatly utilised.Some ofthe States are already doing this. The practice needsto be extended to other parts.

Of great policy significance is also the role of voluntaryeffort. While organised voluntary eflo$ is not a universalnational phenomenon, there are many parts of the countrywhich have extensive traditions of people's initiative andcoming together for such work. The effectiveness of suchvoluntary agencies in mobilising people in diverse fields suchas education, marketing, credit etc. has been ably demonstratedin different parts ofthe country. Health has been a more recententrant into this field. The state should make a more consciousefort to encourage this process and to support people's move-ments in this direction in whatever form they exist. The payofmay not necessarily emerge overnight. Even so, the efficacy ofvoluntary effort as against state action is widely known andaccepted. This needs to be strengthened.

This does not mean that the Governmental machinery shouldnot have a role. Indeed the essence of public policy in popu-lation planning should be geared to the development of anextensive infrastructure of family planning and taking theseservices as close to the people as possible. Instead of becomingover-concerned with the setbacks of the. disastrous campaignof 1976-77, more eforts should be directed in building thesinews of the programme. As other state activities in the fieldsof rural development, employment guarantee, education, etc.grow, there would be a natural fallout in favour of familyplanning programme.

Indeed the various types of economic development activitiesand family planning measures could be more effectively tiedup if the necessary organisational means for fanily planningare created and nurtured over the next few years. This is nomean task, for even in urban India the organisational infrastruc-ture is still inadequate. In the rural areas it is almost non-

Overview and PolicY ImPlications

existent. This progrmme itself would involve investment in the

development of necessary manpower base and supporting

medical and para-medical services. The figure of a mere 5000

and odd family welfare centres for a colurtry of India's size isbut a drop in the ocean. As the present study has noted even

the existing FHCs are woefully understaffed and under-supplied

to maintain proper health and family planning services to the

rural people. A systematic efort to develop them technicallyand with supporting services should be the cornerstone of the

population planning programme which could be re-established

in the next few years.

There are of course several specific suggestions emerging

out of the study. These have been discussed in the respective

chapters. It is not therefore necessary to repeat them here'

Besides many ofrne issues have become dead as a result ofthepolitical developments culminating in the Lok Sabha and subse-

quent State elections in 19'17 . Most of the State Governments

have already resiled lrom their earlier positions in their respec-

tive areas.The danger however is to go too far in the reverse direction.

This therefore calls for a great national debate ofthe issues ofpopulation and development not only in aggregate sense forthe country as a whole but more specifically in disaggregated

terms at the State level. Indeed any further delay in doing so

is dangerous at this crucial State level. None of the State

Governments have yet developed their respective populationprofiles for the next 10-20 years. This must be encouraged by

the national planning agency and the Central policy apparatus'

In other words, a greater political or policy consciousness needs

to be developed in this programme as in many others' The

efforts of the present study are a small contribution in thatdirection.

151

APPENDIX I

Lrsr oF SELEcI ED UNITs

State DistrictUrban Family

Planning Centre

PrimaryHealth VitlagesCentre(Rural)

Bihar

M.P.

Punjab

U,P.

Gaya

Dhanbad

Hosbanga-bad

Datia

Ropar

Amritsar

Allahabad

Rampur

Lady Elgin ZenanaHospital, Gaya.

Civil Hospital,Dhanbad.

Civil Hospital,Itarsi.

District Hospital,Datia.

Civil Hospital,Ropar.

Urban Family,Planning Unit,Rambagh,Amristar.Dufferin Hospital,Allahabad,

Civil Hospital,Rampur.

Bodhgaya

Nirsa

Dolaria

Indergarh

Bharatgarh

Rural areaswere inac-cessible dueto floods.Chaka

Bilaspur

BelidaBairaniAmuaKaliasolef)umariaKerabankDolariaRohanaSemrikburdJauniaRarua RaiChikau

JhakianBeliNaggal-Sirsa

DadariDhanuaDabhanvaManpurOjha LalpurBisarad Nagar

A?PENDIX II

Guron Poturs ron DrscussroN wrtg Opnctlrs

I. STATE LEVEL

The main subject of discussion at th'e State level will be the

policy measures adopted by the State Government for checking

ine j.owttr of population. In this connection, a discussion will

Ue tr-eta with the Secretary, Depaflment of Health and Family- Planning and also, if necessary, with the Secretaries, Depart-

-rnt oi Education and Social Welfare, and the Department of

Food and Agriculture or with their nominees' With the latter

two officers the discussion will relate mainly to the subjects

incorporated in the new population policy pertaining to their

,"rp..tiu" fields. A discussion wiil aiso be held on the steps

taGn or proposed to be taken for the implementation of the

new population policy as announced by the Centre and adopted

ty th. itut.. In ttisregard the discussion will be held with the

Director of Medical and Health Services, the State Family

Planning Officer and other officers of the State Family Planning

Bureau. With regard to the schemes falling in the jurisdiction

of the Department of Education, Social Welfare or Agriculture'

a discussion will be held with the Director in'charge of the

department concerned or his nominee'

The broad guide-points along which the discussion will be

held are as foliows. Ttese are only suggestive and can be suit-

ably expanded or modified in the light of the situation obtaining

in u State both in respect of the adoption of policy and the

organisation of the Programme.-I. What is the broad policy frame of your State for curbing

the growth of population, particularly for the next 3 years' i'e 'the remaining period of the Fifth Five Year Plan?

2. How Joes this frame flow from or is related to the

National Population Policy recently announced by the Centre?

3. What speciflc measures have been taken or are proposed

to be taken by yout State for implementing this policy?


(i) Introducing compulsory sterilization.(ii) Raising the age of marriage.

(iii) Increasing monetary incentive to acceptors.(iv) Introducing or expanding the scheme of group

incentives.(v) Introducing or strengthening the applied nutrition pro-

gramme (ANP).(vi) Expanding or strengthening facilities for female

education.(vii) Introducing population studies in the educational system

of the State.(viii) Expanding assistance to voluntary organisations engaged

in promoting family planning.(ix) Introducing incentives such as grant of priority in house-

building loans, allotment of house-sites etc., and othersuch schemes.

(x) Introducing disincentives such as refusal or reduction ofmaternity benefits, refusal of house-buitding loans,allotment of houses or house-sites, loans for purchase ofvehicles, etc.

(xi) Formulation of special schemes for promoting familyplanning among the rveaker sections of society, such assmall and marginal farmers, landless agriculturallabourers, scheduled castes arid tribes, etc.

(xii) Any other measures taken or proposed to be taken.

4. What are the salient features of the various schemesmentioned above?

5. What is your rating of the efficacy of the various measurestaken or proposed to be taken for promoting family planning?

6. What is the thinking of the State Government on thequestion ofcompulsory registration of marriages? If it is decidedto have compulsory registration, what administrative arrange-ments are envisaged for the purpose?

7. With the'recording of births being so scrappy. particularlyin the rural areas, how is the minimum marriageable age soughtto be enforced?

8. A higher monetary incentive for sterilization will attractonly those who are in dire need of money. This is not likely toincrease the ranks of family planning acceptors appreciably.

Appendix II 155

What particular advantage is then seen in raising the amount ofmonetary compensation?

9. What is the thinking of the State Government on intro.ducing compulsory sterilization? Will it be socially desirable,psychologically acceptable to the people and adninistrativelyfeasible?

10. If it is decided to introduce compulsory sterilization inthe State after the third child, how many more doctors, nutses,

clinics and hospitals will be needed to cope with it and in how

many years will it be possible to provide them?11. Howdoesthe State Government feel about freezing of

people's representation in the Lok Sabha and the State Legisla'ture on the basis ofthe population of 1971 until 2001?

12. What is the reaction of the State Government to the freez-

ing of the devolution oftaxes, duties and grants-in-aid to theState on the basis of the population of 1971 until 2001?

13. What is the opinion of the State Government on theprovision in the new population policy that 8percentoftheCentral assistance .to State Plans will be specifically earmarked

against performance in family planning?14. What steps are being taken by the State Government for

extending facilities for sterilization and medical termination ofpregnancy to rural areas? How long will it take to cover

adequately the whole State with such facilities?15. How and since when have the public health, M.C'A.

and A.N. programmes been integrated with the F.P. Programme

in the State?

16. What have been the results of such integration? Has

there been an increase in the ranks of F.P. acceptors as a

result thereof? If so, to what extent and how has it been

measured?17. Has the responsibility for the motivation of citizens

towards responsible reproductive behaviour been made an

integral part of the normal programmes and budgets of the

different departments of the State Governmeut?

18. What is the system of registration of births and

the State? Is it working successfully? If not, what'proposed to be taken to improve its working?

19. What steps have been taken or are proposed toto dispense better health care to the nursing and

deaths insteps are

be takenexpectant

r56 Family Planning in India

mothers and the young children?20. In what manner has the use of the mass media been

intensified or is proposed to be intensified by the State Govern-ment for propagating family planning?

21.Is the State Government conducting any research onreproductive biology? Ifso, with what results? If not, does itpropose to conduct such research, and if so, on what lines?

22. lt is understood that certain categories of Governmentemployees have been allotted quotas for bringing persons forsterilization and ifthey fail to fulfil their quota, penahies likewithholding of pay or increment will be imposed. How doesthe State Government justify these? What is the reaction ofthe employees to these measures?

II. Drsrnrcr Lrvnr

At the district level, the discussion will relate mainly toprogramme planning. The discussion will be held with theDistrict Family Planning Officer and other officers of the Dis-trict Family Planning Bureau, the District Health Officer andthe District Planning/District Development Officer. With regardto specific schemes incorporated in the new population policysuch as the introduction ofpopulation studies in the educationalsystem or impoving the standard of child nutrition, a discussionwill be held with the District Educalion Ofrcer, the DistrictSocial Welfare Officer or the District Agriculture Officer asthe case might be. The broad guide-points along which thediscussion rvill be held are as follows:

1. Is there a proposal to introduce compulsory sterilizationin your district during the current year? If so, what arrange-ments have been made or are being made to enforce it?

2. How is the current year's quota for sterilization and otherforms of family planning allotted to the district by the StateGovernment proposed to be fulfilled?

3. What categories of public servants have been allottedindividual quotas for motivation for sterilization. What is theirreaction to this kind of work?

4. What arrangement has been made for the payment ofhigher incentive money for sterilization? How is the schemeworking? How is it being received by the people?

APPendix II 157

5. Whom is the higher incentive money atlracting to undergo

sterilization? To what extent is this measure likely to increase

the ranks of accePtors?

6. What is your rating of the efficacy of the various measures

taken or proposed to be taken for promoting family planning?

7. What is the state of recording of births and deaths in your

district, particularly in the rural areas? To what extent do births

and deaihs go unrecorded? If the recording is not satisfactory,

how will the proposed legal minimum age of marriage be

enforced?8. What administrative arrangements are proposed to be

made for the registration of marriages in your district?

9. What are the facilities available for sterilization and

medical termination of pregnancy in your district?

10. What steps have beentaken or are proposed to be taken

for augmentinglhese facilities' particularly in the rural areas ofvour district? How long will it take to cover the whole district

adequatelY with such facilities?

t t. Sinle when have the public health, M'C'H', and A'N'programmes been integrated with family planning programme

in y-our district? ln what manner has the integration been

eflected?12. What has been the result of such integration? Has there

been an increase in the ranks of F'P' acceptors as a result

thereof? Ifso, to what extent and how has it been measuted?

13. What steps have been taken or are proposed to be taken

for raising the livel of education of girls, particularly above the

middle school standard?

14. Have any arrangements been made or are proposed to

be made for introducing population studies inthe schools and

colleges of your district? Ifso, what?

15. Is any child nutrition programme runnlng rn your

district? If so, what' since when and how successfully? Is there

urrj ,.n.-. or proposal to augment, improve or strengthen the

working of the Programme?tO, Wtrictr voluntary organisations have been working in the

field of family planning in your district? What has been their

role in Promoting familY Planning?17. iow are voluntary organisations proposed to be associat-


ed more closely with ihe promotion of family planning in yourdistrict?

18. What has be en the role of popular organisations like theZilla Parishad, the District Cooperative Union, the LabourUnion or Unions etc. in propagating family plaming? Howare these organisations proposed to be involved moreintimately with the impiementation of the new populationpolicy?

19. What kind of group incentives are being given in yourdistrict to whom and for what purpose? Are these proposedto be introduced/strengthened/revised? If so, in what manner?How do these incentives promote or are likely to promotefamily planning?

How is extension education on family planning organised inyour district? What is the role of the mass media in this work?Is the extension education and the use of the mass mediaproposed to be intensified? If so, in what manner?

21. What steps have been taken or are proposed to be takenfor dispensing better health care to the nursing and expectantmothers and the young children?

22. How is inter-departmental or inter-agency coordinationeffected implementing the family planning programme in yourdistrict?

23. How are the various incentives and disincentives introduc-ed by the State Government being implemented in your district?What is the reaction of the people and/or public servanrs rothese measures?

24. What steps does the District Administration take forfulfilling the quota of sterilization and other family planningtargets allotted to it by the State Government from year toyear? What methods does it use to get people round to adoptone or the other of the family planning practices?

25. What difficulties, if any, does the District Administrationexperience in getting adequare and timely supply of the neces-sary drugs, medicines, other material and equipment for runningthe^programme or in the posting of medical and para-medicalstaff.


sion Educator, L.H.V., A.N.M., etc.) to the eligible couple s?

How is their work supervised?8. What is your rating of the efficacy of the various methods

used for motivating people, such as inter-personal communica-tion, group meetings, mass meetings, film shows, etc?

9. Are any targets allotted to your centre by the districtauthorities for sterilization, loop insertion and other forms offamily planning? On what basis or criteria are the targets

allotted?10. What steps are taken by your centre for fulfilling the

quota of sterilization and other family planning targets allottedto the centre? What methods are used to get the requisitenumber ofpersons round for adopting one or the other of thefamily planning practices?

11. If any particular facility, such as for tubectomy orM.T.P., is not available at your centre or within the jurisdictionof your centre, what is done in such cases?

12. What is the quota of your centre for sterilization and

other forms of family planning for the current year? How is theprogramme being organised and run so astofulfilthe quota

within the stipulated time?13. Have any camps been organised or are being organised

for the purpose? If so, in what manner? What are the faci-lities offered and incentives provided to the acceptors at these

camps?14. Have any individual quotas been allotted for sterilization

and other forms of family planning to the staffof the centre

and other public servants? If so, what and to whom?

15. What are the rewards and penalties for the fulfilmentand non-fufilment of individual quotas. What is the reactionofthe staf of the centre and other public servants to thisscheme?

16. How is the inter-departmental coordination effected at the

block/centre level? How are the employees of other departmentsmade to work for this programme?

17. What are the arrangements for disbursing incentive orcompensation money for sterilization? Whom does this incentive

attract generally to undergo sterilization? What is the reaction

of the people to this measure?

18. What steps have been taken to publicize the various

Appendix II

III Loc,ll Level

At the local level, i.e., the Primary Health Centre for therural areas and the Family Welfare Planning Centre for theurban, the discussion will relate mainly to the implernentationof the programme. At these centres a discussion will be heldwith the Medical Officer-in-Charge of the Centre and otherstaff such as the Second Medical Offcer, where there is one,the Extension Educator, the Lady Health Visitor, the FamilyPlanning Field/Welfare Worker and the Auxiliary NurseMidwife. Besides these, the Block Development Officer and certainExtension Officers of the Block for the rural areas and someMunicipal Officers like the Health Officer and the EducationOfficer for the urban may also be contacted and a discusion heldwith them on particular items of the programme. Further, at thevillage or the Ward level a discussion will also be held withofficials like the Village Level Worker, the Patwari, the SchoolTeacher, the Sanitary Inspector, etc., as and where they havebeen associated with the implementation of the programme andare available for discussion.

While specific questions will be asked from the officialswho are directly concerned with particular items, the broadguide-points along which the discussion will be held are as

follows:

1. What are the facilities available for vasectomy, tubectomy,I.U.D. and other forms of family planning in the area coveredby your Centre?

2. What is the mode of organisation of the programme forthe different methods?

3. How are people eligible for practising famiiy planningidentified? What are the criteria laid down for the purpose?

4. Are any records maintained of such persons? Are theseperiodically updated?

5. What other records are maintained by the Centre/Sub-centre?

6. How are eligible persons motivated for practising familyplanning? What are the criteria for recommending particularmethods to particular persons?

7. What is the frequency of the visits of the field staff (Exten-

159

incentives *u u*,".",,,o1','"::^::"rby the state o"".:lment for promoting family planning? To what extent are peopleaware of these measures and what is their reaction to them?

19. To what extent have the said incentives and disincentivesbeen effective in mobilizing people, including public servants,to undergo sterilization or adopt other forms of familyplanning?

20. Are any voluntary organisations engaged in family plan-ning work in your area? If so, which and in what way?

21. ls there any definite plan or instructions from above toassociate these organisations more closely with family planningwork? If so, what?

22. How are the Panchayat Samiti, the Gram Panchayats,the Cooperative Societies, the Labour Unions etc. associatedwith family planning work? Is there a plan to associate themmore closely with the programme? If so, in what manner?

23. Is any scheme of group incentives operating in your area?If so, which and what are its salient features?

24. What is the role of local organisations like MahilaMandals, Youth Clubs, Young Farmers' Associations, etc. inpromoting family planning? Is there any scheme to associatethem more intimately with the programme?

25. Has anything been done so far, in the wake of the NewPopulation Policy, for expanding and strengthening-

(a) female education,(b) child nutrition,(c) care of the expectant and nursing mothers.

26. To what extent are people in your area aware of theproposal to raise the legal minimum age of marriage for boysand girls? What is their reaction to the proposal?

27 , What is the state of registration of births and deaths inyour area? To what extent do these go unrecorded? Iftheposition is grossly unsatisfactory, how is the legal minimum ageof marriage proposed to be enforced?

28. What mass media communication facilities are availableto the centre for propagating family planning? What is thefrequency of their use? Are you satisfied with their use? If not,what is proposed to be done to intensify their use?


29. What difficulties, if any, do you experience in the propa-

gation or execution of the programme in respect of:

(a) staff; (b) supply of essential goods and equipment;(c) transport and communication; (d) any other matter.

30. What are your suggestions for improving the working ofthe programme?

Apprsorx III

SrurcrroN or Accrrrons eNn NoN-accEpronsS.q.MPrtlIc DEstcN

For the selection of acceptors and non-acceptors of thefamily planning programme it was necessary to conduct a census

of all the eligible couples residing in the selected villages of thePrimary Health Centres and selected wards of the FamilyWelfare Planning Centres. These couples would constitute theuniverse for the selection of the sample. However, owing tolack of time and resources at our disposal it was not possible

for us to carry out a census. Consequently, we had to dependupon the record of such couples maintained by the PrimaryHealth Centre in the rural and the Family Welfare PlanningCentre in the urban areas. This record was compiled by themafter conducting a census and was periodically updated. Therecerd is called the "Target Couple Register." A target coupleis that who is eligible for practising family planning, theelicibility being determined by the criterion that the rvife shouldbe of the reproductive age, i.e., between 15 and 45 years.

The target couple registers are maintained village-wise inthe rural areas and ward-wise in the urban: Since we haddecided to restrict our enquiry to a referetce period commen-cing from lst April 1975 and ending with the date of visit ofour investigating team to a centre in the months of June toAugust 1976, we called out the names of such couples fromthe target couple registers as had during the said period adoptedthe programme and ofthose who had been approached and can'vassed to adopt the programme but had not adopted it. Thus,

we got two categories ofpersons from the target couple register,one of those who had accepted the programme and the otherof those who had not.

The acceptors and non-acceptors were then stratifiedseparately into two to three broad occupation groups. In therural areas the stratification was made into cultivators and non-

cultivators and in the urban into shopkeepers and businessmen;

164 Family Plannlng in India

servicemen and professionals; and others. The principal occupa-tion of a person as recorded in the target couple register formedthe basis of the classification of the couples and accordinglythey were placed in the different strita. In the case of womenwho were not following an independent occupation, the eccupa-tion of their husband was taken as their occupation. Each ofthe aforesaid stratum was further stratified into male andfenale categories. The narnes of the persons falling in a sub-stratum were arranged in an alphabetical order and from eachsub-stratum a sample of 25 per cent prospective respondentswas drawn at random with the help of Tippet's RandomNumber Taltles.

In actualiy constituting the sample, however, a number ofdiffculties were experienced. In the first place, a widespreadfear and an intense suspicion of the government prevailed inthe country, particularly in North India, with regard to famrlyplanning at the time our study was conducted. People weregenerally unwilling to talk, much less give an interview, to anoutsider on anything connected with family planning. This mademany a respondent falling in our sample try to avoid meetingour investigating team altogether. The non-acceptors amongthem feared that we would have them hauled up for steriliza-tion. The acceptors felt that we might involve them in somefurther complications. Consequently, we did not get the fullcomplement any where. In some of the areas where the numberforthcoming was too small we had to resort to substitution, carebeing taken to select the substitutes from among the similartype, but in most of the areas we had to make do with suchnumber as was available.

Another difficulty was with regard to getting riomen respon-dents from the rural areas speak to our investigating team whichconsisted of only male investigators. An experienced ladyinvestigator had been recruited for the study but she left thejobduring the very first visit to the field and time did not permitus to appoint another lady investigator. We had, therefore, toconduct field investigations only through male investigators.Except in Punjab, this inhibited the women in the rural areasof the other three States in our sample, viz., Bihar, MadhyaPradesh and Uttar Pradesh, from coming forward to give aninterview. Whereas such women from U.P. and M.P. could

Appendix III 165

somehow be persuaded to talk and give an interview to ourteam, those in Bihar altogether refused to give an interview.Consequently, we had to go without any representation ofwomen in our sample from the rural areas of Bihar,

Yet another difficulty experienced was with regard to theoccuirence of heavy floods in the Amritsar district ofPunjab inthe months of August and September 1976, on account ofwhich we could not reach any villages there inspite of successive

attempts. Therefore, there was no representation of res-pondents from the rural areas ofthat district in our sample.

Even in the city of Amritsar many localities were flooded orwere covered with slush and n)ud caused by floods. We could,therefore, get only a small number of respondents from thereand that too with considerable difficulty.

ApppNorx IV

INcpNrrvrs Fonrrlurarso By SrATE GovpnNusrrs nonPnououNc FAMTLY PtaNNrNc

StatesIncenlircs

Bihar M.P. Punjab U.P.

1. Additional monetary incentive forsterilization offered to personshaving 4 or more children Yes

2. Certincate of Commendation topublic servants for fulfilling quotaof motivation for sterilization Yes

3. Letter of Appreciation to Govern-ment servahts for exceeding quotaof motivations for sterilization by1 to 25Y. Yes

4. gnspecified award to public ser-vants for good performance inmotivation for sterilization Yes

5. Unspecified award to Govern-ment servants for exceeding quotaof motivation for sterilization bymore tha'f, 250/1 Yes

6. Monetary incentive of Rs 6 percase of motivation for sterilizationin ercess of the quotar Yes

7. Cash award to public servants forexceeding the quota of motivationfor sterilization by 50j{ or more Yes

8. One advance increment for fulfil-ling double the quota of motivationfor sterilization*+ Yes

9.50"1 rcbate in land revenue for 3

years to target couple farmers forundergoing sterilization Yes

10. Period of maternity leave to femaleGovernment servants raised to 5

+Admissible to whole-time family planning staf only.**Admissible to employees of Health Department.

Appendix IV 167

Incenlives

States

Bihar M,P. Punjob U'P'

months if the birth of children is

rcstricted to 2 onlY

tt. Priority to public servants having

uDto thre€ children in-aj allotment of lesidential accom'

modation Yes

b) grant of house-luilding loan Yes

c) grant of loan for the Purchaseof car, scooter, etc' Yes

12. Priority to Governnlent servants

who get sterilized after 2 children

in th! allotment of car' scooter etc' Y9s

13. Priority to candidates v'ho get

sterilized afler 2 children in ap-

Dointment to Public scrvices Yes

14. irioritv to families which have

adopted family Planning in mater-

nity and child care Programmesand in facilities made available by

other Government Departments .,

15. Priority to nersons who get steri-

lized after 2 children in allotment

of house-sites and house-building

loans in urban areas Yes

16. Priority to persons who undergo

sterilization in the allotment of

houses and Plots and grant ofloans

17. Priority to persons who get steri-

lized after 2 children in grant olloan from Government or semi-

government sources for establishl

ing an industry or constructrng

b,iitoing. for such industtv . .,. 1T18. Number of incentives oflered

Yes

rl

Yes

-5

APPENDIX V

DIsINcENTIvEs Fonruurerro ny Srarn GovrnNurxts ronpnouorrNc FlIr,rIr,y pr,anNrNc

DisincentivesStates

Bihar M.P. Punjab U.P

1. Disciplinary action proposed to betaken against public servants fail_ing to achieve the quota of motiva-tion for sterilization etc. allottedto them

2, Grant of Transfer T.A. to publicsewants upto 2/3 children only

3. Free medical treatment or reim_bursement of medical expenses topublic servants limited upto 2/3children only

4. R eimbursement of educational feesto public servants limited upto 3children only

5. Grant of maternity leave to femalepublic servants limited upto 2/3children only

6. Denial of encashment of earnedleave to public servants havintmore than 2/3 children only

7. Denial of Government residentialaccommodation or payment of en_hanced rent by public servantshaving more than 2/3 chilaren

8. No house-rent allowance to publicservants having more than 3children

9, Denial of all loans and advances topublic servants having more than2/3 children

10, Denial of annual increment ropublic servants having more than3 children

11. No allotment of houses built byth€ Housing Board or L.LC. or

Yes Yes

Yes Yes

Yes Yes

Yes Yes

Yes

Yes

Y9t

Yes

Yes Yes

Yes

Yes

I".

Yes

Yes

Yes Yes Yes

Yes

Appendix V t69

StatesDi sincentive s

Bihar M.P. Puniab U,P.

other similar bodies or underM.I.G, Scheme or Rent ControlAct to public servants having more

. than 2/3 children Yes12. No appointment to public services

for persons having more than threechildren Yes

13. Appointment to any public servicecontingent upon signing.a declara-tion to limit the birth of childrento 2 only Yes

14, If a person of the eligible categorydoes not undergo sterilization afterthe birth of upto the third child, hewill not be-a) given any loan Yesb) grant€d a license for first arms

or allowed to renew such alicense Yes

c) allotted a fair price shop Yesd) allotted a house or plot of land Yese) entitled to flee medical treat-

ment at Government hospitals Yesf) granted educationalconcessions

or scholarships except meritscholarships Yes

g) granted any facilities offered bythe Harijan and Social W€lfareDepartm€nt Yes

15. Number ofdisincentives introduced 6 8 4 15

Nole.' The U,P, Government are reported to have withdrawn all dis-incentives applicable to both the general public and the publicsefvanls.

APPnNoIx VI

Corvrposluox or Sters-ttvrI, Couurrrrrs

MembersContmittee Oficial Non- Toral

oftcial

Statusof

Chairman

Number ofmeetingsheld in1974-75

Cabinet Sub-Committee

BiharM.P.

Punjab

57

7

l1

5

7

Chief Minister IMinister of Public NilHealth and F.P,Chief Minister - (Constitut-

ed in 1975-76)

Chief Minister IU.P. 6

F.P. CouncillBoad

Bihar 6M.P. 10

Punjab

u.P. 23

State LevelCoordinationCommittee

Bihar 12

M.P. 7Punj4b 14

u.P. 13

Grants Committee

Bihar 3

M,P. 4

)

16

2l

15

22 Minister of Health31 Minister of Public

Health and F.P.

38 Minister of Health

Nil

- (Not con-stituted)

Nil

5

12 Chief Secretary12 state F.P. Officer .

14 Chief Secretary

14 Chief Secretary

3 Director, HealthServices

4 Secretary PublicHealth and F.P.

Nil

- (Constitut-ed in 1975-

76)2

2

1

Appendix VI Itr

Members

Conmitee Oficial Non- Totaloffcial

Stalusol

Chairms

Number ofmeetingshen tn1974-75

PunjabU.P.

Publicity Coordina'tion Committee

4-5 Secretary, Health 1

4 Secretary, Medical 2

and Health

5 25 SecretarY, Medical Iand Health

4-5

BiharM.P.Punjab

u.P. 20

*l**.* | constl-

-J tuted

Appntolx VII

DrsrrusurroN or RrspolrorNrs sy Rrr,rcroN

State andDistrict


HMSCTotalHMSCTotal

Bihm

Gaya 31 4 - 35 17 6 --i: 23Dhanbad 2T2* 29 158_124M.P.

Hoshangabadlg2tZZZ05_25Datia 21 2 - | 24 Zt 4_ | 26

Punjab

Ropar 10 t4 24 13 _ 6 19Amritsar2-Z-431_4U.P.

Allahabad 28 Z - 1 31 t2 51 18Rampur 16 7 3 I 27 6 7_ 3 16

Torar. 154 f9 Z0 3 196 l0Z 35 8 5 155'A ro TorAL 78.6 9.7 l0.Z t.S 100.0 69.0 22.6 5.2 3.2 100.0

H -HinduM-Muslims -sikhC -Christian

173

Ec

\o

6o1

in eQQo+

tro

s3.'N

.rq

\ooeg

r.!

FrQ(nui

taFa{

!l- N

IFti

39FN

EZZ0r!I]!4TEItu4

zF

Appendix VIII

RX

tl\o t.-

lltl

a.l F.

tl

ooF

t:rI

NN

t-I

erl

II

r.t \O O\ $ @\o

at ao cl\ i

<l i rn a..l

It l-ttl

X$ HF

tl Ni

N I ao \gI

q\i (nr+

an an @ v-)

tl t-

€€'oi :-^ . .E=,E 5- =E FaEF T: .3E €E

s di . o cl d a c =

cs

_S (,Q q. EA 'i c< \ <F1G>ds

l:l(t^li st:9

I

FII$s l\ A

\ ls -* tr s* l- a

Il6:.l\ !

Ils:.| ..r G

l*tst:l*I

lst- sl€ x'

I'3lF sE"li xPlU l^ h

Ilo -

I

l-i :

q

Appexotx IX

DrstnItutIoN or RnspororNr CultlvaroRs ny rnr Slzror Tsrrn LANo HorotNcs


State Upto Above Above Above Upto Above Above Above

and 2 2to5 5toI0 10 Total 2 2to, sto10 l0 TotalDistrici qcres acres acres acres qcres acres acres ocres

Bihar

caya 4Dhanbad 6

M.P.

HoshangabadlDatia 2

Punjab

Ropar 3

Amritsar

U.P.

Allahabad 11

Rampur 7

ll24-15 10

l0 1

IJ J

lJ z

7

22

4

2 2 l3l1

t2_lo

1

10

4

5 I 3 5 I

3l6-1

r)14 1 I

TorAL 34 28 18 12 92 27 23 17 13 80ol"ro'fot^L37.0 30.4 19.6 13.0 100.0 33.7 28.7 21.3 16.3 100.0

Index

Asia, 4-6Audio-Visual Aids, 81

Birth rate, 19

Cabinet Sub-committee, 67-8

Causes of Poverty, 18

Central assistance to State plans'

Comnittees, 67-70

Dandekar, V.M., 17

Developing countries, 3-5

Differencesin urban-rural clinics,

66Disincentives to

general public; 27-8, 31

public servants, 27, 29'33

Economic develoPment, l, l8Economic status of respondents, 9l

'93-5

Educational l€vel of respondents'89-9r

Evaluation, T3-4Extension work, 82-3

Falsification of records, 72, 146

Family planningawareness,98-105bureau, District, 50-1

bureau, State,50-1

council/board, 68

methods, 106-7

organisation, 5G4role of commurication. 80-4

Family planning Practicesreasons of adoption, 108-14

reasons o[ lack of knowledge,

l2l , 129

reasons of non-adoPtion' I 14-20

Field Staff, 61-3

Gavin Jones, 4Grants Committee, 69-70

Group Incentives, 33

Growth rate of economy, 16

Incentives togeneral Public, 28, 30-lpublic setvants, 28, 31-3

Indonesia,6-7

Malaysia, 7Male-female ratio among resPon-

dents,88-9,97-8Maternity leave, 32, 48

Measures ofindividual import, 24-6' 35'6

social imPort, 24-6, 34

State import, 24-6, 36-8

Measures taken bY State

GovernmentsBihar, 25, 27'9, 38-4r


Madhya Pradesh, 29-30, 4l-4Punjab, 32-3, 47-9Uttar Pradesh, 30-2, 44-7

Monetary compensation, 36, 43-4Motivation bonus, 44-5

New policy measures, knowledgeof, 120-34

New population policy, 19, 23-6-olicy limitations, 144, 148

Number of children per family, 9zl-7

Objectives ofplanning, 16study,20

Occupational stnrcture of thesample,89-91

Opinion onmonetary incentive, 134-7raising the age of marriage, 138-

40Orientation of the staff towards

the programme, 64-5

Pakistan, 8Per capita

consumer expenditure, 17income, l6

Philippines, 8-9Policy options, 149-50Population

education,83-4Government of India estimates,

t4growth rate, 15-6, 19hard core, 41of India, 15policy, 2-3, 5-6, 19-20, 23-6

Primary health centres, 50-1, 59Processes of study, 21-3

Progress reporting, 72-3

Raising the age of marriage, 36,138-40

Rath, Nilkantha, 17Rebate in

income-tax, 37-8land revenue, 44

Records ofmotivational activities, 71-2potential acceptors, 7r-1services rendered, 72

Sample Selection, 20-1, 23, 87-8,t63-5

Scheme of the study, 23Selected demographic indicators, 14Singapore,9-10State level coordination committee,

68-9Statistical system, 70-3Sterilization

ad hoc arrangements 108, 110, 146as population policy, 146propagation, 100, 104-5quotas for motivation, 27 -8, 38-9,

42, 44, 47-9

Taiwan, 1lTarget-setting, 42, 46-7Thailand, l1-3

Urban family welfare planningcentres,50,54-8

Voluntary organisations, 74-80, 105-6, 150

Women's interest in family planning,118-20, 149

World population, I

family planning under the emergency

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