BIRTH CONTROL AND FAMILY PLANNING IN INDIA

BIRTH CONTROL AND FAMILY PLANNING IN INDIA

India is the first country in the world to realize the importance of controlling the population growth. It initiated its Family Planning Program in 1952. Total fertility rate: 2.51 children born/woman (2014 est.), country comparison to the world: 81. Mother's mean age at first birth: 19.9 (2005-06 est.) Contraceptive prevalence rate: 54.8 percent (2007/08) [Source: CIA World Factbook]

Family planning has been less successful in India than in China, where a strong centralized government has more power to enforce its policies and impose its will. India's efforts have also been compromised by things factors as high rates of illiteracy and infant mortality, low status of women, conflict between castes and religious groups and poverty."

The population issue has traditionally been seen a struggle between India’s democratic ideals and practical matters such as shortages of land and water. The India government has traditionally winced at the idea of using draconian family planning policies like those used in China although India has engaged in forced, or at least heavily coerced, sterilization.

Jayaji Krishna Nath, M.D. and Vishwarath R. Nayar wrote in the Encyclopedia of Sexuality: “As wide differences exist among different regions of the country, the population distribution is also not uniform among these regions. Despite the wide variations of existing customs, beliefs, and socioeconomic development, India’s people generally favor a large family size and thereby are not in favor of adopting modern methods of contraception. The Family Planning Program in India is being promoted on a voluntary basis as a people’s movement in keeping with the democratic tradition of the country. The services of the program are offered through Health Care Delivery System. Since the majority of the population lives in rural areas, which lack a good infrastructure of health-care facilities and an adequate Social Security System, these people almost universally perceive children and large families as an asset. Added to this is a strong preference for a son that acts as a barrier in limiting the family size. [Source: Jayaji Krishna Nath, M.D., and Vishwarath R. Nayar, Encyclopedia of Sexuality, sexarchive.info \*/]

History of Family Planning in India

In 1952, under India’s first prime minister Jawaharlal Nehru, India became the first country in the world to establish a family planning program. The goal was to reach zero population growth by the beginning of the 21st century.

Under Indira Gandhi, family planning oriented towards sterilization. With Sanjay Gandhi, Indira's son, at the helm, the government tried to reduce the number of births by offering men money and transistor radios for vasectomies. When that didn't work it tried more heavy handed methods and some people were sterilized without their knowledge. There was public backlash against the government and the program didn't work. The population rose at an alarming rate. Indonesia had more success with the "supermarket" method of birth control. See Indonesia.

In the 1990s, India tried to embrace the principals promoted at the 1994 United Nations conference on population in Cairo: namely that the best result were achieved not by establishing contraception targets but rather by improving the education and health of children and women and offering multiple methods of birth control.

Since the mid-1990s, India has run a largely successful family planning campaign but the results have not reached the desired levels. The population in 2000 was double what planners in the 1950s hoped it would be, and shortages of resources and problems associated with overpopulation more acute than ever. In recent years there has been a call for tougher policies. Some states have laws that restrict members of village councils and state parliament members to two children, with the idea being that they would set an example to their constituents. Other states have considered denying benefits to third children and offering incentives—pay raises, land and housing—to civil servants who got sterilized.

In July 2003, the Indian Supreme Court decided in favor of two-child limits among village council members in Haryana state, saying basically that the limits are justified because the population problem is so out of hand and the limits do not put “undue stress of fundamental rights and individual liberty.”

History of Family Planning Policy in India

Population growth has long been a concern of the government, and India has a lengthy history of explicit population policy. In the 1950s, the government began, in a modest way, one of the earliest national, government-sponsored family planning efforts in the developing world. The annual population growth rate in the previous decade (1941 to 1951) had been below 1.3 percent, and government planners optimistically believed that the population would continue to grow at roughly the same rate. [Source: Library of Congress, 1995 *]

Implicitly, the government believed that India could repeat the experience of the developed nations where industrialization and a rise in the standard of living had been accompanied by a drop in the population growth rate. In the 1950s, existing hospitals and health care facilities made birth control information available, but there was no aggressive effort to encourage the use of contraceptives and limitation of family size. By the late 1960s, many policy makers believed that the high rate of population growth was the greatest obstacle to economic development. *

The government began a massive program to lower the birth rate from forty-one per 1,000 to a target of twenty to twenty-five per 1,000 by the mid-1970s. The National Population Policy adopted in 1976 reflected the growing consensus among policy makers that family planning would enjoy only limited success unless it was part of an integrated program aimed at improving the general welfare of the population. The policy makers assumed that excessive family size was part and parcel of poverty and had to be dealt with as integral to a general development strategy. Education about the population problem became part of school curriculum under the Fifth Five-Year Plan (FY 1974-78). Cases of government-enforced sterilization made many question the propriety of state-sponsored birth control measures, however. *

During the 1980s, an increased number of family planning programs were implemented through the state governments with financial assistance from the central government. In rural areas, the programs were further extended through a network of primary health centers and subcenters. By 1991, India had more than 150,000 public health facilities through which family planning programs were offered. Four special family planning projects were implemented under the Seventh Five-Year Plan (FY 1985-89). One was the All-India Hospitals Post-partum Programme at district- and subdistrict-level hospitals. Another program involved the reorganization of primary health care facilities in urban slum areas, while another project reserved a specified number of hospital beds for tubal ligature operations. The final program called for the renovation or remodelling of intrauterine device (IUD) rooms in rural family welfare centers attached to primary health care facilities. *

Despite these developments in promoting family planning, the 1991 census results showed that India continued to have one of the most rapidly growing populations in the world. Between 1981 and 1991, the annual rate of population growth was estimated at about 2 percent. The crude birth rate in 1992 was thirty per 1,000, only a small change over the 1981 level of thirty-four per 1,000. However, some demographers credit this slight lowering of the 1981-91 population growth rate to moderate successes of the family planning program. In FY 1986, the number of reproductive-age couples was 132.6 million, of whom only 37.5 percent were estimated to be protected effectively by some form of contraception. A goal of the seventh plan was to achieve an effective couple protection rate of 42 percent, requiring an annual increase of 2 percent in effective use of contraceptives. *

India’s Family Planning Bureaucracy

The heavy centralization of India's family planning programs often prevents due consideration from being given to regional differences. Centralization is encouraged to a large extent by reliance on central government funding. As a result, many of the goals and assumptions of national population control programs do not correspond exactly with local attitudes toward birth control. At the Jamkhed Project in Maharashtra, which has been in operation since the late 1970s and covers approximately 175 villages, the local project directors noted that it required three to four years of education through direct contact with a couple for the idea of family planning to gain acceptance. Such a timetable was not compatible with targets. However, much was learned about policy and practice from the Jamkhed Project. The successful use of women's clubs as a means of involving women in community-wide family planning activities impressed the state government to the degree that it set about organizing such clubs in every village in the state. The project also serves as a pilot to test ideas that the government wants to incorporate into its programs. Government medical staff members have been sent to Jamkhed for training, and the government has proposed that the project assume the task of selecting and training government health workers for an area of 2.5 million people. [Source: Library of Congress *]

Another important family planning program is the Project for Community Action in Family Planning. Located in Karnataka, the project operates in 154 project villages and 255 control villages. All project villages are of sufficient size to have a health subcenter, although this advantage is offset by the fact that those villages are the most distant from the area's primary health centers. As at Jamkhed, the project is much assisted by local voluntary groups, such as the women's clubs. The local voluntary groups either provide or secure sites suitable as distribution depots for condoms and birth control pills and also make arrangements for the operation of sterilization camps. Data provided by the Project for Community Action in Family Planning show that important achievements have been realized in the field of population control. By the mid-1980s, for example, 43 percent of couples were using family planning, a full 14 percent above the state average. The project has significantly improved the status of women, involving them and empowering them to bring about change in their communities. This contribution is important because of the way in which the deeply entrenched inferior status of women in many communities in India negates official efforts to decrease the fertility rate. *

Studies have found that most couples in fact regard family planning positively. However, the common fertility pattern in India diverges from the two-child family that policy makers hold as ideal. Women continue to marry young; in the mid-1990s, they average just over eighteen years of age at marriage. When women choose to be sterilized, financial inducements, although helpful, are not the principal incentives. On average, those accepting sterilization already have four living children, of whom two are sons. *

Population Rate Decreases in India

The pace of population growth has more than halved since independence in 1947. Family planning has reduced the number of births per woman from 6 in the early 1950s to 3.4 in the 1990s to around 2.5 today. India’s fertility rate is now lower than the fertility rate in the United States in the 1960s. India's population growth rate has dropped only slightly. Between 1970 and 1990 it was 2.1 percent; between 1950 and 1970 it was 2.2 percent. Now it is 1.25 percent.

People in urban areas are having considerably fewer children than they were a generation and two generations ago. But that is not the case in rural areas. Although many women are having fewer babies there are still some having more than five children. "In less than a generation, we have been able to bring down the size of a family from six to 3.6—better than many countries, a health minster told the Washington Post. "But our base is so large that the increase in numbers is really staggering. It gives the perception that India is doing poorly with family planning. [Source: Molly Moore, Washington Post, August 21, 1994]

Population rates have declined largely because poor and illiterate women are choosing to have smaller families. Low growth rates have also been attributed to: 1) government propaganda; 2) greater access to television shows and movies in rural areas that help spread the idea that small families are desirable; and 3) the higher survival rate of children which has reduced the desire to have extra children as insurance.

In the 1990s, Andhara Pradesh showed the most dramatic reduction in population growth of India's large states: reducing its fertility rate to almost 2.1 percent. This statistic is especially surprising when one considers that at that time half the state’s women were illiterate and married before the age of 15. In Andhara Pradesh both the carrot and stick approach to population reduction has been used. Andhara Pradesh has also turned away from coercive methods and has attacked population growth by improving the health and education of women and children and offering purely voluntary contraceptive choices. One peasant in Andhara Pradesh told the New York Times in 2001, "if we have more children, our problems will also multiply. We cannot afford to educate more than two. I do not want my children to grow up to be farm laborers like us." See Sterilization Below. [Source: New York Times]

However, the fertility rate is still high in much of Jayaji Krishna Nath, M.D. and Vishwarath R. Nayar wrote in the Encyclopedia of Sexuality: “As marriage is almost universal, in almost all religious groups the age at marriage - especially of females - is very low. For instance, the average age for females at marriage is 18.3 years; for males, it is 23.3 years. Because women have a long reproductive span, Indian couples tend to have large families. The total fertility rate in India is 4.5 and the total marital fertility rate is 5.4. Various factors, such as a strong preference for a son, the low status of women, a high infant mortality, high illiteracy level, inadequate health-care facilities, and irregular follow-up services provided by the health staff play a major role in keeping couples from accepting contraception. [Source: Jayaji Krishna Nath, M.D., and Vishwarath R. Nayar, Encyclopedia of Sexuality, sexarchive.info \*/]

Reducing Population Growth Through Education and Health

India later changed it population containment strategy away from sterilization towards improving the education of women and the health of their children. Educated women generally marry at a later age and have less children. Women with healthy children are less likely to have more if they believe the children they have are likely to survive. The population of India rose above 2 percent a year in the 1970s despite sterilizations but dropped to 1.93 percent in the 1980s when the governed launched programs to improve the health of women and children.

India has been particularly successful in slowing population growth in the southern states where woman traditionally have had higher status and the governments pours more money into health and education. In Kerala, for example, the fertility rate plummeted from 4.1 children per woman in the 1970s to 1.8 children in the 1990s. [Source: Molly Moore, Washington Post, August 21, 1994 ?]

In India it is still difficult to reach women in many areas. Plus there is the problem of ignorance and illiteracy. One Indian population expert told the Washington Post, "Many women do no want large families anymore, but this is a patriarchal society, where men make the decisions of reproduction...Ask a woman in Bihar if she wants more children she will say no. Ask her if she is using [birth control] and she will say no."

Even though the World Bank and other organizations have offered $1 billion in grants and loans, many of the programs have ended in failure. Tens of millions of dollars have been wasted, and millions more have gone unspent on some of the world's neediest recipients. One reason for this situation is that the government tries to stack the boards running the program with bureaucrats and non-governmental agencies enlisted for villages programs generally don't trust the bureaucrats and are unwilling to participate. In 1991 the U.S. government approved a $325 million family planing project in India, but as of 1994 no program payments had been made. ?

Image Sources:

Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, Ministry of Tourism, Government of India, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Foreign Policy, Wikipedia, BBC, CNN, and various books, websites and other publications.

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© 2008 Jeffrey Hays

Last updated June 2015

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