May 27, 2023
May 27, 2023
by Laxmi Murthy
Fifty-one years old and still lacking direction? More than half a century of existence and refusing to learn from experience? Confused is perhaps the more charitable portrayal of India's population policy ï¿½ proudly proclaimed as 'the oldest population policy in the world'. Coercive and undemocratic are probably more realistic descriptions of the National Family Welfare Program (FWP), launched in 1951 with the objective of "reducing the birth rate to the extent necessary to stabilize the population at a level consistent with the requirement of the national economy".
What has gone wrong? Why has population become a 'problem' rather than a valued human resource? From 'Family Planning' until the 1980s to the Reproductive Health, Target-Free and Community Needs Assessment approach in the 1990s, the FWP has had many guises. Yet, the common thread running through has been a lack of attention to the real needs of the people, particularly women, coupled with gross violations of human rights. Judging from recent trends, the government is giving up all pretences in its all-out effort to reach the national goal of reducing the Total Fertility Rate (TFR) to the population replacement level of 2.1 by 2010.
An anonymous 'Strategy Paper' purporting to review the FWP surfaced recently and is, according to press reports, being considered by the Union Cabinet. However, this document not only contradicts the National Population Policy 2000 but is also poorly substantiated by data. The Paper has not been officially owned by either the National Population Commission or the Ministry of Health and Family Welfare but is seen in many quarters as an "unofficial official" document, in keeping with the government's propensity to float trial balloons to gauge public opinion on controversial issues.
The Strategy Paper calls for a "realistic" examination of the current demographic situation and identifies Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh as 'problem' states where demographic stabilization is concerned. These four states make up 41 per cent of the country's population, and all have a TFR of almost 4.0, way above the national average of 3.1. The Paper urges "effective intervention" to bring down fertility levels in the shortest period of time. It also lays the blame for poor quality and coverage of health and family welfare services on "the uncontrolled growth of population" rather than the other way around. In fact, it repudiates the approach adopted by numerous countries, including India, after the International Conference on Population and Development (ICPD) in Cairo in 1994 on the grounds that it is not appropriate for countries like India. The Paper states: "The principles of advocacy, quality of care and right of individual choice may be relevant for developed countries where the population problem is absent and the health care infrastructure is well-established."
Yet, the government itself admits (on its official website) the failure of the target-oriented approach. "The target-based system followed up to 31st March, 1996, suffered from negligence of the quality of services provided to the people under family welfare program. The needs of the individual client were not properly met. Thus the numerical method-specific targets provided such type of demographic planning which is against the democratic ethos of the country." In fact, following the International Conference on Population and Development in Cairo in 1994, the Government of India was pressurized to depart from 'demographic imperative' language and accommodate women's perspectives. The government then attempted to make a paradigm shift in its approach to family planning to one of advocacy, quality of care and individual choice.
But in a complete turnaround, the government today appears to be reaffirming its faith in coercive methods and has allowed states like Rajasthan, Madhya Pradesh and Uttar Pradesh to formulate anti-people population policies - leading to fears that attempts are being made to push coercive population policies through the backdoor. Uttar Pradesh's Population Control Bill, 2002, is a document that embodies these undemocratic measures.
These State population policies and the UP Bill contain a series of disincentives and incentives that are anti-women, anti-adivasis, anti-dalit and anti-poor. The disincentives proposed include denying ration cards and education in government schools for the third child; withdrawal of a range of welfare programs for people belonging to Scheduled Castes and Scheduled Tribes who have more than two children; and debarring people with more than two children from government jobs as well as contesting elections for local-self government. Moreover, in son-crazy India, the imposition of the 'two child norm' has led to sex-determination and sex-selective abortions. Women's groups and health activists in the capital have managed to scuttle the UP Bill and have also highlighted these human rights violations in a petition to the National Human Rights Commission (NHRC).
Quoting the National Family Health Survey, 1998-99, which shows that the Total Fertility Rate (TFR) is 3.15 for Scheduled Castes, 3.06 for Scheduled Tribes and 3.47 among illiterate women as a whole, the petition says: "Imposition of the two-child norm, and the disincentives proposed, would thus mean that significant sections among those already deprived populations would bear the brunt of the state's withdrawal of ameliorative measures, as pitiably inadequate as they are." In response, the NHRC has issued a notice to the Member Secretary, National Population Commission, to "authenticate the so-called Strategy Paper and explain how anti-human rights measures, not in keeping with the National Population Policy, could be contemplated".
Women's groups have also emphasized the fact that policies of 'population control' are targeted at women, who have larger numbers of children for complex reasons that range from immediate survival and necessity, to high infant mortality, lack of access to health services and patriarchal control over reproduction. In the absence of state-supported social welfare, children are the only security in illness and old age, and are viewed as additional working hands and family support, rather than extra consumers who will drain the family resources.
With one of the oldest population programs in the world, Indian women, especially from the poorer sections, have been consistently subjected to a population reduction program, occasionally garbed in euphemisms like 'reproductive health'. Sterilization accounts for 63 per cent of contraceptive use in India, but significantly, women comprise 97.7 per cent of the total number of sterilizations. Despite heavy propaganda, sterilization is usually 'accepted' only after achieving a family size of 3-4 children. Though it is an effective option of birth control for the individual woman, it does not have significant demographic impact. To reduce birth rates dramatically, spacing methods have to gain primacy.
From a policymaker's perspective, long-acting hormonal contraceptives like injectables (Net En and Depo Provera) and implants like Norplant are "ideal" because they are provider-controlled. Women need not be relied upon to remember taking the pill, or keep IUDs in place, and men need not be persuaded to use condoms. The promotion of long-acting, hazardous contraceptives is justified on the plea that birth rates have to be brought down in a hurry ï¿½ the price that women pay with their health is irrelevant.
The nexus between the population control establishment and profit-oriented pharmaceutical companies promoting hormonal methods ensures that safer and cheaper reusable barrier methods like the diaphragm or cervical cap are not manufactured in India and are therefore inaccessible to those who need them most.
The hysteria about 'population explosion' overtakes concerns of empowering women and provision of adequate nutrition, water supply, sanitation and primary health care. It is well known that birth rates are affected by the means of production (i.e. whether it is a subsistence economy or an industrialized economy), women's status and education, family structures and women's entry into the labor force. States like Kerala are often quoted as having successfully achieved demographic transition, but the Kerala development experience is not emulated. Though it was Indian representatives at the first World Congress on Population in Bucharest in 1975 who popularized the slogan "Development is the best contraceptive", official policy has concentrated almost exclusively on provision of contraceptives.
Adoption of incentives and disincentives violate human rights and the technological "solution" of developing more and more effective contraceptives is a politically 'safer' option than genuine changes which impact on birth rates ï¿½ land reform, expansion of social services and more equitable distribution of resources. It is this paradigm which has to shift for birth rates to fall and equitable development to take place.
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