 |
Diagnostic Study Rajasthan |
|
|
1 Pages 1-10 |
▲back to top |
|
|
1.1 Page 1 |
▲back to top |
Diagnostic Study
of .
Population Growth,
Family Planning
and
Development, 1971-81
Rajasthan
THE FAMILY PLANNING FOUNDATION
198, GOLF LINKS, NEW DELHI·1l0003
|
|
1.2 Page 2 |
▲back to top |
DIAGNOSTIC STUDY OF
POPULATION GROWTH, FAMILY PLANNING
AND DEVELOPMENT IN RAJASTHAN, 1971-81
THE FAMILY PLANNING FOUNDATION
198, GOLF LINKSt NEW DBLHI-llQOOJ
|
|
1.3 Page 3 |
▲back to top |
1. The decennial Census ofIndia has always been regarded both
as an evaluator of past population policies and indicator of future
policy requirements. The Census of 1981 has performed a similar
role by disclosing a decadal growth of 25.00 per cent in
1971-81 cQrnpaced with 24.80 in 1961-71. The reaction to the
Census disclosure has been somewhat mixed:
Some relieved that the momentum of population growth (as
a legacy of high fertility in the past) has been contained;
Some anxious that the expected decline in grov,th rate (as a
result of the family planning programme) has not taken
.place.
2. While the above is the picture at the national level, behind
the 'static' decadal growth rate of population at the national
level, the picture is highly variegated at the State level. An
important feature brought out by the 1981 Census is that the
problem of rapid population growth in India is essentially a
regional problem. Among the 14 major States of India (with a
population of 10 million and above excluding Assam), the growth
rate in 1971-81 has varied from 17.50 in Tamil Nadu to 32.97 in
Rajasthan.
3. This project entitled "Diagnostic Study of Population Growth,
Family Planning and Development in 1971-81 in Rajasthan" is a
part of the six-state study project (which includes Gujarat, Orissa,
Punjab, Rajasthan, Tamil Nadu and Uttar Pradesh). The project
has its genesis in the disclosure by the 1981 Census of a constant
growth rate at the national level, but a highly variable growth
rate at state level. The principle objective of this study is to
identify the causes responsible for such variation in demographic
behaviour against the background of both the family planning
programme input (which is a centrally supported scheme on a
uniform basis) and the social setting in different states (which
depends mainly on state policy and initiatives in development)
as well the likely synergism between these two factors. These
diagnostic exercises do not aim at establishing hypotheses or
quantitative relationships nor are they expected to lead to
instantaneous solutions to problems. But it is hoped they
would expand understanding of the problems and the potential
|
|
1.4 Page 4 |
▲back to top |
4. The diagnostic study adopts the framework:
Knowledge
(based on
available
information)
1 Understanding
~ Action
~_ ...•(~ased on interaction l_-+(bas.ed on
J'
wIth programme
officials)
J("
fin. dmgs of
the study)
The study has utilised not only the data available in various
publications and its analysis, but based on the analysis, a set
of structured questions were framed for three core levels of
leadership in the family planning programme: political level
(Health Minister), executive level (Commissioner/Secretary) and
professional level (Director of Family Welfare). The structured
questions, its replies and the subsequent interview have vastly
improved the information base and have imparted a realism to
the exercise.
S. The main findings of the study are presented in the brochure
under four headings:
The Domographic Scene;
The.Social Setting;
The Development Scenario;
Family Planning Performance.
Based on the findings, a set of forty-two Recommendations has
been developed, which it is hoped, would be seriously considered
both by the State and the Central Government. Copies of the
Main Report have already been sent to the programme. leaders in
the State and the Centre.
6. The project has been funded by the Family Planning
-Foundation (FPF). Though FPF has normally a funding and
promoting role, in the case of this particular project the FPF
undeFtook also the implementation in view of the significance of
Ifhestudy for the programme and the need to have a high level
liaison with the States in securing the project objectives. The study
i~noian end in itself. Based on the study, a series of follow-up
meetings are proposed with the leadership in Population and
Development in each State to translate the favourable experience
~nd lessons from one state to another with a view to push up
il,le programme performance, particularly in poor-performance
states.
|
|
1.5 Page 5 |
▲back to top |
The Demographic Scene
- The population growth rate of 33.0 per cent in Rajasthan in
1971-81 is the highest rate among the states disclosed by the
1981 Census.
- The factors responsible for the high growth rate are (i) a
decline in mortality, (ii) an increase in birth rate after 1976,
and (iii) immigration as a resultant of colonisation under the
Rajasthan Canal Project, strengthening of defence personnel
and the rehabilitation of refugees from Pakistan.
- An increase in the growth rate in 1971-81 over 1961-71 is
observed in 17 out of the 26 districts of Rajasthan.
- The four districts bordering Pakistan (Ganganagar, Bikaner,
Jaisalmer and Barmer) have recorded the highest growth
rates (over 40 per cent).
- In the growth rate of 33 per thousand population, the natural
growth rate (as the difference between births and deaths) is 22
per cent while 11 per thousand population is the estimated
net immigration rate.
- Unlike at the national level, there has been immigration both
in the rural and urban areas, though the urban rate of 35 per
thousand population is much higher.
- The proportion of urban population (20.9 per cent in 1981)
continued to be below the national level.
- The pattern of urbanisation in Rajasthan is that large and
medium size towns have grown ,,,hile the small towns with
population below 10,000 are vanishing.
- As in the previous decade, the female population in Rajasthan
had a higher growth rate in 1971-81.
- Rajasthan among all the states has the lowest population
density 100 per sq. km compared _with 221 at the national
level.
- Rajasthan has the highest proportion (43 per cent) of popula_
tion below 15 years.
The young age of Rajasthan's population imparts a 'momen-
tum' to the growth of population .
.- Rajasthan recorded the highest percentage of children in the
age group 0-4 (14.1 per cent).
|
|
1.6 Page 6 |
▲back to top |
- Rajasthan had also the highest dependency ratio of 946 com-
pared with 854 at the national level.
- Also the child-woman ratio is the highest, 656 for 0-4 age
and 794 for 5-9 age.
- In the decade 1971-81, the natural growth rate according to
the Sample Registration System was 21.9 in rural areas and
22.4 in urban areas.
- In 1971-81, the death rate declined faster than birth rate.
"'::"Birth nite declined steadily and substantially in 1971-77 from
42.6 to 35.5 but rose again to 38.7 in 1981.
-:- :Thisreversal of the trend in birth rate and the steady decline
, in death rate has led to the natural growth rate of population
in 1971-81 having two distinct trends: a declining trend in
1971-77 and an increasing trend thereafter.
- Variations in contraception rate cannot adequately explain
. I the change in birth rate. The 'momentum' imparted by the
,'young population and the nuptiality factors could be critical.
- There has been sizeable decline in mortality and the prmatal
effects of a sustained decline in mortality cannot be ignored.
- Women above the age of 30 years, contribute 42 per cent of
fertility.
- The pattern of fertility in Rajasthan is that a decline in birth
order occurs only from the fifth order births in rural areas.
- The average number of children per woman is higher than in
the other states (the highest being in Haryana).
- Fertility persists at higher ages and in rural Rajasthan the
. average number of children for women (in 45-49 years) is 5.99
against 4.10 in Tamil Nadu according to 1981 Census.
- The infant mortality rate (IMR) in rural Rajasthan is still high'
(U5 in 1980) though it has dropped precipitously from 153
in 1978.
- Rural IMR is more than double urban IMR.
- Female IMR which was higher till 1978 is in level with male
IMR later.
~ The neo-natal mortality is higher than post-natal mortality in
Rajasthan (as is common in the North) but in contrast with
the trend in the Southern states.
- The three distinct geographical regions of Rajasthan (the
populated East, the arid West and the hilly and tribal South)
have variations in demographic characteristics.
|
|
1.7 Page 7 |
▲back to top |
The Social Setti'ng
- The Princely States and the feudal system ftom whif,h
Rajasthan emerged three decades back could influence the
socio-cultural setting of Rajasthan.
- Rajasthan has recorded the highest proportion married in the
age group 15-19-64.3 per cent conpared with the national
average of 43.5 per cent.
The mean age at marriage is the lowest in Rajasthan (17.0
years, compared with 21.9 years in Kerala).
- The highest proportion married in the age group 15-44 is also
recorded by Rajasthan-88.5 per cent.
It is a matter of concern that the nuptiality rate may not
change much in the rest of the century and is projected to be
83.2 per cent in 2000 AD.
The general marital fertility rate declines as the age at
marriage is increased indicating the importance of raising the
age at marriage as a non-programme factor in the control of
fertility.
-- Death rate among females (particularly children) are higher in
Rajasthan.
- Literacy in Rajasthan continued to be the lowest among all
the States. In particular, rural female literacy which is one of
the sensitive indicators of the social status and mo'/jility was
as low as 5.4 per cent in 1981 compared with 18 per cent at
the national level.
Literacy is particularly low in the Western Arid Zone varying
from 1.64 in Jaisalmer to 8.50 in Ganganagar.
The education status of children in the age group 5-9 is also
quite low. Among females in 5-9 age, only 16.4 per cent
attended school which is one half of the national average ..
The sex-bias in education in Rajasthan is more pronounced in
the rural areas. Hardly 10 per cent of the female childre~ in
the age group 5-9 and 10-14 attended school.
- Work participation (i.e. main workers as percentage of total
population) of women in Rajasthan was only 9.4 per cent com-
pared with the national average of 14.4.
- The rural culture in which early marriages take place is
perpetuated by the low female literacy and lack of employ-
ment opportunities.
Nearly 90 per cent of the agricultural workers are cultivators.
The land ownership and the concomitant lineage system could
|
|
1.8 Page 8 |
▲back to top |
be an 'important factor in high :fertility.
- There is a gradual shift from agricultural to non-agricultural
occupation since 1961.
- Such a trend has implications for future fertility as non-
agricultural workers have higher fertility in Rajasthan.
- Child labour in Rajasthan is one of the highest among states
(next to Andhra Pradesh).
_ This indicates
Rajasthan.
the economic base of high fertility in
_ The Son-preference Index of Rajasthan is the highest among
states (31.3 against 20.2 at national level).
- An important socio-cultural feature of Rajasthan is that
scheduled castes and scheduled tribes constitute 17 and 13
per cent of population respectively.
- Majority of Rajasthan women (62 per cent) observe 'Purdah'.
The Developm.ent Scenario
- The per capita income in Rajasthan during the decade 1971-81
has always been lower than the national average and less
than half the per capita income of Punjab.
- There is a drop in agricultural productivity between 1971 and
1981.
- The State Domestic Product grew annually at the average rate
of 1.81 per cent in 1971-81 while the population grew at
the rate of 3.3 per cent. Thus the growth of Rajasthan's
economy was not even adequate to match its population
growth.
- Despite the economic stagnation and social backwardness,
the state has done weli in alleviating poverty. Rural poverty
has been reduced from the level of 47.5 per cent in 1972-73
to 33.7 per cent in 1977-78.
- Population-oriented
development in 1971-81 in Rajasthan
indicates a step-up in outlay on infrastructure and social
sectors but rural employment and women's programmes were
virtually neglected.
- However, the infrastructure level re mains low with 8.1 km of
road per square km (compared with 40.9 in Tamil Nadu) and
less than 50 per cent villages electrified compared with 100
per cent in Tamil Nadu.
- A unique example of population-oriented development in
Rajasthan is the Rajasthan Canal Project which has brought
|
|
1.9 Page 9 |
▲back to top |
many benefits to Ganganagar and Bikaner through the colon!-
sation programme.
- The tribal population concentrated in the South Rajasthan
were served through the tribal sub-plan. A major part of the
investments wa!>on 'water and power development'.
The status of women in Rajasthan judged by many of the
indicators remained low.
The importance of distributiVe development in moderating
fertility needs to be recognized because the general marital
fertility declines by more than half when the per capita inconie
doubles in rural areas.
Falllily Planning Perforlllance
- In Rajasthan, performance under the family planning pro-
gramme fell far short of the demographic challenge of the
8tate.
In sterilisation, the predominant method of contraception, the
rate per 1000 population was 29.4 in 1981 compared with 48.8
at the national level and 68.4 in Gujarat.
- Out of the 13.5 per cent couple protected, 12.1 per centis
accounted by sterilisation.
- The promotion of terminal methods in Rajasthan is relevant
against high fertility of Rajasthani women (total marital ferti-
lity 7.2 in 1972 and 6.0 in 1981).
For every acceptor of a terminal method, there is one acceptor
of spacing method in Rajasthan.
Rajasthan requires a 'method-mix' with high priority sterili-
sation (2 terminal for each spacing), as practised by Tamil
Nadu.
Rajasthan did not achIeve the sterilisation target in 1971-81
except in 1976-77. In general, the achievement rates were
lower than Tamil Nadu record.
In common with the rest of India, there was a switch-over
from vasectomy to tubectomy after 1977, because of the
popularity of laparoscopy.
- Laparoscopy was introduced in the programme in 1979·80,
which now accounts for over 80 per cent of tubectomies.
- With the help of 30 laparoscopes available, the State Govern-
ment has been organising 10 to 15 camps in a month in each
district.
The 'camp approach' in Rajasthan is a partial answer to the
infrastructure deficiencies and the socia-cultural constraints.
|
|
1.10 Page 10 |
▲back to top |
- Since laparoscopy is limited both by the availability of
laparoscopes (which are imported) and trained personnel,
there is a case for promoting mini-laparotomy as in
Orissa.
The proportion of Muslims accepting terminal methods is
lower than their proportion in the population.
- The share of rural population in sterilisation is lower than
the percentage of rural population.
Because of the shortage of female functionaries, the IUD
programme was seriously affected and hardly 50 per cent of
the target is achieved.
- The IUD programme is definitely urban-biased.
- Though the IUD acceptance is the lowest (83 per 1000 popu-
lation) among States, the retention rate is quite high (95 per
cent retained at the end of 36 months for Copper T).
Young Muslim women could be an ideal target group for
promoting IUD.
There has. been no steady achievement in the conventional
contraceptive programme.
- Though the pill was introduced in the programme in 1975-76,
there are only a few acceptors.
- Not only is the acceptance rate low, the continuation
rate beyond 12 months was only 14.4 per cent of acceptors.
- The sterilisation programme in Rajasthan is qualitatively
deficient with 64 per cent of acceptor couple having 4 or
more children (para 92)
- But sterilisation of high parity couple has a current justifi-
cation because 43 per cent of the births are of 4th or higher
parity, though the ideal approach was to have promoted
.spacing methods among younger and low parity couple.
- Two out of three tubectomy acceptors are aged more than
30 years.
- .Two major reasons for couples going in for terminal methods
at high parity are the high infant mortality (low child
survival) and the value of children as an income-earning
~ource (para 93).
The average number of living children is higher in Rajasthan
than the national average in respect of acceptors of sterilisa-
tion and IUD.
|
|
2 Pages 11-20 |
▲back to top |
|
|
2.1 Page 11 |
▲back to top |
~ Acceptors of tubectomy (the most popular method) had an
average of 4.2 living children in 1980-81 compared with 3.7
in India.
Mean age of female acceptors is also higher in Rajasthan
than the national average.
- Tubectomy acceptors have a mode in the age group 30-34 and
66 per cent of the acceptors are above the age of 30 years.
- The impact of contraception on fertility during 1971-81 is
not clear in Rajasthan as the birth rate decreased and increa-
sed without much relevance to the trend in contraception
(para 96).
The 36-month 'retention rate' of IUD is quite high (95 per
cent for Copper T and 79 per cent for Lippes Loop).
The 'continuatIOn rate' of oral pill is low (the 12 monthly
continuation rate being 14 per cent).
- During the period 1956-79, Rajasthan has achieved a 'low
equivalent sterilisation' of 27 per thousand population com-
pared with 41 in Orissa (which is a poorer state).
- For every birth averted, there could be a saving of
Rs. 3000-4000.
- The family planning programme could have a cost-benefit
ratio of 1:4 and hence the programme is a desirable invest-
ment policy.
There are large intra-state variations in couple protection
from 4.2 per cent in Jaisalmer to 18.5 per cent in Ganganagar
district.
- Though Ganganagar and Bikaner districts are a part of the
'arid zon~' of Rajasthan, they have recorded the highest
contraception rate, probably due to the benefits conferred by
the Rajasthan Canal.
The political commitment to the programme has been weak
and what is even more disturbing is that the programme is
still politicised.
- The MLAs are not yet deeply involved in the programme and
there has been no meeting of the legislators, despite a request
from the Indian Association of Parliamentarians for Popula-
tion and Development (IAPPD).
- Rajasthan ranks quite low in medical attention of infants
and in immunisation status. Only 23 per cent of children
below 1 year were immunised compared with 54 per cent for
all-India.
|
|
2.2 Page 12 |
▲back to top |
- Less than 50 per cent of medical facilities were available at a
distance of less than 5 kms from the rural community
compared with 63 per cent for all-India.
- In the integration of health and family planning, the input
deficiencies which have affected the programme are (i) accessi-
bility, (ii) manpower shortage and (iii) logistics.
- There is a shortage of female functionaries in the programme,
particularly ANMs.
_. Based on the population density, the State Government
estimates that health functionaries in Rajasthan have to
travel three times more as compared to Haryana or Uttar
Pradesh.
Because of the vastness of the state and the difficult terrain
(desert and hilly), the cost per acceptor of services is much
higher than in other states but vehicles and POL are supplied
on a uniform scale.
There is no Cabinet level Committee. There is a State level
Planning and Development Co-ordination Committee for
health and family welfare.
Inter-departmental co-ordination at the grassroots level is
lacking.
The Civil Administration is involved In the programme,
usually during the campaign months.
- There are only a few voluntary organisations to support the
programme and people's participation is passive.
The full potentiality of the co-operatives, the Panchayat
Unions and the organised industrial establishments in pro-
moting the programme is yet to be realised.
- The Village Health Committees need to be activised.
- There is no high level monitoring of the programme as is
done in Tamil Nadu by the Chief Secretary.
_ .. The diagnosis reveals several overwhelming weaknesses in the
programme with a few positive factors.
Favourable Factors
1. Health care base which can impart credibility to the pro-
gramme.
2. Programme becoming increasingly women-oriented.
3. The popularity of the laparoscopic technique.
|
|
2.3 Page 13 |
▲back to top |
Im.pedim.ents
1. The largeness of the state.
2. Recent emergence from a feudal system and backwardness..
3. Low level of literacy.
4. Poverty.
5. Low per capita income and economic stagnation.
6. Low agricultural productivity.
7. Wide intra-state (or regional) variations in demography and
development.
8. Historical high fertility and high parity births-possibly
resulting from son-preference and child-labour.
9. High infant mortality and sense of insecurity about survival
of children.
10. Low status and weak mobilisation of women.
11. Young age at marriage and high proportion of marriages in
the age group 15-19.
12. Poor response from minority community.
13. Feeble political commitment to the family planning pro~
gram me and even politicisation.
14. Limited enthusiasm among the functionaries generally.
15. Manpower problems.
16. Low level of medical services and outreach.
17. Poor infrastructure support in rural areas (rural roads and
rural electrification).
18. Lack of mobility of supervision officials arising from short-
age of vehicles and inadequate POL budget.
19. Inadequacy of female service providers and their reluctance
to stay in the service centres.
20. Limited enthusiasm of the medical profession toward~ ,th~
family planning programme which is probably considered
'extraneous' to their academic attainments.
21. Absence of a 'team approach' to motivation.
22. Main reliance on camp approach and low extension activities.
23. Pursuit of quantitative targets with poor quality aWareness.
24. Poor inter-departmental coordination and failure of develop~
ment departments to utilise their peripheral contacts to
promote family planning.
25. Absence of a system of monitoring at the highest level.
26. Absence of active voluntary organisations.
27. Low involvement of Panchayat Unions.
28. Non-utilisation of the institutional strength of the coopera-
tives and industrial establishments.
29. High cost of services.
30. Limited resources of the State to give higher incentives to
surgeons, motivators and acceptors.
|
|
2.4 Page 14 |
▲back to top |
1. Political commitment to the programme being weak, the
following measures are suggested:
a) There is need for a CABINETSUB-COMMITTEOENPOPULA-
TION AND FAMILYPLANNING.The Monitoring Meeting
held every month reviews the 20-Point Programme of
which family planning is an item. Since family planning
is probably the most difficult of the social programmes,
depending on attitudes and behaviour of the people,it
requires a stronger political backing than what is
available now. Further the success in many of the other
points of the 20-Point Programme depends on tl)e rapid
adoption of family planning by the people. This requires
inter-ministerial involvement. Accordingly, there is need
for a Cabinet Sub-Committee on Population under the
Chief Minister with membership of the Cabinet Ministers
, ..dealing with Finance, Planning, Agriculture & Rural
Development and Cooperatives, Health,~ducation &
Social Welfare and Local Administration.
b) There is need to establish a STATEFA~lILYPLANNING
BOARDunder the Health Minister with membership of
'Heads of Departments and non-officials to secure
co-ordination at the grass-roots level.
Officials
:)
Commissioner & Secretary, Health & Family Welfare.
b<t.
Director of Family Welfare
Director of Rural Development
Director of Social Welfare
Director of Information and Broadcasting
Director of Labour
Director of Municipal Administl]ltion
DireCtor of Panchayats
Chairman, State Social Welfare Board
,I Director; Population Centre.
Non-OffidOls
/;y', 5 MLAs from different political parties
5 MLCs
Representative of voluntary organisations:
(»:~•...v •: ~.f'J...!••....J,.;llily planning Foundation, Family Planning
<. ;.
~
.••
,
_
•
\\
tion of India, etc.
A leading Gynaecologist and Obstetrician.
.Associa-
•
|
|
2.5 Page 15 |
▲back to top |
c) A Cabinet Minister may be made responsible for each
of the districts of Rajasthan.
d) In order to involve the MLAs deeply in their consti-
tuencies, family planning and immunisation camps may
be held in their name. Such camps called 'PRESTIGE
CAMPSa' re named after the MLA of the area and the
handbills and leaflets about the camp carry the photo-
graph of the MLA. Such camps are regarded as
successful in Gujarat and as they cut across party-lines,
the politicisation of the programme may be less.
e) To improve knowledge, understanding and commitment
of MLAs, a meeting of legislators may be convened as
suggested by the IAPPD.
2. Rajasthan has historically a high fertility and hence a built-in
momentum for high growth rate. The young age population (0-14)
constitutes 43 per cent. In conformity with the national
demographic goal, Rajasthan is required to achieve NRR = 1 by
2000 AD which implies that the birth rate has to decline from
the 1980-82level of 38.7 to 21 per thousand and dea th rate from
14.2 to 9 per thousand in rural areas. Though the high mortality
rate has kept the growth rate lower so far, the prospects of the
growth rate remaining constant for some years or even increasing
cannot be ruled out because mortality could decline faster in
re$ponse to improved medical services, but fertility may persist
unless a major dent is made through a vigorous, sustained and
effective family .planning programme in the 8Qs. The State
Government has to brace itself to this challenging job right now
as time compounds the population problem.
3. Since fertility is quite high in all the age groups and43 per
cent of the births· are of parity 4 and above, there is need to
strengthen. sterilisation services and set up bigger targets which
have to be achieved by: .
i) training more non-specialist medical officers in sterilisa-
tion technique: (In extending the sterilisation programme
in rural areas, it would be advantageous to introduce
the mini-lap technique in which Orissa has specialised.)
ii) improving sterilisation services at static centres.
iii) use mobile teams for out-reach areas.
iv) provision of adequate and timely incentives to acceptors
. and doctors.
3. (b) The fertility control measures in Rajasthan have therefore
two distinct a~pects:
|
|
2.6 Page 16 |
▲back to top |
Ii) moderation of the persistent and traditional high fertility
in the higher age groups (the curative approach to high
fertility) and
di) effectively enabling the younger women (15-29 years)
to build a contracepting society, so that they do not
perpetuate the 'high fertility culture' when they move
eventually into the higher age cohorts (the preventive
approach to high fertility.)
4. High fertility and low age at marriage are the twin demographic
;problems of Rajasthan. Low AGEATMARRIAGaEnd high proportion
of young age marriages are a serious handicap of Rajasthan in
:securing better programme performance. A solution based
·on legislation alone is not realistic. The security system in
.the villages is to be recognised. RURALWOMENDORMITORIEtoS
promote literacy and training in rural vocations could be tried in
a few centres on a pilot basis.
5. The critical situation in Rajasthan is that the age at marriage
is low and hence the recruitment of clients for terminal methods
below the age of 30 is also necessary. The fertility control
measures in Rajasthan should aim at two goals:
i) moderation of the persistent and traditional high fertility
in higher age groups 30+ through a ster.ilisation
programme;
ii) enabling the younger women 15-29 to build a contracep-
ting society, so that they do not perpetuate the 'high
fertility culture'. This would require a mix of sterilisation
and spacing methods depending on the parity of the
couple.
6. Keeping the demographic situation and the time perspective
in view, it is necessary that Rajasthan adopts the 'High Priority
Sterilisation' in its 'Contraception Mix' during the 80s. This
would imply that there should be two acceptors of sterilisation
for one acceptor of spacing method. This strategy is suggested
because, the social backing for the programme is weak and spacing
methods require social counselling to secure a high acceptance
and continuation rate.
7. Promotion of spacing methods among the younger couple
(wife below 25 years) is in turn essential from two angles:
i) the need to moderate fertilty at younger ages both from
demographic and health considerations and
ii) to prepare the younger couples to adopt terminal methods
|
|
2.7 Page 17 |
▲back to top |
'as so.on as they have had their small family (limited
to three children).
8. As the IUD retention rates are quite high, this spacing device
could be promoted more vigorously by increasing the strength of
the female service providers in the programme.
9. Oral pill and Nirodh need to be promoted through the
social marketing approach to improve accessibility.
lOa. Mere pursuit of quantitative targets, without ensuring
quality is a waste of resources. Implementation of the
programme in a systematic manner requires an updated Eligible
Couple Register (ECR) at the PHCjSub-centre ~level, so that
the qualitative aspects are kept in view.
lOb. Once the couples with two children and age group less than
25 years are identified, they should be regarded as a target and
motivated to adopt contraception. For this purpose, a large
number of female social workers should be recruited for the
programme.
lOco Within this group, there is need for MOREATTENTIONTO
THEPEOPLEBELOWTHEPOVERTYLINE (usually the landless labour,
marginal farmers and the slum dweller) as otherwise, there would
be several SURPLUSPOOR CHILDRENby 2000 AD whom the
economic system can never lift out of poverty. The surge in
human numbers, together with economic inequalities and sluggish
economic growth obviously pushes up the size of 'marginal'
population. This is a common problem both for population
planning and economic development.
11. In the case of IUD and Oral pill, there is need to sustain a
high continuation rate by follow-up of the acceptors. For this
purpose, periodic incentives in cash may be deposited into the
beneficiary account so as to watch the non-pregnancy status of
the beneficiary. The deferred incentive scheme launched by the
United Planters Association of South India (UPASI) is worth
emulating.
12. In the promotion of spacing moth ods, apart from the
large number of functionaries (ANM, VHG, Dai, etc.), it would
be necessary to involve the non-physicians or the indigenous
medical practitioners as stockists of contraceptives (Oral Pill and
Condom). They could not only make the family planning
services accessible but also acceptable to the people and what is
|
|
2.8 Page 18 |
▲back to top |
more important, the programme would be made more sensitive'
and responsive to local values and individual needs. Likewise, the
private medical practitioners have to be used more for spacing
methods as terminal methods require special training and
equipment.
13. An important demo-economic feature of Rajasthan is the
regional disparity both in demographic variables and development
status. The low population density and low family planning
performance in Western Rajasthan, on the one hand and the
concentration of population in the East, strongly suggest that a
BALANCEDREGIONAL DEVELOPMENTis an important requirement
in planning changes in the demographic status of the different
regions. In particular, the development of the thinly populated
districts bordering Pakistan (Ganganagar, Bikaner, Jaisalmer and
Barmer) through special programmes like the Rajasthan Canal
Project and the Colonisation Scheme is a necessity to lower their
vulnerability to illicit immigration and improve their strategic
position.
14. This will require a totally different approach. The new
social policy of Rajasthan has to concentrate on removal of
poverty and eradication of inter-regional disparity. The Focus OF
DEVELOPMENT should be on the POOR. "The state will have to
plan for a social service system which would depend not solely
on the instrumentality of institutional services but devise new
and less expensive methods of reaching the poor and be FAMILY
CENTRIC".
15. In the socio-political setting of Rajasthan, there is every
possibility that even the modest resources meant for benefiting
the poor could be diverted by the local authorities or the powel'-
groups in the villages. CONSCIENTIZATIONof the village people
about the schemes intended to benefit them need to be undertaken
by the State Government in the absence of any widespread
voluntary network in rural areas.
16. The typical problem in large states like Rajasthan is the
poor logistics and hence limited out-reach of services on
the one hand and high cost of services on the other. Each
PRC is supposed to have a vehicle but many of the vehicles
are not usable. A policy regarding write off and replacement
of vehicle needs to be evolved urgently by the Centre and
some formula based on population density or the area coverage
of a PHC be considered in the allotment of vehicles and
even more importantly in the allocation of POL budget. A
|
|
2.9 Page 19 |
▲back to top |
uniform policy in this regard, whatever its merits, IS not.
realistic.
17. One of the important measures to promote family planning is·
the control of infant mortality which is still high in Rajasthan.
Infant mortality could be seen both as a cause and an effect of
the high fertility. Rajasthan is typical of the co-existence of the
twin problems of high fertility and high infant mortality. The.
short-term steps necessary in rural areas are:
i) a vigorous tetanus toxoid programme;
ii) safe and hygienic delivery by trained dais who should be
supplied kits;
Ui) adoption of spacing devices to prevent a rapid sequence
of birth;
iF) awareness and ability to prepare and use oral rehydration
powder.
18. The low STATUSOF WOMEN (an unwholesome heritage) is pro-
bably the major impediment in rapid promotion of family plan-
ning. The low age at marriage and the high parities, etc. are
symptoms while the poor female literacy and unemplyment are
the causes. With the programme now becoming increasingly
women-oriented (a welcome feature in itself) there should be a
conscious effort on the part of the State Government to enable
fuller participation of women by improving their literacy and
opportunities. In the present strategy of planning, the women
would not be be able to get over the handicaps. It is, therefore,
necessary to set up a WOMEN DEVELOPMENTCOUNCIL in Rajasthan
under the Chief Minister. It would not be out of place to esta-
blish a MINISTRY CF WOMENDEVELOPMENTto undertake inter alia
the MOBILISATION OF RURAL WOMEN, establish RURAL WOMEN
DORMITORIESAND WORKING WOMEN'S HOSTELS, and embark on a
programme of increasing the work participation of women. It
should be the endeavour of this Ministry to set up 30 Rural
Women's Association (R WA) in each block.
19. There is need to increase the strength of women functionaries
in the family planning programme at all levels. Unless the State
Government embarks on an effective programme of educating
rural women about t he health hazards of high fertility and
improves the accessibility of health services in rural areas, the
sex-ratio would continue to be unfavorable to women.
20. It would also be useful to organise OTe Camps exclusively
for women in rural areas with women speakers and organisers,
|
|
2.10 Page 20 |
▲back to top |
so that rural women can learn about the programme without
inhibitions and reservations.
21. Socio-economic development of Rajasthan is going to be a
slow process, because of
i) the huge population base;
ii) the limited resources;
iii) intra-state distribution of backwardness.
The remedy lies in population-oriented development and not in
.grandiose schemes and in muiti-crore urban establishments.
Rural social services (health, education and village industries)
and rural infrastructure (rural roads, rural electrification) should
be earmarked a least 25 per cent of the plan outlay.
22. There should be more area-specific economic programmes
for the 11 districts comprising the arid zone.
23. Since it would take time for the population-oriented
development to make its impact on the fertility behaviour of the
people, there is a definite need to adopt the 'incentives approach'.
In Rajasthan, all the three types of incentives (as elaborated in
the Family Planning Foundation's Study on Incentives and Disin-
centives) are applicable.
i) Individual one-time cash incentives (for acceptors of
terminal methods particularly from the lower income
brackets and also to non-official motivators).
ii) Deferred incentives payable after a prescribed period
of time (for acceptors of spacing methods who maintain
a non-pregnancy status for a prescribed period).
iii) Community incentives which are development-oriented,
asset forming or distributive (link road, well, pump set,
primary school, health sub-centre, community latrine,
etc. for a community which achieves either a 5'\\, increase
in couple protection in a year or a reduction in birth
rate by 2 points).
24. The incentives scheme indicated above provides a basis for
the much needed inter-ministerial coordination. Indeed, inter-
departmental cooperation in family planning promotion bas to
be built into their work pattern inself and not become an appen-
dage. As a first step, the State Government may review the on-
going field activities of individual departments which have a
mass contact and use such contacts to promote family planning.
For example, in the rural areas, the most important programme
is the Integrated Rural Development Programme (lRDP) under
|
|
3 Pages 21-30 |
▲back to top |
|
|
3.1 Page 21 |
▲back to top |
which certain loans and subsidies are given. It could be ensured
by the rural development agencies that such loans are given on
priority basis to families who adopt contraception. In other
words, people should be made conscious of the family planning
programme by using IRDP loan as a form of incentive. Simi-
larly, the Social Welfare Department which handles harijan
welfare has many contact points to motivate the poor harijan
families to adopt family planning. The different development
departments should use their field inputs to secure a grass-root
level linking between family planning and development.
25. In Rajasthan, the high marital fertility is partly attributable
to a value system that regards children as income earners. This
strongly suggests that schemes which could augment family
income should be a part of the fertility moderation strategy.
Studies have shown that general marital fertility declines by
more than half when the per capita expenditure doubles in the
rural areas.
26. Large states like Rajasthan have certain problems arising
by their very size. There is a strong view that adoption of the
same pattern of assistance for these states, as for smaller states,
is not a correct approach. On the other hand, it could be argued
by progressive states like Maharashtra or Tamil Nadu that giving
special assistance to states like Uttar Pradesh would amount to
a premium on inefficiency in programme implementation. But
the rationale for special assistance is that these states (Bihar,
Uttar Pradesh, Rajasthan and Madhya Pradesh) have a handicap
ill the form of large population or large size.
27. Arising from the feeble political commitment to the pro-
gramme the efficiency of the family planning functionary in
Rajasthan could be low. Other reasons for the low level of
commitment of the field functionary is the absence of an effec-
tive supervision by higher officials for lack of mobility and the
absence of re-orientation training facilities. Though there is a
case for the State Government to seek additional funds from the
Centre for these specific shortcomings, they could atleast approach
the problem selectively. The districts, which are consistently
poor in performance, need urgent and concentrated attention.
28. The Village Health Committees could definitely improve
the overall response to the programme provided its Chairman
and Members take initiative. In Gujarat, the Rural Health and
Family Welfare Training Centre convenes a meeting of the full
Committee of three villages at a time. This is a special type of
OTC in which there is a two-way communication. The Commi-
|
|
3.2 Page 22 |
▲back to top |
ttee members after their exposure to a one-day training 'are-
asked to list what activities they would undertake in their
villages over a three month period. Such voluntary commitment
definitely increases their sense of participation. It would be
useful if the MEM Division could contact the Principal, Rural
Health and Family Welfare Training Centre, Ahmedabad to
know more about this innovative OTC and GUJARATEXPERIENCE.
29. Attempts to improve the family planning performance in
Rajasthan should essentially be based on OPTIMUMUTILISATION
OF EXISTINGINFRASTRUCTURTEh. e ATHOOREXPERIENCEof the
Gandhigram Institute of Rural Health and Family Welfare,
Madurai District, Tamil Nadu has shown that with the existing
infrastructure under the PHe it is possible to improve the family
planning programme in rural areas by:
i) developing an infrastructure for reducing the area and
population allotted to each ANM and thus enabling
her to increase the frequency of contacts with couples;
ii) developing the programme in a phased manner by a
team of workers adopting certain methodologies and
pattern of work to carry out intensive motivational
work in a small area and then to take up other areas by
stages;
iii) periodical job oriented training for the staff;
iv) involving and utilising community leaders, voluntary
workers like dais, teachers, indigenous medical prac-
titioners, etc. and voluntary agencies like Madarsangams,
youth clubs, Village Health Committees, etc. for obtain-
ing social support for the programme;
v) establishing a network of multiple channels of commu-
nication like mass group and individual approach for
educating the community on various aspects of health
and family planning programmes;
vi) improving managerial and supervisory skills;
vii) extending adequate services and frequent follow-up
visits throughout the area.
30. Family planning programme needs a SOCIALCHANGEwhich
cannot be brought about by service-oriented functionaries.
A good deal of social counselling would be required in
promoting spacing methods not only for initial acceptance, but
for continuation. There is scope for appointment of a cadre of
social workers through the voluntary organisations.
|
|
3.3 Page 23 |
▲back to top |
voluntary organisations to secure the same. The programme is
regarded as an official activity. The Department of Social
Welfare and the Ministry of Health need to work out a
scheme:
a) to involve the existing voluntary organisations more
vigorously;
b) to promote the formation of voluntary organisations.
through the Social Workers and Mukhya Sevikas.
32a. Family planning cannot continue to be a successful'
programme unless it acquires an evenness. Tbe adhocism, spurts
in efforts, periodic campaigns and camps to fulfil targets are far
from an approach to build a contracepting society. For this,
more determined efforts are necessary to change the value system
particularly in the rural areas and urban slums and make family
planning away of life of individual couples and not entirely a
response to external motivation. To ensure an expanding demand
for family planning services, relevant social and economic pro-
grammes dicected towards communities have to be combined
with a 'team approach' involving para-medicals and social
workers to convince the people about the benefits of limiting
their family and the availability of services for that purpose.
32b. Since the family planning programme is hundred per cent
centrally funded and the targets are also set by the Centre for
each method. the programme is more regarded as a central
programme which the states merely carry out. In order to enhance
the sense of involvement of the state, it is desirable that the
Centre indicates to the states what the level of couple protection
is to be for different years consistent with the national demo-
graphic goal and suggest to the states to take over the responsi-
bility of working out realistically the targets under different
methods as well as the financial requirements for the programme.
In this process, the states in turn could build up their target
profile on the basis of districtwise exercise in target which would
be in line with the couple protection level in each state and the
general demographic and economic characteristics.
33. To be effective, family planning approaches needs to be
SEGMENTEDand tailored to specific audiences. In the rural
areas, we could divide according to the identifiable homogeneous
groups such as occupational life styles (such as agricultural
labour and margi~al farmers, fishermen, minority community.
harijan, industrial labour, urban slum dweller, etc.) Community
organi~ations that cater to the needs of these sub-groups. could
|
|
3.4 Page 24 |
▲back to top |
be identified and utilised as channels for family planning promo-
tion. In the segmented approach to family planning, the urban
slums need a different strategy as they are far from a concept of
:good living though they may have amenities like fridge and TV
in their dwellings and medical and family planning facilities
within easy reach.
34. To promote higher acceptance in the Muslim Community,
the State Government may have to use the good offices of the
Mullah, in particular stressing that the Holy Koran is not against
family planning and pointing how Islamic nations like Egypt and
Indonesia have strong family planning programmes.
35. A medical back-up to the programme is probably the best
method of imparting credibility to the programme and the
medical profession has therefore both a promotive and creative
role in the programme. There is, therefore, a need actually for
a deeper professional involvement of the doctors in the pro-
gramme. A part of the observed superficial involvement of the
medical profession at present is probably due to the medical
profession not being exposed to the full dimension of the popu-
lation problem, the social aspects of family planning and the
contraceptive techniques available for this purpose. Unless the
basis for a radical change in their attitude and their response is
laid during their academic career, the commitment to family
planning cannot be internalised and the doctors would still regard
family planning as an activity extraneous to their academic up-
hringing. There is, therefore, a strong case for imparting more
knowledge and expertise on family planning to the upcoming
generation of doctors during their academic career by suitably
modifying the medical curriculum. We have still not addressed
ourselves adequately to the long-term manpower problems in
family planning and it is only through the strengthening of their
academic training that the doctors could be expected to render
professionalised family planning services in the way they are now
rendering curative services. (Books such as Practice of Fertility
Control-A Comprehensive Text Book by S K Chaudhuri and
others, Current Book Publishers would be useful in modifying
the curriculum).
36. The Medical Officer of the PHe has several responsibilities
now under the integrated programme of health and family
welfare. Several types of records at the PHC level are to be
maintained, follow-up of cases and for monitoring the progress.
The MOPHC needs to have adequate management skill to handle
the multifarious functions of the PHCs and also impart a systems
|
|
3.5 Page 25 |
▲back to top |
approach to identifying and solving problems through a Manage-
ment Information System. All these point to the need for impart-
ing techno-managerial or micro-managerial training to the
MOPHC, with more emphasis on management practice and not
theory.
37. People's participation as a multi-level phenomenon has been
secured in states like Tamil Nadu and Gujarat through voluntary
organisations, panchayat unions, the cooperatives and informal
organisations. But in Rajasthan such agencies, wherever they exist
have not been comprehensively involved in the programme. * In
particular, voluntary organisations capable of mobilising women
are virtually non-existent. It appears that in Rajasthan, people's
participation in family planning internalising both the demand
for and supply of family planning services is a distant goal. For
the time being, the officially sponsored instruments to secure
people's participation in the form of the OTC and peripheral
functionaries like VHG,ANM, Dai, etc have to be used optimally.
At the same time, it is necessary to change the perception that
family planning is just a Government activity. The communica-
tion strategy must aim to bring them round to the view that
family planning benefits the individual, the community and the
nation in a sequence.
38. Family planning requires an extension approach and the
Block Extension Educator (BEE) has a responsibility in this direc-
tion. But the BEE in the present structure of PHC functioning
does not seem to have household visits for motivation. The BEE
organises Orientation Training Camps (OTC) for Opinion
Leaders, contacts Gram Pradhans, etc. The role ofthe BEE is more
group-oriented and not oriented towards individual households.
Even in the case of OTC Camps, the BEE rarely folIows-up such
camps to secure the 'ripple effect,' of the training and motivation
to which the Opinion Leaders are exposed. This is a task which
the BEE could definitely handle so that more people accept the
programme.
39. One of the main instruments for securing community partici-
pation is the Community Health Guide, now designated as Village
Health Guide (VHG). Some supervision over and guidance to the
VHG through the Village Health Committee, the Gram Pradhan
and the Opinion Leaders of the area could enable this array of
functionaries to activate the participation of the community .
•Particularly the Milk Cooperatives infrastructure is strong in Rajasthan
with 1680societies and over one lakh producer members according to the
NDDB report, 1982-83.
|
|
3.6 Page 26 |
▲back to top |
40. Though Rajasthan has many cooperatives (such as rriHk
cooperatives) the full potential of the cooperative structure in
promoting family planning, firstly among the members and
secondly among the public has not been realised. Inclusion of
family welfare topics in the training course of various categories
of cooperative staff is no doubt an essential input in this
direction.
41. Successful family planning in Rajasthan in the ensuing
years with adequate emphasis on spacing methods requires a
caring and continuous service to the acceptors. It is doubtful
whether the present structure of an officially led motivation and
delivery system can handle Vi idespread and effective spacing
services. A combination of measures is called for:
a) Reorient the functionaries in the programme at all
levels so as to bring in more human values in the
programme.
b) Introduce among functionaries more social workers
preferably females who have themselves accepted family
planning.
c) Utilise voluntary institutions, cooperatives and all the
informal local level organisations in recruiting clients
and supplying contraceptives adopting either the com-
munity based distribution system or social marketing
techniques.
d) Constantly monitor the demand and supply situation in
order to ensure a demand-supply equilibriun at micro
level to avoid frustration among genuine users, on the
one hand and avoid accumulation of unutilised stocks
on the other.
42. THE STUDIES AND SURVEYSthat are considered necessary for
making the family planning program me in Rajasthan more
relevant and responsive to the realities in the field are listed
below:
i) One of the reasons for the high population growth in
Rajasthan is 'immigration'. The Census results do not
show a high rate of immigration. There are therefore
doubts whether there could be 'illicit' immigration which
the Census has not been able to detect. Though the State
Government has denied illicit immigration an enquiry
would be useful both from strategic and demographic
angles.
ii) A unique feature of urbanisation of Rajasthan is that
|
|
3.7 Page 27 |
▲back to top |
small-sized towns are vanishing. This phenomena need
to be studied.
iii) Birth rate in Rajasthan in 1971-81 has declined and
risen without any link with the family planning
programme. A technical probe of SRS measurement of
birth rate would be useful. Likewise, a 'Contraception
Prevalence Survey' is necessary to establish the level of
acceptance actually in the field (as the estimates now
are only analytical).
iv) Why is the fertility decline lower in urban areas?
Is it due to slum population? What are the demographic
features and lifestyle of 'slum population' and how
are they responsible for high fertility, high IMR and low
family planning acceptance? .
v) What is the rationale behind the high parity births
(4+) in Rajasthan and what is the sex of children
sequentially in such families? How strong is the
son-preference attitude?
vi) Why is infant mortality high in rural Rajasthan?
Which of the hypothesis: child replacement or child
survival, is stronger?
vii) Why is the infant mortality higher among female
children? Are the reasons cultural or biological?
viii) To what exent is the intra-state distribution of
backwardness considered in the development strategy?
What specific steps were taken in VI Plan to reduce
regional economic imbalance?
ix) There is a slight shift of female labour from
'agriculture' to 'household industry' and 'others', which
is a welcome feature. What are the non-agricultural
occupations favoured by women of Rajasthan?
x) To what extent have people benefited through the
IRDP? (para 84)
xi) Spacing methods have received more attention in
Rajasthan. What proportion of those practising spacing
methods have eventually adopted terminal methods?
xii) Why is Oral pill having a low acceptance rate?
xiii) Has the health care based approach changed rural
people's attitude favourably for family planning?
xiv) A techno-economic study of the impact of the
Rajasthan Canal Project on the family planning
performance in Ganganagar and Bikaner Districts.
xv) Why is the fertility higher among the Service
Workers (Div 5 of occupational classification)?
xvi) What benefits have accrued to the tribals of South
Rajasthan through the Tribal Sub-Plan?