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Focus 1988 April - June |
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Family Planning Motivation Lacking
in Madhya Pradesh
DEVELOPMENT MAKES NO DIFFERENCE
A detailed study of eight back- to be disease-based. Doctors come
ward districts of Madhya Pradesh to know about the health problems
undertaken in 1983 throws fresh of the people only when the latter
light on the complex relationship visit the health centres on account
between development and fertility of some sickness. They lack the
regulation. White the process of attitude to look at health as a
development has been moving on positive programme to be pro-
steadily in these districts, it is not moted in the community as a
finding its reflection in fertility whole.
regulation.
The study was undertaken by
The study concedes the _point the National Institute of Health
that it takes years for birth control and Family Welfare in collabora-
to decline. At the same time, it tion with the Ministry of Health and
highlights the fact that family Family Welfare, relevant depart-
planning consciousness amongst ments of the Government of
the people is not increasing and Madhya Pradesh and DANIDA.
by and large they continue to Dr. P. P. Talwar, Head of the
remain apathetic to the programme. Department of Statistics and Demo-
This is confirmed by information graphy, NIHFW, headed the survey
culled from other documents. team. The study report runs into
According to this information, in ten volumes.
the rural areas of M.P. as a whole,
The eight districts studied are
the birth rate in 1'980 was 38.1. By Bhind, Morena, Gwalior, Datia,
1983, it had jumped up to 40.1. In Guna, Shivpuri, Sagar and Tikam-
the urban areas it stayed put at 32. garh. rhese were selected from
rhe combined birth rate in 1980 three admini!trative regions.
was 37.1. By 1983, it had in-
In all 8,064 households (48 per
creased to 38.5 and by 1985 to village) in 168 villages were cover-
38.8.
ed by the study. The objective
behind it was to provide baseline
Cure To Care?
. estima~es of fertility, mortality, mor-
Another ,significant
finding bidity, disability, knowledge and
emerging from the study indicates practice of family planning me-
that despite all the emphasis on thods, extent of utilisation of mater-
shift from cure to care, the health nal and child health services, nutri-
system in the villages continues tional status of children and related
aspects against which the succass
of special programmes to be launch-
ed with assistance from DANI DA
could be assessed sub"equently.
Development Situation
rhe survey reveals that during
the last few years, there has been
notable expansion in development
asa whole in the villages studied.-
Primary schools have been esta-
blished in almost all of them.
Facilities for education above the
primary level have a Iso been made
available at convenient drs'ances -
a middle school at a distance of
2.9 kms. and a high school at a
distance of1 0.2 kms. Facilities for
coHege education are available at an
average distance of 24.4 kms.
Thirtyone per cent of the house-
holds live in p,ucca or semi-pucca
self-oWned houses; 10 per cent
have the benefit of electricity and
16 per cent possess their ovyn
radio sets or transistors. rhe ex-
posure to the media as a whole is,
however, much more - 45 per cent
of the households. rhis indicates
good possibility for using the
brcadcast media for health and
family planning education.
Banking facilities are also not
far to seek in the villages surveyed.
rhere is a cooperative bank within
an average distance of 11.5 kms.
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'" r-21( priG::: :'i,Cp slsc&;(ists ':,n n:ap' gO\\Ie(nm,an'c NaarJV j':~, p,at csn:
~ji,a·:~dis'l2JiC'&. Evsry \\Jv9·ek 2 baz:3?" 3aid, on the o'(her hand, that ;,aal·th norv~ h'crr c}:9 sC(:,8dt~j·ed ·uioe~.
(marks"!) is arrang,ed at a con v$'- facilitj·es were inadequate. Nearly
There are ha;'dly any iady aCCTors.
nient place.
33 per cent were of th,e view that Over ninety per cent of thOSe
S'J~;J~iS;!"'gl,!, th,Po literacy I,av,el in these facilities in any case were working in the PHCs are male.
th'e villag,es continu·es to b-e low -- beyond their reach. The pan-
Most of the doctors themselves
only 45 per cent in the case of chayats as a whole were not in- str,essedthe need for rural orienta-
males and 14.5 per cent in the volved. Only some 17.8 per cent tion.
case of girls above the age of five. showed some interest in health
On an average a doctor attends
'The mean age at marriage of the programme.
to about 80 patients on his clinic
curr,ently married women (15-44
The survey reveals an attitude of day.
years age group) at the time of the helplessness. People do not know
Common complaints given by
surv,ey was 13.5 years. Early what to do and where to go in the medical officers were: inadequacy
marriage is the norm. However, event of sickness in the family. of staff, inadequacy of medicines,
eff,ective marriage of girls takes Health education is lacking. The" shortage of funds and lack of
place only at the age of 15 years, average distance between a village sterilisation equipments. Almost
following the "gauna" ceremony. and the primary health centre is all the doctors also complained
'The mean age at first birth was 21.8 kms. It is 4.4 kms in the about inadequacy of transport and
18.6 years - i.e., about 3.5 years case of sub-health centres. Drink- its adverse consequence on their
after ,effectiv,e marriage.
ing water 'facilities are lacking.
movement within the area allotted
One common feature of life in
People complained that they had to them. They also said that it
the villages surveyed is abssnce of to buy their own medicines and affected the promotion of spacing
latrines. About '91 per cent of the they did not have the money for methods under the family planning
villages have no public latrines this. Not much of motivational programme.
and about 87 per cent of the effort was in evidence. In 1,000
Most of the doctors said that
families do not have latrines in villages, just-el)jne film shows were they did not receive any help from
their own homes. The people by organised in·' a whole year.
other development departments.
and large are used to defecation in
the open. They hardly realise the Family Planning
There was, however, good coopera-
tion among health workers.
importance of a latrine in relation
As regards family planning, uti-
<1'/
to sanitation, environment and lisation of services was very low. Health-Workers
their own health.
Out of every 1,000 currently
Health workers are now known
lH3alth Scsns
married women, only five had as MPWs {multi-purpose health
accepted sterilisation and two IU0 workers). They are considered to
In all there are 58 primary health in 1980. Only about 15 per cent be pillars of the entire health
centres, two additional PHCs, 58 of the women had got themselves service delivery system in villages.
mini-primary health centres, 92 dis- registered for antenatal services, A fairly large number of these
pensaries, 10 upgraded dispen- 7 per cent had received TT and workers have been trained and
saries and 875 sub-health centres 16 per cent folic acid tablets. placed in sub-health centres
in the eight districts. The average About 6 per cent of the deliveries (SHCs), at the rate of one per
service area of a PHC is 1,026 sq. were conducted by the ANMs and 5,000 population. It is envisaged
kms. spread over 182 villages and 3.4 per cent by trained dais.
that eventually every SHC will
covering a population of 1.02 lakh.
The use of immunisation have one male and one female
The survey points out that the services intended for children was health worker.
services are inadequate. There are also very low - 9' per cent in the
The functions of female health
other drawbacks. Four of the PHCs case of first dose of OPT, 6 per workers lay emphasis on provision
do not have electricity and 12 are cent second dose and 3.4 per cent of family planning services to the
functioning from buildings in poor third dose. Only half per cent people at the sub-centre level and
condition. Eighty per cent of the (0.6) children were covered by full supervision of workers in the field
vehicles at the disposal of a PHC immunisation.
specially intended for MCH work.
are out of order.
Malaria and skin diseases are Medical Officers
Male health workers tal<e care of
common diseases and national
rampant in the villages surveyed.
The study indicates that most of health programmes. Of ocurse.
Th·ere is generaI lack of awareness the doctors lack sense of belonging MC.H and family planning ar-ealso
in relation to health matters. There to rural areas. They do not have included in their duties.
is hardly any sanitation. A bulk of any orientation in the tackling of
The
survey
reveals :;lat
~.- <:
o:J·'"
the people (62 per cent) felt that rural health problems.
per cent of the male and 61.2 per
it was the responsibility of the
Only 9.3 per cent of them come cent of the female health workers
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In tune with the national accent on modernity,
the television medium in India has expande~ fast in
the current decade. The market is being flooded
with new sets every month. The annual addition is
three million and the total now stands at 15 million.
The number of transmitters has gone up to 237. All
this means that we may be getting close to that point
in time when almost anywhere in India one may be
able to switch on a television programme, provided,
of course, one has the means.
The medium continues to be predominantly
urban in character. It is also debatable whether
commercial advertising, which gets Doordarshan
over Rs. 100 crores every year, is not encouraging
glamour to undermine the appeal and efficacy of
social programmes. In the total context, it is neverthe-
less good to find television getting bold in relation
to family welfare. With what effect? Three small
studies, not so scientific, attempt some answers.
We have been able to obtain access to them and we
present their findings in this issue.
The real communication barrier, however, lies
in villages. To cope with it, a different type of effort
is needed. This is borne out abundantly by a more
scientific and comprehensive study in group com-
munication by half a dozen prestigious institutes.
Through their kindness we are using the findings
of this study as well in some detail.
In the last issue we went deep into factors res-
ponsible for the success of family planning in Kerala.
This time we have taken the liberty to focus on
Madhya Pradesh. The illuminating study on which
we have been able to lay Our hands, and which inci-
dentally runs into ten volumes, throws up many
lessons for policy-planners as well as others con-
cerned with issues p.ertinent to the population ques-
tion.
High infant mortality rates, high birth rates,
effects of mounting population pressures on re-
sources and people's prejudices and preferences are
some of the other subjects we have tried to touch in
this issue.
We acknowledge with thanks the help we have
received from our sources. We;us also grateful to
the universities, -population centres and clubs and
other organisations that have shown interest in Focus.
have education up to the level of
higher secondary and above. The
mean population served by a male
worker is 7,700, as against the
prescribed 5,000. The work-load
on the female worker is generally
within the prescribed limit of 5,000.
The geographical area served by
male workers is 16 sq. kms. and by
female workers 12 sq. kms.
These workers are expected to
have their field visits either on foot
or by public transport. The wide
range makes mobility difficult. On
an average, according to this sur-
vey, a male worker serves 15
villages, while a female worker
covers 6.4 villages. Male workers
use cycles or tongas or buses, but
female workers generally go about
on foot. One redeeming feature
in the situation is that 80 per cent
of the male and 77.1 per cent of
the female workers reside in the
SHe area.
There is hardly any community
participation in health programmes.
The health workers take no initia-
tive in the matter and the com-
munity's own attitude is luke-
warm.
Health Supervisors
The survey reveals that the per-
centage of female supervisors hav-
ing rural background is low (23
per cent). As such, these super-
visors remain aliens in villages.
MaIe supervisors, on the other
hand, have rural background - 66
per cent.
Both female and male super-
visors need orientation training, at
least once in two years.
An important factor which under-
mines the functioning of super-
visors, particularly male super-
visors including block extension
educators, is stagnancy in service.
For ten to twelve years, they have
been working in the same capacity
without any promotion.
Transportation is another pro-
blem. Because of its inadequacy,
female supervisors can cover only
one to ten villages in a month and
male supervisors eleven to twenty.
Male supervisors give priority to
family planning and malaria; female
supervisors and BEEs devote more
attention to family planning and
immunisation.
Supervisors were asked how best
to improve family planning per-
formance in their areas. Their
suggestions are:
(1) supply of audio-visual aids;
(2) expar'l'sion of health edu-
tion;
(3) reguiar supply offmedicines
in the field;
(4) increase in health staff and
greater mobility; and
(5) proper follow-up services
for family planning accep-
tors.
They also suggested that workers
belonging to other development
departments should be involved in
the family plann,ing programme.
According to them, they keep away.
Health Guides
The survey-indicates that health
gui<Ms tl1Ne made their presence
felt on the rural health scene.
Most of them are married. Their
average age is 31.7 years. There
are, however, hardly any women
(only 8 per cent) among them and
very few (9 per cent) belong to
scheduled ca&tes and scheduled
tribes. More than 50 per cent
(Continued on page 7)
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Nine-tenths of the increase in
the population of the world that
is taking place today is occurr-
ing in the developing and under-
developed world.
By 2,225, South Asia will
double, Latin America will grow
to two and half times and
Africa three and half times of
what they were in 1980.
In the next 40 years per capita
availability of water in many
countries will shrink to a quarter
of what it was in 1975.
If the South starts consuming
oil on the same per capita rate
as the North does it today, all
present reserves of oil may
vanish before the century ends.
Every year the world is losing
tropical forests at the rate of
11.3 million hectares - equal
to the size of East Germany;
at this rate, all forest may vanish
in 172 years.
In congested Hong Kong, the
pressure of population on land
is so great that even the dead
are being denied a bit of land
to rest in peace.
Graves are dug there every six
years. The dead bodies are
taken out and then cremated
and reburied in smaller plots.
If this is not done, there would
be no space to bury more
bodies.
In netghbouring Shanghai in
China, foreigners deny them-
selves the pleasure of drinking
locally brewed beer because
they think water used for mak-
ing this beer is heavily polluted.
Back home, in India, the compo-
sition of the population is chang-
ing.
Largescale migration is taking
place from villages to cities -
five million a year.
Twentyfive percent of India now
lives in cities as against 20
percent a few years back.
By 1991, the country will have
20 metropolises (towns having
.over a million people); today
their number is 12.
Between 1951 and 1981, the
population of Calcutta went
up from 3.9 million to 9.1
million, Bombay from 2.9 to
8.2 million, Delhi from 1.4 to
5.7 million, Madras from 1.5
to 4.2 million, Bangalore from
0.7 to 2.9 million and Ahmeda-
bad from 0.8 to 2.5 million.
By the end of the century, the
population of these cities will
be: Calcutta 14.9 million,
Bombay 14.9 million, Delhi
13.4 million, Madras 7.4 million,
Bangalore 8.6 million, Ahmeda-
bad 5.2 million.
Bombay, Calcutta, Delhi' and
Madras now have an estimated
third of their population living
in slums.
From the Frying Pan
into the Fire '7
"With well over a third of our
continuously growing popula-
tion still below the poverty line,
with our agricultural resource
base mercilessly eroded by de-
forestation, soil erosion and
pollution, with availability of new
land for crops steadily diminish-
ing and existing land holdings
relentlessly fragemented, our
villages are no longer havens of
peace and relative prosperity,
and the young increasingly tend
to flee from them in order to
migrate to overcrowded cities
in search of a better life, instead
of which they find theylave to
endure the degradation of slum
life, brittle social relations and
frequent turmoil." -J.R. D. Tata
Half of Calcutta's popuration
does not have any toilet facili-
ties.
In Madras, people have learnt
to live without water supply
on alternate days.
Pressure of population on land
is increasing in villages.
In cities tensions are mounting.
Crimes are increasing.
Between 1961 and 1981, their
number went up from 20,000 to
35,000 in Bombay, 10,000 to
29,000 in Delhi, 4,000 to 17,000
in Bangalore, 5,000 to 15,000
in Madras, 3,000 to 10,000 in
Ahmedabad.
Was Julian Huxley very much
wrong when as Director-General
of UNESCO he said in 1948 -
"somehow or other popula-
tion must be balanced
against resources or civiliza-
tion will perish war is a
less inevitable threat to
civilization than population
I.n.crease"
?.
Population problem
worse than corruption?
How people in towns view it
A survey of 35 urban centres done
recently by the ORG on behalf of
the Times of India Group of
Publications suggests that more
than half the adults living in these
centres consider the population
boom to be a bigger problem than
corruption. More women than
men held this view.
The survey further indicates that
an overwhelming majority of the
people in these towns wants the
government family planning pro-
gramme to be revamped com-
pletely with a strong element of
edl1l::ation,incentives and disincen-
tives.
More ~eor:Ie have advocated in-
centives than disincentives.
The centres taken for the survey
include 12 state capita!s. The
sample comprises 2,100 adults of
21 years and above, 47 per cent at
them women.
The survey was carried out imme-
diately after the family planning
fortnight observed by the country
in SepteQ1ber1'987.
As many as 61 per cent of the
respondents consider population
growth as the most pressing pro-
blem facing the country today when
compared to illiteracy, communal
ten!>ion and corruption.
Everyfourth urban adult feels that
the family planning programme
needs to be made more effective
to attack the population problem.
One out of every five feels that
education holds the key to popula-
tion control.
About an equal number wantg
disincentives to be introduced.
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Nine-tenths of tne increase in
the population of the world that
is taking place today is occurr-
ing in the developing and under-
developed world.
By 2,225, South Asia will
double, Latin America will grow
to two and half times and
Africa three and half times of
what they wer,e in 1980.
In the next 40 years per capita
availability of water in many
countries will shrink to a quarter
of what it was in 1975.
If the South starts consuming
oil on the same per capita rate
as the North does it today, all
present reserves of oil may
vanish before the century ends.
Every year the world is losing
tropical forests at the rate of
11.3 million hectares - equal
to the size of East Germany;
at this rate, all forest may vanish
in 172 years.
In congested Hong Kong, the
pressure of population on land
is so great that even the dead
are being denied a bit of land
to rest in peace.
- Graves are dug there every six
years. The dead bodies are
taken out and then cremated
and reburied in smaller plots.
If this is not done, there would
be no space to bury more
bodies.
In neighbouring Shanghai in
China, foreigners deny them-
selves the pleasure of drinking
locally brewed beer because
they think water used for mak-
ing this beer is heavily polluted.
- Back home, in India, the compo-
sition of the population is chang-
ing.
- Largescale migration is taking
place from villages to cities -
five million a year.
- Twentyfive perc-entof India now
lives in cities as against 20
percent a few years back.
By 1991, the country will have
20 metropolises (towns having
over a million people); today
their number is 12.
Between 1951 and 1981, the
population of Calcutta went
up from 3.9 million to 9.1
million, Bombay from 2.9 to
8.2 million, Delhi from 1.4 to
5.7 million, Madras from 1.5
to 4.2 million, Bangalore from
0.7 to 2.9 million and Ahmeda-
bad from 0.8 to 2.5 million.
By the end of the century, the
population of these cities will
be: Calcutta 14.9 million,
Bombay 14.9 million, Delhi
13.4 million, Madras 7.4 million,
Bangalore 8.6 million, Ahmeda-
bad 5.2 million.
Bombay, Calcutta, Delhi aDd
Madras now have an estimated
third of their popUlation living
in slums.
From the Frying Pan
into the Fire 7
"With well over a third of our
continuously growing popula-
tion still below the poverty line,
with our agricultural resource
base mercilessly eroded by de-
forestation, soil erosion and
pollution, with availability of new
land for crops steadily diminish-
ing and existing land holdings
relentlessly fragemented, our
villages are no longer havens of
peace and relative prosperity,
and the young increasingly tend
to flee from them in order to
migrate to overcrowded cities
in search of a better life, instead
of which they find they have to
endure the degradation of slum'
life, brittle social relations and
frequent turmoil." -J. R. D. Tata
Half of Calcutta's population
does not have any toilet facili-
ties.
In Madras, people have learnt
to live without water supply
on alternate days.
Pressure of population on land
is increasing in villages.
In cities tensions are mounting.
Crimes are increasing.
Between 1961 and 1981, their
number went up from 20,000 to
35,000 in Bombay, 10,000 to
29,000 in Delhi, 4,000 to 17,000
in Bangalore, 5,000 to 15,000
in Madras, 3,000 to 10,000 in
Ahmedabad.
Was Julian Huxley very much
wrong when as Director-General
of UNESCO he said in 1948 -
"somehow or other popula-
tion must be balanced
against resources or civiiiza-
tion will perish war is a
less inevitable threat to
civilization than population
I. ncrease"
7.
Population problem
wors.e than corruption 7
How people in towns view it
Asurvey of 35 urban centres done
recently by the ORG on behalf of
the Times of India Group of
Publications suggests that more
than half the adults living in these
centres consider the population
boom to be a bigger problem than
corruption. More women than
men held this view.
The survey further indicates that
an overwhelming majority of the
people in these towns wants the
government family planning pro-
gramme to be revamped com-
pletely with a strong element of
educlUion, incentives and disincen-
tives.
More people have advocated in-
centives than disincentives.
The centres taken for the survey
include 12 state capitals. The
sample comprises 2,100 adults of
21 years and above, 47 per cent of
them women.
The survey was carried out imme-
diately after the family planning
fortnight observed by the country
in September 1'987.
As many as 61 per cent of the
respondents consider population
growth as the most pressing pro-
blem facing the country today when
compared to illiteracy, communal
ten!:>ion and corruption.
Everyfourth urban adult feels that
the family planning programme
needs to be made more effective
to attack the population problem.
One out of every five feels that
education holds the key to popula-
tion control.
About an equal number wants
disincentives to be introduced.
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~traints of time and sp.ac~
are heavy, it is not worth-
while to load messages
with too much informa-
tion;
(2) television is better than the
print media, particularly in
states where the illiteracy
level is high;
(3) messages create need for
more information which
must be satisfied in order
to avoid negative results;
(4) messages regarding immu-
nisation of pregnant women
and family planning elicit
the least number of res-
ponses; and
(5) the reason for this could
be two-fold - people give
less priority to mothers'
health; on family planning
what is given is already
known.
Varanasi -Saharanpur
Study
The Audience Research Unit of
Doordarshan Kendra, Delhi, con-
ducted a somewhat more compre-
hensive, though severely limited
from the point of view of audience
contacted, study on the impact of
television programmes on family
welfare in seven villages of Varanasi
and the district of Saharanpur
(village, city and slums) in U.P.
in September- Deoember 1987.
The methodology adopted con-
sisted of -
(a) 400 in-depth interviews;
(b) screening of quickies
followed by spot observa-
tions;
(c) group discussion, and
(d) use of secondary data from
PHC.
The salient features of the find-
ings of this study are:
(1) TV Ownership
Four to six per thousand
in Varanasi and nine per
thousand in Saharanpur dis-
trict.
(2) Health Facilities
PHCs/sub-centres
within
three to five kilometers from
the villages; achieving family
planning targets given priority
by medical staff.
(3) TV Reach
TV reach universal among TV-
owning and non-TV owning
respondent. except in villag,es
(76 per cent) and slums (50
per cent) of Saharanpur.
(4) TV-Viewing
(a) TV Owners:
- Regularly 50 per cent,.
frequently 25 per cent,
occasionally 23 per cent
(Varanasi district).
- Regularly 70 per cent,
frequently 23 per cent,
occasionally 7 per cent
(village, Saharanpur dis-
tricts) .
- Regularly 72- 76 per cent,
frequently 12 per cent,
occasionally 12-16 per
cent (slums and city,
Saharanpur district).
(b) Non-TV Owners:
Regularly 33 per cent,
frequently 23 per cent,
occasionally 36 per cent
(both districts).
(5) Viewing Time
On week days maximum view-
ing between 8.30 PM and
9.30 PM followed by 7.30 PM
and 8.30 PM.
Highest viewing on Sundays
between 9.30 AM and 10.30
AM followed by 5.45· PM
and 8.30 PM.
(6) Impact of Quickies
(a) Family Welfare: Over 80
per cent reported aware-
ness and viewing at one
time or the other.
(b) Marriage Age: Majority
understood the message,
but the aged and the
illiterate· could noti
quickies succeeded in
stimulating the thinking
pr9cess.
.
(c) Spacing Method: QUIC-
kies drawing analogy bet-
ween plants and children
found most effective.
{d) fmmunisation: More than
th ree-fourths
under·
stood the message- illi-
terates and the aged
could not comprehend
it; one-tenth went for
immunisation after view-
ing.
(e) Balanced Diet: Majority
understood the message
except the illiterate and
the aged, but few re-
ported alteration in their
diet after viewing.
(f) Equality Between Boy
and Girl: Majority under-
stood the message (ex-
cept illiterates and the
aged) ; quickies re-
portedly succeeded in
sensitising about one-
tenth.
(g) Vitamin 'A': Majodty
comprehended the me-
ssage (except the illi-
terate and the aged);
but few went for the
doses after viewing.
(h) Diarrhoea: All (except
jIJiterates and the aged)
understood the message.
The study has made the follow-
ing suggestions:
(1) Media-mix approach is essen-
tial for the success of cam-
paign;
(2) All forms of media should
follow the same schedule de-
signed for the entire com-
munication campaign ensur-
ing cultural relevance;
(3) Repetition of message is must
for internationalisation; and
(4) InfrastrU'Cture is essential for
the success of the campaign
and to avoid boomerang effect
leading to frustration.
The study was done by Swarup
Singh and Geeta Bakshi.
The same Audience Research
Unit undertook a telephonic survey
on the impact of family planning
(Continued on page 7)
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(Continued from page 3)
have education up to the matricu-
lation level. About 86 per cent
have farming as their main occupa-
tion.
The three main activities p~r-
formed by the health guides are;
(a) attending to minor ailments
(50 per cent); (b) family planning
(including distribution of contra-
ception); and (c) environmental
sanitation. Very few of the guides
consider MCH as one of their
functions. This is attributed to
inadequacy of female representation
in their ranks.
Guides work on an average for
about three hours a day. They
either attend to cases in their own
houses or work in the villages
where, apart from looking after
environmental sanitation, they see
patients. They refer patients having
serious trouble, beyond their own
competence, to the nearby health
service unit.
Most of the guides complained
about inadequacy of medicine, their
irregular delivery and inadequacy of
training. The level of cooperation
between them and the health staff
is low.
Dais
Dais (indigenous midwives) have
been functioning in villages for
ages. The survey has found them
to be extremely useful. Some of its
salient findings are:
(1) Most of the Dais (90 per
cent) regard their training
at the primary health
centre as useful. About
52 per cent have suggested
that there was need for
reorientation.
(2) About 53 per cent of the
dais said that as part of
their training they had
conducted four or more
deliveries under the super-
vision of ANMs or LHVs.
(3) Most of the dais (92 per
cent) belong to scheduled
castes/scheduled tribes.
(4) Illiteracy is universal
among them.
(5) Almost all the (dasi 94.5
from the health staff in the
per cent) said that dai
matter of medicines fo
work was their family
patients and immunisation.
vocation. About 81 per
The health staff take their
cent have been engaged
assistance in motivational
in the profession for over
work relating to family
10 years. For about 66
planning.
per cent, dai work was
their principal s::>Urceof Voluntary Organisations
earning.
(6) On an average, dais attend
seven delivery cases in a
The survey reveals a dismal
situation in relation to voluntary
organisations in villages. the only
month.
such organisations, if these can
(7) Most of the dais advise indeed be called voluntary, in
pregnant women to get existence there are bhajan mandals
themselves immunised and natak mandalies, the former in
against tetanus. They 58 per cent of the villages surveyed
also give them general and the latter in 10 per cent. There
advice about nutrition.
was no evidence to suggest that
(8) Most of them refer com- these organisations were associat-
plicated cases to the ANM ed with family planning work.
or the PHC.
As regards panchayats, these,
(9) More than 80 per cent of too, are not involved. People
the dais give post-natal interviewed suggested that there
attention to their patients. was need to motivate panchayats,
This attention is generally supplement their resources and
in the form of advice on monitor their work.
immunisation of the new-
born, breast·feeding, diet, (Continued from page 6)
nutrition, check-up of spots promoting contraceptives on
mother and child and 300 adu1'trespondents in TV house-
family planning.
holds in November 1987. These
(10) On an average, dais re- spots were telecast after 10 PM.
ceive Rs. 11 per delivery
About 63 per cent of the res-
from the family of the pondents were aware of the tele-
woman. In addition, they cast. The viewing recalled during
receive 5 kg. of grains. the course of the week was: 25 per
They are, however, not cent regularly (6 to 7 days in a
receiving the prescribed week), 23 per cent frequently (3
Rs. 2 per case payment to 4 days in a week) and 15 per
from the government.
cent occasionally (1 to 2 days in
(11) The common complaints a week).
of dais are lack of proper
About thr~e-fourths of the
instruments, conveyance viewers were in favour of the
difficulties, particularly at spots being telecast. The rest
odd hours, non-availability were against it.
of medical help in com-
A good number (145) of the
plicated cases ~nd irregu- viewers suggested that such spots
lar or no supply of medi- on family planning should be tele-
cine like iron and folic cast at prime time, Le., just before
tablets.
(12) The level of collaboration
between dais and health
the news bulletin. Some others
suggested their induction into pro-
grammes like Krishi Darshan in-
staff is higher at the PHC tended for rural audiences.
and sub-centre levels but
The criticism was on the folloW-
lower in villages far away. ing grounds:
Generally dais take help
(Continued on Page 10)
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Group Communication Works-Best inVilJages
The findings of numerous earlier
family planning studies making the
point that to motivate people in
villages, for years to come India
will have to rely heavily on inter-
personal communication have been
corroborated further by a recent
largescale India-wise study of
opinion leaders' camps undertaken
by six institutes- National Institute
of Health and Family Welfare, New
Delhi; Gandhigram Institute of
Rural Health and Family Welfare
Trust, Tamil Nadu; International
Institute for Population Sciences,
Bombay; and Population Research
Centres, Bangalore, Lucknow and
Patna.
Fiftysix primary health centres in
28 districts in seven states - Bihar,
Karnataka, Maharashtra, Orissa,
Tamil Nadu, Uttar Pradesh and
West Bengal - were selected for
the study. The sample chosen
comprised three categories of
people:
(a) health and family welfare
personnel at the district and
PHC levels who are directly
or indirectly involved in the
planning or organisation of
educational camps;
(b) participants in the camps;
and
(c) members of the community
who were expected to be
served by the camps.
The method followed was inter-
views and observation. In all, 158
officers, including 26 district mass
education and media officers and
51 block extension educators
(BEEs), 1,114 participants ('910
males and 204 females) in the
camps and 2,523 members of
community (2,094 males and 429
females) were interviewed.
Community Participation
The findings of the study have
been published by the International
Institute for population Sciences,
Bombay. The principal ones are
summed up as follows:
(1) On an average, the age of
male and female participants
was 40 and 37 years respec-
tively. Almost all of them
were married and had three
to four living children. Lite-
racy among them was fairly
high - 88 per cent in the
case of men and 56 per cent
in the case of women.
(2) A vast majority of the offi-
cials (92 per cent) and
paricipants (96 per cent
males, 98 per cent females)
testified to the usefulness
of the camps - 95 per
expected to be undertaken
by them, Three·fourths of
the officials also said that
following the camps, "some
or most of the participants
were active in relation to
the family welfare pro-
gramme in their villages".
From th,e community, 50
per cent of the respondents
said that the participants in
the camps had discussed
family planning with them.
It is a significant pointer to the
cent of all the paricipants
were willing to attend more
such camps in the future
and almost an equal pro-
portion said that they would
ask their friends and rela-
utility of such camps that the
latest report of the Ministry of
Health and Family Welfare accords
high importance to their organisa-
tion in the new family welfare
strategy.
tives also to participate in
them.
(3) By and large, the leaders
did command esteem in
their villages. About half
of them stated that "as
Immunisation
programme makes head-
way
compared to other villages,
more people came to them
More than a million infants die
for advice and that they in India every year on account of
enjoyed meeting other disea~es that can be prevented
people and discussing de- through vaccines. A massive pro-
velopment activities with gramme Is now on to prevent the
them."
maximum number of such diseases.
(4) Three-fourths of the parti-
Out of the country's 420 districts,
cipants had knowledge of 92 districts were taken up under
family planning methods the programme in 1986. Officials
even before they attended claim a big leap in immunisation
the camps. They stated coverage achieved in these dis-
that participation in the tricts in 1986.
camps had increased ,their
As against the national average
knowledge, particularly in of 33 per cent coverage for TB,
relation to availability of 30 per cent for Polio, 35 per cent
services and voluntary for OPT and 9 per cent for measles,
nature of the family plann- the coverage in the selected 92
ing programme.
districts in the first phase increased
(5) On the follow-up action to 63 per cent for TB and polio,
taken by the participants 68 percent for 0 PT and 40 per cent
after the camps, there were for measles. That would mean it
three views - as given by had been doubled in respect of TB,
the participants them- polio and OPT and quadrupled in
selves, the officials and the respect of measles.
community. Out of a total
The 92 selected districts have a
of 1,114 participants inter- population constituting a quarter
viewed, "a very high" of India's total of 800 million.
majority reported perform-
Last year, the programme moved
ing one or more, activities on to another 90 districts to reach
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9 Page 9 |
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a total of 1o million infants and '11
million pregnant women. Mean-
while, it continues in the 92 dis-
tricts selected in 1986.
Multi-pronged Strategy
All efforts are reported to be on
to meet the challenge of the pro-
gramme. On the supply side,
vaccine production, refrigerated
distribution, training of health
workers and administrators and
engineers have been pushed up
sizeably.
In 1986, about 4,800 doctors,
72,000 para-medicals and 30,000
community workers were trained.
On the demand creation side, a
campaign has been launched to
spread public knowledge about
the advantages from vaccination.
Grass-roots development workers
are involved in the campa~gn.
A significant plank in the demand
creation effort is the orientation of
primary school teachers. Nearly
half a million teachers have re-
ceived orientation on infant immu-
nisation.
Radio and television and other
media of mass communication are
being utilised to carry the message
of immunisation to all parts of the
country. The goal is to immunise
all infants and pregnant women
by 1990.
If the goal can be achieved, it
will help in solving many of. the
major problems of health and nutri-
tion which India's children are
suffering from.
Infant mortality highest
in U.P.
Uttar Pradesh has the dubious
distinction of topping the list of all
states in the matter of infant mor-
tality. There the IMR in 1984 was
as high as 155 - two and half
times the national target of 60
fixed for 2000 AD
Kerala comes at the lowest rung
of the ladder. There the 1MR was
29.
IIV1Rin the country as a whole in
1'984 was 104. In the urban areas High fertility
it had come down to 66 but in system
rural areas it was 113.
and vaJu8
This is revealed by the latets
SRS (sample registration system)
report of the Registrar General of
India.
SRS, it may be stated, is the
main source of information on
fertility and mortality indicators at
state and national leve's. It in-
volves colle~tion of data through
two different procedures, viz. conti-
nuous enumeration and retrospec-
tive half-yearly S'Jrveys which is
followed by a process of matching
two records and sClbsequently field
verification of unmatched and par-
tially matched events.
On the basis of the 1984 SRS on
1MR, the states can be divided in
six broad groups as follows:
Infant Mortality Rate:
(1) 25-50 Kerala
(2) 50-75 Karnataka & Punjab
(3) 75-100 Andhra Pradesh,
Assam, Bihar, Hima-
chal
Pradesh,
Jammu & Kashmir,
Maharashtra, 1amil
Nadu and West
Bengal.
(4) 100-125 Gujarat, Haryana,
Madhya Pradesh
and Rajasthan.
(5) 125-150 Orissa.
(6) 150 and
above
High fertility in India is an
inherent part of the country's value
system and cannot be wished
away by programmes of family
planning undertaken in is'Jlation.
This is the gist of a pilot study on
people's perceptions sponsared by
the Family Planning Foundation
. in Ahmedabad.
The study is part of an action
research project launched by the
Indian Society for Population Edu-
cation which the Foundation is
supporting.
Change in the value system, the
study suggests can be brought
about only through modernisation
of which education is an essential
ingredient. The other basic nece-
ssity is reduction in poverty.
"Poor people," says the study,
"do not care how many children
they have, because they will still
be poor; moreover a large number,
of children-will at least ensure that
one or two survive to be a support
to their parents jn old age."
The poor apart, the attitude of
the society as a whole is pro-
natal. The young women, accord-
ing to the study, "conceives of no
desirable role for herself other than
that of wife, mother and in the
early months of her marriage her
great fear is that she may turn
Bihar leads in birth
rate
, out to be a barren woman." To
the
lies
young wife,
in having a
•ntuhmebebresotf
security
sons.
The study covered 250 house-
In birth rate, Bihar with 39.9 holds comprising 1,232 persons
was on the top in 1984. Next came belonging to five strata of society-
Rajasthan (39.7), Uttar Pradesh (1) rural, (2) urban slum dwellers,
(38.7), Haryana (37.2) and Madhya (3) urban middle class, (4) urban
Pradesh (36.'9).
upper class, (5) tribal. Nine locali-
The national average in 1'984 ties in Ahmedabad and around
was 33.9. Apart from Bihar, broadly representing the various
Rajasthan, Uttar Pradesh, Haryana strata of the population selected
and Madhya Pradesh, the only on random s:tmpling basis. From
other state which recorded a higher each locality 25 families were
birth rate than the national average chosen on the same basis. From
was Assam (35.3).
one rural locality 50 families were
Kerala with 22.9 had the lowest. chosen.
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VVHI scientists meet
the challenge?
After over 30 years of family
planning, the world is still search-
ing for a contraceptive that could
be easily acceptable to the poor in
developing countries. Most obser-
vers of family planning share the
view that millions are keeping
away from the programme because
of the absence of a convenient,
inexpensive reversible device.
Meanwhile, the number of
couples at risk goes on increasing.
The latest "State of the World"
report released by the World-
watch Institute puts this number
at 860 million in 1986.
Out of these couples, only 372
million were using some method
of family planning. The maximum
were in China ~ 146 million, as
against 124 million in all other
developing countries combined and
102 million in the developed ones.
The composition of the 146
million users in China is as
follows ~ female sterilisation 53
million, intrauterine devices 59.
million, oral contraceptives 9
million, condoms 5 million, male
sterilisation 17 million and other
methods 3 million. The total num-
ber of couples in the risk group
that year in China was 200 million.
The Government of India's
Annual Report for 1986-87 gives
the 1985-86 figures of acceptors
as follows:
Male sterilisation 0.637 million
Female sterilisation 4.261 million
IUD
3.273 million
Condoms
9.385 million
Oral pill
1.357 million
In the developing countries, in-
cluding India, the desire for contra-
ception is' growing. While no
single contraceptive can meet the
needs of all couples, technology
has to come up with something
that is acceptable to most.
The challenge is formidable. In
India alone over 130 million couples
fall in the reproductive age group.
High priority to small
family norm
Government's top advisory body
on matters re~ating to health and
family welfare has recommended
that the adoption of the small family
norm must become an integral
part of the programmes of all the
departments of the government
and all government agencies must
accept population stabilisation as
one of their principal objectives.
The advisory body, known as
the Central Council of Health and
Family Welfare,consists inter alia
of Health Ministers of all the states,
prominent Members of Parliament,
eminent persons from health and
family welfare fields, representatives
of voluntary organisations and
senior government officers.
The Council is headed by the
Union Minister of Health and Family
Welfare.
At its first meeting held in March
in New Delhi. the Council fen
strongly that pOlitical and adminis-
trativ'e support should be given at
all levels to the objectives definsd
for the health and family welfare
programmes and effective measures
must be taken to spread mass
consciousness on the conse-
quences of population explosion.
The Council also laid stress on
improving the quality of services.
For this, it was necessary that there
should be an in-built mechanism
that could take care of in-service
training. The practitioners of Indian
systems of medicines and homeo-
pathy, the Council urged, must
also be involved in the promotion
of family welfare.
On incentives, the council com-
mended the scheme launched by
the Government of Gujarat under
which special security servic'e certi-
ficates of Rs. 6,000 are given by
the State Government to parents
with only one living daughter who
opt for sterilisation and Rs. 5,000
to those who opt for it with only
two living daughters.
(Continued from page 7)
(1) Telecast is embarassing in
family•.v. iewing
situation
(45%) ;
(2) Such spots create wrong im-
pression on children (48%);
(3) Such spots lead youth and
married couples in wrong
direction (13%).
Since the survey was done on
telephone only, obviously it means
that it was confined to those
possessing. telephones.
Published by the Family Planning Foundation, 198 Golf Links, New Delhi 110003. Tel: 621135, 697583, 619278
Printed at the Statesman Press, The Statesman Ltd., Connaught Circus, New Delhi 110001.