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Diagnostic Study Uttar Pradesh |
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Diagnostic Study
of
Population Growth,
Family Planning
and
Development, 1971-81
Uttar Pradesh
THE FAMILY PLANNING FOUNDATION
198, GOLF LINKS, NEW DELHI-llOO03
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· DIAGNOSTIC STUDY OF
POPULATION GROWTH, FAMILY PLANNING
& DEVELOPMENT IN UTTAR PRADESH, 1971.81
THE FAMiLY PLANNING FOUNDATION
198. GOLF LINKS, NEW DELHI-1l000~
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The Family Planning Foundation as a funding and promoting
organisation has selectively addressed itself to diagnostic research
on major population issues. As soon as the 1981 census results
were published, the Governing Board of the Foundation expressed
the need to find out why the population growth rates varied
considerably among the states and bring out the programme and
policy implications. In operationalising this suggestion, it was
felt that in view of the significance of the study and the need to
have a high level liaison with the states, the Foundation should
directly undertake the study. For this purpose the Foundation
invited Mr. V. K. Ramabhadran to undertake the study.
The study covers 5 states with different demographic and
economic settings-Gujarat, Orissa, Rajasthan, Tamil Nadu and
Uttar Pradesh. This Brochure presents the main findings and
recommendations in respect of Uttar Pradesh. This would, we
hope, stimulate an informed discussion on the Status of Popul!l-
tion in Uttar Pradesh and pave the way for a more vigorous and
effective action programme in family welfare.
The Foundation would like to place on record its deep
appreciation for the willing cooperation of the state governments,
particularly of the Departments of Health and Family P~anning.
New Delhi
February 1, 1985
J. C. KAVOOJH
Executive Director
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1. The decennial Census of India 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
compared 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 growth 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 ls. essentially a
regional problem. Among the 14 major States ·of India (with 8'
population of 10 million and above excluding Assam), the growth
rate in 1971-81 has varied from 11.50 in Tamil Nadu to 32.97 in·I
Rajasthan, with 25.49 per cent for Uttar Pradesh.
3. This project entitled "Diagnostic Study of Population Growth'
Family Planning and Development in 1971-81 in Uttar Pradesh".
is a. part of the five-state study project (which includes Gujarat, i
Orissa, Rajasthan, Tamil Nadu and Uttar Pradesh)..The,
ptojectbas its genesis in the disclosure by the 1981 Census· -of-a,
constant growth rate at the national revel, but ahighly variable:
growth rate at state level. The principal 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 establi!ihin$ hypotheses or
quantitative relationships nor are they eJpected to lead to
instantaneous solutions to problems. Rut it is hoped they
would expand understanding of the probl~ms and the potential
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4. The diagnostic study adopts the framework:
Knowledge
(ba~ed on
avaIlable
information)
"1 . Understanding
r_.o+(b.ased on. interaction
WIth programme
officials)
} Action
_ ..• (bas.ed on
findmgs 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 nf
leadership in the family planning programme: political level
(Health Minister), executive level (Commissioner/Secretary) and
professional level (Ditector of Family Welfare). The structured
questious, its replies and the subsequent interview have vastly
improved the information base and have imparted a realism to
the exercise.
5. The main findings of the study are presented In the brochure
under four heading,s:
The Demographic Scene;
The Social Setting;
The Development Scenario;
Family Planning Performance.
Based on the findiugs, a set, of forty-two Recommendations has
been developed, whichit is boped, would be seriously considered
both by the State alld the Ccwtral .Governments. Copies of Jbe
Main Report hav~ ,already .been s~nt to the programme .eaders in
the State and the. Cen.tre.
,
i
6. The project has been funded by the FamityPlanning
Foundation (FPF). Though FPF has normally a funding and
proinQting role, in the c~se of this particular project the FPF
undertook also the implementation in view of the significance of
the study for the programme and the need to have a high level,
liiliso.n with the States in securing the project objectives. The
silidy is not an eud in itself. Based on the study, a series of·
follow-up meetings at:e proposed with the leadership in Popu-
lationand Development in each State to translate the favourable
experience and lessons .from one state to another with a view to
push 'up the programme performance, particularly· in poor-
perforQlance States.
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The Demographic Scene
- The decadalpopulation growth in Uttar Pradesh in 1971-81
which was 25.49 per cenfhas the following features:
i) For the first time since Independence, Uttar Pradesh has
recorded a growth tate higher than the national level;
ii) The growth rate is 29 per cent ltigher than in 1961-71;
iii) While the rural grcwth rate in Uttar Pradesh in 1971-81
was only marginally higher than in 1961-71, the urban
growth rate has nearly doubled;
iv) The urbanisation pattern is horizontal with small towns
, coming up fast;
v) In theurbanisation process, the physical movement of
people from rural to urban areas was margii1al.
- During 1971-81, 22.5 million people, have been· added, of
which 7.5 million was in urban areas.
- Uttar Pradesh has a uniformly higher density than the national
,average.
- The reason for the high growth rate is the steep fall in morta-
lity with only a, mC,der!lte fall in fertility ..
- Uttar Pradesh hasrecqrded the highest not out-migration by
place of birth among the major s~tell. ,
- There was marginal decline in tPe percentage of population
in the age group 0-4, butin $e age group 5·9, there was an
increase unlike in the other major states.
- Uttar Pradesh has tll~'hi~est depenthmcy ratio among the
major states.
- The fertility and mO:rtality lyvels were 4~.9 and 23t7 in 1971
~nd 40.6 and 17.3 in 1981; The birth rate has dttfliped by
11.5 per cent \\n rural areas and 6.7 per. cent in urQaJ},.areas
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while the death rate has declined by 27.6 per ceptin rural
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and 30 per cent in urban areas.
- Mortality declined faster "ecause of the development of
medical facilities through more sub-centres, but such an
infrastructure development did not influence fertility because
sterilisa tion which is the main method is not offered through
sub-centres.
The 'slums' in major cities probably sustain the high level of
fertility in urban areas.
= The historically high fertility in Uttar Pradesh has a built-in
momentum for high growth rate and a young population with
42 per cent below t~e age of 14.
- Compared with oiher States, Uttar Pradesh is in the, early
stages of 'demographic transition' characterised by high
fertility and mortality.
- The fertility behaviour pattern was such that in' rural areas,
the proportion of births upto the birth order five has not
declined.
~ The prbportion of live births of fourth and higher orders was
the highest· in Uttar Pradesh both in rural and urban areas.
The ASMFR in Uttar Pradesh is higher than the national
average at all ages 20+ with women in the age group 35+
having twice the fertility or the Tamil Nadu womeb.
- The avelage number of children born per woman in the age-
group 45-49 is 5.32 in rural and 5.02 in urban areas.
-Through fertility in Uttar Pradesh is higher than in many
states, it was definitely on the decline in 1971-81.
- Uttar Pradesh has the highest infant mortality among all the
states (with the exception of Bihar).
- In common with Northern states, the IMR is higher for
females implying a neglect of female infants.
- Again, in .contrast witp l4e· ~outbem states, neo-natal
mortality (i.e. mortality with.in the first four weeks of birth) is
higher than post-natal mortality.
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....• Mortality in' UttarPrad~sh bas experienced a secular deoline
0941-81) while the birth rate has not- changed much thus
leading. to higher natural growth rate' decade after decade.
The critical demographic issue in Uttar' Pradesh is whether
fertility would decline fast enough in the 80s to reverse the
increasing trend.
'
- The demography of Uttar Pradesh is complex becaus, of
marked regional variations which are highly relevant, for
policy and programme.
- In Uttar Pradesh, the low age at marriage (mean is.3 years)
and the high proportion of young age (15-19) marriages(over
60 per cent) are cOl)sttaints in' (trtility reductidn.
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.. .:- '~'
- Analysis at district level shows that in 1971, more than 10 per
cent of the girls were married before the age of 15 in EaStern
Uttar Pradesh.]
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In - Fertility rate drops as the age at marriage of, females
increases.
rural areas, General Marital FertUity declined
from 209 for females married below age 18 to rio when' a~
is 21+.'
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- Age a~ marriage cannot go up through legislation alone.
Female education andemploynient outside agri~u1ture have
. been found to be crucial determinants of age at marriage,
-: It should also be a matter of concern for the State Govern-
; ment that in the remaining period of this century, the
'. iuptiality pattern may not change much according to the
"'I, Registrar General's projections. The need fora strooger
, ':Socio-economic ,base to promote family planning, is indi-
cated.
q
-- The sex ratio (nUmber of females per l00Q ~les) in' \\l.p'. i~
, one of the lowest among thetDajot state~ (886), "hiell tej1ect3
the higher mortality among females and possibly their low
~~o~eponomic .'statua. It is , al~o' possible that mater~al
,-depletioll,arising from high. fertility ot'rural women '(ive'~age
of more thn 6 children in the 70s) and the low'family ,plan-
J ningacceptance (11 per cent of couple protectioQ)bave;
lowered theswvival rate of women apart from increasins' the;
IMR.
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,-~ titeraty intJttal'J'tadtllh has alw~ys ,been lower tban the
natiOnal average. In particular, rural female literacy, :which
,is one of the sensitive indicators of social status and mobility
, .•of women was ,less than 10 per cent compared with the
. national average of 18, Tamil Nadu. 25 and Kerala 63 per
cent.
-- Not only literacy but also the educational status of children in
5-9 is the' lowest in Uttar Pradesh. Only 25 per cent of the
children in 5-9 attended school.
.- In secondary education (age group 10-14) the rural females
I' ,attending school are less than 10 per cent.
-' Work participation of women' (i.e. workers as percentage of
total fe.nile population) in Uttar Pradesh has always'been
lower than the national average. Only 6.5 per cent of rural
"women participated in work on full time, 3.5 per cent on
I' ~
"'Part time, while the remaining 90 pet cent are non-workers.
- The percentage of women's employment in the organised
.. libction was only 6.6 per cent (all-India 12'.2).
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AI.-.:
'......There has been no dwersification of occupation in Uttar
Pradesh during the last three decades and three out. of four
workers are engaged in traditional agriculture. In the case
.'of females, a slight shift has taken place from 'aJricultural
labourer' to 'household industry' and other works,
which is a. welcome feature because, workers in non-farm
production have a significantly low fertility in Uttar Pradesh.
Child labour in rural Uttar Pradesh is the lowest among the
states (1.8 per cent of male children below IS yeats working
compared with 8.6 per cent in.Rajasthan), which shows that
the ,higher fertility is not due to a value system that regards
children as wage earners .
.
- Son-preference is a strong cultural feature in Uttar Pradesh
, 'with an 'index of 25 pet cent compared with 11 in Tamil
Na~hC'
r:Tbe'ditrerences,in4emographic
performance of Uttar Pradesh
and Tafn.il Nadu could be regarded as a part of the 'different
'gender relations inherent in north and south Indian culture'.
So long as the statu50f women is linked primarily with their
motherhood status, .there is bound to be pronatalistpressure
within marriage.
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.:... An i~Portani cultural dfl1lension 0(' Uttar fradesh is' that,
it has the largest proportion of Muslims· (15.S per cent in
-1971) .
.:....Muslim women in the higher age brackets 30+ have a signifi-
cantlyhigher fertility.
.
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The Development Scenario
The per capi/4 income of Uttar Pradesh during the decade'
1971-81 was the lowest among the stateS (barring O'rissa in:
some years). In Ig81, the per capita real incom'e was R·s. SIS'
(atJ970.71 prices) substantially below the national' avetagt
of Rs. 700 and only 40 per eEi.,t of the per capita income of
Punjab.
'- The State Domestic Product at 1910..7'1 pJ;icesi rose from
Rs. 43,900 to Rs. 56,500 in 1971-81 yielding an averase anD\\la.
growth of 2.&6 per cent while the population grew at the
annual average rate of 2.55 virtuany nullifying thebenefits'of
development.
- While such an economic stagnation and backwardness 'are
attributable to the burgeoning population (as the Health '
Minister maintains), there are other crucial variables which
explain the tardy pace of development;
i) low level. of per capita plan outlay;
ii) power shortage and non-productive power
tion:
iii) the intra-state distribution of backwardness.
consump-
- From the poitlt of development planning~ one hilS to recognise
an 'Eastern underdeveloped region' and a 'Western developed
~egion' with the central region falling in-between.
- Apart from the macro-situation of under-development, a more
critical question is' the 'low impact of development 011 the
. people and the perpetuation of poverty.
- There has been a marginal decline in rural and urban poverty
between 1972-73 and 1977-78~ut poverty level still persists
with nearly half of the population below'thepovetty line.
~ Bulk of the rural ~overty is in Eastern region w,ile there'
is a concentration of urban poverty in the Western ~&ion.
-.
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East - While the West has a well developed airic~ltur.~ the
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laces pressure ()J POP-.Jat~nQn land and a seml-feudai system
of land tenure. The per ~pita income of tj)e East in 1981
is estimated to be Rs. 535 while in the West, it was. 4Quble
(Rs. 1068).
- The irrigated area in the West in 1980-81 was 13 per cent
while it was 41 per cent in the East with lOWerpercentage in
the othet regions; '.
:- thhs Uttar Prade&h presents a picttlte of econQmic backward:
ness with a wide regional disparities.
;;,.,.An analysis of population-oriented
programmes indicates in 1911-81:
development (POO)
t) acbnsidetable increase in outlay on rural water supply,
rural roadsl rural electrification, minor irrigation and
village and small scale industry:
ii) a. modest hu:rease in social services, tdugationt health
and family planning;
.
iii) a. virtual neglect of rural employment and WOmen's
welfare:
-- Outlay - on POD was stepped up four-fold only in the second
half of the decade 1971~81. TiU 1974-75, the per capita outlay
on POD was about Its. 6.50 while the per capita plan outlay
was Rs. 103. This shows the neglect of POD.
~ the; iD).PQrtanceo( clistributive development in fertility control
strategy is evideJ:lt from the fact that general marital fertility
declines from 219 in the gro,u.p with per capita monthly
expenditure of less than Rs. 50 to 123 when the expenditure
rises above! Rs 100.
- If fertiliiy IS not con~rolled among the rural poor and-
urban slums, the grim picture is that SOme 50 million
children would be born between now and 2000 ADwho could
never be lifted out of poverty through the prevailing economic
system.
- In Uttar Pradesh, the family planning programme did not
make mucb.headway in 1971-81 and was wholly inadequate to
the dimension and character of the demographic challenge
faced by the state.
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- As in other states, sterilisationwas the predominant nwt~od
but the acceptance rate was the lowest-22 per thousand
population compared with the natjonal average pf 49 and
Tamil Nadu rate of 68.
.' .r
- The percentage of couple protected .through sterilisation
increased marginally from 5.9 per cent in 1971 t08A .per
cent in 1981 (the couple protection from all methods having
increased from 7.7 percent to 10.8 per cent).
Barring the abnormal 'year 1976-77, sterilisationtar8l:t~\\yere
rarely achieved. During the period 1972-84 •.the sho~ in
performance is over 2.5 million and the ,challenging pr~lettl
for the programme managers is how lhis sh(}rtfal\\ is.~ver
going to, be made up wh€fn the targets themselves would be
progressively increased in· pursuit Of the demographic goal o£
NRR ==1 which requires a couple protection rate of 60 per cent
by 2000 AD.
As is the case in other states. there is a complete switch. over
from vasectomy to tubectomy after 1917, the IilUeraccounting
for over 90 per cent of sterilisation.
The acceptance rate of spacing methods in Uttar Pradesh was
relatively higher than in many states. For one acceptor of
,terminal method. there were 3-4 acceptors of spacing methods
while in Tamil Nadu the reverse was the case ..
Against the background of high fertility. terminal methods
needed to be promoted among the eligible younger cpuples. .
Uttar Pradesh led the rest of the country in the,IUD . pro-
gramme witll 1.86 miUionint!Crtions till March 1'81. The
achievement of targets has been much better than in
sterilisation. With the availability of the im proved versjqn of
..IUD (Copper T) the acc~Ptance rate is. increasing. .
- Acceptance of oral pill has been quite low despite the
introduction of the 'depot holders' sch~e to serve Periptieral
areas.
- There is an urban bias in the implementation of ,the
programme with a cumulative couple protection rate'of
9.7 per cent in rural areas compared with 18.2 in urban are~.
,.....TheJamily planning programme in.Uttar :pra<!elin.isnotomy
deficient quantitativelybu! i~lSQijUalitlltive1y wbi~b tQg~ther
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- The two important .qualitative variables which have aff"ted
the impact are the older age and higher parity of acceptors.
Close to 70 percent of acceptors of sterilisation were above
the age of 30 yea.rs with majority of couples having four or
more children.
Though IUD is an important method· of contraception in
Uttar Pradesh (particularly among the lower middle class)
accounting for 2 per cent of couple protection, the 12
monthly· retention rate of IUD was only 47.6 per cent
compared with 62.4 estimated at national level. Bleeding is
the major probleinaffecting nearly a third of the acceptors.
- It is also seen that fertility in terms Of birthrate, general.
fertility rate ~nd total fertility had droppedsubstantiaUy in the
period 1971-76 and there was little change after 1976 which
implies that after 1976 the programme was not adequate
quantitatively and qualitatively to sustain the decline.
Apart from rural-urban differences, it is also seen that
acceptance of family planning varies in different segments
of population. In particular, the acceptance rate among
Muslims is quite low. Musllms constitute aoout 16 per cent
···of the population of U.P. (1971 Census) but among the
acceptors ofsterilisation Muslilll;s accounted for only 4 per
cent.
-. It is also seen that there are wide variations in acceptance
between various administrative divisions. The contraception .
rate varied from 9.1 perceni: of eligibleco~ple in Gorakhpur
Division (East U.P.) to 17.8 per cent in KU11laon(Hill area).
- The political commitment to the . programme has been weak
and the MLAs could do a lo.t mote to promote family
planning in their constituencies.
~ UU8rPradesh adopts the health care based approach to family
planning. But in the integration of health and family
planning. the input deficiencies which have affected the
.; programme are' i) man-power problem, ii) supplies, iii) hired
buildings for su}).centres andPHCs and W) limited out~
reach •
••...The MPW scheme which raised expectation hastumed out to
,be.a· nelative factor ,in the programme.
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,
- the trained medical attention at birth i~ only 6 per cent in
rural areas compared with 24 per cent at the national level.
- Only 31 per cent. of the children. below 1 year are immunized
in Uttar Pradesh against the national average of S4 per cent
and 82 per cent in Tamil Nadu.
- From the point of accessibility,· of me.dical facilities in 'rural
areas (sub-centre, PHC,clinic, hospital etc. only 8 per cent
of the facilities were available within 2 Kms from the rural
community in Uttar Pradesh (41 per cent at national level)
and only 42 per cent available within S Kms (64 per cent ·at
national level).
- Deficiencies in the construction of buildings for PHC, sub-
centres etc, is a Jllajor infrastructure gap in the programme
affecting the. out-reach of the services. Of the 12,000 sub-
centres established, only 2000 have their own building while
the rest work in hired buildings.
- The potential of the existing infrastructure to promote family
planning is not fully utilised.
- With very little voluntary support, the programme is virtually
regarded as a Government proaramme.
- In Uttar Pradesh, the inter-departme.ntal cooperation in
family planning ,is weak because each department has been
given its own target to pursue under the 2o-Point Programme.
- Though a Government circular was iss~ed· calling upon
Departments (other than Health) to motivate 40· per cent of
clients, .there was not much response as each Ministry had
its own target to pursue under the 20-Point Programme.
- Supervision and coordination was handicapped because the
Oy. Chief Medical Officers did not have the ('equisite
mobility.
.
- Nearly SO per cent of thePHCs did not have a vehicle
while. the POL budget of Rs. 3000 per annum bad remained
unchanged since 1960.
- Though female methods are predominant, the prop(Jrtion of
female workers in the programme has declined from. 44 per
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f
-People's participation in family planning in terms of ini~r-
! 'nalising both the demand for and supply of family planning
services is feeble, because there are no voluntary organisations
capable of mobilising rural women.
- The Block Extension Educator (BE~) has' very little contact
with households.
- The Cooperatives in Uttar Pradesh are not· invo)ved actively
in the programme.
-:- The Government is of the view that target cQ:uplesshould
.. be persuaded to adopt family planning by prpvidingmore
incentives.
- The diagnosis reveals only a few positive factors while there
is overwhelming weakness in the family plannjJ;'lg programme
in Uttar Pradesh as listed below. No non-programm~ factors
(or environmental variables) are considered favourable. " On
the other hand; they appear to.be impediments.
Favourable Featares (Programme ladora) ,
/
1. Health care ba~e which can impart credibility to th.e
programme.
2; Availability of a large number of trained functionaries "in the
. form of ANMs, CHGs, Dais.
3. Availability of laparoscopic technique.
4. Programme becoming in~reasingly women-oriented.
S. The feedback provided by the IPP projects.
fmpeclimeDts
1. The largeness of the state.
2. Backwardness,
'
3. Low, level of literacy.
4. Poverty.
S. Low r ereapita. income and cco1\\omic stagnation.
6. Low agricultural productivity.
1. Wide intra-state (or regional) variations in demography and
developurent.
8. Historical high fertility and high parity births.
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9.- ~,
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High intantmortahtYJ'
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10. Low status and weak mobilisation ,of women.
,tt. Young age at marriage and high proportion of marriage's id
the age group 15-19.
12. Poor response from minority community.
13. Feeble political commitment of the family planning.
programme.
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 shortag~
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 towards the
family planning programme which is probably considered
'extraneous' to their academic attainments.
21. Absence of a 'team /Wproach'to motivation.
22. Main reliance on camp approach and lQwextension 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. t()
promote family planning.
25. Too centralized an implementation and monitoring proce-
dure and absence of a regional (divisional) focus.
26. Absence of active voluntary organisations.
27. Low involvement of Panchayat Unions.
28. Non-utilisation of the institiutional strength of the coopera-
tives.
1. Political Commitment to the programme being weak, the
following measures are suggested ~
a) There is need for a CABINET SUB-CoMMITTEEON
POPULATIONAND FAMILYPLANNING. The Monito~ing
Meeting held every month' reviews th~·20·Point Pro-
gramme 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 "
~n wbat is available now. Further"the success in many,
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bt the other points of the 2O-P,oili)t }\\rogran)me depeAds
~n the rapid adoption. of family pl~nninsby the people.
This requites inter-ministerial involvement. Accordingly,
there is need for a. Cabinet Sub-Committee on Popula-
tion under the Chief Minister with membership of the
tabinet Ministers dealing with Finance, , Planning,
Agriculture &. Rural Development and Cooperatives,
Health, Education & Social Welfare and Local Adminis-
tration.
j,) There is need' to establish a STATEFAMILYPLANNING
BOARD under the Health Minister with membership of
. Heads of Departments and non-officials.
Officials
Commissioner & Secretary, Health & Family Welfare
Director of Family Welfare
Director of Rur~.l Development
Director of Social Welfare
Director of Information & Broadcasting
Director of Labour
Director of Municipal Administration
Director ofPanchayats
Chairman,. State Social Welfare Board
Director, Population Centre (IPP)
Non-Officials
S MLAs from different political parties
5 MLCs
Representative of voluntary organisations
Family Planning Foundation, Family Planning ASSQcia·
tion of India etc.
A leading Gynaecologist and Obstetrician.
c) A Cabinet Minister may be made responsible for each
of the 11 Administrative Divisions of Uttar Pradesh.
d) In order to involve the MLAs deeply in their constitu-
encies, family planning and immunisation Camps may
be held in their name. Such Camps called 'PRESTIGE
CAMPS' are named after the MLA of the area and the
handbills and Jeaftets about the Camp c~rry the photo-
.graph of the MLA. Such camps are resarded as successful
in Gujarat.
2. Uttar Pradesh has historically a high, fertility and hence a
built-in momentum for high growth rate. The young age population
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«()"14) constitutes 42 per cent. In conformity with thenationar:
demographic goid, Uttar Pradesh is required to achieve NRR=l'~
by 2000 AD which implies th~t the birth rate has to decline froml
the 1980-82 level of 39;2 to 21 per thousand and death rate:
from 16.0 to9 per thousand. Though the highmortaHtyrate 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 response 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 80s. The State
Goveritment 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 and 48 pel'
eent of the births are of parity 4 and above, there is need to
strengthen sterilisation services and set up big targets which have
to be achieved by -
i) training more non-spe,cialist medical officers in sterilisa-
tion technjque (In extending the sterilisation programme:
in rural areas, it would be advantageous to introduce the;
mini-lap technique in which Orissa has specialised. A
team of UP Doctors could be sent fo Orissa Family'
. Welfare Bureau for training,)
ii) improving'sterilisation services at static eentres.
Ui)' use mobile teams for out-reach areas.
iv) Provision of a4equateand timely incentives to acceptors
, and doctors. .
.
4. High fertility and low age at marriage are the twin demographic
problems of Uttar Pradesh. Low AGE AT MARRIAGE and high
proportion of young age marriages' are a serious handicap of
Uttar Prades!I in securing better programme performance. A
solution based on legislation alone· is not realistic. The security
system in tne villages is to be recognised. RURAL WOMEN
DORMITORIES to promote literacy and training in rural vocations
could be tri~d in a few centres on a pilot basis.
S. The critical situation in Uttar Pradesh is that the age at
marriage is low and hence the recruitment of clients for terminal
methods below the age of 30 ilialso necessary. The fertility
control measures in Uttar Pradesh should aim at two:goals :
i) D10geration of the .persistent and traditional high fertility
in higher age groups 30+ through a sterilisation
. programme;
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ii) enabling the younger women 1S~29 to build&: ~ntracep.
ting society, so that they do not perpetuate the 'high
fertility culture'. This w()uld r~qujre !l mix of stel'iJi~
sation and spacing methods depending on the parity of
the couple.
6. Keeping the demographic situation and the ~ime perspective
dn view, it is necessary that Uttar Pradesh adopts tbe'High.
IPriority Sterilisation' in its 'Contraception .Mix' duringtbe .SOs.
"IT'hiswouldimplythat there should be two acceptors of sterilisa-
ition 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
lbelow 25 years) is in turn essentialfrom two angles:
i) the need to moderate fertility at younger ages both from
demographic and health cpnsiderations and
in to prepare the younger couples to adopt terminal
methods .as soon. as they have bad their small family
(limited to three children).
8a. Mere pursuit 6f quantitative targets, without ensuring. quality
is a wast~of resources. Implementation of the programme in a
systematic manner requires an updated Eligible Couple Register
(ECR) at the PHC/Sub·centre level, so that the qualitative aspects
are kept in view.
.
.•
.
.'
.8b. 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 contraceptiQn.
8c. Within this group, there is need for MOREATTENTIONTOTHE
PEOPLE BELOWTltB POVER,TYLIN~ (usually the landless labour,
marginal farmers and the slum dweller) as otherwise, there would'
be SO MILLIONSURPLUSPOORCHILDRENby 2000 AD whom .the
economic system can never lift out of poverty.
8d.The surge in human numbers, together with economic inequa~
litiesand sluggish economic growth obviously pushes up thesi~
of 'marginal' population. This is a com~on problem both for
population planning and economic development of Uttar Pradesh.
9. In the case of the- IUD and Oral Pill, there is need to sustain
a high continuation rate by follow-up of the acceptors •. for this
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PurPc»e,j)eriociic incentives in cash may he dePosited into tbe
b~neficiaty accou.nt so as to watch the non-pregnancy status of
the beneficiary. The deferred incentive scheme launched by, tho
United Planters Association of South India (UPASI) is worth
emulating. Now that IUD is demedi~alised, it could be promoted
in Ii big way through the large number of peripheral worken
ANM and LHV. IUD, which is a popular programme in Uttar
~radesh has been adversely affected' by supply deficiencies. It
llPl'ears ,necessary that annually a million acceptors of IUD may
have to be recruited for whom regular supplies have to be ensured.
It would be desirable for the State Government to seek the
establishment of a 2 million capacity Copper T Unit in Uttar
Pradesh in place of the defunct Kanpur Factory.
10. In the promotion of spacing methods, 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 conttaceptives (Oral Pill and Condom).
They could not only make the family planning services accessible
but also acceptable to the' people and what is more important, th.,
programme would be made more sensitive and responsive to local
values and individual needs. Likewise, the private medical prac-
titioners have to be used more for spacing methods as terminal
methods require special training and equipment.
11. An important demo-economic feature of Uttar Pradesh is the
regional disparity both in demographic variables and development
status. The high population density, low family planning perfor-
mance and rural poverty in Eastern Uttar Pradesh, on the one
hand and the concentration of urba'n poverty in the West, strongly
suggest that a BALANCEDREGIONALDEVELOPMENiTs an important
requirement in planning changes in the demographic status of the'
different regions. ,
12. This will require a totally different approach. The new social
policy of Uttar Pradesh has to concentrate on removal of poverty
and eradication of inter-regional disparity. The Focus OFDEVE~
LOPMENTl;hould 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 FAr,ULYCENTRIC".
13.• In the socio-political setting of Uttar Pradesh, there is every
possibility that even the modest resources meant for benefiting/
the poor could be diverte<tby th.e local authorities or the power ..,
groups in the. villages. CONSCIENTJZATIOoNf the village people
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.66nt the Schemes inioended tObeitedt them need~ to be under:':
taken by the State Government in the ab~ence of any widespread;
voluntary netwotk in rural areas.
14. The typical problems in large states like Uttar Pradesh is the:
poor logistics and hence limited out-reach of se~ices. Each PHQ
is supposed to have a vehicle Ibut nearly half of the vehicles are
not usable. A policy regarding write off and replacement of veh"
cle needs to be evolved urgently by the Centre and some formula}
based on population density or the area coverage of a PHCbi
considered in the aUotme~t of vehicles and even more importantly
in the allocation of.POL budget, A uniform policy intbis regard,
whatever its merits, is not realistic.
15. One of the important measures to promote family plannin.
is the control of infant mortality which is the highest in Uttar
Pradesh. Infant mortality could be seen both as a cause and an
effect of the high fertility~ Uttar Pradesh is typical of thee<>-
existence of the twin problems of high fertility and h'gh infan~
mortality. The short-term steps necessary in rural areas are:
i) a vigorous tetanus tOJl:oidprogramme;
ii) safe and hygienic delivery by trained dais who shou!d
be supplied kits; .
iii) adoption of spacing devices to prevent a rapid sequence
of birth;
iv) awareness and ability to prepare and use oral rehydra-
tion powder.
I
16. The low STATUSOF WOMEN (an unwholesome heritage) is
probably the major impediment' in rapid promotion of family
planning. The low age at marriage and the high parities etc.
are symptoms while the poor female literacy and unemployment
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 Stat~ Government to enable
fuller participation of women' by improving their literacy and
to employment opportunities. In the present strategy of planning,
the women would not be able get over the handicaps. It is
therefore necessary to set up a WOMEN.DEVELOPMENTC01U>OllA-
TIONin Uttar Pradesh with specially earmarked funds along the
pattern obtaining in Tamil Nadu. It would not be out of place
to' establish in Uttar Pradesh a MINISTRYOF WOMEN DEVELOP-
MENTto undertake inter-alia the MOBILlZATIONOF RURAL
WOMEN, establish RURAL WOMEN DORMITORIESANDWORKING'
WOMEN'S HOSTELS,and embark ona prbgrammeof increasing
the work participation of women. It should be the endeavour·
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of this Ministry to set up 30 "Rural women's Association (RWA)
in each block.
17. There is need to increase the strength of women function-
aries in the family planning programme at all levels. Unless the
State Government embarks on an effective programme of
educating rural women about the health hazards of high fertility
and improves the· accessibility of health services in rural areas,
the sex-ratio would continue to be unfavourable to women .
•8. It would also be useful to organise OrC Camps exclusively
for women in rural areas with women speakers and orgailisers,
so that rural women can learn ab~ut the programme without
inhibitions and reservations.
19. Socio-economic development of Uttar Pradesh is going to be
a slqw process, because of
i).the huge population base;
ii) the limited resources;
Ui) intra-state distribution of backwardness.
The remedy lies in population-oriented development and not in
grandiose schemes and in multi-crore urban establishments.
Rural social services (health, education and village industries)
and rural infrastructure (rural roads, rural electrification) should
be earmarked Ilt least 25 per cent of the plan outlay.
20. Since it would take time for the population-oriented develop-
ment to make its impact on the fertility behaviour of the people,
there is a definite need to adopt the 'incentives approach'. In
Uttar Pradesh, all the three types of incentives (as elaborated in
the Family Planning Foundation's Study on Incentives and
Disincentives) are applicable.
i} Individual one-time cash incentives (for acceptors of
terminal . methods particularly from lower income
brackets and also to 11on-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).
.
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21. The State Government is already committed to the policy of
providing more incentives to persuade the target couples. , The
in~entives s~heme indi~at'ed above provide a basis for the much
needed inter-ministerial coordination. Indeed, inter-departmental
~oorperation in family planning promotion has to be built into
their work pattern itself and not become an appendage. 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 (IRDP) under which
certain loans and subsidies are given. It could be ensUred by
the ~ral development 'agencies that such loans are given on
priority basis to families who adopt <:ontraception. In other
words, people should be made conscious of the family planning
programme by using IRDP loan as a form of incentive. Similarly,
the Social Welfare Oepartment which handles harijan welfare
has many contact points to motivate the poor harijan families
to adopt family planning. The different development departments
shouid use their field inputs to secure a grass-roots level linking
between family planning and development.
22. Large populous states like Uttar Pradesh have certain
problem arising by their very size. There is a strong view that
adoption of the same pattern of assistance for these states, as
for smaller s~ates, is not a correct approach. On the other hand,
# it could be argued by progressive states like Maharashtra or
Tamil Naduthat giving special assistance to states like Uttar
Pradesh would amount to a premium on inefficiep,cy in pro-
gra~me implementation. But the. rationale for s;I1ecialassis-
tance is that these states (Bihar, Uttar ,Pradesh, Rajasthan. and
Ma,db,ya Pradesh) have a hapdicap in the form of large popula-
tion or large size.
23. Arising from the feeble· political commitment to the
programme the efficiency of the family planning- functionary in
Uttar Pradesh is at a low ebb. Added to this, the agitational
attitude of the MPWs and the reluctance of die State Government
to concede to their demands has developed the MPW as a negative
force damaging the programme. A speedy and humane solution
has to be found to the'MPW problem'. TamHNadu is reported
to have rationalised thesatarystructure of MPWs. It would be
usefurib' correspond' with the Commissioner ,& Health Secretary
of :ramilNadu on this issue. Gujarat has also succeeded.
24 . Other reasons for the low .level of commitment of the field
functionary isthe absence of an effective supervillion by higher
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'officials for lack of mobility and the absence of re:orientaiiofl
training facilities. Though there is a case for the State Govern-
ment to seek additional funds frortl the centre for these specific
shortcomings, they could at least approach the problem selec-
tively. The districts, which are consistently poor in performance,
need urgent and concentrated attention.
25. Too centralized a monitoring as done at present reduces its
timely feed-back effect. In Uttar Pradesh, there is a case for
-5 Regional Family Planning Zonal Offic~s headed exclusively by
a Joint Director with supporting services of rtlonitoring and
evaluation, MEM, training and logistics. If the zonal pattern of
decentralization is successful, then it should move to the-
Divisional pattern eventually. This again is a case where Uttar
Pradesh has to seek specifically additional funds, as the pattern
of control in srtlall states is not adequate for Uttar Pradesh.
26. The Village Health Cortlmittees could definitely improve the
overall response to the programme provided its Chairman and
Members take initiative. In Gujarat, the Rural Health &
Family Welfare Training Centre convenes a meeting of the full
Committees of three villages at a time. This is a special type
of OTC in which there is a two-way communication. The
Committee 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 & Family Welfare Training Centre, Ahmedabad to know
more about this innovative OTe and GUJARAT EXPERIENCE.
27. Attempts to improve the family planning performance in
Uttar Pradesh should essentially be based on OPTIMUMUTILISA-
TION OF EXISTINGINFRASTRUCTURET. he ATHPOR EXPERIENCE
of the Gandhigram Institute of Rural Health and Family Welfare,
Madurai District, Tamil Nadu has shown that with the existing
infrastructure under the PHC 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; .
it) 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;
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Iii) periodicai 10b~()tientedtraining.ror the staff;
iv) involving and utilisingcomtnunity leaders_ voluntary'
workers like Dais, teachers, indigenous medical practi~
tioners etc. and voluntary agencies like Madarsangams,
youth clubs, village Health Committees etc. for obtaining
social support for the programmes;
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 ~ills;
vii) extending adequate . services and frequent follow-up
visits throughout the area.
28. 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 continua-
tion. There is scope for appointment of a cadre of social
workers through the voluptary organisations.
29. Social backing for the programme is poor and there are no
voluntary organisation 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.
30a. Family planning cannot' continue to .be a successful
programme unless it acquires an evenness. The 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 a way of life of individual couples and not entirely a res~
pOnse to e,xternal motivation. Th ensure an expanding demand for
family planning services, relevant social and economic programmes
directed 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.
.
30b. Since the family planning programme is hundred per cent
centrally funded and the targets are also set by the centre for each
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method, the programm e 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 tbe states what the level of couple protection is to be for
different years consistent with the national demographic goal and:
suggest to the states to takeover the responsibility 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.
'
31. To be effective, family planning approaches needs to be;
SEGMENTEaDnd' tailored to specific audiences. In the rural areas,.
wgr•eoucposuslduchdiavsidoeccuacpcaotirodninalg
to
life
the
styles
indentifiable homogeneous
(such as agricultural labour
and marginal farmers, fishermen), minority community, harijan,
industrial labour, urban slum dweller etc. Community organisa-
tions that cater to the needs. of these sub-groups, could be
identified and utilised as channels for family planning promotion.
a In the segmented approachto the family planning, tlle urban slums
need 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.
32. To promote higher acceptanoe 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 progtammes.
33. Demedicalisation of family planning is one of the emerging
strategies in Uttar Pradesh. Though there is need to demedicalise .
faJ]lily planning services, it does not imply that the programme
could do without the medical profession. Indeed, a medical back-
up to the programme is probably the best method of imparting
credibility to the programme and the medical profession has
'there'fore 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 programme. A part of the
observed superficial involvement of the medical profession at
present, is 'probably due to the medicai, profession not being
exposed to the full dimension of the population problem, the
social aspects of family planning and the contraceptive techniques
available for this purpose. UQless the basis for a radical change
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in their attitude and, their response is laid during their acade~lc
oareer, the commitment to familY·planning cannot be internalised
. and the doctors would still regard family phwning as In activity
extraneous to their academic up-bringing. 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 ourselvcs adequately to the long-term
man-power problems in family planning and it is only through the
strengthening of their academic training that the d()ctors could
be expected to render professionalised family planning services in
the way they are now rendering curat.ive services. (Books such as
'Practice of Ferli/ityControl-AComprehensive Text Book by S.K.
Chaudhuri and others; Current Book Publishers would be useful
in modifying the curriculum).
34. The Medical Officer of the PHC 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
for follow-up of cases and for monitoring the progresses. The
MOPHC needs to have adequate managment skill to handle the
multifarious functions of the PHCs and alsO' impart a syst.ems
approach to identifying and solving problems through a Manage-
ment Information System. All these points to the need for
imparting techno-managerial or micro-managerial training to the
MOPHC, with more emphasis. on management practice and not
theory.
35. 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
local organisation. But in Uttar Pradesh, such agencies, wherever
they exist have not been comprehensively involved in the pro-
gramme. In particular, voluntary organisationscapable of
rnobilising women are virtually non-existent. It appears that in
Uttar Pradesh, people's participation· in family planning in terms
of 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 Govern-
ment activity. The communication strategy must aim to bring
them round to the view that .family planning benefits the indivi-
dual, the community· andtbenation ioa sequence,
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an A6. J$amliy pluninj re4tiires exi~nSidn approach and. the
:block ExtensioJl Educator (BEE) has a responsibility in this direc-
tion. But the BEE in the'present structure of PHC functioning
does not have household visits for motivation. The BEE organises
Orientation Training Camps (OTe) for Opinion Leaders, contacts
Gram Pradhans etc. It is important to note that in Uttar Pradesh,
the role of the BEE is group-oriented and not oriented towards
individual households. EVen in the case of OTG Camps, the BEE
rarely follows-up stich camps to secure the 'ripple effect' ofthe
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.
31. One of the main instruments for securing community
participation is the Community Health Guide, now design~ted as
Village Health Guide (VHG). In Uttar Pradesh nearly 60,000
VHGs have been recruited and trained. 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.
38. Though Uttar Pradesh has several cooperatives (such as
sugat 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' essential an input in this direction.
39. Successful family planning in Uttar Pradesh 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 a widespread 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, co-operatives and all the
informal local level organisations in recruiting clients
and supplying contraceptives adopting either the cOm-
munity-based distribution system or social marketins
techniques.
.
dJ Constantly monitor the demand.a.nd supply situation in
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brder to eiisure' ~ demand-supply equilibrium atmtcr6';
level to avoid frustration among genuine users, on the
one hand and avoid accumulation of unutilised stocks on
the other.
40. The IPP I and IPPII Projects of the World Bank have
attempted some innovative inputs in the Programme in eleven
districts of Uttar Pradesh and the Population ' Centre, Lucknow
had developed 'Experimental Designs' and had carried out evalua-
tionstudies. The feed-back from the ten-year experienceofthese
Projects need to be u sed in improving the programme. If neces-
sary, the State Government may set up a small 'EXPERT
CoMMITTEOEN ADOPTIONOF IPP EXPERIENCEiSn' the Uttar
Pradesh family planning programme.
41. The STUDIEAS NDSURVEYtShiltare considered necessary for
making the 'family planning programme in Uttar Pradesh'more
relevant and responsive to the realities in the field are listed
below:
i) A unique feature of urbanisation of Uttar Pradesh is
the phenomenal growth c;>f small-sized towns. Does such
a horizontal pattern of urbanisation have potential for a
distributive development on the one hand and rapid
promotion of family planning on the other ? (para 26)
ii) Uttar Pradesh has recorded the highest out-migration
rate by place of birth. What are the factors behind this
phenomena? (para 29)
,
iii) Uttar Pradesh is the only state which has recorded an
increase in the population in the age group 5-9 betw~en.
1971 and 1981. Why? (para 32)
iv) Why is the fertility decline lower in urban areas? bit
due to slum population? What are the demographic
features and life style of 'slum population' and how are
they responsible for high fertility, high IMR and low
family planning acceptance? (para 36)
v), What is the rationale behiiid the high parity births (4+)
in Uttar Pradesh and what is the, sex of children
sequentially in such families? How strong is the son-
preference attitude? (paras 40-44 and, 67)
vi) Why is infant mortality high in Uttar Pradesh? Which
of the hypothesis :'child replacement or child survival,
is stronger? (para 47)
'Vii) Why is the infant mortality higher among female child-
ren? Are the reasons cultural or biological? (para 43)
viii) How is the sex ratio above lOOOin Pratapgarh, Aznm-
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garh and Jaunpur districts, despite low socio-economic
profile?
ix) Continued poverty of a large segment of population is
an impediment to family planning promotion. What has
been the Sixth Plan achievement in poverty eradication?
(para 77)
x) To what extent is the intra-state distribution of back .•
wardness considered in the development strategy? What
specific steps were taken in VI Plan to re~uce regional
e$:onomic· imbalance?
xi) Why is there a concentration of urban poverty in the
West? (para 78)
xii) There is a slight shift of female labour from 'agriculture'
to 'household industry' and 'others', which is a welcome
feature. .What are the non-~gricu1tural occupations
favoured by women of Uttar Pradesh? (para 65)
xiii) Why is that despite poverty, the economic base of high
fertility is weak as child labour is negligible? (para 66)
xiv) To what extent have people benefited through the
IRDP? (para 84)
xv) Spacing methods have received more attention in Uttar
Pradesh. What proportion .of those practising spacing
methods have eventually adopted terminal methods?
(para 90)
xvi) Under the 'intensive approach', there are three phases:
Phase I: emphasis on health services,
Phase II: motivation for spacing methods,
Phase III: motivation for terminal methods.
How successful is this pilot project? What are the pros-
pects of replicatiDg over larger' areas? Doe& this model
make optimum use of the health infrastructure?
(para 94)
xvii) Why is Oral pill having a low acceptance rate? (para
98)
l'Viii) Has the health care based approach changed rural
people's attitude favourably for family planning?
(para 127)
,
xix) How were the objectives of 3A's of I (Associated
Advertising Agency of India) pursued? (para 141)
xx) To what extent are the 'Experimental Designs' developed
by the Population Centre (IPP) successful and replicable
over larger areas?