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Focus 1988 January - March |
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---"'"
'1.-':_--./ '
PERSPECTIVE ON KERALA
MORE TO IT THAN MEETS THE EYE
A careful study of the mass of
material available on Kerala brings
one to the conclusion that family
planning in India can succeed
in a much larger measure even in
the present conditions of poverty
provided there is a strong family
welfare programme, administered
evenly and efficiently and reach-
ing those for whom it is princi-
pally intended.
In 1983, Kerala had a birth rate
of 24.9 which is close to the
target of 21 that the country has
set for itself for the end of the
century, and a death rate of 6.7
which is less than the target of 9.
The correspor,ding statistics for
India as a whole in that year were
33.7 and 11.9.
Kerala has shown that:
(a) low per capita income and
low levels of industria lisa-
tion, urbanisation and nutri-
tion need not alway£ come
in the way of fall in fertility
levels; and
(b) fertility decline can take
place in response to the
parents' perception of the
increase in the cost of
bringing up and educating
children, supported by effec-
tive exposure to contracep-
tive knowledge and services.
Female Education
No doubt, female education is a
crucial factor in fertility decline.
It is also undeniable that not all
the states in India have the same
educational background, parti-
cularly in relation to women, as
Kerala has. Tradition in Kerala has
played an important role in plac-
ing the £tate ahead of others in
this vital respect.
But the processes set in motion
by past tradition have received
immense impetus from planning
at all levels in more recent times.
The benefits from the latter have
by and large been available to
almost all the states in the coun-
try in equal measure. This im-
portant aspect of India's situa-
tion is generally lost sight of by
most social scientists and other
population specialists who hold
the belief that the Kerala experi-
ence cannot be replicated else-
where for the simple reason thet
other states do not have the same
historical background in relation
to education.
Poverty
The per capita income (at 1983-
84 prices) in Kerala was lower
than in the three other South
Indian states. It was Rs. 1,760 as
against Rs. 1,827 in Tamil Nadu,
Rs. 1,878 in Andhra Pradesh,
Rs. 1,937 in Kamataka and Rs.
2,201 in the country as a whole.
The nutritional level in the state
was also low. The per capita
calorie consumption was two-
thirds of what it was in India as a
whole. The bulk of the labour
force in the state continues to be
employed in agriculture.
"
As we stand on the threshold
of the 21st century, the basic
issue is whether, a£ a free and
richly endowed people, we
achieve bare survival or the
vigorous growth which alone
can assure to our people the
happiness and prosperity for
which they have yearned for so
long ....
I believe that a reduction in
the birth rate i.s an essential pre-
condition of our achieving the
ultimate objective of health and
welfare for all
The state certainly stands no
comparison with success stories
elsewhere - Singapore, Hong
Kong, Republic of Korea, Taiwan
and Chine. All these successful
countries (from the point of view
of family planning) have much
(Continued on page 10)
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Early marriage, early pr,egnancy, high
infant mortality among the poor
FPF Survey Reveals Shocking Situation
Not just marriage, but also preg-
nancy before the prescribed mini-
mum marriage age of 18 years -
that seems to be the common
feature of life among women in
the reproductive age group in
vulnerable sections of the society
in rural and hilly areas of U.P.,
M.P., Orissa and Karnataka and
the slums of Bombay.
The result is high infant mortality
- 213 in rural Uttar Pradesh, 180
in tribal Orissa, 140 in hilly Uttar
Pradesh and 119 in Madhya Pra-
desh.
These are some of the prelimi-
nary findings of the largescale
study launched by the Family
Planning Foundation recently to
investigate the critical factors
responsible for high infant mortality
amongst the more vulnerable sec-
tions of the society in 800 villages,
falling in 33 districts in five states
of the country.
In the rural areas of Uttar Pradesh
and Madhya Pradesh, over 90 per-
cent of the women in the reproduc-
tive age group are found to be
married at or before 18 years. In
the hilly districts of U.P., rural
districts of Karnataka and slums
of Bombay, the percentage is 71,
77 and 76, respectively. In the
tribal districts of Orissa and urban
areas of KarnatakCl,it is about 58.
Pregnancy Before 18
Pregnancy before 18 years
among women in the reproductive
age group is 50 to 58 percent in
Madhya Pradesh, 26 to 38 percent
in Uttar Pradesh, around 46 per-
cent in rural Karnataka and slums
of Bombay and 29 to 33 percent
in tribal Orissa and Urban Kar-
nataka.
The overall picture relating to
age at marriage, age at first preg
nancy, term of pregnancy, birth
weight of baby and monthly family
income is presented in tables I and
II. The figures are slightly under-
estimated due to non-availabilitY'\\
of women at the time of the survey.
As the tables reveal, in urban
Karnataka and slums of Bombay
infant mortality is low - 64 and
78 respectively.
The survey indicates that in cities,
including city slums, in'rant morta-
lity rate is considerably low because
of availability of medical facilities
there. In hilly, tribal and rural
areas, which are relatively deprived
of these facilitie3, infant mortality
rate is considerably higher than
what cAficial statistics suggest,
Further, table II makes it evident
that in'rant mortality rate is sign i-
ficantly' higher among women up
to 18 years, as compared to those
above 18 years. The phenomenon
of incomplete term of pregnancy
and low birth-weight of baby (Le.
below 2.5 kg) is generally asso-
ciated with low income group.
This table also shows that infant
mortality rate is two to three times
higher among those women who
had not completed the term of
pregnancy and delivered low-
weight babies due to malnourish-
ment and poverty. Infant mortality
rate is two times higher among low
income families earning less than
Rs. 500 per month.
Main Cause - Poverty
Due to poverty, women marry
and conceive earlier than the legal
age. They cannot complete the
term of pregnancy and fail to pro-
vide the requirec! nourishment to
the baby. They cannot afford to
meet the needed ante-natal and
post-natal care for themselves and
Table I: Percentage of married women in the reproductive age group by age at marriage and
age at first pregnancy in five states.
Madhya
Pradesh
Age at marriage:
Upto 18 years
Above 18 years
Age at 1st pregnancy:
Up to 18 years
Above 18 years
71.05
28.95
26.01
73.99
89.03
10.97
37.50
62.50
94.31
5.69
58.99
41.01
57.20
42.80
28.51
71.49
77.09
22.91
48.07
51.93
57.94
42.06
33.16
66.84
76.25
23.75
47.11
52.89
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THE couple protection rate in India continues
to rise, But the birth rate is not declining.
The complementary relationship between the two
seems to have collapsed. And it is quite on the
cards that 1991 may give to the country as rude
a shock as 1.981 and 1971 did.
Against this backdrop shines thE: example of .
Kerala. It has almost already achieved the goals
which the country had set or itself for the end of
the century. A strong family planning programme,
evenly spread, in towns and villages, backed by
education, particularly among women, has enabled
Kerala to bring down the birth rate to 24.9. The
death rate, too has declined to 6.7.
The per capita income in Kerala is lower thaI"
in the three adjoining South Indian states. It is
much lower than the national average. The state has
belied the conventional theory that family planning
cannot succeed in conditions of poverty.
Not many have gone deep into the matter,
Focus has tried to do so in this :ssue
That poverty continues to be the main cause
behind high infant mortality and high fertility is
brought out vividly by a fairly large study undertaken
by the Family Planning Foundation. The preliminary
conclusions of this study find reflection in this issue.
Also included in it are two other significant stories
one highlighting the inadequacies in the current
approach to family planning communication and the
other throwing some light on the practice of family
planning by members of P.arliament.
We are grl'lteful to the many social scientists,
researchers and other scholars who have contributed
to the studies we are using. The purpose is common
- to draw the attention of those concerned to the
more pertinent aspects of one of the most cr:Jcial
problems of our time.
The previous issue has evoked good response
- within India and abroad. We value the suggestions
that have come.
Infant mortality rate by mother's age at child-birth and term of pregnancy, birth weight
of baby and monthly family income in f'ive states.
Madhya
Pradesh
Overall infant
mortality rate
Mothers age at
child birth:
Up to 18 years
Above 18 years
Term of pregnancy:
Incomplete
Complete
Birth weight of baby:
Above 2.5 kg
Below 2.5 kg
Monthly family income:
Up to Rs. 500
Above Rs. 500
163.64
139.33
168.14
136.17
131.68
254.90
222.75
126.02
281.77
209.76
486.73
203.71
185.83
409.69
255.81
170.67
117.94
120.00
601.05
106.59
101.51
324.56
130.98
103.78
193.48
17'9.41
647.06
169.32
143.96
538.46
194.08
120.88
187.16
100.58
365.85
103.39
84.69
491.23
119.63
95.53
48.39
65.11
492.06
28.74
49.24
441.86
130.84
57.21
125.75
74.24
319.58
66.60
65.73
215.47
112.72
73.20
their babiE's and run high risks of
mortality which in turn compels
them to produce more babies.
This vicious circle of poverty, high
fertility and infant mortality seems
to be operating in the areas cover-
ed by the survey.
The Family Planning Foundation
has undertaken the study not just
to focus on factors responsible for
high infant mortality and their
relationship with high fertility but,
more importantly, to throw up
viable solutions in t e form of
intervention in health and com-
munity action strategies appro-
priate to the peculiarities of
different situations.
Five prestigious institutio ns,
namely Giri Institute of Develop-
(Continued on page 12)
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The Population Situation
=ram 342 million :n 1947 and
'385 million at the time of the last
28:-:::::.:S :01 138'1, india's population
"as today come close to 800
mi!lion.
It is' obvious that the earlier
assumptions that the population
'would be around 950 million by
the end of the century and stabilise
at the level of 1,200 million by
2050 AD are unlikely to prove
correct.
These assumptions were based
inter alia on two principel stipula-
tions, as reflected in the seventh
five year plans -
(a) by 2000 AD, the birth rate
would decline to 21 per
thousand, and
(b) by the same year the couple
protection percentage would
go up to 60.
The birth rate has not shown any
signs of decline for over a decade.
It has remained stagnant at 33 per
thousand.
The couple protection percen-
tage has gone up from 22 to
approximately 35. However, it is
unlikely that it would reach 60 in
the next 13 years. Even if it
does, it may not produce a corres-
3 pondingly benevolent effect on
the birth rate.
The increase in the couple pro-
tection percentage in the last 10
to 12 years has not found even
the slightest reflection in the birth
rate. The relationship between the
two has so far turned out to be
deceptive.
One estimate, based on the
assumption that couple protec-
tion may come to 48.8 percent by
2001, puts the population figure
in that year 991.5 million. This
assumption may also net be able
tc sustain itself.
It envisages a decline in the
population growth rate from 2.1
percent in 1981 to 1.6 percent
over 1996-2001. The birth rate is
not declining. The death rate, on
the other hand, is showing signs
of decline. The growth rate may
increase, rather than decrease.
In the circumstances, it is quite
on the cards that as India moves on
to the 21 st century, the population
may be over one billion.
The Planning Commission itself
has postponed the attainment of
NRR-1 by a decade - the earlier
time-target was 2000 AD; no"v it
is 2006-2011.
An India-wide study sponsored
by the Ministry of Health and
Family Welfare in the recent past
makes the point that the country
is still ~truggiing to emerge out of
the era of large families. Mo!>1:
couples want to have three or
more children out of whom they
want two to be sons,
It is obvious on all accounts that
whatever speed and substance the
family welfare programme may
attain in the remaining 13 years of
the current century, India will have
to plan for a population of at least
one billion.
New FamiIy Welfare
Strategy
Early in 1987, the Ministry of
Health and Family Welfare formu-
lated a new family welfare strategy
for the seventh five year plan
ending in March 1990. This strate-
gy has the following salient fea-
tures;
(1) Expand the services infra-
structure, improve the quality
of services and s,reamii n e
programme management;
(2) Promote the tltVo-chiid ncr~
as the preferred family size;
(3) Increase demand for contra-
ception to achieve over 42
percent couple protection;
(4) Enhance
child
through universal
tion programme
motion of aRT;
survival
immunisa-
and pro-
(5) Secure more effective intra-
sectoral and inter-sectoral
coordination;
(6) Increase involvement of non-
governmental "structures" ;
(7) Generate environment con-
ducive to fertiiity aeclme
through
socio-economic
intervention;
(8) Expa nd population educa-
tion;
(9) Use all media, particularly
television, to influence the
people.
Beyond Family Planning
The strategy also accords priority
to what nave been termed . as
measures "beyond family plann-
ing". These are:
(1) Increase the age of marriage
for girls from the present 18
to "beyond 20 years";
(2) Generate "a social reform
movement to combat the
forces of custom and tradi-
tion""
(3) Expand female literacy and
vocational and employment
opportunities for women;
(4) Link family welfare
poverty
alleViation
grammes ;
with
pro-
(5) Provide social security cove-
rage to "old age people".
(Contd. on page 7)
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Studies Reveal Bi,g Gaps in
Family Planning Communication
Studies in family planning
communication undertaken in India
since 1965 make two significant
points - (a) communication has
played a notable role in desensitis-
ing family planning in the public
mind and increasing its accep-
tance; and (b) it has failed to lend
the full potential of its support to
the programme partly on account
of the constraints prevalent in the
socio-economic milieu and partly
on account of its own self-im-
posed limitations.
The studies bring into sharp
focus the untapped potential of
communication and corborate the
view that, tackled properly, it can
make a much bigger dent in the
Indian demographic situation.
The studies give high marks to
inter-persona I
communication.
These indicate that it is the spoken
word which has contributed largely
to dispelling people's fears and
misgivings about family planning.
These also point out that in recent
times inter-personal communica-
tion has tended to degenerate and
has been acquiring the impersonal
characteristics of mass media.
Amongst the technology-based
mass media, the studies give prime
place to radio. So far as the rest
are concerned, the studies note
that despite the current media
explosion in the country, their
penetration in rural areas conti-
nues to be very low.
Family planning communication
research started in India almost
immediately after the establishment
of fairly largescale family planning
outfits throughout the country in
the mid-sixties. There were some
50Q. KAP studies in the first ten
years. By and large, these were
based on small samples and there
was general criticism later that as
such these could only scratch the
subject and fail to go into the
depths of it. Nevertheless, these
studies did throw up enough
information to guide communica-
tors in planning generalised pro-
grammes. Broadly, their findings
can be summed up as follows:
(1) there is wide gap between
awareness and knowledge
and knowledge and attitude;
(2) the people in general are
keen to know more about
the methods of limiting family
size;
(3) there is no organised opposi-
tion to the programme; and
(4) in relation to family plann-
ing, personalised face-to-
face communication can be
more effective than com-
munication through
media.
mass
Out of the many, we have
chosen the most important and
the most recent one. It was under-
taken in 1981-82, Spread over
seven statas (Gujarat
;,,'ia,ha-
rashtra, U.P., Bihar, Orissa, Tamil
Nadu and Karnataka), it covered a
sample of 14,000 persons 0,250
males and 6,750 females) from 28
districts, four per state, two with
good and two with poor perfor-
~ance in family planning. In addi-
tion, 955 persons directly involved'
in the family welfare programme on
behalf of the government were
contacted.
This study was conducted jointly
by the National I nstitute of Heelth
and Family Welfare, International
Institute of Population Sciences,
Gandhigram Institute of Rural
Health and Family Welfare and
Population Research Centres,
Bangalore, Lucknow and Patna.
The study revealed that even
though 48 percent of the res-
pondents had heard of family pla-
nning for the firft time from family
planning workers through inter-
personal communication, the
workers had tended to adopt the
"touch and go" method. It gave
high marks to posters, wall paint--
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ings and hoardings (75 percent of
the respondents had seen them),
followed by radio 64 percent, films
23 p~(Ceilt, folk media 15 percent,
exhibitions 14 percent, and tele-
vision 10 percent. The reach of
newspaper.s and magazines in the
rural areas was determined as very
low - 12 percent.
The study highlighted two factors
vital to family planning communica-
tion. It revealed that there was
high prevalence of fears in the
public mind about the various
methods of family planning (vasec-
tomy 45 percent, tubectomy -
41 percent, IUD 23 percent, Pill
16 percent). Secondly, the com-
munication level was the lowest
among those who had no educa-
tion. It increased gradually with
the level of education. Illiterate
people, those working in "non-
service Jobs", particularly labourers,
and those living away from the
primary health centres were the
three groups least exposed to com-
munication.
The inevitable conclusion that can
be drawn from this is that those
segments of the society for whom
the family planning programme is
principally Intended are not getting
due benefit from family planning
communication in aid of the pro-
gramme. Hence, they may conti-
nue to harbour whatever ignorance
and mi!>givings they may have
about the programme.
Early in the eighties, a large-
scale study was sponsored by the
government in the Ministry of
Health and Family Welfare to have
a scientific idea of the content of
messages and their impact on the
audiences, through four principal
media - radio, films, posters and
pamph lets/leaflets.
The specific
objectives of th is study were:
(1) to analyse the family welfare
messages, their forms and
coverage
(2) to identify the gaps that
operate in family welfare
messages in relation to stated
government policy;
(3) to assess relative appeal of
messages;
(4) to have a clear idea of fre-
quency. practice and desire;
(5) to assess the reaction of the
audience to the messages;
(6) to assess the extent of under-
standability;
to make specific suggestions
for improving messages in-
tended to promote family
welfare.
The study was conducted in
seven states - Bihar, Gujarat,
Orissa, Karnataka,
Mah<.>rashtra,
Tamil Nadu and Uttar Pradesh.
It was a collaborative study in
which six institutions were in-
volved - NIHFW, liPS, GIRHFWT
and three population
Research
Centres at Bangalore, Lucknow
and Patna. A sample consisting of
100 radio programmes, 28 films,
70 posters, and 70 pamphlets/
leaflets was selected at random.
This sample was presented to
audiences drawn randomly from
the rural/slum areas in the states
concerned.
Individual reactions
were obtained through structured
interview schedules. In all, 3,298
respondents were interviewed. The
overall reaction of the audience is
summed up in the paragraph that
follows.
(1) The messages fail to click
because these are not inte-
grated with the socio-cultural
or health or economic issues.
The tendency is to present
them in isolation.
(2) Where messages are linked
with specific issues, the rela-
tionship is not clearly esta·
blished. For example it is not
expleined how family welfare
can promote family economy.
(3) Issues pertinent to rura I areas
are not taken into account.
Projection of such issues,
wherever it is done, suffers
from vagueness.
(4) In relation to contraception,
the accent by and large is on
the terminal methods and non-
terminal methods, with the
exception of N:rodh,
are
ignored.
The cafeteria
approach does not find due
reflection in messages on
contraception
(5) The messages on methods
give incomplete information,
even through the print media.
Details that are necessary to
dispel misgivings are avoidec.
Some of the misgiving~
commonly prevalent in the
rura I areas are - sterilisation
me affects sexual relations; tubec-
tomy
kes women fat; IUD
causes constant back-ache;
pills lead to loss of heavy
blood. The study has found
th«t most messages fail to
touch such misgivings.
(6) The approach
to most
messages is generally inte-
llectual. Majority of them are
presented
in statements/
reports/ lectures/address / talk
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1.7 Page 7 |
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form. Very few utilise the
play/drama/story form. Emo-
tional appeal is lacking.
(7) Most of the messages use
urban dialects which are not
commonly comprehensible in
rural areas.
Radio: The audience does not
like natiunal level appeals; rather
it has better understanding of
messages which havE;, individual
or family level appeal and which
are presented in entertainme.nt
form. The medium should utilise
rural dialects.
Film: There is better apprecia-
tion of messages through t~,6 film
medium. The study, however,
points out three shortcomings-
(a) relationship between family
planning and cultural issues if> not
established; (b) specific details
are not given; and (c) there is no
effort to dispel misgivings.
Posters: Linkages with £ocio- Family Growth (NSFG) in the USA
economic and even health pro- reveaIs that 95 percent of US
gramOles are not clearly establish- women of reproductive age-group
ed. The cultural aspect is ignored. who have had intercourse had em-
ployed some method of birth con-
(It may be stated th at tllle latest trol; 92 percer.t hac used a method
position about televisimr:1 is not involving a drug, a de:vice or
covered by these studies. Its surgery.
analysis is currently under way. It
may, however, be pertinent to
And yet, in 1985 thee major US
mention that out oft the 9.3 million television networks turned down a
television sets available in India, public utility service announce-
only about 22',200 come in the. ment promoting contraception. The
category of cvmmunity-viewing anncuncement was sponsored by
sets).
the American College of Obstetri-
cians and Gynaecologists. Reason
for rejection - topic too contro-
versial; might offend Americans
Media Attitude to
opposed to birth control.
Contraception
In contrast, in 1987 less than ten
millic.,n of the 130 million Indian
Pre-marital sex in th6 USA is women in the reproductive age-
common. So is the use of contra- group were using an artificial con-
ception. And yet American tele- traceptive device (sterilisation ex-
vision is shy of promoting the cluded). And yet Indian Television
latter.
has accepted a public utility service
~pot on the Copper-T and the pill
for the national network.
'
y
The Population Situation
/"C..
I
lagging behind had started pick-
ing up.
_ A recent statement by the
Ministry of Health and Family
Welfare claims that 1987 was a
record year from the point of
view of acceptance of family
planning by th6 people.
- The overall couple protection
rate and reached 37.4 percent
as against 32.1 percent at the
beginning of the seventh five
year plan.
_ The number of acceptors that
year was 20.43 million.
- The universal immunisation pro-
gramme, which aims at pro-
tecting children and expectant
_ The states which had been
mothers, was being expanded
gradually to cover all districts
by 1990.
- The birth rate has shown
signs of det:line - SRS estimate
had put it at 32.7 in 1985.
On the whole, the pro-
gramme had averted 85 million
'birttJs since i1S inception:o
March 31, 1987.
~ But for family planning, the
~jgrowth
rate of popula-
tion in 1971 -80 might have
been 30 percent.
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132M Ps Accept SteriHzatio 11
Mostly After The Third Child
Findings of FPF Survey
Even though family planning is
not included as an essential pro-
gramme if' the manifestos of politi-
cal partiBs and there is a certain
amount of shyness to propagate it
at the constituency level, a good
number of M Ps in the present
Indian Parliament are themselves
practising it.
As many as 132 of them have
undergone the sterilisation opera-
tion either themselves or their
spouses have opted for it.
This is one of the significant
findings of a survey sponsored by
the Family Planning Foundatiun.
The sterilised group comprise£
60 M Ps whose wives are below 45
years or who, if they happen to be
women, are themselves below that
age and 72 above 45.
Another interesting finding is that
no MP, who might have been
married after 1981, had a wife
below 18 at the time of marriage.
The survey covered 415 M Ps -
292 from the Lok Sabha and 123
from the Rajya Sabha. Consider-
ing that the tota I number of M Ps is
789, it is possible that sterilisation
among them or their spouses
accounts for a larger number lhan
132. In any case, all the MPs
contacted have recognised family
planning as a vital felt need.
This is the first important survey
of its kind undertaken in India to
find out the extent of practice of
family planning among Members
of Parliament as well as their
views on the management of the
programme as a Whole.
Sponsored by the Family Plann-
ing Foundation, field research was
conducted by the Indian Statisti-
cal Institute. Mrs. S. Juyal and
Dr. R. Champakalakshmi of the
Institute were responsible for the
study which was spread over a
period of nearly one year.
Other Findings
Some of the other interesting
findings thrown up by the survey
are:
(a) Those MPs who have them-
selves crossed the repro-
ductive age group are trying
to influence their off-spring
along correct line.>.
(b) The overall average family
size of the Members of
Parliament who have accept-
ed family planning (this in-
cludes those whose spouses
are sterilized) is 3.9. It
ranges from 2.4 in West
Bengal to 4.5 in Rajasthan.
Tamil Nadu, Gujarat ana
Punjab have recorded in
average below 3; Andhra
Pradesh, Jammu & Kashmir,
Maharashtra, Bihar, Madhya
Pradesh and the Union Terri-
tories between 3 and 4; and
Uttar Pradesh, Orissa and
Rajasthan over 4. In the
first two groups, their is a
tapering off after 3 children
or at the most 4. The third
group (Uttar Pradesh, Orissa,
Rajasthan) is marked by
large-size families.
(c) Female sterilization amongst
MPs accounts for more than
male; as against 51 vasec-
tomies, there are 81 tubec-
tomies.
Cd) In most cases, sterilization
was accepted after 2.child-
ren were born; its incidence
rose after the third child
end, thereafter,
decreased
gradually; sometimes steri-
lization was gone through
after four or more children
as in the state. of Bihar.
Largely, the third Or the
fourth child was sought fer
because of the desire for a
son or a daughter; after
the fourth child, this desire
tended to abate.
(e) Andhra Pradesh MPs have
shown pronounced pre-
ference for sterilization. On
the other hand, those in
West Bengal are in favour
of other methods. They are
no longer opposed to family
planning on ideological
grounds.
Child Marriages
Child marriages are known to be
common in Rajasthan. The su~vey
reveals, however, that 22 percent
of those MPs who had married
brides belQw the age of 15 years
come from Uttar Pradesh. Next
come M Ps from Bihar (15 percent),
Madhya Pradesh and Andhra Pra-
desh (12 percent) and Orissa (10
(percent) .
The survey further indicates that
child marriages do not find favour
in Punjab, Kerala, West Bengal
and Assam. These are prevalent to
a negligiblEijextent in Tamil Nadu,
Maharashtra and the Union Terri-
tories. On the whole, 50 percent
of those who had married child
brides are now beyond the re-
productive age group.
Views on Family Planning
A number of M Ps said .tha t
target-setting was a wrong prac-
tice. Some pinpointed the inade-
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quaeies ;n hospital ~ccilities ane.
sugge3ted thElt the programme
should be in competent technical
hands and there should be procer
pest-operative
care, particularly
when camps are organised, Seve-
ral M Ps said that while the family
planning programme itself was
sound, its implementation
in the
field wa~ faulty.
A number of M Ps were of the
view that voluntary organisations
could playa more important rele
in the promotion of the programme.
Some of them stated that they
themselves were "social workers
first. politicians next".
Some M Ps voiced the fear that
if family limitation was not prac-
tised by people belonging to till
religious faiths evenly, the demo-
graphic profile of the country might
be affected. Many suggested that
since no religion favours a large
family and at the same time reli-
gious leaders command a good
deal of respect, they should be
brought together and persuaded
to advise their followers to accept
family planning as a way of life
for every Indian, Some suggested
that a uniform code of marriage
should be adopted for aiL
On incentives, the views were
divergent. Some said that these
should be paid directly to accep-
tors while some others opined
that these should be scrapped
altogether.
Most MPs underscored the im-
portance of taking effective mea-
sures to reduce infant mortality.
At the beginnir.g of the p~,2n
the country had a backk:g of
24.7 million units. Increase in
population
during the p12!l
would take the total sh0rtage to
40.9 million.
As we bid good-bye to the
Internationa! Year of Shelter
for Homeless, which 1987 was.
the que3tion is: will the cauntry
be able to achieve the goal of
houses for all by 2000 AD?
- Tackling the backlog would-
account for Rs. 38,000 crore
in the seventh plan alone. Tho
total allocation for housing in .
the public sector under the
p~an is just Rs. 2,458 crore.
- The amount needed may be
much more since the costs
have been calculated unrealisti-
cally - Rs. 6,000 per dwelling
unit in rural areas and Rs.
20,000 in towns.
The rOle of growth of hOllSi::g
steck is consistently !8gg Ing
behind the growth of house-
hQlds. In 1961, the s~lortage
was 9 million. By 1985, it had
increesed to 24.7 million (18.8
million in rural areas a!ld 5.9
million in urban areas.
WhilEJ all MPs were in favour of
the f8mHy planning programme,
quite a few feared that ageinst
the backdrop of poverty, if they
took it up at the constituency
level, this could have an adverse
effect on their credibili'y. At
least one M P went to the extent
of saying that to pre3ch "family
planning to the people c:Jt the
constituency level would amount
to singing the National Anthem
at a wedding party.
India will need an additional
16,2 million housing units to
meet the needs of additions to
population between 1985-1990,
the period of the seventh five
year plan.
Among the distinguished visitors to the Foundation in the October-
December quarter was Dr. Nafis Sadik, Executive Director, UNFPA.
She was accompanied by Mr. G. Hamdy, Resident Representative,
UNDP, Mr. George Walmsley, Dy. Rep. and Mr. Jyoti Shankar Singh,
Chief, Information & External Affairs Division, UNFPA. The photo-
graph shows them with Mr. Harish Khanna, Exe. Director, FPF.
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(Continued from page 1)
All these statistics find reflec- planning in the state. History has
higher per capita incomes, more tion in the annual population gone into its making. So has the
ra pid economic growth, larger
proportion of labour force in non-
agricultural
occupations and
hig her nutritiona I levels.
growth rate. While at the national
level it went up from 1.95 percent
to 2.22 percent in the 1961-81
period, in Kerala it came down
from 2.24 to 1.7 percent.
health of the people which has
gained as much from it as it has
given to it. Education and health
have as a matter of fact gone
hand in hand with each other in
Other Relevant Factors
Apart from its educational ad-
vancement and the benevolent off-
shoots of education, three other
principal factors which have contri-
Credibility of Services
The intimacy of relativnship bet-
ween education, particularly
amongst women, and low fertility
rates, low infant mortality rates
Kerala and placed the state in a
unique position, distinct from the
rest of the country, despite Kerala's
economic poverty and high popu-
lation density.
buted to the success of family
planning in Kerala are:
(1) efficiency of the programme
as revealed through the
people's faith in it;
(2) proportionately higher finan-
cial allocations for health
and education than in any
other state;
(3) availability of goods and
services to people in a
equal manner, backed by a
land reform system which is
based on the principle that
all land beyond a specific
and low population growth rates
is well known. What, however,
is nct generally recognised is the
importance of factors other than
education which have transformed
the scene in Kerala and made it a
success story 2t par with Singa-
pore and Hong KGng, notwith-
standing thE> latter's higher per
capita incomes and consump-
tions. The fact that people place
greater faith in family planning in
Kerala than in other parts of India
is also generally lost sight of in
common assessments of the
Kerala situation.
'\\
Many scholars, social scientists,
demographers and others, includ-
ing those commissioned by the
World Bank, who have gone deep
into the Kerala situation, have
talked about this phenomenon. In
his "Legacy of Kerala", A. Sree-
dhara Menon has given some idea
of the role that religion has played
in laying the foundations of a
strong education base in the state.
In the ancient past the temples
were treated not just as places of
worship but also as places of
learning.
All the major Hindu temples had
limit belongs to the tiller.
Progress After 1961
What tends to be forgotten in
the totality of the situati-:>n is that
all the success that Kerala has
attained in family planning has
been achieved after 1961. While
in India as a whole, the birth rate
between 1961 and 1981 declined
from 41 to 33 per thousand, in
Kerala it went down from 37 to
26. Similarly, the death rate in
Kerala in the two decades de-
clined from 13.5 to 6.9, whereas
in India as a whole it declined
Another point which needs to
be underscored is that fertili~y
decline in Kerala has occurred not
just among the rich and well
educated, but also among the
poor and illiterates. The credibility
placed by the people in general in
family planning and the ready
availability of efficient services to
them everywhere are important
factors in determining whether a
couple, rich or poor, literate or
illiterate, does or does not adopt
some form of family planning.
Sound Education Base
schools. popularly known ' as
Salais, attached to them. They
were treated as boarding schools.
Later, when Christianity came to
the land, Christian missionary
schools sprang up in many places.
At the same time, Muslims started
their own institutions. While
Hindus had their Salais and Sabha
Matts, Muslims had their Madrasas
and Arabic colleges and Christians
had their missionary schools and
colleges. Side by side flourished
the system of parallel education
which is recognised by the Govern-
ment unto this day.
from 19.0 to 12.5. The infant
Of course, no other f>tat.e in
mortality rate in the 1971 -81 de- India has got the kind of sound Even Spread
cade in the country did not show and wide education base, with
The spread of these schools and
any significant decline. It went high levels of female literacy as colleges was even - in cities as
down from 129 to 125 only. In one of its essential ingredients, as well as in villages. Whether or not
Kerala, however, the decline was Rerala has. It is also undeniable there was a spirit of competition
much more pronounced-from 61 that this base has provided an among them, put together, they
to 44.
excellent take-off point to family did contribute magnificently to
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2.1 Page 11 |
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what Kerala today is from the
point of view of education. The
literacy percentage in the state in
1981 was 70.4 as against 36.2 in
India as a whole. Over 65 percent
of the women were literate that
year, as against 24.6 percent in
the country.
It needs to be stated that the
spread of education in Kerala re-
ceived a good deal of encourage-
ment from the erstwhile enlighten-
ed Maharajas of Travancore and
Cochin. They made the state
pay the entire cost of primary
education. Later, successive govern-
ments allocated higher funds for
education than in other states in the
country and, what is more im-
portant, earmarked bulk of these
funds for primary education than
for higher education.
Today education is so wide-
spread in the state that there are
very few illiterate men or women
in the prime child-bearing age and
the supply of educated personnel
is far in excess of demand.
Political Awareness
Moni Nag, T. N. Krishnan,
Sreedhara Menon, P. K. Gopinathan
Nair and a number of other Indian
sociologists and scholars have
rightly given high marks to educa-
tion as one of the principal instru-
ments of change in Kerala. In
relation to family planning, health,
whi<:h is linked with education,
has no less importance. Equally
sigrificant is the fact that there is
high degree o'f political aware-
ness in Kerala. Almost everybody
reads newspapers there. Protest
m3rches, genaral strikes, hunger
strikes and agitations of other
character are a common feature.
The people cannot be taken for
granted. They must have a say in
everything that is done. Their
voices are aired by the news-
papers which command credi-
bility. Injustice in any manner is
not tolerated. No health centre
can remain closed for a long period
of time, whatever may be the
reason behind the closure. Simi-
larly, no school can remain with-
out teachers.
Land reforms were first intro-
duced in the state in 1957. More
strength was added to these re-
forms in $ubsequent years and
today no landlord can have a hold-
ing exceeding 10 acres. The
this point of view, the line that
divides urban India from rural India
is very dim in Kerala.
In 1970-80, the average service
area of a primary health centre in
the state was 232 sq. kms. as
against 563 sq. kms. in India as a
whole. Similarly, the service area
of a sub-centre was 21 sq. kms.
and 63 sq. kms. respectively. The
number of hospital beds per one
lakh population was 458 in urban
. Kerala as against 263 in urban
Per capita income (1983-84
Female literacy (1981)
Infant mortality rate (1981)
Birth rate (1983)
prices)
Kerala
Rs. 1,760
65.73
44
24.9
India
Rs. 2,201
24.62
125
33.7
Minimum Wages Act for farm
workers has to be enforced. The
workers will just not accept its
violation.
All this has directly or indirectly
contributed to the efficiency of the
principal welfare programmes, in-
cluding family planning.
India, and 107 in rural Kerafa as
against 12 in rural India.
Balanced spread of health ser-
vices marks the scene in Kerala.
That is one of the important facets
of the situation in the state that
most observers tend to lose sight
of.
Health
The health centre in Kerala is
far brighter than in any other state
in the country, including those
which have higher per capita in-
come. The state has a long history
of indigenous medicine, parti-
cularly Ayurveda. Since the people
are educated, they are more health
conscious; since they are politi-
cally volatile, they will not tolerate
denial of health facilities
both
preventive and curative.
While the foreign missionaries
established their own private hos-
pitals and dispensaries in the state,
the erstwhile Maharajas allocated
sufficient public funds for health.
The hospitals and health centres
are today spread allover. From
Sequence of Developments
The mean age at marriage in
Kerala in 1981 was 21.85 years,
as against 18.32 years in India as
a whole. This is directly attribu-
table to the high level of literacy
among women. The infant mor-
tality in Kerala in 1981 was 44, as
against 125 in- the rest of the
country. That is attributable as
much to high female literacy as
to the efficacy of the health system,
including family planning services.
Th e birth rate in Kerala fell down
from 37 in 1961 to 26 in 1981. The
corresponding figures for the coun-
try were 41 and 33. The popula-
tion growth rate went down in the
state during the same period from
2.24 to 1.74 percent. In the
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2.2 Page 12 |
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resuIts;
country as a whole, it went up
from 1.95 to 2.22 percent. That
can be attributed to the totality of
circumstances, which include better
education, better health, better
family planning services and higher
level of consciousness amongst
. the people of Kerala.
Summing Up
Reduction in infant and child
mortality, accompanied by increase
in female education, backed by
effective redistributive policies,
supported by efficient family plann-
ing services and the overall pro-
cess of change, including land
reforms and high value placed on
the education of children - these,
by and large, are the principal
fectors re-sponsible for the success
of family planning in Kerala.
The state would not have attain-
ed the position of distinction it
occupies in family planning today
but for its strong education back-
ground. At the same time, despite
this background, the state would
not have achieved the success it
has achieved in family planning
but for an efficient health delivery
system and an equally efficient
family planning programme.
Policy Implications
What ar~ the policy implications
of the Kerala experience? Broadly,
these can be summed up as
follows:
(d) health and education are the
principe!I variables that create
additional demand for ferti~
lity control and enhance the
value of children; and
(e) there is a higher spin-off
effect between higher socio-
economic development and
a more efficient family plann-
ing programme.
(a) a strong and efficient govern-
ment-sponsored
family
planning programme can
make a substantial dent in
fertility rates not just among
the higher socia-economic
strata of the society but also
among the lower strata;
(b) within certain limits, the
generally accepted positive
association between socio-
economic status and family
planning acceptance can be
broken by a good family
planning delivery system;
- What happens if a doctor in a
PHC in Bihar or U.P. is absent
for days together?
- Perhaps nothing.
- Even though Bihar and U.P.
have high lelJels of politica!
consciousness.
- What happens if a similar situa-
tion. occurs in Kerala?
- People agitate.
- The doctor has to come back.
- And he comes.
(c) if the system is backed by
reasonable economic incen-
tives' as in Kerala, family
planning can obtain better
(Contd. from page 3)
ment Studies, UP; National Insti-
tute of Health and Family Welfare,
New Delhi; , Population Centre,
Karnataka; Institute of Tribal Health
and Social Sciences, Orissa; and a
group ,acting under the guidance
of Dr. 'Victor S. D'Souza, Bombay,
a re associated with the Foundation
in the ,study.
Scene from a street play-USus'stop" organised by Jagran in the
slum areas of Govindpuri in Delhi - part of a family welfare project
for industrial workers being implemented by Parivar Seva Sanstha
with support from FPF.
To o:btain a realistic picture, the
data has been collected from diffe-
rent socio~economic segments of
the society - three hilly and four
plain/rural districts of Uttar Pra-
desh, five relatively less.developed
and five relatively more developed
rural and tribal districts of Madhya
Pradesh, five districts of Karnataka
with both rural and urban charac-
teristics, five tribal districts of
Orissa and ten notified slums of
Bombay.
Detailed analysis of the data is
currently under way.
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 '