 |
Diagnostic Study Orissa |
|
|
1 Pages 1-10 |
▲back to top |
|
|
1.1 Page 1 |
▲back to top |
Diagnostic Study
of
Population Growth,
Family Planning
and
Development, 1971-81
Orissa
THE FAMILY PLANNING FOUNDATION
198, GOLF LINKS, NEW DELHI-llOO03
|
|
1.2 Page 2 |
▲back to top |
DIAGNOSTIC STUDY OF
POPULATION GROWTH, FAMILY PLANNING
AND DEVELOPMENT IN ORISSA, 1971-81
THE FAMILY PLANNING FOUNDATION
198, GOLF LINKS, NEW DELHI-llOOO3
|
|
1.3 Page 3 |
▲back to top |
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
~* Orissa. This Brochure presents the main findings and recom-
mendations in respect of
This would, we hope,
~Iate
an informed discussion on the Status of Population in
•~•--I&IW~;&lp·navde 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 Planning.
New Delhi
February 1, 1985
J C KAVOORI
Executive Director
|
|
1.4 Page 4 |
▲back to top |
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 is essentially· a
regional problem. Among lhe 14 major States of India (with' a
population of to million and above excluding Assam), the growth
rate in 1971-81 has varied from 17.50 in Tamil Nadu to 32.97 In
Rajasthan, with 27.17 per cent for Orissa.
3. This project entitled "Diagnostic Study of Population Growth
Family Planning and Development in 1971-81 in Gujarat" is
a part of the fiive-state study project (which includes Gujarat,
Orissa, Rajasthan, Tamil Nadu and Uttar Pradesh). The
project has its genesis in the disclosure by the 1981 Census of a
constant growth rate at the national level, but a highly variable
growth rate at state level. The 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 establishing hypotheses or
quantitative relationships nor are they expected to lead to
instantaneous solutions to problems. But it is hoped they
would expand understanding of the problems and tpe potential
|
|
1.5 Page 5 |
▲back to top |
4. The diagnostic study adopts the framework:
Knowledge
(based on
available
information)
I Understanding
I Action
J_. f- L ~ (based on interaction L -+(based on
with programme
findings of
officials)
the study)
The study has utilised not only the data available in various
publications and its analysis, but based on the analysis, a set
of structured questions were framed for three core levels of
leadership in the family planning programme: political level
(Health Minister), executive level (Commissioner/Secretary) and
professional level (Director of Family Welfare). The structured
questions, its replies and the subsequent interview have vastly
improved the information base and have imparted a realism to
the exercise.
5. The main findings of the study are presented in the brochure
under four headings:
The Demographic Scene;
The Social Setting;
The Development Scenario;
Family Planning Performance.
Based on the findings, a set of thirty-one Recommendations has
been developed, which it is hoped, would be seriously considered
both by the State and the Central Governments. Copies of the
Main Report have already been sent to the programme leaders in
the State and the Centre.
6. The' project has been funded by the Family Planning
Foundation (FPF). Though FPF has normally a funding and
promoting role,. in the case of this particular project the FPF
undertook also the implementation in view of the significance of
the study for the programme and the need to have a high level
liaison witq. the States in securing the project objectives. The
study is not an end in itself. Based on the study, a series of
follow-up meetings are proposed with the leadership in Popu-
lation and 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-
performance Stite~,
|
|
1.6 Page 6 |
▲back to top |
The DeJDographic Scene
The population growth rate in Orissa which has been rising
rapidly since 1951, declined! substantially in the decade
1971-81.
The decadal growth rate of 20.17 per cent in 1971-81 is much
lower than the national growth rate of 25.0 per cent.
Among the delllographic processes, while the higher mortality
(particularly infant mortality) and the lower fertility could
have reduced the growth rate, the net immigration into
Orissa should have affected the reduction in the growth rate.
The net immigration rate was 0.88 for males and 1.01 for
females according to the estimate of the Registrar General.
i) a strong family planning programme and
ii) a sub-fertility syndrome among tribals and scheduled
castes who constitute around 40 per cent of the
population.
- The population density in Orissa has always been lower than
at the national level and in 1981 it was 169 persons per sq.
km compared with 221 at the national level.
- In 1971-81, rural growth rate in Orissa was lower 05.26 per
cent) and urban growth rate higher (68.29 per cent) than the
national level.
Though Orissa recorded the highest urban growth rate among
all States, the proportion of urban population was quite low
11.8 per cent compared with 23.7 at national level.
The reason for a slow pace of urbanisation in Orissa is that
urban growth is somewhat vertical with high growth in I and
II class towns.
|
|
1.7 Page 7 |
▲back to top |
Immigration from other States into Orissa accounts for the
high urban growth.
According to the 1981 Census, Orissa recorded a high immi-
gration rate by place of birth compared to many States.
If despite such high immigration, the population growth rate is
lower, the argument has tenuously to be built on the fertility
and mortality trends;
The proportion of population in the age group 0-4 registered
the second highest decline (17 per cent) in Orissa among the
major states.
- The child-woman ratio P (0-4)/F (15-49) was 507 in 1981which
is lower than the ratio for all-India 546.
In 1971-81, the rural growth rate of 16.54 in Orissa is sub-
stantially lower than the national rate of 19.84 (natural growth).
On the contrary, the urban growth rate of 19.95 is higher than
the national rate of 19.28 (natural growth).
- In rural areas, the birth rate declined in 1970-77, but there-
after it rose. Mortality maintained a steady declining trend
though the level was higher than the national mortality rate.
The decline in mortality is due to infrastructure development
(such as more sub-centres) but such development cannot
reduce fertility because sterilisation services are not offered at
sub-centres.
In Orissa, the proportion of young age population (0-14) is
40 per cent.
- In Orissa, the proportion of children of 4th and higher
order constituted 40 per cent in rural and 38.4 per cent in
urbun areas. Such a high proportion of high parity births push
up the infant. mortality ratio.
The age specific m/J:ritalfertility in Orissa is higher thCl.nthe
national average in the Cl.gegroup 15-34, particularly the age
group 15-19.
.
|
|
1.8 Page 8 |
▲back to top |
- One important demographic feature of Orissa is the lower
population growth rate among tribals. Such a low growth could
be due to-
i) low birth rate and low fertility among tribals occasioned
by their life style and natural contraception.
Ii) a strong official family planning programme.
_. The total fertility among tribals was 3.63 in 1978 compared
with 4.76 for non-tribalsjnon-scheduled castes.
- Mayurbhanj district with 57.6 per cent tribals recorded the
lowest growth rate of 9.96 per cent in 1971-81.
- Orissa is among the high IMR States like V.P. and Rajasthan
with a level of 143 in 1980 compared with 114 in India and
40 in Kerala.
- The rural IMR is more than double the urban IMR, reflecting
the poor availability of health services in rural areas.
- Unlike the Southern States, the neo-natal mortality is higher
in Orissa reflecting the low availability of medical facilities in
rural areas.
- Among all the States (with the exception of Assam), Orissa has
the lowest immunisation status.
- In the short run, a more vigorous immunisation programme
and use of trained dai hold the key to any reduction in IMR.
The low population growth rate is deceptive as it does not
represent a definite trend towards quicker demographic
transition.
- The low population growth is influenced by a relatively
higher level of mortality in rural areas. This rate may come
down in response to an extended health care system much
faster than the birth rate.
- Neither the satisfactory family planning programme nor the
decline in fertility in 1971-81 should yield place to any
complacency.
|
|
1.9 Page 9 |
▲back to top |
- the demographic trend in Orissa in the 80s is going to be
influenced by all the three demographic processes: fertility,
mortality and migration and the relative influence of these
factors would in turn depend upon the socio-economic
t:levelopment of the State.
The Social Setting
The nuptiality pattern in 1971-81 has been favourable to the
tedutti()D in fertility judged by the significant reduction in
the proportion of young age marriages (I 5-19) and the increase
in the mean age at marriage.
--- 'the proportion of married in the age group 15-19 registered
the biggest decline in Orissa from 56.7 per cent is 1971 to
30.9 in 1981.
Also the general nuptiality rate (proportion married in the
age group 15·44) registered the highest decline in Orissa by
8.1 per cent compared with 3.4 at the national level.
The mean age at marriage of females rose from 17.7 years
in 1971 to 19.1 in 1981 which is a commendable achievement
for a backward state like Orissa.
- At the end ofthis century, Orissa is likely to have one of the
lowest nuptiality rates-61 per cent.
Though the decline in marriage age is a welcome development,
it does not appear to have an impact on marital fertility.
- The sex ratio has been declining since 1951Jhough it is higher
than the national ratio.
..•...Literacy in Orissa is almost on par with India but sex
differential is more pronounced.-
Rural female literacy at 18.5 per cent is nowhere near the
Kerala rate of.64 pel' cent.
In Orissa, two out· of five children in the age group 5-9
attend school but there are sex differentials with only one out
, of three female children in 5-9 attending school..
|
|
1.10 Page 10 |
▲back to top |
lation) of rural women in Orissa (11.3 per cent) has always·
been lower than the national average 16.5 per cent.
- Over 80 per cent of females are non-workers compared with
44 per cent for males.
- With 79 per cent of illiteracy among women and 80 per cent
of unemployment, the status of women in Orissa is low.
Orissa being a traditional agricultural economy during the
last three decades, three out of four main workers are engaged
in agriculture.
Work participation among children (6.4 male and 4.3 female)
is higher than all· India indicating the poverty and the con-
sequent economic value of children.
- Son-preference as measured by an index (15.7) is much lower
than 20.2 at the national and 31.3 per cent in Rajasthan.
The sub-fertility syndrome among tribals could be a possible
result of their life style and culture which requires a detailed
study.
- The per capita income in Orissa in 1971-81 is one of the
lowest among the states (barring Uttar Pradesh during some
years), and has been constistently lower than the national
average and was only 40 per cent of the per capita income of
Punjab.
- Though the per capita income in real terms (1970-71 prices)
had risen from Rs. 434 in 1971 to Rs. 524 in 1981, there has
been no steady growth.
- The economy is stagnant depending on traditional agriculture
with little diversification (nearly two-thirds of the income is
from agriculture).
Agricultural productivity (per capita output of foodgrains) has
remained static during the three decades 1961-81 at 230
Kgs. (Nearly 80 pet cent of the net area sown is rainfed and
is therefore liable to the vagaries of weather. The holdings
are uneconomic, the tribals still adopt primitive methods,
and the consumption of fertilisers is very low).
|
|
2 Pages 11-20 |
▲back to top |
|
|
2.1 Page 11 |
▲back to top |
- The States income rose from Rs. 10,374 million in 1970-71
Rs. 13,830 million in 1981 yielding a growth rate of 3.3 per
cent.
- Such a macro-economic situation meant a low impact of
development on the people and perpetuation of poverty.
- Nearly 69 per cent of the people are below the povety line
(the highest among States) in 1977~78.
- With a marginal decline from 71 per cent in 1972-73, the
poverty eradication programme in Orissa has met with little
success.
- Some efforts to focus development towards the rural popula-
tion is evident as the outlay has been stepped up considerably
on population-oriented development (POD).
But the perpetuation of poverty at a high level (69 per cent)
raises doubts whether the benefits had actually reached the
people in a substantive measure.
i) some emphasis on rural infrastructure;
U) a modest increase in social services;
Ui) a virtual neglect of rural employment and women's wel-
fare.
- A critical reason for backwardness of Orissa is the low
infrastructure development.
- The importance of distributive development lies in the fact
that; there is a close relationship between fertility and per
capita expenditure.
- In Orissa, marital fertility had dropped from 190 in the per
c~pita monthly expenditure bracket Rs. 50 or less to 127
when the expenditure isRs. 100 or more.
- The physical achievements of POD in Orissa are not impres-
sive. Road intensity of 8 Km per 100 sq. km is very low and
rural electrification is also tardy.
One important aspect of POD in Orissa is the Tribal Sub-
Plan into which 40 per cent of the State Phln Outlay had
gone in 1979-80.
|
|
2.2 Page 12 |
▲back to top |
Orissa had a headstart in family planning even in the late
60s and was the recipient of the KARVE AWARD for tWQ
consecutive years 1969-70 and 1970-71.
- This foundation had served the programme build-up and
Orissa doubled its sterilisation rate from 30 per thousand
population in 1973 to nearly 62 in 1981.
- With almost an exclusive attention paid to the sterilisatjon
programme, the spacing methods have receded.
- Out of every three acceptors, two have accepted sterilisation
during the decade 1971-81.
- In the contraception protection of 25.4 per cent of eligible
couple by all methods in 1981, sterilisation alone accounts
for 24.3 per cent.
- The sterilisation programme had a quick revival after the
emergency, because of the popularity of the mini-lap
technique, and target achievement was better than the
national average.
- The 'urban bias' in the sterilisation programme is not as
pronounced as at the all-India level.
- It stands to the credit of the State Government that they
have taken the sterilisation programme to the rural areas
with the proportion of sterilisation acceptors in 1980-81
in rural areas constituting 88.7 per cent while the rural
population is 88.2 per cent according to 1981 Census.
- The IUD programme which was strong in the earlier half of
the decade 1971-81 crumbled later.
- Apart from the attention being diverted to sterilisation,
the basic deficiencies in the IUD programme were on sllPplYt
services and side-effects.
- The achievement of IUD targets in Orissa was lower in th~
post 1977 period.
~ Because the service delivery system was geared to· the pursuit
of sterilisation targets, the conventional contraceptives and
oral pill were also a low-key programme.
|
|
2.3 Page 13 |
▲back to top |
- Though the farhily planning programme in Orissa could be'
regarded as quantitatively successful, it has several qualitative
deficiencies sdch as recrUitment of high parity couple, older
women etc.
- Dispite an increase in couple protection rate from 17 per
cent in 1973 to 25 per cent in 1978, there is no reduction in
the fertility of'the younger ages 15-24 while substantial
reduction has occurred among 40+ wOluerl.
- Over 60 per cent of sterilisati6n acceptors were aged 30 yearS"
and above.
- More than halt of the acceptors of tubectomy had 4 or rnore'
children .
.•....indeed the parity of the tubectomy acceptors in Orissa Was
consistently above the national average.
Likewise, the mean age of acceptors of tubectomy in Orissa
is higher than the national average.
- One reason why there is no large decline in fertility in the
second half of the decade dispite sustained contraception
rate of 25 per cent is that the bulk of the protection COmes
through mini-lap tubectomy which appears to have a built-
in high parity approach.
- The 60 per cent couple protection by 1991 envisaged in the
demographic goal of NRR = 1 cannot be achieved only
through sterilisation.
- The demographic goal cannot be achieved without the
development of the infrastructure' on a large scale .
...- The political commitment to the programme is not particularly
strong. They may have some interest in policy but not in the
, jmpleme,ntation of the programme.
-;;:;.T, he Orissa Legislator's Conference sponsored by the IAPPD
• '. (September 1983), called for a greater exchange between the
Government and the MLAs.
~.There is need for clear-cut guidelines for tbe MLAs and
MPs to promote the programme.
|
|
2.4 Page 14 |
▲back to top |
or -Trained medical attention at birth has been lower than the
;iu~tional ;a~erage; f~r example i'n '1918, haroly ;1 but 6
!births in rura] and hardly' lout of 6 births in urban area'S
;had ~lDYworth~hile ~edical attention.
- :M9re than-70per cent of infants in rurl;llareas died without
trained medicai attention, compared' 'With ie'ss thUn 60 at tHe
national level.
.'
,, , '.
Orissa is one of the states with the lowest medical attention
at death and the lowest immunisation status of children
below 1 year.
- While 54 per cent of infants at the national level and even
above 80 per cent in some states had been immunised, the
achievement is only 14 per cent in Orissa.
- The lack of medical attention and the low immunisation
status are further compounded by the poor accessibility of
even the available facilities.
- If a 5 Kms radius is regarded as an accessible limit of a
medical facility, only 34.6 per cent of the rural population
had access in Orissa compared with 60 per cent at the national
level.
- Similarly, only 11 per cent of the rural population had access
to water supply and 22 per cent to a motorable road compared
with 19.4 per cent and 35.3 per cent at the national level.
- There are also quite a few vacancies in the posts sanctioned
for family planning.
- In view of the poor medical facilities, mortality arid parti-
cularly infant mortality in Orissa is higher than the national
level.
- The MPW scheme is regarded as useful in integration of health
and family welfare. Though this is not substantiated, there
is at least no negative effect of or an agitational approach by
MPW as in Uttar Pradesh.
- Recruitment of staff sanctioned for the family planning
programme has not been satisfactory during the decade with
only 62 per cent of the posts filled.
- Major deficiencies are noticed in the LHV. ANM and FPHA
|
|
2.5 Page 15 |
▲back to top |
category which are very criticai in the outreach of the
programme and the promotion of spacing devices.
- What has sustained a satisfactory sterilisation programme is
the mini-lap technique, and it is claimed that of the over
inmion sterilisations done during the last decade three-fourths
are mini-lap tubectomies.
-.;, A 'hospital type of care' of the clients, provision of incentives
as for regular tubectomies, and a follow-up by the paramedical
staff are claimed to be the promotional factors.
~ Though mini-lap technique is the prime cause of success,
it is not yet established whether it is the 'appropriate
technology' .
.::-..O. rissa's performance in family· planning raises a basic
question of how a backward state could promote family
planning so vigorously.
- The 'acceptance' of family planning has been higher among
the tribals throughout the decade 1971-81.
- The average contraception protection in the tribal districts
was 32.2 in March 1981 while the average for non-tribal
districts was 24.7.
- In the absence of elected #Panchayats and lack of voluntary
organisations, the programme is virtually a Government
programme with low community participation.
- The Civil Administration comes in only during the organisa-
tion ~f Camps.
- Inter-departmental Cooperation is feeble and the programme
has become the responsibility of the Health Ministry.
- The diagnosis reveals the strength and weakness of the
programme as indicated below.
A. Programme/actors (or direct inputs)
1. A head~start in family planning in late 70s and early 80s
and presentation of KARVE AWARD.
|
|
2.6 Page 16 |
▲back to top |
2. The involvement of the medical profession in the pro-
gramme.
3. Dedication of functionaries.
4. Strict pursuit of targets and their distribution down the
line.
5. Pioneering work in mini-lap technique.
6. The useful role of Village Health Guides.
B. Non-programme factors (or environment variables)
1. The smallness of the State.
2. A substantial decline in young age (I5-19) marriages.
3. A decline in average age at marriage.
4, Tribal concentration (nearly one-fourth of the population)
and the high degree of acceptance in tribal districts.
5. A massive tnbal sub-plan.
Impeditnents
1. Poverty.
2. Unemployment.
3. Low agricultural productivity and economic stagnation.
4. High mortality, particularly high infant mortality in rural
areas.
5. Poor infrastructure support in rural areas (rural roads and
rural electrification).
6. Low level of medical services and outreach, particularly low
medical attention at birth or death of an infant and low
immunisation status.
7. Major deficiencies in staff recruitment (particularly MO,
LHV and ANM).
8. Application of resources to the pursuit of sterilisation targets
to the neglect of spacing method.
9. Side effects, cumbersome procedure and requirement of
female service providers for spacing methods.
10. Lukew.arm political commitment.
11. Absence of elected Panchayats.
12. Poor involvement of voluntary organisations.
]3. Pursuit of quantitative targets with poor quality awareness.
14. Poor inter-departmental coordination and failure of develop.
ment departments to utilise their peripheral contacts to
promote family planning.
15. Absence of a system of monitoring at the highest level.
16. Non-utilisation of the institutional strength of cooperatives
and industrial establishments.
17. Limited resources of the State to give higher incentives to
acceptors and motivators.
|
|
2.7 Page 17 |
▲back to top |
1. 'PoiiticalCommitment 'to the programme being w~ak, Jh~
following measures are suggested-:
a) There is need for a CABINETSUB-COMMITTEOEN-POPU-
LATIONANDFAMILYPLANNING.The Monitoring Meeting
held every month reviews the 20-Point Programme of
which family planning is an item. Since family planning
is probably the most difficult of the social programmes,
depending on attitudes and behaviour of the people, it
requires a stronger political backing than what is avail-
able now. Further the success in many of the other
points of the 20-Point Programme depends on the
rapid adoption of family planning by the people. This
requires inter-ministerial involvement. Accordingly,
there is need for a Cabinet Sub-Committee on Popula-
_tion under the Chief Minister with membership of the
~Cabinet Ministers dealing with Finance, Planning, Agri-
-culture & Rural Development and Cooperatives, Health,
-Education & Social Welfare and Local Administration.
:b) There is need to establish a STATEFAMILYPLANNING
"BoARDunder the Health Minister with membership of
Heads of Departments and non-officials to secure co-
ordination at the grass-roots level.
Officials
-Commissioner -& Secretary, Health & Family Welfare
-Director of-Family Welfare
-Director of Rural De-velopment
LDirector -of'Social Welfare
Director of Information:.& 1ll.J:.0.adcasting
Director of Labour
Director of Municipal Administration
Director of Panchayats
Chairman, State Social Welfare Board
Director, Population Research Centre, Bhubaneswar.
Non-Officials
5 MLAs from different political parties
5 MLCs from different political parties
Representative of voluntary organisations:
Family Planning Foundation, Family Planning Associa-
tion of India, etc.
A leading Gynaecologist and Obstetrician.
c) A Cabinet Minister may be made responsible for each
of the districts.
d) In order to involve the MLAs deeply in their constitu-
|
|
2.8 Page 18 |
▲back to top |
enci'es, 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 leaflets about the Camp carry the photo--
graph of the MLA. Such camps are regarded as success-
t:ul in Gujarat and as they cut across party-linea. the
politicisation of the programme may be less.
2. The recommendations of the Orissa Legislators Conference"
September] 983 regarding the close liaison between MLAs and,
administratIon in promoting the programme at the local level,
need to be pursued vigorously. In particular, the following points.
that emerged at the Conference need careful consideration:
i) that Orissa being a poor state cannot afford to give
additional incentives to acceptors as in the case of
Maharashtra, Haryana and Punjab. (accordingly, the;
whole concept of giving national awards for performance.
needs a fresh look.)
-ii) it is necessary to develop the infrastructure of the family
planning programme on a very large scale, if the demo-
graphic goal is to be achieved.
iii) in view of the expertise developed in Orissa on mini-lap
method, there should be no switch over to the costly
laparoscopic method.
iv) at the current rate of progress, Orissa may soon reach
the saturation level of sterilisation and it is therefore
necessary to lay more stress on spacing methods.
3. The nuptiality factor in fertility is not as consequential as
socio-economic factors. Raising the age at marriage does not
bring down fertility in the wayan improvement of standard of
living does. Though raising of age at marriage has its own merits,
the eradication of poverty shoul~ receive the highest priority in
development in Orissa alongwith a suitable contraception strategy.
4. The new social policy of Orissa has to concentrate on removal
of poverty. The Focus OF DEVELOPMENshTould 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 e'Xpensivemethods of reaching
the poor and be FAMILYCENTRIC."
5. Sterilisation has already reached a level of above 25 per cent
of eligible couple. The high parity couple who constituted the
majority of clients would soon taper off and sterilisation could
|
|
2.9 Page 19 |
▲back to top |
reach a saturation point in a short time. It is therefore necessary
that keeping the demographic situation and the time perspective
of less than 10 years (by ]991-92) to reach NRR= I, the 'Con-
traception Mix' in Orissa has to shift to 'Medium Priority
Sterilisation', i.e. there should be two acceptors of spacing
method for each acceptors of sterilisation. In the sterilisation
programme, it would be advantageous to encourage vasectomy in
Orissa to bring about a rapid reduction in fertility as the mini-
lap has an appeal to mostly high parity women.
6. Promotion of spacing methods among the younger couple
(wife below 25 years) is in turn essential from two angles:
i) the need to moderate fertility at younger ages both from
demographic and health considerations, and
ii) to prepare the younger couples to adopt terminal
methods as soon as they have had their small family
(limited to three children).
7. Oral pilI and Nirodh need to be promoted through the social
marketing approach to improve accessibility.
8. Mere pursuit of quantitative targets, without ensuring quality
is a waste of resources. Implementation of the programme in a
systematic manner requires an updated Eligible Couple Register
(ECR) at the PHC/Sub-centre level, so that the qualitative aspects
are kept in view.
9. Once the couples with two children and age group less than 25
years are identified, they should be regarded as a target and
motivated to adopt contraception. For this purpose, a large
number of female social workers should be recruited for the
programme.
10. Within this group, there is need for MOREATTENTIONTO
THEPEOPLEBELOWTHBPOVERTYLINE(usually the landless labour,
marginal farmers and the slum dweller) as otherwise, there would
be several SURPLUSPOOR CHILDRENby 2000 AD whom the
economic system can never lift out of poverty. The surge in
human numbers, together with economic inequalities and sluggish
economic growth obviously pushes up the size of 'marginal'
population. This is a common problem both for population
planning and economic development.
11. In the case of IUD and Oral Pill, there is need to sustain a
high continuation rate by follow-up of the acceptors. For this
|
|
2.10 Page 20 |
▲back to top |
puropse, periodIc Incentives in cash:may be- d-eposited into the'
beneficiary account ao as to watch the non-pregnancy status of
the beneficiary. The deferred incentives scheme launched by the
United Planters Association of South India (UPASI) is worth
emulating.
12. 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 a~stockists of contraceptives (Oral Pill and Condom).
They could not only make the family planning r,ervice accessible
but also acceptable to the people and what is more important,
the programme would be made more sensitive and responsive to
local values and individual needs. Likewise, the private medical
practitioners in all systems of medicine have to be used more for
spacing mothods as terminal methods require special training
and equipment.
J 3. In the socio-politic~l setting of Orissa, there is every
possibility that oven the modest resources meant for benefiting the
poor could be diverted by the local authorities or the power-
groups in the villages. CONSCIENTInZOAN of the village people
about the schemes intended to benefit them need to be under-
taken by the State Government in the absence of any widespread
voluntary network in rural areas. In particular, the Tribal Sub-
Plan needs to be monitored more closely as it represents a
sizeable part of the State Plan Outlay.
14. The higher acceptance of contraception among tribals of
Orissa is a situation which requires to be investigated both from
the demographic and sociological angles, to dispel doubts about
the voluntary nature of their acceptance and adopt a moderation
if any 'excesses' are detected.
15. Since fertility among tribals (as also among Scheduled Castes)
is found to be low, a detailed and authoritative investigation is to
be conducted to confirm their sub-fertility and also whether the
causes are economic, cultural or bio-social (their hard way of
life) or the prevalence of natural contraception.
J5A. There is a clear indication that promotion offamily planning
in Orissa in the years to come has to be vigorous among the non-
tribals, both from the sociological and demographic point of view.
16. One of the important measures to promote family planning is
the eontrol of infant mortality which is still high in Orissa.
|
|
3 Pages 21-30 |
▲back to top |
|
|
3.1 Page 21 |
▲back to top |
infant mortality could be seen both as a cause and an effect of
the high fertility. The short-term steps necessary in rural areas
are:
i) a rapid increase in the immunisation status and a vigo-
rous tetanus toxoid programme;
ii) safe and hygienic delivery by trained dais who should be
supplied kits;
iii) adoption of spacing devices to prevent a rapid sequence
of birth;
iv) increase awareness and ability of rural women to prepare
and use oral rehydration powder;
v) improve accessibility of medical facilities.
17. The low STATUSOFWOMENas judged by their illiteracy (79 per
cent) and unemployment (80 per cent) is probably the major
impediment in rapid promotion of family planning. With the
programme now becoming increasingly women-oriented (a wel-
-come feature in itself) there should be a conscious effort on the
part of the State Government to enable fuller participation of
women by improving their literacy and employment opportuni-
ties. In the present strategy of planning, the women would not
;be able to get oyer the handicaps. It is therefore necessary to
:set up a WOMENDEVELOPMENCTOUNCILin Orissa under the Chief
Minister. It would not be out of place to establish a MINISTRY
(OFWOMENDEVELOPMENtTo undertake inter alia the MOBlLISATION
(OF RURAL WOMEN, establish RURAL WOMENDORMITORIESand
WQlllKING W-OMIEN'HS OSTELS,and embark on a programme of
lncreasii~ fie work participation of women. It should be the
endeavour of this Ministry to set up 30 Rural Women's Associa-
tion (RWA) in each block.
18. There is need to increase the strength of women functiona-
ries in the family planning programme at all levels. Unless the
State Government embarks on an effective programme of educat-
ing rural women about the health hazards of high fertility and
improves the accessibility of health services in rural areas, the
decline in sex-ratio cannot be halted.
19. It would also be useful to organise OTC Camps exclusively
for women in rural areas with women speakers and organisers,
so that rural women can learn about the programme without
inhibitions and reservations.
20. Socio-economic development of Orissa is going to be a slow
process, because of:
|
|
3.2 Page 22 |
▲back to top |
i) the backlog of poverty (with 69 per cent below poverty
line);
ii) the limited resourct:s of the State;
iii) the large proportion of scheduled castes and scheduled.
tribes (40 per cent).
The remedy lies In population-oriented development and not in·
grandiose schemes and in multi-crore urban establishments.
Rural social services (health, education and vilIage industries)
and rural infrastructure (rural roads, rural electrification) should
be earmarked at least 25 per cent of the plan outlay.
21. Since it would take time for the population-oriented
development to make its impact on the fertility behaviour of the
people, there is a definite need to adopt the 'incentives approach'.
In Orissa, all the three types of incentives (as elaborated in the
Family Planning Foundation's Study on Incentives and J:.?isincen-
tives·) are applicable.
i) Individual one-time cash incentives (for acceptors of
terminal methods particularly from the lower income
brackets and also to non-official motivators).
ii) Deferred incentives payable after a prescribed period of
time (for acceptors of spacing methods who maintain a
non-pregnancy status for a prescribed period).
iii) Community incentives which are development-oriented,
asset forming or distributive (link road, well, pump set,
primary school, health sub-centre, community latrine
etc. for a community which achieves either a 5% increase
in couple protection in a year or a reduction in birth
rate by 2 points).
22. Since Orissa is a poor state and cannot afford to pay extra
incentives, special financial assistance for implementing the
scheme of incentives should be provided.
23. The incentive scheme indicated above provides a basis for the
much-needed inter-ministerial coordination. Indeed inter-depart-
mental cooperation in family planning prumotion 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
* Copies of this were distributed among the senior officials concerned with
family planning in Orissa.
|
|
3.3 Page 23 |
▲back to top |
Integrated Rural Development Programme (IRDP) under which
certain loans and subsidies are given. It could be ensured by
the rural development agencies that such loans are given on
priority basis to families who adopt contraception. In other
words, people should be made conscious of the family planning
programme by using IRDP loan as a form of incentive. Similarly
the Social Welfare Department which handles Harijan welfare
has many contact points to, motivate the poor harijan families to
adopt family planning. The different development departments
should use their field inputs to secure a grass-roots level linking
between family planning and development.
24. In Orissa, the high maternal fertility is partly attributable to
a value system that regards children as income earners. This
strongly suggests that schemes which could augment family
income should be a part of the fertility moderation strategy.
Studies have shown that general marital fertility declines by more
than half when the per capita expenditure doubles in the rural
areas.
25. The Village Health Committees could definitely improve the
overall response to the programme provided its Chairman and
Members take initiative. In Gujarat, the Rural Health and
Family Welfare Training Centre convenes a meeting of the full
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 the
. three-month period. Such voluntary commitment definitely
increases their sense of participation. It would be useful if the
MEM Division could contact the Principal, Rural Health and
Family Welfare Training Centre, Ahmedabad to know more
about this innovative OTC and GUJARATEXPERIEl'IC6.
26. Attempts to improve the family planning performance in Orissa
should essentially be based on OPTIMUMUTILISATIONOF EXISTING
INFRASTRUCTURE.THE ATHOOREXPERIENCEof the Gandigram
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;
ii) developing the programme in a phased manner by a team
of workers adopting certain methodologies and pattern
|
|
3.4 Page 24 |
▲back to top |
of work to carry out intensive motivationai work in <i
small area and then to take up other areas by stages;
iii) periodical job-oriented training for the staff;
iv) involving and utilising community leaders, voluntary
workers like Dais, teachers, indigenous medical practi-
tioners etc. and voluntary agencies like Madarnsangams,
youth clubs, Village Health Committees, etc. for obtain-
ing social support for the programmes;
v) establishing a net-work of multiple channels of commu-
nication like mass group and individual approach for
educating the community on various aspects of health
and family planning programmes;
vi) improving managerial and supervisory skills;
vii) extending adequate services and frequent follow-up
visits throughout the area.
27. Family planning programme needs a SOCIAL CHANGE
which 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 conti-
nuation. There is scope for appointment of a cadre of social
workers through the voluntary organisations.
28. 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.
29. Family planning cannot continue to be a successful pro-
gramme 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 \\\\'ay of life of individual couples and not entirely a
response to external motivation. To ensure an expanding demand
for family planning services, relevant social and economic pro-
grammes 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.
|
|
3.5 Page 25 |
▲back to top |
3b.s·irice lhe family planning programme is hundred per cent
centrally funded and the targets are also set by the centre for
each method, the programme is more regarded as a central pro-
gramme which the states merely carry out. In order to enhance
the sense of involvement of the state, it is desirable that the
Centre indicates to the states what the level of couple protection
is to be for different years consistent with the national demogra-
phic goal and suggest to the states to take over 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 district-wise 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
SEGMENTED and tailored to specific audiences. In the rural
areas, we could divide according to the identifiable homogeneous
groups such as occupational life styles (such as agricultural labour
and marginal farmers, fishermen; minority community, harijan,
industrial labour, urban slum dweller etc.). Community organi-
sations that cater to the needs of these sub-groups, could be
identified and utilised as channels for family planning promotion.
In the segmented approach to family planning, the urban slums
need a different strategy as they are far froma 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. A medical back-up to the programme is probably the best
method of imparting credibility to the programme and the medical
profession has therefore both a promotive and creative role in
the programme. Unless the basis for a radical change in their
attitude and their response is laid during their academic career,
the commitment to family planning cannot be internalised and
the doctors would still regard family planning as an activity
extraneous to their academic up-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 stiIl not addressed ourselves adequately to the long-term
man-power problems in family planning and it is only through
the strengthening of their academic training that the doctors
could be expected to render professionalised family planning
services in the way they are now rendering curative services.
(Books such as 'Practice of Fertility Control-A Comprehensive
|
|
3.6 Page 26 |
▲back to top |
Text Book by S. K. Chaudhuri and others, Current Book Publi-
shers would be useful in modifying the curriculum).
33. The Medical Officer of the PHC has severa] responsibilities
now under the integrated programme of health and family we]-
fare. Severa] types of records at the PHC ]evel are to be main-
tained for folIow up of cases and for monitoring the progress.
The MOPHC needs to have adequate management skill to handle
the multifarious functions of the PHCs and also impart a systems
approach to identifying and solving problems through a Manage-
ment Information System. AII 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.
34. People's participation as a multi-]evel phenomenon has been
secured in states like Tami] Nadu and Gujarat through voluntary
organisations, panchayat unions, the cooperatives and informal
local organisation. But in Orissa such agencies, wherever they
exist have not been comprehensively involved in the programme.
In particular, voluntary organisations capable of mobilising
women are virtually non-existent. It appears that in Orissa,
people's participation in family planning in terms of interna]ising
both the demand for and supply of family planning services is a
distant goal. For the time being, the officially sponsored instru-
ments to secure people's participation in the form of the OTC
and peripheral functionaries like VHG, ANM, Dai, etc. have to be
used optimally. At the same time, it is necessary to change the
perception that family planning is just a Government activity.
The communication strategy must aim to bring them round to
the view that family planning benefits the individual, the com-
munity and the nation in a sequence.
35. Family planning cannot be sustained through camp approach.
It requires an extension approach and the Block Extension Edu-
cator (BEE) has a responsibility in this direction. But the BEE
in the present structure of PHC functioning does not seem to
have household visits for motivation. The BEE organises orien-
tatior.. Training Camps (oTC) for Opinion Leaders, contacts
Gram Pradhans etc. The role of the BEE is more group-oriented
and not oriented towards individual households. Even in the
case of OTC Camps, the BEE rarely follows-up such camps to
secure the 'ripple effect' of the training and motivation to which
the Opinion Leaders are exposed. This is a task which the BEE
could definitely handle so that more people accept the pro-
gramme.
|
|
3.7 Page 27 |
▲back to top |
36. On e of the main instruments for securing community parti-
cipation is the Community Health Guide, now designated as
Village Health Guide (VHG). Some supervision over and guid-
ance 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.
37. Successful family planning in Orissa 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 pre-
ferably females who have themselves accepted family
planning.
c) Utilise voluntary institutions, cooperatives and all the
informal local level organisations in recruiting clients
and supplying contraceptives adopting either the com-
munity-based distribution system or social marketing
techniques.
d) Constantly monitor the demand and supply situation in
order to ensure a demand-supply equilibrium at micro
level to avoid frustration among genuine users, on the
one hand and· avoid accumulation of unutilised stocks
on the other.
e) The State Government may review why there are so
many vacancies in the sanctioned strength in various
categories for family planning work and improve the
recruitment so that the programme could handle the
more difficult stage it is about to enter (viz. motivation
and servicing of younger couples).
38. The STUDIESAND SURVEYtShat are considered necessary for
the family planning programme in Orissa more relevant and
responsive to the realities in the field are listed below:
i) The low pace of urbanisation in Orissa.
ii) The causes of immigration into Orissa and its influence
on urban growth rate.
iii) The causes of high infant mortality in Oris'sa, particu-
larly the influence of birth order. Which of the hypo-
theses: child replacement or child survival, is stronger?
|
|
3.8 Page 28 |
▲back to top |
iv) The low fertility among tribals. In particuiar, is there
any evidence of prevalence of STD which could lead to
low fertility?
v) The low population growth in Mayurbhanj district.
vi) The prevalence of natural contraception among' the
tribals.
vii) How was it possible for Orissa, a backward state, to
achieve a sub!>tantial decline in the younger age (15-19)
marriages.
viii) An independent evaluation of the impact of the Tribal
Sub-Plan based on beneficiary interviews.
ix) Why is the oral pill having low acceptance in Orissa?
x) Why are there such wide gaps between sanctioned
strength of staff and those in position in different
categories.
xi) To what extent have people benefited from IRDP/
ERRP-to be based on beneficiary interviews?