Neied for -Basic Chang:es in
Implementing F.W. Programmes
Dr. Moni Nag, an internationally renowned population
expert-he is a Senior Associate at the Population Council, New
York-gives some very practical and useful suggestions for
improving" the performance of the Family Welfare Programmes
in the Eighth Five-Year Plan. We reproduce below excerpts of
his recently published article.
The urgency of the need for
a faster decline of birth rate
through in\\;reased use of con-
traceptives and higher age at
marriage requires some imme-
diate changes in the family
planning programme strategies
and identification of appro-
priate, development priorities.
Reversible methods
The programme issue that
needs the utmost attention is
how to shift its present em-
phasis from sterilisation to
reversible methods such as IUD,
oral pill and condom.
The compensation payment
system for sterilisation also
wurks as an incentive for steri-,
lisation, both among users and
service providers. There is an
emerging view among family
planning experts including
some programme adminis-
trators that the present system
should be discontinued altoge-
ther in view of its negative
effect on wider acceptance of
reversible methods as well as
it,:;negative ethical implications.
If not cliRcontinued imme-
di.ately, ways should be devis-
ed to eli.minate it gradually,
even at the cost of some tem-
pOTary decline in sterilisation
ac,~eptanc~
Currently, family planning
workers' performance is evaluated
by the achievement of predeter-
mined targets. The shift of em-
phasis from sterilisation to revers-
ible methods should be accom-
panied by a ehange in the criterion
of evaluation. It may be based
on indices related to quality oj
care rendered by workers.
Sterilisation is the most
widely used method in all
Sc!}th Asian countries but in
other Asian countries where
co~traceptive prevalence is
higher, reversible methods are
more popular than sterilisation.
Fo:' example, IUD is the most
widely USed method in China,
and the pill in both Thailand
and Indonesia. Perhaps the
experience of these countries
can provide useful lessons for
South Asian countries.
Decline in birth rate usually
occurs through increased con-
traceptive use and delayed
marriage. Postponement of
age at marriage of women has
contributed significantly to the
fertility decline in Kerala, the
State with the lowest birth
rate at present. Family plan-
ning programme facilitates the
use of contraceptives by those
couples which are motivated
to do so, but it cannot do much
to motivate people towards a
small family norm. The pri-
mary function of the family
planning programme is to pro-
vide contraceptive information
and service. The motivation
for small family is generated
when people are reasonably
assured of their children's sur-
vival and when children's eco-
nomic cost/benefit ratio, as
perceived by parents, increases.
The latter usually happens
with socio-economic develop-
ment which also raises the age
at marriage of women.
A small family norm cannot
become commonplace in India
as long as the infant and child
mortality rate is as high as at
present. Although Kerala's
infant mortality rate (nurnbe,"
uf babies dying within a year
out of 1000 born) in 1987 was
28, the corresponding figure
for the four large North Indian
States of Bihar, Madhya Pra-
desh, Rajasthan and Uttar Pra-
desh, ,was as high as 124. The
infrastructure needed for infant and
child survival has to be expanded
significantly.
Female" Literacy
Out of all the socio-economic
variables affecting fertility
negatively, female literacy and
education seems to be the most
effective. It is known to re-
duce fertility by increasing the
motivation for small family,
by decreasing infant and child
mortality, enabling women to
utilise the family planning
information and services more
effectively, and by delaying the
age at marriage of women. OJ
course, improvement in child survi-
val and female education should
have priority for their own sake,
but their demonstrated negative
effect' on fertility should enhance
their priority in the Eighth Plan.
" The Ministry of Health and,
Family Welfare which imple-
ments the family planning pro-
gramme does not have any
jurisdiction over development
programmes related to female
education, female employment,
child labour and old age secu-
rity which are known to affect
fertility. Hence a powerful
body needs to be created which
can coordinate and influence
the policies and programmes
of all development sectors in
favour of the desired demo-
graphic balance. Political
parties can play a significant
role in demanding such a body
and making it effective. Also,
adequate provisions should be
made in Eighth Plan for using the
vast resources of voluntary orga-
nisations more effectively than has
been done so far in famiJy plan-
ning and other development pro-
grammes.