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Diagnostic Study Gujarat |
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Diagnostic Study
of
Population Growth,
Family Planning
and
Development, 1971-81
. Gujarat
THE FAMILY PLANNING FOUNDATION
198, GOLF LINKS, NEW DELHI-llOOO3
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DIAGNOSTIC STUDY OF
POPULATION GROWTH, FAMILY PLANNING
AND DEVELOPMENT IN GUJARAT, 1971-8J
THE FAMILY PLANNING FOtJNDATlO~
198. GOLF LINKS, NEW PELRI-llOOO3
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The Family Planning Foundation as a funding and promoting
organisation has sel~ctively addressed itself to diagnostic research
on major population issues. As soon as the 1981 census results
were published, the Governing Board of the Foundation expressed
the need to :find out why the population growth rates varied
considerably among the states and bring out the programme and
policy implications. In operationalising this suggestion, it was
felt that in view of the significance of the study and the need
to have a high level liaison with the states, the Foundation should
directly undertake the study. For this purpose the Foundation
invited Mr V K Ramabhadran to undertake the study.
The study covers 5 states with different demographic and
economic settings-Gujarat, Orissa, Rajasthan, Tamil Nadu and
Uttar Pradesh. This Brochure ~~he
main findings and
recommendations in respect of ~-_ ••••-.•• This would, we hope,
stimulate an informed discussion on the Status of Population in
Gujarat and pave the way for a more vigorous and effective action
programme in family welfare.
The Foundation would like to place on record its deep
appreciation for the willing cooperation of the state governments,
particularly of the Departments of Health and Family Planning.
New Delhi
February 1, 1985
J C KAVOORI
Executive Director
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I. 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 the 14 major States of India (with a
population of 10 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 27.67 per cent for Gujarat.
3. This project entitled "Diagnostic Study of Population Growth
Family Planning and Development in 1971-81 in Gujarat" is
a part of the five-state study project (which includes Gujarat,
Orissa, Rajasthan, Tamil Nadu and Uttar Pradesh). The
project bas 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 stUdyis 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 the potential
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The rieni~graphic Scene
- The population growth rate (27.67 per cent) in Gujarat in
1971-81 has been higher than the national average (25.0 per
cent) as in the previous decades.
But the growth rate is lower tban tbe hi~h~st· growtb rate
(29.39 per cent) recorded in 1961-71. The criti~al quest~o~
is whether the downt!Jrn in popUlation growth h~s .beg!Jn i~
1971-81.
~ The hi~h popl,llation~rowth rate in Gujarat is due to two
plausible re.asons:
i) high fertility witb l>\\.geclining JI,lortality;
Ii) immigration.
.
-- The characteristics of high fertility in Gujarat are:
i) higher live birth rate (41.2 in 1970 compared with 36.8
at national level),
ii) higher age specific marital fertility rate, particularly
among women 25+,
iii) high parity births (40 per cent of rural births of parity4 + ).
In the rural areas, birth rate declined in 1971-81 by 14 per
cent while death rate declined by 37 per cent. In the urban
areas, the decline was 16 per cent and 30 per cent respectively.
- According to the 1981 Census, Gujarat has recorded the
second highest immigration rate for males (next to Maha-
rashtra). This is attributed to the rapid industrialisation of
Gujarat.
- According to a 1976 Census of Ahmedabad, 40 per cent of
the slum population comprised occupational migrants from
neighbouring states.
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births. There is a decline in the proportion of birtlls o.qly iQ
the fifth and sixth birth orders.
- Marital fertility is higher in urban areas also which indicates
that there could be an occupational culture in the business
community to have a lineage system requiring sons to carry
on the activities of the asset-owing classes (business com-
munity).
One dubious distinction which an affluent state like Gujarat
shares with the poorer states of India is the high level of
infant mortality.
The infant mortality rate (IMR) in Gujarat during tile pecade
1971-81 ranged from 109 to 161 and was substantially higher
than in Punjab and about three time~ the IMR of Keral~.
- One of the reasons for high IMR is the high risk faced by the
high parity children (4+), which constitute nearly 39 per cent
of births in Gujarat.
- In Gujarat (as in many Northern states), the female IMR is
higher unlike in Southern States.
- Also the neo-natal mortality is higher than the post-natal
mortality in contrast with the Southern States.
- A high neo-natal mortality despite a large number of births
attended by ANM or trained TBA shows qualitative defici-
encies either in the training or in ~he application of their
training.
- The mortality push effect of fertility is also evident as live
births with a retrospective interval less than 18 m~>nthsare
the most vulnerable with an IMR ex;ceeding200.
- A significant reduction in IMR is obtained when the spacing
is above 30 months, which underlines tbecrucial role the;
spacing methods of contraception can play in nwder~tini
IMR.
The Social Setting
_ In Gujarat, the nuptiality pattern has changed significantly,
The percentage of young marriages (15-19) has dropped fr()Jll
39.5 to 26.9 in 1971-81.
- The average age at marriage of f~mal~ has incr~a§~g from
18,(j to 19,6 years,
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lill
Muslims constituted 8.4 per cent ofthe population in 1971.
The scheduled castes (7.2 per cent) and scheduled tribes
(14.2 per cent) constitute 21.4 of the Hindu population in
1981.
The fertility among rural Muslims is not much different from
that of Hindus (unlike in Uttar Pradesh).
the fertility among scheduled castes and scheduled tribes of
Gujarat is not much different from the non-scheduled castes
and tribes (unlike in Orissa where the forn;ter ~d lower
fertility).
- To sum up, the social setting against whieh the State (Sovern.-
ment has to embark on tbe arduous task of ;moder;ating
fertility has necessarily to contain the following elelJ,le~s of ~
segmented approach:
.
i) improving the stat\\lS of women both tbrO;llgh l~eraC¥
and expanded opporhmities for en;tpfoy~ent (the elected
Panchayats of Gujarat have a special role in this effort).
Ii) organisation of women in rural areas by establishing
Rural Women's Association (RWA) at the rate of 30
RWA per development block (the experience of Gandhi-
gram Institute of Rural Health and Family Welfare,
Madilrai Tamil Nadu may be useful).
iii) special efforts to moderate the fertility of urban Muslims
by involving religious leaders and an effective pro-
gramme of incentives and disincentives.
iv) special efforts to moderate the fertility of younger
couples among scheduled tribes in urban areas probably
based on intensive health and family welfare inputs and
incentives.
v) innovative efforts by social workers to moderate the
son-preference attitude among the asset owning classes.
The Developlllent Scenario
The per captia income of Gujarat during the decade 1971-81
was the second highest among the states next to Punj ab. The
decadal average real income was Rs. 809 compared with
Rs. 1,229 in Punjab.
The real income at 1970-71 prices fluctuated b~tween Rs. 650
in 1972-73 to Rs. 914 in 1978-79 depen4ipg upon the
monsoon. There has been no steady growth io:income.
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38.0 - Trained medic~i attention of i~fant at death w~~
iJ
GUjarat compared with 4i.7 at the national level.
- However, Gujarat has the distinction of having the highest
immunisation status of 89 per cent among children below 1 year
in the rural areas.
- In Gujarat nearly one-third of the villages had medical facili-
ties (sub-centre, PHC; hospital etc.) beyond a distance of
5 Km .
..:.:.T...he high fertiiity-high mortality combination is a challenge to
the 'integrated approach' though Gujarat is committed to the
Seven Point Programme (GOBI-F3) for improving child care
and reducing infant mortality.
- Unlike in some other states, the MPW scheme which is one of
the planks for integration, is working reasonably well in
Gujarat.
- The medical profession in Gujarat is taking to family planning
naturally. Though the doctor render services, they are probably
less enthusiastic about motivating the eligible couples.
- Because of the functional expansion of services in PHC, the
MOPHC needs to have techno-managerial competence.
- The MCR and EPI programme provide several 'contact points·
with eligible women for promoting family planning. But these
have not been fully utilised.
- The State Government has judiciously applied the scheme of
incentives.
- Most of the incentives are built around sterilisation.
Besides direct cash incentives, the State Government has
introduced purpose-oriented cash incentives such as for
construction of hut, purchase of cloth, labour welfare etc.
_ The incentives appear to have attracted the poor tribal popula-
tion.
- Gujarat has to achieve its demographic goal of NRR=1 by
1991 which means that there are only 8 years to bring down
the birth rate from 35 to 21 and the IMR from 120 to 60. This
GOBI-F8 : G = growth monitoring B = Breast feeding
o = oral rehydration
I = Immunisation.
F8= food supplement,familyspacingand femaleeducation.
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lnopedinoeDt/~eakDesses
1. Rural poverty (arising from a decline in agriculture).
2. Poor infrastructure and difficult terrain (sandy, hilly).
3. Low level of medical service outreach in rural areas.
4. Urban slum syndrome.
5. Historical high fertility and high parity births.
6. High infant mortality in rural and urban areas.
7. Lack. of techno-managerial competence on the part of the
MOPHC.
8. Excessive reliance on sterilisation, particularly tubectomy and-
the relative neglect of spacing methods.
.
9 Main reliance on camp approach and low extension
activities.
10. Pursuit of quantitative targets with poor quality awareness.
11. Prospects of the programme entering the 'hard rock layer'
after 35% couple protection achieved.
12. Inadequate utilisation of the strong operative infrastruc-
ture.
13. Feeble voluntary support.
14. Lack of women's organisation in rural areas.
15. The lineage system of the asset-owning class.
1. To convince the people that family planning is not just a
Departmental activity or just a Government concern, it would
be useful to establish a STATEFAMILYPLANNINGBOARDunder
the Health Minister (as in Tamil Nadu) with the membership of
both officials and non-officials to secure participation at the grass-
roots level. The suggested composition is:
Officials
Commissioner & Secretary, Health & Family welfare
Director of Family Welfare
Director of Rural Development
Director of Social Welfare
Director of Information & Broadcasting
Director of Labour
Director of Municipal Administration
Director of Panchayats
Chairman, State Social Welfare Board
Director, Population Research Centre, Baroda.
Non-officials
5 MLAs from different political parties
5 MLCs from different political parties
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of has already achieved a couply protection fate about 56 per cent
should have only a. 'low priority sterilisation'.
7. The 'contraception mix' which would be relevant for the
different regions of Gujarat consistent with the contraceptiorl
rate already achieved and the level of IMR appears to be :
South Gujarat : Low priority sterili sation (one sterilisation and 4
spacing method users)
North Gujarat : Medium priority sterilisation (one sterilisation
and 2 spacing method users)
Saurashtra
: High parity sterilisation (one sterilisation and
one spacing method user)
8. Successful family planning in Gujarat 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.
c) Utilise voluntary institutions, co-operatives and all the
informal local level organisations in recruiting clients
and supplying contraceptives adopting either the com-
munity based distribution system or social 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.
9. Infant mortality in Gujarat is rather on the high side. Since
spacing methods have both health and survival benefits, there
is a further justification for promoting spacing methods on a large
scale in any package of measures designed to control infant
mortality in Gujarat.
10. 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 continua-
tion: There is scope for appointment of a cadre of social workers
through the voluntary organisations.
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the community in providing sterilisation service through the medi.
cal profession. But family planning has now to move"to spacing
methods, wherein the non-physicians (particularly indigenous
medical practioners) have a role to play. The traditional)
medical practitioners could not only make the family planning
services 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.
15. Though there is need to demedicalise family planning
services, it does not imply that the programme could do without
the medical profession. Indeed, a medical back-up to the
programme is probahly the best method of imparting credibility
to the programme and the medical profession has therefore both a
promotive and creative role in the program Tie. There is, there-
fore, a need actually for a deeper professional involvement of the
doctors in the programme: A part of the observed superficial
involvement of the medical profession at present, is probably due
to the medical profession not being exposed to the full dimension
of the population problem, the social aspects of family planning
and the contraceptive technique available for this purpose.
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 upbringing. There is, therefore ..a strong case for
imparting more knowledge and expertise on family planning to
the upcoming generation of doctors during their acadmic cal eer
by suitably modifying the medical curriculum. We have still not
addressed ourselves adequately to the long-term man-power
problems in family planning and it is only though the strengthen-
ing of their academic training that the doctors could be expected
to render professionalised family planning services inthe way
they are now rendering curative services. (Books such as 'Practice
of Fertility Control-A Comprehensive Text Book by S.K.
Chaudhari and others, Current Book Publishers could be useful
in modifying the curriculum).
16. The Medical Officer of the PRC has several responsibilties
now under the integrated programme of health and family wel-
fare. Several types of records at the PRC level are to be main-
tained for follow-up of cases and for monitoring the progresses.
The MOPRC needs to have adequate management skill to handle
the multifarious functions of the PRCs and also impart a
systems approach to identifying and solving problems through a
Management Information System. AU these point to the need for
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for purposes of economic programmes and family pianning.
Rural Women's Association (RWA) camprising 30 or 40 women
have been found to be suitable units in the studies made by the
Gandhigram Institute of Rural Health and Faniily Welfare,
Madurai for 10c~iIlevel organisation of women cl:1lledMathar-
s~ngam (Mother's Club). It would be a worthwhile ,ended-vourif
the Ministary of Social Welfare and the Women's Economic
Development Corpodtion could establish with the help of
women's organisations and voluntary bodies, around 30 RWAs
in each block.
22. In its future operation, the family planning programme
tequires a stronger sociological base. It needs a SOCIALCHANGE
which cannot be brought about by serVice-oriented fUllction-
aries. A good deal of social counselling would be required in
promoting spacing methods not only for initial acceptance but
for continuation without which the spacing methods are not only
wasteful but sometimes harmful (such as the 'bouncing effect'
in oral pill discontinuance). There is scope for appointment
of social workers (preferably females) through voluntary
organisations.
23. Once the couples with two children in the age group less
than 25 years are identified on the basis of the Eligible Couple
Register and they have not been using any contraceptive, such
couples should be regarded as the 'Core target' group for
motivation by the social workers.
24. Oral pill and Nirodh need to be promoted through a
community-based distribution system and/or a suitable social
marketing approach (utilising the social workers and the
community workers). This would not only ensure better accessi-
bility and supply of contraceptives but would also enable local
level monitoring to maintain a high continuation rate which is so
necessary for the effectiveness of such contraceptives.
25. Gujarat requires a more vigorous IUD pragramme based
on Copper T for which advance planning is necessary to estimate
demand and ensure adequate and timely supply. It may be noted
that Muslims prefer the IUD.
26. The State Government has sanctioned additional cash
incentives to acceptors and service providers and to the organised
industry. But all these incentives are related to sterilisation.
In order to promote spacing methods on a large scale, which is
the dire need of the programme in Gujarat, it would be necessary
to introduce several types of incentives in the spacing programme.
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32. Mere pursuit of quantitative targets without simultaneously
ensuring the quality is a waste of reSOl,lrces.Majority of the
tubectomy acceptors are high parity and older women 35+ whose
recruitment is less consequential demographically. In this
context, since vasectomy has been popular among younger
couples, attempts to promote vasectomy would be rewarding.
Also spacing methods among the younger couple (wife below
25 years) would not only moderate their fertility at younger
ages and confer health benefits but also prepare them eventually
to adopt terminal method as a contraceptive continuum.
33. Further fertility trend in Gujarat may be influenced more
by the age at marriage and the standard of living which are the
two factors that have reduced marital fertility in Gujarat. The
development policy of Gujarat in the context of the need to
reduce fertility in the short-run has to concentrate on improving
the standard of living and raising the age at marriage above
20 years.
34. The higher acceptance of contraception in the tribal
districts 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 the lure of incentives
for the poor and adopt a moderation if any 'excesses' are
detected. Simultaneously, their is need to promote the family
planning programme more vigorously among the non-scheduled
caste and scheduled tribe population.
35. The studies and surveys that are considered necessary for
making the family planning programme in Gujarat more
relevant and responsive to population issues are listed below:
i) The reasons for the lower growth rate (compared with
all-India average) of small and medium towns.
ii) In several districts which had recorded a sizeable decline
in population growth, the contraceptive protection is
lower than the State average. It would be useful to
study the non-programme factors responsible for this
trend.
iii) The extent to which a lineage system prevails among
the business co.mmu~ity (and other asset owning classes)
needs to be lDvest1gated so that a suitable strategy
could be evolved to moderate the fertility in this group.
iv) Gujarat is one of the states with a "reasonably higher
consumption" of sugar, edible oils and milk. A well
designed enquiry is needed to study whether the