A sustainable population stabilisation strategy needs to be embedded in a rights-based and gender-sensitive local community needs-led approach. An authoritarian top-down target approach is not the answer.
The evolution of government-led population stabilisation efforts in India goes back to the start of the five year development plans in 1951-52. A national programme was launched, which emphasised ‘family planning' to the extent necessary to reduce birth rates to stabilise the population at a level consistent with the requirements of the national economy. A clinic-based approach with equal emphasis on natural methods like rhythm as on some contraceptives was taken, but cautiously. Alongside, there were efforts towards awareness-building and research on new contraceptives and their acceptability.
A Family Planning Research and Programme Committee was constituted. At its first meeting in Bombay in July 1953, the committee took a comprehensive and broad view of family planning. To quote from its report: “The committee emphasised that the family planning programme should not be conceived of in the narrow sense of birth control or merely of spacing of the birth of children. The purpose of Family Planning was to promote, as far as possible, the growth of the family as a unit of society, in a manner designed to facilitate the fulfilment of those conditions which were necessary for the welfare of the unit from the social, economic and cultural points of view. The functions of a Family Planning Centre would include sex education, marriage counselling, marriage hygiene, the spacing of children, and advice on such other measures (including on infertility) as necessary to promote welfare of the families.”
Around the same period, in China the new Communist government under Mao Zedong looked at population basically as an asset, and took many benign measures aimed at social development. These brought in more equitable access to basic health, education, assets (including revolutionary re-distribution of land) and income over the next 20 years. The concept of family planning services that China followed was in tune with what the Family Planning Research and Programme Committee had conceptualised.
Instead of a top-down, prescriptive target approach, China went in for a localised community approach. The Cultural Revolution made the bureaucrats and service providers more responsive and accountable to local party hierarchies, communes and production brigades, and purged them of their elitist-intellectual hatred or indifference to peasants. They became more alert to the needs of the communities and were responsible to meet these needs in an equitable manner.
Such a style of governance brought in quick results in all indicators of social development including women's status; and the fertility rate came down sharply by the 1970s. The perception of the families and that of the state converged when it came to the acceptance of a small family norm. Only with western education, the threat perception of growing numbers took deep roots in the mindset of some Chinese scholars and leaders. They advocated restrictive population policies such as the ‘one-child policy.' But this appears to have created societal and family problems such as skewed sex ratio, female infanticide and foeticide, rather than helping in a smooth stabilisation of the population. There are thus lessons to be learnt from the Chinese experience in governance. In India we tend to misrepresent the Chinese story whenever we compare the Indian situation for advocating coercive policies like the “two-child norm” and the concomitant regime of incentives and disincentives to solve the population problem quickly.
It is a pity that we paid only lip-service to the rational and sane advice of the Family Planning Research and Programme Committee in 1953, and instead adopted disjointed, verticalised and top-down contraceptive programmes with targets of sterilisation. Although the programme was integrated with maternal and child health during the Fourth Plan (1969-74), and further with health and nutrition in the Fifth Plan (1974-79) with the creation of multi-purpose workers, introduction of mass motivational efforts and population education, the primary objective was to achieve targets of male and female sterilisation imposed from above. The compulsory and coercive nature of the programme during 1975 and 1976 made it highly unpopular.
The drive to reduce population growth by means of stand-alone family planning initiatives in India, with technical and financial back-up from U.S. and international bodies became a paramount concern. But its “impact on the experience of the poor and marginalised” has, more often than not, been negative, disastrous and inhuman.
The paradigm shift that occurred with the conduct of the International Conference on Population & Development (ICPD) 1994 gave a new, but more realistic, dimension to the resolution of the population problem in all circumstances. It has been realised that the “target” approach to reducing the population has been ineffective, and has to be rejected straightway. Governments in many countries are moving away from narrow demographic approaches to population issues, to focus on issues of “gender inequality” and lack of “reproductive rights and choices” as key factors contributing to the problems of population growth.
The Government of India's family planning programme was being criticised by non-governmental organisations, women's groups and rights-based scholars for its lack of concern for, and sensitivity to, human rights and dignity abuses associated with the target approach. In view of these concerns and sustained campaigns, and upon India signing the ICPD Programme of Action in 1994, the government abolished the system of targets. The “target-free” reproductive and child health care approach was accepted from 1997.
The Reproductive and Child Health (RCH) programme approach (further backed up by a solid national policy on population in 2000) opened a new vista with “a decentralised planning approach” and a more comprehensive and holistic vision of “women's health” throughout the life cycle. Goals are to be set primarily at the district and block levels, based on the village work plans of local communities prepared with a Community Needs Assessment (CNA) approach. Family planning/contraceptive targets for specified numbers of acceptors are to be replaced by targets that could serve as indicators of the “quality of health and family planning care needed and provided.”
There are some diehard ‘population control' exponents who have not reconciled themselves to the paradigm shift, and who feel more comfortable with an authoritarian policy regime of quantitative targets, in order to achieve quick-fix solution implementation. They often deride the “target-free” approach as one that leads to complete lack of accountability and lack of quick and visible results on the ground (as reflected in the administrative reports). Such a mindset is understandable inasmuch as most of the present generation of politicians, bureaucrats and scholars have been trained and oriented in Neo-Malthusian studies of population and have been players in or witness to the implementation of maternal and child health policies, which “throughout India have been dominated by Family Planning and driven by numerical targets for so long that it will take time for a fundamental reorientation to transpire…. It is yet to take deep roots in peoples' minds …”
The operationalisation of the National Population Policy and the RCH strategy has not been taken up with sincerity in many districts. Some State governments simply linked together pre-existing programmes concerning family planning, child survival and safe motherhood, reproductive tract infection, sexually transmitted diseases and abortion services. And, “Family Planning remained the dominant force in the equation.” The numerical family planning targets fixed from above have not been completely given up. They refer to the “expected level of achievement” – a euphemism for “top-down targets.” The ambivalent instructions and directions from some State governments complicate the situation further.
The increase in female literacy, women's increasing role in panchayati raj institutions, the formation of consortia and watchdog institutions of non-governmental organisations, community based organisations, self-help groups and gender and rights activists will ensure commitment to active participation in, and better implementation of, the target-free reproductive health and family planning strategy at the community level. Any deviation from, or distortion of, the basic norms of the new strategy should not be allowed. Human Rights Commissions and Women's Commissions at the national and State levels have to play a vital role here. More systematic and evidence-based advocacy efforts have to be mounted by advocates and researchers who have fully internalised the paradigm shift, and the elite target audiences at different levels have to be educated and influenced to stay the course. This is the key challenge.
(This is an abridged version of one of the ‘Advocacy Papers' of the Population Foundation of India, 2010. The author, a former Secretary, Ministry of Health and Family Welfare, Government of India, is Executive Director of the PFI. July 11 marked World Population Day.)