Plan the Indian family

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If Iran has been able to bring down its fertility rate from 5.6 births per woman in 1985 to 2 by 2000, India can definitely do the same, if not better. What is needed is political will, apart from better planning and coordination
In January this year, an All Party Parliamentary Group of the UK’s House of Commons published a report on Population, Development and Reproductive Health. The forecast: The Millennium Development Goals espoused by 189 Govern-ments in the year 2000 are practically unachievable, given the current levels of population growth.

The report assumes significance because the evidence of all population stalwarts the world over was recorded before releasing the findings. “Population issues have lost priority,” says the report and “funding has stagnated or decreased at a time when unmet need for family planning information and services is increasing.” Women in developing countries are dying for lack of access to family planning services and having to confront unwanted pregnancies and forced abortions even when options are available.

Ironically, if there is any concern about population it is related only to the extremely low fertility of European countries and Japan. The End of World Population Growth in the 21st Century, a book, which is considered a must for policy-makers, simply overlooked that in the country like India, 17 million more births than deaths take place every year. Western thinking about global warming has overtaken even the Indian psyche, despite the fact that India emits less than half the carbon dioxide of Brazil, only a third of China and a not even a fifth of the European Union, leave aside the United States.

The fact that population pressure is eating into agricultural land, forest, water, and biodiversity is never even mentioned. In countless meetings about ecology, climate change, deforestation, urban migration, demographers are notably absent or unheard.

It was in the late 1980s that the subject of population growth began to be swept away from policy agenda. The 1994 Cairo Conference on Population and Development successfully muffled it behind the nebulous nomenclature of reproductive and child health (RCH). Any mention of numbers and sankhya still draws the wrath of activists, who in their zeal to end coercion and sub-standard family planning services have unwittingly helped to overturn the family planning programme.

India’s discreditable memories of 8.3 million sterilisations, performed in a single year 1976-77 – four times higher as compared to the year before – have sealed the lips of politicians of all hues forever and drawn stony silence from the media.

The RCH alternative has not provided the synergy that was expected observes a paper by Srinivasan et al (IIPS Mumbai). They found no co-relation between per-capita expenditure incurred on RCH and the level or pace of change of indicators. The National Commission on Population charts display decline in sterilisations and IUD insertions – attributable largely to the low performance of Bihar, Rajasthan, Assam and Uttar Pradesh. The IIPS study ends on the unhappy note, “The RCH umbrella seems to be leaking.”

Against this backdrop the story of Iran bears telling. There the equivalent of the Planning Commission painted such a grim picture of the country’s economy and how the nation’s resources simply could not support the services stipulated under its Constitution, that all Government departments were directed to review the population growth rate impact.

The Iranian media disseminated how the country’s population growth was too high and if left unchecked, would have serious negative impact on the national economy and the welfare of the people. Iran’s Health Ministry and its Judicial Council then declared that there is no Islamic barrier to family planning.

Families were encouraged to delay the first pregnancy, and space out subsequent births, to discourage women to become pregnant younger than 18 and older than 35; to limit family size to three children (not even two). Resources were poured into family planning services and to help couples prevent unplanned pregnancies.

The village health workers (two instead of our one ASHA) put up charts of the age and sex profile of each village at a central place, which were updated each month. The data showed the number of children who had been born since the beginning of the year, the number of children vaccinated, the number who died and the cause of death. The data also showed the number of married women, their age and the contraceptive method used.

Contraceptive pills became the most popular method. Population education remains an integral part of the curriculum at all educational levels; university students must take two credit courses on population and family planning. Couples planning marriage have to participate in a family planning class before receiving a marriage license and these pre-nuptial classes are mandatory for both the bride and groom-(to-be). Women’s average age of marriage had crossed 22 years by 1996.

The result of all this has been astounding. From a total fertility rate of 5.6 births per woman in 1985, Iran brought total fertility down to 2.0 by 2000. Infant Mortality, Maternal Mortality, Under 5 Mortality, have all reduced; literacy has gone up, and now more women than men have entered Universities.

What we need is less looking the other way; less emotional outbursts in donor-driven seminars and much more by way of sustained family planning services. And an effective leadership in the northern States which are disproportionately delaying India’s population stabilisation.

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