How fair is it that men are never targeted to accept blame for the unwanted pregnancies that occur year after year? Must women continue to suffer for policy failure?
Last month I was in Ghadchiroli district. It ranks last among Maharashtra’s 35 districts on a combination of social indices. Synonymous with remoteness, surrounded by forests and inhabited by tribal people, a health worker was to show me how neonatal care had improved survival rates of infants. I asked her how many people used contraceptives. She told me straightaway, no one did. Women went in for tubal ligation as soon as they had two children.
Visits to see newborn babies ensued. Entering a shack, I noticed an infant clinging onto his grandfather. Inside the house an emaciated woman, removed a dirty cloth from a tiny mound on the floor to reveal a shrivelled neonate underneath. As soon as she lifted the cloth, swarms of flies settled on the baby’s face. She had delivered the second baby within a year of the first. She herself was no more than 18 and a bag of bones, her eyes devoid of emotion, and her lips a straight line.
Ghadchiroli is ranked at the 345th position out of the 593 districts surveyed by the International Institute of Population Studies (IIPS). Not bad compared with hundreds of lower ranking districts in the country. At least they had access to sterilisation services.
The percentage of women having three or more children is a direct measure of fertility. The larger that percentage, the weaker the impact of the family planning programme. As can be expected, the worst hundred districts in the country according to the IIPS study done belong to Bihar, Jharkhand, Madhya Pradesh, Rajasthan, Uttar Pradesh and some North-Eastern States where between 50 per cent and 60 per cent of women beget three, four and even more children.
India was the first country to launch a Government family planning programme in 1952. Due to mismanagement, forced sterilisations and chasing fictitious targets, the programme received an unsavoury reputation it just cannot discard although decades have gone by.
Post-1994, Cairo and ICPD, Governments the world over supported by international organisations and NGOs ushered in a new reproductive child health approach. Today, people who talk of population control and explosion are considered barbaric. In the name of giving “reproductive choices” to women and offering “a cafeteria approach”, the old targets, incentives and disincentives have been struck off the strategy list. Rightly so, if one goes back to the horrors of family planning excesses, but wrongly so if there is no cafeteria, no coffee (read condoms), IUDs or oral pills to make that choice.
The emergency contraception pill, the most needed of all, is unheard of in most of the country. The social marketing approach can deliver up to a point – no more.
So steeped is our present culture in the soft new approach that we refuse to face the fact that of the 26 million babies born each year, some 40 per cent are underweight, underdeveloped, often stunted and incapable of later imbibing even elementary education, leave alone become productive citizens. Infant and under five mortality continues to be extremely high, mainly because family planning is denied the thrust it badly needs.
While tender talk about quality issues and women’s rights is well intentioned, how can we enable severely anaemic women not to have to produce unwanted babies and face repeated pregnancies? How can one prevent men from forcing pregnancies? How can one stop adding generations of unhealthy children if there is no insistence on increasing the age of marriage, spacing and male sterilisation?
How fair is it that 98 per cent of all sterilisations performed in the country are on women? How fair is it that men are never targeted to accept blame for the unwanted pregnancies that occur year after year?
The unmet need for contraception continues to be displayed in colourful computer generated bar charts at all population conferences. But who is going to fill that unmet need and how? To provide access to contraceptives more than a modicum of sustained service delivery is essential. A large percentage of villages, particularly in the northern States, are more than 10 km away from a primary health centre (even if such outfits are functional). How do women living there protect themselves from unwanted pregnancies?
Some right thinking industries and tea estates have tried to help and ended up complaining how their efforts to sensitise men to stop child marriages, early marriages, several marriages and multiple partners and to explain how all such behaviour is self-damaging, falls on “deaf ears”. Government schemes, letters, meetings, monitoring supplies and disposal will continue, as it must. But at the end of the day if women are still forced to bear children they do not want, at the cost of their own physical health, what could be a greater denial of a human right?
It is time that spacing and male sterilisation were resolutely brought back on the front line. Lest the next generations require more hospitals than schools to attend to the abysmal levels of anaemia among women, and the resultant wasting and stunting of children, accompanied by high levels of under-five mortality. This beckons a deliberate restoration of family planning services to prevent unwanted pregnancies.