Demography India Vol. 24, No. 1 (1995)

From the Chief Editor’s Desk

THE population programmes in the developing world seem to be at the cross roads and are going through a phase of metamorphoses following the International Conference on Population and Development held at Cairo in September 1994. The family planning programmes launched by the governments in the developing countries, during the past four decades, with India leading the group with its programme-launched as early as 1952, were mostly undertaken to curtail the population growth rates in these countries, which were accelerating sharply because of rapid declines in mortality, and such high population growth was seen as great hurdle to rapid development in these countries. The programmes were largely viewed as measures to curtail the population fertility levels with maternal and child health programmes as appropriate and convenient carrier programmes for family planning message and services. In the sixties and seventies there were a plethora of studies, by demographers and sociologists, for assessing the impact of family planning programmes on fertility, the number of births averted by the programmes, the methods of setting family planning targets in order to reach predetermined goals etc., etc. The demographer-bureaucrat alliance was coming to be viewed as a divine agency who can manipulate fertility at the macro level-one setting the family planning targets and the other achieving it.

Even before the Cairo conference there were rumblings that this approach was not a very effective one and probably unethical, to say the least. But the discussions and recommendations at the ICPD in Cairo and the subsequent two international conferences, the Social Summit held at Copenhagen in March 1995 and the International Conference on Women in Beijing in September 1995 seem to have nailed the coffin on the traditional family planning programmes as sensible endeavours by the governments to reduce the fertility levels of their population. They all have emphasized on the need for empowerment of women, women'& rights especially their reproductive rights and the need to have family planning programmes as an integral component of the efforts of governments and NGOs in these directions and not repeat not as policy measures to reduce fertility rates of the population. For example the Programme of Action adopted at the Cairo conference defines the objectives of family planning programmes as:

(a) To help couples and individuals meet their reproductive goals in a framework that promotes optimum health, responsibility and family well-being, and respects the dignity of all persons and their right to choose the number, spacing and timing of the birth of their children;
(b) To prevent unwanted pregnancies and reduce the incidence of high-risk pregnancies and morbidity and mortality;
(c) To make quality family-planning services affordable, acceptable and accessible to ail who need and want then]., while maintaining confidentiality;
(d) To improve the quality of family-planning advice, information, education, commu- nication, counselling and services;
(e) To increase the participation and sharing of responsibility of men in the actual practice of family planning;
(f) To promote breast-feeding to enhance birth spacing.

The above objectives do not state anything explicitly about aggregate fertility levels of the population.
All the three international conferences seem to have converged on the themes of sustainable development; education as a basic right for all people, especially for women: gender equity and equality and on programmes that emphasize on women's rights that include reproductive health and reproductive rights including the right to space and limit their family size. Macro level fertility levels and trends will be the logical outcome of the efforts that governments and NGOs will be taking in these directions and are not to be prefixed by the governments. As a natural corollary there should not be any family planning acceptor targets set by the programme and not at all with a view to achieve any predetermined fertility goals. That will be considered here after a heresay, anti women and anti human rights.

But there is a catch in such an argument. A government that has to find the resources for its educational, reproductive health and sustainable developmental programmes, in a poor developing country as India, has to mobiIize the needed resources from those who have them, through taxes or otherwise and they will definitely have a say on whether the poor's fertility should be allowed to be an outcome of the reproductive rights and choices of women (couples), or they have to share the cost for the exercise of such rights. Exercise of rights involve sharing of responsibilities as well. In the search for a solution to this problem, we land up with the age old problem of costs and benefits of children and the allocation of these to the individual, family and the society. No clear cut solutions have been reached thus far nor are they likely to be reached in the near future since the value orientations of the society creeps into the problem. The solution is beyond the realm of scientists, demographers or any special groups. It has to be realized in each country within its social and cultural milieu. No universal solutions should be sought after.

India, which is a signatory to the Programme of Action, at the International Conference on Population and Development at Cairo, is also beginning to redefine the objectives of the national programme of family planning and integrate it with the national programmes of maternal, child health and reproductive health. There is also an attempt at improving the quality of services, which is long overdue. Further the epidemic of AIDs looming large in the Indian horizon has given a sense of urgency to the need for improving personal and sexual hygiene and the need for the revival of the values on sexual fidelity between spouses, strengthening the age old value on abstinence or brahmacharya, before marriage and the need for the use of condoms in all vulnerable groups and vulnerable sections of the society. The government of India have lifted their targets on family planning acceptors, wholly in the states of Tamil Nadu and Kerala and in one district from each of the other states. Family planning targets seem to on their way out in this country. The main issues that are likely to arise in this context are:



(1) Should there be any concern at all on the burgeoning population of this country which seems to have crossed the 925 million mark and adding 18 million a year? if so who should do what? What should be the role of the government in this field? The environmentalists, particularly hydrologists, have warned that we have not got adequate potable water, over the surface or sub soil, in different parts of the country to meet the needs of the existing population and in some areas as in Madras city and in a few other districts of Tamil Nadu the sub soil water levels are dwindling fast and there may be accute water scarcity in .the near future. Similar resource crunches are likely to occur in the coming years and in this context should the government be unconcerned about the population growth and distribution issues at the macro or areal levels and be concerned only with honouring the reproductive rights of couples? When there is no water exercise of one's reproductive rights become a luxury.
(2) What are the mechanisms for ensuring a minimum quality of service to the clients visiting the government run sub-centers, PHCs and CHCs? should there be a 'Quality Commission' at the center and the states and make periodical certifications as for ISO 9000 for industrial products? How do we ensure that the needles and instruments used in these places are properly sterilized and the clients are given adequate time and care r by the medics and para-medics?
(3) Are there easy means of assessing the reproductive choices of couples? Should the workers go by the opinions of the woman only or in male dominated society, should she go by the opinions of the husband or both? What does such a combined decision making involve in terms of additional cost and additional unwanted births?

These questions do not admit of any easy and readily available answers. But we know that we are in the cross roads of family planning programmes and that there is an inherent philosophical and scientific conflict coming up between the need to honour the reproductive rights of couples and the need to limit or adjust the population size in different areas of the country taking account of the serious limitations of basic resources of the areas. The resource crunches, grimly facing the country, especially of potable water and forestry in some states, are of immediate concerns. Our future generations should not be accusing us, (among many others that they are bound to make on our generation!) that we have injudiciously exercised all our rights and not our responsibilities.

K. Srinivasan
Chief Editor, Demography India