STERILISATION IN INDIA.
Singh's administration claims its population control plan will empower women by offering them contraceptive choices and childcare facilities. Azmi disagrees. 'How can women help population control when they have no say in the number of children they have?'
India established the world's first national family planning programme over 50 years ago, and the country's overall total fertility rate has declined in the last twenty years. But Madhya Pradesh's growth rate is 40 per cent higher than the national average. The law follows a federal population policy introduced in February 2000. Its long-term objective is to stabilise the country's population by 2045 by reducing the total fertility rate -- the number of children a woman will bear during her reproductive years -- from 3.13 in 1999 to 2.1 by 2010.
While the national policy includes some progressive measures such as promoting primary education for girls, addressing the need for contraception and granting state incentives to reduce infant mortality, there are disincentives for those who do not toe the two-child line. Health insurance will only be provided to the poor if they undergo sterilisation after two children. Although targets for contraceptive use were officially dropped in 1996, quotas for government health workers were never eliminated. Instead, they have been renamed with euphemisms like 'Expected Levels of Achievement'.
Abuses of women's reproductive health and rights are rife. Oral contraceptive pills are distributed by health workers without mention of possible side effects. Until a recent Supreme Court decision banning its use, the drug quinacrine had been used to sterilise women despite a World Health Organization warning about side effects. All this has led activists to charge the Indian government with violating its promise to honour international pledges rejecting the use of family planning quotas and coercion to achieve lower fertility rates.
Madhya Pradesh -- part of the northern tier of poverty-stricken and populous states -- is not alone in punishing large families. A bill before the Delhi assembly proposes that families with more than two children be denied ration cards that allow cheap food, bank loans and enrolment in government housing schemes.
For human rights activitsts -- and ordinary citizens -- the new population control moves invoke the spectre of state-sponsored rights abuses in pursuit of contraceptive targets. Seared into public memory are the forcible mass sterilisation camps for women and men set up in the mid-1970s by then Prime Minister Indira Gandhi.
Protests over these camps are believed to have helped bring down Gandhi's government in 1977. But the fear was so great, recalls Dr Thelma Narayan, member of India's Population Commission, that villagers would run away from health workers long after the Gandhi government fell. The family planning programme virtually collapsed, before recovering several years later.
Mindful of the legacy, India's current prime minister, Atal Behari Vajpayee, among politicians who opposed the Gandhi government excesses, recently warned health officials in another northern state, Uttar Pradesh, that achieving family planning goals 'shouldn't be done the way it was in the late 1970s don't force people. Spread awareness, instead'. But Brinda Karat, a prominent left-wing activist belonging to the All India Democratic Women's Association (AIDWA), believes the government has not shed its fondness for bloated budgets -- swollen by foreign donors with their own population agendas -- in pursuit of slashing birth rates.
'National and international experience...clearly indicate that family size is dependent on non-demographic factors', a memorandum by AIDWA and other women's groups stated in response to the Delhi draft bill, pointing to the need to enhance women's status in order to ensure smaller families. In states such as Madhya Pradesh these factors include inequality in land, resources, income, education, poor health indicators and women's lack of decision-making power.
In contrast, the southern state of Kerala addressed these factors by investing heavily in women's development. One result was that it achieved the fastest and greatest drop in fertility rates in the country. The fertility slow down exceeded even that of China, with its draconian one child policy, over the same time period.
The Madhya Pradesh population plan -- to reduce its present fertility rate of 4 to 2.1 by 2011 -- is also unrealistic, said T. K. Sundari Ravindran, an expert on women, population and development. Early marriage followed by repeated childbearing is the norm in the state. Families want many children because of high rates of infant mortality at 99 per 1,000 births. Sons are seen as the only security for poor parents in old age, and women face intense family pressure to bear male children.
The state government says it intends to reduce maternal and infant mortality in order 'to facilitate the process' of fertility reduction. Yet its plans to improve contraceptive choice remain very narrow. Condom promotion and female barrier methods are not mentioned. Policy documents continue to discuss 'eligible couples' rather than services for all men and women, including the unmarried. Couples with two or more children will be 'motivated' to adopt permanent methods of contraception.
'We have to start somewhere', insists the Health Secretary, D. S. Mathur, pointing to a pilot project in one of MP's sixty-two districts, Raigarh, which enumerates each family's number of children, educational status and related details. 'We will use these to pinpoint contraception, schooling and whatever is needed', he says.
After decades of propaganda for smaller families, nearly everyone recites the mantra. When Panos Features visited the western districts of Dhar and Jhabua, where voluntary and government efforts at education and development are visible, women were cannily correct in the presence of officialdom, affirming they don't want more than two children.
But after the government officials departed, Leelavati, an experienced midwife of 22 years, said: 'Women won't go for an "operation" [sterilisation] till they have at least two boys. Most have four, five or six children', she explained.
Deep inside the lush teak forests of tribal-dominated Chhattisgarh (now a separate state), the two-child policy seemed a world away. 'This is wrong. Who is the government to tell us? What will happen if the children die?' asked the thirty-two-year-old Sarwan Kumar. Pachibabi, an elderly woman, dismissed the state's medical services which, along with village councils, are now expected to provide family planning choices and health care. 'They come once a year, ask questions and go away', she said.
Mindful of history and population control legislation, Sundari Ravindran and other activists fear what might happen if health workers do turn up. She warned: 'When officials declare that birth rates must fall, can coercion and abuse of women's reproductive rights be far behind?'
This article was provided by The Panos Institute which specialises in information and communication for sustainable development.
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|Date:||Jul 1, 2001|
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