Monthly Archives: July 2013

The Mirage of Choice in Family Planning: Case Study from Odisha


By- Leena Uppal, Advocacy Officer, Centre for Health and Social Justice

The Times of India, on July 11, 2013 carried an advertisement on ‘small families’ and mooted India’s gains in achieving replacement level fertility to about 44%. It also advertised the various contraceptives available in Public Health Centres and with the ASHAs. For many, this advertisement reflected of government’s assumption that parents select their family size in more or less the same way as they choose consumer durables.

Such messaging is unfortunately not telling of the deeply ingrained social inequalities that exist in India. It is hard for the common people to really understand the implications and impact of the strategies that family planning programmes utilize in their repertoire of programmes to promote birth control. In my recent visit to Odisha on 22-26 June, I understood how family planning is reinterpreted by the states and how it is being pushed across to reach the replacement level fertility.

“We have been asked to motivate and bring in clients for sterilisation and we do that, we try not to bring in those clients who have girls, but focus on those who have already given birth to boys, and motivate their mother-in laws to send them across for sterilisation.  They immediately agree as they do not want daughters.” – ASHA, Balugaon Block Khurda

It struck me in my interview with the health officials in Odisha, how important for the programme planners was the reduction in numbers and population growth. They were quick to let me know a mathematical formula to calculate the Expected Level of Achievement (ELA-0.4% of the Mid Year population of the district) which is then applied as target for contraceptive needs of people.

It was striking to see the minutes of monthly meeting held on 12.04.203 during the review of family welfare & maternal and child heath in the district of Khurda, the Chief District Medical Officer has praised blocks like Balugaon, Banpur, Tangi, Haldia, Mendhasal CHC and has expressed deep dissatisfaction against low performing blocks like Janti CHC and had specially warned them to perform well.

The Odisha government celebrated the World Population Day on July 11, 2013, where key districts and Medical Officers were felicitated for best performance in achieving optimal sterilisation targets. Awards were announced for best performing surgeons in minilap operations as well as male sterilization operations as well as best performing NGOs in mobilising sterilisation cases.  

The data shared by the Directorate of Family Welfare, Odisha, reflected that the districts which were awarded best performance in sterilisation performance (2012-13) included Malkangiri (achieved 138.27% sterilisation target), Koraput (achieved 109.08% sterilisation target). These are predominantly tribal districts (with the tribal population of around 50% or more) and Anugul (achieved 106.09% sterilisation target) which has 11.6% of tribal population. It was shocking to know that all these three districts have crossed the stipulated 100% female sterilisation targets set in 2012-13. This was the fact that no award was announced for distribution of other contraceptives like IUCD, or oral pills or condoms does signify the seriousness with which sterilisation is being promoted in the state.

In another meeting, at New Delhi on the eve of world population day organised by coalition against two-child norm and coercive population policies, the in-charge of national family welfare programme of government of India, Dr. Sikdar shared that the family welfare has moved away from a camp based approach to fixed day services for women in CHC, evidences from the field however suggests otherwise and do imply that family planning services rarely addresses the gender barriers or address the special needs of the marginalised communities. The family welfare programme in states continue to limit people’s family planning options to sterilisation in the belief that people cannot be relied on to practice temporary methods effectively.

This trend is especially a matter of concern since in the Family Planning Summit 2012; the international community took an enormous stride towards rectifying the human rights violation faced by women and girls globally and where India committed to providing greater access to modern contraceptives. 



Violence in West Bengal over the panchayat elections

By Leena Uppal
There is an article in the HT (attached) about the violence in West Bengal over the panchayat elections. The article makes a quick reference to the panchayat election process in India and it has highlighted that anyone with more than 2 kids cannot stand as a candidate for panchayat elections, referring to Andhra Pradesh. 
It was ironic for me to read that despite the fact that the report focuses on West Bengal, the writer had made sure to make a reference to the two-child restriction in elections picking it from another state. Also, the report on panchayat election process did not go clear without making a reference to the two-child restriction.  

This rampant reporting of the norm in an un-thoughtful way leaves the readers with no scope of thinking that this restriction has rendered communities in India vulnerable and doubly disadvantaged. 

Almost every day, readers are bombarded by population control rhetoric in the media without any specific mention to the dis-empowering nature of the current population control policies and policy prescriptions.

The Irony of Targets: Sterilisations in Jharkhand


By Priya John

After six of their children survived the crucial first five years, Dabri Paharin (name changed) and her husband were content with their family size. They decided to adopt a permanent method of contraception – Sterilisation. Among Paharias, as in most communities in India, male sterilisation is almost inconceivable. On being asked how and why it was decided that she would go in for the procedure and not her husband she simply declared that it is the only option and that in her community ‘it is just not done’. So once the decision was taken they approached the state’s health department which incentivises both male and female sterilisation. At the health centre, however, the couple was informed that they are not eligible for sterilisation as they are Paharias.

The government of India identifies Paharias as a Particularly Vulnerable Tribal Group (PTG) which is a sub-category within the Scheduled Tribes. They are identified as ‘vulnerable’ because they are understood to be an isolated indigenous group living in very poor socio-economic conditions. In Jharkhand, the government proposes to take special care to preserve these communities as they are perceived to be nearing ‘extinction’ (GoJ 2013). The main strategy to meet this end is to deny permanent methods of contraception regardless of the need of individuals in the community. This is seen as a foolproof way of ensuring steady increase in their population which is presumed to be dwindling.

The problems with this strategy are manifold and fairly obvious. Firstly, this paternalistic treatment of these vulnerable populations is in gross violation of their right to self-determination. The most absurd logic lies at the heart of this government policy-driven demand to reproduce in order to fight extinction. Men and women are not seen as rational thinking beings who could choose not to reproduce after a point or even in some cases ever in their lives. It is indeed ironical that in the name of their preservation they are compelled to continue reproduction even if they do not deem it fit for themselves. Secondly, the burden of this denial falls squarely on the wombs in the community as male sterilisation is literally unheard of in the area. Women are reduced to wombs, mere receptacles for future generations! The government uses these wombs to fulfill the objective of preservation of an entire community. Paharias traditionally believe that large families translate to more resources to support a household and its needs. The pressure to deliver takes a toll on women’s wellbeing. The government’s strategy to increase population by denying sterilisation is then the last straw that breaks the camel’s back. Thirdly, local organisations working in these areas dispute the state’s claim that Paharias are going ‘extinct’. They cite figures generated in the census to show that there has been if anything a steady increase in their populations over the decades – 8800 in 1991, 13500 in 2001 and 16000 in 2011. Finally, this strategy is objectionable owing to how these communities are equated to endangered flora and fauna which need only be planted more or reproduced more in laboratory conditions. If the government concentrated on ensuring proper implementation of its PTG focused programmes and schemes it might be a more befitting approach to addressing the historical marginalisation and continued structural deprivation experienced by these communities.

A bit of statistics to further punctuate the irony of targets set by the government – Female Sterilisation accounts for 66% of the contraceptive use in Jharkhand (NFHS 2005-6). Data from National Family Health Surveys 2 and 3 show a reduction in male sterilisation from 0.8% in 1998-99 to 0.4% in 2005-06. In the year 2011-12, the population stabilisation targets set by the Government of Jharkhand were:

Male Sterilisation


Female Sterilisation


Intrauterine Device (IUD) Insertions


Source: National Rural Health Mission, Record of Proceedings, GoJ 2011 

The above figures together avow that the state actively entrenches patriarchal structures in which male virility trumps female fertility. Promotion of female sterilisation is much higher than that of male sterilisation. This is despite the fact that male sterilisation is far simpler, less time consuming and requires nearly no surgical intervention in comparison to female sterilisation. Here again women’s bodies are conveniently the sites of state intervention which in this case is to stabilise population as opposed to promoting reproduction to preserve a community.

Also, these set of targets highlight that even though there is heavy emphasis on sterilisation, Paharia women are denied access to this method in the name of a larger good. It appears whatever the problem may be – women and their bodies provide ready panaceas!

Fortunately, the Planning Commission of India recently asked the Chhattisgarh government to revoke this archaic order which was passed three decades ago in 1979 (The Hindu, 2012). The Planning Commission has clarified that the orders were ‘misconstrued’ and members of the PTG community in the state seeking sterilisation cannot be denied the facility. One hopes that the Commission would instruct other states with PTG populations to follow suit soon so that women like Dabri Paharin are not compelled to deny their identity to avail the facility under an assumed name.     



Aarti Dhar (2012) Misconstruing order, Chhattisgarh tribals denied sterilisation for three decades, The Hindu on 7 June 2013

Government of Jharkhand (2013) State of health in Jharkhand – A Retrospect, Department of Health, Medical Education and Family Welfare accessed on 7 June 2013

International Institute for Population Sciences and Macro International (2008) National Family Health Survey – 3, India, 2005-06: Jharkhand. Mumbai: IIPS

National Rural Health Mission (2011) Record of Proceedings – State Programme Implementation Plan, Department of Health, Medical Education and Family Welfare, GoJ.

India’s family planning programme and policy under ‘rights-based’ scrutiny

Stephanie Nolen’s (The Globe and Mail, Canada) who wrote an article on “Why India’s acclaim for protecting reproductive rights rings hollow” has been quoted in a china digital times website.
This reflects that India’s family planning programme that had once had been viewed as inspiring is actually being equated to the china’s coercive one child policy and India’s ‘rights-based approach in family planning’ is now internationally being questioned.
Please read the link below:

Duo in demographic race


By Abhijit Das, Published in New Indian Express, 11th July 2013

The cat is out of the bag! India’s population will overtake that of China around 2028. This was part of the first sentence of the UN press release on its report, World Population Prospects: The 2012 Revision, a month ago. As nearly headline material, it is obviously important, but as an Indian citizen I don’t know whether to be happy or worried.

Let us see it another way — for a second let us assume that the report was one from World Bank on World Economic Prospects and the sentence read India’s economy will overtake that of China by 2028. Some of the readers will immediately respond “wishful thinking”, others will say “impossible”, still others may say “I wish”. There is a tinge of wistfulness to this reaction on comparison of economies, while a sense of regret, frustration, and probably anger may be associated with the population-level comparisons with China. Clearly, we think differently about people by comparison with how we think about economies; people seem problematic but financially healthy economies desirable. So, should I be happy or worried about the UN predictions?

As a person dealing with population issues for some time, I would not be too alarmed by the fact that India’s population will overtake that of China. We knew this for a long time. What this report says is not new, but what it does is set the date forward. India had adopted a National Population Policy in 2000, making some programmatic promises and predictions. If those programmatic promises had been kept, then the predictions would have been met and the goal posts would not have shifted. Within any country development and population are related. They are related through the health status of the people, their educational capabilities as well as their access to family planning services. In large parts of India, the status of health and educational capacities continue to be comparable to sub-Saharan Africa, and it is the part we like to forget about when we make the BRICS-level economic comparisons. Unfortunately, we cannot forget about them for too long as the list of internally disturbed areas grows. Also, we cannot forget them because many of our natural resources are “trapped” in those very regions.

I have not seen the village in which my forefathers lived and probably tilled the land. Many of the readers of this piece may also have tenuous links with their ancestral land-based livelihoods. We and our previous generations have had the privilege of health care and educational opportunities, increased our capabilities and become less dependent on land for survival at an individual or family basis. Why can’t we evolve a similar solution for our fellow citizens in India’s heartland where population and development both appear to be an impossible problem?

Many of us are irked by the crowds we see in our urban centres, and immediately the population problem hits us at a primal level. All the lessons from our textbooks about shrinking resource bases and smaller size of the cake for each individual seem true, regrettably the textbooks have not been revised for years, and the problem we see is more related to lack of rural livelihood opportunities than to extra births anywhere — in villages, cities or slums. The urban crowds are also partly due to lack of urban planning. The middle class, whose needs often form the subtext of planning exercises, need cheap labour, and they are getting it as thousands pour into cities from the hinterland. Unfortunately, the cheap labour finds little designated infrastructure, and in the name of urban beautification and renewal they get physically pushed out of sight. But they remain as crowds every day as they stream into their poorly paid and insecure jobs.

The poor hardly consume any resources, while SUVs, completely air-conditioned homes and offices and neatly manicured lawns are the privileges that the rich enjoy and are loath to leave. So while one small set of people across the world increase their carbon footprint and direct and indirect use of natural resources, a much large number of marginalised people face the accusation of destroying the environment and also bear the brunt of calamities that are part of the climate change that is slowly but surely coming about.

So, development is related to people, but we often forget that population includes all people, even those we would like to forget about. While some choose to ignore the poor in their imagination of India, others would like to reduce their numbers through aggressive family planning programmes. Thus, we have lottery schemes gifting DVD players, washing machines and Nano cars to women coming in for tubectomy. In still other places, these women are operated in a great hurry and in sub-human conditions by surgeons who want to meet their targets. People need family planning services, want to use them, but don’t need to be forced to use methods that they either do not want or are not suited. We continue to have nearly 25 % of couples in many states still not getting the method that they want. We continue to emphasise the permanent sterilisation method even though we know that the largest reproductive age group in India is that of new and young couples. Sterilisation operations, especially in women, are as serious a surgery as say an appendix or gall bladder surgery. In all these operations, the “peritoneum” or abdominal cavity needs to be opened. Though tubectomy is technically simpler, the consequences of infection of the peritoneal cavity are the same in all the three operations mentioned. But we continue to conduct surgical “camps” in the most unhygienic, hurried manner on lakhs of women annually as part of a national programme. Clearly, Indian citizens deserve better.

How do I then feel now that the day India’s population overtakes China’s seems closer than before? I feel sad that we are still unable to harness the energy and creativity of our billion-plus people, making them economically productive through their good health and capabilities. I also feel happy and relieved because I know that our policy makers did not make the huge mistakes made in China. Today, China is not only faced with the prospects of an ageing population and depleting workforce, but a tremendously skewed sex ratio as well. In my mind the comparison is redundant. In India our challenge is to be able to meet the aspirations of our billion-plus people, not compete with China in a game of numbers.

The writer is a clinical assistant professor at the department of global health, University of Washington, Seattle.

बढ़ती जनसंख्या पर नेताओं की चुप्पी


The UN once again has come out with projections that India’s population will surpass that of China’s soon.
Centre for Health and Social Justice, hosts a National Coalition against Coercive Population Policies represented at the panel in NDTV raised concerns with regard to effect of population momentum, negative implications of two-child restriction on women’s participation in panchayats and social welfare schemes (IGMSY) and forcefully put forward the need to make food security unconditional and the need to de-link the population control mindset with women’s right to nutrition and basic right to health care, need for policy planning keeping the focus on equity and reproductive rights justice.