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.