People's Participation in Family Planning

PEOPLE'S PARTICIPATION INFAMILY PI-ANNING

/

PEOPLES'S PARTICIPATION INFAMILY PLANNING

V A Pai PanandikerAjay K Mehra

In Collaboration withP N Chaudhuri

Under the Auspices oJ

Centre for Policy Research

mUPPAL PUBLISHING HOUSE

NEW DELHI

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@ Centre for P$icy ResearchFirst Published 1987

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FOREWORD

rINDIA'S demographic problem has been' a malter of consider-able concern in recent years. The latest data has only added to thissense ofconcern since the birth rate isstill high at estimated 33 perthousan{ according to our plans and hopes, it should have beenmuch lower. The consequences of high population growth to thepolity as well as to the economy are indeed serious. As the SeventhPlan document states "The fairly high rate of gowth of populationneutralises to a significant extent the fruits of economic growthand uses up part of the potential savings which could otherwise beused to raise capital per head and the productivity of the labourforce at a faster pace".

The Seventh Plan Document howevei, does not give a centralfocus to the population policy and programme in the overalldevelopment strategy. It does recognise, however, that to attain thelong term goal of NRR-I by the year 2000, it is important to havethe programme accepted voluntarily by the people .and for thepeople to participate in it extensively.

The population problenl therefore, requires a fresh look interms of the level of people's awareness, motivation and demandas well as the supply of family planning services to the people,including organisatioiral issues connected with fertility controlWithout the closest involvement of the people in the family plan-ning programme through their representative institutions, volun-tary groups and local organisationq the task ofpopulation controlis almost irnpossible to meel

The current population policy does not as yet, suggest a wellthought out programme of people's participation. It is a major gapin the policy conception.

The pr€sent study is an attempt to fill the gap, albeit partially. Itexamines some of the basic problems anci issues in people's par-

Secretary Public Health ard Family Planning Department,Government of Gujarat Dr A ,4, Contractor, Deputy Director,Health Services, Government of Qujarat and his officerq Dr(Mrs)Banu Coyaji. Director, KEM Pune and her officerg Dr LP Ramachandrarl Director, The Institute of RuralHealth and Family Welfare Dr Raini Kant Arole andDr (Mn) Mabel Arole of Compdehensive Rural Health ProjectJamkhed (Ahmednagar District), and Shri Satish Chandra of thelltrew Delhi Branch of Indian F Planning Association forvaluable help and facilities for on the study.

We also wish to record our appreciation of the work done byShri P N Chaudhuri and Shri K Mehra in the conduct ofthis study.

Centre for Policy ResearchNew DelhiAugust, 1986

V A Pai PanandikerDirector

ticipation in family plarining and suggests some concretepolicy action.

We wish to recerd our deepest {ppreciation of the partial filan-cial assistance rcndered by the Fhmily Planning Foundation forthe conduct of this study.

We are also gmteful to Shri P R Chari, the then SecreBry to theGovernment of Madhya Prade$h Public Health and FamilyWelfare Departhent and his ofllcerg Shri M S Dayal, the then

PrefaceA

AS part of the CPRs larger interest in population policy, the pre-

sent study seeks to examine the role participation can play in ,

family planning and the manner in which such participation can

be built in the official arrd non-official progrbmme with a view tobringing down the national fertility rate.

The transition of lndia from a feudal and colonial society to a

modern democratic polity has resulted in increasing emphasis onpopular participation. Population control" and family planning as

its main instrument has been identilied as a developmentalactivity considering that unplanned population growth is an

impediment to economic development. The role ofparticipation is

even greater in a programme like family planning which in thelndian context is basically voluntary in nature. Effectiveness ofthis programme depends to a large extent on voluntary acceptance

of"small lamily' norm by every couple. Since the programme has

so far not evoked adequate response from the people as a wholg itis of utmost importance to move towards a greater acceptance ofthe programme by the people.

Keeping in view the need to bring down national'fertility rate

the Planning Commission of India appointed a Working Groupon population policy in 1978. The Group in its report urbmitted in1980, expressed the opinion that the taskwill not be easy to achieveunless the programme of family planning had the fullest-par-ticipation ofthe people, individually and through their represen'tative institutions, voluntary associations, local organisationgetc.

.lt was \i/ith these concerns that we undertook the present strrdy'

In the very nature of the study, it could not have been completedwithout field visits in different parts of the country. Since we weremaking case study of two models of participatory population con'trol programme, the field visits were possible only with willing

cooperauon of the institutions ed Weextending all the facilities to us. e olficials

extremely

thank thern forand staff accom-cooperative and

Not everyone was easilydifliculties also in meetinpi

panying us during freld visitsmade our trip. as fruitful as

Ouf problems in the field did not with transport and board-ing lodging facilities. Once we viere i the villages during 1981 and

how difficult it was to talkfamily planning, With the

memories of the Emergency still fade4 we were" sometimes

started approaching people, we replito people freely on a subject like

taken as paft of a sterilizationforthcoming for interviews. Therepeople in villages during the day. We however zucceeded inapproaching people, persuading,comforting them to respond to

to join the interviews andquestions with the help of

oflicials accompanying us. We are to all our respondentseven though most of them will not

We gratefully acknowledge thethis study.

ion offered by ProfImtiaz Ahm ad of the Centre for Studies of the JawaharlalNehru University . in preparing schedule lor thisstudy.

The study could not have acqu the present shape withoutcooperationi and help and support Mr. Karnal Jit Kumar,Librarian Mr. Trimbak Rao and er members of typing pool

We record our gratitude toand adrhinistrative ;taff of the CPthem.

The views and opinions expressed in the study are entirely oursand do not necessarily represent th[se of the Centre for PolicyResearch or the Family Planning Fpundatiorr

V A Pai PanandikerAjay K Mehra

Contents

Chapters Pages

Foreword VI Introduction III Objectives and Design of the Study 15

III Voluntary Efforts in Family Planning-I 23New Delhi Family Planning Association

lV Voluntary Efforts in Family Planning-Il C,5

Gandhigram Institute of Rural Health andFamily'Welfare Trust

V Voluntary Efforts in Family Planning-Ill 96Vadu Rural Health Project

VI Voluntary Efforts in F-amily Planning-IV 128Comprehensive Rural Health Project Jamkhed

VII Family Planning Through Panchayats-I 159Madhya Pradesh

VIII Family Planning Through Pahchayats-Il l9IGujarat

IX Family Flanning and People's Participation 226

X Policy Conclusions and Recommendalions 249

Bibliography 254

Chapter IIntroductionP.tnrtctpnrloN is the very essence of democracy. A democ-ratic society is a participant society. The close relationship belween society and polity makes legitimacy and efficacy of a

democratie polity, dependent on the extent and level of participa-tion in society.t Popular participation is also considered essentialto ensure effectiveness and success of developmental program-mes. The importance of popular participation in a democraticsociety, therefore, would grow directly in proportion with theemphasis on development2 lt would place participation in anentirely new context

The process of evolution of democracy as an ideology andinstitution and of participation as a process of strengthening(emocracy in both its manifestations would not only bring outclearly the place ofparticipation in evolutionary and transplantedforms of democracies, but it would also be'crucial in determiningthe degree and style of contemporary political participation' (DiPalme- 1970:23).

The way historical beginnings and advancement of mass par- .

ticipation is related to the development of civil, political and socialrights establishes it as an essential prerequisite of democracy. Itshistory began with Greek civilization only to disappear with thedecline of the civilization. The medieval European societies res-

tricted participation by granting rights and liberties oirly to certaingloups, corporations and estates, which also had representation injudicial and legislative bodies (Bendix, 19&:43-85). But graduallythese regimes also started breaking down (See Tocquevillq1945:II:198-3ll) and through the experience of the struggle forparliamentary democracy in Britain, the Arnerican War of.Independence and the French Revolution a new order emerged.Thus. democracy and participation died a natural death with the

People's in Family Planning

decline of the Greek Civilization, be reborn only in the scven-

teenth and eighteenth centuries in rope and North America..Growing frqm inlancy in the seven th and eighteenth centuriesto adolescence in the nineteenthtwentieth century.

it came of age only in the

The three c,ases indicate the tion of Western democracyand the form of participation wh was acquired gradually by

n of participation as thepeople. The discussion on evolumainstay of democratic system wou be incomplete without men-tioning one of the biggest of the tieth century revolutions,which established that participatio can also be mobilized for a

particular purpose and c in a 'definite' direction.Russia's was probably.the first case in the modern history wherean organised cadr+based party advantage of the populardiscontent against autocratic andrevolution, overthrowing the mofeudal order, and creating a new

ressive Tsarist rule staged a

hical rule, destroying the

being run by. one party. Different-up based on one ideology,of ooinion exist on whether

mOdern Soviet system is democra ic or nol But it is generally

agreed that the erstwhile T agrarian Russia has been

transformed into modern: in USSR by mobilising par-elopment The Cornmunistticipation for planned economic d

party is the instrurgrqt of mobilisRussian Revoluticm,lles in -transla

tion. The impo(ance of theg a philosophy into reality

and giving bifih'tO'a new social and political systern.lcrDatorv movements 1n ex-ln b sharp conttast, the modern

colonies, the so-called third worldlate nineteenth or early twentieth

ntries oftoday, date back totury. Advent of colonialism

at the feudal or tribal stage of d opment impeded growth ofexperience of participationirrdigenous institutions. Thus, th

begins with the rise ofprotest agai exploitation. But low level ofment restricted pa.rticipationcases, like India, it did tricklemasses by some'chairsmatic

literacy and economic underdeveloto the privileged few, though indown to lower levels due to appealleaders.

ln spite oi many limitatlons, countries have been able to

!ustain democratic institution for long period of tirne.

India is'one such country. was established in Indianearly four decades ago and for India's level of literacY and

ecenomic develoPment electoral P icipation has also been fairlY

:high (see Elders, veld and Ahmeel 1978 and Goel. 1974). This is

Introduction 3

because of two reasons. First of all, at every stage ot the nationalmovement the leadership was able to wrest from their colonialmasters not only democratic rightg however limited, but alsodemocratic institutions. Thus, when independence camg Indiahad some institutions, to be used as foundation stone. Secondly.Mahatma Gandhi was able to provide the national mov€ment a'mass' character (through a mass based Congress system).Therefore, at the dawn of independence India'had an availableleadership enjoying widespread legitimacy, a structure of insti-tutions, and a lirm sense ofthe kind of society that lndia sought tobecome in the coming generdtions. Central to all this was theresolve both to build the nation and to develop its social andeconomic base through the democratic political process' (Kothari,1976:511). The leadership did not show any hesitation in using theavailable institutional structure and the ideas nurtured during thestruggle for independence to create iranchise and periodic elec-tions and keen competition between a number of parties was pre-ferred as the'model of ordering social and political diversity.

The leadership did not merely succeed in creating a democraticstructure but also sustaining it through the early years of crises.The Indian people also demonstrated, remarkable flexibility inadapting themselves to the new form of political culture.

Two p6ints corne out clearly from the Indian experience: ,

(a) Participation takes deeper roots if it has evolved over a periodof time; and

(b) Nature, iorm, extent and level of pirrticipation would dependupon historical as well as environmental factors.

Political Participation

Political participation has been interpTered to'refer to theactivity of private citizens designed to influence governmentdecision-making (Huntington and Dominguez, 197 5:32'). ltinvolves a whole range of activities from discussing politics tocampaigning voting contesting electionq attending publicmeetings. joining protest marches, etc. This definition putsemphasis on activities rather than attitudes. Sometimes the term isapplied to political orientation rather than activities (Nie andVerba, 1975:1). lt may also refer to building attitudes for politicalactivities. As J.S. Mill puts it,'Among the foremosi benefits of freegovernment is that education of intelligence and the sentiments


which is carribd ''down to the very ranks of the people whenthey are called to take part in actsinteres.t'of the country' (Mill, 1873

ch directly affect the great

Thus. attitudes and activities are important in determin-of attitude is as important as

of a continuous process ofbuilding participatrory attitude the se would. remain narrow andthe whole democratic structure t tumble oie day. In otherwords, existence ot absence of suchmine political culture of a society

process would finally deter-

ing politi6al participation. Buildiactivd participatio4 for in the abr

political participation itself is a multifaceted phenomenorlencompassing a wide range of variahles. But most studies have nottaken 'the alternative ways in whicti citizens can participate' intoacco_q4t- dccording t9 Hunti ngf on afi d Nel son-(1 976: I 59-60):

Political panrcipation is a much more complex and less clear-cut phenomenon than it appears to be at first glance. It is not a

single homogeneous variable. lt ls, rather, an umbrella encom-passing many different forms of 4ctions; all of these actions aredesigned to inlluence governmeht at some level, but they arenot all related to each other, nor $o they vary in the same direc-tions or respond to the same prqssures.

Crude indiCes, such as voting t|rnout, the incidence of par-ticipation in demonstrations, or membership, can capturegross contrast-a sudden expahsion or contraction in par-iicipation within a country or very wide differences in participa-tion levels between two countries. But in most nations. trends inthe level of political parti are usually ambiguous.

This is a very revealing stateme4l lt points out the lirnitationsof the study of political participatibn within the context bf elec'

toral politics as well as the dangQrs of treating participation a

unidimensional phenomenon. lt alio contradicts the earlier posi-

tion of derelson et al (1954) that 'allmost all measures of politicalinvolvement and participation arb highly correlated with one

another and for analytical purposed interchangeable'. Lane (1959)

and Milbrath (1965) have argued ftrr a hierarchy of political acls

suggesting that the citizen who engpges in moe difficult acts also

en!-ages ii.earlier one. Here agaitt ibfitence is mainly toielection.This is too limited a treatment of pof itical participation. Election is

one of the political activities and lvoting is only one way to par-

ticipate, As Nie and Verla point oirt, 'the citizenry is not divided

Innoduction 5

simply rnto gladiators and non-gladiators Rather, there are maytypes ofgladiators engagihg in different acts with different motivesan{ different consequences' (1975:7). Verba Nie and Kim (1971,

1978) and Verba and Nie (1972) presented participation in a cross-national context These studies ertelded the boundary of par-ticipation by including involvement with community activitiesand other non-elecforal activities. But non-conventional methodsofparticipation were overlooked even by these scholars. As $atishArcira points out

Most o ler writers on the subjecf omtt reference to non'conventional political behaviour, Demonstrations, strikes asdmorchas-not to speak of more violent activities are absentfrom most standard typologies or operationalized indexes ofpolitical padicipatio& rarely does one find any willlngness todiscuss these modes in relating to more conventional ones ...There seems to be a pressing need for a typology of politicalactivity which will include hll acts. from voting to political acts

involving physical violence (Quoted by Chaturvedi and Mitra,1982:5-6).Political participation theorists have established correlation

between socio-economic status (SES) and participation As Verba

and Nio (1976:41) exflain:.., individuals of high socie'economic status are found to have

attitudes that motivate thim to be politically active. They are

morb ir&rested in politicg have a gteater sense of politicaleflicaqy, and a greater sense ofobligation to be a participant Inaddition, they have more developed cognitive skills. These

attitudes make it likely that all else being equal, the upper status

citizen will be more politicallv active'

Naturally,'thrs reldtionship would show at the societal andnational lwels as well 'It comes as no surprise', one set of authors

conclude4 'to learn that a nation s level of political participationcovaries with its lqel of economic development'4 (Nig Powe-ll andPrcwitt, 1969). Milbrath (1965) and Dye (1966) had alreadv made

the discovery that lwels of voting participation among the flftystates were i function of levels of economic developmenL Status

variables tend to produce greater political participation because

ffi status is associated. with feelings of political efficacy andco-mpetence. In other wordg status variables are closely correlated

withattitudinal variables Moreover, in social and naiional con'texts. socio-economic development leads to multiplication 'of

?aple's in Family Planning

organisations and assqciatior! l encourage and augmentparticipation (Huntington and 1975:34-35).

The Indian cdse has both and dissimilarities withPther developing nations. Apart its distinct history. both pre-colonial and colonial, and the mostvisible dissimilari& isIndia's ability to sustain processes and institutions for

existence of traditional" prinearly four decades Similarities xist only in generic sense, i.e.,

and parochial grouployaltiesWhat has, perhaps, sustained Ir s experiments with the democratic institutions and valuespoliti cization of traditional

from the West is first

participation base which hasdirection

Democracy ard participationthe models operating in the Wes!

India, though borrowed frorn.however, Indianised them-

solves, ie., they have acqriired ' own character and can nogrore be identified as an exact of original models. Studiesin the functioning of democracy India aS well as nature ofpoliti-

this beyond any doqbtcal participation haveWeinet's study of India's two cultureg for examplg

highlights emergence of an political culture in Indi4which he describes as thd mass ylililnl culture, as against the

The latter'is located in Ngwestablished elite politicalDelhi. and the State capitals is the political culture of theEriglish speaking intelligentsia, the former is in the districtsand permeates local politics, urban and rural, local parryprganisation and local adml The former is an expand-ing political culture and the1965:199-244\.

is the established one (Weiner,

Participation in Development

The study ot participation in ent rs an area oftenneglected by social scientists It started receiving som€ atten:tion recently as most of the rping nations began grappling

e face of scarce natural resour-with problem of development inces. They.do not only suffer from tal aspira-tion lag time development lag is acute. There is. thercforegrowing feeling that participatio would be able to narrow both

... popular participation can be

and, second, wideningchannelised in positive

the gaps-As a UN study points

Innoduction 'l

an effective means of promoting policies for economic and socialdevelopment ... (through) a sincere commitment by national'political ltiaders to promote popular participation ... (and) awillingness to create the necessary institutional structure andother political conditions that make popular participation poss-ible' (United Nations, 197 5:62).

Keeping this in view and owing to the larger interest in thedeveldpment of the member countries, United Nations hasattempted to study participation in the context of developmentThese include' study of Social development policy (UnitedNation+ l97l), a study of participation in decision making fordeveloprfient (United Nations, 1975), etc. Lately some Indianscholars have also shown interest in this theme (see Arora 1979,Chekki, 1981, Fernandes (ed), 1980; Chaturvedi and Mitrar982).

Thqre is a tendency to confuse participation with mobilizationThus, while planners and bureaucrats complain about la'ck ofpopular participation in development process, what they gene-rally refer to is the failure of people tci ratiff and accept the pro,grimme uncritically rather than participate. And when they talkabout moves to ensure people's participation in development pro-gramme, they actually refer .to mobilizatibn (Chtturvedi andMitra 1982:l-2).

Therefore, there is sometimes talk distinctly about participa-tion in decision-making for development (United Nations, 1975and Arora, 1979). As Arora succinctly puts il'An active participa-tion would not simply ratify but in fact influence the administra-tive behaviour and the outputs of the official action' (1979:xvi).Clariffing the point further the United Nations study says, 'In rela-tion to developnient, popular participation as a process can bedefrned as abtive and meaningful involvement of the masses ofpeople at diffeient levels, (a) in the decision making process for thedetermination of societal goals and the allocation of resources toachieve. them, and (b) in the voluntary execution of resulting pro-gramme_and projegts' (197 5 : 4\.

A study by Cnaturvedi and Mitra (1982), one of the very fewstudies exploring this question empirically, has argued that par-ticipation in development may take place at three different leyels:in decision making in implementation and in receiving benefitsThe study also points out that thelevel at which citizen participa-tion in development takes place depends on the organisation of

8 Pmple's f,arxcipuion in Family planning

the institutional structure, prevailing value system, the naturp ofleadership and the nature of citizehry itself (Chaturvedi and Mit-

prwailing value systems and the of citizenry could become

,ra 1982:l0l). Thug the level ar.development prgcesg and the ilsustarn and sftengthenelements which encourage

a serious irnpediments or an, stage, the nature ofleadershiploag run

results in delay in takingnational leaders and adm

h people participate in thestructure designed to

come out as imporraurand developmeqt While

propellant at the initialdetermine their impact in the

handling by lafinen It alsorvhich reducee :the ability of

'fhere has generally been a to highlieht the borls oipopular participation in terms of f{ulty inplementatibn and lnef-rhciencies resulting from

ito make development policyand programmes expeditiously (United Nations. 1975:l&11).Etperience however shows that in ithe context of underdwelopedcountries, inefficicnces resulting frqm inexpert handling are likelyto be common iqitiatally not only dt the lower level but also at thehigher level Secondly, it is not only. necessary to formulatedwelopmental plans and expeditiously but also ma&e'policies anil programmes that are Fffective. In fact these excuseshave very often been used by the,at the lower'level not realising tha{ wfthout popular participationthey may have the po\r'er to decisions but relativelv little'Fower to enforce then

nature bfthe problbm and may tncrease theNations. 1975J5-16).

It would be worthwhilg at thiq stagg to highlight benefits ofpopular participation in developmbnt process The first benelit of.cgursg would be channelisation of people's energies for construc-tive purposes which would also {ct as educational process forthen Since the programme base{ on .felt' necdq as'contrastedwith needs perceived by the expertf, have more chances ofacceptiince (Pareel 1978:.72 ), potenrial mistakes in planning andimplementing programmes bould be minimised. It would also.rensure more .equitable distribution of benelits (United Nations,,1975:10).

level of conllict iil Society (U

Intrcducrton

Family Planning and People's Padicipation

Nowhere in the programmes of social and economic..develqpment is the people's participation more relovant than inthe far.nilyplanning programme. Family Planning by policy prongun-,cements is a voluntary programme based on persuasion about acouple's choice of the size of the family. The official policy as.announced in the 1980-85 Five Year Plan also gmphasizes thatfa.mily planning programme has to be an'integral part of thedevelopmental package.

As the Plan Document states: 'Limiting the growth of popula-tion is... one of the main objectives of the Sixth Plah. This has to beachieved through persuasion of people to adopt the small familynorm voluntarily backed by appropriate programme of suppliesand services for countraception The Family Planning Pro.gramme has also.to be made a part of the total national effort forproviding a better life to the people' (India l98l:375). The sevenrhFive Year Plan not only accepts the voluntary nature of the familyplanning programme but also emphasises the need for participa-tion in it According to the Plan Documeht 'Inter-sect;ral coor-dination and cooperation and the involvement of the voluntaryagencies in the programme will be necessary in this programme toan even greater extent than in healtll Community participation is,essential for g[e _v_oluntary acceptance of the Family Welfare Pro-gramme. Indentirication and active :involvement of non-govem:mental organisations and of informal leaders in the communityand imparting them the necessary training to motivate and to p6r-ticipate in the programme are important,aspects of efforts in theIield' (India, 1985:II:282).

In'p'ursuance of this broad approach, the family planning pro3ramme in Indi4 barring the brief aberration of 1975-7 6, has beenesseridally a voluntary programme; emphasizing the need for-asmall:family and slower growth rate of population in the nationalcontext hnd happiness that it wpuld bring to the familt'. Thugwhile family planning programme in the national context wasviewed as a developmental activity, considefng unplanned population growth as an impediment to economic developmenl its

.appeal for indivrduals was seen and projected In terms of 'healthand welfare of the family'. Ensuring the elemeirt of voluritarisnr.cafetaria approach was adopted which ofigred people a.wide

.choice instead of trying to push a particular r,rethod.

l0 People's

However, tle family planninginclude particip:ition of 'benefi cii

in Family Planning

till mid-7Os did notes' in it as a major policy goal.

Whatever shifts in emphasis t have been brought in the pro-gramme during the hrst two andtion, the attitude of the elites and

decades of its implementa-licy makers left little room for

people' participation at impl tion levelT In the entire plan-ning of the programme till thenthe people's own choice.8 So m

ttle consideration was siven to.

force was considerej the onlyso that at one point of timeimplement this programme,e

Apparently, . too much has made out of ignorancgorthodoxy and superstition of people in accepting the family

of, and participation in, a pro-planning prograrnme. Acceptangramme depends, to a large on whether people find itrewarding or not(Di Palmq 1970: 22). And in the context of ruralIndia, a farmer does not find a Tamily rewarding. He feelshelpless if he does not have sons to help him. Mamdani's study

One of his respondents toldbrings out this point forcefully.

The backlash of the coercive used in 1975-76 ledparticipati0n1977 for the fiist time to a

family planning.of people's

The election of 19.77 broueht me vividly the implications of'imposing the family planning p on an unwillins massofthe population. It also forced th policy makers to think in terms

the programme. But in retros-h may well have been tactical

of more 'popular participation'pect, perhaps the shift in a

lnin

rather than due to realisation ortance of participation'of people.

true recognition of the impor-The chanse in nomenclature

from family plartning to family is one indication of this.The ambivalence emerging out of is is also evident from the factthat neither a proper definition people's participation in thiscontext was made. nor an overallsuch participation could be achi

trategy evolved through which

him:You were trying to convince mb rn 1960.that I shouldn't haveany more sons.l I Now, you $ee I have six sons and twodaughters and I sit at home in feisure. They are grow4 up andthey bring me money. One evtn works outside as a labourer.You told me I was a poor me{r and couldn't support a largefamily. Now, you seq because of my large family, I am rich man(Mamdani, 1972:109).

It was essential to clearly de participation in this context in

Intmducjion I I

oroer to evolve an effective strategy for mobilising.people becausethe use of the concept of participation in family planning is likelyto be confusing How are people going to participate in this pro.gramme? Idchlly the popular participation in family planningwould involve a great deal of role for the ppople and their localinstitutions to make decisions regarding the programme ind alsoa role in implementing and executing the programme.

Basically participation necessitates taking the programme tothe peoplg involving them as txtensively as possible in all thedimensions of the programme. Decentralization and localizationare therefore two crucial parameters of such an approach. Remotebureaucratic and even.political operation of the programme sim-ply cannot deal with the apprehensions, needs and even concemsof the poople. In other words popular participation of the familyplanning programme implies a great deal of its democratization.

tven rn tne changed scenario srncq 1977 the governmental andbureaucratic conception ofpeople's participation has three maincharacteristics: (a) people's readiness and active cooperation infulhlling (he govemment's sterilization targets; (b) unquestionedacceptance by the people of the government view of 'small family',and (c) 'unquestioned acceptance of the family planning, pro-gramme by the people. Thus, the emphasis is on mobilisation ofthe people to accept the governmental programme. There is noteven attempt towards mobilised participatioq whibh after a stage .

reaches the level of autonomous participation.Before we go into the question of translation of the concept ot'

participation in family planning it would be worth-while to defineand demarcate the boundaries of participation in this speciliccontext

. Participation should ideafly be autonomous-that is decidedupon.directly by the people. However, in mqny countries includ-ing some of the developed world, participation is more of themobilised' variety. Mobilised in the sense that participation isachieved through a conscious organised effort to enlist the suppoitaf the.pebple for the prograrnme. As stated earlier, participationappears to need mobilisation initially.t: lt could range frdm;motivatiori for thb small size family to the delivery of contracep-tives, organisation of campg mass meetings, etc. Thus, at one levqla group ofenlightened citizens could be mobilised and supported(by governmental agencies) to create a favourable atmosphere for.the accepfance of the 'small farnily' norm. On the other level, every

t2 Pople's in Family,Planning

accepto{ could be so motivated tha! helshe takes upon hinl/her theacceplo{ coulq D€ so mouvaresponsibility to spread the to othe$. And finbllY, volun'

tary associations (eg Youth Mahila Mandalq etc,), whichtary associations (eg Youth clubsi Mahila Mandals' etq)' rYnrcn

should be created where they do rlot exist, could also be broughtl

into the ambit o{ family plannin$ Thug participation in familyplanning as we define il is a proceds whereby the.consciousness of;small family' norm is spread with {he help of enlightened citizens'

voluntary aisociations and each of the acceptors, ultimately lead-

ing to vbluntary acceptance of thd'small family norm'-But

at each of these levels it iC necessary that people should

have tlie feeling that they are also lrroluntarily taking the decision

This would meaf, creation of a mtaningful relationst'ip betwee4

the family planning agency on the one hand and people and thbir

voluntary association on the othqr. The most impottant institu'

tion and effective in'the long run, [n this context could be democ-

ratically elected body at the grassiroots level. Another institutionwhich iould prove useful is volulntary associations at the local

leveLMontgomery and Essman noted that, 'participation is

.more likely to be induced and when it produces tangible".-'- -----J --

benefits to clients ... and appeal t$ felt needs' (Quoted in\Kralbtz.

and Goodmarl 197 3 :37 6). U , as mentioned earirer, rne

linked to the felt needs.l3family planning programme wasfelt deeds are going to beefforts, however, have so

Even in our scheme of Partici the

an important factor. Thefar not been sucaessful in the progra.mme to PeoPle's felt'needs. Some experiments have ddmonstrated that this link couldprovide fillip to participation in fhe programme.tr

A role in decision'making would automaticallY link the

iprogramme to felt needs, thus, isticipation even mobilised Partic

in ensuring people's par'in any programme. This

requires building specific channels for providing the

in the present policies and

approaches to actuallY the objectives of peopleis Par-e has been a variety of effortsticipation iir'family planning

iencies and organisationsboth through oflicial andto bring about a conscious in of the people into the Pro-

means for such particiPatioc :

Despite all the inherent limita

gramme. While dre scale of the is indeed limited. the effort is

*hat is possible and howin many ways a Path finder and6iihin the lndian context- The study seeks to examine this

Intductian 13

record and experience with a view to arrive at tedtativ€ @n-

clusions on thi effective modes and modalities of people's par-

ticipation in family planning in India ll

NOTES:

I For a detaited discussion see Almond and Verba (19d3) and Ecksiein

(r96r).?ln lndia the.importance of pebplds participation in d€velbpment was;

recognised wiit the beginning of plarned developmenlal efforts in l95l' Th'e lirst'

hve year plan acc€pted that 'conditions should be created to enable individuals

and groirps to make their maximum contribution as citizens and in fulftlling the

tu.gels ofih" Plao und advancing its objective$ therefore' it called for making ade I

quue urruttg"-"nts for enlisting public co-operation and associsdon "' from the

ver| beginningl (lir dia, 19 52: I tG47 ).I For a detailed discussion see Cam(1966).a Daniel Lerner has highlighted this difference in terms oftraditional and mod-

em societi€s-former being non-participant and latter participants For a d€tailed discussion on this theme see Kothari (1970a and 1970b) GoeI

(19?4);\ryeiner(1965 and 1974), Huntington and Nelson(1975) and Eldersveld and

Ahmed (1978).6 In recommeoding the programme of family planning the firsl FiYe Y€ar Plan

stated:'ltis appar€ntthatpopulation coniml can be achieved only by the reduction

ofthe birthrale to the extent necessary to stabilis€ the population at a level consis-

tent witli the requirements of national economy. This can be Secured only by the

realisatircn ofthe need for fami$ limitation on a wide scale by rhe people' The main

appeal for family planning is bas€d on considerations olhealth and welfare of the

f;mily. Family limitetion or spacing ofthe children is necessary a4d desirable inorder to secure better health for the mother and better care and upbJinging of.children Measures diftcted to this €n'd should therefore form part of the public

health programme' (India 1952:522)7 The attitud€ ofthe elites becomcs an important faclor shich broadens sr con-

tracts participatiorl Moreover, participation for the elites has 'an instrumental

rather than a primary value' (Huntington and Nelson" 1976:2&30)'

l4 people\ Pgnicipation in Famity planning

. s Huntington bnd Nelson ( 1976:3g.1 poinlout that the patrem ofparticipation in

developmenr is significantly, influenced by fhe organ isarlon and administration ofgovernm-ents programme. Any government programme will have little support ofpeople if it does not try to establish a balafrce between governmental goals andpeople's own participotion. As pointed ou( earlier famiiy ptanning programmecompletely ienored p-eople s yiews l-nd perce[tion regarding size ofthe fam ily. Thiswas refl€cted in the failure ofthe Khanna efrperiment. ln I perceptrve cntrirsm orthe Khanna experimdnt,Mahmood Mam{ani's (1972) study (in the same area)rcvealed the gulf betwien cognitions of thd two.

9 The experience of the irnplementation bf the sterilization programme duringthe,emergency, and its repercussion eighteeri months later confirms the position ofHuntington and Nelson (1976:38) and revehls what a misconceived programmecan do to a governmcnl-

l0 The preference for sons came out quite strongly even during our fietd work inDelhl Madhya Pradesh Tamil Nadu. Mahairashtra and Gujarat A farmer wantcda minimum of two surviving sons, who could help him ii his old age. A panchai,atleader in Maharashtra said that he would nbt like to motivate a person who doesnot have two sons.

ll Since Mamdani was making a reasselsment of lhe Khanna experimenl hewas taken to be a part of the same team re{,isiting the area-

l2 Here it is desirable to distinguish mobifisation from mc.rbilised participation.Th€ former gives the impression of herding pr driving from behind toward a pre-determined goal where the driven is nothand" is based on persuasion. appeal totioq thus, leaving an element of volition

ll The experience of thc family project ofthe KEM Hospital, Punc',and LTNDARP's{a voluntary agency) with rural developrqent in VaduBudruk (a village 30 krns from Pune) andurban perceptions of rural needq and thc

villages has rovealed thirt' own felt needs do rarely con-

verge. In fact they have a bettercan rarely grasp.

oftheir necds which an urban mind

14 In the Jamkhed Rural Health Proiect in Maharashtra peoplc have volun-mortalfty and death rate was chec-tarily gone for small family, once a high

ked. The assurance ofhealth servicehaving two or three children.

at door step has removed the risk in

a choice. The latter. on the otherand to use a cliche. conscientisa-

Chapter IIObjectives and Designof the StudyrrrI HE basic objective of the present study is to give concrete shape

to the theoretical and policy concerns through an examinat-.on ofthe nature and extent of citizen's participation in family planning.The study is intended to develop specific policy options regardingthe ways and methods of involving the people with a view to bring-ing down the iertiliry rates on the basis of different kinds ofe-i-berience in th. .o,rrrtry. To*ardi ihese objectives, we propose to

examine the following:l. How do people participate? What are the institutional. formal.

and informal structures and processes of participation?2. What are the effective instruments and institutions of par-

ticipation of people in the larnily planning programme? Doselected institutions work better for both motivation and'delivery system? What is the role of voluntary and local groupslike Mahilo Mandals. youth clubs. etc.?

3, What is the level of effective citizen participation in successful

cases a nd whf4. Who participates and who does not participate and under

what conditions is the participation more effective?5. What are the factors behind non-participation. and apathy?6. What are the policy implications of people's participation

both in terms of programme and administrative design to the

tffl1L?ff::li.'l?,il1 *uay reing the deveropment orerrec-tive modalities of people's participation in family planning we feltthat it was desirable to examine a series of successful cases ofpeople's participation through diflerent organisational instru-ments. Considering that only two broad models of citizen's par-

16 People's P4rticipation:in Family planning

ticipation in family planning-through panchayats ahil throughvoluntary agencies-are availablp in the country we . haveincluded in our study two.case stud[es of conducting family plan-ning activities with the help ofpanchayats and four case studies offamily planning activities of differefirt voluntary agencies working

. in different parts of the counrry. WE followed case study as well aisurvey methods for our study. HencN, while six cases under the two'broad models were studied a sarn$le survey of two good perfctr-mance villages and two poor perfortnance villages at the first stageof sampling and of eight acceptors and four non-acceptors fromgood performance villages and fpur acceptors and two non-acceptors from poor performance Villages at the second stage ofsampling was also undertaken.

In the panchayat model Gujarat bpilies one type ofexperiencein which attempts have been made io enlist people's participationthrough differeht oiganisational ingtruments at the Statq districttaluka antl village levels. ln the sirme model Madhya pradeshtypifies another experience in whicfr the village panchayats havebeen enlisttld recently in the deman{ generation network of familyplanning through awards and incefrtives.

There are different sets of expprience available among thevoluntary agetcies working in the freld in various parts of thecountry. Our aim was to choose sucbessful cases in different partsof the country so a$ to provide a nati]onal sample as far as possibleand to examine the socio-cultural vilriation in people's participa-tion in family planning But we hqd to choosi frorr among iheorganisations which responded fdvourably to our communi-cation.

Our choice had to start with theHealth and Family Welfare Trust

igram Insdtute of Rural

of Tamil Nadu, which entered the offanlily planning work asearly as 1959 with a five.year pilot project under the jointauspices of the Governments and Tamil Nadu, the IndianCouncil of Medical Research and

'f,he Jamkhed Proiect is another

.tried to involve the governmentalWe also selected for our studv

in the Madurai district

Ford Foundation.which has shown

and resources.Delhi Family Planning

remarkable results in a short one decade.The Vadu Rural Health started in 1972 by the King

Edward Memorial, Hospital, Pune,This is another kind of experience

also shown some success.which a private agency has

span

Objectives and Design of the Study l7

Associatio4 which is active in rural and semi-urban areas or theUnion Territory of Delhi as it would have provided insights intothe attitudeq beliefs and behaviour-patterns of the villagers livingunder the shadow of sprawlingmetropolis.

The study ofvoluntary agencies was easier than ofpanchayat3in Madhya Pradesh and Gujarat Selecting districts frgm Statesand panchayats from the districts was a difficult process. Theselection of districts and panchayats on the basis of their perfor-mance in family planning was made on the advice of the StateGovernment oflicials in both the cases. The performance of a dis-trict or panchayat in a State is normally adjudged on the basis ofthe fulfilment of the sterilisation targets given to them by theState Government

Thug in Madhya Pradesh we selected Indore and Dhar drs-tricts for our study. In Indore district Sanwer PHC was recommen-ded by the State government officials for our study. We selectedfour villages Ajnod, Kankaria Pal, Khan Barodia and DarjiKaradia-located in the jurisdiction of the PHC for the samplesurvey. Out of these four viilages. the first two were villages withgood performance and the last two with poor performance. The,fiIst-mentioned vilage, Ajnod. was awarded under the incentives.tcpanchayats scheme of the government of Madhya Pradesh. InDhar district we studied two good performance villages-Umarban and Bakaner-in Bakaner PHC and one poor perfor-mance village Mandava in Nalchha PHC.

The Government of Gujarat had suggested two good perfor-mance districts-Valdad and Kheda- Selection of villages from thetwo districts was made on thetasis of their record in family plan-ning maintained by the district authorities. In Valsad district weselected Rabra and Kosamba panchayats (good and poor perfor-mance respectively) in Chandvi PHC, and Hond and Alipore(good and-poor perfiormance respectively) in Alipore PHC. In,Kheda district Piplag and Hathaj (good and poor performance.respectively) panchayats under Alindra PHC in Nadiad Talukaand Bhadarenia and Harkhapura (good and poor pe'rformanceresBectively) under Dawol PHC in Borsad Taluka were selected.foi Our study.

Each of the voluntary agencies was studied as one unrt in termsof their activities with focus on their contribution in family plan-ning For sample suryey villages were selected in their area ofoperation on the basis of performance in family planning. In New

l8 People's P, in Family Planning

Delhi, where New Delhi Family nning Association is active,both rural arid urban samples were n. Fourvillages were selec-

Colony and Bharat Nagar,ted near Okhla-Okhla, Julana,Urban samole was taken from Parbat-an area near Karol

Rural Health and Family

their main area of activity. Hence, selected four villaees on thebasis of percentage of protected les in each of them. The com-bination of two good perfi (Chettiapatti and A.lamar-thupatti) and two poor perfi (Ramanathpuram and

here we well.Munnilaikottai) villages was mainSimilar, Dattern was followed studying the Vadu Rural

the study of the Project theHealth Project ofPune too. Apartvillages selected were Shikrapur Phulgaon (good perfor-mance) and Jategaon Budruk andmance)

le Jagtap (poor perfor-

Studying the Jamkhed Project easy, but selection ofvillagesaccording to usual combination ofvillages was difficult Since all the

and poor performancelour villages studied- BavL

Rajuri. Ghodegaon and Khandvi- more than 50 per cent cou-ple protection rate, we modified ouOur sampling pattem is'illustrated

sample pattern accordingly.

TABLE ling Pattern

State District/Proiect ViUagA Samplet

Bagh. The Gandhigram InstituteWelfare Trust is located in AmbathMadurai district in Tamil Nadu.

I Delhi (f[ New Delhi FamilyPlanning Associatipn

Rural

Urban

2. Tamil Nadu Gandhigram Insti$teof Rural Health addFamily Welfare Trlrst

village in Athoor Block ofBlock also has been

Table 2.1.

Okhla 6:23Julana 6:2Canal Colony 6:2Bharat Nagar 6:2Than Singh 8:43NagarNai Basti 8:4Punjabi Basti 8:4'Ha,rijan Basti

Chettipatti 8 :4Alamarathupatti 8 : 4Ramnathpuram 4:2*A"

Objectives and Design of the Study19

State Distict/Projea Wllagd Sampl?t

3. Maharashtra Vadu Rural HealthProject

ComprehensiveRural HealthProjectJamkhed

lndore

Munnilaikottai

ShikarapurPhulgaonJategaon BkPimple Jagtap

Ba.viRajuriGhodegaonKhandvi

AjnooKankaria PalKhan BarodiaDarji KaradiaUmarbanBakanerMandava.RabraHondKosamba.AliporePiplagBhadreniaHathajHarkhapur

,8

8

8

8

6

666

8

8+

4

2

4a,|

2

34

J

J

J

442z

44z,42I

4. MadhyaPradesh

5. Gujarat

Dhar

-Valsad

Kheda.4422

8

8

44

L2.

Acceptors: Non-Acceptors:

3.

The Villages with good perfoimance in lamily planning havea sample.ratio rif 8:4, while those with.poor p'erforrnu.r.i huu.a sample ratio of 4:2.Acceptors and .non-acceptora were interviewed in equal ratiobecause of equal level of performance in different ireas.Since the performance ofall the villages under the project wasquite high, we took the sample ratio of 6:3.

Sampling Cross.sectionTable 2.1 indic,ares the pattern of cross-section sampling in the

sample villages. Villages were stratified into nvo categorieigood

20 People's in Family Planning

:and'poor performance according to per cent ur more oI protec-50 per cent protection oftion of eligible couples and less

couples. Two villages each were from each category ofthecase studies on the basis oftheir brmance in family planningFrom a village with good perform ce, four acceptors and two.non-acceptors were interviewed the help of a strucrured inter'view schedule.

The respondents were selected onl a random basis. Our arm wasto interview fifty per cent males an{ Iifty per cent females in thecategories of respondents. But we not alwavs successful inachieving this aim because it was not always possible to find malemembers during the day in most nlrral families. The males nor-mally used to go out to fields for wofh or to weekly bazars duringthe day. In that case we had to imprdvise with female respondents.We have still attempted our best tq maintain the ratio. We alsokept our performance for couples i/l younger age groups (in bothcategories) rather than middle-aged couples. This was done inview of the fact that the future demqgraphic profile ofthe countrywould depend largely on the family planning behaviour of theyounger couples.

It was also 4ecessary for us tci define acceptors and non-acceptors. Our difficulty arose from the fact that it was not easy toensure that respoldent used contr{ceptives regularly. We there-fore, decided to accept only those aN acceptors who had acceptedterminal methods of family planni4g We also decided to take thecouples as acceptors or non-acceptors rather than individuals.This was done .because of unpopularity of vasectomy in. ruralareas,.which makes it difficult to hrtd male respondents who hadbeen stdrilized. Thereforq if one ofthe.spouses had accepted theterminal method wb interviewed bither of thenl whoever was,

availdble as the accbptor.We did not strictly go by the socloeconomic status of th€ res-

.pondenL Even so we tried our best tcj include various sections from

.the villages to give our sample a rqpresentative character.

Schedules and Interview

As described and illustrated earlipr, there were three (main) dif-lerent units in our sample-case $tudy, village and individualEach case was studied on the basi$ ofihe org-anisational detailsavailable with the departments or o{r the basiiof figures available

Objutives and Design of the Study ZI

with them as well as with the impressions of our research team.Thus no .structured schedule or questionaire was used for thesecase studies.

Villages were studied with the help of structured villageschedules as well as with the qualitative data gathered by ourresearch team. The village schedule was divided into six seitions(see appendix'A). The frrst section was devoted to the identifica-tion particulars of the village, vihile the second section elicitedinformation on demographic dethils of the villages. The insti-tutional information about elected and voluntary bodies and theirstatuq were kept in the third section Details of health care andfamily planning facilities were gathered in the fourth section oftheschedulq. The fifth section dealt with education and employment,while the last section was devoted to the participatory activities ofthe villagers.

The village schedule was filled up with the records availablewith the health and para-medical staff as well as with panchayatshnd school teachers Rest of the information was gathered with thehelp of the village elders. Haphazard way of kee'ping the recordsand vague information available with the village elders did createproblems for us, but we wer€ still able to get most of theinformation

Since our aim was to study people's participation in familyDlanning programme and activitieg we decided to study pai-ticipatory attitude of the people as well as their 'motivation forfamily planning with the help of a respondent schedule (seeappendix 'B'). Considering that participation is a graded activityand an individual does not.like to participate in all kinds ofactivitieg we framed a number of hypothetical questions to test the.respondents' attitude and drive to participate in political, social as.well as cultural actiyities Concealed among the questions on par-ticipatory attitudes were questions to test the respondents' attiiudetowards participation in health and family planning activities.' The second section was designed to tesi motivatiJn of the res-pondents towards family pldnning- A number of indices, like thefrequency of a person's visit t<i a family planning centre, whetherhe took doctofs advice on family planning whether he/she wasadvised by some to accept family planning etc. were used to test.the respondents' motivation.

The third section was devoted to the person's family planning.behaviour. The indices used were number of children, whlther he7

22 in Family Planning

she wanted more children and the numberof children he./she

considered ideal and whether he/The fourth section was devo

the respondents.The two sets of questionaires ire pretestod 1n the tield and

the light of lield response"some modifications were madeA good part of the material in facl collected during the

course of interviews with various fficers responsible for impl+menting plan programme at the ict block and village levels

for which no structured was used. Similarly, alot ol

e used. contrac€ptives.to personal particutars of

information was collectedwith persons engaged withible for success of theirform ofdiscussion notes for whichused

The interviews were conductedwith the help of investigators. In

our research team as well as

the iqterviews were con-ducted by an investigator emp for this purpose on an adhocbasis. In lndore and Dhar also an investigator who knewlocal dialect was employed S Hindustani was also widelyunderstood and spoken in theseducted interviews. In Tamil N

villages. In Pune interviews were c

with the help ofthe research statf

interviews and discussionsorganisations and respons-These were collected.in theschedule/questionnaire was

ducted bv our research teamthe KEM Hosprtal Pune. At

our research team also corrit was not possible for our

research team to interview any as neither member ofthe team knew Tamil. Hence, local investigators were hiredwith the help of Gandhigram te of Rural Health and'Femily Welfare Trust and they interviews in all the four

Jamkhe4 the social worker ofteam. In Guiaral the interviews

project helped our researchconducted with the help of

the Block Extension Educators and the Districi Extensibntric6 r€spectlvely.Educator in Valsad and Kheda

The field work was conducted in New Delhi in January anddistricts of Madhya PradeshFebruary 1981. Indore and Dl

were studied in March li8l. Gandhigram. Institute inMadurai district of Tamil NaduPune aird Jamkhed Proiect were

adu Rural Health. Project ated during May-June, 1981.

?he districts of Bulsar and Kheresearch team in September., l98l

in Gujarat were visited by ourtr

Chapter UIVoluntary Efforts inFamily Planning-f : New DethiFamily Planning AssociationFFI HE New Delhi Branch of the Family Planning Assirciation of

India (FPAI), one of the 46:units of the FPAI in the country wasestablished in 1962 s.ith the objectives of disseminatingknowledge and education of family planning among different sec-tions of community, promoting its adoption and practice and givecounselling services to individuals and couples on fertilityproblem.

The association commenced functioning in 1962 with the.grants-in-aid from the Ministry of Health and Family WelfareGovdrnment of India. It started with an information and Educa-tion unit a male sterilisation unit and a sterility unit for treatmentof childless couples. For spread of educational and clinical ser-vices at the doorstep of residents a mobile clinic was also startedIn lp64 loop insertiort and in 1966 oral pill programme wererintroduced through the mobile clinic. From 1968 onwardsdemand for female sterilisation began to increase and a rhreq.bedded tubectomv unit 'was established in 1970 with inputsreceived from the headquarters of Family Planning Associatronof India. Tubectomy facilities were expanded by openirig a l0-bed<led comprehensive clinic in 1972 and later to a 15 beddedclinic.

The New Delhi Family Planning Association introduced population education programme in 1970 for creating awareness ofpopulation control among young people. In 1971 when the

'bovemment of India enacted 'Medical Terminatiori of Pregnan-

cy' for liberalising abortion, the New Delhi Family Planning

,Association arrailged for providlplanning services were'integratedservices for enhancing family/co

in Family Plannins

this service. In 1976 familymaternity and child health

unity .weffare. A family lifeand marriage cdunselling unit set up in 1978 for coping upwith the psycho- $exual problems in the community as aresult of implernrentation ofindustrialisation

planning programme and

Realising that family planning in isolation was ootlikely to make the desired on population control untilsome economic development.. prAssociation raised a number of

were launched the

operational areasiin 1979 forand child welfare programme atance of small farhilv norm and

encouragng accep-pare nthood For pro-

viding services to rreet the needsutilising its volunleers and staff,

people the Association startedexperience, skills, and

abilities in collaboration withwelfare and development

In order to EralntainAssociation started providing

character of programmes, therrmation and education for

uar Pmgati Mandab in itssocio-economic, mater_nity :

organisations e.ngaged inr for the commuhitv.

family planning pnd clinical serTrans-Jamuna area from one unittion to undertaki4g the variousin 1980 $owards raising the sti,upliftment programm€s byMandqls. As coovpntional femaleexpe{rse (becausq ofsterilisation by l4paroscopyduced

Illethod ofWorf

to the people residing inlished in the area. ln addi-ifs activities were directed

of womea through economicmore Pariwar Pragati

involved risks andand cxpensive medicines),was' proposed to be intro-

Lme and formulate suitableand information that

a population of 2,71.000.

by staff of Informatlon andrctioned proj6cts-a) Informa-in the ollice preriises of the

Voluntary Efrons in Family Planning-I: 25

rAssociatio4 b) Cis-Jamuna Area comprising Anand parbdt, aruial area of Okhla/Temur Nagar, New Delhi South-East villagesand organised sector and c) two urban and semi-urban .family

welfare centres comprising of Rashid Market, Kridhna Nagar.Ghonda, Raghubarpura and Bholanath Nagar in Trans-Jaminaatejd-

Major activities of the Association were aimed at mobilisinglocal community leaders for understanding needs of the com-qynity, making faniily planning services available and makingeffective use of mass communicatibn measures to establish a rao-port with the community. The Association thus took effectivemeasures for training local leaders, production of audio-v,iusualaids like slides, charts, posters, pamphlets, etc. to establish com-munication with community and establishing and keeping thesupply channels functioning regularly for distribution of conven-tional contraceptive.

To achieve these objectives, the extension workers were instruc-ted to make a survey of the population to identify eligible couplesto compile a register of the eligible couples and acquaint thim-selves with the localities preparing detailed maps. The workersoperated at (i) macro level by arranging frlm shows, massmeeting$ cultural events and exhibition etc, and (ii) at micro levdlby group discussions, personal contacts/counselline and follow-,up visits A feasibility survey was undertaken to idenilfy the accep-tors of family planning and ro get themselver acquuini"d *ith thedifficulties that might be faced during motivation of ' thepeople.

At the individual level Extension Workers established con{actswith the households. Married members of the reproductive age-group were. approached after the Extensiofl lvorkers classified thesurveyed households into the following categories:

(a) those having three or more children;(b) those with two children;(c) newly married and without(0 sterile.E4phasis on motivation and

a child; and

advice varied with each of theabove categories. Thos0 in category (a) were rcported to need.stronger motivatioft€nd greater altention. The Extension Workersought the help of acceptors. local leaders and doctors in convinc-ing suth people. Those with two children were considered poten-tial acceptors, if convinced properly. Entirely different arguments

Peop le's lartici p a t io n26

for acceptance offamily planningnewly married couples and for tt

tain interest of the people, follow-undertaken so that the couple did

in Family Planning

were neaded for thenot having any child They

were advised to visit family centre$ get themselvesexamined and seek advice from e medical doctors.

Credibility of Extension W was considered very impor-lant if the motivation was to be The Eitension Workers.thereforq had to maintain visits to the area. Interest of thepeople was likely to wear out if emphasis was always focusedon planned farnily, i etc. The programme.therefore, adjusted and new es included in it toand sustain the interest of the le. lntegration of health careprogrammes! nutrition p es and other programmes foreconomic development of ho and families was under-takbn and supplemented'with th planning programme. To sus-

p actions of programmes were

some time.

Services of the Association

give up contraceptives after

Clinical services in support of planning programme areprovided through (a) a comprehclinic funded by FPAI since Juiy. 1972, and (b) two urban family

model family planning

welfare centres funded by the ent of India with effectfrom April, 1978. The com e model family planningclinic was designed to intensify e family planning programmeby providing all services like ion and education activities,maternal and child health and cal services of IUD insertiontubectomy and vasectomy as well as medical termination of ore-gnancy while the urban welfare provided information ser-vice. carried out IUD insertions undertook MCH work for

of the centres. One of thesepeople residing in the allocatedcentres was located in Raghu hola Nath Naear Com-plex providing vasectomy and the othet centre was keptmobile to visit remote pockets of in areas alloted to theAssociation for $ving family cover:

The NDFPAhas been ing MCH activity since its veryinception in 1962. Introduction mobile clinic for undertakinesuch services consolidated the on's activities by offeringa broad-based care programme in areas thereby providing

was,held

additional incentives by wav of care to mothers before and

Voluntary Effons in Family Planning-I: 27

after pregnancy and to their children rill rhey attained school-going agE Thls approach considerably enhanbed the motivationto accept family planning

The two centres that were established were manned by a VLWwho provided services under the supervision of a mdeical oflicer,,equipments being provided by FPAL Immunising agents, antianaemics and supplements were supplied by the State Gdvern-ment whereas medicines and dressings were purchased fromFPAI grants. Routine medical check-up of expectant/nursingmothers and their children and advice (including referred) to out-door and in-door specialised treatmen! treatrnent of minorailments and injuries affecting women and childre4 immunisa-tion of infantg preschool children and expectant mothers against'specific communicable diseases like Diptheri4 Tetanus, PertusigPolio.myolities, Small-pox, Cholera and Typhoid etc. administra-tion of anti-anaemics (Iron and Folic Acid).and nutritional sup-plements like Vitamin 'A' concentrate etc. made easv themotivation of expectant and nursing mothers for acceptance offamily planning Health education of mothers in feeding .nutri-tion and other aspects ofhealth care and baby sHows to inculcatecompetitive spirit among- mothers and follow-up of. growth ofchildren by maintaining weight records, etg brought in expecra-tion of long like to existing childron" Nutritional demonstrationwas periodically arranged to.teach mothers simple methods ofcooking presewation of fruits and vegetables so as to enhance thinutritional status of the familv.

The N DFFA Introduced ilinrcal services for chirdless couplesin a place adjacent to the family planning clinic. Availability ofthis service under the same roof where the message for fertilitycontrol was disseminated, strengthened credibility of the NDFPAMedical check-up, investigations and treatment for appropdatecases of infertility and their follow-up by home visits by socialworker enabled the Association to win the confidence of people.Increasing number of repcirted pregnancies as a result of treat-ment added to the credibility of the NDFPA

Realising that family was subjected to considerable stress andstrain as a result of rapid social change and implementation of'family planning programmg the Association established aFamily Life and Marriage Counselling Centre with an objective toproviding curative as well as preventive services for proper adjust-ment and harmony in family life. The Centrd offered services of

28

irained ano comdetent Psycland anxieties in accepting dialso organised conferences.different aspects of family lifeeffect of stress sltuation in lifeadjustments for improvingmaladjustments formed thefamily life. The Association feltcounselling servicrs considerablyplanning by the people.

The Associatiorr alsoregarding the prossure ofquality of life in homg localityof the advantages of a smallneeds, availability of nutritioushygiene etc. were emphasized inmen and women of differentexposure to population educationpotential acceptofs of familY

ln 1975-76 the New Delhi Fadjudged the best voluntaryformance in the field of familyPlanning Awards Committee of

People's Response

The Extension workersponse to the progfammes of thebe both enthusihsdc andaccording to thefrr,.varied due toeconomic statu s qf the populatio[able and spont4neous as theeconomic scale. Many persons atbe hostile to the programmechildren were asset to theineome. Slum dwellars were iheshared this idea. The cost-benefithigh as the cost bfbringing upbenefits of contribution of incowas relatively higtr

The level of education also

Pmple's in Family Planning

to those manilbsting fearsfamily planning methdds. Itions seminars and talks ona view to prevent the adverse

the family and promoteof life. Sex education and sex

point for many problems offamily life and marriage

in the adoption of family

a centre to educate the youthgrowing population on and

neighbourhood Appreciationin relation to basic human

balanced diet persolrale training courses of Young

The NDFPA felt thatgreatly influenced the

Planning Association wasin terms of over-all per'by the National Family

Government of India.

found mixed popular res-People were found to

t The People's response,varietv of factors like socio-

response was more lavour-moved up the socio-

bottom of the scale seemed tothey thought htat more

as they added to the familyamong those who

of children was consideredwas very low while the

to the family by the children

individual's response.

Voluntary Eforts in Family Planning-I: 29

The workers had happibr experience with educated people' tackof education" they pointed ou! certainly created difficulties' Iilos-

tile reaction normally came from those who had individualisticcppproach to life. Some people, the family planning-woikers repor-

;ed, "nett arg,red as to why the Government shou-ld be concemed if

[rt.y-p[a"i"a more chiidren, as they and nof the Governinent

lvould rear up and feed the childrenThe Extension Workers, however, did not encounter any

drganised religious opposition to the Dro$amme in Delhi In fact

on-e of tbe most successful cases.was that of Muslim'majorityvillages near Okhla Even if the degree of resistance was high

' among the Muslims, if approached in proper manner and convin-

ced gradually and symphatetically, they also accepted the pro-

grarome. In one of the cases, for examplg a Muslim ladyapproached a lady Extension Worker for IUD insertion' The

Worker, in order to suppress her enthusiasm, advised her against itas she had only two children. The lady told the worker that she

wanted to be protected by IUD because she did not want to give

birth to richshaw pullers and tonga pullers (Muihe ricksheywaley

aur tangy waley nahin paide karne).

Rajasthani immigrants were reported to be apprehensive ofcontraception A little apprehension was also noticed among ttie

Catholics. The family planning workers of the Association feltthat hostile and apprehensive reactions changed and even became

' favourablg if the people were tackled with tact, sympathy- and

restraintResponse was not at all favourable in the organised sector'

Though the management took interest to offer incentiveq it didnot really make much difference' If the incentive had a long term

impac! then perhaps they could become effectii'e; monetaryincintives did not work in many though it acted at times.

Centres of NDFPA

The Centres of the NDFPA are located in Anand Parbat' rural

areaof Okhla/Temur Nagar, New Delhi South East villages and

organised sector and lvo urban and semi'urban family welfare

ceitres comprising of Rashid Marke! Krishna Nagar' Ghonda

Raghubarpura and Bholanath Nagar in trans-Jamuna area'

in each of these centres the Association offered family plan-

ning as a package aloog with a broad-based health care pro'


care and care of the children

clinics in these are4s opened oncelarly given artention. Theirweeh but door-to-door con-

tact and distribution of by the Extension Workers.continued on other days of the as well.

In each of the Centres, the ion has been able to over-come initial resistance and apathy. have since gone beyondhealth care and tamily planning d have started playing usefulrole in the socio-economic life o peoplg especially women in.these areas Paiwar Pragati organised by the NDFPA in'these

areas has almost broueht revolution in these areas bythey claim. is amazing In.conscientizing women. The

,Anand Parbat are4 for instancq e NDFPA claims that it hasr

30

gxamme. Ante.natal and post-under five fears 0f age was l

brought down average irumber ofcin 1980. A reduction of 50 per cent

dals convened r4eetings of themothers-in-lawagreed to allov/ tand look after the children in theircould add even Rs, 50 per month to

dren from six in 60s to threeabout two decades. Besides.

ers-itr-law. Most of the:ir daughters-in-law to go outbsence if the daughters-in-lawl

family income. Some of thebefore their eyes. In Anand

involvement of women intheir status in family.

Pariwar Pragati Mandal

activities improved

The NDFPA decided to Pariwar Pragati Mandals, amultlpurpose social organisation women in its areas of ooera-iion when they realised that the of fertility control wasnot likely to succeed unless realised its imoortance andcame forewar4 atd the womenuntil they suffered subordinate

not likelv to come forwardin family structure. The

insJitution was aLso aimed at pimage.

dins a boost to their self-

Starting with sdcio.cultural like organising picnics,festivals and playg they switched activities like stitching gar-ments, knitting woolens, preparingNDFPA helped the Mandals in

, pickles and syrups. Theng and operating bank

accoultt, securing orders and m finished oroducts.But the activities of the required. being away from

home foi long hours and soon the others-in-law started obieccing The Extension Workers inatine activities of the man-

member;.wanted to keep the

Voluntary Elforts in Family Planning-I: 31

Parbat the local "Chaudhary" lent.space in a local dharmasalafree of charge for starting a nursery school. Two young girls wereemployed by the Mandal on a small honorarium to look after.andteach the children.

Paiwdr Pragati Mandals not only proved an economic success,they were extremely successful in motivating not only their mem-bers but the entire family of the members. Eversinc,e the womenstarted augmenting lamily income their voices were heard andcarried weight in their families. This also enabled them to makechoice about family size. The Mandals thus proved to be catalyticagents in every sense.

Performance of NDFPA

The NDFPA thus, has been able to enlist significant com-muhity participation in its programme in all its ar'eas. The impactof cornmunity involvement is clearly visible on its target achieve-ment in health and family planning held*.As compared to DelhiAdministration target achievement of the NDFPA has beenvery impressive

In the year 1979-80, wtren the fa.mily planning prograinme hadstill not recovered from the stigma of the emergency,.the Associa-tian was able to achieve 116 per cent sterilisation target, 197 percent IUD insertion target and 183 per cent in Conventional Con-traceptives. In comparison the Delhi Administration was not ableto go beyond 48,?8 and 49 percent respectively. On the otherlland,the Association's achievements exceeded targets in 1980-81 aswell. The Association also turned out an impressive performancein immunisation.

Trends in Sterilisation

The sterlisation data of the Association lor males and femalesby number of children and literary standards is quite revealingVascetomy according to age and number of children (Table 3.1),for'example, points out that almost two-thirds were in the agegroup of 30-39 years. That means that most of these would havethree or more children. In fact, about 68 per cent had more thanthree children and one third had more than four children. Thedata, which is for 1980-81, clebrly shows that the NDFpA still has a


lot of ground to cover. It could mchildren for sterilidation. This is

only 27 fer cenfwith twoto sav that the achievements

of the Associatign is in anY waY It was pointed out that when

the New Delhi branch of the FPAI its operation six-childhave brought to it down to

data Two-thirds of thosechildren

TABLE 3.1: Vasectomy.Number of

to dge and

* . Tqtal Percenlgge

3 0.4767 r3.st94 30.41

198 3r.03w 16.77

49 7.68

Total 170 255 638 100.00

lPercentage 0.31 26.65 34.97 3 100.00

Looking at the vasectomy data the NDFPA for 1980'81 bY(Table 3.2) we realize that

were matriculate and

family was the nogn TheY claimthree. It is partial$ suPPorted bY

tvase€tomized had a maximum. of

Age Group(Y"r,)

20-2425-263G343'39404545+

l2L!37

47N

125

J

4980

3610

4IJ

abovg and.only 7.2 per cent of were illiterates and about 40

per cent were matriculate and,kage between education and t

This data establiihes a lin-my. Over 90 per cent of the

vasectomy acceptors being literate highly educate( and twc,

,literacy status of husbands andmore than two-thirds of those

thirds of the wives being in this cator literate person ip easier to conv:steril-isation The full importof this

we look at the tubectomy figures byto rthis discussiorl

The figures of tlrbectomies byIirms the trend indicated by similttwothirds of women opting for tu

. shows that an cducatedabout the 4erlts of male,

lata can be unoer stood whentGracv. We shall come back'

and parity (Table 3.3) con-figures on vasectomY. O'tier

age-ies were in 25-34

Voluntary Efidrts tn Family Planning-I: JJ

group atro'had ibunplus children In fac! over 90 per cent had,morJ than three children. The implication of these Iigures for the'NDFPA is very clear. The figures also indicate the tough task that '

lay ahead of them. They must concentrate on young€f age'gxoup

and couples having tl'o childieir"-Wh€t[er th-ey sh0ukl eniphasize

TABLE 3.2: Distribution of Vasectomies During 1980'.'81

by LiteracY

LiteracySmtus

Wife Husband

Pencentages Percmtage

IlliterateLiterate

,.Primary

MiddleMatric/Hr- SecondaryGraduates &.above

662

'100

l923r

2W2

7299

t49r07

32;160.31

tI.2915.52

23.3516.77

7.21

9.72

15.67

31.19

36.21

Total 638 100.00 100.00

TABLE 3.3: Distribution of Tubectomies During 1980-81by age and Parity

Age Group'(Yn)

No. of Childn

4+ Urr!.gsa__2U2425:2930-34

_35-3940'4445+

8.0938.6335.0416.79

1.37

0.08

106506459220l8I

@37178 306108 337

29 187

315I

5

22t44

,Percentage 29.16 67.40 100.00

100.00382 883 1310

34 People\ in Family Planning

be carelulty decrded- Theto use their discretion moretake into account would be

husbands and wives.and tubectomy by literacy of

thble i.4 showd that half ofilliterates. One third of them were

the sterilized women wereupto middle school

level The education level ofsuch was thus very low Look-ing at the literary status of their h though only about 20per cent were illiterate, over one- were educated only up tomiddle and about one.third were A mere ten per centwere graduate an{ above. It shows : of female steriliza-rtion among illiterates and ted class.

TABLE 3.4: of Tubectomies bvLiterary Status of and Husband

LiteracyStatw

vasectomy or rubectomy shouldExtension Workers, thuq would Icarefully. The factors that they mclear when we look at the vasector

IlliteratesLiteratePrir4aryMiddleMatric/Hr.SecondaryGraduate &

This trend is fuither confiirmedand tubectomy datq (See Tables 3.2

.we compare vasectomy

50.

l.

I

I4.

657

t7263185

143

45

26rt2

220267

419

131

Hr,.chaid.

Percentage

19.92

0.9216.79

20.38

31.99

10.00

thirds husbands in vasectomy beingthan half the husbands in the tubr

3.4). As cornpared to two-and abovg more.

group we re educatedonly upto middle. Slmilalry as to over4O per cent of thewives in the vasectomy group being and abovq above

,E5 per cent of the wives in theup !o middle. Interestingly, n

group were educated onlyhusbands;t!61 about o_4qtwo implications of thesethird of both the groups. There

Voluntary Efibm in Family Planning-I: 35

figures. Firstly, the bxtension Workers should carefully use theirdiscretion before motivating a couple for a particular terminalmethod. Secondly, if vasectomy has to be popularised the illiterateand moderately educated will. require greater motivation.

People's Participation

The basic strategy of the NDFPA from the very beginning hasbeen to enlist active co-operation of people in their programme ofpopulation control. But their major difficulty arose from the factthat family planning being a programme involving changein rep-'roductive behaviour of human beings touched a very sensitiveaspect of an individual's life. and any ingression on this aspect islooked upon with suspicion. Realising that co-operation and par-ticipation might not be forthcoming because of these reasons, theNDFPA decided not to present it as.an isolated govemmental pro-gramme but as. an integrated package together with MCH and

, family welfarg which . also incltrded socio-economic pro-grammes.

Gradually, people's co-operation sought by the NDFPAtransformed itself into active participation as MCH program me ofthe Association brought down infant mortality and their socio-economic programmes not only added to income of the familiesbut it aho had a positive impact on the status of women in its areasof operation. The conscientization of illiterate.and semi-literatewomen has been able to create a lasting impact on the totalprogramme.

In facl the fay-reaching impact of the activities oforganisationslike the NDFPA can be seen in terms of creatioq of a belief ingovernment that a coordinated approach involving governmentalf.and voluntary agencies may be able to convert family planningfrom a governmental programme into people's movemenl The

. large.financial contribution by the government to the NDFPA isperhaps a realisation of this facl

Sampre Survey in Anand Parbat, New Delhi

Anand Parbat is located near Karolbagh. the first suburb of' Delhi and now a busy market place. Since the area is located on a

hilloch the area has been named by puffixing p arbal lmountain othill). Though anaid (pleasure) prefixes parbat, the locality does

36 People's

not provide any pfieasure to virslum. A number cif authorised--.^-l-^L^- ^.Il +^ rL- *:.-;66

services are not inaccessible for th

in the city offer protectionDelhi branch of the Family

clinic operates on Tuesdays. Theworkers of the NDFPA visit the

dom sampling for conducting athe research design. The demplanning profile 4re given in tab 3.5.

TABLE

Area Popu-lation

in Farhily Planning

The entire area looks like aunauthorised industdes and

Association of India also

le survev in accordance witihic particulars and family

c Pxifile

Planning Accepton

Others Tonl % age

63 3ll 4

workhop add to:the miseries of residetrts. These are also.

however, a source of livelihood I

Beiig locitbd in the heart of t.

many of the residents.

Delhi metropolis, health careresidents. Apart from the dis-

pensary run by the Municipal Co ratio4 a numbdr of hospitalsserious ailments. The New

provides health care and family p services. Their weeklyon Educators and other

four times a weekFour areas in Anand Parbat bi Basti, Nai Basti, Harijan

Bacti and Thansirl3 Nagar were st at the lirst stage of ran-

IUD Niro-dh

PunjabiBasti 4525

NaiBasti 8703

702 168 66

1518 138 1.14

36 49

223 233

67 35r

JJJ

106 390

270246'

l2t 28

12 g& 44

I4

Harijan'Basti 3325 428

Than- 13680 2182singh .

Nagar

Thansingh Nagar had the population of the four areas

and Harijan .Basti the smallest Harijan Basti where onlY28 per cent of the eligible couples e protecte( rest of the areas

some or the other methods of.stl as gooo peflornance area

had 44 to 46 per cpnt protectioncontlaceptioIL Wa took Harijan

Voluntary Eforrs in Fainily Planning-I: 37

because the NDFPA workers us assured us that a large number ofeligible couples had agreed to accept the terminal method

Table 3.6 presents numbers of serviceable couples by age ofwife and number of children in four sampled areas. Of the 3583serviceable cbuples identified by the NDFPA in the four areag

TABLE 3.6: No of Serviceable Couples by Age of Wifeand No. ofiChildren irr Sampled Arbas

ASe of ,

wife

No. of living children Semiceable Couplds

3 4+ No. Percentage

3651275899513

361t70

r0.235.625.1

t43l0.l4;l

272 80 lt 2380 475 305 90 2596 154 276 220 15338 48 108 t26 19325 30 43 77 186ll 14 13 28 104

l5-192U2425-2930-3435-39M

Total 822 .801 7s6 543 661 140

Percentage 22.9 22.4 2l.l 152 18.4

one third had more than three children Of tne rest of the t\ilo-thirdg about ond-third had yet to have a chil4 and the rest werealmost evenly distributed between one and two children. Thisindicates that the crucia!. section for the NDFPA s family plan-ning programme in this area are nearly 45 per cent who neededencouragement on spacing methods and over 36 per cent whoneeded notivation for terminal methods. While those with four ormore children (18.4 per cent) also needed motivation for terminalmethods, a majority of them were already nearing the end of rep-roductive age In terms of age group 15-24 seemed to be the mostcrucial for'spacing methods and 25-34 fior terminal methods.

The entire area rvas inhabited predominantly by Hindus(mostly displaced persons from West Pakistan) with some Sikhs.Therewere3500 Hindus(77 percent) and9@ Sikhs(23 peicent) in

r00


Punjabi Basti 73f,3 Hindus (92 cent) and 909 Sikhs (23 percent) in Nai Ba*i ll26"upper (32 percent) alrdz,4nschcduled caste liindus 96t per in Harijan Basti and 11,700

(13 percent) arid 1942 otherHindus (75 per cent ) and 2053 Spersons (12 per cent) in Nagar.

The people irt this ar6a are nottrro national partieq the Congressthe are4 political, participation is

active politically. Thoughand the CPl. have offices in'

tion, only a miniscgle minority is ito electoral participa-

actively in politics. Thel9E0 Lok Sabha rvitnessed heaw turnout in the areawhich reflects political of the residents. But since

tan Council and thedissolved and suoerseded

in 1980, there was no opportunity participation in local elec-tion Absence of local bodies hi _also had adverse impact onpolitical activity.

As far as voluntary social activrties were concernedPaivar Pragati Mandals were found be very active in all the fourselected areas. The New Delhi Fa

both the local institutions, theMunicipal Corpoiation of Delhi

fac[ gave fillip to their activities.

Kalybn Samiti in Harijan Basti

from adjoining areas availed of thea mobile dispensAry to Nai Basti

Planning Associatioq inwas one Nacftc hitar Samaj

There was one Harijanwas found to have good

ities. While weekly visit ofided the facility for treat-

Seva Dal which was very active in iabi Basti not only amongthe Sikhs but also among the

influgnce over the local Harijans. I reported to work very well.The New Delhi Family Association extended its co-operation to these Samitis.. There was one Adult Education Centre working in ThansinghNagar. About thirty to torty were reported to make use of

have any such organisation.this Centre. Harijan Basti did.noYy'orden were in the other three le Bastis were active in theNDFPA sponsored Pariwar Mandal.

Puniabi Basti had the facilitv of allopathic, unani and Ayur-d Harijan Basti had only anvedic dispensarywherdas Nai

allopathic dispen$ary each.dispensary in addition to a

Nagar had an allopathiction centre of the Municipal

Corporation. of Delhi In additionNDFPA provided treatment to the

the central dispensary of thepeople of these localities. TheBasti twice a week and peoplemobile van dispensary came to

meat of ordinary illness in Anand arbat are4 people. had to go to

Voluntary Efons in Family Planning-I: 39

bigger hospitals in the city for chronic illness or specialmedical treatment

The NDFPA also assisted trfa chchitar Samai Seva Dal of pun-jabi B4sti to maintirin a health care and family planningblinic. Byoffe4qg healtli care facilities the New Delhi Faniily planningAssociation has been able to maintain close coltacts with the peJple of the sample localities and mobilise peopie's participation infamily planning. The NDFPA delivers the family planning ser-vices in all the four selected areas.

One Extension Educator, three social workers and one volun-Fary worKeruslted PUnJabi Basti thnce a weekwhde one ExtensiofiEducator, rwo social workers and one voluntary wofkei werereported to visit Nai Basti daily. One Extension Educator. threesocial workers and one voltrntary work"i lririte,t Harijan Bastitwice a week while one Extension Educatot two socral workers anetone voluntary worker went round the houses in Thansingh Nagarfour days in a week Thus communication between the househoidsin one hand and the para-medical staffand social workers on theother was made easy.

The Extension workers identified the potential acceptors oIfamilyplanning by individual contact and sought the help oflocalleaders, prominent persons or members of paiwar pragatiMandals. Contacts were established at individual and gr6uplevels.

For contacts at the group level lilm show and mass media wereused Screening of films was popular in all the areas. Massmeetings were rrot frequen! but small group meetings wdre fre.quent they were held once in a month in rotation from area toarca. Pariwar Pragati Mandals organised these meetings once a*eek in.each locality. Screening of lilms on family planning wasreported to have been seen by 500 to 700 persons while smallgroupmeetings were attended by 1.0 to 20 persons.

Naihchittar Samaj Seva Dal maintaned a primary coedu-cational school in Panjabi Basti where 50 children receivedrudimentary educetion- Nai Basti had three primary schoolg oneofwhich was a government school About 950 boys and girls were.reported to attend these schools. Municipal Corporation of Delhi

. maintained a primary school in Harijan Basti where 300 boys andgirls received their elementar! schooling In Thansingh Nagar theMunicipal Corporation of Delhi maintained a primary school

. with several sections attended by 900 boys and girls.

q People's P, in Family Planning

Characteristics of Sample

As stated earlier, the entire tional area of New DelhiBranch of Family Flanning of India in Anand Parbatwas treated as a good performance area and as such eight accep.tors and four non-acceptors were lected randomly from all the

made to have a cross-sectionups, income brackets, caste$the respondents in this sam-

four selected localities. Effortsof respondents representingoccupations and literary groupsple were male.

Estimation of income of the of the households was. $ot they wanted to hide it, butdoubt a very difficultjob. It was not

being mostly self-employed, they estimated their income bymonths or years. Salaried peoplg owever, had no difficulw ingiving out their income. Table 3.7 the distribution of annualincome of the sample heads of households.

TABLE 3.7: Economic of Respondents

Annual Income(Rl

Acceptors Non-Acceptorc

No. PercentageNo.

0-10001001-20002001-30003001-,10fl)4001-500q5001-60006001-70007001-80008001-9m

1

II)5

9I9I

6JJ

10

l628

J

28

3

2z

;43

J

l3l3

IJ25l8

18

100100

This was not a h.igh income area. majority of the respondentsboth acceptors and non-acceptors in low or. at the most inmiddle income category. The concentration of both accep-tors and non'ac$eptor's (over fiftybracket This falls ln the middle of

cent) was in Rs.300l -6000ten slabs created by us for

Voluntary Eforts in Family plannmg-I:41

:grnpylStiglpltlposes. This shows the income range of the clien-tele of the NDFPA" and apparently they seem to beltriking at thenght point No wonder, they have had to put emphasis oneconomic unliftment programmes.

TABLE 3.8: Age-Group Composition of Respondents

Age Group(Yrs)

Acceplon Non-Acceptors

No. Percentage No. Percentage

638JI25

I65

4

65038

6

zl6t22

z0-2425-2930-34i5-39

Total100l610032

Age-wise our respondents were in 20_39 age_group. Half of theacceptors were in2S-29 agegroup and anoiher3-g peicent in 30-34age.group. Similarly. 69 per cent of the non_accepr.i., *.r" in UJ-J4 age'group. our data in this area therefore, is rikely to revealparticipatory attitude of a group of persons who are crucial forfamily pla_nning programme. ti is atso likelti;;e revealingbecause 25 per cent of the non-acceptors were in 35-39 afgroup.

TABLE 3.9: Educational Levels,of Respondents

Educational' Standard


No. Perceniage No. Percentage

IlliterateMiddleMatic/Hr SecondaryGraduate andabove

I5

l39

43

6JI

25

38

q

38

l3

l2

Total 32 lm l6 100


More than threelburths of the s{mple respondents with educa-

thirds of the total flon-acceptors some levels of education. Infact t\e non-acceptors with educalion upto the middle standardand rnore formed 94 per cent of tlie sample (See Table 3.9).

The locality consisted mainly of Hindus, Sikhs and scheduledcaste with very few Muslim The NDFPA was able to:nlist ceoperation of all religiong groups and Hindusand Sikhsweie equally reieptive to the of family ptanning Harijanswho were earlier reluctant were fi now and HariianBasti was highly responsive to the message of family Planning

Participatory Attitudes

tion of rrqtriculation and grthe category of acceptors of

of shortage of essential commoraosence ofa high school apparently

levels and above belonged toplanning against about two-

and drinking water orwas no dillererice bebrcen

The reaction of the respondentb to participatory questlons i[Anand Parbat are a of New Delhi confirms our sub-mission thatparticipation is a graded activity. The responses indicated willing-ness to participate in activities accohding to preferences and needs.Willingness of over 90 per cent respondents ( ol both categories) todo something about shortages c|f esse ntial commoditie s and..drinking water shbws their preferi:nces Similarly, their willing-ness to do something about'havidg a school opened or help aschool teacher to gather pupils showed that the area did not haveadequate. schoolirrg facilities A large majority of them alsodemoristrated willingness to participate in health and family plan-ning activities (riee Table 3.10).

The acceptors and non-acceptois demonstrated similar as wellas different participatory attitude. pn issdes of commdn interesfthey displayed qimilar attitudq,while on some critical issues thedillirence between them was noticeable. On the questions !

the attihides of acceptors and nori-acceotors. Similarly the dif-Isrence was not much on most ofr

ptors, DrmuaflY Ine 6rI-political parucipaflon In

fact more non-acceptors in election campaigns thanacceptors. Not -surprisingly, on qu_estions relating to this

50), 13 (9G68), 14 (93, 68) and,24 (78,50) the difference in theattitudes ofacceptors and non:accOptors is more than 20 per centThe difference is marginal only in question T which relate to visit-

study; ie.. those dealing with planning vtzT (68,72),8 (75,

Voluntary Efions in Family Planning-I: 43

ing a neighbouring village/ward to see a film un familyplanning

TABLE 3.10: Participatory Attitude of',Sample Respondents

Participatory Questio ns Percentage of RespondentsAlfirminS

Acceptan Non-Acceptors

1. If there is shortage of essentialcommodities (keroseng sugar,fertiliser etc) in your village/ward, would you make efforts to' make these commodities availa-ble to your village/ward ?

2. If there is shortage of drinkingwater in your village/wardwould you make efforts to makeit available?

3. Ifthe neighbouring village/ward has a school, whichyour village/ward does not have,would you make effods to get

one opened in your village/ward?

4. If a family planning camP isbeing held in a neighbouringvillage/ward, would you go

there?5. Would you also make efforts

to get one such camP heldin your village/ward?

6. lfa hlm is being shown inthe neighbouring village/ward would you'go thereto see the film?

7. tf ihe film being shown inyour neighbouring village/ward is on family planningwould you go there to see

9396

93

93

100

92

43

37

8'1

7l

75

7l

68 62

M People's

Partic ipa tory Questio ns

village/wart!9. If your villale/ward does not

have a health centre/dispensary would you makeefforts to get one opened inyour village/ward?

f 0. If the government decides toopen a health centre (sub.

in Family Planning

Percentage of Respondents

Afirming

Acceptor Non-Acceptors

8l90

6896

Centre) dispensary withthe help (material and pof people in the village/wdr4 would you help?

Would you like to pay torhealth service?Would you like to join inorganising hsalth servicesto your vill agelward?If a farhily planning centnis being oirened in theneighbouring village/wardwould you go there?

ward?If a nationaVlocal leader rsdelivering a speech in your

hysicql)

8'l

8l

68

68

96

90

o0

93

'71

12.

13.

14. Would you make efforts to ge{one family platrning centre/sqb-centre opened in your village/

75

62 62

Volwttary Efforts ih Family Planning-I:

i7. would you lll(e to campatgrrfor a party/candidate inelection?

18. Did you campaign for any pancandidate in the last election?

19. Did you vote in the last electionfor (a) ?anchayat, (b) State

Assembly (c) Lok Sabha?10. If the local leaders organise

demonstration on rising pricesor non-availability of certaincommodities, would you parti-cipate in it?

21. If the VLW/VHW is not visitingyour village/ward would youmake complaint to the con-

' cerned officials?22. lf you are requested to volunteer

your serviies to the gbvernment/voluntary agency to take thehealth services to the peoplgwould you volunteer yoursell?

23. If the school teacher in yourvillage/ward requests you topersuade people to send theirchildren to school, would you

ZtS.

help him?If the WWTYHW requests you tohelp in persuading and motivat-ing people for accepting familyplanning would you help himIf Keertan/Ramlila is organisedin your village/ward., wouldyou attend?

45

8l

8l

37

28

81

37

47

56

JI

37

93%

78

5678

50.

Average 74 67

6 People's in Family Pla4ning

The average partieipadon rate 25 questions was 74 for theacceptors and 67 for the non The differencg though

from activity to activity.An4 in some activities their o pation rate is very high; attimes even higher than the Before we discuss implica-

apparent, does not look sizeable.deal with a wide range of socialticipation rate of nori-acceptors

tion of this trend we would like toween the participation rates ofvisible. And this as well as somecbme to them later) areplanning in thi6 area.

reason is that the questionspolitical activities. The par-

out that the difference bet-two sets of respondents is

factors (we shallfor non-acceptance of family

norm. We shall discuss t]rewhen we analyse the data

it as an ehcograging rrend Ifwe regard a score of50 and above ashigh rate of participatiorl then in2d out of25 items their participa-

than the acceptors and they eqial {cceptors' participation rate inthree items. The obvious inference of such a trend iould be thatmotivation to padicipate ts not la If the reasons for theirnon-acceptance is understood .,it would not be difficult topersuade them to accept small-pobsible reasons for non-further.

An over-whelming number of the acceptors and non.planning sewices shouldacceptors felt that health care and f

be maintained and operated by the ent Only an insignifi-cant proportion of respondents of the opinion that health

be maintained and workedcaie/family planning services s

bythe people themselves or their This was affirmedby the replies to questions 1.9 and I 10 in the respondent schedulethat whereas 90 and 96 per cent of tors and 81 and f8 per cent

to make efforts to eet aof non-acceptors respectivelyhealth centre/dispensary opened their village/ward. 90 and 8lper cent of .acceptors and non- rs respectively, in faclshowed their willingness to such services.

Asked about the type of helphealth services, 4l per cent ofthe

they wanted to make for thedent acceptors and 56 per

cent of non-acceptors stated thatphysical help to the health servi,

were prepared for rendering25 per cent each of acceptorsr giving financial help, 34 perand non-acceptors were prepared fi

voluntary Effons in Family Planning-I: 47

cent acceptors and 19 per cent non-acceptors were prepared toprovide both kinds ofhelp (Table3.l l).

TABLE 3.11: Help for Health Services

Type of Help Acceptors

No. Percentage

Non-Acceptors

No. Percentage

PhysicalFinancialBoth Physicaland {inancial

13

8

1l

5625

is

9.t

4l25

34

Total

Motivation

Motivation for family planuing vias judged by the respondents'Visit to the family planning centre, using the facilities provided,asking for advice from the doctoa VHWCHW, voluntary workersof family,planning friends/relatives etc in respect of family plan-ning taking friends/relatives to the centre etc.

fYide dlfferences can be^noticeO in the replies to iI-quesuonsgrven by the acceptors and non-acceptors of family planningexcept the last one (see Table 3.12). Itwas natural that consultationwith medical officer and availing the. faciliries provided by thefamily planning centre would differ considerably in case of thetwo categories of respondents. However, 50 per cent of the non-acceptors visited family planning centre and 75 per cent werebdvised to adopt family planning measures. Eventhough differen-ces in rates of motivatiorl both itemwise and averagg of acceptorsand ndn-acceptors is substantial, and partly exptrains the reasonsfor non-acceptancg scores for item I and 6 presents a ray ofhope.

Participatioq Motivation and Famity PlanningThe analysis of participatory attitude and motivation of the two

categories of respondents reveals significant diffdrences between

I0016100

in Family .Planning

motivation than in attitude. This can be easilvexplained The latter includes on on general participatoryattitude as lvell whereas former sharply on family plan-'ning We have already that there is significant dGference in the participatory atti of acceptors and non-acceptors in questions relating to family planning. Narrow dif-ference in the general partici attitudes ofthe two sets of res-

and the other does not Motivatiod could be one reason but whl

TABLE 3.12: Motivation Sample Respondents

Questions on Motivatian Perctntage of RespondentsAffirming the Q,uestion

Acceptors Non-Acceptors

L Have you ever been to a

3.

planning centre?Have you ever used the facilitlesprovided by the family planni;rgcentre?Did you ever consult themedical officer in the

pondents raises the. question as tO why in spite of similar par-ticipatory behavioqr one responds to family plandrrg programme

dispensary/health centre/sub-centre?Did you ever take your friendg/relatives to the familyplanning centre and persuade{them to accept family planninfmethod?Did you ever take your spouse tothe family planning centre?Has anyone ever advised you tbadopt family planningmeasure?

12

37

100

100

100

844.

5. l8

90 75

Voluntary Effons in Family Planning-I:. 49

this difference in motivationlLet us look at some of the social variables for explanation We

are aware ofpreference for sons in the Indian society. An analysisof percentage of sons and daughters of both categories of respon-dents would be one indicator of choice for family size. In our sam-ple 65 per cent of children of acceptors were male while only 42 percent of non-acceptors' children were female. Apparently, this wasone of the reasons for non-acceptance

It would be worthwhile to analyse the views of non-acceptorsregarding ideal size of family and as the number of children a cou-ple has and the number they consider ideal as well as other socio-psychological factors are likely to govern their attitude towardscontraception.

It would be worthwhile to analyse tne views of non-acceptorsregarding ideal size of fanaily and the reasons for their non-acceptance of family planning measures, as the number ofchildren a couple has and the number they consider ideal as.well.rs other socio-psychological factors are likely to govern theirattitude towards contraceptio[

An analysis of the views of lGnon-acceptors in Anand Parbar(see Table 3.13) indicates that a majority ofthem considered fourchildren as ideal number for any family. Most of them also feltthat two sons were must for any family. Since a majority of ournon-acceptor respondents had less than four childre4 they wereall waiting for the fourth chii4 preferably 4 son Interestingly, twoof the respondents felt that a family should have five children anilone of them was in fact waiting for a lifth child" One was scared ofsterilisatioq one did not assign any reason and the rest were wait-ing for their ideal family size to materialise.

The responses of the non-acceptors reveal the task ahead fiorthe NDPFA Though it is hazardous to make a sweepinggeneralisation on the basis ofa sample ofl6 non-acceptors! it cer-tainly indicates that there still are a number of couples who consider four children ideal for a family and have a preference for atleast two sons. Grad,l.' ally but persistently the NDFPA must iden-tity and motivate such couples for a &€ater lmpact of the familyplannipg prcgramme. Though this does not diminish what theyhave aheady achieved, this does indicate where they may have toconcentrate in future.

Apparenuy, monerary incentives were not sufficient induce-ment for the non-accefitors to chang€ their.views. The acceptorg

slNo.

No. ofchildren

l. I

2. lM,2F 3

IM

2}d,2F

5. 2M,tF 4to5

6. llvl"2F 4

childlen particu- essential.larly dr son.Wants 2 more -do-

childrien.Want$ 3 more Married threechildien years back only.Secre{ of sterili- Sterilisationsationi. leads to weak-

ness.

Wantg at leastone nlore child-Want$ a son Two sons are

essential.Want$ fwo more -do,childlen.Wantg one morechil4 preferablyson.No sf;ecific reasonWantg at leasta son.Want$ two nlorechildrfen.No ctiild thoughmarried for 6 yrs.

Wantb 2 more At least onechildlen. daughter.Want| I more Two sons are

People's PQrticipation in Family planning

TABLE 3.13: Views Non-Acceptors

Ideal family Rea -for Remarkssize (No. ofchildrea)

rwo more o sons are

4.

7. lM

8. 2M,2F

3to4

4to5

A

49.

10.

ll.

12.

2M,2FIF

1M,1F 4

Nil 3

13. 2M

14. 1M,2F 4

15. tM

16. 2M, 1F

childasow 34chil more,

essential.

Two sons, twodaughters ar.e

ideaL

-do-

referablv

Wanda

one moreter.

3 to4

Voluntary Eflons in Family Planning-I: 5l

on the other han4 declined that they were induced by incentivemoney. The respondents generally were not in favour ofincentiVemoney, but thought that gifts in the form of utencils may be agood idea.

The choice was generally made by both the couple and in moStcases other family members did not influence thtj decision.

SAMPLE SURVEY IN OKHLA

The Rural Project

In its rural projecq inaugurated in 1964, the NDFPA providesMCH and family planning services besides income generatingactivities for women for raising their socio-economic status. Theproject area consisted to 15 villages around Okhla-

We selected four areas from the Okhla project area of theNDFPA on rindom basis. These areas were Okhla Julen-a. CanalColony and Bharat Nagar. Since the entire area under theNDFPA s rural project had 40 to 60 per cent protection rate, wetook these as good performance areas and interviewed six accegtors and two non-acceptors on a random basis from each of thefour. The demographic particulars and family planning profile.ofthese areas are given in Table 3.14.

TABLE 3.14: Demographic Profile

Area Popula- Eligibletion cquples

Family Planning Accepton

Vas Tub. IUD Niro- Others Total %agedh

Okhla 5803

Julena l3gCanal 530ColonyBharat 2556Nagar

106 103

41466

320 6r.279 4936 38.3

69 40.1

523t7694

1',72

75

39l7

I

II

35

2l7

2415t9

Okhla had the largest population of the four areas and Canal

52 People's PQrticipation in f amily Planning

Colony had the smallest Canal Colfny also had the lowest protec-tion rate at 38.3 per.cent The rest had over 40 per cent protectionrate and Okhla with 61.2 per cent had the highest protection rateamong the sample areas.

nearly 48 per cent, was the crueial that the NDFPA neededto e4courage in spacing methods. Ir| facl ifwe include the couplesthat had yet to have a child the clqster constituted nearly 60 percent of the total serviceable couples. The 40 per cent with three andmore children required motivation for terminal methods. In fac!the couples with two children also npeded motivation for terminalmethods. In terms of (wife's) agelroup 15-24 was relevant forencouraging spacing method and ),5-34 for terminal method

TABLE 3.15: No. of Serviand No. of

No. af living

Couples by Age of WifeChildren

Semiceable Couplas

4+ No. Percentage

l5-1920-2425-2930-3435-394044

36 68 l775 193 148 50 16

121

482494273113

26

1509

8.0231.94JZ,tq18.09

7.49r.72

100.00

I42 88 131 1468164s542 4 11 1',7

1024

87

50

7919

Total t& 369 354 27r 351

.26Percentase 10.87 24.4523.4,517.96 100

Voluntary Efforts in Familv planning-L. 53

dissolved srnce 1980, the peopie had neither the oppoftu[ity northe enthusiasm to participate in local political affairs.

Socially, however, the area was quite active. Zakjr HussainMemorial Society .located in.Okhla organises various socio-cultural activities in the area. The Society also closely collaboratedwith the NDFPA and the activities of the pariwar pragati Mandalsorganised in these areas by rhe NDFpA

Apart from the services ofJamia Milia educational institutions,three areas-Okhla Julena and Bharat Nagar-have primaryschools run by the Municipal Corporation olDelhi Each of thischools have 100 students on their rolls.

Aside from the Delhi based hospitals like AIIMS or Safdarjunghospital, the areas were servcd by the mobile dispensary of theNDFPA Each of the areas had locally based allopathic dispen_sary and but for Canal Colony, the rest had homeopathic dispen_saries as well. The Holy Family Hospital located niar Okhla alsoserved these areas. Apart from the dispensaries, the NDFpAlooked after family planning needs of population in these areas.The sub-centre of the NDFpA at Okhla served the entire areacomprising of 15 villages oo all days. The visit of the NDFpA'mobile dispensary every Wednesday and of extension worker,social worker and village health workers every week strengthenedthe services exterded by the NDFpA and established direct con-tact with the local population

To educate and involve more and.more people in the pro_gramme the NDFPA periodically arranges to scieen documen-taries and films on family planning and also arranges lectures byexperts from time to time. Apart from house to houie contacts bvits ExtensionVorkerg smau group meetings were also arranged inthese areas. The biggest succesg howevJr, has been the iocio.economic programmes organised by the paiwar pragati Mandalsunder the auspices of the NDFpA Its functions and aihievementshave been of similar nature as in Anand parbat area,

Characteristics of Sampld Respondents

As stated earlier, the awarefless of family planning being highin area around Okhla due to the efforts of the NDFPd wetook theenfre area as good performance area" Thus, we randomly selectedsix acceptors and two lon-acceptors in each of the sample areas.All'the respondents in this sample were male.

54. Pmple's forticipation in Fgmily planning

not belong to high incomeA majority of tho respondentsgroup. Most of them (in both theftiddle income groups (see Tabletors did befbng tb the high incomepoadents were concentratedbteskets.

All our respondents in thisgrouo. 83 per cent of th€ accr

Income Groups(Rs)

) belonged to low oi16). Wbile some of the acceprackets, the non- acceptor res-in low and middle incomd

were in the reproductrve ageand 75 per cent of the notr-

TABLE 3.16: Economic of the Respondents

G'1000l00l-20002001-3000300l4un4001-50005001-60006001-70007001-80008001-90009001:100(D

Age Groups(Years)

25-2930-3435-394A-44

3912

Non-accepton

No. Percentage

15

3

82

1,|

2511

100

I

2t

8

2lt234

8

4444

100

lt93

I

No.

24

255025

242

453613

4

100

Voluntary Effons in Family Planning-I: 55

acceptors were in 25'34 age group. Our data în

this area igtherifore likely to reveal participatory attitude of a group ofper'sons who'are crucial for family planning progJamme'

A maJonty ot the responderts m both the categories, ie' 8J per

cent of the acceptors and 75 per cent of the non-acceptors were

educated above high school level In fact 25 per centoi both accep-

tors and non-acceptors were graduates or more. There was no

illiterate in our acceptor samplg while 12.5 per cent of the non-'acceptors were illiterates. (see Table 3.18).

TABLE 3.18: Educational l-evel'. of Respondents

EducationalStandard

Acceptors Non-accepton


IlliteratesPrimaryMiddleMatric/HSCraduate & above

I 12.5

| 12.5

450,) ,<

'4

13

58

is

I

J

t46

Total 10010024

Participatory Attitude

An analysis of rispondents' pailicipatory attitude reveals'the

role of personal preferences in participation as well similarity in.the attiiude of the two sets of respondents.'The averag€ score for

the acceptors and non-acceptors respectively for this area is 75 and

74. This shows only marginal difference in their attitude' In fact"

itemwise scrutiny of particip4tory data reveals that on 15 of the 25

questions the non:acceptors have scored over th€ acceptors and

on rwo items they have equalise their scores This leaves out eight

items on which the acceptors' score exceeds that of non-acceptors'

Six out of these eight questions relate to family planning On one

question relating to family planning both sets ofrespondents have

equal score (s'ee Table 3.19).

Let us lool at the questions relating to family planning and the

difference'in attitudei of the two sets.of respohdents' The ques'

tions relating to family planning are 4 5, 7, 8' 13' 14 and 24' The

Pmple's

TABLE 3.19: Farticipatory

in Family Planning

of the Respondents


Affirmtng


l. If there is shortase ofcommodities (kerosene, sugar,fertiliser, etc) in your village/ward, would you make effortsmake these commoditiesble in your vill agelward?

2. If there is shortage of drinking 9lwater in your village/ward,

100

100

would yog make efforts tomake it available?.If the neighbouring village/wafdhas a school which your villa$e/ward does not have, would yoqmake efforts to get one openedin your village/ward?If o fornih' nlonni-rr .omh i.

7.

If a family planning camp is 1@.

79

62

75

being held in a neighbouringvillage/ward, would you go

neighboirring village/ward uon family planning would yoggo there?

8. Would you make efforts to getthe f-rlm screened in yourvillage/ward?

9. If your village/ward does nothave a health bentre/dispensa{y,

100

83

62

62

75

62

6262

83 67

Yoluntary Efforts in Family Planninq-I: 57

Paniapatory Questions

would you make efforts to getone opened in your village/ward?

10. If the government decides to 91 100open a health centre (sub.centre)/dispensary urith the help (materialand physical) of people in thevillage/ward, would you help?

ll. Would you like to pay for health 87 100services?

12. If the family planning centre 95 62is being opened in the neigh-bouring village/ward, wouldyou go there?

13. Would you make efforts t6 get 8j 75one family planning centre/subcentre opened in yourvillage/ward?

14. If a nationaVlocal leader is 11 75

delivering a speech in yourvillage/ward, would you attendthaP

t5. If a political meeting is being 62 75held in the neighbouring village/ward, would you attend thafl

16. Would you like tg campaign 37 25for a party/candidate inelection?

17. Did you campaign tor any 25 25partylcandidate in the lastelection?

18. Did you vote in the last election 91 62'for (a) Panchayat (b) Stare

Perc entage of res po nden tsaflirmine

Accepton Non-acceptorc

58

Assembly (c) Lok Sabha?19. If the local leaders organise

demonstration on rising priceqor non-availabi-lity of certaincommodities, would you parti.

50

7550

m.

21.

cipate ir ifIf the WWVHW is not visitingyour village./wrir4 would youmake complaint to the cotrcerdedofficials?If you are requested to voluntderyour services to the govdrnmenVvoluntary agency to take thehealth services to the people,would you volunteer yourselfl

22. lf the school teacher in vourvillagdward requests you topersuade people to send theirchildren to school, would youhelp him?

23. If the VLWVHW requestshelp in persuading andting people for acceptingfemily planning wbuld youhelp him?

24. If 'Keertan or Ram Leela isorganised in your village/ward, would you attend thafl

10095

scores for acceptor$ and non-accept$rs for each ofthese questionsrgspcctivelyaie l and62,79 atd6l,75 and62,62 and61,95 and62, 87 and 75 and E7 and 62. The d{fference in scor4 except onequestion ivhere scores are equal ra[rges from 38 to ti. Generally

Voluntary Efrorts in Family Planning-I:

speaking the queitrons which are crucial to our study.do show.dif_ference in attitude and this is partially responsible f; ";;accept€nce.

But at the same tifte the data shows that even nof-dcceptors inthis area ar€ not apathetics They are participant in nature Their

'

flon-acceptance, thereforg is either due to sdme .appreherlsionstowards family planning or other personal of domestic rlasonsWe sha-ll go into these socio.psychological factors laier.

A majority of the respondents were prepared to help govern-mental or voluntary agencie!. in organising health services Thisrellects their.utge for a more efficient apd easily accessible healthservice. This data also shows that the non-acceptors in this area'marginally score over the acceptors. While all non-acceptorsrespondants were prepared to render some help or the othe! 8 percent acceptors did not want to make any kind of help (see Table3.20). This data also corraborates our inference drawn from dataon participatory attitude that the non-acceptors in this area havet"he necessary participatory motivation to be mobilised toparticipate in activities like family planning


59

Acceptor Non-AcceptorType oJ Help


PhysicalFinancial6othNone

5

10

72

20.84r.729.2

8.3

37.5

37.5

25.0

JJ

2

'Total 24 100.0 '8100.0

We noticed substantial difference in the motivations of the two..catqgories of respondents toward family planning The averagemotivation rate ofthe acceptors (89) was substantially higher thanthat of non-.acceptors (25). This also explains their non-accept-:ance. Only 12 per cent of the non-acceptors admitted havingvisited a family planning centres, having used the facilities havingconsulted the medical officer, having taken their friends or

g) People's larticipation in Family planning

relations to the family planning centre and having persuadedthem to accept family planning arid having taken their spouse tothe family planning centre (see Talble 3.21). This means that only12 per cent of the non-acceptors re$pondents have had an interestin the family planning programrnle and have not accepted it forreasons other than lack of A large majority of the non-acceptors (87 per cent) acceptedfamily planning measures. Theq

been advised to adoDty is it that they did not accept

the advise? What are the reasons br their non-acceptance?

TABLE 3.21: Motivation of e Respondents in Ol;hla


ffirming the questions

Ques tio ns o n M o tiv atio nAcceptors

medical officer in thedispensary/health cen trelsub-centre and seek adviceon family planning?

4. Did you ever take your friend$/relatives to the family planningcentre and persuade them toaccept family planning' method?

5. Did you ever take your spousbto the family planningcentre?

6. Has anv one ever advisedyou to adopt familyplanning measures?

t2

12

95

1003.

t29l

t2

87

75

75

Average

Voluntary Effons in Family Planning-I: 6l

Let us look at the resliunses of the non-acceptors to answerthese questions. Out ofeight non-acceptors in our samplg only 50per cent had children. This explains why halfofthe non-acceptorsin our sampls did not accept family planning. The other half waswaiting for a male child. Two of them already had four

TABLE 3.221 Views of Non-Acceptors

Sl Number of Ideal family size Reason for RemarlesNo. children (Number of Non-Acceptance

children)

2.

J.

4 daughters As smallnumber aspossible

2 daughters 34 children2-3 children

Wants a son

Wants a sonNo issue yelmarried 5 yearsbackDoes not havea son yet'

at No issue ye!married 9 yearsbackNo issue ye!married 3 yearsbackWants at leastI sonNo issue ye(married 8years ago

A son is must

A son is must

2 sons aremust

2 sons argmust

2 sons aremustI son ismust

4. I daughter

5.-

6.*

7. 4 daughters

8.-

4-5 childrerlat least 2sons2-3 childrerlleast I son

2 sons and Idaughter

2 sons and Idaughter2, at leastI son

,daughters. One of them had two daughters and one had only,daughter. Each one of them wanted at least one son Onerespondent with four daughters agreed that it was better to have

. small number of children, but a son according to him ryasessential for a family. Three respondeiits felt that two sons were,r.nust f<rr a family.


Thus, while halfofihe non- rtors in our sample had yet bwanted at least one son Idealnave an isdug another half

jsize of the family apcording to ty of them was not less thanthree, Those who advocated twohinting at a four-children family.the attitude ofthe non-acceptorq

children were in any casethis data is any indication of

to achieve its objective of boperational areas.

down fertility rate in its

Overview

care and family.planning to goverriment hospitals. This removed

The overall achievement of the NDFpA is impressive. Itsstrategies reveal good plannirig and organisation. It wasappropriate on their part to devi{e their strategy into micro andmacro approach'es. Gradu.alism in reachingf-and convincingpeople also helped In additior! t{e assessmeniof local needs andadjustments in emphasis of the programme to locai preferencehelped a great deal in enlistinglpeople's participation in theirprogramme. Thc lield workers of the Association were alwayscareful to remove shortcomings afid adjust the programme to theneeds of the people.

Secondly, the integration of h$alth carq nutrition and socio_economic programmes with that 0f family planning was anotheifactor for ensuting better cooferation- of the ieople. Earlyrealisation that the family plannifirg programme in isolation dirt

Secondly, ihe integration of health carq nutrition and socio_economic programmes with that 0f family planning was anotheifactor for ensuting better cooferation- of the ieople. Earlyrealisation that the family plannifrg programme in isolation didnot ehlist pegpl{s participation epriUteO ttre NDFPA ro quickly.reorganise and adJust their programlme rn accordance wrtlipoput-aineeds Integration of a broad-bhsed health care progru*-gespeciallyJor the mothers before aird after pregnancy and for theirohildren till they attained school going ug{guu.'.orriderable ,

strength to the programme as it re4noved ,uspiiion from people,smind and encouraged popular accdptance of a small family nofrnKarsing starus of women through ifirstitutions like pariwai prugatiMalda\ proved {o be very effecti{,e in enhancing .participationand. mdtivation in family plannipg *h.n *o-Jrr.. words and.ooj:: Yrt* c-arVile significanr weight in the family.

I hrrdly. rhe New Delhi Family' plannin! Association always

1,1i*t"..d .close cooperation with goui*-.niui agenciesengaged in similar activities and rpfened serious cases oihealth

NDFPA has to work harder

fear and .suspicion fromthe mindg of the pot"ntiui u"""pto., of

Voluntary Effotts in Family Planning-I: 63

fimily planning ,,fountrty tne ra iwar Pragati Mo'edals organised by the NDFPA

in its various operational aredS ultimately became very :ffective

instruments in mobilising popirlar participation in family

planning They, in fac! became good forums for undentanding

iopular- feetings and mobilising non'accep,tors . by qhowing

e*a-ples of the successful acceptors of family planning The

strately of identifying local leaders and doctors and seeking their

cooperation for . mobilising people's participation was r'ery

suciessful not only in fulfilling the targets of family planhing

given by ihe Govemment but also to win popular confidencei- .Fifthly, the availability of the family welfare centres and sub''

centres maintained by the NDFPA as delivery agencies for familyplanning facilitated family planning services at the doorstep'

immunisation of expectant mothers, infants and pre schgol

children against communicable diseases, and nutritional'supple-ments like vitamin'A'concentratg brought the NDFPAveT close

to the people. Health and nutrition edgcation of mothers and

other aipects of health care attention and baby shbws inculcated

competrtive spiirit among parents and follow-up of growth ofbhildrert in expectation of long life to the existing children' These

activities of the family welfare Oentres maintained by the New

Deihi Family Planning Association enabled the raising of the

effective level of citizen participation in family planning because

the people developed a sense of security about the survival ofexisting children

The-first thlng that the Extension Workers of the Nbw DelhiFamily Planning Association did in the preliminary survey was to

identify families with three or more children, families with two,:hildrin and newly married couples without a child and a sterile

couple. Emphasis on attention and motivation was given tofamilies with two children and more. The help of acceptors, local

leaders and doctors was sought in convincing such people' Once

such couples were convinced, the acceptance of family planning

bebame easy.' Non-participation was mostly visible in case of couples not

having at least a male child. In some cases the couples reported

beingifraid of a surgical operation and loss of physical strength

after steflisation The idea of responsible parenthood seemed to

be developing graduallv over the entire operational area of the

New Delhi Family Planning Association. Still in some cases

families *ere large because tne,such cases seemed to belesire for at least one malehowever being accepted in theclaim credit

The people in the operauonalan acqegs !o healfh care andThey Also seem to h.ave oppodevelopment The ITIDFPA hasmobilising their participationand still making it appear as thdividends.

ce of family planning int on the socio-psychologicalThe small family norm wasfor which the NDFPA could

ot the NDFPA thus. haVeand family welfare services.

ies for child and . women -

lceeded to a large extent instrateg)rof persuading peopleown choice has paid ggod

Chapter -IV

Voluntarv Efforts inFamily P-lanning-Il :

Gandhigram Institute of RuralHealth and FamrlyWelfare TrustTI HE Gandhigram Institute of Rural Health and FamilyWelfarqTrust was selected for our study because it was oqe of the firsq

vqluntary agencies to enter the field of family planning. Its experi'ment based on co-ordinated involvement of the health and blocksfaff on the one hand and involvement of the community on'theother, started in 1959. By the.middle of the 1960s' when policymakers were still groping for a strategy to m3ke this programmesuccessfu! Gandhigram successfully experimented with themethod of coordinated involvement for implementing familyplanning in rural areas. With this method it brought down birihlrate substantially in Athoor Block, its area ofopbration Since thenit has been providing consultancy to the Tamilnadu governmentas yell as training their medical officers and para'medical staffusing lheir "Athoor Experience". This "Athoor Experiencel' is thebaiis bf all their activities.

In this chapter we shall discuss the activities of the Institute,examine their "Athoor Experience" and analyse the sample sunvey date collected from four villages in the area of the Institute'soperation.

The Institute

' ' The genesrs of the Institute hes in the establishment olGandhigram near Ambathurai and Chinnalapatti villages inDindigul taluka of Madurai district The same year it opened an

MCH clinlc at Chinnalapatti vill[ge. In 1960 its servrces were:"T:-*q tomore v.rllages in Atho{rBlock as a total programme.In 1959 the Government of Tamilnladu requested Cananlgram toundertake a pilot project in Athoop Block to assess and evaluatethe existing rural health services. thus, the pilot Health project195!-64 was launched under thejoiFt auspices ofthe Governmentof India and Taqrilnadu Indian Cotrncil of Medical Research andtlre Ford Found4tion. In 1962 the Gandhigram was sanctionedFamily Planning Communi"atioF Research project by theGoveryment of India. With five jears of experienJe of action_research in health and family planfing Gandhigram Institute ofRural Health and Farnily plannin! wai establish]ed in 1964 as anrnstlrutton engaged in researcb. seryice and trainine.

- As a training institution it is a Central Training In-stitute underthe pattem of training schemes of the Governnient of India for!91tjt a{ flmily welfare. It is also { Regional Health.and FamilyWelfare Training Centre under the same scheme of the Tamii-nadu Govemment The Central Mfnistry of Health and Family.{eJf.are is providing 1007o financihl ariirran"" to the Institutiwhich undertakes various short tent, training courses on behalfofthe Government of India and the familnadu GovernmenL TheInstitute runs traiuing courses for tfainers, senior administratorsand district level officers of the Fealth and Family WelfareDepartments of the southern Statls. It also trains the Medicallffic9rs and para-medical staff of fhe four southern districts of,Tamilnadu in family planning

As stated earlier, the Institute was foundgd on the experience ofthe action-research in health and fainily planni"g u"ae, ttre eitoiHealth Project It has not given up lesearch in these fields sincgand continues to conduct research 0n methodological problemsin implementing programmes, tr4ining and hJalth activitiesunder the supervision of a senior sOcial scientisl

ffi People's Participation in Family planning

Farnily planhing is the major of activify of the Institute inresearcll training and service since 959. the year the Pilot HealthProject was launched In 1962 thev k their second majorassignment in the shape of the FResearch Project The intentionimplementing family planning in.an appreciable decrease.in birth

Planning Communicationto develop a method forareas, which would lead to

and which might be a pro-totype Of the programme What was envisioned was a

Vpluntary Eforts in Family Planning-Il:

co.ordinated apBroach-involvement of local leaders and to theextent possiblg of Block and other staff available to complementthe efforts of health and family planning staff in planning andimplementing eduthtion, serviceg follow up etc.

The study intdnded to work out a methodol6gy for (1) motivat-ing the people, (2) delining job functions and training needs of dif-rerent categories ofhealth and fainily planning workbrs and otherworkerg government and voluntary (3) working out in detail themanner in which family planning services should be delivere{the administrative and technical support they need and theirfollow up, and (4) conducting continuous evaluation. During thestudy the Institute provided family planning service s to thevillages in Athoor Block After the successful completion of theprojec! its main activity in family planning has been consultancyto the state government agencieg training of their para-medicalstaff and conducting further action-research to strengthen themethodology developed during the "Athoor Experience".

The Athoor Experience

As stated earlier, the "Athoor Experience,' is the basis of theInstitute's work in health'and family planning Athoor Bloc(located in Dindigul taluk, Madurai disrrict, had d population cifover ooe lakh ( 1,00,606 according to 196l CenJus), when.Gandhigram launched its experience therel. The populatiorlinhabiting 106 hamlets of 22 village panchayats and three townpanchayats, was overwhelmingly Hindu (g6.4 percent). Christiaps(9.9 per cent) and Muslims (3.7 per cent) fonned a very small partof the population2.

. .The family planning clinics had already been functioning inthis area. The clinicg established as part of the Second Five yearPlan in the town panchayats of Chinnalapatti and Sithiankottaiin the Block in 1.958, concentrated on the popularization and dis-trihltion of contraceptives like the condom, diaphragm and jelly,and provided advice on pennanent methods.

But the clinics could not really attract people to adopt familyplanning though they were staffed with'sociai workers as well tomake family planning popular. A study conducted towards theclose of 1961 on the functioning of the two clinics showed that lessthan 5.per cent of the couples needing family planning serviceshad utilized these services. The couples who uied the clinic ser-

I

68 People's Pdnicipation in Family ptanning

vices were mostly froni:the middle ifcome groups Rs. 60G12fi) perfamily a year, while thE much largef segment of the population inthe income of less than Rs. 600 per annum and who presumably ,

needed family planning most, did not make use of the clinicservices., The study pointed out three mgif reasons for the failure of theclinics : (a) the timings of the clinic fere inconvenient to people ofthe low income group, specially whpre both the husband and thewife worked in the field until late ifr the evening (b) most of thecoupleg particularly illiterate couples, felt shy and hesitant to go tg

This helped the Institute to their programme accordingto local needs. People's to come forward and adopt

to them as the baseline sur-family planning was little parpyey-conducted by them in 1959 for the Pilot Health Project in asample of 459 households did an optimistic picture. The

ient Hindug 57 per centsurvey established that about 66Muslims and 58 per cent Christito-wards family planningwhile 24

grammes and (3) use angroup and mass media ap

were favourably inclinedcent Hindus,29 per cenl .

combination of individua-for education

Muslims and32 per cent Christians against it The maximum'located in the.25-34 ageparcentage of favourable persons

grcup among all the religious Thirty per cent men and 32per ccnt women r€spondents ex' willingness to avail them-selves of the facilities for family p "Economic condition"and losmall family is good" seemed be powerful motivating fac-tors for favourable attitudes family planning Objectionsbased on religious grounds wereby merl.

more by women than

The Institute decided to embark three pronged strategy inlaunching the projecq which at evolving methods to: (l)involve interest,ed and infl uential from the village in thedwelopment of the programmeordinated efforts of the health

their villages (2) achieve co'

agency in planning andcommunity developmentvarious aspects ofthe pre

a public place to discuss their perponal problem; and (c) com-munication barrier between the falpily planning workers and thecommunity existed particularly wifli workers who were unmarriedor who did not belong to the corhmunity in whicir they wereworking

fire first major task of Gan was to meet the organisa-

Voluntary Efforts in Family Planning-Il: 69

tional ueed of the programme; The infrastructure was available interms of the Primary Health Centre (pHC) staff But they had to besupplemented with additional personnel for extensive lield workrequired to make this programme popular. Hence, it was decidedto augment the strength of the Auxiliary Nurse Midwife (ANM) toestablish a ratio of I : 10,000 population; to appoint one fam-ilyplanning field worker (male) for 20,ffi0 population; one LadyHealth Visitor (LHV) for 40,000 population The strength of theANM and LHV was raised in 1965 to provide one ANM for 5000population and one LHV for every four ANMs. At the Block level,apad from one lady physiciarl one Extension Educator wasappointed for ceordinating all aspects of family planning workThe Government of Tamilnadu could not organise the districtlevel organisation for family planning till 1965, and the projectstaffassumed this function forAthoorblock The project staffilsoassumed the role of family planning field workers in the inirialstages to gain the first hand experience.

Since both the PHC and the Block were involved in the worlg itwas difficult to leave the organisational control to one only. Hen-cq a rather complex structure of organisational control wasdevised. The family planning field workers and computer wereplaced under the Block Exrension Educator (BEE), while hereported directly to the PHC medical officer. The ANMs under thethree sub centres of the PHC reported to the pHC through theLH{ while the others reported directly to the BDO. The medicalofficer of the.PHC, however, provided technical guidance tothem.

. Gandhigram undertook the responsiorlrty for purchasing stor-ing and distributing condoms duringlg62-67,as tlie suppliei fromthe 'governmental 'sources were inadequate. The supplies werghowever, channelled through the BEE. Gandhigram alio organisedthe transport facilities.

To ensure co-ordination in the activities of the pHC and theBloc( an Action Committee was constituted at the Block levelconsisting of the PHC doctor, BDO, Chairman of the panchayatUnion Council, Deputy Inspector of Schools at the Block, Direc-tor of the Gandhigram Institute and representatives of the localcommunities. The Committee was entrusted with planning of theprogramme as well as with ensuring direct communication amonehealt[. family_ planning and development workers. The implelmentation of the family planning programme and its operational

70

details were worked out in the staffmeeting of the PHC

and the Block The attendance of repre sentatives of the each at

the othefs stbffmeeting was in promoting co- oPeration

and ;co-ordination and it workedalso'generate participation at all t

This arrangement couidlevels

All the workers recruited by the under the progxamme

were given preliminarY trainingthree to six nronths before theY v

Gandhigram ranging fromsintio the field. Later, they

were called for more extensive'their job.

depending on the nature of

The curriculum for training of brent categories of workers.

was developed in accordence the job'funitions. The curri-culum combined both theoretical

,of skills to perform tasks throughfi eld training DeveloPmentexercises and field training

was yery important Part of the training To facilitate this, the

Institute dweloped a field practice area The post-

training phase of workers was alst

them. with suppo( as well as to cclosely supervised to provide

any mistake they migbtcommit Regular staff meetings at PHC and Panchayat Union

family planning team andattended by members of healthBlocl planning and evaluation m of the Block-level com-

mittees ahd demonstration of the bctiveness of certain methods

in the field provided at different levels and at dGferent stages to set the errorg if

The programme itself was im, right-

in phased manner. Invillages spread over each ofthe initial stage six mqst responsiYe villages spread ov€r eacn ol

the family planning workey's jurisdiction were selected After the

rprogramme reached the take offsthge in the first set of villageg itwas extended to a other group and thus, to the entire Block As the

prrgramme was introduced to a il€xt set of villages' the earliergroup received regular follow'up' One of the important advan-

iages of the phased implementatio[r was that weakness, if any, inthi strategy in the fitsi phase could be eliminated at the second

stage and so forth, Besides, it ensuded concerted efforts in a group

ofi[ages and the earlier set of vilfages served as an example forthe next sgt Involvement of the cpmmunity and training of thevillage leaders was .also facilit+ted because of the phased

implementationAs mentioned earlier, Block-level Action Committee was

tentrusted with the responsibility ffr overall planning of the pregramme and for pdordinating acjivities witb other departdrents

Voluntary Elforts in Family Planning-Il: il

As a trrst step, onentatron sesslons were arranged for the PHCstaf[ Block staffand Panchayat Union members, and this helpedin enlisting their supporl Involvement of the staff in details ofplanning programme also proved to be a successful way of assur-ing their commitment to the programme. Thus, apart from theAction Committee meeting at about three months intervalmeetings of the supportive and -the field staff were held at regular'intervals to solicit their suggestions. which always proved useful.Sulficient flexibility used to be left in the plans for localadjustrnents and periodical meetings helped in reviewing andmodifring them.

Voluntary acceptance of the programme and involvement ofthe iommunity was an important part of the plan. Thus, the'Institute developed a methodology for identiSing and trainingleaders-both formal and informal-in family planning activities. Both male and female leaders as well as indigenous medicalpractitioners and dais were trained and used One-day trainingcamps were conducted for the leaders. The agenda ofthe trainingusually consisted of two parts. In part one, discussions were heldon the advantages of small family and means to achieve it In parttwq the official family planling programmq and the role of com-munity leaders was discussed and simple educational skillstaught Following this joint planning was done by the communityleaders and family planning stafl with the responsibilities of eachclearly established Some ofthese leaders were also used as depotholders Those selected for this purpose were given a half daytraining in explaining the use ofcontraceptives to others and keep'ing supply records Care was taken to select the individuals whowould be acci:ptable to the people?

The Athoor programme was based on the assumption that the

creation of the three conditi<jns of increase in knowledgq group

acceptance and provision ofacceptable contraceptive servicg willlead to an appreciable increase in number ofcontfaceptop whichin turn would lead to a decline in fertility. Itwas also assumed thatthe creation ofthe three conditiohs should be preceded by certaintype and amount of inputs and efforts While the inputs referred topersonnel, frnances and materials, effoits are iri terms of activitiesthat have to be carried out to create the necessary conditions-

Drd the programme succeed in rts goal? The evaluation of the

impact of the programme by the Institute indicates that it

People's

rncreased (a) knowledge 4ndand (b) acceptagpe of contt

in Family Planning

unication in family planningand (c) reduced fertility.

The KAP studies conducred by lhe Instituie have indicaiea ttatovereo percentof the il-;#6 il;"ii;irffiHffxl:r:well informed about tamily plarfni

Pupulation: 1,24,498 Eligible Couple:18,312

Method since Couples Vunentlyproteeted as on

31.10.1977

1957 to 31. 1977

Number Number Percentageof couplesprotected

ofprttected

VasectomyTubectomyNirodh & other CCIUD

54195747

160

2394

29.5

31.4

0.9,

13.0

20.16s33023i60228

4&

0.91.3

22.3By all methods r3720 4.8

Source: GIRH & FW Trust S

The fertility survey carried out every six months since 1964shows that the resident birth rate rggistered a decline.of 34.8 percent during 1959-1968, from 43.1 tq 28.1 per thousand

The decline was more steep durirfg 1964-196g. In 1977 the birthrate stood at25.6 and the death ratd at 10.3. In 1980 the birth anddeath rates in Athoor Block were esltimated tobe23.7 and 6.7 perthousand respectively.

Voluntary Effons in Family Planning-Il:

In 1959 infant mortality in Athoor Block was 120, the Institutesuryey for 1977 indicates infant mortaliry rate of 90.7.3 The inlantmortality for rural Tarnilnadu still stands much above thehundred mark

TABLE 4.2: Resident Birth and Death Ra.res

73

Year Birth Rate Death RateAilIndia(Rural)

Tamil- Madurai Athoor (Athoornadu 'Dist Block Block)(Rural) (Rural)

1959

L9&1965

19661967

1968

1969l9'10197 |1972t97419751976t9't'11978

43.1

35.s

36.131.633.8J t-z29.4

J.I.Ja1 t

27.4

25.6

20.1

39.0

38.9

38.935.9

35.936.7

35.8

34.9

33.8

32.6

32.9

J I.J

3 r.332.7

32.1

30.920.4

33.8

33.C

32.s31.8

31.0J I.U3l.0

16.9

13.4

13.4

10.3

Source : Institute Survey for Athoor Bloch SRS for all India.Tamilnadu and Madurai District.

Lessons from the "Athoor Experience"

There seem to be three main features of the..Athoor Experien-ce" (a) organisation, (b) co-ordinarion, and (c) partiiipation.

In Iaunching the Atho<ir progra.rimeo the tnstiiute aii noiltrowany hurry. Each and every arp"it oithe progru-rn. *", oiscussedand planned. lt starred with KAp study w-trich gave them a fairidea..of what.people thought about family planiing and ..smalltamrly_ norm". The srudy team took note of the i.act that the twoIamlty plannlng clinics already functioning in the area did not,

74 PeoPle's

really attract peopie. TheYfailure of the ciinics so as to drawlWhile evolving the stratbgy tothe environmental andilhe project staff also worked inexperience. Before theassessed the organisational needs

ture to sustain the programme. Allwhich could not be met with theproject staff Moreover, instead o!hurry, they decided to phase outprinciple of "strategic managemenin their strategy before thein every subsequent Phase.

A programme like familY Pand hence it requires coordinaorganisation as woll as betweentions on the one hand and PeoPlecognisance of this fact Its majorbetween the PHC and the BlockAction Committee and generatingof the two agencios. BY inviting thUnion Council to be the member oopened gates for PeoPle's

Apart from involving thegramme, it was equally necessary

the population in the Programme.training of communitY leaders

later. Besides, it was realized that'family planning and talking allmight hinderthe Progtamme. Thattended to the imrnediate healthrather than talking about familYpeople's participation as well as

Another positive aspect of thebeginning both the PHC and the B

at every stage of the Programme.cussed in previous sections.officially handed over thement, the two agencies in the areaexperience by another institution

in Family Planning

the reasons that led to thefor their programme.

the programme they took allfactors into consideration.

field to gain the first-handwas launched. they also

d created the necessary struc'additional responsibilities

staffwere assumed by thestarting the programme in a

programme, an impgrtant, so as to know the weaknesse collapses. and strengthen it

has many dimensions to itamong the workers in an

developmental organisa-the other. The Institute tookwas to ensure co-ordinationwas done by constituting an

tion between the staflChairman of the PanchaYatthis Action Committee it also

tion in the programme.office.bi:arers in the Pro-

involve local leaders as well as

led to the idenfication andproved'immensely useful

ine ahead head-on with thetime about family Planning

at times the project-staffof the local population,

lanning. It helped them elicitover a long period

ence was that from the veryk staff were actively involveddetails of this we have dis-

ereforg when the Instituteto the Tamilnadu Govern:not merely handed over an

ey had shared the exPerience

Voluntary Efforts in Family Planning-Il:

at every stage. Hencg they were better equiped to carry out th€programme.

The Institutb's Role in Family Planning Today

Frcm the very beginning the Institute was not interested in con-ducting family plannihg Its aim was to develop a methodologyand a strategy, which it did with considerable success. Since then,it has assumed the role of h consultancy agency to the governmen-tal institutiqns as. well as a fesearch and training institute. Thebasis, of course, is the "Athoor Experience":' To take into account various changes that may have occurredor that are taking place, the Institute undertook various kinds ofaction research projects to enrich their experience as well as tosustain people's interest in the matters of health and family plan-ning Two research projects currently under,way iq the lnstitutgwhich our research team visited are Distr'ict DevelopmentDemonstration Project (DDDP) and Integrated DevelopmentProject for Iinproved Rural Health (IDP).

District Development Demonstration Project (DDDP)

Under this project the Institute has adopted ten CD blocks in'Madurai district The Institute's main role is that of a consultativeagency to the PHCs and CD Blocks. The Institute also organisesand activates Mathar Sangam (Women's Club) and Youth Qlubsin villages and works for improving environmental sanitationthrough such organisations.

For PHC staff the Institute is a training centre as well as con-,sultative agency. They train traditional birth attendents (dars) who,'after training are provided with midwifery kit They are paid a sti-pend of Rs. 300/- per month for attending to deliveries and lookafter MCH programme as representatives of the PHC. TheInstitute also organises Orientation Training Camp for villageopinion leaders, who help in health and family planningprogfammes.

As consultative agency the Institute helps the PHC and the CDBlock para-mbdical staff in popularising family planning as wellas maintaining records for each of the villages. The ProgrammeDevelopment Officer of the Institute attends the monthlimeetinss in the PHCs and talks to the para-medical staff about

75

76 People's

their difliculties in ihe fieldapproach people, how to talk to

prove very useful in such--rnattersis also sought Mathar Sangams

fmaily planning Thereforg theponsibility of eiergqsing Mat har

'and collect children for

arq tniem, etc.

in Famifi Planning

advised on how to

te has undertaken the res-in economic and social

help in family planning worttion. The members are trained

In villages the Institute people to construct soakingpits and trench latrines. They taught about enviornmentalsanitation and other health res. Village opinion leaders

ofschool teachersproved very useful in this

endeavour. They are more to such ideas. Idea also travelsfast among them.

It is not possible to organise merely for health and

activities as well Every Block Tamilnadu has thirty Mathar,Sangams, as approved by the of India- DDDP hasselected ten Ma thar Sangams for Sixteen ANMs have beenentrusted with the respo to energise thirty Mathar

about thirtv members. TheSangams. Each Mathar Sangam'members of the Mathar Sangams

Integrated Development Prog_ramme

Under this programme fifteen {illages-ten experimenral andfive control-have been adopted liry the Institute. The emphasis,undef this programme, is on the f rovision of basic needs-whichhave linkage effect on health. Uhdei this projecl communityleaders (teachers, dais or caste lea{ers) and kinship leaders havebeen identilied and trained. Fami$ and group meatings are con-

. ducted with their co-operation. Malhdr Sangams and youth Clubs(are being organised), which worpld be useful in carrying outvarious programrnes under the proJect Students' ceoperation hasalso been enlisted in three vilfages. They are utilised fordemonstration in nutrition progra[nmes.

The Institute is preparing a list Qf intervention. programmes aspart of integrated health programqire. Some of these programmesare (a)

-environmental sanitation, (!) socio-economic programmes

in tailpring and embroidery. TheRs. 100 per mont[ which was la

ees were paid a stipend oladjusted towards the cost ol

sewing machine. They had to paJl

about Rs.5 a day.Rs. 280 more. Now they eqrn

and (c) MCH.

Voluntary Efforts in Family Planning-Il: ':-7

(a) Environmental SdnitationThe Institute has made attempts to ensure protected water sup-

ply to the villages. Tubewells and hand-pumps are being providedin the :villages under this programme. Scarcity of water andavailability of sub-soil water at great depth are some of the pro-blems that they are encountering Villagers are being advised andhelped in constructing latrines and soaking pits. A proto-type oflatrines has been prepared which does not require much space. Toencourage the villagers to go for soaking pits and latrines, it hasbeen tied up with socio-economic programmes. The Institute hasarranged Rs. 2,500 loan from the State Bank oflndia for those whoagree to construct latrines. Along with the latrine constructior\they buy milch animal (cowor buffalo) with this amount Thosewho agree to construct a soak pit get a loan of Rs. 250 for a goat orsheep and Rs. 75 for a soak pit The institute has also tried to con-struct bore hole and trench latrines for communitv use.

(b) Socio-economic ProgrammeAs discussed above, the programme of environmental sanita-

tion has been tied up with socio-economic programme. Apartfrom this anangement, the Institute has selected some boys forindustrial training The industrial training centre has been reques-ted to provide training to these boys in small trades. The SmallIndustries Service Institute has been requested to train some girlsin silk threading etc.

(c) MCHUnder this programme, 70 per cent to 90 per centANC has been

ensured. Once a week clinic is held at two villages. These clinicsprovide treatment for minor ailments. Male and female volunteersare selected and trained as health workers. Earlier these volunteerswere paid some honorarium which was latQr stopped at therequest of the health committee of the villages. These alinics alsoimmunize the children.

Health Committees have bgen formed in each of the villases forensuring popular involvement The Institute has been u-bl. toachieve limited success in this direction. This is, of coursg slowbut sure and gradual process.

Under another project a village: Balasamundaram-has beenadopted by the Institute in Pallani Block in Madurai districl OneMini Health Centre (MHC) is functioning in the village under the

/8 People's in Family Planning

direction of the institute. At presen the MHC is functioning in thebuilding ofthe PH Sub-centre of Block A new building con-

utiorq awaits inaguration. Astructed solely with people'sland owner of the,village, livingcontribution The rest . of thethe people.

To sum up, for prornoting li planning work the Gandhigrant Institute : ,

.i) developed suitable infras reducing populatron and

i0iit)19v)

vi)

Sample Villages

therefore, decided to go by thethp Institute. Their criteria was

erg has made a substantialhas been contributed by

rds and recommendations ofcent of couples protected by

vii) utilised satisfred adopters;viii) established a net-work of mriltiple sources of communica-

tion;ix) orgnised educational-cum-mfni service camps; andx) educated all those other th4n the target groups who are

involved in decision-making process.

SAMPLE SURVEY

Samole Villaees

In accordance with our we selected four' villages, two each with good as as two each,with poor perfor-mances in family planning It is n an easy task to judge perfor-mance of a village in a re like family planning We,

permanent method of family p Thus, the two good perfor-mance villages were Allamarath (45:2 per cent protectedcouples) and Chettiapatti (M.4' cent protected couples). The

Ramnathpuram "A'6 (4.7 pertwo poor performance villagescent protected couples) and M (6.8 per cent protectedcouples). In each of the good perfi villages eight acceptors

by three investigators.and four non-acceptors were in

Voluntary Effors in Family Planning-Il:

All the 36 respondents were selected on random basis.

The demographic profile of the four sample villages is given inTable 4.3 Alamarathupatti was the largest village in the samplewith a population of 1335, followed by Chettiapatti (952)'

Ramathupuram "A' (751) and Munnilaikottai (746)' Except

Alamarthupatti (which had 15 Christians in- its population), the

rest of the villages had all-Hindu population. Only Ramanth-puram had a small scheduled caste population. In rest of the

villages the scheduled castes were in substantial numbers.

TABLE 4;3: Demographic Profrle of Sample Villages

Villages

Alamaro- Chettia-thupatti patti

DemographicProfile Rama.na- Munnilai'

thapuram kottai

Total PopulationHindusChristiansScheduled CastesMaleFemaleSamples in Repro-ductive age grouPCouples Effectivelyprotected

1335

1320

15

605.

710625197

89

751751

746746

2t043303

118

6382309

102

952952

125522430180

80

ln Tamilnadu p-anchal'at elections were last held in 1971. Pan-

chayats were superseded in 1977. The panchayat bodies, therefore,

were non-functional in all the four villages.Onlly Alamarathupattiof the four sample villages had a farmet's co'operative and a Milk'Society. Each of the villages had a Mathar Sangam (Mahila

Mandal) and Balwadi.In addition to these, Alamarathqratti ha$ a

.Farmers' Club and Munnilaikottai had a Youth Club. We had no

means to measure villagers' participation in these bodies, butroughly 50 per cent to 80 per cent participation was reported by the

villagers in the activities of the above organisation.Alamarathupatti and Chettiapatti had a government Primary

Health Sub-centre each in the villages. These two villages were ser-

ved by.MCH centres. Rest of the two villages-Ramnathpuram

80 People's Pfirticipotion in Family planning

"A" and Munnilaikouai we.e serve{ only by para-medrcal statf ofthe govemment in the village. A.n ANM each resided inAlamarathupatti and Chettiapatti Qhettiapatti also had a Gram-sew_ak residing in the village. Alaq\arathupatti was visited by aVHW every fortnighl RamnathpurNm "A" was visited by an ANMevery weelq a VLW fortnight and a Health Visitor and a Hbalth.Inspector every month. Munnilaikottai was visited bv a GramSevak once a week and an ANM once a month. The hearestreferral hospital was eight kilo metefs tiom Alamarthupatti, threekilometers from Chettipatti and Rlamnathpuram "A" and fourkilometers from Munnilaikottai Bepides, each of the villages wasvisited regularly by the staff of the Gandhigram Institute.

Family planning services in the dample villages were providedby the para-medical staffi who didtributed the constraceptives.School teachers and small shop kefpers in the villages like bar-bars, tailors, etc. were appointed depiot holders for contraceptives.Clinical facilites were, however, available in pHCs Kasturba Hos-pital (part of the Gandhigram instifutions) and Taluka hospitalin Dindieul.

meetings twice a year, in Chettiap4tti and Ramnathpuram "A"films were screened periodically. Aftendence in film shows wasreported to be impressive. Mathar Sdngalz also played useful rolein the good perforrnance villages.

cQ-r)peration.


Very active form of participation was not reported ftom any of

the viliages. Apart from accepting permanent and non-parmanent

methods-of family planning on persistent motivation'-few accep-

t i. fr.ip.O ttre treitth stafi moiivate non-acceptors' if required'

i.opl. *.t" reporred to be helping in organising family planning

camps and tritping experts to ccme and sp<-'ak to the non-

uaa*tor. in Alamarathu pattL lulathar Sangam was also reported

;;;*ty active in the abbve village' Participation in rest of the

villages was reported to be limited'

Sample ResPoridents

As stated earliet the selection of the respondents in both good

performance and poor performance villages was done on the ran'

bom brisis. Effort was howeve! made to select respondents from

different sExes in both (acceptor and non-acceptor) categories. so

as to give the sample a representative character. We had our olvn

difficulties due to constraint of time and availability as well as

willingness of the respondents. Hence, we had to make com'

promises. BuL bv and large, the samole was representative'

There are difficulties in assessing income of the rural popula-

tion specially ofthose subsisting on agrictllture' People were hesi-

t*t'oirtutirrg their income; but -not

beiause they wanted to hide itbut because they never made an estimate of their income' We have'

however, accepied the statement of the respondents in this regard-

which most of them made on persistent enquiries' On the basis ofthe ten slabs of Rs. 1000 each prepared by us for tabulation pur-

poses, the respondents ofthe four sample villages fall in the hrst

TABLE 4.4: Economjc Status of Respondents

Annual Income Acceptors Percentage lJon- PercentageAcceptors

Rs.' 0-1000Rs. 1001-2000Rs. 2001-3000Rs. 3001-4000

7 29.2

t2 505 20.8

4b

II

33.4

50

8.3

8.3

Total z+ 100.0 l2 100.0

82 People's 'pation in Family Planning

four slabs (see Table 4.4), a majorii.e.. Rs l00l-2000. slab.

of them falling in the second,

The acceptors in the sample onged td relavively youdgerper cent of acceptors in theage-group. Eleven acceptors. i.e.

sample belonged to 25-29 years group, while no acceptor res-,pondent was older than 34 years. to an extent, is indicative ofthe success of thefamily planning rkers' efforts in the area. Thefamily planning programme

groups from 20 to 44 years (see Tr e 4.5).

TABLE 4,5: Age-Group Cotnposition of Respohdents

Age-group Acceptors Non-Acceptors

Percentage

couples are prorgcted by one or theThe non-acceptors, however,

be successful only if youngerther family planning method.distributed in various age-

,1

25 3

I6II

4625

i5-1920-2425-2930-3435-3940'-44

1

6ll6

25

8.3

508.3

8.3

Total !.) 100.0

was educated above middle school l]evel. The surprising feature is

2+

Table 4.6 indicates educational levels of the respondents inTamilnadu. No responden! whethei an acceptor or non-acceptor,

that a majority, i.e,, 6l per cen( of lthe acceptors werJilliterates,while a majority, i.e.,41.7 per cen! of the non-acceptors had oassedmiddle school examinations. Lookilpg from another angle, only 37per cent of the acc6ptors were literaft (primary and middle) while75 per cent of'the non-acceptors were literate (primary andmiddle).

As stated earlier, we had planne[ to include both males andfemales in equal propbrtion in our {ample. But we had to modifyow strategy and make ddjustments i[ the field. The main problemwas of cpntacting during the day m(n who used to go out early inthe moining to work in the field h{t conte back only late in the


evening Under such circumstances we had to inverview women.We could get the non'acceptor males and females in equalproportions, but not the acceptors (Table 4.7).

TABLE 4,6: Educational Level of Respondents

Educationalstandard

Acceptor Percentage Non- Percmtageacceptor

IlliteratePrimaryMiddle

t53

6

J

^

5

63

t225

25

JJ.J

4t.7

Total 100ai t2 100.0

Sex

TABLE 4.7: Sexwise Distribution of Respondents --

Acceptors Percmtage Non- PercentageaccePtors

5050

66

8 33.3

16 66.7MaleFemale

Total lo0L2100


That panrctpation is a, graded activity. and people select

activities for participation according to'their nbeds as well as on

being influenced by several environmental factors was further'affirmed by our survey of the villageS ' near Gandhigram'Respondents' variation in affirming . questions on differentkinds-social, political and cultural activities d€monstrates thispoint effectively (Table 4.8). The respondents' concern for healthcare is evident from the fact that cent per cent of them (both

acceptors and non-acceptors) were prepared to help government

in opening a health centre in the village, (h) organise healthservices to the village, (c) volunteer their services to government

voluntary agency to take health services to the people.

People's PQnicipation in Family planning

TABLE 4.8: Participatorv Aftitude of Respondents

Percentage of res p o nde ntsaflirmint the questiorc

Acceptors No.n-acceptors

l. If there is shortages of essen

commodities (Kerosene S

Fertilisbr etc.) in yourwould you make efforts tothem available?

2. If there is shortage ofwater in your village, wouldmake efforts to make it

3. If the neighbouring

41

4l

75

66

66

54

4.

5.

87

)U

village?6. If a film is being shown in fthe

neighbouring village, would Yougo there to see it?

7. If the film being shown in ypurneighbouring village is on farigily.planning would you go therel

8. Would you also make efforts to get

the film screened in your village?9. If your village does not havb a

health centre/sub-centre/disp[n-iary would you make efforts to getone opened in your villaee/wa[d?

29


J't

10. Ifthe government decides to open 100 100

a health centre/sub-centre/dis'' pensary with the helP ofPeoPle inthe village, would You helP?

1l: Would you be willing to join in 100 100

organising health services to yourvillage?

12. Would you be willing to pay for 79 91

health services?

13. If a family planning centre is 79 83' opened in the neighbouring village,

would you go there?14. Would you also make efforts to get 20 25

one family planning centre/sub-centre opened in your village?-

15. lf a nationaflocal leader rs dbli- 91 83

vering a sPeech in Your village,

would you attend that?

16. If a political meeting is being held 66 50

in the neighbouring village, wouldyou attend that?

17. Would you like to campaign for a 62 83

partylcandidate in election?

18. bid you campaign for any partyl 66 91

.candidatd in election?

19. Did you vote in the last election (a) 91 91

Panchaya! (b) State AssemblY,and (c) Lok Sabha?

20. If the local leaders organise 87 6demonstrations on rising prices ornon - availabilitY of certaincommodities, would You Partici-pate in iP

21. if the wwvHw id not visiting 75 83

your village, would You make

complaint to the concernedofficials?

22. lf you are requested to volunteer 100 100

y6ur services to the government/


voluntary agency to take theservices to the people, wouldvolunteer yourselfl

23. If the school teacher invillage/ward requests you topersuade to send children toschool would you help him?

24. If the VLWVHW requests you tohelp in persuading and motivati]ngpeople for accepting family plarin-ing would you help him?

25. lf 'Keertan' or'Ram Lila' is organi-sed in your village/ward would ybuattend tha0'

Average

lhe same is true tbr their fbr eoucation of thetr children(question 23). For some reason or they themselves were not

centre or family planningprepared.to make efforts to get dcentre (see responses to questions 8 d 13 in Table4.8) opened intheir villages. Both the acceptors non- acceptors demon stratedluke-warm attitude in this reeard werg however, as pointed

govern4ent or a voluntaryout earlier, preparod to help ifeitheragency takes the initiative. The of immediate nbeb is alsovisible in their response to questi I and 2. It seems that theshortage of drinkirrg water in acornmodities like kerosenq sugar,attitude towards political participr

75

100

95

83

7l

79

75

Percentage of reqpondents voting inalso seemed very positivelast Panchaya! Legislative

as high as 9l per cent.Moretheir intereSt in attending

'Assembly and Lok Sabha elections

The average score lbrltems (75,71) shows only margiral brence between the attirudes.of acceptors and non-acceptors The acceptors' score were;

non-acceptors equalled lhesurpassed them. Thus, thetwelve items. Of the seven

'is graver than other essential

tilizers etc The respondents

for a caodidalesand non-acceprors over 25

however. higher. But oir six items

Volunbry Efiorts tn FamiIy Planning-Il: ql

iluestions dealrng with family planning: 4(6AD, 5(5431),

7(E6,65), S(50,50), l3(7e,E3), r4(20,2s), 24(9s,7s)- the non-

Fcceptors equalled one with the acceptors . and marginallypxceeded them on trvo. This creates a rather confusing scenario.

but it can be explained if we look dt the data.carefully. Scores forguestions on family plbnning show that on two questions where'ple non-acceptors exceed the acCeptors, the difference is small,But the acceptors have sizeable lead in three questions It can

lherefore be inferled that participatory attitude does have someth:

[ng to do with this. But the participatory attitude of the two sets ofrespondents is not substaltially different hence there is someth'ling more that accounts for Jhis. We shall come 3o it later.

All the respondents botli acceptors and non-acceptors were ofthe view that the government should pay for and organise health

services Only one person wanted voluntary agencies to organise

health servicis. B,rl aq indicated earlier, people did not seem to

Bhy away from their'ou4r role. The evidence comes from the

aor*et to question 10, where 100 per cent respondents have

Fllirmed that they would help if the government opens a healthcentr€ with the help of the people. Wg then, asked a supplemen''

tary questiotr to know what kind of help would they provide. A lit-lle more than 58 per cent of the accepSors and 75 per cent of the

non-acceptors were prepared to help physically;20.S oer cent ofthe acceptors agreed to provide material help, while 20.8 per cent

bfthe acceptorsand 25 per cent ofthe non-acceptors were ready tohelp both physically as well as materially. This, on the one han4eflects their attitude to participate in this social activity, and oa.te other hand shows their concera with the health of the villagers'[t alsb means that available health services leave much scope

i"or improvementTABLE 4.9: Help for tlealth Services

of Help JorHeakh Semicet

Physical HelpMaterial HelpBoth

Acceptor Pertentag3 Non-Accqmr Percenage

t455

58.420.820.8 )<

9

2

Iotal tz100.0 100

88

Motivation


a percentage as 9l and 83viiited family plan-

nrng centtes and 95 and 75 per cent of acceptors and non-acceptors use{ the facilities. An majority of theq

consulted the doctors for

tion of the acbeptors and-non-apersuading friend$ or relativeqning centrg etc. The ayerage pl

difference inlhe motiva-toro is visible in questions ot

spouse to the family plao,

acceptors and non-acceptors carference in motivation rates shows

of the family plannin!to 74 aqd 49. The wide diFt motivation towards family

a family planning centre or

their non- acceptanca Arnot suspicious ofgoing to

motivation is a faotor,. there aierg a doctor. Thus, whilefactors as well We shall

come to it later.In abour 30 per cent cases ihe dec

Motiv. ation of lhe respondentsin terms of their visit to the fanfacilities, seeking ddvice from the'family planning atc. Here ftain.the motivation of the accept<irs ifhe responses reveal that a visit tomore looked at with suspicion. Asof acceptor$ and non-acceptors n

(87 and 77 per cent respectively),advice on family planning Slightly

'planning was partially responsibleitemwise analysis r'eveals that thev I

cent got the wife sterilised Only insion to get herself sterilised withc

thcir decision to accept,.familywhat should be done to make Isizes the importauce of attaching

family planning,was judgedplanning centre, using thc

advising others to acce.ptsimilarity can be seen in

nod-accepton (Table 410).family planning centrc is no

ing But their opinion onplanning popular empha-rnomic benefits to familv

ion to gc[ sten]tseo was BkeD.either by husband or wife and in 70 per cent cases thedecision was taken jointly by the In 50 per cent ofthe caseswhere husband decide{ he got hi sterilised and in the 50 per

case the wife took the deci-

husband or the mother-in-law.the knowledge either ofthe

, Except one accoptor, who having gone for sterilisa-tion for money, tho rest denied incentive money influenced

planning in rural areas. Fifty per of the acceptance felt ihatprovided some economicbenefits varied Some sug-

family planning adopters shouidbenefits, their perception ofgest€d that the amount of the money should be raised,few of them offering iearion that people cannot afford going

Voluntary Efrorts in Family Planning-Il:

off the work lbr a strerch of lgng peno{ some others suggested

economic help in the form of milch animalsT or long-temrbenefits. Equally important seemed to be tlie emphaiis on follon'up services for acceptors as well as general health care facifties' .

Fifty per cent ofthe acceptors sugg€sted strengthenitrg ofthese tii'oserviceg implying thereby that the existing facilities were not sufli'cient for them. The resDonse of another.2l p'er cen$ acceptors

TABLE 4.10: Motivation of,Acceptors and Non'Acceptors of FamilY Planning

Question on Motivation Percmtage of rslondenbafrrminq the audtons

Acceoton Non-acce?ton

E3

t)

75

9l

95

87

o

t

2.

4.

Have you ever been to a fdrtilYplanning centre?Have you ever used the facili-ties provided by the familyplanning?Did you ever consult themedical oflicer in the dis-pensary/health centre/sub'centre and seek adviceon family planning?Did you ever take your friends/relatives to the familyplanning centre and persuadethem to accept family planningmethods?Did you ever take youi spouseto the family planning centre?Has anyone ever advised youto adopt family planningmethods?

Average 74 49

25

8

70

37

5:

6.

in Family PlanningSrought out the rrnponance ol' le's panrcipauon 'Ihey sugges-ted that happy acceptors be used to motivate non-acceptors who can tell them that planning measures do not

. affect health adversely.e Only onegood publicity.

emphasised the role of

Padicipation, Motivation and Planning

Thug the data ,presented abthat the participatory attitude is

ticipatory attitude even for theextent attributed to the activities

accepto? can be to a largee Gandhigram Irstitute. It is

apparent that one reason whv non-acceptors in the are4 inspite of high participatory attitudening is that the Institute could not

ve not accepted family plan-the level of their motiva-

tion But this in itself is not t explpnatioo

TABLE 4.ll: Views Non-acceptors

the family planhing behaviour

. acceptors\ while motivation does

and its analysis demonstrateof a reason for differences in

of the accepiors and non-play some role. A high par-r

If somethinghappens to ongat least theother willsurvive.

look afterDoes not likein contraceptives.

S/ NumberNo. of

children

Desirablenumber ofchildrenaccotdingto the res-pon(ent

2or3J

Has noNone tr

the chilcas€ino

of them

Voluntary Eforts in Family Planning-Il: 9l

l24.6 Scared of sterili-

sation

Scared of sterili-sationHas no child yet

Wants one morechild"Had a child only 3 Prepared to getmonths back and sterilised after onedid not want to get year.sterilised imme.diately.Wants to have onemore childWife is pregnant

' for the fourth timE

Not conceived forfoul years sincelast child, so no

_ needCan't say,

It may lead toryeakness Eo€snot like bontra-ceptives.

. It'may lbad toweakness.Does not likecontraceptives

Four children areneeded to helpparehts in old age,

Sterilisationaffects health

Does not likecontraceptives"

5.4

3. Nil

7. I

8.3

9. I

10.: 3

lt.5

t2. 4

A number of other factors influence an individual's familyplanning behaviour as well. Some of these factors are: the numb6rof living childre4 the number one consi.deri dEsirablg one'sattitude towards.contiaception as well as a number of other socir*psychological factors. An analysii of the views of all the 12 nonlacceptors in our sample provides a clear pricture (see Table 4.1l).The da{p makes interesting reading and provides valuable insightinto thb respondents' perceptions

_Only four non-aoceptor respondents had more than threechildren and none had more than six Two had yet to havechildren and thpe each had one and three children All but one


consic€rcd two ot three childrenthought live was the ideal numl The two who did not have a

while only one person

.child did not accppt for obvious

children desirablp for a family.because they did not like it Three

ns They considered threedid not use contraceptives

the respondents with only onechild were waiting for one or two One ofthem consideredtwo as desirable and rest though three were desirable. Givingreasons one ofthem said that if happened to one child,at least two would suwive to look the parents in their old age.All the three who had three each considered three asdesirable numbef but had difl reasons for non-acceptance.

the family in case one of theOne ofthem had no one to look'spouses gets sterilised And he not like contraceptive either.

to a child only three monthsThe other ong a womarl gaveback aqd since she did not want to sterilised immediatelv. shedecided to pospone it for a year. Ipregnant for the .fourth time andminal method after the fourth.saying that four children were tial to look after parents. Thetwo respondents with four children considered five and threeas the desirable number of The first one was scared thatsterilisation might cause while the second was not sure'why, but he certainly did not likewith five children considered two

contraceptives. The one

and did not accept familychildren desirable for farnilymeasure because she had not

conceived for fouryears since last Besides she thoughtthat sterilisation effected healtlr" And the only one with sixchildren thought dhat a family sh have only two children. He

contraceptives and thoughtThug ncine of the non-

did not accept because he did notthat sterilisation causedrcceptors beli6ved in too large awere potential acceptors.

and at least eight of them

It is not possible to make generalizatioos on the basisr respondents. But fre can.of the intprviews of 12 non-

advantages of smallfamilY is. safely conclude thlt awareness ofdgradually sPreadiug in this area a

lcertainly claim sorne credit for thisthe area for nearlY two decades

from ideal. A nuntber ofPeoPle

fourth respondent's wife waswas prepared to accept ter-,He contradicted himself by

Gandhigram Institute canthey have worked for this in

though the situatioq still is far'still apprehensive about con'

traceptives and afpaid of

Volunrary Efforts in Family Planning-Il:

Overview

The study of Ghandrgram Institute of Rural Health and FamilyWelfare Trust offers useful lessons in planning organising andimplementing family planning programmes. It emphasises com-munity involvement in population control in developing peopldsparticipation in family planning programme. Assessment ofpeople's need according to local requiremearts and continuousadjustment of the emphasis of the programme according to localpreferences and reactions made the people feel that the targets andstrategies weie not imposed from above, but were chalked out bythem. The pdect staff could gauge the reactions of the people atevery stage and recti,$ the shortcomingsj if any.

Secondly, the programmes are usually implemented on thebasis of the principles of what is known in the administrative andmanagement parlance as strategic management. There rrre fourcritical interventions for the success of any programme accordingto this concep( ('1) the formulation of a strategy for the programmeconsistent with the objeetives given by the government and theenvironment in which it is implemented; (2) the creation or adoption of an organisational structure that matches the programmestrategy and facilitates its implementation; (3) the operation of theorganisational processes of planning and monitoring performan-ceq and motivating and developing human resources consistentwith the strateg5r and structure referred to above;.and (4).continuedorch_ristration of these three types of interventions over time so thatthey reinfoice one another even as environmental conditionschange (Paul 1981:H-l3l).

As our study of the "Athoor Experience" which is the basis ofthe Institute's entire worlg today, reveals that each of the interven-tions were used during the project to achieve 'results. It must beipointed out liere that the application ofthe above interventions, soessential for strategic managemen! is diflicult at macro level

Thirdly, the most important feature of the programme of workof the Institute and hence the lesson for the implementation offamily planning is the coordination among various governmentalagencies which have a role in the implmentation of a programme.The rivalry between the heads of two or more governmental agen-cies at one level over their status and the resulting disputes over,rights, duiGi and jurisdiction very often tells upon ihe perfior-mance of a developrirental programme. The tug of war over such

93

in Family Planning

petry issues has been reported toPHC staff and the Block staff in tt

very common between the

planning programme. Theimplementation of the familystudied this aspect of rivalry

,and jealousies not onljr in the of other development pro-lon is ensured between

situation the Institute evolvedby constituting an action

committee which [s the base of coordination. Whilethe situation is far from ideal ere in Tamil Nadu, the experi-

successful. The result was theclaimed prize money. The

ment of Gandhigram Institute wasInstitute fulfilled the targetsInstituk does not have the target- approach in famillplanning but aicepts 'cc ' as the basic obiective infullilling the allotted targets. BV ir g block and PHC staff

friction between thernthrough coordination and thusthe Institute has been successfulgrammes of fertiliff and mortality

involving ...- both in its pro-The strategy ofidgn-

ti$ing community leaderq trai them and using them forcommunity participation in devel t projects has paid a richdividend in fulfilllng the ob of the family planning

Finally, the creation and r

Mathar Sangams and Youthof voluntary groups like

structures can be used successfullvproved that these informalenlisting popular participa.

tion in programqes like family p The eiperience alsoshows that once such institutio are create4 activated and

hannelize their efforts in dif-energized it becomes much easierferent directions. Such institutions only become agents of

of rural reconstruction, theycaste and religious pre-

judices if used judiciously.

change and accelorate the processalso have the potential for weake:

94

lgrammes as wel! so that proper'idepartments. To tackle this type. the method of coordinated invo

Voluntary Efrorts in Family Planning:-Il:

survey of the Institute, its poprilation was 1,24,498 in

95

NOTtiS:

t According to the,t977.

2 The percentages areInstitu!e.

based on 1961 Census figures, as given to us by the

3 It is difiicult to surmise how has the Institute achieved a birth rate of25.6 withinfant mortality as high as 90.7. But these are the figures indicated by the InstituteSurvey, and they claim that they hav€ achieved such a low birth rate.

I For i{€tails of the l'Athoor Experience" seg Pisharoti, etal, 1971.5 For a detailed discussion on the concept of strategic management and its

importance to dwe.fopmental programmes see Samuel Paul (1981 : Ml3G.Ml,l0).

6 There were two villages ofthe same name in-the area. Thereforq t'he Institutechristcned them !'A' and 'B" for identific4tion purposes.

? Thc importance of Gandhigam lnstitute's progammes rs qurre apparenr.bere, llt one of their projects to improve environmental sanitatior! they have tied'up economic assistance for soaking pits or sanitary latrines with milchanimals.

t The ove apping in the percentage is because many ofthe agceptors suggestedtwo or three measures

9 Hereagairi the Gandhigram Institute seems to have effected th€ perception ofthe respond€nls, This method was used by the.Institute in course of their"Athoor Ex.perience".

Chapter V

Voluntary Efforts lnFamily Planning- : Vadu RuralHealth Project

THn vudu Rural Health a relatively young projec! wasselected for otr study for two ,s. Firstly, it is one of thb few

with the Communitv Healthhealth projects whichWorker Scheme much befiore the ent of India recommen-ded it in 1977 and secondly, ithas tely embarked upon the newapproach of .cootdinated i ent between its staff and themedical bureaucrracv of the t of Maharashtra The pro-ject was launched in 1972 the King Edward Memorial(KEM) Hospital under the leadersfrip of Dr Banu Coyaji decidedto'enlist its resources in the area (f rural health, which though avery high priority area was a relativbly neglected field' (Coyajiet.al,1978: Annexure). In its decade old bxistence this action-researchproject has been able to show somp interesting rbsults in the areaof health and family planning After'achieving some success inthis are4 the project is now diversi]fuing itselfin the area of ntitri-tion, environmental sanitation an{ rural reconstructiorL in whichUnited Development And Reconstruction piogramme(UNDARP), another voluntary agency, is also helping theKEM Hospital.

This chapter is devoted tb an indepth analysis of the VaduRural Health Project on the bas[s of its activities and surveydata.

THE PRPJECT

The projec! druws its name frofn the villagc Vadu Bqdrukr inSintr Taluka" locdted 18 miles fro$ Pune which was selectcd for

.Voluntary Efrons in Family Planning-Ill: 97

setting up a primary tlealth unit Immediately after the KEM Hos-pital developed into a full fledged general hospital, offbring a widevariety ofbasic specialities to the people ofPune. the need was feltto take its facilities to the rural areas as well. Btrt considering thatthe health needs of the rural population are ofdifferent kind, a bighospital on the same scale would have aggravated their problemsrather than solving them. For- one thing the rural populationcould not have shouldered the burden of a curative medical cargand for another, distances in ruril areas being considerable withno proper trarsport and communicatiou facilities, another hospi'tal in a village would have been as good or as bad as having a hos-pital in a distant town or city. Thus, a different kind of expertisewas noeded to operate a project on rural health. Besides, morefunds were also required, which were not easily available.

The search for funds, dxpertise as well ae an area for this experi'ment thus started When the KEM Hospital approached OXFAIv!they proved more than willing to help not rnerely with funds butalso with expertise. Once the financial and technical resouices

' were availablq the village .of Vadu (Bk) in Sirur Taluk4 in anendemic drought area with low income and no community healthsprvice was selected.

The project started with the aim of providing a basic healthframework for the village community, with the thrust directed

towards the foltowing priority areas:

a) Maternal healtlL including antenatal, perinatal and pgstnatall

care,b) Care of children under and upto five years old'c) School health. andd) Famib Planning'

The Project Team realised the importance ofpreventive system ofmedicine in the rural context, but it could only have been a'chieved

at the second stage. In the first placg it was essential to provide

curative services to the villagers to take care ofprevalent mortalityan4 in the secon4 it was necessary to gain the confidenie ofthelocal people. It was therefore, decided to provide basic curative

service af the village with a strpng back up service by the KEM

'Hospital at Pune" Secondly, the aim of the Project was also to

develop a sense of participation and achievement amp1rg.the

villagers so that they can stand on th-eir own feet some day.

Tire participation was elicited at two levels-at the level of com-

munity as weli as individual. The villagers responded oir both the

Peopk's in Family Planning

lwels. At thi level bf,community, the Panchayat gave a stonebuilding in the heart <iithe village setting up the health centre.

a small quarter for the resi-,Eater on the village alsodent Medical Officer with theindividuat they were asked to

ty effort At the level of(token) payment for drugs

and vaccines which they wilinglyIn operatiog a y programrne the villageg .it is essential to

take into account the immediatethis the project tcam fotrnd that

of the piPople. Realisingarea had been in the grip of

drought for the past three years. It have been pointless totalk to them of health and nutricient food to eat OXFAM agreedScheme for under hve children in

when they did not have sufh:support the Efoergency Food

Hospital A basic supply ofAre4 prepared by the KEMand calories fas providedpulses, supplemented withdaily from a mix of whea! gur

skim-milk and MPC powder by OXFAfv[ was main-morrsoon that vear easedtained from February 1973 till the

the situation Though this did the basic work of the Projectby a few monthg it proved anBecause of the beneficial effecl of

useful entry point

The Working of the Centre

'rhe project declded to initially on Vadu Bt. alonewhich consisted on the main surrounded by a number ofsatellite hamlets upto a few miles. to'house family surveywas conducted and the basic details recorded on a FamilvHealth folder which formed the record and the nucleus of allthe other records kept Initially the functioned with a medi-cal doctor assisted by two Auxiliarylnitial work consisted of

urse Midwives (ANM). This

l. Mctemal Heahh .Al.te at^l were i&ntifled examined-

cerned, the Project staff crruldvillagers.

given necessary supplements and.cases were either delivered in theregular postnatal care given inreferred to the KEM Hospital at

scheme on the children con-the confidence of the

immunisation Normalor in their homes with

case. Diflicult. cases wereAppropriate family plan-

oing advice was also given at thisl. Family Welfure All the eligible ples dibcovered by. surveywcre-giren apptopriate advice. All contraceptive methods were

l/oluntary Efons in Family Planning-Ill nbrought within the easy reach of the villagers. In additro4 a spe-cial'camp'was held in 1976 in conjunction with the state healthauthorities Vasactomies were performed at the Centre by the doc-tors from the KEM Hospital, and rubectomies were performed inthe main hospital in Pune.3. Underfvediare.' fhis wai based on thrice weekly clinics (whichwere combined with well-baby and ill-baby clinics for rural con-venience), supplemented as necessary by hbme visits by theANMs, and hamlet by hamlet drives whenever necessary.

a) Immunization: Triple vaccinationg polio vaccination and^small pox vaccination were main parts of the immunization pro-.gtammes. The help of the government vaccinator was sought for.the latter, but the rest were carried out by the Centre staff After ini-tial reluctance to accept these procedqres with only 'abstract','benefits, there was a good acceptance to the extent that parents;willingly paid lor polio vaccine, which was available free to theCintre.

b) Health: Attempts were made to ensure health care for all theunderlives in the village. Their health.and weight records were'maintained.on Morley type cards, which iq, order to encourageunderstanding of and participation in their chilpren's healttlmothers were ridide to keep. Gradually it became evident thatmalnuhition wqs widely prevalent in this group not only because

of impolaris[nent of the family, but also because of 'their

ignorance. Hence, elementary nutritional education were impar'

tld to mothers with demonstrations. The Centre providedsup-

piementaries to the poor to avoid malnutritior with the help of

f*f "y: t :il:rTJ;Jl,L..-.m,n ario n or al the schoor goi ng

;ilffi; *"t'tt"a. regulirly' They *'ere-immunized against

i.""tt.ta.,U.ir heatth-recori was kept in the school in the form

il;;il;Lookler The teachers were requested to carefully

ffirveil: ;notmafity and bring lt to the notice of the

dgctor,5. Tuberculosis Scheme: lnrs scneme was initiated in 197'l-75' All

#;"#;;;-ffi; o, pt"i'ttot '*niratov

rvst3l.were X-rive4

and had.sputuni'examinJ iositive cases were put on to triple

,d";;-Jt;n trr.i' to"titt iot"tinto uvno:tr€ visiting tested

iand treated wherever necessary' To ldentifylt:].Y :19 asymptc

matic cases, a mass tt'*tv *o ttieesspry" out' could not be

arrartged in the firsl few Years


:6. Health Education: Many a dir

;due to ignorance. Helrlth eduiatlter the ignorancg ANMs took i

prevalent in villages spreadwas the onlv measure to coun

the responsibility to educatetfe villagers on their home visits precaution to be taken toavoid a particular type of The Centre also organized

rgers. In additioq irtformalgroup meetings. to gducate the'teachir.rg was given by both qr and doctors during clinicsat all times.

Structure of Staff .

The Project was carried out in limited area till 1978. Durine1972-76 the staff of the Centre isted of a medical doctor andtwo ANMs, aided by fourANMKEM Nursing School. Curative

living in by rotation.fromclinics were found to be

. an essential pre.requisite to of the preventive program-mes, but were kept to a minimum of thrice a.week

A consultant Paediatrician the Centre once a week and, supervised the infant and baby which functioned thricea week

ANMs visited homes at and pre-planned intenal*They, however, did makevisits were considered to be amonethe Centre and involved treatmeit follow up of cases unableto come to the clinic, healthforthcoming vaccination drivesfor family planning andcases.

visitg if necessary. Hencemost important activities of .

.cation and propaganda for,surveying of eligible couples

ion and carg of antenatal

Worker(CHW) scheme wasion of this scheme not

This structure of the Centre and above mentioned functionscontinued till the CommunityHeaintroduced in January 1977. The ionly enlarged the staffin the proi it also led to enlargement of'its functions.

Community Health Worker

.-,-.-1,

T.he Communi8 Health Workers (now known as CommunityHealth Volunteers) Scheme wa, f""p._fr"A iri li. fuai r-.;""t inJanuary 1977. Th,e Government o[ India,s CHW scheme on ]similar lines came onlv bv the end "i,fr.,.", iiif, tt. irrt.oO.rotion of this scheme ttre area of thd qoj;-w;r'."'riLa ,o rsvill?ges with a little over30,000 ooo|rtlaiil;ffiiluLr ro 0..

Voluntary ffira in Family Planniig-Ill: l0l

i.

i

p-

Vna'

I

,vide cach villagg with the basic health care at the door step as wellas to bring dbout changes io their social life. The CHWs' thereforg'rvcrc oot only !o be bare foot doctors, but also change agents work'iqg at the grassroot level"On" .ile and one female CHW has been identified and

hained in each of the 19 villages On the whole there are 39 male

and fcmale CHWs. One village with large population has beengiveri an additional CHW The 19 viltages in the project have been

divided into six scctors Each sector has been put under two Multipurpos€ Wortrers (MPW), one male and one female (see figure

3.t). ffrese 39 CHWs and 12 MPWs helped the Medical Ollicerand bcaltb supenrisors (2J io ensuring primary health to the

villagers.I tre iraining programmes of the CHWs was desigaed carefully.

In fact, their training was a continuous process. ln a regular mon'thly meeting the work of each CHW' was presente4 discusscd and

reviewed Thc probleqs faced by them were debated and praciical

solutions werc evolvid To know the yiew of the villagprs alsqthese meetings werc organized in rotation in each villagg where

thc vi[agers alro participatdd and tcok p'rt in discussions

The CHWs Eain function was to provrde p imary health care

.'particularly to under'served and unserved com aunities living intiie vilages; (Rao and Coyaji, 19?9:3). Their function consists of(i)Maternil and child Hcalth;{ii) Family Planning (iii) lmmuniza-

tion; (rv) Control bf Cpmmunicablc diseases; (v) Hgalth Educa-

tionj(vr) Nutrition and Nuaition Education; (Yii) Environmental

. Santitation; (viii) Health and vital Statistics; and (ix) Treatment ofminor ailments.(i),Matemal and Child Health: This is the responsibility of the

iemale CHW who is supported by the female MPW. A Mothcr

Health Record Card to be filled up by the female CHWs was

introduced The CHWs record expectant mothers at risk and then

refer them tg the female MPIVs and the public health nurse' The

cases are registered in the,Iifth month of pregdancy. Thus" the

female CIIWs have been given the charge of antenatal and.posttratal carc" Apart from regular visits by the CHW, at least six'antenatal visiti are paid by the female MPW and trvo by public

health nurse in the case of every pregnant woman. Considerind the hith rate of penatal mortalig_, some female.

CHWs were gfvor training to conduct deliveries. One reason forprenatal mortality was found to be non-avlilabitty of doctors or

'tr.-'a>-'a6ct)

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v

oo

v

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Yolunnry Eforts in Family Planning-Ill: 103

nurses at the time of delivery which made the villagep dependentupon the traditional birth attendants. Since the CHWs werewithin the easy reach of the villagers, it proved to be a wisestep. The female CHWs soon showed fine results'in cases ofdelive.ry.

But, it was obsenre4 still many deliveries rivere conduqltd athome by untrained relatives. Two steps were taken to tackle ihis'problern The female MPWs were used to communicate techni-

.ques to conduct safe delivery. A compact delivery pack consistingofa used razor blade for cutting the cor4 several cotton swabs andrsurgical gauzg cotton thread for tying the cord was sealed in apolythene.bag and irradicated by gamma rays along with a tinyplastic bag containing liquid soap was given to the person likely toconduct the delivery This pack costs less than a rupees.

Second,lyr,thq yillagers were stimulated to provide a room to beused as Matemity Home. The roor4'was disinfected and fitted withminimum facilities like wash b4in, delivery equipmentg erc.Lrcreasingiy. more and more vrllagers are offering rooms as theyfind how useful this has been(ii) Family Planning Family Planning as slated earlier, is anintegral part of this health project Il tlierefore, became one of theimportant functions of the'CHWs. In facg they were in a bettdrposition to motivate people to accepting family planning as theywbie from the same village an4 moreover, being uominee of thecomrrunity, they also enjoyed their confidence. It'would, perhapghave been difficult to revive the programme so soon after thd set-

back it received in 1977 without the help of CHWs.(iii'1 Immunization.' Immunization of infants, children and infantmothers is an essential part of community health lt not onlyrbduces infant and prenatal mortality but also helps in reducingbirlh-rate. This ig therefore, one of the important functions of theCHWs. The CHWs have not been trained in immunizatioq. Theymerely inform the parents when to get their children immunizedand against what disease. They are best-suited to perform thiS

tlnction because they fill up and maintain Mother. HealthRecord Cards.

The MPWs. however, have been trained as vaccinators as well.They.carry out most of the vaccinations in the villages. It has beenpossible to immunize more than 80 percent children in theproject area(iv) ContruI of Communicable Diseases: The CHWs have played.an

l(x

imponant rcile id containing IV

'They have successfully createdspreads what ard its symptomsmust be taken ouce it occursPreva_at,bre€ding of mosquitoes

The success in controllingfli1the CHWs have become quite r

type" diarrhoeas, known as F'

played curcial role in prwentinginfepting wells, pot disinfection,vi@es ihroughout the seasonETort€d by the MPw wasrq€asures against furtherations were also carried out

The CHWs have alsoregular trcatment of leprosy and.,(v) Health Education: The mostimp[rt health education to the.illustrating health messages andlaken in daily lifo to prevent

.inently at strateglc places TheseCHWS. ANMs and other healthtration of health problems, their

To equip the health workergMPWs with the art toreorientation training camps Itima The invited experts taughtlocal forms of mass media like'give health education'Thecamp made it more useful.(i) Nutritien and Nutritiont6nt role to play in this profeeding progiamme was initiatedhelp of CASd not many children'tions

came regularly. It was foundg€t time to hring the childrenCHWs provided useful help in

Night blindneos amongt9 project villagec The CIIWsreasoos bchind this wldespreddvcd usefu| ;n cnrnusing the r

People's furnctpation in Family Planning

and Diarrhoeal diseases.ousness of how Malarit,

what immediate measureshave also been taken to

dseases was limited Bufof infectious "'Cholefa-ritis".The CHWs have

spread ofthis disease by dis.of Chlorine in the river sideAny case of gastro-enteriti"

treated arrd prwentivetaken Anti-cholefa inocu-

helped in the detection and

firnction of CIIW is.toBesides, wall posterdand precautions to be

havo oeendisplayed prom-are used by the MPWs,to give graphic demons-

and treatmentpecially the CHWs and thewith the villagers effectively,

been organised frgm time toe CHWs how they could usethan','Kirtan' and'Bhajan to

of the iillagers in the

'The CHWs have an impor-Even though a supplementary

about 500 children with thefrom the under privileged sec-,

most of the fuomen do notthe Centres for feeding Theendeavour. :

was quite common in all thesuccessfully teli the viltagersse. The CHWs have alpo.pm-to raise ki&hen gardens ai'id

Voluntary Efiorts in Familv Planning-Ill: 105

planting of fruit trees.

ivils Environmenml Sanintion: No health measure can be success-

ful in rural areas unless steps are taken to ensure environmentalsanitation.-Keeping this in view, the CHWs were trained to ensureenvironmental sanitation in the villages. All the wells in the pro-jectvillages are disinfected regularly twice a week Where a river isthe only sourceof water, pot disinfection with chloriwat is resortedto in the rainy- season A plan'has been drawn up to providetubewells in the villages.

Thg drsposal of waste water is the source of many infections in .

the villages The villagers, therefore have been convinced either toconstryot soalage pits or to raise kitchen gardens. Due to the per-sistence of the CHWq the scheme has been quite successful.

Equally important is the need for sanitary latrines. Both thegovernment'as well as the Gandhi-Smarak Nidhi came forewardwith assistance. Once the assistance was available the CHWs havebeen able to get 125 latrines constructed in the project area.

Frii) Hdahh and Vinl Statistics: This job has been entrusted to theCHWs. The regular updating of the family survey has been poss-ibl€ with the help of the CHWq who regularly visit homes Theavailability ofthe fool proofdata helps in drawing up the rightlfatery to tackle varidus problems.

Apart from family dat4 the CHWs have also been able to pro-vide the details of the male and female by age.

(i) heatment of Minor Ailments: The male ane the female CHWsare proiided with simple basic medicines for giving relief topatients coming to them for treatment The medicines given tothem are much less than what has been provided for in the kitrecommended by the government of India for use by the CHWs.The medicines given to the CHWs ard: Chloroquine, Aspirin,Sodamint Berberyl, Sitophaldichums Tiphalachums, Chorosol(Oral Rehydration Salt Mixture), Vitamin 'A and 'B' and lirstaid materials.

A majority of the cases treated by the CHWs are fever cases,-ikin drseases. urarrhoca and injuries. The medicines given to the ,

CHWs are mainly meant to. give symptomatic,relief to patientswfio come to them. The patients'who do not get relief in48 hoursand serious cases are referred immediately for treatmeni'to theMPWs orthe doctor depending on thd lev€l oftreatment requiredThe emphasis waq however, gradually shil'ted tiom the curativecare to preventive health care. The CHWs have successfully pre-

H5 in Family PJanni4g'

vented the cases of malaria or ron in diarrhoea cases wiif,thn help ofthe needicines tb then '

TheMPWs are the lust levcl givirigguidance to theCHWs. These MFWs have been trained in their role at thetimc of the launching of the CHWtinuous education at the monthl

TheV alsb receive con-

held from time to time. They har,tipurpose role because of their

meetings -hnd special campsnot yet got used to their mul-

for vertical progfammes.

The Co-ordinated Involvement $pproach

Vadu area to the KEMoperation to 59 villages andtion under their Care.

operation with the goyatnmental in order to avoid duplica-tion Their efforts bore fniits and iq recognition to their effortg theMaharashtra Government to entrust rural health care in

thus enlarging their area oian additional 30,000 popula

ill the PHCs and their sub-have come under the adminis-

trative control of the KEM Though the staffrng patterngiven by the govefnment has been followed theKEM Hos-pital has putin extra staff from itsthe salaries fcir.the staff and funds

resources Similarly, while

come from Zilla Parishaddrugs and equipments nowrequirements are met with

thc projgct funds. For CFIWs recruited under theGovemment of India Scheme by e Maharashtra Government

Vadu Project they r.eceive an

Upder this new arratrgementcentres catering to these 39 village

are paid Rs fr) only, while underhonorariur-n of Rs 125, the addKEM Hbspital $imilarly, twoHealth Unit atVadu'Bkhad alsowith its own resotrrces,

As the PHCs in this area were

,nal Rs 75 .coming fronr_ theMs placdd with th€ Primary

hired bythe KEM Hirspital

Yolunury Eforts in Famity Planning-Ill: l1lin villages remained the lowest link in the chain of health carg butthe role of various other para-medical staff had to be redefined.Under this rddefinition they came to be designated as Multi Funpose Workers (MPID, rellecting an integrated approach towardshealth care delivery,

The restructuring that resulted following entrusting of healthcare to the KEM Hospital has done away with the rivalry at locallevel, which in. other cases has proved to be one of the majorimpediments for the voluntary agencies Neither the medicalofficer has any fear of losing credentials because someone else inthe same area is achieving better results than hin, nor has the pro-ject staff any apprehension about possible competitioa or tusslewith the medical bureaucracy. The experiment is also useful fornot only creating a demonstration effect of the staffplaced with theVadu project but if successful it may also result in widerreplicability of the experiments carried out in cooperation withthe govemment

Satisfied with its cooperation with the Government ofMaharashtr4 the KEM Hospital looked for larger cGoperationAs the area ofoperation for the project had increased from 19 to 59villageg need for a local referral hospital as a tind ofiotermediarybetween PHCs and the KEM Hospita[ was felt Thug under theCentral Government scheme of hospials on onethuu (contnbutionby the Central Governmeit), onethird(by the State Governmcnt),and onethird (by the Voluntary or Charitable Organisations)basi$ a hospital was being built at Vadu Bk While Dr BanuCoyaji and her colleagries seemed quiie happy to have achieved ahospital for the iural population they were not happy with the cen:tralized building and stalfing plan of the Government of IndiaThere wera they felt, trro major-limitations ofthiq approach- First-ly, tbe Uujlding plan drawn up in Delhi di<t not take into accounfthelocAlneeds. And secondly, the buildingunderthe Central Planworked out much costlier.

One positive aspect of the co-ordinated involvement approachhas been that the govemmenhl staffplacedwith theVadu pmjecthas been injected with the enthusiasm that Dr Banu Coyaji and .

her colleagues had ihstilled into their own stalf Gradlally, thepeople drawn from the medical bureaucracy of the glordrnment ofMaharashtra have given up theit targel oriented appqoach andha'|e become achievement orienteil Their coiceri to*ards healthcare and familj, planning is much grea'ter now than bdore.


' However, the overall impact of new arrangement was tooearly to be assessed at the time of study. Many things were still

tal at Vadu Bk was still underat thebrganisational stage. The hconstruction. Dr Eanu Covaii satisfaction with the flex-ibility shoryn by the government but larler impaci was still tocome. As indicated earlier that ifimpact of this approach would notbut in larger parts of the state as

in the long rur! thebe felt in the Vadu are4

Rural Health, Family Welfare

The porformance of the Vadu ural Wealth Proiect did notseem very impressive either ln' health and family planningorin rural rebonstruction at the time f our visil But the project was

only eight years old In these they have moved graduallyfrom one field to another. Instead f stretching their hands fully atone timg they have moved in They admit in theii reportfrankly that when the KEM decided to move into the area

of rural health. they had no They did not have any

Rural Reconstruction

in rural areas eithorand cautiously.

The first step, thereforg was start with rural health in onevillage. Thus, started their Primary Unit inrhe village VaduBh It is only aftor working fordecided to experiiment with the

years in the village that theyscheme and expand their

area of operation to more villages. made their entry into thecare. Once they won pop-.

,

to talk to them about thefield of family planning throughular confidence it was not veryadvantages of a small family. In fac! their,advice could carryweight only after they could conthere to take care of their health.quiik results in family planning the emergency had anadverse effect and they decidedsome time.

to talk of family planning for

The impact of their earlrer is vrsrore in'the birth anddeath rates for tha vear 1977 and I 8. The birth rate stays at24 perthouSand for both the years, while death rate came down from13 per 1000 in 1977 to ll per th in 1978. Since no record_.rlas available for earlieryears it is for us to assess the real

experience of conducting familyHencg they decided to move gra

inrgncc But sincE the.fural livethose t*o years according to the

:e t\e people that they werethe lovernmental zeaL to get

th rates for Maharashtra forof SRS data was 26.8

Yoluntary Efforts in Family Planning-Ill: 109

and27 .6,we can attribute some success to the Project in this fieldSimilarly, the rural death rates for Maharashtra during these twoyear's were 14.5 and 11.3 according to the SRS data' whichindicates that the Project is achieving slow but gradual success inthe freld of rural health'care.

The adverse impact of the emergency years is visible in figures

for 1979 (Table 5.1), where both the birth and death rates went up.

Due to the antipathy created against family planning during the

emergency, it was decided to avoid any talk of family planning iq1977 . ln 1978 the efforts to revitalize the family planning programme was started in a low key' We do not have figures for subseqirent years and, thereforg we cannot hazard any guess regardinithe impact

Nevertheless, we can attempt a general picture on the basis ofthe d-ata giyen to us on family planning activities of the projecg as

well is the imoressions of our researchers. Table 5.2 indicates thatsterilizatioirs,-which had become rare during 1977-78, graduallypicked up during 19?9'80. But tubectomies werb giveri preference

over vasectomies. There are various reasons for this preferenced,

which we shall discuss later. In general, the fanily planningactivities are gradually gaining l4omentum. The CHWs have been

able to involve the Panchayat officebearers in their respective

villages. Furtheq in order to involve more and more people fromthe community in their efforts, the project staff have from time totimg organized various camps in the villages, which have been

tremendous success (see Parulkar and Parulkar 1978)' Enthusinga sleeping community was not easy. It was a slow process and theproject was aiming at gradual transformation of the community inthe area.

Finding that health care was part of the broadei development,

TABIJ 5.1 Birth and Death rates in the Vadu Project

Year BirtUI0m Deatl,/In

r9771978

1979

242426,7

l3llt2

Iq)()

I(l)

()

.=

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I l-".rn | |

-l--lll,-. lorll or I ro

llll-ll

rrrtl,tlr+ \o c{ oq |.o.o.

I

I

9

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t-.tttttllttlttl

OO\O

rat c{ o\ aa tal \o F ra, a.l 0o

-..- l- | c.r o.r | .-r

I l* | l*-.a\oc{

.O\OC.l€tlC.l\i.vta)ttra)€ra)doOOoOO.n$F-c{ a{ t-.

a.l

F .- d: dhH EEtd6 H.,.#_ r.S.;E E H!F fiEESdAff

.o o\ \o c\l c.l o\ o\rd*a.tra)*\4

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3

Yoluntary Efons in Family Planning-IlI ! llthe project-team decided to venture into rural recohstructioqr Thetpain realized that without solving some of the immediate pro-blems of the rural populatioq it could not talk eitler of health.orifamily planning. For example, without increasing life expectancyof children at birtb it is difficult to convince a couple to restricttheir family size. Thus,, the problem of post-natal care and under'five care arose. The problem ofunder five care led to the awarenessof mal-nutrition The problem of night blindness among childrerlwhich is another aspect of mal-nutritio4 also came of light Andcan one talk of mal-nutrition among the people who have 4t timesnothing to ea0 So the team decided to help and encourage peopleto raise kitchen-garden The people were told whal kind of foodprevented what diseases.

Gradually other problems of the community also came to thefore. Thus a new agency fo{ integrated rural development-UNDARP-was created with several prominent citizens of Pune..The office bearers of this agency go to villages discuss with themabout their immediate felt needs and offer technical as well ls

.financial help. A reyolving fund had beeS created to providefinancial he.lp. The {lnance provided for a prgject is in the shape ofinterest free loaq which the villagers may reium back The schemehas been weil received by the villagers

TABLE 5.3. Demographic P-rofile of Sample Villages

DemogmphicProfile'

WLIIIGES

Shikrapur ;Futgaon; Jarcgaon Bk lfpt"Jagnp

'Total PopulationHindusMuslimsScheduled Castes

MalesFemalesCouples in Repro-ductive ageCouples Effectively Protected

1687 1135'lg2 1136

45133 70

823 578864 558

232 2t3

s7(2s) 5E(27)

4f,994@l

9891

24092290

400

26q67)

1065-

1069:45

536s29

195

83(43)

Note: Figures in parantheses indicate percentage.

t12 People's P, in Family Planning

We witnessed work on one scheme in the villaee Saras-wadi in the project area. The complained to the experts of

draw water from the wellsthe UNDARP that thpy couldthroughout, the year When they asked as to what could be

said that there was a dry

rain wate( the water wouldcould be built there to retaindown to raise the water-level

in the village wells. When the UND asked the villasers to con-tribute, they gladly agreed to do for seven days. Anyoneworking after that was to be paid. scheme was prepared and

even small children werewhen our team rgached the viworking on it witl pleasure Sev suchschemeShave been takenup and it would have its impact in the years to come.

SAMPLE

Th'e Sanple Villages

URVEY

The fourvillagqs selected on theand two poor performaflce com

of two. good perforrnance

done to solve the problet4 theNala near the viltrage and if a

and four non-acceptors and inacceptors and two non acceptors

ination worked out in our

performance villages fourinterviewed by our research

research design were Shikrapur Fulgaoq and Jategaon .Bkand Pimple Jagtap. The.selection the villages was made on thebasis ofthe records of performance the 19 project villages main-tained by the.KEM Hospita[

The two good performance Shikrapur and Fulgaonhad 67 per cent and 43 per centwhereas the hvo poor performanceJagtap had 25 per cent and 27 per

rotected couples respectively,Jategaon and Pimple

protected couples respec-tively. In each of the good perf villages eight acceptors

team with the help of two social woPune. All the 36 respondents were

'kers from the KEM Hospitatselected on random basis.

The demographic profile of th sample villages is given invillage in the sample with aarcgaon Bk (1687). Pimple

'Table 5.3. Shikraour was thepopulation of 4699, followed byJagtap (1136) and,. Fulgaon(l9rPimple Jagtap had an all Hindu

Two villages, Fulgapn aniltion.'The.rest two had

small Muslim population. had 98 Muslims whileJategaon Bkhad45 Muslims. All four villages had scheduledcaste people also, the largest tration being in J ategaori-

Voluntary EfJons in Family Planning-Ill: ll3

(133), followed by 91 in Shikrapur, 70 in Pimple Jagtap-and 45 in'Frrlgaon. All the villagesr except Jategaon (which. had more

femaies than males) ha{ an adrrerse male-female ratio'

Panchayat-bodiis are alive and quite active in lvlaharashtra'

Thus, all the four villages had active panchayats ftlected in 1979'

Shikrapur and Fulgaon had govemment sponsoredMchila Man'

dals. While Pimple Jagtap had a voluntary Mahila Mandal an.d

LINICEF operated Bal Wadi. Shikrapur also had a government

soonsored Bal lhadi One Adttlt Education Centre as well as Milk

il;i;;fi;'i;;;.;il;;nd'touttno.''ationcentreswere'Ip"railue itt ottter three villages as well..Pimple Jagtap had aTarun

Mandat as well as a Co-operative Society'

rur the fourrvillages,were served by the Primary Health Unit(PHL) located in the village Vadu Bk The KEM Hospital' Pune'

which runs this project, is the main referral hospital' The distance

of each of the fourvillages to the PHU and the KEM Hospital is as

follows-Shikrapur (10 kms and 25 kms) Fulgaon (16 kms and 27

kms), Jategaon Bt. (20 kms and 40 kms) and Pimple Jagtap (10

kms and25 kms). Apart from that each village had nvo CHWs (one

male and one female) re siding in the village, who provide primary

health care ai the door step. They can be approached whenever

needed, but they visit every household once a fortnight on their.

routine round. The CHWs are also depot holders for contracep-

tives. The villagds, Shikrapur and Fulgaorq had' one MPW e3ch

residing in the village. Fulgaon also had 1- ANM in addition'

The sairple villageialso had traditional birth attendants (dars),

Shikrapur had additional facility of wo private doctors'

ThJ pattern of the health care delivery established after the

launching of the CHW scheme under the Vadu Rural Health Pro'

iect has already been explained' The entire gov'ernmental health

rtuff itt the project area has b:en placed under the project

team.Very active kind of co-operation was not reported from' any of

the sample villages.: In Shikrapur big farmers. small !usinessmanend professionul. *.." reported to be more co-operative. while

landliss labour, shlre croppers and service castes were less co-

operative. Well-to-dq but illiterate, farmers were also reported to

bi resistant to family planning In Fulgaon also similar trend was

reported. Citizens' -co-operation

in Jategaon Bk ahd Pimple

Jagtap was also limited to negligible.-Since little active co-operatiod came from pe'ople' processess of

lt4

PHU at Vadu Bk. and even buili. ollicer next to the PHU buildingThe villages have also offered lar

ted iD the village. These indicatecould be. But.in each of theseteam approached the villagersreasonq people came forward withthey were convinced that thoseand not with any ulterior motives,CII\Yg were also available bccause

;participation wgre dlo limited tomore in recognition of the sincerityproject Leaders helped in cbntimore on request Occasionallythem,

Our data may soem to colHospital and its team on themunity in its programmes (see

diflicult even to mobilise their

do not intend to challenge or negatmany faceted phenomenon and ita society like India. The communitvticipation potential by offering pa:

utility. But in no case is the helo c,voluntary. People offered help onlygnly ifthey felt that they shoul4in their priority list This isthe UNDARP sponsored projects.not seem to rank very high amongonly the'autonomous participation

tion of mosl ol-the vilaggrs tnci cfamily, they would not even helpboth the kinds ofparticipation wereimrt the claims of the KEM H

Sample Respondonts

Inspite ofresortrng to randomlondents in both categories of vilftselect a representative sample in tigroup, 'educational level and ser We

in Family Planning

acceptance, which nas comeand services provided by theand convincing peoFle butenlightened citizens joined

heir contributions only whene had come only to help them

the claims made by the KEMparticipation of the com.and Parulkar, 1978). We

their clairn Participation is auires strange dimentions inthis area has proved its par-i

chayat oflice to be used fora quarter for the medicalcommunity efforts

for.a hospital to be construc->w participative the peoplethe KEM tlospital Projectdue to politico.historical

help and cooperation towere cgnyinced of theirtion and participation

they were asked to, andthe activity ranked highby their enthusiasm inplanning somehow didpriority, Therefore, not

missing but it was alsoion. Since in the percepwere not sullicient-ior a

CHWs in motivation Thuqin this lield This sup

as well as our andlysis.

ing in the selectio.n of res-we have tried our best toof economic statusr age-to make compromises at

Volunmry Efons in Family planning-Ill: I 15

im€s dU& to constraitrt ot time and willingnesb of the respoluents..t!tr y: have managed a sample rellecting the cross-iection inthe villases

Assesgment of rncome of our respontlentg mainly cultivators,was as difhcult in this as in other case studies. Wg however, could'come out with a rough estimates of income in such caseg. Ttreacceptors fell in the eight of the eleven slabs of income we cfeatedfor classrficaiion purposes, whrle rne non-acceptors were dis-hibuted into four-different slabs (table 5.4). A majority of th€accepton (33.3 per cent) as well as non-acceptors (50 per cerlt)oome from_very poor bacSround Tfie next major group in boththe categories (20.9 per cent and 25 percentleppectively) was from I

the middle income group. The higher income gr. oup w3s also verywell represented

TABLE 5.4: Economic Starus of Respondents

AnnualIncome AccepnrPercentageNon-Acceptorpettentage

R& l00i -2000R.s 2001-3000Re 3001-4000[(l, 5001-6000Rs. 6001-7000R& 7001-80008s 9001-t0,m0Rg 10,m0 & above

E

22tII2

33.3

E.3

8.3

20.94.1

4.1

8.3

12.5

6 i0.0

I 8.3

3 25.A

2 16.7

24 lm.0 100,0

_ AMajorityortt" ".""@up.In fact, the middle age-group of 35-44 yqrs formed more than 65

per cent ofthe acceptor sample. But a good 20,8 per cent were in25-34 years agegroup. The non-acceptors, however, belonged tomuch vquqger age goups (Table 5.5). lf we ;an hazard agenerahzauon on this .dsta (not too sweeping thgugh), it can bes-aid that acc€ptance of permanent methods oifamity ptahning intbis are begins only after 25 years of age and most people acJeptp€rmanerrt qethods only by mid-thirties nre itrol-ect teaetbcrcfore had to @ncentrate o'l youtrger agefroup, todi f<iripac-

TABLE 5.5: Age-group Co

Age-Group Acceptors

of the Responders

Acceptors Percentage

20-2425-2930-3435-3940,44454950-54

J

2ll5

I)

24

l0'l5

II

4 33.3

3 25.0

3 25.02 t6.7

twq illiterate and middlen-acceptors belonged only to(Table 5.6). A majority of..res-

pondents in both thi categories (41 per cent acceptors and 67 percent non-acceptors) were illi and only a small percentagewe re educated bevond matric.

TABLE 5.6: Educational I of the Respondents

Total

The acceptors in 'our sampleilliterate and gradtrate, while the

EducatioinalL"vel

Acceptors

IlliteratePrimaryMiddleMatricGraduate

Total

We were. again only partiallysexwise distribution of males andget male and female acceptors innon'acceptors (Table 5.7). It was

well-distributed between

Percentage

8

4

l

67.0

33.0

t224

in maintaining equales in our sample. We could

proportions, but not theto find a female respon-

dent than male, who used to go out inthe moming Hence weinterviewed male and female non- rs in the proportion of

Voluntary Lllons in Family Planning-Ill: ll7

!:3 rather than 1: l.

TABLE 5.7: Sexwise Distribution of the l<esponctents

Sex Acceptors Percentage Non- PercentageAcceptors

MaleFemale

J

95050

t212

2575

Total

?articipatory Attitude'The participatory protile of the sample respondents, in this area

was not very encouraging Actually, only on the basis of this dataand the impressions carried during collection of this dat4 thal weventured to contradict the position of the KEM Hospital ori theissue of participation. Moreover, this data further confirmed ourcontention that participation really is a'graded activity as far aspeople in general are concerned. They would be socially andpolitically actiVb only if it suited them and if they had time, nototherwise. If an activity was not in conformity with their priorities,they would desist from taking part (Table 5.8).

We framed 27 questions to test the participatory attitude of therespon{ents. The \uestions ranged from making efforts for theavailability of essential commodities and drinking water, toattending fiIry shows, arranging for them, voting in. elections,attending public meetings and volunteering their services forhealth and fanrrly planning acuvlties. And we gor signrficandyaflirmative replies only to 13 questions, ie..roughly fifty pel

1001210024

The maximum participation was reported in voting for localstate and national elective bodies. Cent per cent acceptors and 9lper cent non-acceptors affrrmed that they voted in the panchaya!the State Assembly and the. Lok Sabha elections. This is not sur-prising because votiirg rate had been very high in this area for allihe three elections. Since voting in rural areas to a large extenrdepends on mobilisation ofvoterg we can safely infer that peoplein this area can be effectively mobilised If we look carefully at thereponse pattern of question on participatory attitude, we shall getfurther proofofthis. As many as 58 per cent acceptors and 25 percent non-acceptors affirmed that they would attend a public meet-

118

rng addressed by a local ordance in Such moetings also

thina that by participating in anbenefit would accrue to them" thev

The average parti4pation rateofthe acceptors and 23 in case ofr

in Familv Planning

leadef (question 5). Atten

cent non-acceptors were pre-health services to the peopleties did not rank high in the

inight also be weighed in

defilite answer for this ques-ofour srudy. But we can cer-

the basis_ of the response pat-ie part in voting or to attend a

,People's

ded on mobilisation to a greatextent Furthermorg 70 per cent and 25 per cent non-acceptors a{firmed that they persuade people to send their

e school teacher (question I l)children to school ifrequested byand 79 per cent acceptors and 25that they would help the CHW

cent non-acceptors affirmedmotivate people for accepting

family planning (question l2), a good percentage ofthe res-pondents showed their willi to be mobilised for the abovementioned activities, not more 29 per cent acceptors and 16

join local leaders to organiseper ceirt non-acceptor were willingdemonstration on rising prices (than 33 per cent acceptors and 16pared to help an agency to take

ion 8). Similarly, not more

(question l0). Somehow thesepriorities of the respondents. One understand their reluctancewith regard to joining because of ribky nature ofthis activity, but why so much against helping thehealth services? Similar is visible in the question deal-ing with essential commoditiesand 2).3,

Lack of time is an importantticipate in many activities Their

drinking water (question I

why people refuse to par-with earning two

square meals for their family does leave them with much timefor such activities. But they do time to participate in some

participate in some activitiesactivities at least And why doand not in others? We do not havetio4 as this was not within thetainly venture a'fuess. People ha,activities which they think would

e a tendency to participate inbe beneficial to them. Ifl thev

no long or short-termnot likely to participate We

have already ilemonstrated thistern People also get dgbilised topublic meeti4g etc. The mobiliz.terms of benefits.

all the items was 49 in cirsen-acceptors. These figures par-

' tly explain differcnt behavi<iur of two sets of respondents. Butgeneralisation because 75we must maintain caution in

per c6it offur non-acceptor r wef€ females. It would

ri|t;;ia ni;ii i' id,ii ii;,;ing-rr1 r16

TABLE 5.8: Participarory Attltude of thu Resp'ondens:. . ,l ,f , i,r. ;r,:.i'lil

S/ Participatory Q&estions ' ;)'-:. ,,: , , ) ibtfuttuge of.FeAnleNo. ..,"

2. If a fitm is,shown in the neigh- 29 ,' . 6bouring villagq would yougotheretoseetheIilmi ' r'' rr' i r:i ilr l;jr:r': r:1'

3. if the government a"aio., to ' r' ir'33 r' , :i) r :rlr :i'

:11" : l:"lll. :entre/sub-cen rrel

yori'help? li ''' "rirrr "'' :.' :.' r' :lii :'r:i.,ii :ri ii:: i

e. 'WJurJ !"u be #inine to pay 'sq ' ', ,ru '. ,

foi healtli seri,ices? - ' '1: " -'

1 1r.1.nqti9aiivis-"qt.r.ed9t jlr,',..,,, . :,, iq,,' .,,,. j .' ;5;;l;,1 :delivering"a speech ir,' you r

disfensary with the help of thepeoplein thevillase. *?..,11d,,,, ...,:; :.., .,1. ,.1.,t, ,1,,,,.1,,. ,,: 1;1,;you help? ;

, village, would6j.i'lfa poltttcai i.:r iiii. rtile: niidhi.i

Io . ., 4l E'iri'lhl:na

'rl:wobltl voilh7.r:Did yijh vbii

'J3

70

120

I l.

Voluntary agency to take thehealth Service to the people,would you volunteer yourselfl

If the schoot teacher in yourvillage requests you to persua{epeople to serid their childrento school, would you help hiri?If the WWVHW requests yoqto help in persuading andmotivating people for acceptilgfamily planning would you

in Family Planning

16

25

2512.

13.

help him?lf 'Keertan' or 'Ramlila' isorganised in your villagewould you attend thad

Average

not be proper for us to draw about the participatorybehaviour of the husbands on basis of the responses of thewives. But if we combine their of family planningwith .low participatory score ofwould not be wrong in assuminghigh on participatory scale

acceptoN in the are4 wethey Eoo would not rank very

The respondents also a tendency to be hardlya voluntary agenry for healththe respondents wanted the

government to operate health se while 25 per cent wantedprivate agencies to do so. The also demonstrated con-tradictory attitude with respect to ing for the health services.On the one han4 33 per c€nt felt that people shouldpay for health services and 8 per wanted the government toshoulder this responsibility, on other, not many respondentswere pre.pared to help the either physically ormaterially to organise health Cent per cent non-acceptorsand 66.7 per cent acceptors were preparc{ to help the govem-ment (Table 5.9). This variation indemonstrated deuendency in this

is a little baflling and .

A maJority of the acceptors ht taken joint decision for con-traceptiorl Only one male had taken decision on his

dependent on either govemment r

serlices As many as 44 per cent

23

o.wn without consulting his wife one female respondent got

Yoluntary Efons in Family Planning-Ill:


Kind of help for Accepton PercentageNon-Accepton Perceptageheahh semices

Physical HelpMaterial HelpBothNone

t2l

12 100

| 4.1

2 8.35 20916 6.1

Total

s0erilised without informing her family as she thought that hermother-in-law would not allow her to do so.

Most of the acceptors stated that they adopted terminal methodof contraception because they considered a small family easier tosupport and that they could take better care of their childttn Butin a majority of the cases the respondents wanted at least two sons,and the number of daughters they got was imrnaterial till theycould have two sons.

Motivation

. Motiv.ation of the respondents, judged in terms of.their visit tope rl.mity planning centr.e, usini ,h; f""tili"r,";king adviceT:jT 9:.t advising olhers to .."atiu-lfiurrr"e:"i. *",:ir_:_r:,

very encouraging in this area- Forty five per cent of the::..ptoT stated that they visited family planning'cenre and 4lper cenr were advised to accept family plannini eiiher by themedical officer, or CHW, or friends and relatives-Though g3 perlill "l^,1"- i.*acceptors were atso aaviseJio

"alpiii.ilv prun-nrng tor some reason or rhe othei they did noi- All t#;;_acceptors respondents had three or fou. ihildrerr, .lr"ept one *hohad two children. - - ------'-'+ !^wl

^ However, 37 per cent a-cceptors admitted having used thefacitities. provided by the famity pili;;;#, il p", ."n,admitted having consulted.and sought trr.-"Jrrc Jrirre medical'o{ficer, and 25 per cent aid that they 6ot ifr.i,,p""* t the familyplanning centre for consultation it. i.rpiir.-oi ,rrr oon_acceptors to these questions. was negative. Their moti;ation p.o-

L11,. b:. absolutely negativs tfroigf, .o*i'fr.'u""".pto., rruOreak motivation_

100100

though the project h?s achieved s

aldi remalirsto bi done if faniily 1

pJqf.l-qlrnov€11r91,1.+i.-d:tttdPl.bliftat'l

j': ir I j 1i i ; i r1': rr.r I r : i-l'i i-.- ; i:,l

,I22 'Ieollb.*

Participation], M0ii\r,idbf i bfff.,;4r-.[ih€.respon$olt$ 6ro'n]rthe ardAsdemonstrate weaker participatorythe respondents from the areas ofdata collected by us does to anby the project staff in oril_isting

entirely, because in the vifl'bge Vtp*rticipatory credentialir ty offi

.hg.ahh unil of the projecr We shall r

Ais far as overall oicture is concerrweak participato4i attitude and r

tn' vrimlt5;'r-tutint i g

, ,t'Ci.rirkt'' ,', ,,

:,1;, :;t:::.;... .-.ir 'l-,r,i' .rjli i',; lii.:-'

1r; a. {)l -l.i .,i ,:11'.r' i -:lrr::"'

. r r1{'la-n?6i, Otre i,iiirjre.

SO*:i: i l,:i.. "i.'1 ;r,i:

This view ofall the l2 non-acceDto

lve from thjq

poinr of view lTat\!

some other socie pisychologicalimportant role in acceptance th

lr 1\.& ?F',, 3lv['2F: I ri'son

&;i,2\62F,,;,, l}d, l;E :: u, :

! ft.:.r:, :'.ii,r il: .l::.rt'.r',' :,llt'r

]','J${128"r :21\fi lF,' :,.rir

rilr;liii l l;.J t:l :!:'Lrl:r. ii'l'jl

.i, ;;1f if :,:::'6"[li

r;r"'

,-;r:,1 r,.i.i!t l,';i ;,:: i.;fi-lir't;i,'l'

i:,1i: l ia .. 1.'l; i -;;i:1,.:-;'-;;i'lr-,

4r,,lMr,*F'i','d$ le:esi:ir''itras "'. Tivolbrrts ai€rijirj'f i

-J)Jii f1r..rii:,iiilwolffoiis l'':i lsi md*l:r,'.hrist'Ill ji,' l1.ij'l'r" i:

ir Jrli.r.iarfi ,i"il:tltl:'1:1 r":i 'rl i'':':

Not of Scafedl''dfr:';rrr "'l'':""

,'*::!!,F!/:1:t:!!,:,ry,,tt1,!!:,\r:rp;{r!'

, t. r.:'.r:.1,: t':',. i' ,., '.1 -:, i-.j,, .-r.lii :r;i i.!it.;::'., . . :: : | ,' .i. :; :.. ,:,-. ..:'.: 1.,,. :;i,1.:'.... ::1.::.;:.i;l ,1..- j :rr :.! !,:.:;..r,f: .. ,r,.J. !r.t:.,r; tir.,lr's .r1 ;.: ...,,,:,.',, .ir: ,ii- ,;lti:lt':,r,::r-:;ll.

l?.rr ?lVL,, 2F,,, ; At :teafi '.., . I{ob@dy, fii rloots. r: ;.gg6 r' di@ ;.,rtcll. titiiid

,: ... .. | , ; two:sorrs," ,afterl,: dhild{co :;ifi11yi11g.4ror€ ,. , i,/ .,'r ':::._i ::r.t..: ..,:.: ,::,.,She.: ..; l'r(r' Ir i.,::iC.hi&akb$tiltStiO;lS

lrlr,:: ' ",,:' ,r r.l |, ;ii,steritbtd,.Shel rbtbtilizddri.,:.r.r.rt !r;i

did not likecontraceptives.

;i- 1{ i 't';.* il { . i

All thc non:acc€pto$Oaly ore bad twochildren(a sonthree children (all ofthem hadfour children (each had one orsidered two as deslrable number ofthree children and were prepareddelayed it because her elder sonwas no one to look after him ifconsidered three adthe desirablebe gons. One of tbese. with twoparcd for sterilization; another onewanted one more son: the thirdbut there was no one to look afterand the last one with two sonsstcrilization, did uot have anyonewas etcrilized and was preparedaccqrtors considered four (2 * 2)the three did not accept terminal-one sn Two not-acceptorslcast two sons One of them wascomplained that there was nowas sterilized and she did notsaid'that she would not mindsterilized. Only one respondentdesirable number of children,childrcn he wanied He did notscared that it would make him

Thus, two important reasonsdcsir€ for a second son andthat their children would bebed-ridden f,or some time. Othernot very popular. some peopleBut an awareness of smallercouples get more children becausetill they had got two sons. Theher team ig therefore, tougb-decline in fertility only iftheyfor two sons, which invariably

Ovenricw

'the Vadu Project dra not seem

People's in Family Plapntng

, had more inatr one chrlca daughter each), seven had

or more sons) and four hadsons) Two of these con-

fora family. Both hadsterilization One of the mnot keeping well and there

was sterilized Four of thcmbut two ofthem should

and two daughters was pr€-th a son and three daughters

was prepared for sterilizationchildren ifshe was sterilized

a daughter was scared oflook after the children ifshe

for anotber son Three non-the desirable number and aU

hod bfcause they had onlythat a couple must have atfor a son and the other one

to care for her children if she

other contraceptives. She alsomore children till she war

not sure what should be thewas he sure as to how many

sterilized because he was

for tron- acceptance were thefamily, wtere females thought

if thev were sterilized andof contraception were

also scared of sterilizationsize is also visible. Most of the

would like to take chancesahead for Dr Banu Coyaji andcan hopc to achieve a drasticchange the strong prtferences

in four-children family.

have created a major dent in

Voluntary Effons in Familv Plonning-Ill: 125

the field ot lhmily planning For one ihing therr tfrust has bdenmore on rural health whichrmade them devote moie time inorganising ig and for another, they decided to abandon the familyplanning dimension because of the adverse reactions creat,ed bythe Emeryeacy. Moreover, they also decided to launch the CHW'scheme at a time when the project had acquired firm base at thevillage Vadu Bk The CHW scheme consumed quite a bit of their '

energy, as they had to select, recruit and train the selected con-didates It was quite an arduous and tirne consuming task to trainilliterate and semi.literate persons in health care. After trainingthe CHWs also took some time to stabilise themselves in theirvillages and inspire people's confrdence in them. By then the pro-ject had started diversiffing in the areas like environmentalsanitation and rural reconstruction Then,. in co-operation withthe Government of Maharashtra they undertook coordinatedinvolvement approach which placed medical bureaucracy at theirdisposal and enlarged their area of operation- Therefiore, the pro-ject did. not have an impressive result to show at the time of ouryisit Its real assessment would be possible only after a fewmofe years.

Thiq however, does not mean that the Vadu Rural Health Pro-ject, has nothing to offer. It does offer a variety of experience inorganising rural health, which is a very complex phenomenon.The complexity of organising rural health arises, firstly, from thevery enormity of the task in terms of area and population to becovered, it also arises from the relative under-development of therural society within the overall underdevelopment ofthe society asa whole. This necessitates adjustment or, at timeg redesigning ofthe concept of basic health care keepin! in view the deprivationand impoverishment of the rural masses. Lastly, the complexityalso arises from the 3ocio.economic structure of the village Indiaand resulting political scenariq where any sincere effort toimprove the living conditions of the rural poor is looked atbith suspicion

If we look at the experience gf the Vadu Rural Health Projectthey have tried to tackle each of the problems gradually. In the firstplacQ, because of their inexperience in the frel4 they borrowed.expettise and even then they beganin a small area Their aiiminitially was not merely to gain experience but also to win the con-fidence of the people. They also tried to create a confrdence in thecommunity about their ovr,n potentialities They involved the com-

Voluntary EfJorts in Family Planning-Ill:

.. i l

127

Chapter VIVoluntary Efforts inFamilyPlanning-fV :

Cdmprehensive Rural HealthProjecq Jamkhed

l'TI\O srudy of rural health care Fnd.family planning in lndiawould be complete today withput taking into account theexperience of the Comprehensive $.ural Health Projecl located atJamkhe4 a taluka town in Ahme{nagar district of MaharashtraIt presents a remarkable success story in the lield ofrural health.The project popularly known amofrg the villa gers as Prakalpa,hasnot merely succeeded in waking up the sieepy village communityto fight diseases but also in aw{kening the entire communityagainst social-problems and injustice.

We followed the general patterrf of'this study in examining theJamkhed experience, i.e., an in-defth study ofthe project and sam-

.ple survey of four villages in the p;oject area. The project did notoffer us much statistics; thereforf assessment of the project isbased mostly on qualitative data as well as impressions of ourstudv team.

The Project

Jamkhed is a stnall backward tafiuka in Ahmednagar' district ofMaharashtra located at 75 kms frdm Ahme{nagar and about 200

kms from Pune. The sleepy towrf of Jamkhed shot into prom-inance in 1979 when a medical co{rple Drs. Rainikant and MabelArole received the Ramon Magga]tsay award for their pioneeringefforts in rural health care. The bfforts of the 'Aroles not only

Voluntary Effotts in Family Planning-IV: 129

'demonstrated that it was possible to provide health care to the

poor villagers at ag cheap in expence as Rs 6- per household per

unnuo," bit also that it was possible to bring down rates of deatb'

infant mortality and birth without expensive equipments' costly

drugs and highly trained medical personnel

Genesis

The genesi3 of the project lies ia the decision of the Arole cou-

ple to work for the rural poor. Their devotion to health care was

ilready recognised before they left for higher studies to the USA as

Fulbright scholars in 1965 when they were awarded the Paul

Harrison medal while working for the Vadala Mission Hospital inAhmednagar district

When they planned their return to India on completion of theirstudies in 1970, they had started writing to prominent persons indifferent areas in Maharashtra about their interest They received

some encouraging replies. When they visited all these placeson

their returr\ they realised how ditncult their tasL was going to be'

Medical Officers of the PHCs, local private practitioners and

several other officials and leaders did not really welcome the idea

ofhealth care for the poor villagers. Thcir search for a responsive

area ended at Jamkhed where Bansilal Kotharl a local busi4ess-

man, was highly enthusiastic about their plans' The taluka pan-

chayat and local officials also seemed positively responsive. Thuqthis project was launched located in an unused veterinary dispen'sary and few cther old buildings in the heart of Jamkhed town

For the Aroles this was the beginning of a new set of troubles'

They had to face rumours branding them American agents, Chris-tian Missiona'ries working forconversiorl etc. Obviously, though a

majority of the officialq local leaders and citizens had welcomed

thdr arrival, some vested interests- specially the private practi', tioners-visualised threat to their interests. Even il the villages

they were received with suspicion and doubt The exploited

villagers found it difficult to believe that someone could work fortheir-welfare without any personal interest They also feared that

the couple inight convert them to christianity. The"Aroles decided

to counter the suspicion and anti-campaign by keeping a low pro'file and avoiding iny controversy. They never raised the question

of religion with their'workers or patients. Their devoticn to health

care finally won them the confidence of the villagers.

,rkiii&' bki; ii Ftrtiij) iiii,;i;t1l .]'.l3I

Medicines were another costly item. But tae cost of medicinescould be easily red-uced by buying thent.u.ndery gprteris rlaffieg. i

lss 1ltll9,{?{.9#8ft?,4 YElY,WutaDre ro.qe[verv,u per cenr Qr,ute prEf

Eq4$qatr,ap,,Sp,Rr-sl4pg$,Sq per cenJ of the females of .t\q ghrt{be+fr.ngril,tr,.w,ltA'|lclgqr,tets+ief 19; g.nd"elgg lf.b.a;ctplnll+.ais.4titpehod ot six.4qgptll;.;f,he.4lola$,tbpp Sptjhs ans.wer, to .Sq ppc!Srtg1!fi Sq&pq{qgfnSi"g,lp*tJh.9u,9tarrrd, ryl9SliBq,VFWr ip. gir-fef R+[ y+lsgffi 94 l+,silqcl]aeq',l$ $qvt?rsJq sgp,e, thg Yf{w5 q5-o;y9,4rh9g'tq;r-b.f Sttgpgss-of.t1rE.P,q9j99l!!SLehi|}c,Sedig?!e.,Ciqqaf9sSk;-shpkrq pn$ doim avqv lv'4,,$?l:ctl,{ritig"rl ampe-c pbl,14rp4,These VHWs also organised women in their respective l,illages

132 Pmple's in Family Planning

and tackled social problems.

Village Health Workers

rt is dilhcult to surmise whafi aiternative the Aroles wouldhave tried had someone in a not suggested them to entrustthe .responsibility of the health care to an illit€rate

Once the Aroles saw howeffective this VHW proved theY to replicate this in other

villages. They also reviewed the of the firstVHW and

tned to plug anY looPholes that t have been left

The first VHW was used as the for subsequent selectionsbetter in this job, theyRealisins that the females

decided to select only females as s. The criteria for selectionof the female VHW was that they be middle aged, marriedor widowe4 should be able tomust enjoy their confidence.

te with the villagers and

VHW could como from anY casteor religion was no barrie! areligion But she must be pre

pared to serve all castes and in the villaga Nor did sheneed to be educated indeed most the VHWs are nol Illiter-acyproved no handicap; perhaps it It wag however, importantthat the VHW should be a resiclen of the village they were to serveand their name must be by the villagers themselves

for the VHWs was not a pro-Designing trainingblem. Aroles had seen the first doing wonders with a week'sshort training A little im t in that would have been sufli-

it was easv to train one VHW.cient for other VHWs as well

Banjara (a backrrard tribe)

Training a group of them comingmunities created the fundamental

the VHWs contained 18 essentialdelivery pack containing a blade

different castes and com-

edicines as well as a sterilised

'a week's training E attend toges. The kit providedto each of

n ofboarding and lodging them together. If the VHWs not forget caste and religious

whole purpose would havedifferences during the trainingbeen defeated. Ihe Aroles. ftere so arrangeil that the triinees

de to sleep under one blankbttook tums in cooKng and they wCre

which was especially stitched for the purpose And to freethe VHWs from the the Aroles preparedblood-slides for dach ofthem an showed them on micro-scope

were man-madethat caste and relieiousThe VHWs were initiallv

essential health needs of their

and thread the 18 medicines

Volunnry Qforts in, Family Planning-IV:

given to them were sufficient to attend to 80 per ceat of the ruralailments Apart from the use of the l8 patent medicineg the VHWswere also trained to use some local herbs as well as what can bedescribed ag'common-sense treatment' in mild cases of diarrhoea.$sennf and fwer. Later on to reinforce the use of herbs, the", Arolssengaged 4nAyurv€dic doctor to go to each of the villages and iden-tiff some local herbs to the VHWs. They were also trained to con-duct aseptic delivery with minimum facilities (even under a tree).With the use of their sterilised pack they could bring down thenumber of fatal deliveries, most of which were due to cutting of theumbilical cord by a scythe. But what were they supposed to do justin case they did not have the delivery pacl? Thcy knew that if ared-hot blade was use4 it would not create any'complicationThey were also told of the importance of child immunisatiorlwhich they were supposed to convey to the villagers.

The Aroles were aware that this training was not the end butonly a beginning for the illiterate and semi-literate rustic womentrained as VHWs Even the rirost qualified doctors had to keep intouch with the latest derelopment in aredical science by attendingconferences and interacting with their colleagues in the profes-sion. These simple women were not likely to remember foreverwhatever was taught to them during a week's training Hencg aweekly meeting was organised for the VHWs All the VHWs canreto the project headquarters at Jamkhed once every week to reporttheir worb clear their doubts and seok advice on the difficultiesthey faced. The meetings held in infonnal atmospherg provided atwo.way education process for the Aroles and the VHWs. N6w thatthe project is more than a decade old, the VHWs do not have tocome to Jamkhed every week They have now becn divided intogroups according to seniority and geographical area.l

Thus, with each weekly meeting the VHWs grew wiser andmore conlident Most of them could communicate only inMarathi but they had their activities on finger tips. They look after

' the following activities :

a) Care of children under five : This includes immunizatiorlnutrition and supplementary feeding and minor illnessu

b) Antenatal care: Which also includes educating wom€nabout nutritiotl

c) Tuberculosis: This incidence ofTB in the area is 12-1411000.

Tbe VfiWs detect early caseg provlde-them'with medicines

and make sure thai they took medicine regularly.

i

l3J

.:..-.. ':li :. .1: ; .,. j r:,,,,.i:-,;;,,.r

r to provide the pcople withioned above. Their main .role

:and ;sprea{ rrfisuch disetisdr*successful if th€$

became pospessive alrout'tbeid , The, governrnedt p*.fa. '

r,to,., &eep . I their.;,41i11fuf r4gdieal*,failpd,rbpcqnip,€ ., t&e}-kn$uledgp:te their supi:riority amoilg th€

VHIV.s to.dis$ennirstb :

thpir..kpowledger trtt ug ap a*' fsofi e VllWri,ma$y morc'olderly i

wotnqtr4ow nditio*s fo* coirdncdng:a safe delivery,; ,how m deal,with. diarrhBea,triinfpctiroq amang chitdre& if,his onli reducdd :peoplds depbn-

, colrlidened ano i€specl lpmf;dancp,qn thes.r".*;d.alsg got ththEta They:-@uldt rno.l.: have, successful, in checking mat-nutrition and improvingeducating ,people,;

Oncoirhc iiHlrysdecided,to.use.thebn for latgsrmore diverse jobs for VHWs

Tbey alsq had rto think of.rafter about ;thrce:yga{s of

woski thgir r curative rryork .;dra$dqally fl*rdr lhpy., alsorfinishedr the ibacktog lin, and famiiyuplbuding andfound that thtig ;,ludrhadly,,anlthplained that their work was getting

dq r.$omE: qf,,thetrl @m-onotonous. The Aroles asked

them. to organise Mahila Mandals and lrght against such social

VolunuryEfuns in Fafiily ptanning_M135

evils as drinking dowry, untouchability etc. They also encouragedthem to.advise the women to start small trade which could augment their family incomes and improve thbir status in familv. TieVHWs performed this task also with remarkable success.

The Project Today

Today the project covers65 vlllages in two community develop_ment Rlocks-Jamkhed (30) and Karjat (35)_and a pojuhtion ofabout 80,000. Not all the villages in these two talukas have beenadopted by the Project There are already two Covernment runPHCs, eight sub-centres and two taluka dispensaries in this area.The PHCs in these two adjacent Blocts are located on twogpposite ends. Thp project has adopted the villages which fall inthe'middle, far from thd two pHCs.

The project starteci with only one centre at Jamkhe{ now it hasfive centres Besidds the one at Jamkhed, there are three centres in9!"1 p]:* Tley are located at Mahijalgaorq Koregaon andChincholi The fifth centre is located at Mindeli in ShrivandarB9ock, There are five mobile teams-two at Jamkhed and one eachatMahijalgaoq Koregaon and Chincholi Each of the teams vistsabout four villages every day:-two in thi: morning and two in theaftemoon. Each village is visited once a week The nurse or thesocial worker accompanying the team meets the VHW, checks herrecordg talks to her aobut her difliculties and supplies her with themedicines. The riurse or the social worker also iliets the membersof the Mahila Mandal or Tarun Shetkari Mandal to know theirdilficulties.

Te pro]ect conslists ol six doctors, three social workers (twoma-les and one female), six.leprosy tbchnicians, six trurses, 14

ll!{s, two laboratory techniciang two X-ray technicians and 65VHWs, one in every village. Neither the.soiial workerg nor thelaboratory technicians, nor the X-ray techniciads are diplomaholders Each one of them has been trained by the projeci TheAroles feel that the trained and-qualified technicians and socialworkers might not like to stayin yiilage.,Besideg they might ask forremuneration too high for the project tq pay, The maint€naitce .

staffare few. Attendants are allowed to stay with the patients. Theyare permitted to cook in the hospital premisses for iheniselves aswell as for patients. They have instructions to keep the place cleanand they do so quite willingly.

136 People's futticipation in Family Planning

As already discusse4 the VHWb play a prvotal role in ihe pieventive health cafe sckeme of the lroject It is not always easy to

make the people believe that illitefate women trained for a w,9ek

would be able to look after their health needs. The Aroles were

aware of this problem. Therefore, to generate confidence among

the VHWs and to create faith amorlg the villagers on the capabilityoftheVHWs, theAroles decided nsttovisitvillages orto allow anyofthe doctors to visit villages. Locll health problems had to be tac-

Lled by the VHWs. For any serlops problen, the patient had tovisit one of the centres of ihe projpct A mini-bus and a bullock'cart ambulance of the project mak]e frequent visits to the bus stop

atJamthed to bring patients. Hous]ecalls are not entertained even

at JamkhedEven the serviccg provided il tfe villages by the Vf{Ws are not

free" The charges are graded. The VHW charges 5 paise forinedicined. The same medicine givdn by a nurse costs 20 paisg andif given by a doctor, the coSt goes luP to Rs. 5'2 But not every one

. coming to the ce[tres can afford to pay for the medicines makesome contribution according to his/her capacity. Those who can-

not pay in casl1 do not mind paylng for the services by offeringphysical labour. Initially people did {ind it awkwar4 but now no

one minds it and those unable to ply voluntarily olfer their labour'Itfveqi them two kinds ofsatisfac{ion Firstly, they are happy thatthey.have not taken charity an4 sepondly, they also have the satis-

faction of contributing for the prioject which is doing so muchfor them.

Family planning constitutes a{ integral and essential part ofthe project But ,realiEiqgl the hoFtility of the villagers towards

family planning the Aroles did npt start preaching small familyaorm from the very beginning waited till the villagersdweloped conlidence in then task bccame easier with the

launching of the VHW scheme inl973. They used health care as

.entry point for family planning rural I evelopment Once

death and inf,ant mortality rates failling people gradually

stadcd accepting familY\ilhathai finatrly emrirged at

structure. The VHW, as the io'khed rs a four-tier health care

rung and the nucleus of thisstructurq looks after the and preventive aspects ofhealth care in the villages. At the level, more. complicatedcases are dealt wlth by the tra nurses and ANMs visiting the

villages at iagular intervals to the VHWs with medicines,

Voluntary Efrons in I'amily Planning-IV: 137

check their records and offer their advice. Complicated cases are r

referred to various centres to be attended by medical doctor$ AtJamkhed the Aroles themselves look at the cases referred to thatcentre. These three tiers are integral td the project Al the fourthlevef the cases which cannot be treated in any ofthe centres andneed specialised attention, are referred either to the district hospital at Ahmednagar or to Bombay.

Acceptance of family planning in Jamkhed has not beenwithout the.problems faced elsewhere in the country. Acceptanceof spacing methods has generally been poor all over ihe country.That is why the Government has been emphasising terminalmethods. Even in terminal methods vasectomy, which is muchless complicated, has not become as popular as tubectomy. Theseproblems were faced inJamkhed Project as well. The Aroles over-came the problems gradually by organising people with the helpof the VHWs. Condoms were not very diflicult to popularisg butoral' pills were not easily accepted by the rural women Theilliterate women foind it too cumbersome, to keep the record andtake it daily. The Aroles taught the YHWs simple method of keeping record and asked them to undertake this responsibility for all.t}re women who accepted it

A preterence for tubectomy was clearly visible in Jamkfredvillages also. Once the Aroles understood the real problem behindit, they decided not to insist on vasectomy. One of the reasonsliven against vasectomy is that it leads to weakness and loss ofvirility. Even women.give this argument and do not allow theirhusbands to get sterilised.

Family planning practices today have become part of thevillagers' life. Over 70 per cent of the couples ofchild bearing ageare protected. The nro-children family has become the nornr.specially among the young whq apart from the womerl are thelargest section €nthus€d by the Project Table 6.1 shows that in amattcr of seven years the percentage of females with two or three,:hildren going for tubectomy has gone up from 17 to ?O which is aremarkable abhievement

This achievement in family planning as discrlssed earlier, has ,

not come in isolation. It is a result of the Aroles' total programme.They creatcd this low cost partipipatory health care system bymaking curative health as the entry point In fact success of theWfWs largely depended on the ground work created by the ANMsin eight villages. Later on tfoe VHWs in other villages also devoted


considerrble time in curative This becomes clear as we com-pare rural infant hortality and death rate with Maharashtraand the country. Table 6.2 that rural infant mdrtality in

death rate in the project areaJamkhed (41.1) as also rural(8.5) is much below the rates in state and the country. Thisachievement has rnade theticipation ofpeople in their

work easy by ensuring par-and has made the accep

tance of small familv norm a process,

TABLE 6.1.: Percentage Females Sterilizeo

No. of Children 197 r978

TABLE 6.2: Rurai lnfant M and Crude Death Ratesin India, Maharashtra Jamkhed compared

India Maharashtra lamkhed

921

424

6l716I

5

4J

2

Rural Infant MortalityRural Crude death rates

(te76)

TAbLE 6.3: How

How Heahh Care is Met

!y qualified doctorsBy indegenous doptorsBy Village Health WorkersDid nothingSelf-medication

t22r6.3

4t.l8.5

(re76)

107.1

t2.5

Care is Met

1978 (%)

24.0

24.2

32.2

8.7

10.9

Total

The experiment carried out by e Aroles at Jamkhed has also

100

exploded the myth that low cost health care with the help of

Voluntary Efforts in Family Planning-llt;

VHWs and para medicals cuts into the practice of medical dbctors.Their experience suggests that as routine and minor ailments aretreated by the para-medicals, more andmore serious cases come tothe medical doctors. Their assessment in Jamkhed 4rea showed(see Table 6.3) that in seven years oftheir experiment, cases treatedby qualified doctors increased by about four per cent While theVHWs took over the care of32.2 per cent cases, they mostly cut intothe share ofindigenous doctors and influenced those who ignoredtheir ailments or believed in selfinedication. The cases coming tothe qualilied doctors were of a more serious nature giving themgreater job satisfaction

From Health Project to Movement

The Jhmkhed project might have started as a Rural Health Pro-jecq today its activities are not limited to health care alone. Alongwith physical ailments ofthe people. the Project has undertakenthe responsibilitv to nght social ailments as well

The Aroles grabbed the lirst opportunity to use the VHWs as

change agents when in one of the weekly meetings they complainedthat monotony was creeping into their job. They thought that byohdnging a woman they would be able to change the entire family.They, therefore, asked the VFIWs to organise women into MahilaMandals. Rajuree was the lirst village where Mahila Mandal wasformed. Five women joined the Mahila Mandal with reluctance.But very soorr the membership swelled to 25. They startedtransmitting the message of ch ange to Mahila Mandals through theVHWs.

As expected the women first wanted to put their house in order.The Aroles were told by the VHWs that drunkard males used tocome back home late at night and best up their wives and childrenBesides, they used to waste a good part of.their irlcome on alcoholThe question was not merely of drinking it also reflected what thestatus of women was in rural society. On Aroles' suggestion thewomen organised.- They iocked up their husbands if they mis-

. behaved after drinking and later gave them a good thrashingbefore the entire village. The impact was high. Ivlbst of the maleseither abjured drinking or sobered top. The Mahila Mandak alsoencouraged their members to take up sryrall trade. Loan was pro-cured initially form the Project and later from a hank Womenstarted either selling vegetablg or dried fish, or poultry products,

139

The Project also invited agri or veterinary experts fromtime to time to advise the villagers. that veterinary pro-blems were not solved merely by ilrviting experts, the Aroles gotone youth in every village trained fhis also helped in solving theproblem of rural unemployment Aj the villagers started setting upbio-gas plantg sorne youth were ed in that also. Few youngmen are also going for cottage i with the help of Khadiand Village Industries Besideg the Tarun ShakaiMandals have also succeeded in seiting up community irrigationprojects by Nala bunding or diggi4g wells.

With'all these activities and the level ofawareness. conscious-ness and enthusiasm rising the project is gradually beingtransformed into a movement Thl vilages have come alive qotonly socially and culturally, but algo politically. If rhe dominantsections in the villages opposed the activities pi ther of the MahilaMandals or of the Tarun Shetkai Maltdals, they were overthrown inthe next panchayat elections. Most bf therrl" therefore. have cometo tenns with realities now. The Village Khandvi did not vote.inZilla Parishad dlection one year, belause the elected members hadnot fulfilled their promise of electrijfting the village. Commudityfeeling is so high in the same village that the villagers have con-tributed dri one-acrc plot Ilor the sdhool-going children to growvegetables

Volunmry Efons in Family Planning-IV:

The Aroles.stepped i.nto other sp_heres because they realisedthat they could not talk about health and family planning in isola-

For example, it was not enough to talk about kitchen gardeq theyhad to supply the plant$ Similarly. since they took a keen isterestand helped the farmers in agriculturg they had to think of ways tomake irrigation more effective.

Apart frorir encouraging Nala-bunding and lift-irrigatioq theyhave been experimenting with sprinkle'irrigation aqd drylandfarming One ofiheir former leprosy patients, who is a carpenterby professio4 has been encouraged to develop a wind-mill fordrawing water from well purely from.indegenous.and scrapmaterial. They plan to put it dri various roads at regular intervalsfor demonstratio.n elfect Theii effort to use and Encourate iocaltalents has further helped the project to transforri itself from ahealth project to a movement in w.hich wery villager in the areatakes a keen interest The activities of the project have generatedand diveloped the serise of participation to an extent that it seems

that the fatalist, non-participant and passive rural society has dis-c6vEreil-i-ts4F-itsoiriipo-enfr aft o-solvelo-alproblctii$

SAMPLE SURVEY

Sample VillagesQo,lqi4qg4S !!4t tbe performance of villages under Jamkhed

Projecl is quite-gooC in fain;ty ptanning we had'to alter bur research

design a little. It was not diffiar$ ior us to select good performancevillageg 3s svs160'Tcftanfof the couples in the Project ar€a wereeffqtively protected There were villages with relatively poor per-forlnance, but by no stretch of imagination could'we call thempoor, because nearly all ofthem had over45 percentcouples effec'tively protected. Wg thereforg decided to study four good perfor-maace village and interview the acceptors and the non-acceptorsin the ratio of 6 : 3 in each one of tlem. Thus, the four villagesselected for our sample on the advice of Dr. Mabel Arole wereKhandvi (45.98 per cent protected couples), Ghodegeon (48 percent protected couples), Rajuree (58.96 per ceiit proteited.couples)'and Bavi {63.57 per cent protected couples). In each of the fouryrilages nine respondents were interviewed by our research team

l4l

la People's in Family Plariningwith the h,;rlp of the social of the Project

The demographic profile of the bur sample villages is,given inthe Table 6.4. Ghodegaon waswith a population of 12g6, follcand Khandvi (523). Only KhandGhodegaon had 109 Muslims in iBavi had 35 and25 respectively.Scheduled Caste population. R

and Khandvi (125). Onlvmales.

largest village in the sampleby Rajuree ( I 130). Bavi (8i0)

had an all-Hindu populationrpulation while Rajuree anoe four villages had a sizeablehad the highest number ofScheduled Castes (306). followed Ghodegaon (281), Bavi (168)

TABLE 6.4: Demographic pro of the Sample Villages

i had more females than

VillagaRajuree

DemogmphicProfile Khandvi

Total PopulationHindusMuslimsSihedUed CastesMaleFemaleCouples in the repreductive age groupCouples effectivelyprotected

q g6)

Note: Figures in parantheses in

Maharashtra has one of thethe country. Jamkhed taluka is nochayats in Maharashtra, and.thenvillages, were last held in 1979. Instrongest support bases for thecreated problems for the Aroles.active Mahila Mandal artd Tarun

523523

l2s24128287

t286rt77

109

281g6ffit75

84 (48)

I1301095

35306567

563

ttJ

102 (59)

820

79s25

168.a2398

IN

8e (64)

Mandal alRajuree was the most actittkai Mandal. The Mahilaof the Mahila Mandals. Themembeiship of each of these

te percentages.

active panchayat systems inion. Elections for pan-

:, also in the four samplepanchayats are one of thethough initially they hadof the four villages had

betweeir 25 and 40. Excepta Balvadi.Ghodegaon each of the villaees

Voluntary Efforts in Family Planning-IV: 143

We have mentioned earlier that the Project lillages in the two. Blocks Jamkhed and Karjat lie between two PHCs located on twoopposite ends. Therefore, all the sample villages (our sampleincluded villages only from Ja.mkhed Block) depended for theirhealth care needs on the Project Each one ofthem had a VHWresidlng in the village and was visited by the Project's mobile teamonce a weak or afortnight The project hospital at Jamkhed was 7kilometers frorn Khandvi, 21 kilometers from Ghodegaorl 9kilometers form Rajuree and 14 kilometers from Bavi The govern-ment PHC at Khandvi was 2l kilometers from Ghodegaon and 23kilometers from Bavi, but patients preferred to go to Jamkhedrather than to the government hospital or the PHC. Family plan-ning facilities were also available at the PHC, but people had mor€faith in the Project They received their supply of contraceptivesalso from the VHW.

Sample Respondents

We followed random sampling for the selection of the respon-dents in Jamkhed villages also. And, we must confesg that wefaced similar difficulties in making the sample representative.As would be apparent from our data thatwe did not succeed in get-ting the sample we had decided on paper and had to makeadjustments. One of the main adjustments, as stated earlier, was inthe composition of the categories of reipondents in our sample.The local situation demanded this alteration. Similar adjustmi:ntswere made in other respects as well but we have not really failed ingetting a representative sample..

The respondents in the four sample villages of Jamkhed fellunder seven of the eleven income slabs that we have used in thisstudy. Neither the area nor the people were very rich. As a resuli a

majority of the acceptors and non-acceptors belonged to lowereconomic category. Nearly 75 per cent of the acceptors and nonacceptors belonged to the low income group, whereas neaiy 4.2per cent ofthe acceptors and 8.3 per cent ofthe non-acceptors werefrom the high income grqup. Rest ofthe respondents-belo4ged tothe middle income group (see Table 6.5).

The non-acceptors in the sample belonged to relatively youngeragegroup. They were distributed between 15 and 39 yeras ofagg alittle over40 per cent were not older than 29 years. No acceptorwasyounger than 25 years and 37.5 per cent were between 40 and 50

- years of age. Those belonging to younger age gr6up constituted

People's P4rricipation in Family planning

TABLE 6.5: Economic of the Respondents

Annual Income Acceptors Non- PercentageAcceptors

0000-1000!001-20002001-3000

3001-40004001-5000

6001-700010000 & above

16.7

58.4

8.3

8.3

8.3

100

27

I

I

I

*100

7

llJII

l

29.r45.812.5

4.24.2

Total

34.2 per cent of the sample. Thus, the acceptors were equally dis-tributed in various age gloups (see ]Table 6.6). A feeble attempt atgeneralisation on the basis of this small sample would indicatethat acceptance of family planning of Jamkhed begins after 25,which is natural and a majority of phe people accett it by 39. Butsome people still resist till they crciss thirties. The real reason ofresistance would be clear when we analyse the responses of thenon-acceptors.

TABLE 6.6: Age-group Compisition of the Respondents

AC"Cr"rpacceptors

l5-i920-2425-2930-3435-39q-4445-50

*?s.0

20.8

16.7

I685

.+,

1

224J

:

8.3

16.7

16.7

JJ.J2s.0

Total

Voluntary Efions in I'amily Planning-IV: 145

acceptors (41.?%) could, afford education only till primary level.While illiterate also fonned sizeable section of the respondents inboth the categorie . Looking from another angle 58.4 per cent ofthe acceptors and 75 per cent of the non-acceptors were

''lit€rate.

TABLE 6.7: Educational Irvel of the Respondents

Educationalsandgrd

AcceptonPercentage Non-PercentageaccePtors

IlliteralePrimaryMiddleMatricGraduate

10

12

1

I

41.6

50.01.2

4.2

25

41.7

25

83

3

5

J.l

We had problems similar to other areas at Jamkhed also inmaintaining equal malefemale ratic in our sample. However, wesucceeded in maintaining this ratio for the non-acceptorg whilethe acceptors were interviewed in the ratio of I :2 (see Table6.8).

TABLE 6.8: Sexwise Distribution of the Rbspondents

,Sg AceeptonPercentage Non-Percentageacceptors

MaleFemale

8

16

33

6766

5050

Total 100l210024

Participatory AttitudeParticipatory attitude of the respondents in the four villages of

the Jamkhed Project was generally higtr" Both acceptors as well asnon-acceitors showed remarkably high attitude to participate in

a health centre/sub centre,/dissa_rywith the help ofpeople invillaga would you hllp?

I l. Wouldyou like to ioin in

13. If a family planning centre isopened in the neighbouring,wontd vou go there?

14. Would you also make efforts toone family planning centre,/

. - 9:ntt opened in your village?l).. lI a nationaVlocal leader is d

vering a speech in yourwould you attend that?

16. If such political meeting isheld_ in the neighbouring vwould you attend thaf

complaint to ihe concerned

17. Wouldyou like to compaign for4partylcandidate in election?

18. Did you campaign for any partyl.^ candidate in the last election?

-

19. Did. you vote in. the lasr electio4for (a) pancha at (b) State

_ Assembly, (c) Iok Sahha?20. If the local leaders organise

demonstration on risiirg prices ornon-availability of certain com-modities, would you participatein i0

21. If the I'LWVHW is not visitipgyour villagg would yori make

100

100

.91

75

50

4l

9l

75

9l\

95

100

87

62

9r

9l

58

l6

20

100

9l

officials?

95 t)

Voluntary Efons in Family planning_IV: A7

Various sociepolitical activities_slight fluctuationsin the respon-ses. to.different <iuestions merely shows that people iraOeO tteactivities.acbording to their preferences before particiiating (seeTaole 6.9).

TABLE 6.9: Participatory Attitude of the Respondents

S Panicipatory Questions Percmtages of respondenuNo. affirming the questions

Acceptors Nonlacceptols

l. If there is shortage of essential 91 75commodities (Keroseng Sugar,Fertilisers etc.) in your villagqwould you make efforts to makethese commodities available inyour village?

2. If.there is shortage of drinking 95 75water in your village, would yogmake efforts to make it avd'ilable?

3. If the neighbouringvillage has a 95 75school which yourvillage does nothavg would you make efforts toget one gpened in your village?

4. Ifafamilyplanningcampisbeing 75 58held in a neighbouring yi113gqwould you go there?

5'. Would you also make efforts to get 83 58one such.camp held in yourvillage?

6. If a film is being shown in the 91 75neighbouring villagq would yougo there to see-the film?

7. Ifthe film being shown in your 79 83neighbouring village is on familyplanning would you go there?

8. Would you make efforts to get the 9l g3

filrn screened in your village?9. Ifyour village does not have a 87 100

23.

L+,

People's

22. lf you are requested toyour Services to thb governmvoluntary agency to take thehealth services to the peoplgwould you volunteer

m Family Planning

rn in this area was in themaximum participatiop (for

efforts for a family plan-service for health car6

If the school teacher in yourvillage requegts you to persualdepeople to send their children toschool, would you help him?If the WW/VHW requlsts yoq tohelp him in persuading andmotivating people forfamily planning would youhim?

25. If 'Keertan' and :Ram Lila' isorganised in your villaggyou attend thht2

Since the genesis of participaactivities of the Rural Healtn

. ning centre (Question l4), volun(Question 22) and helping VIIW

both acceptors and non- ) was visible in organisinghealth services (Qugstions 9-11),

9l100

planning (Question 24). Themotivate people for familyfor education was also vis-

ible amorig the villagers ( 23).partisan attitude tolvardsThe respondents also showed

political participation While cent fier cent acceptors and 9l percent non-accepto$ aflirmed that thly voted in the last election forlocal bodieg State AssemblS and I lok Sdbha, not many had com-paigned nor were interested in ing for a party or can-didate. The respondeng alsomake essential commodities

strong motivation toble to their villages.a

Voluntary Effons in Family Planning-Il4 149

the non-acceprance to some extent, the nigh Score even lor rnenon-acceptors indicates that there are likely to be some otherreasons that have compelled them not to accept farnily planningWe shall come to it later.

Let us have a look at the questions relating to family planningThe non-accepton have lower score only in four-a f5,58), 5 (g3,58),8 (91,83) and24 (100,9l)-of the seven questions. And, onlyinthree items the difference is substantial. In rest of the three ques-tions the non-acceptors have equalled the acceptors in one-14(91,91)-and exceeded them in rwo-7 (79, 83) and 13 (62,75). par-ticipatory attitude is thus, at least partially responsible for non-acceptance of a section of population in this area"

That people in this area.are highly motivated to participate insocio-political activities does not need to be established anvmore.However. our data further strengthens this fact We asked tlhe res-pondents as to who should pay for the health and family planningservice$ and in respons e 47 per cent said that people should pay,while 25 per cent wanted the government also to make contribu-tion tbwards this. Only 28 per cent respondents thought that thegovernment alone should pay for these services.

Appreciation for thb work of the project and respect towardsthe Aroles came out clearly when we asked as to who shouldoperate hdalth and family planning services. ,No less than 52 percent of the respondents were in the favour of vcilutrtary agencies,42 per cent wanted to entrust goyernment with this responsibility,and 6 per cent thought that it was people's responsibility to runthese services for themselves. Their motivation to participate inhealth- services become very clear when -we asked what kind ofhelp would they provide for health services. A majority of theacceptors (62.5 per cent) and 41.7 per cent non-acceptors offeredphysical help, 4.2 per-cent hcceptors and 16.6 per cent non-acceptors offered material help, while 33.3 per cent acceptors and!.7 p", cent non-acceptors offered both kinds of help(seeTable6.10).,

Motivation

Motivation appeared to be affecting acceptance gf family plan.ning at Jamkhed more rhan partic-ipation Th.';;p betweenmotivatioT_ of acceptors and non-acceptors looked iignificant at

fluj^:n]!:":h except for rwo questio". tq. 2;i";hich 33 percenr rron-acceptors affirmed as against 95 per cent acceptors and

150 Paple's in Family Planning

Q. 3, in which only 25 per cent aflimred as against' 50 percent acceptors) motivation the non-acceptors looks quite

percentage rate is substantialstrong the difference in the(see Table 6.ll). A large number notr- acceptors (58 per cent)also visited family planning centre they generally implied projecthospital at Jamkhed), but only33and only 25 per cent consulted

cent used the facilities (Q. 2)medical oflicer and soright

advice on'family planning "'ly enougfu 66 per cent of thep-isiraded their friends andnon-acceptors replied that

relatives to accept family pl but they themselves did notthey believed in family plai-did not accept it The average

accept it It merely shows thatning for some personal reasonsperceltage of motivation of planning acceptors and non-acceptors came to 72 and 48

TABLE 6.10:

Accepton Non- Percenngeacceptan

they

Kindofhelp

Physical 15

Material IBoth 8

4r.716.6

4t.7

5

25

Total 24 t2 100.0

Thus, participation nrarginallyplay a role in acceptance and non-

motivation substantiallyof familyplanning

at Jamkhed. But equally are sociocultural reasonstron-acceptors, we can haveBefore we analyse the responses of

a look at the number of male and children the respondentshad While the acceptor had 52 per cent of malechildren and 48 per cent of female43 per cent of male children and

the non-acceptors had

became even more apparentwhen a couple whose two out of children we re dumb showedtheir rcluctance to adopt terminal of family planning

This seems to be an importantyet to accept famif planning

Most of the respondents saidplanningwas tqken jointly with

per cent of female childrenwhy some respondents have

the deqision to adopt familyspousc Only in two carcs (a

Voluntary Elforts in Family planning_IVl5t

hale and a lbmale) the decision was taken individually.. Not onlymales were relucttant to go for vasecto_x b;;;l* ;i;ir wives didnot want their husbands to get sterilised" ffre expfinutiigenerally offered by both was th;t it might leadio wJahess andloss of virility. Sinie the male had to work hard in the field andthey were the main bread-winners f", th. i;;i; ;ues ulro rn"..against ilTABLE 6.ll: Motivation of the Respondents

sNo.

Quest io ns on M otiv atio n Percentage affirming

Acceptors Non-acceptors

l. Have you ever been to family planningcentre? 58

JJ

2s

66

87

95

50

9l

3.

4.

5.

Have you ever used the facilities pro_

I9:a UV the family planning centre?rJlo you ever consult the medical officerin the dispensary/health . centre/subcentre and seek advice on familyplanning?Did you ever take friends/relatives iothe family planning centre and per_suade them to accept family planningmethods?Did.you ever Jake your spouse to the

.Iamlty planning centre?Has a1y on. ever advised you to adoptfamily planning?

50

58

50

58

Average4872

*rur,fft,X:,,'J;'-"

*xT*,il.:f#*y,T: ff:s{iTii".:Jj1".1,:,.1l;t ffare determined by a number of socio_

152

analysis shows that Percentage ofthan the non'accoptors' Thoughdents indicated that theY were

daughters, a preference for a malewas.no doubt weaker than manY

the non- accFpt6rs resPonses willWe have alreadY shown that

ged to relatively Younger age-

(33.3 per cent) belonged to 30-40

tributed between 15 and 29 Yearsfor non-acceptance. APart from tlvet to have a child or wereponses of the non-acceptors Putfor non-acceptance (see Table 6.

One respondent did not havewaiting for a second child" Two ofwhether s-ons or daughters were

others considered two sons and asix of them were Potentialhad truo or three childrenwith two children considered twodid not state any reason for his

Five non-accePtors had three

psychologipal as well as economias against doughters, is one factor

grgup with the largest number ofpondents. Two of the resPondentr

two children suflicient for aand a daughter were ideal and mfor a daughter before he accePted

was waiting for his wife tofelt that three children (twoleast ooe son for the other) were

ofthem did not state any reasonwanted one more son since

daughters. An<ithertwo sons and two daughtersone more son before accepting

The responsos of the 12

trates acceptanqe of 'small


factors. A prelbrence for ion$have mentioned earlier. Ourfor the acceptors was larger'

Jamkhed a number of resPon-

with two issues, sons orwas not entirely absent lt

areas we studied A look ata clear picture.

non-acceptor sample belon-Though, the largest majoritY

41.7 per cent were dis'f age. This may be one reason

either the non-acceptors hadfor the second child The res'

tabular form reveal the reasons

cn d vet and five others werethought that two children

for a family, while threeter ideal for a familY. All

planning agceptors after theY

by thenr Another respondentideal number for a familY but

acceptance.each, and this was thein this category of res'

with three children consideredOne of them thought that a son

for a family and was waitingplanning while the other

from malnutrition. Two others

and a daughter for one and at

ifable for a familY. While one

his non accePtance, the otherthree of his children were

with three children consideredfor a fam'ily and was expecting

planning

acceptor resPondents demons-norm'. by the villagers in this

Voluntary Efons in Family ptanning_IV:t53

TABLE 6.12: Views of Non-Acceptors

.x

No.Numberofchildren

Desimble Reasons for non-numbbr of acceptancechildrenaccordingtoR

Remarks

l, I

2. I

Wants bne morechild

Two children areenough whether

daughter are muslWill get his wifesterilised after

sons or daughtersWarrts one more Two are enougtlchild whether sons or

daughters.Wants a daughter A son and a

3 2 (1+l)

3M2

Itvt, 2F 4 Q+2)

2or3

lF J(2il)

Wife is weakand put on

<t nutrition check up.Reason not stated Wants no more

children.Wants one moresonYet to have a _child

9. lM 3 (2+r)

3 Q+r)

J (2+l)3 (at leastone so[)

Wants two moresons

Wantg a son anda daughter moreWants a son anda daughter more

Reason not statedWants one son

Two sons areessential to helpin family affairs

Two sons are .

.essential forshouldering familyresponsibility.

All the tiree aredaughters.

10. lM

lr. 3F12. 3

Note : Figures in parantheses inai"ut" *TOuught"o

novel and, at the same timethe Aroles in the f,relds ofruralas rural rcconstruction and awakening The remarkable

a"hieu"m"nt. of the Project in a s*rort period ofjust over a decade

le experiment conducted bY

and iamily Planning as well

facing our country are unsur-

of approach is adoPted bY the

are .properlY mobilised and

shows that none of the

mountable Provided the rightright people and the reso

exploitedLike Gandhigram and Vadu

society like ours The imPortanct

greater in a Programme like. f

project entered the freld of fthealth care and the curative

amkhed also demonstrates the

effectiveness of the micro' in planning The macro and

absolutely imPersonal aPProach by the Indian Planners

and policY makers so far does taki into account local realities,

: in a vast and equallY diversewhich assumes great

Indrely depends on Personal of individuals. The

Arolel for examPle. could with various waYs of

delivering health care onlY

drea and theY decided to enlargesucceeded TheY could also

when their exPeriment in one

monitor the resPonses of the and bring shifts in their

emphasis also so as not to annoy who were generallY susPi

cious of persons coming to any kind of develoPqegt or

welfare programm€$The Jamkhed experiment shows that familY Planning is

likelv to succebd if PeoPle are health care. The Jamkhed

of micro.level Planning is;wenmily planning whose sutcess

thev were working in a smallir aLa of operation graduallY

planning through Preventiveh'care services Provided the

entry point for Prwentive care. InitiallY 4o one talkid of

Voluntary Elfuns in Family Planning-Iv: 155

tamity planning Once death rate and infant mortality droppetrvisibly, people were gradually told and convinced aboui theadvantages of a small family, and people did accept it But evenhere the human and personal touch was maintained Thosecouples who did not have sons and wanted one were not pre.ssuriied But on the informal level it was argued that the numberof chances one can take to have a son was also limited" Thus,gradually a section has emerged which boldly says that sons or onsons, two children are enough.

Another significant point is tha! the Aroles did not conceive ofa system of health care delivery whictr, like family planninginitially, adopted a cafetaria approach. That ig when people fell ilithey came to the health centre or a medical doctor for treatmentHealth care they had come to provide, planned to banish diseases,first by curative measures providing relief against minor ailmentsat the door-step and then through preventive measures by creatingconditions for healthy living. The system also provided healthcare without involving over-qualified expensive doctors.

Ihe most important aspect of the Jamkhed prolect is theattempt of the Aroles to {irst win conlidence of thi rural peopleand then to enlist not only their co-operation but also active par_ticipation in the entire endeavour. Whether it was evolution of theVHW-system or it was their selectioq the people were not merely.taken into conlidence butwere made to particiiate as well. Sugges_tions came from thern, and they selected a VifW in each viliige.Gradually with the constitution of the Mahila Mandals and TarunShakai Mandals a formal structure of participation was alsoc_reated Particiption of the people in the activitiei of the project isthrough the VHW and the two bodies mentiored above. Lately,the panchayats haye also been infected with the participatoryvirus. Naturally after all an elective body like panchayat represents and reflects the mood of the people. WhilJ the message ofchange reaches through the VHW and-the office bearers.of theabove bodies, the two bodies take decisions in their meetings andseek the help of rhe projecr

In spite of the fact that the Aroles did not raise the question offamily.planning initially and concentrated their energy on healthcare along gradually with the success of the VHWicheme themessage-of family planning was conveyed easily and effectively. Itwas further reinforced when voluntary associations like MahilaMandals and, Tarun Shatkai Mandals were constituted" In facL the

156

former proved to be a betterbecause the women have to bear

The three institutions-VHWkai Mandal-have not onlyticipatiort birt also of motivationsystem. The VHW, of course,health care delivery as well as Imerely a depot holder forrecords ofthose women who adoPtemerged as an effective motivatotraeeption. She has received thetrom the Mahila Mandals Laterhelped. The two voluntary associiand deliverors of change. Andment in the areas has alreadY

The success ofthe Jamkhedpeople, which has led to effictivegrammes We wish we had anparticipation in this projectattitude does give a glimPse ofJamkhed Compared 3o otherticipation in the Jamkhed is muchture see Chapter IX in the

Pa rticipation in Jamkhedraised to this levcl because thescheme on the people. Once theY

ing a cheap, preventive andpeoplg they eliciited their adviceinvolved at every stage. Evencame in the form of an advicethe peoplc suggested someinste4d ofrigidly keeping theprogrammes of socieeconomicpeople demand it Herb agaiq theple were respectod

Whether in health caresocio-economic change one ofstitions. ln fact, the Aroles alsoblock They had to launch aand misbeliefs prtevailing in theplayed in this effort bY the the Mahilla Mandals and the


than the latter, probablYbrunt of procreation

Mandal and Tarun Sheteffective instruments of Par'

well as network of deliverybeen an integral part of thefamily planning She i$ not

and pills, she also keepspill She has also

for terminal methods of con-in thisendeavour

Tarun Shetkari Mandals alsohave also been motivators

extent of change and develoP-discussed at length.

lies in its confidence in theparticipation in its pro'

scaie to measure the level ofthe data on participatory

the level of participation instudied by us, the level ofpan

higher (For a comparative Pic'volume.).

be mobilised to this extent anddid not try to impose anytheir intention of provid-

ioatorv health care scheme toopinion The people were

a scheme came from theq itsuitable changes were made ifmodifioations Not only that,

as a mere health care schemqwere introduced when the

and opinions ofthe peo'

or in any other programme ofmajor obstacles in suPer-

it as a majop- road-€ffort to fight superstitions

Agaiq an active role was

Voluntary Effurts in Family Planning-IV 157

farun Shetkari Mandalg in that order.None of the experiments carried out by the Aroles at Jamkhed

are non-replicable. They can be replicated in different areas withsuitable local variations. The need is to understand people andmake them understand the utility of the programme. Involvementof local population in this act would only help the programme.The compulsions. imposed by the target approach is not reallyrelished by many people. Besides a programme like family plan-ning also goes against. deeprooted superstitions and beliefs. TheAroles rightly attempted, therefore, to counter these superstitionsand beliefs, rather than to force the people into accepting theprogramme.

158 People's Pbric:ipation in t amily Plann.ing

NOTES:

I We attended one such weekly meetinfi of the VHWs at Jamkhed" We were

struck by th€ informal atmosphere, the ran$e oftopics discussed (from health care

to agriculture and anigral husbandry to in{ornal education' to anti-leprosy drivq

etc.),and intetligent interjections and srrggfstions made by the VHws

2 The higher charges by the qualified dpctor is also meant to discourage con-

sultation with specialists for ordinary ailnients.-

3 Death rate of the Jamkhed project as $iven to us, was 8'5 and iifant mortality

rate was 41.1. Bolh ofthese are much lowel than rates for India and lVaharashtra

offered them seat and a cup of tea.

Chapter VItFainily Planning ThrougfnPanchayats- I: MadhYa Prade sh

THn onlv institutional structure at the local level that could sus-

tain popuiar'participatioln in any programme is the Panchayati

Raj Insiitutioqs. The lt{adhya Pradesh and the-Gujarat Govern-

ments recognizirig the potential ofthese bodies decided to involve

paxchayatJ in the faririly planning programme' though the two

Governments used different schemes..

We. therefore, did not have many options in the panchayat

model. Madhya Pradesh, as well as Gujarat thus, rrad to be our

choices for study. Moreover, response from the Madhya Pradesh

Ministrv of Health and FamilyWelfare wasvery encouraging The

result oi our srudy of Panchayats' Participation in two good per-

formance districts of Madhya Pradesh, lndore and Dhar' is pre-

sented below.

Demographic Profile

Madhya Pradesh, the largest State in area in the Indian Uniorlhas a low density of population (94 per square kilometer against

178 for India). Its population, 41,654,37 5 in 1971, jumped bv about

106 million during the decade 1971-81 bringing the ligure at 52,-

131.717 in 1981 (see, Provisional Census Repor! i981)' This gives

the State a decennial growth rate (for 1971-81) of25'15 as against

28.67 for 196l-71.The live birth and death rates for all India and Madhya Pradesh

indicate sharper decline for MP than for India (see Tables 7'1 and

7.2) eventhough MP is still above the national average' The live

birth rate for MP came down from 40.3 to37 .2 it 1978, a decline of3.1 in four years. The decline was sharper in rural sector than inurban sector. though rural birth rate still remained substantially

160

TABLE 7.1: Live Birth Rates

Yetir 1975

MP India

in Family Planning

M.P. and India II75-28

1977 1978

MP MP. India tr4P. India

hrgh. For India on the other han4 five birth rete declined by 1.9 infour yearq 1975-'18.

CombinedRuralUrban

CombinedRuralUrban

35.2 39.836.7 41.028.5 33.2

m.341.7

32.6

38.3 33,0 37.2 33339.4 34.3 .36.4 34.732.5 27.8'30.4 21.8

LIP. India LIP India

TABLE 7.2: Death Rates.in P. and India l97S-iS

1975 1977 1978

MP.'India Mp.

15.9 16.517.3 17.7r0.2 to.z

. Source: Sample

Similar trend was rellected inrate declined from 18.5 in 1975 to 15four years. While the death rate for14.2 (mere 1.7) during the same per

ol. XIi No. I Iune. 1980.1.

th rate as well Mp's deathin 1978-a decline of 3.4in,India declined from 15.9 toBoth rural and urban sec-

18.5

19.8

I l.l

5.0 17.0

6.3 't9.495 9.6

l4;t 15.1 14.216.0 16.0 lE:39.4 9.4 9.4

'Infant mortality which is usallv crates has also been higher in Mpas

tors revealed similar trends for MP and India.

with birth and dearhpared to the country as asuch a high rate ofinfant

birth rates was difficult to

Delivery of Health and Family Service

whole. Table 7.3 illustrates this factmortality a substantial decline inexpect

. Health andfamily planning sin India, was delivere-d through

in IU.P., like anyother Srateary Health Centres (pHCs)the para-medical stafl The

. and'their Sub-Centreg supported

.Family Plapning Through Panchayats- I:

PHCs and sub-centres are looked atter by qualified medicalo(ficers. In biggerPHCs there are additional medical df{icers (altimes a lady) to help the medical officer'in'charge. The other staflinclude a Block Extension Educator, Multi'purpose HealthWorkers (male and fernale), Health Assistants (malc and female),ANMs, Dais, Mass Education Officers (male and female), etc Thesub-centres generally has one medical doctor,. and compounderand other maintenance staff

Multi-purpose Health Workers. lt{ealth Assistants and ANMvisit villages under their control over a month or a fortnigh((depending on convenience and the distance covered) and dis'tribute medicines for common ailments. They mainly provide

curative service. Serious cases are referred to the sub-centr€ or the

PHC. In serious cases the villagers themselves prefer to consult the

doctor at the PHCs.

TABLE 7.3 : Infant Mortality in M.P. and India 1974"16

Year 1974 1975 1976

LLP. India IilP India MP' Iadia-

16i

t37 126 151 140 138 129

145 136 159 l5l 145 139

83 74 90 84 88 80

CombinedRuralUrban

Source : Sample RegistrationDecember, 1979).

Note : The aggregate estimateWest Bengal.

Bulletin (Vol. Xllt 'No. 2,

for' India excluded Bihar and

Family Planmng work is undertaken both by the lamrly plan-ning staff and the health staff They motivate and advise people onfamily plannirig. Motivation generally.meant motivation forvasectomy or tubectdmy, and the staffget incentive money meantfor motivators. These people are partic.ularly active during thecamps. The para-medical health and family planning staff is alsothe depot-holder for contraceptives.

The health and family planning workers along with the pani

chayat office'bearers make Derson to person contact in order to

162 People's Palicipation in Family planning

educate people about the advanta$e of a planned l'amily andcreate ani. awareness about the available family planningmethods. Mass meetings as well als small group meetings arearranged in co.opelation with the pafrchayat officebearers as wellas prominent citizen of the villa$e. Cinema shows are alsoorganised from time to time to spread the message of familyplanning.

Family Planniirg Performance

Though the demographic irends present an encouraging pic-ture of Madhya Fradesh, the fafuily planning programmeadministration in the State.is not qdite satisfactory. A major dif-ficulty arises from the problem of distances-State capital todivisional headquarten, divisional headquarters to district head-

down to 33 per thousand by 1985, thE State would need to protectan additional 16 lakh couples (Chdri 1982:19). Considering thelimitations of the administration it is quile a tall order.

Mbreover, the larnily planirrflg progiamme in MadhyaPradesh has yet to settle irto a ste[dy routine (Chad 1982:19).Chari's study shows that achiever{ents have fluctuated widelyover the last decade. The peak achierfement years have been the 18months of the national emergencf, specially due to prepon-derence of male sterilizations. Only gteady trend is that of increas-ing use of oral pills. It would bg interesting to check whatpercentage of i{ has been in rural afeas. The small number itselfsuggests that most of it is likely to $e in urban areas.

Another important trend indicatpd by Chari's srudy is steadyincrease since 1979-80. We shall $ome to the reasons.of thisincrease later. Since the inception of the family planning pro-gramme till March 1979, MP was ablp to protect 20.5 per cent of the

Famiiy Planning Through Panchayats- I:

eligible couples effectively, while 20.2 per cent of the couples were

protected by the same method in the entire country.'But only 21.4

per cent of the eligible couples in MP were protected by allmethods as against 22.8 per cent in the country as a whoie MP was

thus slightly below the national average.

Apart from the administrative problems faced because-of thevastness of the States, one of the serious impediments for the pro'gramme is that it is firmly embedded in the minds of the people as

a sterilization programme (Chari, 1982:19). This unfortunateimpression was further strengthened during the Emergency. Thegovernmen! therefore, faced a difhcult task ofrevitalizing the pro'gramme after 1977 because popular apathy had given place toantipathy or even hostility. lt was apparent that the family plan-

ning programme under the existing framework was not likely to be

accepted e asily by people and, more specially by the rural masses.

The Madhya Pradesh governmenl thereforq decided to give a new

slant to this programme by involving panchayats.

Rural Development Linked Family Planning

The new programme, designed and launched since 1979-80, is

an experiment with rural development linked family plannigtg.

The idea is to involve the Panchayati Raj institutions in the pro-

gramme by providing them monetary incentives for rural develop'ment in order to generate popular participation. The involvementof the panchayats, it was assumed, would take away some of the

stigmi attachid to the programme during the Emergency' The

assumption was not totally wrong as Chari's paper and figurespresented by him indicate (Chari, 1982).

The response of the village panchayats as well as villagers sur-

prised the government The scheme has been renewed in gach

financial years since 1979, thoulh it amounts [o giving lakhs ofrupees to the panchayats as well as to the'individuals as incentive.The enthusiasms of the panchayats'is quite understandablebecause their own ftnancial resources are quite meagre' This gives

them a chance to mobilise additional resources for developmentalprogrammes in the villages.

Under the scheme the government has fixed sterilizationtargets for village panchayts. The districts have been divided intothree categories (i) most resistant (ii) resistant and (iii) easy dis'tricts. Till 1980-81 the targets for each ofthose districts were 8, ll

163


and 14 sterilizations per '1,000

target was raised to I l; 14 and 17

ulation During l98l-82 thens per thousand pop-

ulatiorl making prize.winning diflicult Besides, it wasbetween vasectomv and

my by makiirg it essential fora panchayat to ensure 50 per centorder to cualify fqr the prize.

tions as vasectomies in

The panchayats achievrng tne were awarded Rs 10.000.

by 50 per cen! the prize'Should a panchayat exceed themoney was raised to Rs. 15,000. if a panchayat was entelpris-ing enough to exceed the target by I per cent, it would be awar-ded Rs 25,000. The money to the panchayats was

being contemplatgd. to strike atubectomy and to encourage va

expected. to be utilized for developof a school road a dispensary or

mental plans. Thus, by generating hpanchayats, the scheme has beenticipation as well.

tal works like constructionwater facilities etc..In

fac! the State government provided list of dwelopmental worksfor which the money should be utili Enterprising panchayatscould, however, mobilise lareer ifthey had bigger develop-

thy competition among thele to create a sense of par-

' Although sterilization targets fixed for the panchayats inthis scheme, it should not give the ion that the PanchayatRai institutions have been in in the delivery network ofhealth and family planning The panchayats' role is strictlymotivational. The panchayat o bearers are supposed tocooperate with the PHC staff in ent of the targets assigaedto them. Since the office-bearers hais expected that their persuasionof the government medical andresults indicatg their expectatibnpanchayats have succeeded inthem.

The results could be ascertained three ways. Firstly, by look-h have been awarded prizesing at the number ofpanchayatC

in different years since the progri was launched^ Secondly bylooking at the family planning figu The third way, however,could be to look at the imoact of th programme on birth rate inthe State.

The figures for two yeafs to us indicate a1979-80 only 250

this number wenttremendous response from the

their roots in the local soil, itcarry more weight than thai

medical staff. And. as thenot been misplaced Thelimited role assisned to

availablerayats In

1980-81panchayats received the prize while

family Planning Through Panchayats- I: 165

up to 639.'l hug.inlusr one year the pertormance ot the pancnayatsiir terms of numbers, had more than doubled. Looking fromanother angle with more and more people accepting pennanentfamily planning methods in the villageg impact is likely to be felton birth rate.

The family planning performance since 1979 also seems to be .

looking up ip Madhya Pradesh. However, it has not reachedl9T6-77 level, but in spite of a drastic decline in the following year,

acceptance of terminal methods picked up since 1979 (Table 7.3).

Similarly non-lerminal methods like IUD and condom alsobecame more popular than before.

It was still a little too early to make an assessment of thisscheme's impact on birth rate. The Madhya Pradesh governmenthad not made any such assessment But if the programme makesprogress the way it took offand the rising enthusiasm could be sus-

tained over the yearg it is likefy that the birth rate will startdeclining

Motivation and Participation

The. main purpose of this scheme. was to create motivation atthe institutional as well as individual levels so as to enlist pofularparticipation in the family planningprogramme in the long run.As far as institutional motivation is concerne{ the prize-moneyhas succeeded in motivating the panchayats.

The limited participation offered under this scheme has led towider participation in developmental work The panchayat office-bearers who would not think of any new development project'because there never was money available were seen enthusias-tically mobilising more funds for various projects'. Completion ofany project seeined to be fulfilment of long-cherished drbams. Invillage Ajnod in Indore district, for example, the panchayat had

. constructed the building for the Ayurvedic dispensary. A rirater-.nity room was being added to the building when we.visited the

. ,village. There were plans to construct a building for a middleschool 'ahd the panchayat was mobilising funds for thatpurpose.

lndivrouat morivation and participatioq however, are muchlnore complex phenomena. Motivation is governed by a numberof socio-economic factors. In the case of family planning forexarnple, poverty, iiliteracy and superstition do.play their role. But

tffi People's in Family Plsnning

far more rrnportant tnan these rs socio-economic structureof the rural sociery In tbri agrariansecfire unless he has two survivine

y a farmer does not feel .

The strong preference forsons along with high infanton fertility behaviour.

has their own implications

Therefore, while motivatioq a4d consequently participatiorL

The lure of prize and the of village elders were alsoresulting in acceptance of terminal ethods. But in larle number

towards sterlization and the ,of cases the wives were beinghusbands were staying away.on pretext that vasectomy led.toweakness, loss of virility and aoperation

Apparently, the indivi<lual tives were also not much ofmotivating factor for accepting planning One reason pf

tial economic benefit to athat the poor families sus-for the period the bread-

study of acceptors in ruralareas indicates that a majority ofmarriages were consummated asty,. teproductive span was quite

back-ache after the

clustered in 30s. Since childas the bride attained puber-Most of the couples in the

course. is that it did not bringfamily. It mattered only to thebsisting on daily wages couldwinnl"r is laid off. Moreover. a

mepntirng had more thari three four children Such.coupleswere motivated more because of th large families than becauseof the incentive monEv.

Generally speakinglevel of acceptance wbs still

n in family planning at thein Madhya Pradesh.-It was

relatively high only in thelevel of taking initiative in

villdges. Participation at thefamily planning was also

not quite high. But our formal and informal chat withthe villagers indicated that theyparticipate. If their sewices were

willing to be mobilised toired, they would not hesitate

to offer the same provided they the time. The time and oppor-rtant variables determiningtunity toparticipate were

. participatiOn.

F'amily Planning fhruugh Panchayate-\.

Sample Survey in Villages ofIndore District

The Indore district was suggested for study by the officials <ifthe Government of Madhya Pradesh. As usual, the villages of thedistrict were divided irto two groups, one with good records offamily planning and anotherwith poor performance records. Twovillages, Ajnod and Kankaria Pal, were selected as represen-tatives of good performance villages while Khan Barodia andDarji Karadia represented poor performance villages. At thdsecond stage random selection of eight acceptors and four non-acceptors was maoe from villages of the Ajnod and Kankaria Paland four acceptors and two non-acceptors respondenls fromvillages Khan Barodia and Darji Karadia-

Information for the village schedules were taken from the'records of PHCs, knowledgeable persons like school teachers, dtc.

while the respondents' schedules were lilled up by interviews.withthe respondents with the help of the locally recruitecl personfamiliar with the local dialect

The village Ainod" which was nine kilometres from SanwerPHC had 2,306 people according to 1971 Census and had i5 percent bf eligible couples sterlized while Kankaria Pal, located 14 '

kilometres from Sanwar PHC with 1,840 people had 70 pel cent ofeligible couples (men and women in equal numbers) piotected.The village Khan Barodi4 one kilometre from Sanwer PHC had974 people (1981 Census) where 12 persons were operatod o.irt of150 eligible couples and Darji Karadi4 four kilometres away fromSanwer'.PHC had 1,040 people (1981 Census) and 200 couples inreproductive age group. The.Family Planning work was at a verylow key on account of lack of pucta road connecting the villagervith the main road

Characteristics of Sample Villages

Demographic profile of the four sample villages in lndore dis-trict (see Table 7.4) indicatds .that the Ajnod was the largest villageand Khan Barodia the smallest The population was overwhelmingly llindu in all the villages, with a very small Muslim'poptilation in three villages. Each one of the villages had substan-tial scheduled caste population, and Kankaria Pal had a srnalltribal population as well. There were more males to females in

t67

168 People's in'Family Planning

each ofthe villages. Thp two good70!er cent protection rat6.

brmance villages had7l and

TABI E 7.4: Demographic e of the Sample Villages

WlagesDemagraphic Profile

Ajnod' Darji KhahPal Kamdia Barodia

Total populationHindusMuslimsSchedul0d CasteMaleFemaleC-ouples in the re.productive age groupCouples effectivelyprotected

2,306rJ5r

20500.

r2w1,100

376

269(71)

1,359

1,064

20275*

732627

?10

147.d0)

1,002

69049

263

54ffi200

974874

100

500414294

85

ir)f6

(18)

* Includes 75 Scheduled TribeNote: Figures in parentheses te percenta-ges.

That the villages had activethe fact that they were participaschema Janpad was the forum at tehsil level where the rep-

with bureaucrats for deter-villages There was District

resentatives of the villages inminig developmental priorities inAdvisory Committeg a represen (not elected) permanentbody, to advise the Zilla Parish on developmental matters.

The sample villages had milk which collected and

marketed milk to dairies- or private-located incooperative for dis'tribu'Indore. Kankaria Pal had an

tion of fertilizer on loan. OnlY Karadia had a Yuvak MandalKhan Barodia was the onlY

n and a government

bided Seva Sahkari Sansthan. apart from women's w.qlfare

organisation at Khan Barodia ich was engaged in childwelfarg help ofnone ofthese i

engaged in same social actiYities,village having a women's welfare

panchayats is obvious fromin incentiveto-panchaYats

planning programtme.was sought in the family

Family Planning Through panchayats-I: 169

Of the four selecti:d villages only rhe Ajrod had an Ayurvedlcdispensary and a family planning sub-centre attached to it Rest ofthe villages were served by thq PHC at Sanwer and its paramedical

{al[ Each of the Village had a CHV and a dai residing there.Besides they were visited by Supervisor and MPW periodically(fortnightly or monthly).

. These para. medicals provided curative health services to peo.plp. They also supplied conventional contraceptives. But supplieswere irregular and inadequate. Hence most people lra.d to dependon friends visiting nearest town or cities It was not convenient forrrost of them to go and queue up at the Sa4wer PHC., I he motivation work was the responsibility ot the paramedicalistaff residing in or visiting the villages as well as the staffof CDBlocks. Ever since the new scheme was launched, gram pah-chayats had become active campaigners, so much so that iheyspegt from their own resources to supplement the incentives sothat they can motivate more people and win cash awards. But thecampaign as well as motivation was restricted largely to termiiralmethodg and as a result spacing methods were no! emphasisedupon The family planning campaign particularly becamevigorous during sterlization camps. It is duriug such camps {hatfilms on family planning were.screened and exhibition of fosterqmass meetings ard.small group meeting$ were orqanised

The samfie villa-geilC<i-eaucational-iaciliry onty upto middleschool level The schools had reasonably g0od attendance. The,,enthusiasm for bettering educational facilities was witnessed inAjnod where the Sarpanch was makitrg efforts to raise fuuds forschool b*ildins. '

Eleclgrat . parucipation ln the sample viliages was also

reasonably hi$. V-oting reported in papchayat elecion was 65 tos) qer cenl and 60 to 70- per cenl in the.Lok Sabha ele'ctions

. AJn9d was the only village in our sample with a family plan_ning sub-centre.Âccording Lo rhe sub_centre stufq ZO f"opf" o., uo::._ttfl:-t:"9h, f1mily plannirg advice every week ihe coopera_,uon base ln all the villages was reported to be wideninggradually.

Sampre Respondents

Like other case studies wb used random sampling for selectingour respondents in the sample villages oflndore district In spite of .

170 People's 'pation in FamilY Planning

Umitations of time and willinlbestto select a representative

ofthe iespondents, we tried ourle. Let us look at theProfile of

the respondents in lndore din all the income brackets

e resoondents, i.e. over three-middle income grouPs. The

high income group formed less one-fourth of the samPle.

Considering that antipathy family planning and apathy

towards participation is greatest the low income grouP and

middle income group is also brakcet from the point ofview

Our respondqnts were distri(see Table 7.5). A majoritY offorirths, belonged to the lower

of success of the familY.participation in develoPmenqsample from the high incometheir views on the subject

TABLE 7"5: Economic

Incotne rangg(R.i,

progratnme and promotion qfsample is justifipd The smallket is sufficient to get a feel of

of the Respondents:

Non-Acceptors

No. Percentage

0-1000t00r-20002001-30003001-40004001-50005001-60007001-80008001-90009001-1000010000 +

26I4J5

I1

J

8

8

27

t78

:8

8

8

100

IIJ'

2

II

1''

8

254

l6

13

44

13

100

group (see Table 7.6).-The <

30-39 age group (it was not

Total

Age'wise the acceptors we(e y concentrated in 20-39 yearson of half the acceptors in

to get acreptors ln younger age

group) meant that four to family is the norm in this area.

As we have mentioned in the and we shall deal with itin detail later, frrost peoPle on two sons. Though 46 per

. cent acceptors were in 20'29 age it was not a very encourag-

Iamily Planning Through Panchayats- I:ing sign if the aim was to promore rwo-child family. Il racr rn tlierurdl contelt 25 -29 xge group would have 3 to 4 childreL In thatcase in our acceptor sample we had only 16 per cent respondentsrelevant for two-child family. The trend is further confirmed from

Ithe non-acceptor sample ofwhom two-thirds were concentrated in35-39 age group.

TABLT 7.6: Age-group composition of the Respondents



t7r

.Age Group(Yeari '

18) r1

86718

t6302525

-t4

47

66

I

20-2425-2930-343s-39&4445+

Total 100t21002+

Illiteracy was endemic in this fficollege graduate. Thus, the most educated in our sample hadpassed matriculation or higher secondary. Half qf the u"..ptorcand one,third of the non-acceptors were illiterate. One-third of theacceptors and 59 per cent of the non-acceptors were distributedbetween primary and middle school educated- This shows whatsmall number we could find ofeven high school educated personsof this area {see Table 7.7).

TABLE 7.7: Educational level of Respondents

Acceptors Non-Acciptors

No. Pefcentage No. Percentage

Educational[zvel

IlliteratePrimaryMiddleMatric./Hr. Sec.

t2624

5025

8

l7

JJ42t78

45

2I

Total 'lJ24. ,100 100

172 Pmple's in Family Planning

of both the sexes-inWe had planned to keep equalour sample. While we largely in achieving*hat objec-tive with respect to the acceptors, had to make do with an all-male 'sample for the non- (see Table 7.8).

TABLE7"8: Sex.wise ution of Respondents

,Sex .Acceptors Non-Accept6n furcentige

Male 13

Female 1l

Total 24


The respondonts, both and non-acceptors. demons-trated fairly strong participatory (see Table 7.9). In boththe cases, average participatory was above 50-51 for accepSors and 59 for non-acceptors. the strange aspect is strongerparticipatory score for non- than for acceptors Whilethe difference bctween the two is not very largg the fact remainsthat the non-accepton have a scorg and it would indicate

attitudg the non- acceptorijthat in spite of stronghave not participated in family programme. But beforedrawing such a conclusion itto further analy$es.TABLE 7.9: Participatory

be desirable to subject the data

of the Respondents

sNo.

Panicipanry Questions Percentage alfrmingthe questions

Acceptorc

l. If there is shortase ofcommoditief (kerosengfertilizers, etc.,) in yourwould you make efforts tothese commodities availa

2. If there is shortage ofwater in your village,

100t2

t2

54

6100

make efforts to ryake it

'Family Planning Through Panchayats* I: t73

3.

(t) (it)

3" If the neighbouring village has a school 91 66which yourvillage does not havq would yournake efforts to get one opened in yourvillage?

4 If a family planning camp is being held 79 50in a neighbouring village, would you gothere?

5. Would you also make effort to get one such 70 66camp held in your village?

6. If a iilm is being shown in the neighbouring 6 4lvillagq would you go there to see thefilm?

7. If a film being shown in your neighbouring 37 50

village is on family planning would yougo there?

8. Would you make efforts to get the film 37 4lscreened in your village?

9. lfthe village does not have a health centre/ 58 58

dispensary would you make efforts to get

one opened in your village?10. If the government decides to open a health 6 83

centre/sub-centre/dispensary with the helpof the people, in the village would youhelp?

11. Would you like to join in organising health 79 58

services in your village?12. Would you be willing to pay for health 45 75

services?13. If a family planning centre is being opened 45 33

in the neighouring village, would you go

there?14. Would you also make efforts to get one 54 50

family planning centre/sub-centre openedin your village?

15. lf a nationaVlccal leader is delivering a 33 66

t.

174

18.

People's .in Family Planning

speech inthaf

your.vi[age,

td If sucha political meeting isthe neighbouring villaggattend thaflWould you like to for a partl 12 '41

candidate in election?Did you campaign for anyin the last election?

20. If the local l,eaders organise

/candidate 12

onstration 22

100

4l

58

JJ

g)

19. Did you voto in the last for (a) Pan- 9l(c) Lokchayat, (b) State Assem

Sabha?

on nslng pnces or non- of:cgr-tain commodeti€s. would.in it?Ifthe VLWVHWisnotvisiwould you make compcerned offrcials?

22. If you are requested tovices to the

non- acceptors have better score,(9) both have equpl scores Ano

d you'attend

being held in 16 33

would you

participate

yourvillagq 25to. the con-

your ser- 25agency to

would

acceptors and on one itemimportaht feature of the res-

and the acceptors havingiterng the pon acceptors

take the health services to theyou volunteor yourselPIfthe school teacher in youryou to persuade people

requests 37 9l

chi.ldren to schoo[ wouldsend their

help him?u to help in 50people forwould you

24. If the WIWHW requestspersuading and miaccepting Ibmilyhelp him?

25. If 'Keertan' or'Ramlila' isvillagg would you attend

inyour 91 83

Average

On a closer sct'itiny we find on fifteen items out of ?5 the

6

595I

ponse patterir is that in spite of non-acceptors having bettelscore than acceptors on fifteenexceeded non-acceptors only onhave a slender lead of eight over items. This means whenwer

the aiceptors have taken lead it is sizeable. This is borne out

clearly ii we make an itemwise analysis of Table 7'9'

Lei us also look closely on items related to family planning The

scores for seven questions dealing with family planning are-4(?e, 50), 5 (70,66\,7 (37, s0), 8 (37, 41), 13 (45, 33), 14 (s4, s0),24

i58,06;. ltr fo,r. out ofseven items the acceptors have a lead overthe

non-acceptors, and in three questions the lead is substantial, while

the non-acceptors have a slender lead in three questions' The

acceptors. therefore.'demonstratq marginally better attitude

towards family planning than the non'acceptors.

That the respondbnts generally did not demonstrate a very

strong partipatory attitude in this area is clear. from our data- If we

makJi close scritiny of the data and responses, the slender lead

for the non-acceptor-s can be easily explained' The distribution ofthe respondents sho*s an all-male sample for the non-acceptors'

.while among the Scceptors 54 per cent were male and 46 per cent

were femalei. Most of our female respondents perferred to give an

explanatory reply rather than a clear affirmative or negative one'

Since the responses had a negative connotatioq they were put as

negative for statistical computation, and that has brought down

thJ scores of the non-acceptors. The women respondents' respo-n-

ses to our questions were rather varied*"what can we women do,

the decisions are not taken by us", "these are male{unction$ we-do

not go out of our houses", etc. Several of the male respondentq

.rp.ii"lly those belonging to poor sections of society' said that

thly would not do some of the things as nobody would listen to '

them-"who listens to the Poofl"The data on participatory attitude indicates that though the

scheme of giving incentive to Panchayats had been successful in

rinlf 7.10: Help ibralealth Seh'ices

Family Planning Through Panchayats- I: 175

Kind of help Accepton Percmtage Non' Percentage

- acceptors

Monetary3l2.5325Both 9 37 '5 5 4r

Nond93'1.5211Total 24 100 12 100

176

programme.

tMotivation

respondents ir both the

ing these services.

that they did not want tohealth services.

17 per cenr non-acceptors saidany kind of help for the

The acCeprors had a clear over the non- acceptors inmotivation. The rrotivational for the acceptors was 69 while

Table 7.ll). A majority of the(83. per cent acceptors and 75

'for the non-acceptors it was 37 (

People's in Family Planning .

targets, and had alsoions, it had yet to give a

major boostto people's parti atritude. It had made no dif-ference in -the status of wo who are so cricial to the

All the respondents wanted government to pay for and thehealth and family planning r

were not averse to providingBut most of the respondents

achieving family planning ste:'eliergised sleepy Panchayat raj

help to_ the government in maOnly 37.5 per cent acceptors

The question of individuattor in this case study as well.

per cent non- acceptors) wereBut on their own, 87 percent a

acceptors were male. This seems

non-acceptance. It will be furtherresponses of the don- acceptop

Participation, Motivation andFimily Planning

cal monetary or both kinds of

to adopt family planningconsulted the local medical

when we look at the

emerge as a Oominant fac-'

officer for family planning and 25 per cent of the non.acceptors did so. But on some or the other, they did notaccept family planning. Their is further ccinfirmedfrom the questions. They might having reasons against goingfirr terminal method" but one finds difficult to see why only 8 percent should.use dther facilities by the family planningcentre. We can explain it onlymotivation.

terms of apathy and lack of

'Thug while participation did play any significant role inFamily planning motivation did There must also be socio-

cultural reasons. Before analysing .of the non-acceptors,

let us look at the number of male female children the respon'dents were male only 47 per of the children of the non-

be an improtant reason for

ference for sons as against

tfamlly Planning Through Panchayats- I:

TABLE 7.ll: Motivation of Respondents

177

Questia ns on Motivation Percentage of respn-dents ffirming the

questions

Acceptors Non-. acceptors

l. Have you ever been to a family plan-ning centre?

2, Have you ever used the facilities pro-vided by the family planning centre? . .3. Did you ever consult the medicalofficer in the dispensary/health centre/sub.centre/family planning centre/sub'centre and seek advice on familyplanning?

4. Did you eyer take your friendVrelativesto the family planning centre and per-suade them to accept family planlringmethodf

5. Did you ever take you spouse td thefamily planning centre?

6. Has anyone ever advised you to Cboptfamily planning?

JJ

25

6

54

87

50

JJ

75

79

45

83

Average:

daugllters comes out as one factoi. Our anaiysis shows that per-centage of sons for the acceptors wab larger than the non-racceptors. Let us have a hOk at ihe responses of the non-ac-ceptors r

to get a clear picture.Of the twelve respondents in this category one had only two

daughters and one had only two sons. Only other respondent with, a two-child family had a son and a daughter. Five had threechild

;

families and the rest had more than three children Seven respon-dents considered two to three children as ideal numb€r providedat least onq arid preferably two were sors. The rest livb coosideredfour to be ideal number, For a majority of them expectation of

lanother son was the major reason for not adopting farnily plan-

3769


ning At least five of them c remarked that two sons wereessential for qtability of a

The responses of non-accepto respondents cleariy brings outthe imoortance of the socio- ical factors in family plan-ning This also showr that the eme of providing incentives toPanchavats in order to be sustaiir and strensthened further will

TA,BLE7.l2: of Non-acceptors

S.No.No. ofchildren

Desirable No.of childrenaccording torespondent

3 with a son

3*4 children

2 sons and2 daughters2-3 children

1.

2.

3.

4.

6.

7.

8.

9.

10.

11.

tz. .

2F

IM 2F

3M 2F

1M2F

daughter

2-3 children

2-3 children

2-3 children

4 children

4 children

4 children

4 children

for

ting forn

58old

e pregdant

son

ting forby

d wifeine for a

specific

for a

ting for a

specific

ting forn

Remarlcs

One son ismustTwo sons aremusl

_

Two sons aremusL

Two sons givestability to thefamily.

Two sons afenecessary.

:

Two sons aremusL

5. lM lF 2 sons and oneW ts one

2N42F

2Nl

IM 2F

IM 2F

2M2F

2M2F

lM 2F

wsowso

wa

Family Planning Through Panchayats- I: n9

have to go beyond the target approach and ileal wilh these lactors.

Apparentfn so far little has been done to counter such beliefs. Thiscould be one reason why participation in the programme is

still low.

Sample Survey in Dhar District

Dhar is a relatively backward district of Madhya Pradesh.

Located on the-western fringe of the State, it has a large tribal pop-

ulatio4 living in abject proverty. Terrain is difficult and rocky, so

agriculturally it cannot be in a very happy position. It also seems tohave been robbed of most of its forest wealth.

It was suggested to us for study by the Health. Department of theState. We selected two good performance and one poor perfor'mance village from a list given to us by the oflicials of the HealthDepartment of Madhya Pradesh. Due to paucity of time we had tolimit our survey only to three villages. Thus, we selected Umarbanand Bakaner as representatives ofgood performance villages andMandwa as represersative of relatively poor performance village.As usual, eight acceptors and four non-acceptors were randomllselected dt the second stage of sampling from the two good perfor-mance villages and four acceptors and two non-acceptors wereselected from Mandwa.

Sample Villages

Umarban and Bakaner were award-winning villages under then-ew scheme of the Madhya Pradesh gov€mmenl

Umarban was the largest village in the sample with a popula'tion of4,518 and Mandawawas the smallestwith 2000. A1l of themhad overwhelming Hindu population. Bakaner had a largeMuslim population as well. Scheduled Caste and Scheduled Tribeformed substantial part of the population in each village. Male-female ratio was tilted in favour of males. Umarban and Bakanerhad 4l' per cent of the eligible couples effectively protected whilelvlaqdwa had oply 3l- Del aeqf couples piotected.

Umarban ano Bakaner were award-wirlning villagbs, so theyhad active Panchayats elected in 1978. The Notified Area Com-mittee of Mandwa was under suspehsion. Janpads at taluka leveland.ZiJla Parishads at the district level were also active.

A Mahila Mandal run by the government functioned in

People s in Family PlanningBakaner. All the sample villages Child Welf are Organisatiorlsrun by Panchayaits. The Mp ent was also running anadult education programme in all three villages. But the localresidents did not Seem very enthof these.

'large meetings, display of posters.films. Sterilizalion camps were i

about the success of any

Each of the sample villages had facility of a government dis.pensary. Umarban had a mini- C, while both Bakaner andMandwa had a PHC. The pHC at' was the biggest of all. Itwas said to be catering to the heal needs ofabout 80,000 people.Para-medical staff posted under PHCs" served the popula-tion living deep in the rural areas.

These PHCs distributedthrough their staff Regular

either directly orfor family planning was

reported.in these areas through group ineetings as well asshows and screening of.

reported good follow-up service.regularly held and people

TABLE 7.13: Demographic of Sample Villages

DemographicProf;b

Villages

Bakaner Mandwa

PopulitionHinduqMuslimsScheduled CasteScheduled TribeMaleFemaleEligible CouplesCouples effectivelyprotected

Sample Respondonts

We managed to get a sample the broad spectlum ofeconomic status. There were probl i in assessing the income ofrural population subsisting on

4,5?5

5'r188

3,028I,160

5601,458

22ML9A

761

3t2(4rvo)

2,0001,800

2W200

1,000

l,&09@350110

(31v")

getting the nearest approximation.ture. But we succeeded in

Family Planning Thrcugh panchaybts_I:

TABLE 7.14: Economic Status of Respondents

lEt

Income range(P-',) Acceptors Non-Acceptors


50l020

10

l0

210525s945 I3152l5

I1

l00l-20002001-30003001-,1000

4001-5000500r-@007001-800010000+

Total 100

Table7.14 shows,35 percent ofacceptors and halfol the non-acceptors were from the low-income group. Nearly two-thirdsacceptors and 30 per cent non-acceptors belonged to the middle-income group; and 20 per cent non-acceptors were from high-income brackel

Agewise our respondents were distributed between 20 and 45years (see Table 7.15). One.lburth ofthe acceptors and 40 per cent

TABI .E 7.15 Age-group Distribution of Respondents

l010020

Age-groupsyean

:Acceptors Non-acceplors

No. Fercentage No. Percentage

I' l0330330220110

l5420735630l5l5

20-2425-2930-3435-39N-4445+

Tota\ 20 100 l0 100


of the non-acceptors belonged 20-29 years of age. Two-thirdsacceptors and half of the were in 30-39 age group.Ten per cent ofboth categories of belonged to the age-

bracket of ,1045 veats. Thoush it hazardous to make sweepinggeneralization, it seemed that in this area did not acceptterminal method of family p till thev were around 30 vearsof age which would meant least ur-child family. We shall see

later whether-this is bo.rne out I fu-rther analysiq.-sentative sample in terms ofWe also managed to get a

educational level Onefifths of th acceptors and 30 per cent no;r-acceptors and halfofthe non-,acceptors were illiterate. Two

acceptors were distributed primary and middle schoold l0 per cent non-acceptors'only l0 per cent of both

education. One-fourth acceptorsrwere high school graduatespategories of respondents belo to college graduates (see Table7 16)

TABLE 7.16: Educa iLevel of Respondent!

Non-Accepton

No. Percentage

IlliteratePrimaryMiddleMatric/Hr. Sec.

Graduate & above

TABLE 7.17: Sex-wise on of Respondents

Acceptors Non- PercentageAcceptors

MaleFemale

202515

25l0

100

Na

45

J

5

2

20

2

I

7030

l0

30302010

l0

100

8020

8

2l4l

Total 20 100 l0 100

Fantily Planning Through Panchayats- I: 183

We did not succeed in maintaining equal ratio ol male andfemal€ respondents in our sample (Table 7.17). Among acceptors,70 per cent wgre male and 30 per cent female, while 80 per centnon-acceptors were male and 20 per cent female.


Looking at the responses to the drll'erent participatoryquestions.it is clear that the respondents were not very keen to participate inall the activities. The acceptors' responses varied between 23 and100 while the variation in the rcsporises ofthe non-acceptors wasI I to 100. This clearly indicated that participatory attinrde was pre-seht in both the categories of respondents. Greater variation.among the non-acceptors was perhaps an indication of slightlyweaker spirit among them. The average score-60 lor the accep-tors and 5l for the non-acceptorsalso indicated this. But speak-ing on'tbe basis of averages, we can say that the difference was nottoo wide (see Tdble 7.18).

Let us look at the questions relating to family planning. Ot theseven items relating to family planninga (85,55),5 (66,44),7 (42,33) 8 (38, 44),13 (33,33),14 (52.44) and 24 (90, 55)-five show aclear edge for the acceptors. On three the difference was quite sub-stantiaL The non-acceptors equalled the acceptors in one (13) andhad slight edge over them on one (8). On the ',vholq we can say thatthe acceptors' participatory attitude towards family planning wasstronger in Dhar than the non-acceptors. Participation seemed tohave played a role in acceptance in Dhar districl

A majority ofthe respondents (80 per cent) felt that the govern-ment should run as well as pay for the health and family planningservices. But people did not seem to be unaware of their own res-ponsibilities. We asked whether they would want to render anykind ofhelp in creating or running these services. Only l0 per centeach ol'acceptors and non- acceptors said that they would not wantto render any kind ofhelp. ln facl65 percent acceptors and40 pe.rcetrt non-acceptors were prepared to give both physical and mon-etary hclp.

Motivation

Motivation also seemeu ro be affecting famrly planning accep-tance in Dhar districL The acceptors generally demonstrated

I tJ4 it:rpotion in Fdmilv Planning

hisher motivalion than thc Iron- tors. One clear cxarlDle is

the last question. As againrt 77 pct' t tlon- accrcptors. only6l per

cent acceptors werc adviseil to a pt iamily planning measures.

T'hus. 39 per cent acceptors di(i n nce<J anv extemal advice to

adopt family plauning whilc 7lr r cent nou-acceptors did notadopt family planning ever) thou h the.,' wcre advised. The dif-fereuce in the avetage sco r,: of thsubstantial.

twcr. 72 and 42, is aiso quite

TABLE 7.18: FarticiPatory ude of the ResPondents

slJo.

PaniciPatorl' Questio

PL,rcentage of respon'

rlent,s afftrming the

questions

Acc?ptors Non'Acceptors

I. tial cotrt-fertilizersou makemodities

available in Your village?2. If there is shortage of

your village, would you mak{ efiorts tomake it available?

3. lf the neighbouring village h

which your village docs not hfve' wouldyou make efforts lo g3t oneyour village?If a family plannirrg camp is being held

in a neighbouring village. fctuld you

t.

85

56

go there?5. Would you also make efforts to get one

such camP held in Yo-ur vill{gel

6. lf a film is being shown in [he rreigh'

bouring village. would you $o therc to

iee th6 film?

7. lf the film is being sholn in Your

I

JJ

66

6t

42 JJ

Family Planning Through Panchayats- I r85

1. 3. 4.

neighbouring village is on tamily plan-ning would you go there?

8. Would you make efforts to get the fihn 38 4screened in your village?

9. If.your village does not have a health 61 55centre/dispensary/sub-centre, wouldyou make efforts to get one opened inyour village?

10. If the government decides to open a 90 66health centrelsub-centre/dispensarywith the help of people in the village,*ould you help?

ll. \','ould you like to join in organising 80 7jhealth services to ycur village?

12. Would you be willing to pay for health 42 55services?

i3. If a family planning centre is being 33 33opened in the neighbouring village.would you go there?

i4. Would you also make efforts to get one 52 ufamily planning centre/sub-centreopened in your village?

15. Ifa nationaVlocal leader is delivering a 42 55speech in your village, would you attendthat?

16. If such a political meering is being held 33 33in the neighbouring villagg would youattend that?

17. Would you like to campaign for a party/ 23 I Icandidate in the election?

18. Did you campaign for any part/candi 23 lldate in the last election?

19. Did you vote in the last elbction for 90 100(a) Panchayat (b) State Assembly and(c) Lok Sabha?

20. Ifthe local leaders organise demonstra- 3g 33tion on rising prices or non-availabilityof certain commodities, would you par-ticipate in it?

4.3.

90

186

2t.

22.

If the VLW/VT{W is not yourvillage, would you make cothe concerned offrcials?If you are requested to vol teer yourservices to the governmen untaryasencv to take the health to thepeople, would you volunteer

2J, If the school teacher in r villagerequests you to persuade le to sendtheir children to school, youhelp him?

24. If the VLWVHW requests u to help 9(tin persuading and motil a people

wouldior accepting family pyou help him?

25. If 'Keertan' or'Ramlila' isyour village, would you a

Average

TABLE Help Health Services

People's rticipauon in !'amily Planning

laint tc

Non-Acceptors

lage No. Percentage

66

fype of help

PhysicalMonetaryBothNone

4I

l3z

No.

100l010020

205

65l0

3020410

242

Both partrcipation and motlv rL thus, seemed to have played

a role in Dhar district in a tance of family planning. Butmotivation plaYed much stro role lhan participation. Gene'

rally participatory attitude was very high but the differencebetween the two was not loo This was quite wide in motiva-

Family P.lanninz Through Panchavats - I: 187

tion. Motivation is governed by individual priority and we willhave to look into individual priorities of the non-acceptors.

TABLE 7.20: Motivation of Sample Respondents

sNa.

Questicns on tr'Iotivation

Percentage of Respon-dents ffirming the

questions


55

JJ

4

85

903.

33

ll

77

85

42

6l

l. Have you ever been to a family plan- 66ning centre?Have you ever used ihe facilities pro-vided by the family planning centre?Did you ever consult the medical officerin the dispensary/health centre/sub-centre/family planniag centre/sub-centre and seek advice on familyplanning?Did you ever take your friends/relativesto the family planning centre and per-suade them to accept lamily planningmethod?Did you ever take your spousc to thefamily planning centre?Ilave any one ever advised you to adoptfamily planning measures?

Average

Participating. Motivationand Family Planning

Eventhough high participatory attitude and motivation emerge

as the dominating factors for better performance of the acceptors

in farnily planning programme in Dhar district, thpre was stillmuch to be desired on participation fronl General participatorypicture raises optimisnr, but in order to be sustained it will require

4272

r88

greater push. That people gradealso clear from the data. Hence.planning must relurre higher

But if the preference for the soning require higher grading? An

people did not accept familyacceptors' respoqses carefully.

S. No. of DesimbleNo. Chiidren No. of chil-

drcn accord'ing toRespondents

1. 3M lF

2. 2M2F

2 or 3 Wife

T.ABLE 7.21: Yiews or Non-Acceptors

in Family Planning

before participating 1s

order to be accepte4 family

is too stron& can family plan-of number of sons and

Let us look at the non-

.fo, Remarks

of At least qne son

1.t least 2 sons

one more

Two sons are must

for

A son is mustTwo sons are must

At least 2 sons

daughters of the acceptors and n acceptors shows that 54 percent ofthe acceotors' children male while only47 per cent of

male. Not surprisingiy, thesethe non-acceptors' children

LtionofLtion

4.

.3. 2M IF

lM 2F

5. 6M 3F

6. 3F7. lM lF8. 3M lF

3M lF2M2F

WantsciaughWantsson

one more

a sona soll

J

J

z- 5

J

ste tionWantsWantsWife

9.

10.

I or24 -Does

need

getsoon

do-feel the

There was only one family wi two children (No. 7) and theytoo wanted one more chil( p brably a son. There were threefamilies with thtee children andmore child-one for a daughrer

of them were waitirrs for oneand two for sons. Five families

Family Planning Through Panchayats-I 189

had four children and practically all of thcm were prepared forsterilization. T'here was one family with nine childrbn (No. 5)where the husband was prepared for sterilization. A majority ofthe non-acceptors felt that two sons wele essential for a family.This will inevitably lead to four-child family, which is clearlyreflected in the data.

This shows that it is essential to tackle people at the level olbeiiefs. IVlere monetary incentives to panchayats and individualswere not going to serve the purpose. The pressure ofthe panchayatoffice-bearers was also not sufficient In fact, having been broughtup in similar social milieu they were likely to share much of thesebeliefs and hence they would also have limitations in motivatingpeople. This was cupported by our survey in Maharashtra wherethe Sarpanch of a village .told us squarely that he r.vould notmotivate people unless they had tur'c' sons. The belief-pattern wasnot much differert in MP eithcr.

Overview

Though it was not possib.le to judge the effectiveness of the rrrraldevelopment linked family planning being experimented inI\4adhya Pradesh in a short span of two years (we dtudied thescheme in Nlarch 1981, while it was launched in April l9Z9), itshowed the promise of being a novel exoeriment worth replicatingin other areas. It had enormous possibilities for population con-trol as also of rural developtnent The scheme, however, had itsapparent limitations, which needed a thorough study andunderstanding if it had to be sustained and made more effective.

Firstly, while it was laudable to bring panchayats into thefamily planning as well as developmental networ( the schemecorrtpletely ignored other voluntary associations which couldhave supported the efforts ofpanchayats. F-or exarnple, most ofthevillages studied by us had milk cooperatives. Some of them alsohad Yuvak Mandals or government sponsoredM4 hila MandaLs. Butnone of these were formally incorporated into the overall scheneeither family plannin! or of rural developmenL One wonders horvthe MP government plans to ehlarge or even sustain participationwithout galvanising such voluntary bodies.

Secondly, the role of panchayats itself was weak Two impor-tant sources from which motivaticn for participation flow; isimmediate benefit accruing from an activity and e share irr

190

decision-making The system of amcr but since panchayats havene iworh their task remainstargets assigned to them by the S

to dampen enthusiasm in the longother Iamily planning methods.thuq is likely to be reduced toprogramme.

Thirdly, a programme like healnot likely to be very efl'ective wimunication network Uarea. A large part of the Statethroughout the year. Manythe rainy season and are accessibAn4 shortage of vehicles addsdifficulties.

The health and farnily ptructulally weak Aside from beingplaints of shortagcs of supplies.in short supply.

Finally, there was an inherenttargets for villages. Some smallerdid not have requisite number ofwerq thereforq unable to ccmpelikely that in long run more anding about this because as thehave as many couples for protecti

I{owever, inspite of theseregarded as a good beginning of athe long run it is successful or notadaptibility of the lorver level medinnovations and changes in themakers in rhe state.

'pation ,n Family Planning

has taken care of the for-beeir includeci in the deliveryly fulfilling the sterilizationgovernment While it is likely

rup, it is also going to neglectfamily planning programmeeuphemism for sterilization

care and family planning ist good transport and com-

, this remains a neglectedis not yet easily accessibleare completely cut off duringonly by jeep in other seasonsto the health department's

deparlment was also infras-'ed there were com-

were particularlv

in the system of fixingcomplained that they

uplcs to be protected. Theyfor the prize. Moteover. it is

panchayats stan cornplain-become higher they nay riot

the scheme should beovel experimenr Whether inwould depcnd largely on t.re

bureaucracy' as well as thcheme brought by the poiicy

Chapter VIIIFarnily Planning ThroughPanchayats-Il: GujaratYIN Gujarat, as in Madhya Pradesh,, panchayats are actively

invol.red in the t'amily planning programme' There are, however,

some significant diffcre nces. Firstly, Gujaiat has the advantage ofa more effective panchayat system. Secondly, the panchayat sys-

tem in Gujarat has bberr an integral part of the denelopmental net-

work ever since its inception. The vcry organisation of the

panchayati raj institutions at the district (Ziila Panchayat), taluka(Taluka Panchayat) and viliage (Gram Panchayat) levels puts thepeople's representatives and the developmental bureancracy iaclose association. And, finally, the invohement of panchayat sys-

tem in family planning effort as well as the irrcentive prize scheme

starteci in l97l in Gujara! that is about nine years before, inMadhya Pradesh. The scheme of incentive prize schcme, however,

was discontinued in 1976 and u'as again resumed in 1978.

Moreorer, Gujaiat also has a richer experience ofco-operativesthan any other state in India ' ris would meart that communityfeeting was likely to be deepcr and, consequently, the level ofpar-ticipation higherjn Gujarat than most other parts of the counlry'A study of people's participation in family planning in Gujaraltherefore, assutned significance ir the context of this work

Demographic Profil d

The demographic profile of Gujarat presents a picture of lightand shade. Theie are certain bright aspects which show that the

family planning eftbrts in the state are having an impact on the

demographic gro\+{h while.some other aspects pcint out that the

efforts are not eifective enough.

lq2 People's in Family Planning

Gujarat's populatior;fol exam le. was 33,960,905 according tothe l98l census. Its decennial rate of 2,1.21 for 1971-81 as

against29,39 for 196l-71 indi a reduction of 2.81 durine thetwo decades. Thus, while its ial growth rate was still higherthan the national averagg whichtion,was much sharper in case of

at24.75. the rate of reduc-t than in case of the courr:

try as a whole, which registered a reduction of .05 only.Live birth rates for all-lndia Gujarat indicated decline for

both Guiarat and the country as a ole during the years 1975 to1978. It was 1.2 per thousand in jaral from 37.0 to 35.8 against1.9 ie. from 35.2 to 33.3 per th d in case of India. Decline,thoueh reflected both in urban rural areas of Guiaral is muchsharper for rural areas than for The hieher birth rate forGujarat explains its higher growth rate of population.Table 8.1 gives tha estimated annIndia durine 1975.78.

live birth rates in Guiarat and

TABLE 8.I: Estimatecl ual Live Birth rates inGujarat India

lv/) t97 / 1978

Sector Gujaw India Gujarat Gujarat India Gujarat India

CombinedRurrlUrban

3s.2 37.436.7 39.0 3

37.038.931.8 28.5 32.7

36.1 33.0 35.8 33.3

37.8 34.3 37.4 34.731.2 27.8 3l.l 27 .8

.4

.8

4

Sample Registration Bull (Vol. XIV No. l Junq 1980)

,. Similar trend was reflected inthe same period. The estimated

death rates in Gujarat duringth rate in Guiarat came down

from 15.4 in 1975 tc 12.7 in 1978. The death rate, however, hasdcclinid more sharply than the bi rate. Furthermore. the SRSdata also indidates lower death ra for Guiarat in rural areas as

well as in aggregate (rural and r) teims than for.India. And itrdia raie by 1978. No wonder,had received a parity with the all-

then" that Grriarat's decadal rate ofpopulation was higherthan the national average (see Ta le 8.2).

tt intant :noitality of both theThe Table 8.3 clearlv indicatessexe s in jujarat was r.ruch higher the All-lndia average and

Family Planning Through Panchayats- II:

that rnf ant mortaliiy bf femate chlldren was much hrgDer th an thatof male.phildren High" infant mortalit_v thus, seems to be animpeding factor for population control in Guiarat

TABLE 8.2: Estimated Annual Death Rates inGujarat and India

r975 1976 1977 1978

Sector Gujarat India Gujarat India Gujarat India Guiarat India

193

Combined 15.4

Rural 16.6

Urban i2.2

t4215.3

9.4

15.9 ls.3 15.0

17.3 16.0 16.3

t0.2 11.0 9.5

14.8 t4.7 t2.715.8 16.0 l3.B11.8 9.4 9.4

Source : Sample Registration, BulletiriVol XJV, No' 1, June 1980)

TABLE 8.3: Infant Mortality during 1973 in Gujarat

Gujarat Male Female Combined

RuralUrban-{ll-areasIndin

RuralUrbanAll-areas

t71105| 55

177

113

161

:4389

lJ+

184

t20168

t490

135

l4l88

132

Health Cbre and FamilY Plannirrg

The basic unit of health care and lamily planning delive-ry net-

r*ork in Gujarat, like most other States inlndia, is primary fiealthcentrg assisted by sub cent:es. These PHCs and their sub'centresafe supposed to reach deep into nrral areas with the help of theirpara-medical staff. Tbe Medical Ofhcers remain stationed at thePHCs and pay periodic, visits to the sub-ccntres.

But we were told that health and farnily planning services w:rehandicapped by the shortage of nren and material. The PHCs and'subcentrei were making do with much below their sanctioned

i94

brorrght from Ahmedabad, Surat and Bombav for


strength. According ro the Health Gujarat had ZStPHCs in 250 Blocks with co ruralfamily welfare centresattached to each of them with I rural sub-dbntres. Against

Officers. Block. Extensionsanctioned posts of 251 MedicalOflicers and LHV there were only each working and againstsanctioned 1251 ANMs, there werethe sanctioned posts of 7l Medical

1155. Similarly, against

welfare centreg only 28 appointmenOflicers in 70 urban familyhad been made. Apparently,tres were without a Medicalmany PHCs and family welfare

money bn rural health ser-viceg the shortage ofservices has a perpetual problem Shor-tage of staff and transpon vehicles er adds to the problern.The existing health services in a p ary health centre or a sub-centre are utilised only by people in the adjacent villages. Asl result though va$t resources arecffectiveness in cootainnent of dir

in the rural areas. theirdisability or death i; not

known. Gujarat is still having high t mofialiry (Tables 8.3)and birth rate (Table 8.1) both in and urban areas as com-pared to all-India. These dbficiencihealth care facilities rn the State.

indicate the weakness of the

The family record cards arg no t maintained in the healthcentres, but they are far frum com and not maintained oro-perly. The visits of the health carc family planning personnelro the villages are not also very The importance of bothpreventive and curative aspects of h th facilities do not seem tobe properly organised. Mere tion of camps and idvice ofpanchayat olficials for sterilizati

Officers and other supporting staff.In spite of investing large amount

targets given by the Governrrenl bplannrng .a oeople's programme

Whether ante-natal cases .are pand given proper supplemcnt a

available in the PHCs/Sub-centres.cqntraceptiYe methods are brought

may fullil the prescribedit can not make the family

y identified, examinedd imnfunisation. whether

delivery cases are attended by a ti ed Dai and whether post-not clear from the recordsnatal care was adequately givenis not also knom if all theith:n the easy reach of the

.villagers. Organisation of special ps lor operations and ser-vices of school teachers and panc yat officials are. however,widely publicised Even the names well- known doctors who are

Farnily Planning Thmugh Panc hayats- II: 195

operadonq are advertiS'ed widely in advance.

Triple vaccinations, polio vaccinations and small pox vac-

cinations are, however, reported to be an important function ofchild welfare programme' Health and weight records of childrenare incompldte in many cases. Mal-nutrition of children and

mothers and impoverishments of rural masses are widely pre-

valent After enumeration of eligible couples by actual survey the

various types of contraceptive methods are not made available to.

the villagers. The main emphasis and expenditure on incentives

are given on.tubectomy and vasectomy. Home visits by the ANMsof the children below five years, which are prevalent in other

states, were not enforced.Child.health education for mothers is no! in many cases,

emphasised for proper understanding and participation inchildren s health. Gradually, it becomes evident that malnutritionis widely prevalent and because of impoverishment and ignorance

of rural masses infant mottality is high. Elementary nutritionaleducation imparted by demonstration to mothers in other states

go by default in Gujarat Many deseases prevalent in rural areas ofGujarat are due tc ignorance' The health care and family welfare

staffin fact acted very liesurely toeducate the people for necessary

action. Health education is not given due importance.

Iocal Self.Gov€rnment and Family Planning

Family planning performance in Gujarat picked up since 1'97i

when the health and family planning administration was decen-

tralised and incentive prize scheme was initiated. Under this

arrangement the PHC staff has been placed under the Zilla Pan-

chayal which consequently became the main administrative unilThe State Govemment since then has been performing onlysupervisory and advisory role. The health administration has

reportedly become more efficient as a result of decentralisation.The intentive prize scheme for various layers of the Pancliayati

Raj institutions as rvell as for various officials initiated along withthe decentralisation provided further fillip to the programme. But

after this scheme was terminbted in 1976' the famity planning per-

formance received set-back The performance again picke{ uP

only when the scheme was resumed in 1978. The decision to

resume the incentive prize scheme could also be seen in the lightof the set:back that the family planning programme received in

196 People\ Pa

the aftermath of the emergenry.Before reintroducing the incenti

ment of Gujarat had tb set up fourogramme from the post-1977 set bac

i) creation of favourable publicmitment to family welfareplanning

i0 r'e-vitalising tle family welfareplanning;

ii0

rv)

removal of fear complex fromoflicials and assuring full suplenlisting the co-operation of th

tors from various sections of socipnzes wefe :

District Panchayats, Talukachayats and- all voluntarypublic leaders,

ln lact resumption of the incenristep to realize the aforementioned owere very elaborately planned to mbodies. bureaucratsi. doctors. mo

i) a landless labourer whofamily planning received ahousing plot;an asricultural labourer or a s

of land accepting terminal mhundi of Rs. 50 for ourchase

iir)

ro

a motivator would get Rs. Icharges for a vasectomy andIf all the eligible couples inworkers were covered underwould get a cash award offor labour welfare activities.couples were covered undertory would be entitled to Rs.

v)

vi)

a surseon received Rs. 7 andvasectomy and tubectomya cash awarfl was given tocentres which achieved 10 orulation depending upon the

ii)

in Family planning

prize scheme the Govern-jectives to rejuvenate the pro-

These were :

inion by reassuming com-e; including familyr

e inciuding family

e minds of the Governmbntand

Government Departments,anchayats and Gram Pan-

local bodies as well as

prize scheme was onlv oneectives. The prizes. however,ivate rural and urban localrs as well as potential accep-

Some of the incentive

ed a terminal method ofaward of Rs. 300 for a

former with two hectafesod.was entitled to receive a.

f khadi cloth;and Rs. l0 as motivationalbectomy case respectively;factory with more than 500

methods. the factorv'15,000 which could be used

imilarly. if 75 per cent of theinal methods then the fac-

10,000;

l5 percase as incentives forively;

staff of the PHC and urbansterilisations per 1000 pop-tegory of the districq

Family Planning Through Panchayats- II 197

vii) extra development grant was given to District PanchayaqTaluka Panchayal Nagar Palika and Gram Panchayatwhich achieved the targets and secured the best performan-ce; and

viii) additional incentives of Rs. 20 to sterilisation cases weregiven if the local body agreed to pay Rs. 10 to each Steriliza-tion case.

Prizes were given to a District Panchayat (First piize oniy).three Taluka Panchayats, three Nagar Palikas (Municipalities)and one Corporation (First prize only) on the basis oisierilizationon pelcentage basis. The districts and l\{unicipal Corporationswere divided into the following categories for awarding prize :

A- Sural Bulsar Baroda, Bharuch aud Kheda.B - Ahmedabad, Bhavnagar, Surendra Nagar, Amroii, Rajkol

IVlehsena and Junagadh.C - Banaskanth4 Jarnnagar. Panch Mahal and Kutch.D - Dang and Gandhi Nagar.E - Municipal Corporations.

A first prize of Rs. 1.25 lakha was given to each of the DisrrictPanchayats of all the three categories (into which they weredivided), Rs. i.00 lakh to the best of the four M.unicipal Cor-porations and Rs. 25,000 to the category D of District Panchayatsstanding firsl

First prizes of Rs.30,000 and Rs.25,0UJ were paid to each of theTaluka panchayat of categories A and B and of C and D respec-tively. The categorisation of Panchayats was done on ihe basisof population.

The District Panchayais presented stainless steel utensils andsuch other gifts to acceptors of rerrninal methods of family flan-ning in addition to incentives given to acceptors of:

(i) Vasectomy- Rs. 25 (State Government) * Rs. 70(Government of India) * Rs. l0(Village Panchayat): Rs. 125;

(i1) Tubectorny-Rs. 10 (Stare Government) * Rs 70(Governmenr of India) * Rs. 10(Village Panchayat): Rs. 90.

198 People's farticipation in Famtty Planning

First prizes of Rs 50,000, Rs. 25.p00 ancl Rs. 10,000 were given tocategory I, II and III municipalities respectively for sterilisationoperations. Simitrarly, category I, If and III gram panchayats wciegiven Rs. 15,000, Rs. 10,000 and Rs. 5,000 respectively as fiotprizes.

Foi post partum cases Prografnme Director. Senior MedicalOfficer and Medical Officer-in-c$arge was given Rs 150 each.

Other elaborate systbm of distdbutibn of prizes on the basis ofperformance of terminal method$ of family planning was :

i) 4 Presiderrts of District Pa{chayats got a Tamrapatra ancRs. 200 each;

iDiir)iv)

v)

vi)

vii)

ix)x)

xi)

xii)

Four Deputy Developmenf O{ficers got Rs 200 each;Four Collectors got Rs. 200 each;Five Medical Officers and five additional medical offrcersof municipalities and got Rs. 60 each;Four district mhss media got Rs. 50 each;One Mayor of a Municipai Corporation receivtd a Tapatra and Rs. 200;

ion receivtd a Tamra.

One Mayor of a Municipal Corporation received a Tamra-patra and Rs. 200;18 Pramukha of Taluk Fanchayats received Rs. 175

each;18 Taluk Adhikaries receiVed Rs. 175 each;19 District Mamlatdars (Cfass II Oflicers) andAdminisffative Officers (Class D received Rs. 200 each;Sresth (Best) Medical Offi$er received a Tamrapatra andRs. 175 for doing maximufr number of vasectomy cases;and19 Block Extension Officef's received Rs. 50 each.

The scheme of the Gujarat enL thus. is much moreelaborate than that of Madhva desh. Apart from involvinglocal bodies. both rural and it seeks to involve a wholeranee of individuals and ofhcials providing them incentives. Acareful look at the awards would reveal that it seeks to enthuseinstitutions, individuals andriate kind ofincentive. Local

by providing them appropare alwavs starved of funds. so

there are developrnental funds forsociety have different kinds ofincentives, clothps or cash for

Impoverished sections ofthereforq there arc cashland for them. Officials

Family Planning Through Panchayats- II: 199

require an award to give them a sense of achievemenu so there areTamrapatras and small cash awards for thern A very carefullyworked out sch.eme indeed!

It has created a sense of competition among officialg local '

bodies office bearers and urban and rural local bodies. Prizes areawarded on the basis of sterilization targets achieved by thesebo{ies and officials. The level of enthusiasm has reached a stagewhere local bodies add from their own resources to the incentives(both cash and kind) sanctioned to them for the acceptors by thestate govemment The enthusiasm particularly reached its peakduring the sterilization camps, Sterilization carips which pre-viously used'to be organised only for vasectomy are organised forwomen since Laparoscopic tubal ligation has become common.

But the role of panchayatg particularly Gram Panchayats, ispurely motivational It cannot strictly be said for the Zilla andTaluka Panchayats becausg as mentioned earlier, the PHCs inGujarat have been placed under the administrative control oftheZilla Panchayats. It is little difficult to say what part the bureau-crats play and what part the elected representatives play in thescheme. It wag howeveq pointed out to us that the programme hasstarted looking up since this arrangement.has been introduced

The Gram Panchayatg however, have a very limited role, Theirrole is strictly motivational But they have developed stake even inthis limited task because cash incentives and the prestige ofbeing' a winner are involved They, thereforg actively assist the healthand family planning staff in'motivating young eligible couplesTheir help, we were told, was particularly beneficial in motivatingreluctant sections of rural society. The pdnchayats were, howeveigiven no place in the delivery and distribution network

. Care rs also taken to include school teachers ano prominentpeople of the area in this endeavour. In some places institutionslike Lions Club and Rotary Clubs were also involved The pro-gress achieved with the scheme can be seen.from the progreJs ofthe first quarter of l98l in Tatile 8. 9.

Prevalance of tubectomy comes outclearly from the quarterlyrelort of Guiarat presented in Table 8. 9. Not only the trend butalso the arguments were srmilar to most other areasof the countrv.Complaintsof weakness after sterilization were commoc Interes.tingly, the woglen also expressed these views. Because tubectomvhas become relatively easy and convenrenr since the introductionof laparoscopic tubal ligation, whatever little hesitation existed

People's

TABLE &4: ProgressJanuarv to

in Family Planning

the 4th Quarter1981

Dsticy'Corporation

noN

2,354r,4ffi3,0271,t463,3542,6364,5902,305

39-.I,8234A6l4.857l,7l l1 497

44232,9333,4211,2982,J871,426

1.9.p. Condoms

Vasco-

tomyTubec- Totaltomy

,724Ahmedabad CorpnAhmedabad DistAmroliBanaskanthaVadodera CorpnVadodera DistBhavnagarBharuchBulsarDangsGandhinagarJamnagarJunagadhKhedaKutchhMehsanaPanch MahalRajkotSabar KanthaSurat CorpnSurat DistSurendra Nag4r

9t7215

731839965ll282

1,783

786ts7g29

3801,879

44n8

1l(1

282253509

1,286

63

2,641 2,001

2,569 4951,533 313

3,210 3932,142 513

3,865 489

2,918 693

6,373 267

3,091 148

161 4463 169

r,852 4854,841 7686,736 t,3t9t,'755 2023,7'10 6895,674 180

3.2t5 6633,674 6141,807 281-3,673 s1389 393

269,759224,785t27,380r70,223

48,670r42,390t56,273:13s,661

148J489,108

44,935t36,614168,128

526,617

88,047154,03289,092

249,89926r,6213r,254

122,766164,860

Gujarat 1) 'r71 496 70.71'7 11,389 508,664

Source: Directorate of H th and Family PlanningGovernment of Gu

about it has disappeared. Laparopopular in Gujaral

People's Participation

Like the family planning prrthe programme in Gljarat also

camDs nave become ver v

e elsewhere in the countrv.basically a target oriented

Family Planning Through Panchayats-Il: 201

governmental programme. While the idea ol elaborate lncentiveprizes is novel and it has created some enthusiasr4 it is not likelyto create a suStaihed participation over time. It is quite evidentfrom the fact that when the incentive Drize scheme was discon-tinued in 1976, a slump was noriced in the achievemenl Conse-quently it had to be resumed in 1978.

'It is true that the government has decentralised the administra-tion and madethe district the main administrative uniL This has,as admitted by the government ofhcials, resulted in administrativeeffciency. But it is not likely to mobilise effective participation asin spite of the elected bodies at the district and taluka levels, thebureaucrats headed by the District Development Officer(and theTaluka Development Olncer in talukas) have the effective say inrunning the administration. Moreover, the fact that the GramPanchayats have not been entrusted with any responsibility otherthan motivating people, speaks volumes about the pisconceivedconceptions of participation prevailing in the governmental andadministrative circles. It has not yet resulted in participation infamily planning

But this is not to say that people are hostile to family planningor are not prepared to be motivated. Awareness of family planninggoals and methods existed. This has softened iesistance of thevarious sections ofsociety, though larger family needs or religiousbeliefs still create apathy, Fishermen, for example, were apatheticbecause large number of children were an asset to the family asthey helped in fishing and augmented family income. Apathy was'also noticed among Muslims.

The Community Health Vdlunteer(CHV) scheme proposed bythe Government of lndia in 1977 was accepted and introduced inGujarat in 1979 with the hope that it would re$ult in communityinvolvement. lt has also had very limited success. In fac! it waspbinted out to us that most of the CHVs were not serious-about:theirwork Whatever impact it might have had on the health caredelivery its impact on family planning specihlly in crearing popu-lar participation has been marginal if any.

Gujarat has the advantage of active,Mahila Mandals and co-'operatives. These, it seemed, have not been harnessed properly tocreate a favourable atmosphere for family planning or any otherdevelopmental programme. One of the Mahila Mandals visited,bythe rdsearch team in Bulsar district was affiliated to the All-lndiatSocia'l

'Weliare Board. {r arranged for vocational training for

202

the gram sevah tpacher and oth knowledgeable persons while

in Family Planning

women. Its involvement in t.amilv prografifin€, for exam-.plg could really be useful. ButSimilarly, youth clubs in villages

.has not really been involvedeither culturalclubs or lying

idle. Milk ce.opefatives are many their involvement in a pro-rgramme like family planning is only in Kheda district

how long a scheme based:s interest. Whether an

approach based on targets . by the government wouldmobilise people's participationremains an important question.

consceintize people also

It woul4 thus, be interesting toon incentive prizes would hold

A SAMPLE SBULSAR D

random sampling at the first sta;performance villdges. A random

Similarly, two villages (i) Kosapopulation of7776 PeoPle and 1147

Afipo.e in Chikhli block havingthe reproductive dge.group of wh:

\rEY INTRICT

Sample villages

a sample survey was in villages of Balsar districtThe district of Bulsar was purposively at the instance of'the Department of Health and F Welfarg Governmont ofGujarat It is in South Gujarat ranks high in family planning

Rabra in luls61 block havingperformance. As trsual, villages (i685 people and 303 eligible coup in the reproductive age.group

cent) were protected and (ii)people and 500 couples in the

of wh-ich 165 couples (about 55 pr

Hondin Chikhli block havine373reproductive age group of which couples (more than 70 percent) were protected by family ins methods were selected on

as the representative of goodle of eighf acceptors and

four non-acceptors of familystage of sampling

in Bulsar block having a

couples in the reproductive agegioup ofwnom 396 (34 per cent) les were protected and (ii)

people and 807 couples in283 (35 percent) couples were

effectively protedted as tives of poor performancevillages Four random sampleacceptor respondents were se

respondents and two non-at the s€cond stage of selec-

tion. The village schedules were up through the assistance of

was selected at the second

Family Planning Thrcugh Panchayats-Il 203

the respondents schedules were tilled up by interviewing theacceptors and non-acceptors of family planning The BlockExtension Officer helped the research team in interpreting thelocal Gujarati dialeet into Hindustani and English.

TABLE 8.5: Demogrqphic Pro{ile of Sample Villages

VillagesDemographicPrortk Alipore Kosamba

Total PopulationHindusMuslimsScheduled CastesScheduled Tribe'MaleFemaleCouples inReproductiveAge.groupCouples effectivelyprotected

1,68sr,675

l01,400

48382,6712,167

802,5912,6182220

807

1 777

7,7'.r'l

100

3,9;3,8391,t47

J,/Jl3,731

68t,7282,1@1,622

500

820865303

163 366 283 396(54) (73) (35) (34)

Note: Figures in parantheses indicate percentag€s.

There were elected bodies like Taluka Panchayats which wereactive and all the four selected villages had active village pan-.chayats assisting the thmily planning programme. Panchayatelections were held in 1980 in 1980. Congress(I) andJanata Partiesbecame very active during the elections, but none of the partieshad any perm:inent office in the selected villages, A MazdoorKalyan Kendra in Alipore was doing some social welfare workamong the Harijans in the village. Milk cooperatives operated informally without being registered.under the Cooperative Act Theinstitutions other than Panchayats were not called open for assis-tance in family planning work

The villages, Rabra and Alipore had allopathic despensariestreating the sick villagers. Difficult cases were referred to the PHCwhich was within a distance of 5 kilomefers an{ tothe district hos-pital which was 16-20 kilometers away. Out of l8 PHCs in Bulsar

2U

,district, Charidity PHC wasHond. The PHCs had all thewere sterilised in FHCs and convasectomy operations werePeople of Alipore village madewas l/2 kilometor away andBulsar PHC which was 4 kilo

The MPW visited Rabra twice ain the village. The CHVs wereand CHV, ANM and MPW delilfwo ANMS and one MPW reriAlipore where one CHV residedresided in the big village ofservices there. The MPW visitedvillage panchayats were veryfamily planning' Screening of filrps on lamilyorganised, but no posters w.ere

and family planning camps weplanning camp was being held invisited the village in September,reported to be thin as housing plcamp. Follow- up services forfrom the respondents in all thethe people.

The Panchaydt Department olcoeducational school with 173

schools in Hond. one with 130

There was one primary co-edustudents and a co.educationaladdition Alipore had awith 250 students; Kosamba was agovernment middle school also.

schools numbereil I l4O girls andeducation. the students madeschools in neighbouring villagesticipation in education wasarea.

Etectoral participation of the 1

and as many as 55 to 7O per cenvoted in the last panchayat electi<


4 kilometers of Rabra andof family planning Women

ives were distributed whilein family planning camps..

of a PHC at Billimona whichof Kosumba made use of

away.onth while two CHVs resided

rted to visit Hond twice a weeke family planning services.

tamily planning services inMPW and five CHVs who

ba rendbred family planningvillage twice a month. Thein assistine motivation for

and mass meetings wereted. Small group meetings

held in the villages. A familyioore when the research team

1981. But the attendance waswere not distributed during thelical operati6ns were reported

villages wtrere availed by

ujarat maintained a primaryin Rabra two primary

and another with 101 girls.al school in Alipore with 150

school in Kosamba . lnmiddle co-educational school

village and had. therefore, astudents enrolled in Kosamba

080 girls. Beyond middle stageof .public buses to !o to highd to a collese in Bulsar. Par-common and active in the

le in the area was also highper:ple in the selected villages

while 50 to 60 oer cent voters

Familv Planning Througlt Panchayats- II:

voted in the fast State Aosembly elections and 50-55 per cent voterswere reported to have voted for the last Lok Sabha. election.

Sample Respondents

Both the categories ofresporidents in Bulsar diitrict ofGuiaiatwere also selected on random ba$is. We had difficulties similar toother sample dreas in strictly adlering to the norms set by us.

lmprovisation is, thus, clearly visible inbur sample. We have stilltried our best to ensure that 'he representative character of thesample is not losl

The respondents fell into nine ofthe eleven slabs we created forassessing income. In spite of the difnculties faced in incomeassessment due to varied nature of the occupations andjobs ofthe5espondents, we have managed a representative sample. Persons

lvith low income dominated the sample; 60 per cent'bf the accep-

tors and half of the non-acceptors falling in this category. Middletncome group constituted 28 per cent of the acceptors and 17 per

cent of the non-acceptors. Rest in both tn'e.categories belonged tothe high income group (See Table 86)'

Ale-wrse we got relatively' young sample. The acceptorsbelohged to 15-39 groun while the non-acceptors were concen-

TABLE 8.6: Econoniic Status of the Respondents

Acceptors Non-AcceptorsIncome (Rs)

Number Percmtage Number Percentage

205

00m-10001000-20003001-40004001-s0005000-60007001-80008001-9000

,9001-1000010000 +

,|

4J

IJ

J

31

t7t24

t725

t7

i,

23

:

2III

t2l2444

Total 24 100 t2 100

2W

l5-19'2U24

25-29,30-34

l5-39

trated in 2G34 group (seeTablo 8.iboth acceptors (38 per cent) and nrp5-29 group. This is the most crui'of family. planning

, We.could not get people abovelllliterarcs formed 416 per cent of the

Number

in Family Planning

The largest concentratiqq olacceptors (50 per cent) was ingroup from the point of vier+

for our sample

of the Respondents

Non-Acceptors

Number Percmtage

People's

and a qudrter ofthtnon-acceptors. The largest of the non-acceptors (4!per cent) was among middle educated (See Table 8.8)

TABLE 8.7:Age.group Respondenfs

Acceptors Non-AcceptorsAgegvup(Ymrc) Number Percentage

2+95

4

t2

8

l63E

22l6

100

2550

25

100

J

6J

25)5a

8

100

3

3

5

I

12

628

13

l3

100

24

EducationalStandard

Acceptars

Nwmber

IlliteratePiimaryMiddleMatric

Total

While we could maintain l:lthe non-acceptors, we could not dotors were overwhdlininelv females

' of male and female amonefor the acceptors, The accep-

ll7

J

J

24

See Table E.9).

Family Planning Thlough Panchayats- II: 207

TABLE 8.9: Sex-wise Distribution of the Respondents

Sex Acceptor Percmtage Non-Abceptor Percentage

MaleFemale

222

5050

66

8

92

Total .A t2100 100,


Our respondents from Bulsar district did not show veryhigb

participatory attitude. Overall difference between the two cate'

gories oftherespondents was also not much. The average score forihe acceptors was 42, while for the non'acceptors it was 39 (See

Table 8.10), lt shows that while there is some difference in the par'''.ticipatory

attitudes of the acceptors and non'acceptors, it was not

very signi{icanl But before we rush to conclude that participation

dois n-t play any, or plays only marginal, role in the acceptance offamily planning we must not forget that while 50 per cent of the

non-icceptors in our sample were males, only eight per cent of the

notr-a"ceptots were male. And, our experience has shown that

women tinded to reply many questions on participation in the

negative for obvious reasons.-Eu.n

to, if we look at individual items in participatory' ques-

tions we find that the acceptors have exceeded the scores ofnon-'acceptors in 15 out of25 itemg the non'acceptors have exceeded inthe iest Both the categories of respondents demonstrated high'degree of politrcal partrcipatron- cent per cenr of the acceptols ano

92 per cent of the non-acceptors having voted in the last

elections.

On lurther analysis we find that in questions related with family

planning-4(33, zi), s(zs, q, t (s0, 25), 8(29, s), 1 3(17' 25), l4(l 7' I 3)

and.24(79,69) - the acceptors have a clear lead over the non-acceptors on all but one question. Thus, considering all aspects we

can say that the acceptors in our sample, eventhough over'whelmingiy females, have demonstrated bettcr participaSors

attitude in family planning This highlights the role of participa-tion in family planning

Two-thirds ofboth the acceptors and non-acceptors wanted thel

208

rlsr.b 8.ro:

People's

Panic ip a tor! Ques tio n s

l. If there is shortage of essencommodities (kerosene, sugarfertilizers etc) in your village,would you make efforts tothese commodities available

2. If there is shortage ofwater in your villagg would u

,le?make efforts to make it av

3. If the neighbouring villagea school which your villagenot hirvg would you makeget one opendd in your

in Family Planning

of the Respondents in

Percmtage of respon-dents affirmingthe questions


4. If a family planning camp isheld in a neighbouring villaX

25

25

25

25

4

25

JJ

29

29

50

5.

7.

,8.

9.

would you go\there?Would you alpo, make effortsone such camp held in yourIf a lilm is being shown in th

getaEei!

neighbouring village, would ydu gothere to see the lilm?urefe ro see tne lrlm?If a film is being shown in thelneighbouring village on famil$plu"Ing would you go there?Would you make efforts to set thefilm screened in your villagi?If your village does not have a healthcentre/dispensary would you r{rakeefforts^to get one opened in yoprvillage?

--t--

421

Family Ptanning Through Panchayats- II: 209

Participaory Questions

Percentage ofRespondents Affirming

Questions

' Acceotors Non'Acceptors

10. If the gov€rnment decides to'operi a 83 8

health centne/sgb-centre/dispensarywith help of people in the village,

, would you help?ll. Would you like to join in organising 38 58

hedlth services to your village?12. Would you be willing to pay for 38 - 33

health services?

[3. If a family planning centre is being l7 25opened in the neighbouring village,would you go' there?

[4, Would you also make efforts to get a l7 13

fainily planning centre/sub-cenrreopened in your village?

[5. If a nationaVlocal leader is delivering 50 75

a speech in your village, would youattend thaP

16. If such political meeting is being 25 67held in the neighbouring villageswould you anend thail

17, Would you like to compaign for a 13 33pafiyl candidate rn ei?ction?

18. Did you compaigrr for any parry/ 4 33

candidate iu the last election?

19. Did you vote in thi last election for 100 92(a) Panchayat, (b) State Assembly(c) lok Sabha?

20. If the local leaders organise 42 33

deinonstration on rising prices ornon-availability of certaincommodities, would you participatein i0

21. If the VLW/YHW is not visiting your 50 58

Peopte's

Panicipatory Questions

villagg woul<l you makethe concerned officiat?

22. lf you are requested toyour serrices to thevoluntary agedcy to take theservices to the peoplq wouldvolunteer yoursell?

If the school teacher is yourrequests you to persuade persend their children to schoolyou help him?

24. If rhe VLWVHW requestshelp him in oorsuadingindpeople lor abbepilng family, vyou help him?

25. If 'Keer'ran'an<l Ram Lila' isorganised in your villaggattend that?

Average

Type of Help

MonetaryPhysicalBothDon't know

in lamily Planning

Percentage olRespondmts Afinhing

Question

Accepton Non-Accepton

Ct63

/)54

@79

TABLE 8.11: Help Health Services

75

39

7l

42

33t733t7

4242

l0 42625833

Non-Acceptor Percennge

Total 100 t2 100

Family Planning Through Panchaya*-Il: 2llgfovernment to pay lbr health services, while one-thirfl were infavour of people paying for it Not many favoured the health ser'vices being run by a private agency or a cooperative. But most ofthe respondents were prepared to render some kind of help orother in running health services (see Table 8.11). Only two non-acceptors did not have any clear idea.

Motivaiion

The acceptors in this area were motivationally stronger thanthe non-acceptors. In spite of thb fact that most of the acceptors inthe sample were females, the acceptors' overall score (59) is muchhigher than that of non-acceptors (40). The acceptors also lead initemwise analysis. The non-acceptors equal the acceptors orr oneitem3. The last question (6) also establishes that the acceptors hadbetter motivation than the non-acceptors. While only 71 percentacceptors adopted family planning on advice, in spiteof advicdT5per cent non-acceptors did not adopt family planning

TABLE 8.12: Motivation of the Respondents inBulsar District

Questions on Motivation

Percentage ofrespondents affirming

the questions

Acceptors Non-Atceptors

50

JJ

25

7l

75

25

1.

3.

Have you ever been to a familYolannine centre?hun" uol, ever used the facilitiesprovided by the familY Planningcentre?Did you ever consult the medicalofficer in the dispensary/healthcentre/sub-centre and seek advice

on family planning?Did you ever take Your friends/relatives to the familY Planningcentre and persuade them to accept

family planning methodt

7l 42

Questions

Did you ever take yourfamily planning centre?Has any one ever advisedadopt family planning

Average

in Family Planning

Perxmtage ofRespondents Aflirming

Questions

Accepnn Non-

_ Accepton

Remari;s

Two sorrs are essential

In case something happe s to one, at least onewill survive.Two sons are essential.

Two sons are essential.


There is no daughterin family.l'wo sons are essential,

A son is mirsl

38

7l

l7

75

459

SI No. of lfualNo. Children Familv

1. 1F

2. l4lM2M, lF Wants

more2M, lF Wants

nsIne

more

3. 3F,

4. lF,

5. 2F,

6. 4M

7. 2F,

8. 2F

2M,2F

2M, IF

2M,2F

2M,IF

iw,zr

2il4 rr

2ivl, I F

WantsmoreWantsmoreWantsmoreWantsdaWantsmoreWantsleastsonHusinMa,ast

IM

IM

IM

IM

9. 2p, tv

Familj; Planning Through Panchayats- II 2t3

lb. lR lM

ll. 1F,2M

12. lF,lM

Wants onemore sonHusband isnot keepinggood healthWantsanother son

sons are essential.2M, lF,

2M, IF

2M,IF

Two


Aside from participation and motivation, the non-acceptorsdid not adopt family planning due to socio'psychological reasons

as well. As indicated by Table 8.13 most of the non-acceptors were

favour of two sons. The argument was that the family needed twosons to look after it and in case of unnatural death atieast one'ionwill survive. Only one acceptors did not accept family planningbecause he want6d a daughter. So, it is not,only preference for sons

but desire for two sons that prevented people from acceptingfamily planning

Sample Survey in Kheda District

Sample Villages

A sample survey of.accepto:: and non-acceptors of family plan-ning was conducted in villages of Kheda district As usual villagesin the district were put into two groups one group with good perfor-maice records and another wiitr poor peribrmani6 records. thedistrict Kheda was suggested for study by the officials of theGovernment of Gujarat and wag thereforq purposively selec-ted.

Villages 1i) Harkhapura in Borsad Taluka having population 6I''1593 and 301 couplesin the reproductive age-group of which 273cbuples (90 per cent) were protected and (ii) piplag in NadiadTaluka having population of 3381 and 650 couples in the reproductive age group of which 488 couples (75 per cent) were effec-tively protected, were randomly selected at the first stage asrepresentatives of good performance villages. Villages (i)

'214 People's

Bhadarenia in Borsad Talukathe reproductive age-group of

1,593

1,593

65't70

823301

273(e0)

in Family Planning

1984 people and442 couples inh 203 couples (45 per cent) were

protected and (ii) hathaj in N Taluka having population of3208 and76l cbuples in thecouples (42 per cent). were

lve age-group ofwhich 303were selected randomly as

representative of poor perform villages (See Table 8.14).

TABLE E.14: Profile

ILLAGESDemographicProf.le Piplag Bhadrenia Hathul

Total Popu-lationHinduMuslimS. CasteMaleFemaleCouples inreproductiveage groupCouples effect-ively protected

,NOTE: Figures in parantheses percentage.

The second stbge of random as usual. consisted ofselecting 8 acceptors each and 4 acceptors each in the twogood performance villages and acceptors each and 2 non-acceptors each in poor perlr villages.

Panchayats were the only e e institutions in selectedvillages. Village panchayat electi were held in-1980. So alsoTaluk:i panchayets had theirbecame politicalfy very active

At that time the peoDleparticipated in the electibns.

Janata Party and Cpn-ofseats in panchayat eled-

tions. Zilla parishad was also at that time. All the phrtiesopened their temporary officesthe election.

Parties in the fiel$ were Janat4 Bgress (I) and the llrst party won ma

3,381

3,3305l

2N1,661

t,520650

488(75)

1,984 320

1,980 1,608'4 1,600

250 25987 1,680

99'7 1,528

42 761

'\. 203 303(46) (40)

the selected villages beforc

Family Planning Thtough Panchayats- II:

The Yuvak Mandal" a voluntary organisation in Harkhapurahad its main function of conducting a mid-day meal programmefor students in the village schools. In Piplag Mahila Mandal, a

ivoluntary women's organisation did some welfare activitiesamong wome[ The Yuvak Mandal here also was arranging somesocioeconomic and cultural programme. In Bhadrenia Mahila.Mandal organised a Balwadi for babies of working women while'the Yuvak Mandal organised some cultural programme. In

'Hathaj also the Mahila Mandal organised a Balwadi and theYuvak Mandal arranged some cultural programmes. But therewere no other social welfare organisations which were very actiiein the village. No adult education centre was notiqed in the selec-ted villages. Milk cooperativeg however, were there in almost.every village and were supplying milk to Anand Cooperative MilkSociety whose vans came everyday and collected milk from thevillages centres. None of these institutions were involved in familyplanning work. None of the selected villages other than Hathaj which had anallopathic dispensary facility of a government hospital/dispen-sary/health centre of their own. The villagers made use of thehealth centres in adjacent villages for minor ailments. People inHarkhapura were served by Davol PHC and Piplag people by theDrstnct Panchayat PHC nearby. In case of chronic or difficult dis-eases people had to go over 12 kilometers from Harkhapura to,Borsad, l6 kilometers from Piplag to Borsad. For villagers of othertwo villages it required travel oflO- 13 kilometers to reach a districthospital. For using a health and family planning centre peoplehad to travel upto 10 kilometers. Motivation in family planningwas done in the villages both by government agencies like theblock stalf and the panchayats. One CHV each resided in the'villages Harkhapura, Piplag Bhadrenia and Hathaj and a MPWvisited the villages twice a week One ANM, in ldditioq worked inPiplag villages. In other villages ANMs came as and whenrequired.

Mass meetings were held in Harkhapura two months before thevilit of the research team as an instrument of motivation for familv,planning camp in the villagc. Follow-up services were usually pro-vided in the village after operations for any possible compli-cations.

All the four selected villages had coeducational primaryschools maintained by the Panchayat DepartmenL Piplag had, in

215

2t6 People's in Family Planning

addition" a middle school by.the Education Depart-iment of the government of t The primary school in,Hatkhapura had 129 boys and 77 and there were provisions

schools in other villages.seats for bovs and 180 seats

for girls The students' strength the time of the visit of thercsearch team in tlathaj village school was 189 boys and53 girls

,of 150 boys and 100 girls in the pThe middle ichool in Piplag had

The respondents fell in eight of the eleven income slabs wecreated for the pufposes of assessmbnt We could not get people ofvery high income category in our spmple. As in other rural areas,

diffrculties in assdssment of iscomb were faced here as well Overeighty percent of the acceptors and two-thirds of the non'accplrtors belonged to low-incomb group. Eight percent of theacceptors and a quarter of the nonl-acceptors belonged to middleinqpme group. The rest in toth the categories belonged to highincome group (see Table 8.15).

TABLE 8.15: Economic ot'the Respondents

Non-Accepton Percennge

0000.'1000r00l-20002001-30003001-4{n04001-5{n05ml-60m7001-8{n0

'8(n1-9m0

33

l7l7

t7.88

422

2

I{

2l62l4

4

4

100

5

1t)I

.l

Total

Agewise our respondents in Kheda district were distributed bet-ween l5'to44 yearc Half of the acceftors and over4O perc6-nt of the

Sample Respon{ents

Random selection of responderlts was done in Kheda as wellttt^ .-.^-- ^Ll- 1^ ^-+ ^ --^-^- -Ll- -^-^l- :- --:+- ^f -^"^:r.' ^l

Famity Ptanning Through Panchayats-Il: 2r7

non-acceptoru beloqged tp the crucial2&29 age-group, while one.'

,third of both were in 3(F3{.age.group. Hencg a majority bf both:!ugg.in crucial age grouo (see.Table 8.16).,

"fABLE 8.16: Agegroup compoTitrorr oT-the Respondents

Age goup Acceptors Percentage Non-acaeptorc Percentage

IT't<

33,)(

2

4

42l2933

l3

I)783

l5-1920-2425.2930-344544

Total ' 100 t2 {00

Educationally our sample was very well distributed Seventeenpercentofboth categories ofrespondents were illiterate whilb tiilo-thirds- of the acceptors and halfofthe non-acceptors had receivedprimary or middle school educatiorl A quarter of the non-:acceptors and 13 percent of the acceptors were matriculatec while8 percerit each were graduates (see Table g.l7).

TABLE 8.17: Educational l-evel ofRespondents

Standads '.4cceptorsNon-

re rcm IAge Accepprs, Fercen tage

IlliterbtePrimaryMiddleMatric/H SecGiaduate & above

4ll4J

2

t745t7.l38

t7JJt725

8

242J

I

Total 12100 l0c

We could not maintain l:l ratio of males and femalet in our.sample Somehow females were reluctant to come fotwards andreply to o_ur questions in this area There-forg both the sampleswere tilteal rn favour of males- nro thircis of tlie acceptors anO tliree

218 in Family Planning'

the acceptors. The average scores

should not be surPrising because

forefront of the white revolution

fourths of the nofl-acceptors were (see Table 8:18),

-TABf,E8.1E: Sexwise of the ResPondents

Sex Acceptor

MaloFemale

Total


The respondents of both 'tle

showed high par-

ticipatory aftitude. The non- showed marginal lead overtwo was 66 and 67. This

d district has been in thenot only in Gujarat

but in thewhole country. The diffi of one can be exPlairred in

terms 6f marginal differences in of the respondents.

Let us look at the questiors'retating to famrly planning (see

Table 8.19). In the seven questions felating to family planning the

;;-tT"; ;;,;.t utttrtiott-u..ef tois wCre ;tt 1611eu/5-47q5$'

siit. on,rcq,o?), atso. 42)' l3(331 50). 14(33. s0)' 24(83' 83)' on

iftr.L i,.nrtirt. accgptors have lead. and on another three the non-

;;;;il';;;; t ud sotn have equalled the score on one' so' the

;;;;;t t* even here as well ApParentlY' some- other factors

;;;;;;;;*-"cceptors in Kheda districL where otherwise people

i;;;il;ilp"rticlpatiue we shall look into the socio psvchologi-

.ui iu.io.t fut.r to determine the factors behind non-acceptors

rnspite of high participatory attitude'

Most of the respondentswece in ravour ol the governmen. pay-ing for the health and family plafrning seivices. However, theywere not averse to helping the gpvernment or its agencies inorganising health services. Except two acceptors, who were notprepared to provide any kind ofhelp, rnost ofrhe respondents wereprepared to gwe phystcal, monetdry or both kinds of help (see

Table 8.20).

168

7525

10012

67JJ

10024

Family Plandng Through Panchavax-Il: 219

TABLE 8.19: Participatory Anitudes qfthe Respondents

Participatory Questions

PercEntage ofRespondents Afiirming

Quations

Accepnrc Non-.Acceptors

1. If there is shortage of essential 79 67commoditigs (Keroseng sugar,fertilizeri etc) in your villagq wouldyou make efforts to make thesecommodities available in yourvillage?

2. If there is shodage of drinking water 79 67in your village, would you makeefforts to makb it available?

3. Ifthe neighbouring village has a 75 50school which your village does nothavg would you make efforts to getone opened in your village?

4. If a family planning camp is being 79 58

held in neighbouring villagg wouldyou go there?

5. Would you also make efforts to get 71 67

one such camp held in your village?6. If a film is being shown in the 63 58

neighbouring villagg would you go. there to see the film?

7. If the film being shown in the 54 6'1

neighbouring village is on familyplanning would you go there?

8. Would you make efforts to get the. 50 A.. film screened in your village?

9. If your village does not have a health 42 50centre/dispensary would you makeelibrts to get one opened in yourvillage/

10. If the government decides to open a 96 67

ll.

12.

13.

l4

15.

16.

17.

People's

Panicipatory Que*ions

- health Cdntre/S"b-"*t.r/with help of people in thewould you help?

Would you be willing to pay

in Family Planning

Percentage olRespondmts Affirming

Questions

Acceptorc NonAcceptoN

33

;"JJ

6'1

IL

42

ta

92

54

health services?If a family planning centre is lieingopened in the neighbouring viflagqwould you go there?Would you also make efforts td getone family planning centre/sub-centre/opened' in your village?If a nationaVlocal leader is delliverinea speech in your village, would] youattend.that?If such political meeting is bei4gheld in the neighbouring villagp,would you attend thafWould you like to campaign Ilr aparty/candidate in election?

67

83

50

50

83

83

58

t)

IJ

100

58

a54

96 92

Family Planninz Through Panchayats- II:

Panicipatory Questions

221

Percdntage ofRespondents Afirming

Questions

Accepton Non'AccePtors

ra*tat, to the governnGnvvoluntar'agency to take the health services to

the peoPle would You volunteer

voursell?23. if the school teacher in your village

requests you to persuade people to -

r"nd th.i. children to school" would

you help him?24. If the VLWVHW requests You

to help in persuading and motivatingpeopli for accepting family planningwould You helP him?

25. lf 'Keedan' and 'Ram Leela' is

organised in your villagg would you

attend that?

83

83

79

83

7586

6766Average

TABLE 8.20:

Nature oflelPNumber

Help for Htialth Service

Percentage Nunfter Percentage

MonetaryPhysicalBoth monetaryand physicalNone

JJ

2929

8

7

7

45

25JJ

42

Total 100l21001A

Motivation

A look at the figures relating to mofivation reveals that the lackr

bfmotivationisonereasonwhysomepeopledidnotacceptfamily

in Family Planningplanning il this aiea. The averag€ motivation score for acceprorscame to 71, while for the non- it was only 33 (see Table

,8.21). While 96 per cent were advised to adopt familvplannin!, only 75 per cent non-acq(

TAELE'8-JI:M-otivationoFtdmpriitespondi:ntCrnKheda District

Percentage ofRespondents ffirming

the QuestionsQuestions

Acceptors

l. Have you ever been to aplanning centre?

2. Have you ever used theprovided by the family pcentre?

3. Did you ever consult theoflicer in the dispensarycentre//sub-centre and seekon family planning?Did you ever take friends/relalivesto the family planning centF dndpersuade them to accept familyplanning methods?Did you ever take your spouse to thefamily planning centre?Has anyone ever advised you tlo adoptfamily planning?

t7

8

I77l

33

96

5.

6.

75

,75

This is indicativc of some slacklress on the part of the para-.medical staff who work as motivators.

Participatiorr" Motivation and F{mily Planning

I High participatory attitude arid relatively low motivationexplain to some extent why some people did not adopt familyplanning This gives rise to the qufstion as to why motivation is

Family Piantning Thuoush panchayats- II:TASI-E ti.22: Views of the Non-Acceptors

SL No. of ldeal Reasons for RemarksNo. Children family Non-

size Acceptance

l. 2F lM, lF Waitiiig for A son is essentiala son

2. 3M..2F 2-3 does not Husband not pre-Children keep well pared for vaiec-

tomy.3. llvl 3F - do - Family wants I have to bear one

one more sort. more child for myfamily.

4. 1 M l lvl. lF Wants a daughter5 lJ.' 2lvi, I F Warits a-son, - ,

6. 2 M 2 None t6 look Wints no moreafter the children childrenif she is sterilizedand husband notprepared for steri-

7. rrvr. lF 3. lfiltort,,. lno,"child

8. rrvr,lF 2 3Jffi:Xj:

9. lF 2M, lF Wants at least A son is a must.. one son.

10. lM lI\4 lF Wants onemore child.

11. 2lvt. lF 2lvt, lF Scared ofsterilization

12. 2M, lF 3'or 4 Wife does notkeep well.

;the responses of the non-acceptors to understand this pheno-

menon (see Table 8.22).

Seven of the twelve respondents in this category were waitingfqt a e,hild. most of them for a sgn. Three of them had onlv Qne

223


daughter. There is one interesting where the respondents had

stenlization or were not going f6r on health grounos Preferencefor a male progeny was quite t in this area which kept many,from accepting family planning

Oveiview

a son and three daughters andfamily wanted one more son

ted to get sterilized but hert rest were either scarid of

l notwere

a[tnot

h any importance to localy local associations, and

ih this programme either for

The involvement of the panchayati raj bodies had had itssalutary effect cin the family planni[rg programme in Gujarat,theprize-money offered by the govergment to the various layers ofpanchayati ryj bodies and officeis and oflice-bearers of thesebodies had motivated many of the{n to achievebetter results. Not,only the lure of money but the prestige ofhaving been rewarded iswhat motivates. The fact that the hihievement of target p!um-:{n-e!gAl o,n1e1hG scheme was discoptinued s_[6wa *tiutin.qfuio.do to achieve bbtter resglts in. suclr a programme.

But no piogramme could be 'srlccessful if men and materialwere in shirrt supply. And, we havepoinlbdout earlierthat this wasone of the biggest handicaps tha ptogamrne in Gujarat sufferedfrom. A number of posts remained kac'ang as a result manv pHCs,were without a Medical Officerand other paramedical stafi. Therewere not sufficient vehicles to approach far flung vjllages. And,finally, contraceptives ivere also id 3hort supply. .

In Gujara!likeln Madhya Pradfshu gram panchayats were notbrought into the delivery net wofk They were assigried orilymotivational role. Thus while the panchayats enjoyed even this;rolq they could not do anything wh$n cohtraceptives were in shortsupply. If panchayats are actively lnvolved this deficiency couldlbe removed and the panchayatg could be made more res-ponsible.

The programme in Gujarat had another similarity with I

Madhya. Pradesh.associations. First

did,r€wnot

It. dithere

few that existed were This completely ruled outpossibility of the government or encouraging such,institutions. Even the milkactive in Gujara( were not

which are so strong andl

motivation or delivery purposes.

Family Planning Through Panchayats- II:

Finally, in spitd of lnvolvement of locai bodies through the

, incentive scheme the programme remains largely bureaucraticand officious in nature, with emphasis on target-achievement Asmaintained edrlier in this study, while target is a necessary evil inthis programme; unless a feeling of volition is created through theuse of local' associationg it would not acquire a popular charactetand popular participaion on a large-scale would be difficult toenlist

CHAPTER D(Family Planning andPeople's Participation

studie4 set out to seek

P,snTrcrPAno'N, as is wirtrIy is a process dependentupon people's assessment ot its i and interesi to thernThe level3 of people's vary from person to person,aitivity td activiry place to place from time to time. Mostdemocracies are predicated u people's participation,even

for people to participate maythough in practice theand indeed do vary.

As a democratic polity India is to people's participa-tion in development programme a$ much as in the political process. In a programme like'famili, planning the oflicial pro'nouncements have repeatedly the voluntary character of

The starting point ofthe present ofeach of the case

ltudies in our sample was the that a programme likefamily planning where the of volition played .a crucial.rolg was not likely to be effei implemented without a large

Each of the organisationsparticipation ard devised

amount of popular involvement

Strategies according to their understanding and made

the programme. Yet as a recent stu{y points out, the family plan-ning programme in India is not onl$ a central programme but alsoa highly bentralised one (Pai Panafidiker et al1983:207). Fven spseveral efforts in the country'both ht the voluntary and the Statelevels have sought to base family fllanning activities on peoplelsparticipation as revealed in the sid case studies reported here

Enlisting Participation in Familf Planning

adjustments as thgy went along ey achieved ihried degrees of

Family Planning and People's Participation 227

success. But their experiences put together are rich enough toevolve a generalized approach for seeking popular participation

not only in family planning but also in health, nutrition ands.everal other developmental schemes.

The experience of the New Delhi Family Planning Associationis important because it provides an insight into participatory andfamily planning behaviour of lower and lower middle class urbanand rurban population. The NDFPA divided its strategy inton-iicro and macro approaches. At the micro level the accent was onmaking personal contacts and involving small groups whereas atmacro fevel on involving larger community. The programme tookoff effectively once the NDFPA decided to integrate health care.

nutrition and socioeccnomic programmes with that of lamily'planning. The creation of .Pariwar Pragati Mandals and consequen'tly conscientization of women created lasting participatory base

for the population control programme of the NDFPd There weretwo crucial e.ements in its strategy. First, its attempt to assess andmeet the unment needs of people and, second, to gradually goabout propagating and popularising the programme, learning inthe process about people's difficulties and objections and bringingsuitable adjustments in the programme.

The Gandhigram experience in Madurai district of TamilNadu typilies another pioneering experience. Basing its pro.gramme on the "Athoor Experience", the Gandhigram Institute ofHealth and Family Welfare Trust achieved remarkable success infamily planning, rural health and rural development Its ex-perience highlights the importance of micro. level planning inenlisting people's participation in family planning programme,which facilitated local adjustments. The effective use of localleaders as ooinion-leaders and creation and fruitful utilisation ofvoluntary groups like Mathar Sangam and youth club is anothersignltlcant feature of the Gancihigram experience. However, tnorganisational terms its most significant achievement is develop-ment of coordinated involvement approach, which secureafft thehelp of the local PHC rind Block staff, lt also succeeded in bring-.ing tdgether the staff of the PHC and the Bloch not a smallachievement given the traditional problems between them. TheGan_dhigram institute also realised that ihspite of all the effortsthey made in cooperation with the medical bureaucracy, popularinterest could not be sustained unless health and family planningwere offered as a package along with developmental f rogrammes.

People's Panicipation in Family Planning

They, therefore, launched sevcral es and it helped rnfamily planning acceptance as

The Vadu Rural Health Projec! of the KE.M.tlospital, punealso offers several lessons. Even its achievement in thefield of participation or family p was not very impressivgyet it was not negligible either. In { negative sense it showed thatsuch a programme cannot be successfully run frorn a longdistance. The main reason for its slow progress was that itsworkers were Pune-based. Vadu ( Bk), where the pro-gramme originated and from it project derived its namqseemed quite participative and othbr villages seemed to be catch-ing up. This project has also to gradualism. It alsoemphasied the importance of unmet or felt needs ofpeo-ple. And above all, Vadu project albo tells us that family planningis likely to be accepted more as a part of a.package. A vital

The Comprehensive Rural H Project, Jamkhed. is a novelexperiment in Ahmednagar of Maharashtra. This exoeri-ment also highlights the effi of micro approach in ruralhealth and family planning A ugh in family planningwas not achieved until the death fate and infant mortalih/ ratewere brought down with an eflectirie health care system that shif-ted focus from curative to care and the rural mass -

awakened-to its own- key to sriccess wi's also an

effort to involve more and more le. Apart from tho VHWsof two local associations -trained under the project, the

Mahila Mandal and Tarun Shetkari Mandal proved very useful tothe programme.

The Madhya Pradesh experirnlent showed that panchayatscould be effectively used in developfnental programmes as well as

in family planning programme..IhQ experimeht carried out underthe project since 1979 for the impllmentation of family planningestablished the useful role which thd panchayats can play in.family planning.

.Gujarat, anoth€r State using p4nchayats in family planning,piogrammq also demonstrated sinf ilar featurei. The programmbwas based on rewards and incentiv0s,-ivhich were awarded on thebasis of fulfilment of assigned tardets One of the important dif'ferences between the two cases is a rblatively strong panchayat sys-


tem in Gujarat Unfortunately. gram panchayat is the weakest lirikin the chain of panchayat institutions in Gujarat Thus, while.Gujarat has definitely rnade headway in family planning pregramme, it has yet to achieve a breakthrough. Participation levelalso, except in Kheda districi did not seem to be very high. Neitherthe cooperatives, nor any other local associations have been usedrin Gujarat in family planning programme. And family planningdoes not come as a package even with health carg let alone other

'developmental programme. This has restricted the response

Voluntary Agencies and Level of Participation

Of the four voluntary agencies studie4 only ong the NDFPAwas working exclusively in the field of family planning The otherthree started basically as rural health projects and later venturedinto the field of family planning making it an important part oftheir projects. The NDFPA on the other hand as a branch of the,Family Planning Association of lndia (FPAI), started family plan-'ning project and later ventured into health activities as well. Eachone of them at some stage had to initiate programmes of socio-economic upliftment to sustain popular interest in their pro-,jects.

The NDFPA is different not only because it started as a familyplanning projecl while others started as health care projects. It is a,case apart because its clientele is basically urban. It does serve the,.rural fringe of Delhi, but the rural fringe of an expanding met-.ropolis is different from an isolated rural pocket in one importantrespecL The exposure to urbanism makes it less resistant and moreopen to new ideas than the deeper countryside.

In sharp contrast, the villages located in the deep country-side. pose bigger problems when someone comes to them with a welfarepackage. They ieact with suspicion towards anyone talking abouttheir welfare Moreover, deeprooted beliefs and superstitions aswell as well-entrenched power structures also prove majorimpediments, The linkages between local interests and govern-.mental agencies further complicate the scene The task is renderbd.,even more difficult by low receptivity to new ideas and .apathyitowards their surroundings. Any effort to mobilise. the hardcore'rural masses. thereforg would have to take these factors intoaccounL

Thus. Gandhigram, Vadu and Jamkhed projects started with

230

bigger handicaps than

J in Family Planning

A Their aims and objectiveswere also far broader in scope the NDFPA Gandhigrdrn, theoldest of the fourvoluntary

People

the Nf

out towards the close of the 1950s

ning in the early 60s at theNadu. Jamkhed and Vadu

in our sample for instancg setassess and evaluate the exist-

of the Govetnment of Tamilstarted in earlv 1970s to pro-

ing rural health services and to a stratery for family plan-

vide rnexpensivc ano casrly Dle health care system toremote rural pockets in the State Mdharashtra. Logically, sincethe NDFPA started (in 1962) with objective of disseminatingknowledge and education ol planning it should have facedgreater resistanee. But, as stat€d ier, the difference was that itselected a rapidly expanding like Delhl

Of the other three, Gandhigr was likely to face less ofbureaucratic resistance because governmental sponsorshipand the limited nature of its task entrusted witb the respon-sibility of evolving a communicatJamkhed and Vadu, on the other

strategy for family planninghad to face their share of

suspicion. First of all" both these es faced some resistance,arising out of suspicion of the bureaucracy. Efficient han-idling of rural health by any tal agency would?eveal chinks in their own Therefore, suspicion some-.times bordering on hostility was a very natural reaction from.them. Secondlv. Jamkhed and V also had to deal with suspi-cion and uncooperative behavi of the Panchayat officials andelEcted officials. And finally, they to deal with rumours andpropaganda started by and even hostile local medi-cal fractitioners .

Organisers of Jamkhed and Vad]u projects dealt with this suspision'in entirely dilferent manner. $oth had to start in a low key torassure the medical bureaucracy, Fanchayat officials and local

lractitioners that they neither mefnt any harm to them nor did[hey intend treading.on their path. fhe Argles atJamkhed decidedhot to entertain any house calls At the second stage, the Vadu pro-

iect decided to collaborate with t$e medical buieaucracy, whilethe.Jar-nkhed project decided to ke$p distance and maintaina lowprofrle qo as not to create any c{ntroversy and strengtfren thesuspibion.

The strategy of the Vadu projelt had sornc similaritrj' with theGandhigrarn which developed the coordinated involvement'

lpproach for implementing fanili planning in rurbl areas. They

Family Planning and People's Panicipation

decidqd to work in collaboration with the medical bureaucracy inorder'to avoid duplication. This approach paid rich dividends in

,the long run. In recognition of their efforts, the MaharaShtraGovernment decided to entrust niral health care in Vadu to theREM Hospital thus placing the enlire'health srqff in thls area

under tne administrative control of the KEM Hospital. Pune. TheJamkhed project on the other han$ maintained its aloofness andtook care not to offend the sensibilities of the medical bureaucracyand even local medical practitioneri. tt had the locational advan-tage as well since its operational area lav between two distantPHCs. l he proiect also avoided any controversy that would tufiiPanchayat officrals hostile to it

Popular suspicion was another problem that each of the sam-ple organisations encountered. The quality and quantity ofsuspi-cion, however, varied from organisation to organisation. As statedearlier, the degree of suspicion against the NDFPA was not asstrong as others. The basic of suspicion was the family planning'programme which was their main objective, while in case of theother three, their basic motive itself was suspecL

The main strategy to deal with lhe suspicion in each case wasbased on gradualism. This was to avoid any wrong step taken inhaste, which might compound the existing suspicion into hostility.The NDFPA" therefore, propagated the mbssage of plannedfamily but never forced anyone to accept any of the methods.Gradually, and persistently, they sustained their relationship withthe pcople. Once few of the people came forward, the NDFPAstrengthened their case by involving the acceptors. The Gandhi-gram on the other hand, banked on raining a set of village opi-nion leaders yho proved very useful. In the other two casei thegrassroot app{pach paid good dividends. Their "barefoot doctors"CHV/VHW got them the breakthrough which probably thetrained medical doctors may never have gol After they got somebreakthrough and gained popular confidence, each.one of them,built their projects and took them from strength to strength on'community apporac[ even though they had to diversify them-selves a number of rrnanticipated activities

Once the initial hurdles were crossed successfully, it"was notdiflicult for the projects to take reots. Here agaiq we.noticesimilarities in their experiences, but,as in initial stages, theexperiences were not the same. Each one ofthem was built on thepopular'support that they were able to muster. They used success-

231

confidence in each case. In theWorkers, in Gandhigram theand Jamkhed. tfiO CHWVHW.'

The differences in each caseNDFPA concentrated mainlv onvices were also meant to support iOperating through nine sub-centtsion Workers it built up itsresponsibilities were over whenimplementing health and familytinctiveness of its pxperience lies init with the State governmentleaders, leaving the impleme:and itself assuming consultativejects distinguished by evolving ative imple mentation of preventivedifferences not only in these grarprojectg but also in theirdeveloped a hierarchy ofsuch fuJamkhed has only VHW. In Vadufemale CHW, most of them lian illiterate womam as VHW Wefer€nce of approach in dealingtal agencies in the two projects.

Whatever the approaches andinvolving more and.more peopleing the participation-base. TheirExtension Workets. village opini

l-ul cases to rnlluence and rope lnjects The grassroot functionaries

meant not only to create conscioulplanning among tfre peoplg but tople to transform these into commi,gramme which the people r

on'theri Each one'of themeffort to mobilise participation. Itwith accuracy and therefore,

Pmple'.s

marked. TheIts other ser-

family planning programme.and periodic visits of Exlen-

The Gandhigram's mainit developed a strategy for

ing programme. Birt dis-lving an approach, sharing

es and the village opinionwith the State government

The Vadu and Jamkhed profunctionary for effec-

care. But there are basic

appropch. While Vadufunctionaries in the fwo

hasies as CHW. MPW etc..

each village has a male dnd ain Jamkhed each village hase already pointed out the dif-

local leaders and governmqn-

tegies, each project aimcd atprogramrires and enlarg-

functionaries whetherleaders or CHWVHW, were

about health and fdmilvmobilise more and more peG

1

in Family Planning

reluctant and apathetic sub-vital for gaining popular

of the NDFPA the Extensionopinion leaders and in Vadu

are also quiteplanning

some degree of success in itsnot always easy to mdasufethe degree of participation.ided of the degree of par-

I presents a comparative pic-

projects

lty-Daseo programme - a pro-their own and not as. imposed

is that norie oI&ature of

Family Planning and People's Panicipritiotr 23.3

thgm. could stick to health and/or tamlly ilannrng alone. Theinadequacy of health and family planning-programmes to dealwith the problems of the local people started gripping each of theprojects at some stage or the other. To be precisg this was the stagewhen each of the projects could claim some breakthrough in thefields of health and family planning As they' received the reports-of such inadequacy they had to think of diversifications oftheir activity.

The NDFPA for instancg was told by its Extension Workesthat people, especially women, were increasingly.getting boredwith their programmes. Having accepted their advice on familyplanning they had nothing more ro listen to. Since the NDFPAwas catering to lower and lower middle class areas,.it decided tostart some programmes of socio-economic benefit ln consultationwith the local population they started a number of such program-mes. Gandhigrarl on the other hand after developing and hand.ing over the methodolog5r to the Govemment of Tamil Naduembarked ugon a number of projects with wider horizons. lt hassince been experimenting with holistic rural development pro-grammes, of which health and family planning forms a smallsegmenL

The Vadu prqiect also had to diversify itself.into areas ofenvironmental sanitation and rural health because it found thatunless the project could cater to the felt-needs ofthe local people, itwas difficult to sustain the programme. At Jamkhe4 the Aroleslbund that having awakened the participatory psyche of the p-eo-ple they could not keep it confrned to health and family planningComing to be accepted as deliverers froor disease, ignorancgsuperstition and fear, they had aroused.popular expectations to alevbl where they had to get involved in other aspects of people'slife The diversification of the Jamkhed project in rural health iswideranging

While there are similarities ,and . variations in the nrethodo-.logiesi strategigs,and experiences ofeach ofthe voluntary agenciesstudie{ the level of participation-. achived by them has widevariations,r These projects - the NDFPA Gandhigram andlJamkhed - have significantly higher participatory attitudes of thepeople, whilb the Vadu project has rather low. This is likely to givethe impregsion that the methodology and strategl adopted by theother three projects were superior to Vadu. While tfere could besome truth in this, the point should not be overstretched One.han-

234 People's in Family PlanninS

dicap which the organisers ofVwas that their staff was not I

project themselves admitteo,in the project hrea. and

o@asional visits did not create kind of impact that stall loca-tion in the area could create. This i explain Vadu's weakness tosome extent because in both and Jamkhed prox-imity of ihe projoct headquarters the proltct area was muchcloser. .However, this weaknessExtpnsion Workers made onli

also true of the NDFPA itsvisits to the area. Even if

one explains the srrccess of theone may have to look deeper to

Ato its urban surroundings,the weak participatory

attitudes and moLivatiots aJ VFirstly, the project at the village Vadu Budruk

since its inceptio4 where the centre of the project is locatedThis is the place where the people the building of thehealth centre as well as the res ce of the medical officer. It is

attitude and motivations inour survey in thg village.

into the project after 19'17, theThug when we conduc-

ted our sunrey in l98l the was only four years oldMorcover. in tho meantime the embarked upon coor-dinated involvement appfoachMaharashtq and the entireadmrnrsrative control of the

likely that individual partiqipathis village are higtr" We did notMost of the villages were inducteyear when the CHW scheme was

other fields. This probably madeSecondly, the Vadu prqiect has not

with the Govemment ofstaff was ..put under the

I Hospnal, Pune, which

main thrust a little weakable to create and activise

operat€d the Vadu project The also diversified in many

the local voluntary associations Mahila Mandals. youth clubs,etc., which the other three plojectsiq however, possible that in yer

done very successfully. It

becomes successful inhealtll

to comq this project alsopopular participation for

Ponchayato aqd Levels of

Both the States-Madhya and Gujarat-usiag pan-chayats in the faqily planningween the two. Both the sysl

e had one similarity bet-

incentives, the basis of awards achievement olsterilisationtgrgets set_by thc respeetive $iateanel VID. This is when the simi

were based on awefds and

ts (see Chaprers VIIbetween the two end$

Family Planning and feople's Participation n5Madhya Pradesh, ad arready elaborated earlier, had linked the

awards to the panchayats to rural developmen! i.e., the pan-chayats must use the award money on rural development schemes.A list of various development works on which the money could beused was supplied by the govemment Gujarag on the other hand,attached no such st4ngs. It plobably assumed that the panchayatswould use the money on public works. Moreover, Guiarat has anelaborate system of awards whieh included panchayat officebearers at all the three levels - villagg taluka and district - as wellas the government officials. This would probably activise largenumber of functionaries involvdd in the family planning pro-gramme.

Th . role ol panchayats in both the States was purelymotivational. Theironlyjob was to help the govemment in achiev-ing sterlisatibn targets They have not been included in thedelivery network in either of the States. This not only made theirrole subordinate but also took away the elerdent ofchoibe or voli-tion from their role.

It is probably the{arget-oriqrrted approach of the scneme inboth the States that had not encouraged the local voluntaryassociations like Mahila Mandals ar.d Youth Clubs and broughtthem in the'ambit of family planning campaign. This emerges asthe majorweakhess of the panchayat schemes of both the States. Itwould be worthwhile to mention here that three of the four volun-iary agencies studied un{ei the project had used local organi-;ations successfully.

The participatory achievements ot the programmes of both theStates look similar (see Sample Survey in Chapters VII and VIII)as far as the hgures are aonceroed Probably Gujarat would scoreover Madhya Pradesh on a few grounds. First its panchayat sys-

tem is older, more successful, and more elaborate than that ofMadhya Pradesh. Second, the system of awards'and inc'entives'being more elaborate in Gujarat the response probably would bemuch greater than in Madhya Pradesh-Finally, the cooperativemovement is much strongei in Gujarat and soh_etimes the linedividing the panchayat and cooperative leaderships is very thin.Thug it received .thd support of coopprative movement as wellMoreove! the cooperative rnovement had also helped the con-scientization process.

Pmple's in FamilY Planntng

Vbluntary Agencies Vs.

and motivations as well as

the two models suggest thatvoluntary agencios have donechayat models,, both in mobilisingfamily planning a popularly programme. The Jamk-

,hed project, Gandhigrarn" and,able to bring it tg a level where

the NDFPA have in fact beeneligible couples have started

laccepting the programme vt.is : in wnat respegts have the

i. The question which arisesagencres been able to score

pver tne panchaYats?The {irst major difference is the approach. The vpluntary

relatively small area of opera'agencies, localised as they are with[ion, operated at the micro level. were thus able to establish

The figures o_n particiPatorY :'the qualitative data collected by

government for the districtg talul[he level was worried about fullillpeople in the ptogramme. Such

to diversify in odhei asPecti ofplanning part olla packager In

personal and intimate contact v

them the opportunity to modtol

better than the two pan-pation as woll as making

the people. This also gave

programme as well as theirweaknesses and faults. The

in spite of the fact that familYhealth {epartment, it had not

Ftratery at,every level and recti$panchayats, o! the other han( part of the macro pro-

gramme of the State government ot onlv was their role limite d to

bring people to the sterilisation le, they were not in a positioneven to offer suggestions, let think about btrategies. Thug inspite of panchayat involvemtrelatively impersonal.

the programme remained

4rIverJ uuPvrrvrqr.

Secondly, in each of the agencies there was a personto the programmes who(or a group of persons) dedi

motivated thd field workers and them in establishing closethe people This was lack-contact or even close relationship

ing in the panchayat model. The road strategy rv.as the same as

determined by lhe Central Gopneihod of contfaception As a

of effecting terminalthe sterilization targets

issued by the Ceutral were btoken down by the $tateand panchayat levels. Each of

targets rather tharr involvingipproach also reduced the

family planning programme topopnlar -r-esijtl nce lgcame ggea

sterilization'progiamme and'

Thirdly;,in the panchaYat it had not been.possibledevelopment to make familY

planning departfnent is Part of

Family Plairning and P@pUs Panicipation n7been possible to offer health and family planningas a package.This made a major difference in making it a feople's pro-gramme.

However, this does not mean that the panchayat bxperimentdid not have its plus points. It certainly had For the fint time.thegrassrbot institution had been involved in a ilifficult progfammelike family planning There was considerable enthusiasm visibleamong the panchayat o{ficebearers in both Madhya Pradesh andGujarat In Madhya Pradesh where the awards have been tied upwith development activities, the panchayat oflicL*bearers seemedhappy at the grrospect of having more developmental funds. Thisacted as a catalysL

The importance of grassroots democratic institutions can bebetter understood when we realize the chinks in voluntary agen-cies' armour. Most of thenl as already pointed ou! have adedicated person or a grcup of them working as the motivatingforce. Will the impact of such agencies sustain the absence ofthem? Is such,a dedicated person or group based organisationreplicable for the country as a whole? It is difficult to answer thesequestions in the affirmative. Moreover, being micro experimentqreplicability of their experience is also not an easy propositionWhat would perhaps make replicability possible are grassrootsinstitutions like the pancliayats. If a proper nexus could beestablished whereby strategies are worked out by the voluniaryagencies. like Ganohigram did, and later it is passed on to thedgmocratic institutibns at the local level which of course wlll haveto be strengthene{, a sustained and effective.implementation ofprogrammes like family planning may be possible.

Bases of Popular Response

One of our important quests was to find out the general profileof the persons who accepted and participated in the family plan-ning programme. Is there any specific agegroup which is moreinclined to the acceptance of family planning? Is participation in

- fa.nily planning confined more to the educatedpersons than per-'soos with lover agademic atJainmenfl Has household incomeanythi$g to qo with rnc.eased participation in family planning?Does the number of children that an eligible couple has, motivatethe couple for sterilization? Does the type of occupation of a per,son affect his participation in the progrsmms2 We decided to look


to these questionsthe largest number ofrespon-

dents fell in 25-29 group, Nearly3T30 percent were in the next ie., 30-

cent fell in this group, whilegroup. These two groups thus

accounted for two.,,thirds of the sample; 25-29 age groupaccounting for over onethird of e sample is the modal age-group for terminal method of f planning In rural areas mostcouples have two children by them. ion of almost one-third in the neit age'group of30-34 reflective of the change com-ing ir It indicates that bulk ofthe populatiori is beginning toaccept family planning after about bur children Yet the fact thatabout halfthe population stillquieting (see Table 9.1).

four or more children is dis-

TABLE 9.1: Age-group tion of Sample Acceptors

Group (years)

r5-19 20-24 30-34 35-39 40 + Total

No. of AcceptorsPercentage .

4281.8 12.7

6634730.0 15.5 3.2

220100.00

Table 9.2 shows that illiteracy is a major impediment to thesample contained respon-acceptance of family planning.

dents from all categories. Though e illiterates and moderately.educated needed to be motivated a slightly mdre than a well-educated person, it would not be to say that educationallevel was an impediment to accep ce of family planning

TABLE 9.2: Educational lev I of Sample Acceptors

f.il-b*Percentage

7t 5232,3 23.6

Illite- Prirqte mary

Matid Gradu T:otalHr Sdc ate and

above

43 24 22019.5 11.0 100.00

30IJ

Famity Planning and People's Participation

TABLE 9.3: Economic Status ot Acceptors

239

Like illiteracy, ecoriomic stalus is also not a major impediment

in the way of family planning As our data shows more than half ofthe acccitors belonged to low income grqup, while nearly one'

third belonged to the middle income cEtegory (sde Table 9'3)' Atthe same tirie we would not like to underestimate the problem' We

have mentioned this in each of our case studies, the lower income

group, aswell as the:agrarian community is not impressed with the

i"..ttild tto.-. The lower income groups feel that more children

means moie income. Their children start working fairly early and

the cost of upbringirig is also not too high. The agrarian commurri-

ty, on the otltrer trin4 feels that two male children are essential to

l"ook uft.. their interest It thus means a minimum of fourchildfamilv. As the economic strucrure of the rual India and the vdlues

of the rural population chang{ some of these factors will recede

into background.

0- tnl- 2WI-run 2n0 3M

An n ua I Ho use ho ld I ncome

3m1- 4W1- 500r- ffi01-4An 5Un 6W 7m0

7AU- 6A00+ Total8000

. Number 32 55

Percentage 14.5 25.5

'27

12.3

26.. 2lI1.8 9.5

u315r722010.9 0.5 6.8 7.7 100.0

Table 9.4 gives us distribution of acceptors by rrumber of surviv-ing children. If in accordance v'ith the national policy, we con-sider acceptors with trvo children as normal and the rest as

deviang the emerging picture is notvery.encouraging 4u"O t-"ttpercentage (3.2) of acceptors had only'brie child These could becases where after acceptance, the one child died- We did not comeacross any couple which would accept family planning with onechild. Nearly 18 per cerrt couples had two children" which is arather low percentage. Ifthree plus are taken as deviants then theemerging picture is rather disconcerting with'nearly 80 per cent

. falling in this category. Even if we separate three'child couplesrfrom this category who are nearly3l per cerrt of the acceptors sam-plg it leaves ne4rly half the sample in the lour plus category. Onthe other hand nearly half the population is now bciepting ter'minal method of family planning after'three children.

24in Family Planning.

TABLE 9.4: DisCiU <if Sample Acceptorsby t{e Number of S Children'

Number of Sumiving Children

5 6+ Total

No. of Couples 7Percentage 3 .2

59 27 2026.8 12.3 9.1

39 6817.7

220100.0

Levels of Participation

The most meaningfulactivity, and hence in family

in any developmentaltoq is voluntary. And. theplanning is the volunlary

the discussion in our casethe base and raising the level

highest stage of participation inacceptance of the programme.studies shows that efforts to broa

has been able to attain in raisingutilising it for family planning as

explains why some people accept I

nol Eicept in Okhtra, where partici

of participation has yielded mixed Our sample survey datafrom each of the case studies the success each ofthe efforts

level of participatiotr andas for other programmes.

- Table 9.5 presents comulative tion data (average of thepercentage of the respondents participatory questions ofeach of the sample survey). A looJamkhed stalds out among the

at the table 9.5 suggests rhat.

attitude of the respondents. Weof Jamkhed that the extent of and consciousnessgenerated in the project villages had the project into amdvgmenl The success of theinvolVing people in the progr The NDFPA has also relied

experiment also lies in

on similar technique. The two experiments showrelatively weaker rates of participa and this perhaps suggests

targ€t- oriented approact. ;weakness of the government

Relatively weai partrcrpatibn' ra of non-acceprors partiallt

of respondents wel€ equal an4acceptors had slightly higher par

planning and some dorates of both categories

and Khed4 where n<iir-n rate, iii rest ofthe cases,

ise studies in participttorymentioned in the case study

acceptors demonstrated stronger tory attitude than non-


acceptors. This not only shows difference in strength of par'ticipatory attitudes of the two categories ofrespondents, but it also

shows how the! grade their activities. A look at the survey data

.from different sample clearly reveals that people do not want toparticipate in all activities. A very interesting example would bethat of voting Voting in nati,onal State and local elections, com-paigning for a party or a candidate as well as attehding campaign'ing for a party or a candidate as well as attending public meetingsaddressed by political leaders are allied activities. But not equalnumbers of respondents have participated in all the three.

In most ot tne areas the hrgnest number of respondents have

vote4 a lesser number have attended public meeting and very

small number have campaigned. One important inferenca that we

can draw from this is that if the level ofpeople's participation infamily planning'has to be raise{ family planning should rankhigh among their preferehces, and this is possible only throughconsciontization. Among the cases we studied the level of con-screntization was rhe hrsnesr ln ,lamkherl villags5, which par'

ticipaJory ligures from Jamkhed clear\ reveat.

At this stage it would also be worthwhile to examine the dif-ferences in participatory attitudes of acceptors and non-acceptors.

An itemwise analysis ofthe participatory attitudes of220 acceptors

and I l0 non-acceptors iri our sample clearly brings out similari'ties and differences in the oarticipatory attitudes of the two

TABLE 9.5: Participation Rate of Respondents in Study Areas

.Area Panicipation Rates of Respondents


Anand PrabatOkhlaGandhigramVaduJamkhedIndoreDhar,Bulsar

Kheda

67697rz)78

59503967

74'10

75

4983

5l60,a

66

242 peopl

gategones of respondents with9.6 presents this data.

in Family Planning

Of the 25 items we have used participatory attitude ofour respondents the siores of rs were trigher in 16 andthose of non-acceptors in nine. us, in terms of numbers and

TABLE 9.6: Itemwise of ParticipatoryAttitudes of Sam Respondents

. Diflerence

to different activities,Table

CiticalRatio

Non-\cceptors

Question

{a

2.

J.

4.

5.

6.

7.

8.

9.

10.

ll.t2.tJ,14.t<

16.

t7,18.

19.

20.21.22.

?4.25.

I J.3)74.7 5

72917r.0165.3563.7662.2556.36

55.73

83.6',1

77.097i.2459.q57.47

6522499830.1827.6r91.5958.4151.9068.37

81.2983.3976.78

63.12

62.A58.1 I45.45

43.9653.8358.5845.3650.7066.38I J.Z570.9251.00.61.23

69.8056.57

42.9142.91

w.2ls1.0953.407 r;t790.51

73.43

'80.66

5.41

5.38

5.51

5.72

5.83

5.78

5.77

5.905.89

4.895.065.365.866.18

5.91

6.27

.96

.88

.56

.78

.57

.00

.19

9.63

12.33

14.81

25.6221.38

e.23

3.67

11.01

5.03

r7.303.860.31

8.40

3.764.676.59

12.7315.30

1.38

7.32l.5l3.q9.229.963.88

1.78

2.29*2.69**.4.49t*3.67 **11t0.641.86

0.853.53**0.760.061.43

'0.61

o'7s1.05

2.14+2.ffi**0.321.18

0.24'0.592.02*1.99+

0;15

* Significant at ;05 levetr of+t Significant at.0l level ot

Family Ptanning and People's Panicipation 243

aggregates the broad ionclusion could be that due to better par-ticipatory attitude the acceptors went for family planning or par-ticipated in the programme while the non-acceptors did not. Britthis would be a rather superlicial conclusion unless we look at thepata in greater depth.

Alook at the critical ratios ofthe differences between the accep-tors and non-acceptors reveals that it is significant only in nineitems and in four it barely fell short of significance. Out of ning itis signihcant in favour ofthe non-acceptors in three. In four where.

,it just falls short of significance it is tilted in favour ofthe accep-itors. On five ilems it is sigrrificant at.0l level of signifrcance whileon four it is significant at.05 level

The fact that on sixteen out of25 questions relating to participa-tion in social, political and cultural activities the scores of a_ccep-

Itors and non-acceptors do not show any statistical differencemight convey the impression that participatory attitude is not animportant variable in acceptagpe. of family planning But thiswould be a hasty conclusron to draw. Ifwe loox at the questions wefind that thet include a broad range ofactivities touching upon the:concerns of individuals on suqh community problems as shor-tages of essential commgdities, drinking w'ater, educalionalopportunities health and family welfare facilitie s. While trying togauge the concerns ofthe respondents the questions also sought tojudge their participatory potential. Thereforg it is not surprising,that on items of common concern the difference is not significanl:In fact, one important inference that can be drawn from this is thatparticipatory potential exists in the community and it has not beenproperly tapped.Wherever it has been tapped, as in some of our'case studies, the response has been overwhelming The fact that onthree items the statistical signifrcance is in favour ofnon-acceptorsalso supports our argument

Of the nine items on which percentage difference betweenacceptors and non-acceptors were found to be signifrcant six wentin favour of the acceptors and thr-ee in that of non-acceptors. Ofthere six items in favour of acceptors, iter4s 4 and 5 related directly,to family planning programme. Acceptors showed greater willing-

. ness to join a family planning camp being held in a neighbouring.village (item 4) and they also exhibited more willingrless toorganise such a camp in their own village (item 5) than the non-.acceptors. They also showed greater willingness to assist the VLWVHW in motivating people to accept this programme (item 24).

2+t in Family Planning

The acceptors' showed'a more attitudd towards the needfor, maktng education'available children in their own village(item 3) while non-acceptors greater willingness to helpthe school teacher in persuadingNon-acceptors al$o a evinced a

to go to schocl (item23).political consciouness as .

compared to acceptors by ea party or a candidate in the

willingness to compaign for(item 17) and also indicating

that they had compaigned for a or a candidate in the lastelections (item l8)-This is annotice of Non-participants-are

ing phenomenon to be taken.for geffing political leverage

than for actual participation in\r'hilg participantb on the other I

planning programrGs,

igrass.root activity of direct

l.evels of Motivation

Participation theorists regard as importarit a factor[n enlarging participation base aticipation and place of individual

resourbes for mobilising par-socieeconomic hierarchies.

The data in Table9.7 shows sharp between motivations..

TABLE 9.7: Motliatiiin olfte in the StudyArea

4rea of RespondenuNon-Acceptors

Anand PrabatOthlaGandhigramVadutIamkhedlndoreDharFuisarKheda

for any statistical, analysis

explains to a large exbgland some did not.The

of acceptors and non-.accep3ors.phy some,people accepted fdmilytwo Delhi arcaq qhgre thc acceptr

are more interested in theto family planning

JJ2549

493E

42.10

25

9l89

73

7269725974

rts show€d stiongest

Family Pnnnmg and Pople's Panicipation 245

motivatioq nad very weak motivation for the non-acceptor res-pondents Moreover, their strong motivation (considering the grpecf questions we asked to measure motivation in family plannindcan be attribute4 to some extent, to their proximity with the met-ropolis. Aside from the two Delhi areas Gandhigrar4 Jamkhe4Dhar and Kheda show strong motivation for acceptors Thereasons tor strong motivation at Gandhigram and Jamkhed havebeen explained eadier. The involvement bf Panchayats is prc,bably responsible for raising motivation at Dhar and KhedaKheda has additional advantage of.active milk cooperatives. Butmotivation among non-acceptors is high only at Gandhigram andJamkhed and this gives these two projects an additionaladvantage.

We also made an itemwise comparison of the motivation of thesample respondents. The six questions on motivation were put tostatistical test similar to participatory attitude. The result showsstatistically significant difference at.0l level of freedom on all butcne item (see Table 9.8).

TABLE 9.E: Itemwise Comparison of Motivationof Sample Respondents

Questian AcceptonNa

Sigma Difference CiticalRatio

Non-Acceptors

l.2.

4.5.

6.

5.245.51

5.51

5.525.705.21

85.0487.6973.6979.8854.23

72.23

4.s322.2025.0034.7727.5068.,m

,m.51 7.73t65.49 11.88*48.69 8.55*45.t2 8.17*26.73 4.69*3.83 0,74

+ Signifibance at .01 level.

246 People's |,ortiripotion in Family Planning

family planning. l.eck of motivatiofr is best expressed by the statis-

tical non-significance of the last duestion which aske{ whetherthey were even "ddvised by any oire to accept family planning".The marginal difference shows tha{both were advised about it, butthe former accepted while the l{tter did noL How can it be

explained but in terms of lack of fnotivation?

health, family planning and o and developmental pro'grammes. Once unleashed, themore and more, as demonstrated

pation psyche demands

ces lt is thus impossible toVadu and Jamkhed experien-a limited view of popular

participation. It should be that not only wouldr participation help the process but i would also demand more than

family planning The mobt el eiample is from MadhyaPradesh where panchayats beganmental .activities.

seek more funds for develop-

The modeb and processes of' ular participation in familyplanning and other similar es are not limited. Theylargely depend on the extent which the programme has

appealed to the popular i and also to the extent ofmobilisation of popular on. This is where formal and

informal institutlonal structuresour case studies these structuresinformal structures like local vo

e importance. In each oIhave played important role-

Overview

Participatory attitudes and inas two importanf factors that affiAn expanded base of participatition which consequently, helps

volqntary agencies and formal sh

of governmental programmes inWhile iormal structures have Pimportance, informal structuresness. An{ as our study reveals,mal frafnework

These structutes, formal andbase. Therefore. if no attemPt ispeople are given the necessaryticipate in these institutionscate that people participate in

dual motivation, thus, emergefamily planning acceptance.

also raiseb the level of motiva-mobilising the cornmunity for

associations in case oflike panchayats in cases

ya Pradesh and Gujaraltheir utility and long termscored in terms of effective-

are replicable within the for-

brmal. ar,e built on a popularde to brode their base,and thecouragement, the peoplti phr-Both sets of case studies indi'

arein

institutions in every possible

Family Planning and People's Panicipation 247

manner. Not only do they enrol more and more people in the pro-gramme, they also work for welfare of the community at large.They do not hesitate to mobilise resources if required.

Strategy to enlist popular participation comes out as an impor-tant element It is essential to understand people's attitudes beforeseeking their support for any programme. It would seem wrotlg toassume that popular support, which would eventually result inparticipatioq would come naturally for any programme. Unlessproperly explained and carrying necessary level of conviction,popular reaction could be apathetig suspicious or even hostile. Itis also importan! in case participation is being sought in a

partic'ular progratume to identi& the target group; otherwise thepurpose of the programme may not be achieved.

Family planning programme is likely to attract popular par-ticipation only if it is offered in a package at least with health ser-

vices. Health services are important even otherwise becauseacceptance of family planning is dependent on reduction in infantand child mortality rates. Also closely linked is ahte.natal andpost-natal care. But as the experience of most voluntary agenciesand even Madhya Pradesh panchayat scheme shows, unlessfamily planning comes with other developmental programmes as.

a package, it is not likely to sustain populat interesl An4 thedevelopmental programmes should be such that they presentsolution to immediate local problems immediately.

This is not possible through a riacro appro'ach. While no onewould deny that broader national or State-level policies should beworked out at appropriate levels, i.t is essential.to understand thatappropriate level for working out micro strategies in a diversesociety sueh as ours is the local level. Thue proper emphasiS has tobe placed on micro level planning As we have seen most volun-tary agencies succeeded in their efforts mainly because of theirconsciousness of the riricro problem and because of their microlevel planning

This brings us to the final point that emerges from a compara-tive analysis of six case studies in this chapter. We have observedthat macro strategies worked out in the national or State capitalsneed adapatation at the local level. This could be done only ifthere is an effective local machinery with'sufficient autonomy. todo so. The existing local macbinery, bureaucratic as well as rep-resentatrve, have proveo unequ4l to ihrs task due to inhercntlimitations. Moreover, unlike the voluntary agencies they are also

248

not capaDle or expenmentationThere is therefore. a need for crearmore autonomou$ organisationsbreate a nexus between them and:are any in that, arca.

in Family Planning

r evolvmg micro strategies,more bffective and relativelythe local level and also tovoluntary agencies, if there

NOTES :

I There are difficulties iu quantifying anl measuring a ph.'nom!-nbn likc poPular panicipation. No quantitative scale can givc exact mcasurc of popular par-

ticipalion. While our scale does give a fair idep ofparticipalion in eilch casc study.

wc did face some probldms in this effort To {ite the example ol thc Vadu projeclthe local population did give ample evidcnpe of its parricipator.r zr'al mcdical

oflicer. but wh€n it camc to individual attitupe and motivalionr. it ranlt'd ralhet

iow on scalq (See Chartter V).

l

CHAPTER XPolicy Conclusions andRecommendations,-\LTVER the last few years the Government of India has repeatedlystated that the family planning programme in India is basedentirely on the voluntary participation of the people. Despite thesepolicy professions, over the years very little conscious effortappears to have been made to movc in that direction. In anextremely sensitive programme like family planning the resultsspeak fpr themselves. The acceptance of the programme isgenerally low in the country consequently the fertility level isdisconcertingly high.

The evidence of the last fewyears makes it quite evident that thefamily planning programme will make little headway through theprdbent bureaucratically organised system. The bureaucratic sys-tem, especially at the grassrootg inspires little conlidence even inmaintaining the supply side. as many of the studies have cledriyshown. When it comes to the demand side the bureaucratic svs-tem is perhaps the least effective because the demand senerationfor family planning is a far more complex socio-ecoiomic andeven political p.rocess.

- C)n tne otherianq there is increasing evidence that wherevert[e programme is based on the participaiion of the people, ttri-res-ponse has been much better. A much larger percentage of the eligi-ble couples accept protection even by the drastic methed ;fsterilization. And a lesser number of persons oppose the program-me. Indded if the programme has tq be voluntary as.the offiqiAl,po[icy of the country repeatedly stresses, then the need for par:ticipation by the people is obvious. Given the political structuie otthe country and the events in recent years! there is in fact littleoption than to seek a greater voluntary participation of the peoplein the family planning programme.

250

lesser perhaps

in Family Planning

i'he present stirdy was designed fino out as to what kind ofparticipation ofthe people was nottantly feasible and Possible'

desirable but more imPor-

The lindings of the study show that without particiPa-

tion by the peoplg there is not h chdnce of acceptance of the

progxamme by'the PeoPle. But study also shows that while

au3onomous PartiFiPation is it is not yet feasible given

the social and polltical context ofof development of the countrY a l

country. At the present stage

percentage of the PeoPle do

not autonomouslY ParticiPate in programmes meant for

them" While India is not an in this regar{ it is necessaryorganising public policY infor us to accept the pr€sent reality

the field of familY PlanningThc study, however, Provides conclusive evidence that

people do and lndeed ParticiPate in family planning whenever

they are mobilized bY an agen-cY tion close to them. This

leads us to the po$itive PolicY that there is a need for a

shift in the public PolicY towards conscious mobilization of the

people for acceptlng familY PlalSuch mobiliz dtion cannot be through the bureauc'

racy. Indeed ParticiPation and are conlrary

phenomena and processes' Thelesser oerhaDs willl be the PeoPpeoplC

the bureaucratization the

participation has thercfore to be

participation The mobilizedned through non-bureaucratic

institutions and organisations'The study of the Performance o the voluntary agencies and the

panchayats suggosts that bottt of institutions are useful for

mobilizing people's partigipation in family planning However,nder our studY is strikingly bet'the record ofthe voluntary bodies

ter for mobilising PeoPle'sThe panchayats have been

than of the panchaYats.

by the restrictive Policies ol

the State governrhents with to their role in mobilising the

people. They werE beiflg merelymanagement.and organisatiQn

as a part ofthe bureaucraticthe programme.

As stated earller, the Perforrtions is strikingly superior. This

of the voluntary otganisa.us to the policY conclusion

that wherever such agencies they should be encourangedin mobilising PeoPle for Par'

rogramme Tlrey are esPeciallY

effective in jnnovative exp€rimen tion. And such innovativeness

is necessary af the Present

'and supported a$ rnuch as Possilticipating in the familY Planning

of the family Planiring

Family Planning and People's Panicipation

programme.We do recognise, however, that an extended

251

role for suchbodies is not a viable all-India policy option. For a variety ofreasons, the voluntary bodies thrive in limited parts of the country.They are not available in precisely the areas of,the country wherethey are most needed. The four case studies ofsuccessful voluntaryorganisations did not touch the vexacious areas oJ the countrysuch as Bihar or Uttar Pradesh. For a conceivably long period, it isalso unlikely that.such agencies will spring up in these areas oreven ifthey do, thrive as they do in the western or southern parts ofthe country. Perhaps this phenomena has a great deal to do with

the diTforential social and political development of the country'The panch.ayat system given the national context is, therefore' a

more vilbte pplicy option. The findinq of the study clearly lead to

the policy ronclusion that despite thi limited role within whigh

the.panchayats operated in Madhya Pradesh and even in Gujarag

they were remarkably successful in extending couple protection

significantly. A more .liberal and properly' conceived role for the

panchayats could help a great deal more in bringing about par-

ticipation of the people in the family planning programme'

This is not to say that the p4nchayat system is likely to be

uniformly good or effective in all parts of the country. Indeed the

pinchayat, map of the country il..uneven and even patchy' Yet

ihere is no alternative people's insiitution as widely available as'the panchayats in the country. Our study suggests that the poten-:tial of the panclrayat system for the acceptance of the family plan'

ning has not been adequately exploited. And hence efforts should

be immediately made in that directioo.Our policy conclusion is also that the panchayats should be

'utiliied not only foi motivational role but also in the delivery sys-

tem. Even the motivational role of the panchayats today is con-

fined to pursuading eligible persons for sterilization. This ishardly desirable or even possible given the lowering ag€ structure

of the eligible couples. The motivational role of the panchayats

should, thereforg be rdviewed and extended And as the experience

of some other developing courttries has shown, the locally elected.bodies and persons can play a very useful role on the supply side

especially of the conventiondl contraceptives which will bb

intreasingly more important with the changing age structure ofthe eligible couplcs.

While our study regarding the elected bodies was confined only

People\ in Family Planning

to the panchayats and that roo in iujarat and Madhya pradesh,choice is indeed wider. Therewe should like,to point out that r

are several other locally elected in the rural areas.of thecountry which have a similar tial. In particular we feel thatthe elected cooperatives, the vari women's organisations, the

are all possible instrumentsvoluntary acceptance of the

youth clubs. the farmers orsa'nisati

e people. The Governmentneeds to make a conscious effortfamily planning programme.

Our general observatibn ib that

involving these bodies in the

social institutional map of thecountry is varied And yet some institutions do exist andeven thrive in many parts of the co try. This is the strength of theIndian political system at the with whatever problems itfaces. Such institutional has to be given a role in a dif-ficult programme like a family p ing without which the pros-pects are more diflicult and li

which emerges from

political, economic and social: community of people inis also a more participative

community in the family programme. In other wordsparticipation is a process and and the more it isencouraged, the more it is useful

which could help in the process offamily planning programme by

, A general but important policythe study is that a more Darticil

ticipation should be encouragedas the supply side of the progrr

252

gramme. This conclusion desermakers and planners because the ,lic policy- while preachingfor more participation il of the programmes doesprecisely the opposite. The family programme is onlyone case in point

These are in brief our maior conclusions. There areseveral minor one$, which are within the text of the studv.The principal recommendations naturally out of these con-clusions which we list below.

Srnce our basic conclusion is that will.be no acceptanc€ olfamily planning without by the people, our firstr needs to be takeri torecommendation is that every

encourage the process of in thd programme. The par-in the motivational as weil

Such a policy should bemade an integral part ofthe national amily planning programme.

t)ur. second major and crucial is thaq given

for the family planning prethe attention of ttre poticy

the state of political and social i of the country par-

Family Planning and People's Participation ZS3

tieipation of the people in the family planning programme willhave to be mobilized as a matter of deliberate policy.

Thirdly we also recommend that the elected panchayats andthe voluntary agencies are best instruments of mobilization andhence should be utilized extensively for the purpose in the familyplanning programme.

Our fourth recommendation is that the voluntary bodieswherever they work in family planning should be given as muchhelp and encouragement as possible without destroying theirvoluntary character.

The fifth recommendation is that the elected bodies at the locallevel not only in terms ofthe panchayats, but also the cooperatives,

the women's organisattons. the youth clubs. the farmers grganisa-

tions should be utilized a! extensively as possible in the process ofmobilizing the people.

Our sixth and Iinal recommendation is that_the process of par-ticipation by people should be encouraged as extensi!ely as poss-

ible in all programmes because we find that those who have a

participative attitude generdlly participate more actively in thefamily planning programme.

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People's Participation in Family Planning