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PERIODICALS OTHER NATIONS their attacks as for those who remained in coronary intensive care units. In Britain, salaried doctors under NHS have the primary responsibil- ity for holding down health care costs. They must function within budgetary limits, and they are paid no more for prescribing costly treatment or surgery. With US.. health care costs skyrocketing, says Malone, most British analysts expect to see some form of nationalized medicine in the United States, sooner or later. "The Indian Dilemma-Coercive Birth Control or Compulsory Pregnancy" by for th6? FU~UT~ Tim Black and Malcolm Potts, in Con- femporav Review (Nov. 1978), 61 Carey St., London WC2A 21G. India's abandonment of its policy of sterilization has put the country back where it was in 1952 when it launched the world's first national family planning effort on the Gandhian principle of "abstinence." Family planning in India has passed through a five-stage cycle, say Black and Potts, who are, respectively, director of European operations for Population Services International and executive director of the In- ternational Fertility Research Program in the United States. Early drives to bring standard birth control methods and services to urban and rural populations through health clinics were followed in 1972 by the introduction of mass vasectomy camps and liberalization of abor- tion laws. Major incentives for sterilization (e.g., payment of as much as 60 rupees in some areas) brought dramatic results: vasectomies jumped from 1.6 million in 1968 to 3.1 million in 1973. But red tape hampered the effort to provide inexpensive, legal abortions. In April 1975, Indira Gandhi decided on a coercive approach, raising the legal age of marriage and pressuring men to submit to sterilization. The number of forced sterilizations probably represented only a small fraction of the total. But crude tactics were often used (one 19-year-old unmarried man was told he could not get a driver's license unless he was vasectomized), and they turned the public against the whole idea. Today, India lacks any real family planning policy and the population (625 million) is growing by 1 million each month. Legal compulsion-requiring sterilization of husband or wife in families over a cer- tain size-was never tested. Four Indian states passed such legislation, but it never went into effect. Whether a compulsory sterilization policy could ever be applied without inequities is doubtful, say Black and Potts, but "we should be cautious about condemning compulsion if we are unable to put forward alternative effective strategies.'' Soon other nations, including In- donesia, Egypt, Nigeria, and Brazil, will face the choice between attain- ing social and economic gains through compulsory birth control or "suffering the oppression of [population increase through] unwanted pregnancy ." .

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Abortion, International Development and Grandstanding
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