Family Planning in India: Recent Developments in September 1965 K
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Family Planning in India: Recent Developments In September 1965 K. S. Sundara Rajan published an article on "India's Population Problem" in Finance and Development. In this article he surveys this great problem—so important in its implications for the entire developing world—in the new perspective given by two further years of effort in India. K. S. Sundara Rajan N AUGUST 1966 the population of India rate has dropped only by some 20 per cent in I crossed the 500 million mark. Since then it this same period. Life expectancy at birth, has been increasing at a rate of more than a which was only 32 years in 1950, had jumped million a month. We in India have to contend to 50 years by 1966. It was because of this with an annual increase in population which sharp fall in deaths that the population began is more than the total population of Australia, to soar. As long as this irresistible increase in or that of Norway and Sweden combined. If population continues, the gains arising from things go on at the same rate, India will have India's economic development are eaten up a billion people just 27 years from now—as and efforts to raise the standards of living of many people as there were in the whole world the people through Five Year Plans are nulli- in 1830. fied. This tidal wave of population in India and Lowering the Birth Rate in many other developing countries is not the result of any striking increase in birth rates i>ut The target set by the Government of India of a truly spectacular and successful fight early in 1965 was to bring down the birth rate against death and disease. Over the years the from the then 41 per thousand to 25 per thou- death rate in India has actually been falling, sand within as short a time as possible. This as the accompanying chart shows. In the decade is to be achieved by adopting all known meth- 1911-21, the death rate was 48.6 per thousand, ods of contraception and by motivating the and in the intervening half century it has been people to adopt these. What does this target brought down by almost 75 per cent to 14 per mean? There are at present 90 million couples thousand last year (see Chart 1). But the birth in the reproductive age group in India. To 250 ©International Monetary Fund. Not for Redistribution Family Planning achieve the birth rate target of 25 per thou- leadership was convinced of the urgency of sand, at least half the couples in the child- the problem and the need to take action, the bearing age must practice contraception regu- same urgency was not felt at middle levels and larly. In other words, we have to raise the at state levels. One reason was a basically percentage of couples doing so from the present conservative attitude with regard to this highly 5 per cent to 50 per cent of the childbearing personal matter. An even more important fac- age group. Since the number of childbearing tor was the lack of a safe, cheap, and reliable couples increases pari passu with population, method of contraception, which was at the by the early or mid-1970's at least 70 million same time simple enough to be adopted by the villagers. There was also a lack of trained per- sonnel. Under the Constitution of India, health, which includes family planning, is a state re- sponsibility, and the central government can only advise and assist. The family planning bureaus in the states did not function very effectively. Though the central organization was better, it did not have the necessary finan- cial backing. The Third Five Year Plan (1961/66) was important in the history of family planning efforts. That Plan stated unequivocally that the objective of stabilizing the growth of popu- lation must be at the very center of planned development and sharply stepped up the pro- Birth control information and supplies must be vision of funds to Rs 270 million ($57 million). made available to 90 million couples. Even these new efforts, however, took some time to gather momentum. Starting in 1963, couples must be practicing contraception regu- far-reaching changes in organization were in- larly. The magnitude of the task will be appre- troduced. Family planning in the rural areas ciated if it is realized that 80 per cent of these was made part of the extension activities. The couples reside in 560,000 villages and that technical direction of the Plan at the center many of them are illiterate. Most of them will was greatly strengthened, and in 1965 a Com- be conservative and shy, as are villagers every- mittee of the Cabinet was constituted specifi- where. They present vast problems both in cally for family planning. This Committee is persuasion and in logistics. now presided over by the Prime Minister her- The Indian government was the first any- self. In 1966, a new Department of Family where to adopt an officially sponsored family Planning was created in the central govern- planning program. Funds were provided in the ment. In preparing the Fourth Plan (1966/71), First Five Year Plan which began on April 1, family planning was given the highest priority 1951. But progress during the first ten years next only to agricultural production. The Plan was painfully slow. Although the country's top provided Rs 2,29 billion ($306 million) whi<& 251 ©International Monetary Fund. Not for Redistribution Finance and Development the country—the President, the Prime Minister, the Cabinet Ministers, and State Chief Min- isters. The Family Planning Program The chart on page 257 indicates the present organization of family planning in India. At the top there is a Cabinet Committee for family planning headed by the Prime Minister and in- cluding the Deputy Prime Minister and the central Ministers for Planning, Health and Family Planning, and Social Welfare. The Department of Family Planning is headed by a Secretary, and it has a secretarial wing and a technical wing headed by a Commissioner of Family Planning. The secretarial wing deals K. S. Sundara Rajan was born in Madras with planning and policy matters, issue of sanc- and graduated from Madras University in tions and grants, development, budget, and co- 1934. He has been serving the Government of ordination with state governments. The tech- India for 27 years in a variety of posts, in- cluding those of Commissioner of Income Tax nical wing provides the technical advice and and Joint Secretary for External Finance. He direction and also keeps track of the progress has been Executive Director for India at the and implementation of the various aspects of World Bank and Minister (Economic) in the the program in the country. There are six re- Embassy of India in Washington since 1963. gional health offices of the Government of In- dia, each headed by a Regional Health Di- rector to watch and help in the progress of was eight times the amount provided in the family planning work in the states falling with- Third Plan and represented the equivalent of in their respective jurisdictions. Rs 26 ($3.50) for every couple in the repro- The states have their own family planning ductive age. Though this amount is large, it Cabinet Committees and their family planning has been made clear that further funds as re- bureaus. To ensure close cooperation between quired would be made available. Further, the central government agreed to finance the the state and central governments and to evolve whole of the capital expenditure incurred by new policies as well as to review progress and the states in family planning and practically the exchange experience, there is a central Family whole (97 per cent) of the recurring expendi- Planning Council with the Union Minister for ture. Administrative and financial controls Health and Family Planning as chairman and which had hampered the program in the early state ministers for health and family planning years were removed and the jungle of red tape and others prominently connected with family cut through. Most important, there was the planning work as members. Each of the 335 public commitment of the top leadership in districts (population 1-3 million) in the states 252 ©International Monetary Fund. Not for Redistribution Family Planning has its own family planning bureaus. Under creased to 46. District level units are also being the district bureau, there are urban and rural established. family planning centers and subcenters. The objective is ultimately to have one urban family Mass Communication and Education welfare center for every 50,000 of urban popu- In the final analysis, the success of the pro- lation, one rural primary health center for a gram will depend on the extent to which the rural population of 80,000, and a subcenter for average man and woman in the country can be a population of 10,000. made aware of family planning and be moti- Full cooperation with the public, particularly vated to practice birth control. Information and the doctors, surgeons, and gynecologists, is knowledge must be made to flow throughout sought at the various stages. There are expert the country in the 13 regional languages as committees set up to advise the Government of well as in Hindi and English. It has to reach India on research and evaluation, and separate every one of the cities and towns and villages. technical committees to advise on the intra- Ultimately this knowledge, together with sup- uterine contraceptive device (IUD) and sterili- plies and services, must be made available to zation; the universities and research institutions every one of the 90 million (140 million in are fully associated with these committees.