The Social Context of In a South Indian Village By A. Dharmalingam

A quasi-anthropological study, relying on structured and unstructured interviews and observa- or none, became matters of irrelevance since the objective was to tote up awesome tion of participants, reveals several factors that have a strong bearing on in a South figures as proof of loyalty to the powers- Indian village, where the level of contraceptive use is lower than the statewide level. These fac- that-were in New Delhi.”7 tors are the lack of follow-up services, gender inequality and the unsuitability of to Once the emergency ended, it took al- most five years for the government to re- all working situations and living conditions. To improve program performance and quality of life, store family planning acceptance to its pre- the government family planning program needs to address the side effects associated with the vious level. Although the government had of sterilization and facilitate individual choice, taking into account the village’s social changed, the policy of persuasion re- and economic context. (International Family Planning Perspectives, 21:98–103, 1995) mained intact, and the program’s ap- proach of setting targets at the central level also remained essentially unchanged. arious population projections have large that further increases would ham- After the emergency, however, the strate- estimated that will have one per efforts to improve the standard of liv- gies adopted seemed to be more passive billion inhabitants by the end of ing. Successive plans placed increasing and women became the targets.8 V 1 this century. The implications of this pop- emphasis on improving the family plan- Despite the family planning program’s ulation size seem ominous in view of the ning program, in order to achieve targets shortcomings, its coverage has expanded thinking of some academics that “a small that would help reduce the birthrate. since the early 1980s, and its performance India is a happy India.”2 For a country al- The family planning program started appears impressive. Overall contraceptive ready burdened with many social and eco- with a clinic approach in the 1950s and prevalence has risen, and reversible meth- nomic problems, an expanding popula- 1960s, and subsequently added a network ods account for a larger share of use. Fer- tion seriously jeopardizes the prospects of fieldworkers. In the mid-1960s, the IUD tility declines, however, have been small- for eradicating poverty and improving the was introduced on a massive scale. This er than expected.9 living standards of the masses. was followed by an extensive communi- With these complexities of the Indian Reflecting the seriousness of the prob- cation drive to motivate acceptance of the family planning program as a background, lem, the late prime minister Rajiv Gand- small-family norm. The failure of these this article examines family planning atti- hi stated in 1989 that “a solution to India’s approaches to bring about substantial tudes and practice in a South Indian vil- population problem would, in large mea- changes in the birthrate led to the adop- lage, with emphasis on the social context sure, amount to a solution of the world’s tion of target-oriented programs. and implications for the national program. population problem.”3 Some demogra- Also as a result of the ineffectiveness of phers warn that unless the social and in- these initiatives, during the 1975–1977 po- Study Design stitutional obstacles that impede fertility litical emergency, the government estab- A “quasi-anthropological” approach was decline are soon removed, “more dra- lished mass vasectomy camps and under- employed to collect quantitative and qual- conian population policies will eventual- took a forcible sterilization drive. To fill itative information. Quantitative infor- ly be contemplated.”4 government quotas, sterilizations frequently mation was collected between June and The Indian government’s concern about were performed on individuals who were October 1987 through structured and un- rapid population growth, however, is not more than 45 years old and in poor health; structured questions, participant obser- recent; India prides itself on being the first many of them died within a few years. In vation and in-depth probing. The impor- country to have adopted an official fami- some public health clinics in North India, tance and contribution of this approach to ly planning program––in 1951. In fact, the men and women beyond a certain age were understanding a community’s demo- foundation for the program was laid in the forced to undergo sterilization before re- graphic, cultural and political character- 1891 census report, which asserted that ceiving routine medical attention.6 istics have been well demonstrated.10 overpopulation was responsible for What the family planning program was The study village is located in the south- India’s misery.5 The first development all about, particularly during the political ern district of Tirunelveli in Tamil Nadu plan after independence, launched in 1951, emergency, was succinctly described in an State, about 50 kilometers west of the dis- recognized that the population was so editorial of a leading Indian journal: trict headquarters. In 1987, the population “Thousands upon thousands of people, of the village was 1,451, including 318 house- A. Dharmalingam is a lecturer at the Population Studies mostly poor and illiterate, were herded like holds and 196 currently married women. Centre, University of Waikato, Hamilton, New Zealand. The author would like to thank John Caldwell, Geoffrey cattle to face the butcher’s knife and then The majority of the population (85%) be- McNicoll and Gavin Jones for supervising the research to become statistics of targets achieved two longed to the peasant caste (Nadar), and on which this article is based, and Philip Morgan and Pat and three times over.…Whether the per- about 10% were untouchables. The selection Caldwell for valuable comments on the text. This research son on whom the knife was wielded was of the study village, where I was born and was supported by the Ford and Rockefeller Foundations; the Australian National University; and the Population 18 years old or 60, whether he was married grew up, was based largely on my famil- Studies Center, University of Pennsylvania. or unmarried, whether he had six children iarity with its population and history.

98 International Family Planning Perspectives Seven households were excluded from of reproductive age), five male workers and The implications of these changes for the the analysis because attitudinal and fam- 39 female beedi assistants (roughly half of small-family norm and for adopting fam- ily planning information was not collect- them young girls). About one-half of the ily planning methods are manifold. For in- ed from them, and two declined to par- beedi workers were introduced into this stance, uncertainty about future return ticipate. The structured questionnaire was work at 5–10 years of age, and the rest at ages from the younger generation could trans- administered to all married women under 11–15. Typically, by the age of 15, a beedi as- late into a preference for a small family; 50 years of age, but only about 10% of cur- sistant becomes a main beedi worker. women’s demand for equal participation rently married men and women were se- About one-third of beedi workers work in decision-making could give them a lected for in-depth interviews. six days a week, and about one-half work greater voice in matters related to fertility My familiarity with the village facili- five days a week; the average work day is and contraceptive use. Similar observations tated informal discussions about family 10–14 hours. Beedi work is done in the have been made elsewhere in South India.12 planning and gender relations, a tech- home, although the women must bring nique particularly helpful to in-depth case their work to an agent in the town at an Family Planning Awareness studies. However, some respondents were appointed time each day. Workers are paid In this article, knowledge about family hesitant to give information on property a piece rate, and annual earnings average planning methods refers to knowledge of and wealth. And on certain attitudinal Rs 1,700–2,200 (US $85–$110 in 1987). modern contraceptives. This usage pre- variables, some asked me to record my Likewise, the brick industry has pro- cludes the wrong notion that in the past, own assessment, assuming I was familiar vided new employment opportunities for people had no knowledge of how to avoid with their day-to-day life. I had to explain males. As making raw bricks demands conception and terminate — the objectives and importance of the pro- great strength, it is reserved for males aged actions that invited social sanctions. De- ject before I could get their responses. 15–40, but boys younger than 15 are em- mographers evaluate the knowledge of ployed in brick carrying. On average, a family planning methods to get a rough Village Economy and Society brick worker works 11–12 hours a day, five idea about the potential for fertility re- Until recently, the majority of the popula- days a week, eight months a year. As in duction. Knowledge, however, does not tion in the study village worked in agri- the beedi industry, the wage is paid at always translate into behavior. culture. As a result, social relations were piece rate. Most workers net about Rs Over the last half century, the Indian gov- shaped largely by individuals’ and fami- 2,400 ($120) annually and are indebted to ernment has worked relentlessly to en- lies’ function in agricultural production and their employers.‡ courage couples to have small families. The distribution. Despite the emergence of al- This economic transition—especially slogans and symbols seen on billboards, in ternative employment opportunities in the women’s ability to earn income—has en- movies, on television and in the newspapers last 15–20 years, the possession of land suit- gendered a number of social changes. conveyed the prospect of a prosperous life able for paddy cultivation remains an im- Women’s earnings facilitate short-term if the number of children was restricted to portant determinant of social status.* planning and budgeting for families; in bet- two. In addition, a major instrument of the As in the rest of India, the distribution ter-off families, daughters’ wages are saved program has been the payment of financial of land is highly skewed. More than one- for special purposes, such as marriage or incentives to contraceptive acceptors. The half of the households do not have access land acquisition. Furthermore, being wage payment, intended as compensation for in- to fertile land. Further, the occupational earners gives women personal power; they cidental expenses and lost earnings, was Rs characteristics of the cultivators have can translate earned wages into relative 150 ($7.50) in 1987. The program also offers changed significantly over the last two freedom of movement and some degree of incentive payments to official providers and decades. More than two-fifths of the autonomy in decision-making. private motivators. These strategies were in- paddy cultivators are engaged in non- Another major social change has been in effective in motivating people to adopt a agricultural secondary occupations. the dynamics of intergenerational relation- small family size, particularly before 1980,§13 The transformation from a solely agrar- ships. When agriculture was the main field ian to a mixed economy began in the mid- of economic activity for men and women, *Caste has always been a dominant social parameter in the village. Land traditionally has been owned or oper- 1970s, with the massive expansion of the children handed over their earnings to their ated only by the peasant caste; a few washermen and bar- beedi† and brick industries, which draw parents, and newly married couples usual- bers have recently acquired some land, and the un- large numbers of women and men, re- ly lived with the husband’s parents at least touchables are still landless. spectively, into their work forces. Owing until they had their first baby (but an only †Beedi is a crude cigarette: Tobacco is rolled in a small to the growth of these industries, only son rarely moved his own family out of his beedi leaf and tied with a cotton thread. A beedi is small- er and less expensive than a cigarette; it is considered the about one-fifth of all women and men parents’ home). Today, however, with ma- poor man’s cigarette and is smoked only by men in the now do some agricultural work. More- terial necessities available in the market, a study village and in rural Tamil Nadu generally. over, the last five years have seen an in- young person does not have to be sub- ‡The majority of workers who were indebted to their em- creasing number of adults migrating out servient to an authoritarian family head, and ployers reported that they had to borrow in order to pay in search of remunerative employment. most couples live on their own and start essential household expenses. Also, most brick workers receive their wages before the work is completed; if rain their own families within six months after destroys the bricks already laid, the wage becomes debt Effects of Emerging Industries marriage. This weakens the control a young to the employer. The beedi and brick industries have had a man’s parents have over his wife, and most §A group of young boys I spoke with related how the strong effect on the lives of the local popu- parents feel that an increasing proportion recent showing of a family planning movie in the village had been canceled because of some boys’ disruptive be- lation. Almost all beedi workers in the vil- of the younger generation have become dis- havior. In the early 1970s, elsewhere in Tamil Nadu, even lage are females, although this is not the case obedient. Parents commonly complain adult men disturbed family planning propaganda events, elsewhere in India. At the time of the survey, about the uncaring attitudes of their son and and in Maharashtra, where researchers collecting base- line demographic data were mistaken for government there were 346 female beedi workers (rep- daughter-in-law; in some cases, parents are family planning workers, “great pains” had to be taken resenting more than 90% of village women physically abused by their sons.11 to correct the misunderstanding (see reference 13).

Volume 21, Number 3, September 1995 99 Family Planning in a South Indian Village

ily limitation, the emer- creasing age and because of the strong so- Table 1. Percentage distribution of husbands of women younger than 50, by approval of family planning, according to selected char- gency deterred people cial sanctions against in late acteristics, South Indian village, 1987 from accepting it in the middle age. A study in North India made future.16 the same observation.17 Characteristic N Approve Disapprove No Total opinion As Table 1 shows, Breastfeeding, although not covered in Total 192 57 35 8 100 57% of husbands in the the village survey, is another factor that can village approve of fam- lengthen the birth interval. Indian women Landholding* Landless 105 61 32 7 100 ily planning, but that typically breastfeed until their infant be- Landed 87 53 37 10 100 leaves a substantial pro- comes entirely dependent on other foods, Years of schooling portion who do not. The breast milk supply fails or they become <3 98 48 42 10 100 3–5 58 62 31 7 100 differences by charac- pregnant again. Research in another Tamil >5 36 75 19 6 100 teristics are not signifi- village documented that people knew that Occupation cant, and no consistent prolonged lactation reduced the likelihood Wage laborer 96 58 33 9 100 pattern emerges in the of another pregnancy.18 In the study village, Cultivator† 58 48 41 11 100 Self-employed/salary level of approval. For women breastfeed their children as long as earner/businessman 38 68 26 6 100 instance, while increas- they can,† although not with the intention *In this table and in Table 2, “landless” refers to those with less than one-quarter of an acre of ing education seems to of postponing the next pregnancy; how- land; “landed” refers to those with one-quarter of an acre or more. †In this table and in Table 2, cultivators are those whose reported main occupation was farming. raise approval, land- ever, they likely are aware of such effects. holding appears to have little influence on ap- Use of Sterilization probably because they overlooked the fact proval levels. Likewise, there is no differ- The adoption of a particular contraceptive that material and social conditions were un- ence by occupation; in particular, the ap- method is influenced by the perceived favorable to a small-family norm.14 proval rate among the wage laborers benefits of its use, as well as the perceived While the program’s motivational ef- (58%), who are poor and account for 46% social, economic, psychological and phys- fects are dubious, it has at least increased of the population, is not significantly dif- ical costs.19 It may also be influenced by awareness of family planning. More than ferent from that among the self-employed, the inequalities in the relationship be- 90% of couples in the study village were salary earners and businessmen (68%). tween a husband and wife. aware of at least one contraceptive meth- The majority of the study population od. This increased knowledge of family Traditional Methods are not against the use of family planning planning methods has occurred through- Even before modern contraceptives were methods; thus, there is no significant so- out India. The All-India Surveys on fam- made available, the villagers prevented cial sanction preventing an individual ily planning conducted in 1970 and 1980 unwanted pregnancies and births, not to from practicing contraception. The gov- showed that the program’s major achieve- limit family size, but to fulfill social and ernment program offers free contracep- ment in the 1970s was the substantial in- cultural expectations and to improve the tives and services (although of poor qual- crease in the level of awareness of at least health of the baby and mother. , ity); therefore, economic cost cannot be a one method among the rural population.15 withdrawal and abstinence were the most major deterrent to use, either. Even psy- “Family planning,” however, has become commonly used methods.* chic costs, in terms of lack of sexual plea- a euphemism for sterilization. Among sur- In the past, rather than disclosing pre- sure, violation of sexual modesty and con- vey respondents who knew of any method, marital pregnancies and jeopardizing their flict with religious belief, do not seem to all knew about sterilization; only 6% knew chances of eventually marrying, unmarried be an obstacle. And because most young of the condom and IUD, and 2% the pill. To women often resorted to folk remedies to couples live apart from their parents, in- most, acceptance of family planning meant induce . Unripened papaya was tergenerational conflict cannot account for the end of reproduction. This perception commonly consumed as an abortifacient, nonuse. As will be seen, however, in the may be partly the result of the role of the as were certain local herbs that were be- village context, strains in spousal rela- 1975–1977 political emergency in making lieved to act both as abortifacients and as tionships and physical and material costs the family planning program known. While contraceptives. There is, however, no evi- (health effects and costs of medical treat- ostensibly promoting sterilization for fam- dence of the effectiveness of these methods. ment) after sterilization appear to dis- (Today, women can obtain abortions in courage the practice of family planning. *The information about traditional methods was not col- nearby towns without the knowledge of lected through the survey; rather, it was obtained over years of informal exchange with a few young and old anyone in the village. This option is made Overall Acceptance people in the village. possible by the independent cash income Despite the high level of awareness about women earn through beedi work; im- family planning methods, particularly †A man in the study village now 30 years old was breast- fed until he was about 10. proved bus transportation to the towns; sterilization, the level of use is low. Of all and increased access to information about women with at least two living children, ‡Condoms are available in some grocery shops in the vil- lage, and small numbers of them are sold. This suggests a abortion through health workers, networks only 26% were practicing contraception certain level of use, although none was reported. The local of friends and the mass media.) at the time of the survey. More important, health worker confirmed that no women were using other Withdrawal is used relatively widely in all of these were protected by sterilization; modern reversible methods, and added that women do not resort to abortion as a birth control method. The health the case of extramarital relations and to 36 had undergone the surgery themselves, worker is a reliable source of information because it would space births, but the overall prevalence of and one had a husband who had under- be unusual for a married woman in the village to obtain this method is probably low. gone vasectomy. No one reported using an IUD, pills or an abortion without her knowledge. Among the oldest couples, strict absti- any of the available spacing methods—the Women who become pregnant premaritally, however, may resort to abortion for social reasons, and may obtain the nence is followed, both because of the less- IUD, pill and condom.‡ procedure without the health worker’s knowledge. ened urge for sexual intercourse with in- Sterilization dominates contraceptive

100 International Family Planning Perspectives use partly because many women are not given the small sample size, socioeconom- some young people go once a week. even aware of the range of methods avail- ic differences are difficult to determine. Another change stems from the work- able. In addition, the official motivators Available evidence for India shows a lin- ing environment itself. When women do not encourage using other methods be- ear relationship between education and de- worked in agriculture, their older children cause they have to keep track of acceptors mand for children, and between education looked after the younger ones and kept of reversible methods, but not of those and contraceptive use.20 Nevertheless, the them away from the mother so that she who become sterilized. Furthermore, most study data show no significant difference was not disturbed while working in the women themselves prefer sterilization be- in acceptance by level of education. fields. But women in the beedi industry cause they would like to end childbearing. work at home, where children may dis- Most sterilizations in the village took Acceptance Among Wage Laborers tract them and affect their productivity. place after the emergency; the few village Whereas cultivators are underrepresent- Given the need to produce a certain residents who underwent vasectomy dur- ed among sterilization acceptors, and the amount of beedi each day, the importance ing the emergency were so old that their self-employed, salary earners and busi- of practicing family planning and having wives were beyond reproductive age. The nessmen are overrepresented, wage la- small families takes on new meaning. level of acceptance in the study village is borers account for the same proportion of Financial constraints are particularly lower than the national level of 35% of cur- sterilization acceptors as they do of eligi- acute for beedi workers whose only source rently married women and the state level ble couples (46%). Two factors seem to ac- of income is their earnings. A woman with of 41% in 1985–1986. This contrast is sig- count for acceptance among wage labor- four children whose husband was an al- nificant because the village women’s earn- ers: the government’s encouragement of coholic and did not contribute his earn- ings from the beedi industry make this vil- the small-family norm and families’ eco- ings to the family reported: “I cannot even lage economy relatively sound compared nomic circumstances. feed the children I have. The better alter- with the country’s average rural standard. The effect of the small-family ideology native for me was to get sterilized. I did The demographic characteristics of the has to be seen in the context of the chang- that and got about 150 rupees; the money acceptors indicates that the impact on the ing village economy and society. When provided us with good food for a week.” fertility level of the village would be mod- most of the village population depended Similarly, brick workers’ income may not est. About one-half of sterilization accep- on agricultural work to earn their liveli- be enough to cover essential costs for their tors in the village were 30–39 years old hood, the family planning workers had lit- families. For instance, a brick worker in his when they underwent the surgery, and tle chance to meet people and persuade 30s with three sons said that the oldest, a about one-half were aged 20–29. About them to adopt family planning because the teenager, wanted to go to school: “But the two-fifths of eligible women aged 30–39 are work schedule of the motivators was in- economic problem of my family did not per- protected by sterilization, compared with compatible with that of a largely agrarian mit that. I want to educate at least the two fewer than one-fifth in the younger and population. Furthermore, in agricultural younger ones, who are in the primary older cohorts. This pattern indicates that work, young and old people work to- school. If we keep having children one after increasing acceptance of family planning gether, and discussions about sex and fam- another, we cannot educate anyone, so my is a recent occurrence and that the accep- ily planning would therefore be considered wife underwent the sterilization operation. tance level rises as couples enter their 30s. inappropriate. Additionally, the effect of But now it seems to me that even educating Achieved parity appears to be the main persuasion through radio and cinema was at least one son would be out of my reach.” demographic determinant of sterilization. limited because only a small proportion of Evidence from other parts of South India Just 10% of acceptors had two living chil- the population had access to these media. also shows that poverty-driven family plan- dren; 43% had three, and 46% had at least Today, the environment is much more ning acceptance is a widespread phenom- four. Among couples younger than 30, the conducive to the spreading of information enon. One study in the mid-1980s revealed proportion sterilized increased from 9% about contraception and the exchange of that the high level of family planning adop- overall to 18% when only those with at least views among women about the adoption tion among the agricultural laborers in Ker- two surviving children were considered. and side effects of particular methods. In ala State was due to their poverty and re- The levels of acceptance of sterilization beedi work, younger by landholding, education and occupation and older people usual- Table 2. Percentage distribution of currently married women with are shown in Table 2. The acceptance rate ly work separately; this at least two living children, by sterilization acceptance, accord- appears to be higher among women whose provides opportunities ing to selected charateristics of their husbands husbands are landless (35%) than among for discussions about Characteristic N Acceptor Non- Total those whose husbands own land (19%). family planning and acceptor However, this difference needs to be in- other issues. Around Total 139 27 73 100 terpreted with caution because the land- 40% of households have Landholding* less group includes some well-to-do self- transistor radios, and Landless 66 35 65 100 employed persons and businessmen. Thus, some even have tape Landed 73 19 81 100 it is very likely that there is no relationship recorders. Furthermore, Years of schooling <3 72 25 75 100 between landholding and sterilization. an increasing number 4–5 44 29 71 100 Sterilization prevalence among wives of of young people, both >5 23 26 74 100 cultivators (21%) is slightly lower than that married and unmar- Occupation among wives of wage laborers (27%), which ried, go to the movies Wage laborer 63 27 73 100 Cultivator 48 21 79 100 in turn is slightly lower than the prevalence (where family planning Self-employed/salary among the self-employed, salary earners advertisements are usu- earner/businessman 28 36 64 100 and businessmen (36%); these differences, ally shown) at least once *Differences within this category are significant at p<.10. however, are not significant. Moreover, every two weeks, and

Volume 21, Number 3, September 1995 101 Family Planning in a South Indian Village duced employment opportunities.21 In an to look after themselves; they bear most from the village well. I am blaming myself earlier study, using micro-level data from of the hardships. If there is not enough for what we did.” He reportedly told some a few villages in Kerala, the investigator ar- food left for breakfast or for lunch, the women who were interested in undergo- gued that because of the extreme pressures wife goes without. She bathes the children, ing sterilization: “Your husbands are not on employment in a situation of a steadily and the husband can bathe at his place of like me, to fetch water from the well; so decreasing amount of work available, “the work; the wife does not have time to wash. don’t do it.” That was enough to put those decline in fertility among agricultural la- Other considerations also constrain the women off. He added: “It is good for rich borers need not be seen as an indication of working mother’s chances of taking a people because they do not have to do hard an improvement in their quality of life. In bath. For instance, most houses in the vil- work. For poor people like us, who have the Kerala context, it can equally well be lage do not have a bathroom; if there is to work every day without any break, it is seen as a sign of greater poverty.”22 one, it offers no privacy. Also, since it is the not good. I would not recommend to any- Thus, it seems that family planning ac- women who fetch water from the well, one to undergo this after my experience.” ceptance among wage laborers, most of they will sometimes forgo bathing to re- Similarly, a landless brick worker aged whom are poor, is influenced by their eco- duce their workload. 35 and married with one child said: “I will nomic conditions and the spread of the ide- If a woman accepts sterilization in such not accept it, even if am offered 1,000 ru- ology of the small family; acceptance is fa- an environment, the follow-up services pees. After sterilization, we cannot do cilitated by easy access to sterilization. It need to be exceptionally good to avoid hard work.” In support of this claim, he may be that among the relatively well-off any health problem. In addition, she cited a movie in which the hero was beat- self-employed, salary earners and busi- should have someone to do her house- en up after undergoing sterilization; under nessmen, acceptance is due to their aspira- work for at least a week after the opera- normal circumstances, the villain is beat- tion to make use of modern facilities (e.g., tion; but in most cases, that does not hap- en up by the hero. education, urban jobs) and thereby improve pen. Her husband may be willing to help It is not, therefore, surprising to find that their social status.23 This does not mean that her, but he has to go to work. about three-quarters of eligible couples the poor do not also aspire to improve ma- For example, Uma was a beedi worker who were not intending to use family terially and socially; they do, but their ob- with three children at the time of the sur- planning, and more than four-fifths of jective conditions do not seem favorable. vey. Her husband was a bricklayer with no those who disapproved of sterilization, other source of income. They live in a small cited health effects as their reason. Some Family Planning Intentions room in a cattle shed of a rich man in the couples use withdrawal instead, because When the eligible couples were asked village, who does not ask for rent. Their it does not involve any health risk.* about their intentions to use any family home has no washing facilities, so it is hard planning method, the responses given for her to take a bath very often. Having Gender Inequality were not encouraging: Two-thirds of considered the incentive offer and hoping Another factor that discourages the prac- women did not intend to use any method for a better future for her children, Uma de- tice of contraception is the unequal rela- in the future. The reasons for this lack of cided to undergo sterilization when her tionship between husbands and wives.25 interest are not hard to trace. last child was less than one year old. Although women initiate the discussion It appears that Uma did not receive prop- about adopting family planning, men Health Concerns er follow-up care, and the surgical wound make the final decision. Men usually do Although it is generally argued that steril- did not heal well. Eventually, she was taken not consent to use condoms or undergo ization should not affect health, and there- to the public hospital, where she was given vasectomies. Even when couples rely on fore fears about the procedure are mis- medication. After a few days, her condition withdrawal, some women said it was they placed, the poor living conditions, poor had deteriorated; she was, according to her who must draw away from their husband health (e.g., malnutrition) and lack of good- brother, “almost dead.” Uma was moved before he ejaculates. quality family planning and follow-up ser- to a private hospital, and her husband had Men’s opposition to female sterilization vices in the study village increase the risks to borrow about Rs 1,000 ($50) to pay for it. arises both from their concern for their for some people undergoing sterilization. Uma is fine now, but it will take years for wives’ health and from fear that they are Living conditions for women in the vil- her and husband to repay the Rs 1,000. losing control over their wives. Men may lage are especially poor, leaving them sus- Similar conditions prevail in Punjab, be suspicious that sterilization will make ceptible to ill health. Before a man leaves for where the family’s social and economic it easy for their wives to indulge in extra- work each day, his wife has to get up, clean conditions may affect the risks associated marital sexual relations because there is less the house, go to the well to fetch water, and with sterilization acceptance, and where risk of pregnancy and, hence, discovery. make his breakfast and lunch. After he has sterilization may lead to unintended Disagreements between husband and left for work, she has to feed the children, repercussions for the family.24 wife on this issue sometimes create sig- send them to school if they go and start mak- A further obstacle to acceptance is that nificant tensions in the family. For instance, ing beedi. She must submit her day’s beedi if even one case goes wrong, the news is a woman in her early 30s with three chil- to the agent in the village (her failure to do likely to spread rapidly throughout the vil- dren said: “My husband does not want me so may create tension with her husband) lage. For example, a brick worker in his to undergo sterilization, presumably be- and should have her husband’s dinner 30s related that after having three sons, he cause he is suspicious of me. But I want to ready when he returns home in the evening. and his wife, a beedi worker, had decid- have it. Whether he likes it or not, I am In village families, women have no time ed to stop having children; his wife un- going to go after a month to the nearby derwent sterilization. town and get sterilized without his knowl- *The observation about withdrawal comes from the in- He said: “My wife cannot perform any edge. Even if he does not support me later depth interviews, not from the structured interviews, which did not collect systematic information on reversible hard work after her sterilization. She finds in my life, I can support myself and my methods or abortion. it very difficult to fetch even a pot of water children from my beedi work.”

102 International Family Planning Perspectives For some men, their wives’ health does Hopkins University Press, Baltimore, Md., USA, 1988. Political Weekly, 4:1887–1892, 1969. not matter in their pursuit of the desired 2. K. S. Parikh, ”India in 2001,” in A.J. Coale, ed., Eco- 18. G. Djurfeldt and S. Lindberg, 1980, op. cit. (see ref- number, and combination, of children they nomic Factors in Population Growth, Wiley, New York, 1976, erence 13). p. 320. want to have. When the expected subor- 19. M. Nag, “Constraints on the Use of Fertility Regu- dinate role of a wife is not sustained, the 3. ”Gandhi Addresses the World on Family Planning,” lating Methods,” Center for Policy Studies Working Pa- family is in turmoil, as in the following case. International Family Planning Perspectives, 15:106–107, 1989. pers, No. 107, The Population Council, New York, 1984. A young couple have only an eight- 4. R. Leete and G. Jones, ”South Asia’s Future Popula- 20. A. K. Jain and M. Nag, “Importance of Primary Ed- year-old daughter. The delivery had been tion: Are There Really Grounds for Optimism?” Inter- ucation for Fertility Reduction in India,” Economic and so complicated that the woman had had national Family Planning Perspectives, 17:108–113, 1991. Political Weekly, 21:1602–1608, 1986. to be hospitalized; but wanting to have at 5. P.K. Wattal, Population Problem in India: A Census Study, 21. A. M. Basu, “Birth Control by Assetless Workers in least one son, she became pregnant again. Minerva Book Shop, New Delhi, 1958. Kerala: The Possibility of a Poverty Induced Fertility Tran- sition,” Development and Change, 17:265–282, 1986. This pregnancy was more complicated 6. D. R. Gwatkin, “Political Will and Family Planning: than the first, and surgery was necessary; The Implications of India’s Emergency Experience,” Pop- 22. J. P. Mencher, “The Lessons and Non-Lessons from the baby was born dead. The doctors who ulation and Development Review, 5:29–59, 1979. Kerala: Agricultural Labourers and Poverty,” Economic and Political Weekly, 15:1781–1802, 1980. operated warned this woman that anoth- 7. ”The Verdict,” editorial, Economic and Political Week- er pregnancy might cost her her life. ly, 12:519–520, 1977. 23. A. Schnaiberg and D. Reed, “Risk, Uncertainty and Family Formation: The Social Context of Poverty 8. A. M. Basu, “Family Planning and the Emergency: An Knowing that her husband would not let Groups,” Population Studies, 28:513–533, 1974. her undergo sterilization, the woman made Unanticipated Consequence,” Economic and Political Week- ly, 20:422–425, 1985. her own decision to obtain the procedure. 24. J. Pettigrew, ”Problems Concerning Tubectomy Op- erations in Rural Areas of Punjab,” Economic and Politi- 9. G. F. Brown, A. K. Jain and J. Gill, Analysis of Popula- Once her husband learned that she had been cal Weekly, 19:995–1002, 1984. sterilized, he began drinking away his earn- tion Policies and Programs in India, The Population Coun- cil, New York, 1987; and A.K. Jain, “Revising the Role 25. S. J. Jejeebhoy, ”Women’s Status and Fertility: Suc- ings, coming home drunk a few times a week and Responsibility of the Family Welfare Programme in cessive Cross-Sectional Evidence from Tamil Nadu, India, and fighting with his wife. Villagers take this India,” Economic and Political Weekly, 24:2729–2737, 1989. 1970–80,” Studies in Family Planning, 22:217– 230, 1991. case as a lesson to all women that if they dis- 10. J. C. Caldwell, ”Strengths and Limitations of the Sur- regard their husbands, the consequence is vey Approach for Measuring and Understanding Fer- Resumen lifelong quarreling and unhappiness. tility Change: Alternative Possibilities,” in J. Cleland and Un estudio cuasi antropológico, basado en en- J. Hobcraft, eds., Reproductive Change in Developing Coun- trevistas estructuradas y no estructuradas y tries, Oxford University Press, Oxford, UK, 1985, Conclusion pp. 45–63; J. C. Caldwell, A. G. Hill and V.J. Hull, eds., en la observación de los participantes, revela The family planning program in India has Micro-Approaches to Demographic Research, Kegan Paul In- varios factores que influyen significativamen- not been successful in making people ternational, London, 1988; H. L. Smith, ”Integrating The- te sobre el control de la natalidad en un pue- aware of a variety of birth control meth- ory and Research on the Institutional Determinants of blo ubicado en el sur de la India, donde el uso ods. For villagers such as those inter- Fertility,” Demography, 26:171–184, 1989; and W.G. Axinn, T. Fricke and A. Thornton, ”The Micro-Demographic de anticonceptivos es más bajo que a nivel es- viewed for this study, family planning Community Study Approach: Improving Survey Data tatal. Estos factores son la falta de servicios de means sterilization. Neither does the pro- by Integrating the Ethnographic Method,” Sociological seguimiento, la desigualdad por razón de sexo gram address the problems associated Methods and Research, 20:187–217, 1991. y el hecho de que la esterilización no es apro- with adopting birth control methods. 11. A. Dharmalingam, “Social Relations of Production piada en todas las situaciones de trabajo y con- The organized family planning pro- and Fertility in a South Indian Village,” dissertation, De- diciones de vida. Para mejorar el programa y gram in India was originally designed to partment of Demography, The Australian National Uni- la calidad de vida, es necesario que el progra- versity, Canberra, 1991; ——, “Old Age Support: Ex- improve the quality of life of ordinary peo- pectations and Experiences in a South Indian Village,” ma de planificación familiar del gobierno re- ple by enabling them to choose a small Population Studies, 48:5–19, 1994; and ——, ”Economics suelva los problemas secundarios relaciona- family size. Although a considerable pro- of Marriage Change in a South Indian Village,” Devel- dos con el uso de la esterilización y facilite la portion of sterilization is poverty-induced, opment and Change, 25:569–590, 1994. elección individual, tomando en cuenta el con- the program’s ultimate success depends 12. J. C. Caldwell, P.H. Reddy and P. Caldwell, The Caus- texto socioeconómico de la población. partly on how it contributes to achieving es of Demographic Change: Experimental Research in South a better standard of living. India, University of Wisconsin Press, Madison, Wisc., USA, 1988; and T. S. Epstein, South India: Yesterday, Today Résumé Program performance and quality of life and Tomorrow, Macmillan, London, 1973. Une étude quasi-anthropologique, basée sur des cannot be improved if the side effects expe- 13. G. Djurfeldt and S. Lindberg, “Family Planning in a entrevues structurées et non structurées ainsi rienced by poor acceptors of sterilization are Tamil Village,” in L. Bondestam and S. Bergstrom, eds., que sur l’observation de participants, met à jour left unattended, and a variety of contracep- Poverty and Population Control, Academic Press, London, plusieurs facteurs qui exercent une forte influ- tive methods that are appropriate for Indi- 1980, pp. 103–123; and International Institute for Popu- ence sur le contrôle des naissances dans un vil- an men and women’s living and working lation Sciences, Bombay, and Department of Sociology, lage du sud de l’Inde, où le niveau d’utilisation conditions are not offered. By ignoring issues Aurangabad, Baseline Survey on Fertility, Mortality, and Related Factors in Maharastra, International Institute for des contraceptifs est inférieur à celui à l’éche- faced by a large majority of people, the pro- Population Sciences, Bombay, 1985. lon de l’état. Ces facteurs sont le manque de ser- gram not only fails in its objective, but also 14. J. P. Mencher, ”Family Planning in India: The Role of vices de suivi, l’inégalité entre les sexes et le fait delays achieving replacement-level fertility. Class Values,” Family Planning Perspectives, Vol. 2. No. 2, que la stérilisation n’est pas adaptée à toutes les 1970, pp. 35–39. situations de travail et conditions de vie. Pour References 15. M. E. Khan and C. V.S. Prasad, “A Comparison of améliorer les prestations des programmes et la 1. V.S. Verma, Population Projections for India 1981–2001, Cen- 1970 and 1980 Survey Findings on Family Planning in qualité de vie, le programme gouvernemental sus of India 1981, Series 1, New Delhi, 1984; United Nations, India,” Studies in Family Planning, 16:312–320, 1985. de planning familial doit aborder les effets sec- Department of International Economic and Social Affairs, 16. “The Verdict,” 1977, op. cit. (see reference 7); and A. M. World Population Prospects: Estimates and Projections as As- ondaires liés à l’adoption de la stérilisation et Basu, 1985, op. cit. (see reference 8). sessed in 1984, Population Studies, No. 98, New York, 1986; faciliter le choix individuel, compte tenu du con- and K. C. Zachariah and M. T. Vu, World Population Projec- 17. K. H. Gould, “Sex and Contraception in Sherupur: texte social et économique du village. tions 1987–88 Edition: Short- and Long-Term Estimates, Johns Family Planning in a North Indian Village,” Economic and

Volume 21, Number 3, September 1995 103