PEOPLE'S PARTICIPATION IN

FAMILY PI-ANNING

PEOPLES'S PARTICIPATION IN

FAMILY PLANNING

V A Pai Panandiker Ajay K Mehra In Collaboration with P N Chaudhuri

Under the Auspices oJ

Centre for Policy Research

UPPAL PUBLISHING HOUSE NEW DELHI

UPPAL PUBLISFING HOI-'SE

3,

Ansarl Road, Daryaga{r} l.{ew Delhi-l10002

@ Centre for P$icy Research First Published 1987

ISBN:

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PRINTED|*,^o,o
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FOREWORD
r INDIA'S demographic problem has been' a malter
of considerable concern in recent years. The latest data has only added to this sense ofconcern since the birth rate isstill high at estimated 33 per thousan{ according to our plans and hopes, it should have been much lower. The consequences of high population growth to the polity as well as to the economy are indeed serious. As the Seventh Plan document states "The fairly high rate of gowth of population

neutralises to a significant extent the fruits of economic growth and uses up part of the potential savings which could otherwise be used to raise capital per head and the productivity of the labour force at a faster pace". The Seventh Plan Document howevei, does not give a central

focus to the population policy and programme in the overall development strategy. It does recognise, however, that to attain the long term goal of NRR-I by the year 2000, it is important to have the programme accepted voluntarily by the people .and for the people to participate in it extensively. The population problenl therefore, requires a fresh look in terms of the level of people's awareness, motivation and demand as well as the supply of family planning services to the people, including organisatioiral issues connected with fertility control Without the closest involvement of the people in the family planning programme through their representative institutions, voluntary groups and local organisationq the task ofpopulation control is almost irnpossible to meel The current population policy does not as yet, suggest a well thought out programme of people's participation. It is a major gap in the policy conception. The prsent study is an attempt to fill the gap, albeit partially. It examines some of the basic problems anci issues in people's par-

ticipation

in

family plarining and

suggests some concrete

policy action.
We wish to recerd our deepest {ppreciation of the partial filancial assistance rcndered by the Fhmily Planning Foundation for the conduct of this study. We are also gmteful to Shri P R Chari, the then SecreBry to the Government of Madhya Prade$h Public Health and Family Welfare Departhent and his ofllcerg Shri M S Dayal, the then 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) Pune and her officerg Dr L Banu Coyaji. Director, KEM Institute of Rural P Ramachandrarl Director, The Dr Raini Kant Arole and Health and Family Welfare Dr (Mn) Mabel Arole of Compdehensive Rural Health Project Jamkhed (Ahmednagar District), and Shri Satish Chandra of the Planning Association for lltrew Delhi Branch of Indian F valuable help and facilities for on the study. We also wish to record our appreciation of the work done by K Mehra in the conduct of Shri P N Chaudhuri and Shri this study.

Centre for Policy Research New Delhi August, 1986

V A Pai Panandiker Director

Preface
part of the CPRs larger interest in population policy, the present 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 to

AS

bringing 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 on popular participation. Population control" and family planning as its main instrument has been identilied as a developmental activity 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 the lndian context is basically voluntary in nature. Effectiveness of this 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 it is of utmost importance to move towards a greater acceptance of the programme by the people. Keeping in view the need to bring down national'fertility rate the Planning Commission of India appointed a Working Group on population policy in 1978. The Group in its report urbmitted in 1980, expressed the opinion that the taskwill not be easy to achieve unless the programme of family planning had the fullest-participation ofthe people, individually and through their represen' tative institutions, voluntary associations, local organisationg
etc.

.lt was \i/ith these concerns that we undertook the present strrdy' In the very nature of the study, it could not have been completed without field visits in different parts of the country. Since we were making case study of two models of participatory population con' trol programme, the field visits were possible only with willing

cooperauon of the institutions extending all the facilities to us. panying us during freld visits

ed We thank thern for e olficials and staff accomextremely cooperative and

made our trip. as fruitful as Ouf problems in the field did not with transport and boarding lodging facilities. Once we viere i the villages during 1981 and started approaching people, we repli how difficult it was to talk to people freely on a subject like family planning, With the memories of the Emergency still fade4 we were" sometimes taken as paft of a sterilization Not everyone was easily forthcoming for interviews. There difliculties also in meetinpi people in villages during the day. We however zucceeded in approaching people, persuading to join the interviews and

,comforting them to respond to questions with the help of oflicials accompanying us. We are to all our respondents even though most of them will not this study. We gratefully acknowledge the ion offered by Prof Imtiaz Ahm ad of the Centre for Studies of the Jawaharlal Nehru University . in preparing schedule lor this
study.

The study could not have acqu cooperationi and help and support

the present shape without

Librarian Mr. Trimbak Rao and and adrhinistrative ;taff of the CP

Mr. Karnal Jit Kumar, er members of typing pool We record our gratitude to

them. The views and opinions expressed in the study are entirely ours

and do not necessarily represent th[se of the Centre for Policy Research or the Family Planning Fpundatiorr V A Pai Panandiker Ajay K Mehra

Contents
Chapters Foreword I Introduction II Objectives and Design of the Study III Voluntary Efforts in Family Planning-I
lV
New Delhi Family Planning Association Voluntary Efforts in Family Planning-Il Gandhigram Institute of Rural Health and Family'Welfare Trust Vadu Rural Health Project Voluntary Efforts in F-amily Planning-IV Comprehensive Rural Health Project Jamkhed Family Planning Through Panchayats-I Madhya Pradesh Family Planning Through Pahchayats-Il
Pages

V I
15

23
C,5

V Voluntary Efforts in Family Planning-Ill VI VII

96 128
159

VIII IX X

l9I

Gujarat Family Flanning and People's Participation 226 Policy Conclusions and Recommendalions 249

Bibliography

254

Chapter

Introduction
P.tnrtctpnrloN is the very essence of democracy. A democratic society is a participant society. The close relationship bel ween society and polity makes legitimacy and efficacy of a democratie polity, dependent on the extent and level of participation in society.t Popular participation is also considered essential to ensure effectiveness and success of developmental programmes. The importance of popular participation in a democratic society, therefore, would grow directly in proportion with the emphasis on development2 lt would place participation in an entirely new context The process of evolution of democracy as an ideology and institution and of participation as a process of strengthening (emocracy in both its manifestations would not only bring out clearly the place ofparticipation in evolutionary and transplanted forms of democracies, but it would also be'crucial in determining the degree and style of contemporary political participation' (Di
Palme- 1970:23). The way historical beginnings and advancement of mass participation is related to the development of civil, political and social rights establishes it as an essential prerequisite of democracy. Its history began with Greek civilization only to disappear with the decline of the civilization. The medieval European societies restricted participation by granting rights and liberties oirly to certain gloups, corporations and estates, which also had representation in judicial and legislative bodies (Bendix, 19&:43-85). But gradually
.

these regimes also started breaking down (See Tocquevillq 1945:II:198-3ll) and through the experience of the struggle for

parliamentary 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
be reborn only in the scven-

decline of the Greek Civilization,

teenth and eighteenth centuries in

.Growing frqm inlancy in the seven to adolescence in the nineteenth twentieth century.

rope and North America.

th and eighteenth centuries it came of age only in the

The three c,ases indicate the and the form of participation wh people. The discussion on evolu
mainstay of democratic system wou tioning one of the biggest of the which established that participatio

tion of Western democracy was acquired gradually by

n of participation as the

without mentieth century revolutions, can also be mobilized for a in a 'definite' direction. particular purpose and c was probably.the first case in the modern history where Russia's advantage of the popular an organised cadr+based party ressive Tsarist rule staged a against autocratic and discontent hical rule, destroying the revolution, overthrowing the mo feudal order, and creating a new t-up based on one ideology, of ooinion exist on whether being run by. one party. Differen mOdern Soviet system is democra ic or nol But it is generally agrarian Russia has been agreed that the erstwhile T USSR by mobilising partransformed into modern: in ticipation for planned economic d elopment The Cornmunist party is the instrurgrqt of mobilis tion. The impo(ance of the Russian Revoluticm,lles in -transla g a philosophy into reality and political systern.l and giving bifih'tO'a new social crDatorv movements 1n exln b sharp conttast, the modern ntries oftoday, date back to colonies, the so-called third world tury. Advent of colonialism late nineteenth or early twentieth opment impeded growth of at the feudal or tribal stage of d experience of participation irrdigenous institutions. Thus, th exploitation. But low level of begins with the rise ofprotest agai literacy and economic underdevelo ment restricted pa.rticipation cases, like India, it did trickle to the privileged few, though in
be incomplete

down to lower levels due to appeal

leaders. ln spite oi many limitatlons,

masses by some'chairsmatic

countries have been able to long period of tirne. institution for !ustain democratic was established in India country. India is'one such nearly 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

because of two reasons. First of all, at every stage ot the national

movement the leadership was able to wrest from their colonial masters not only democratic rightg however limited, but also democratic institutions. Thus, when independence camg India had some institutions, to be used as foundation stone. Secondly. Mahatma Gandhi was able to provide the national movment a 'mass' character (through a mass based Congress system). Therefore, at the dawn of independence India'had an available leadership enjoying widespread legitimacy, a structure of institutions, and a lirm sense ofthe kind of society that lndia sought to become in the coming generdtions. Central to all this was the resolve both to build the nation and to develop its social and economic base through the democratic political process' (Kothari, 1976:511). The leadership did not show any hesitation in using the available institutional structure and the ideas nurtured during the struggle for independence to create iranchise and periodic elections and keen competition between a number of parties was preferred as the'model of ordering social and political diversity.
The leadership did not merely succeed in creating a democratic structure but also sustaining it through the early years of crises. The Indian people also demonstrated, remarkable flexibility in adapting themselves to the new form of political culture. Two p6ints corne out clearly from the Indian experience:

(a) Participation
of time; and

takes deeper roots if it has evolved over a period

(b) Nature, iorm, extent and level of pirrticipation would depend

upon historical as well as environmental factors.

Political Participation Political participation has been interpTered to'refer to the activity of private citizens designed to influence government decision-making (Huntington and Dominguez, 197 5:32'). lt involves a whole range of activities from discussing politics to campaigning voting contesting electionq attending public meetings. joining protest marches, etc. This definition puts
emphasis on activities rather than attitudes. Sometimes the term is

applied to political orientation rather than activities (Nie and Verba, 1975:1). lt may also refer to building attitudes for political activities. As J.S. Mill puts it,'Among the foremosi benefits of free government is that education of intelligence and the sentiments

People's

in Family Planning

which

ranks of the people when carribd ''down to the very ch directly affect the great they are called to take part in acts interes.t'of the country' (Mill, 1873 are important in determinThus. attitudes and activities of attitude is as important as ing politi6al participation. Buildi of a continuous process of activd participatio4 for in the abr
is

building participatrory attitude the se would. remain narrow and t tumble oie day. In other the whole democratic structure words, existence ot absence of such process would finally determine political culture of a society

political participation itself is

multifaceted phenomenorl encompassing a wide range of variahles. But most studies have not taken 'the alternative ways in whicti citizens can participate' into acco_q4t- dccording t9 Hunti ngf on afi d Nel son-(1 976: I 59-60): Political panrcipation is a much more complex and less clearcut phenomenon than it appears to be at first glance. It is not a single homogeneous variable. lt ls, rather, an umbrella encompassing many different forms of 4ctions; all of these actions are designed to inlluence governmeht at some level, but they are not all related to each other, nor $o they vary in the same directions or respond to the same prqssures. Crude indiCes, such as voting t|rnout, the incidence of parmembership, can capture ticipation in demonstrations, or gross contrast-a sudden expahsion or contraction in pariicipation within a country or very wide differences in participation levels between two countries. But in most nations. trends in are usually ambiguous. the level of political parti stateme4l lt points out the lirnitations This is a very revealing of 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 position of derelson et al (1954) that 'allmost all measures of political involvement 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 participate, As Nie and Verla point oirt, 'the citizenry is not divided

Innoduction

simply rnto gladiators and non-gladiators Rather, there are may types ofgladiators engagihg in different acts with different motives an{ different consequences' (1975:7). Verba Nie and Kim (1971, 1978) and Verba and Nie (1972) presented participation in a crossnational context These studies ertelded the boundary of participation by including involvement with community activities and other non-elecforal activities. But non-conventional methods ofparticipation were overlooked even by these scholars. As $atish Arcira points out Most o ler writers on the subjecf omtt reference to non' conventional political behaviour, Demonstrations, strikes asd morchas-not to speak of more violent activities are absent from most standard typologies or operationalized indexes of political padicipatio& rarely does one find any willlngness to discuss these modes in relating to more conventional ones ... There seems to be a pressing need for a typology of political activity 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 political eflicaqy, and a greater sense ofobligation to be a participant In addition, 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 and national lwels as well 'It comes as no surprise', one set of authors conclude4 'to learn that a nation s level of political participation covaries with its lqel of economic development'4 (Nig Powe-ll and Prcwitt, 1969). Milbrath (1965) and Dye (1966) had alreadv made the discovery that lwels of voting participation among the flfty states 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 and co-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
organisations and assqciatior! participation (Huntington and The Indian cdse has both
l

in Family Planning encourage and augment

1975:34-35).

and dissimilarities with its distinct history. both prePther developing nations. Apart colonial and colonial, and the mostvisible dissimilari& is processes and institutions for India's ability to sustain nearly four decades Similarities xist only in generic sense, i.e., existence of traditional" pri and parochial grouployalties What has, perhaps, sustained Ir s experiments with the demo cratic institutions and values from the West is first politi cization of traditional and, second, widening participation base which has channelised in positive

direction
Democracy ard participation

India, though borrowed frorn.

the models operating in the Wes! however, Indianised them' own character and can no solves, ie., they have acqriired grore be identified as an exact of original models. Studies in the functioning of democracy India aS well as nature ofpoliti-

cal participation have Weinet's study of India's two highlights emergence of an which he describes as thd mass established elite political Delhi. and the State capitals Eriglish speaking intelligentsia, and permeates local politics, prganisation and local adml ing political culture and the
1965:199-244\.

this beyond any doqbt cultureg for examplg political culture in Indi4 ylililnl culture, as against the The latter'is located in Ngw

is the political culture of the the former is in the districts urban and rural, local parry The former is an expandis the established one (Weiner,

Participation in Development
ent rs an area often started receiving som atten: rping nations began grappling with problem of development in e face of scarce natural resources. They.do not only suffer from tal aspiration lag time development lag is acute. There is. thercfore growing feeling that participatio would be able to narrow both
neglected by social scientists tion recently as most of the

The study ot participation in

It

the gaps-As a UN study points

...

popular participation can be

Innoduction

'l

an effective means of promoting policies for economic and social

development ... (through) a sincere commitment by national' political ltiaders to promote popular participation ... (and) a willingness to create the necessary institutional structure and other political conditions that make popular participation possible' (United Nations, 197 5:62). Keeping this in view and owing to the larger interest in the develdpment of the member countries, United Nations has attempted to study participation in the context of development These include' study of Social development policy (United Nation+ l97l), a study of participation in decision making for developrfient (United Nations, 1975), etc. Lately some Indian scholars have also shown interest in this theme (see Arora 1979, Chekki, 1981, Fernandes (ed), 1980; Chaturvedi and Mitra
r982).

Thqre is a tendency to confuse participation with mobilization Thus, while planners and bureaucrats complain about la'ck of popular participation in development process, what they generally refer to is the failure of people tci ratiff and accept the pro, grimme uncritically rather than participate. And when they talk about moves to ensure people's participation in development programme, they actually refer .to mobilizatibn (Chtturvedi and

Mitra

1982:l-2).

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

(1982), one of the very few studies exploring this question empirically, has argued that participation in development may take place at three different leyels: in decision making in implementation and in receiving benefits The study also points out that thelevel at which citizen participation in development takes place depends on the organisation of

A study by Cnaturvedi and Mitra

Pmple's f,arxcipuion in Family planning

the institutional structure, prevailing value system, the naturp of leadership and the nature of citizehry itself (Chaturvedi and Mit,ra 1982:l0l). Thug the level ar h people participate in the .development prgcesg and the il structure designed to sustarn and sftengthen come out as imporraur elements which encourage and developmeqt While prwailing value systems and the of citizenry could become a serious irnpediments or an propellant at the initial stage, the nature ofleadership determine their impact in the loag run
,

with needs perceived by the expertf, have more chances ofaccep tiince (Pareel 1978:.72 ), potenrial mistakes in planning and implementing programmes bould be minimised. It would also. rensure more .equitable distribution of benelits (United Nations,,
1975:10).

It would be worthwhilg at thiq stagg to highlight benefits of popular participation in developmbnt process The first benelit of. cgursg would be channelisation of people's energies for constructive purposes which would also {ct as educational process for then Since the programme base{ on .felt' necdq as'contrasted

'fhere has generally been a to highlieht the borls oi popular participation in terms of f{ulty inplementatibn and lnef-r hciencies resulting from handling by lafinen It also results in delay in taking rvhich reducee :the ability of national leaders and adm ito make development policy and programmes expeditiously (United Nations. 1975:l&11). Etperience however shows that in ithe context of underdweloped countries, inefficicnces resulting frqm inexpert handling are likely to be common iqitiatally not only dt the lower level but also at the higher level Secondly, it is not only. necessary to formulate dwelopmental plans and expeditiously but also ma&e' policies anil programmes that are Fffective. In fact these excuses
have very often been used by the
,at the lower'level not realising tha{ wfthout popular

they may have the po\r'er to 'Fower to enforce then

nature bfthe problbm and level of conllict iil Society (U

participation decisions but relativelv little

may tncrease the

Nations. 1975J5-16).

Intrcducrton

Family Planning and People's Padicipation

Nowhere in the programmes of social and economic..develqp
ment is the people's participation more relovant than inthe far.nily

planning programme. Family Planning by policy prongun-,

cements is a voluntary programme based on persuasion about a couple's choice of the size of the family. The official policy as .announced in the 1980-85 Five Year Plan also gmphasizes that fa.mily planning programme has to be an'integral part of the developmental package. As the Plan Document states: 'Limiting the growth of population is... one of the main objectives of the Sixth Plah. This has to be achieved through persuasion of people to adopt the small family norm voluntarily backed by appropriate programme of supplies and services for countraception The Family Planning Pro. gramme has also.to be made a part of the total national effort for providing a better life to the people' (India l98l:375). The sevenrh Five Year Plan not only accepts the voluntary nature of the family planning programme but also emphasises the need for participation in it According to the Plan Documeht 'Inter-sect;ral coordination and cooperation and the involvement of the voluntary agencies in the programme will be necessary in this programme to an even greater extent than in healtll Community participation is ,essential for g[e _v_oluntary acceptance of the Family Welfare Pro-

of non-govem: mental organisations and of informal leaders in the community and imparting them the necessary training to motivate and to p6rticipate in the programme are important,aspects of efforts in the Iield' (India, 1985:II:282). In'p'ursuance of this broad approach, the family planning pro 3ramme in Indi4 barring the brief aberration of 1975-7 6, has been esseridally a voluntary programme; emphasizing the need for-a small:family and slower growth rate of population in the national context hnd happiness that it wpuld bring to the familt'. Thug while family planning programme in the national context was viewed as a developmental activity, considefng unplanned pop ulation growth as an impediment to economic developmenl its .appeal for indivrduals was seen and projected In terms of 'health and 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.

gramme. Indentirication and active :involvement

l0
However,

People's

in Family Planning

tle family planning

include particip:ition of 'benefi cii

Whatever shifts in emphasis gramme during the hrst two and tion, the attitude of the elites and people' participation at impl ning of the programme till then the people's own choice.8 So m
force was considerej the only Apparently, . too much has

orthodoxy and superstition of planning prograrnme. Acceptan gramme depends, to a large

rewarding or not(Di Palmq 1970: India, a farmer does not find a helpless if he does not have sons

brings out this point forcefully. him: You were trying to convince mb rn 1960.that I shouldn't have any more sons.l I Now, you $ee I have six sons and two daughters and I sit at home in feisure. They are grow4 up and they bring me money. One evtn works outside as a labourer. You told me I was a poor me{r and couldn't support a large family. Now, you seq because of my large family, I am rich man (Mamdani, 1972:109). The backlash of the coercive used in 1975-76 led ln 1977 for the fiist time to a of people's participati0n in family planning. The election of 19.77 broueht me vividly the implications of 'imposing the family planning p on an unwillins mass ofthe population. It also forced th policy makers to think in terms of more 'popular participation' the programme. But in retrospect, perhaps the shift in a h may well have been tactical rather than due to realisation or true recognition of the importance of participation'of people. 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 fact people's participation in this that neither a proper definition context was made. nor an overall trategy evolved through which such participation could be achi participation in this context in It was essential to clearly de

till mid-7Os did not in it as a major policy goal. t have been brought in the prodecades of its implementalicy makers left little room for tion levelT In the entire planttle consideration was siven to. so that at one point of time implement this programme,e made out of ignorancg people in accepting the family of, and participation in, a proon whether people find it 22). And in the context of rural Tamily rewarding. He feels to help him. Mamdani's study One of his respondents told
es'

Intmducjion

II

oroer to evolve an effective strategy for mobilising.people because the use of the concept of participation in family planning is likely to be confusing How are people going to participate in this pro. gramme? Idchlly the popular participation

in family planning

would involve a great deal of role for the ppople and their local institutions to make decisions regarding the programme ind also a role in implementing and executing the programme. Basically participation necessitates taking the programme to the peoplg involving them as txtensively as possible in all the dimensions of the programme. Decentralization and localization are therefore two crucial parameters of such an approach. Remote bureaucratic and even.political operation of the programme simply cannot deal with the apprehensions, needs and even concems of the poople. In other words popular participation of the family planning programme implies a great deal of its democratization. tven rn tne changed scenario srncq 1977 the governmental and bureaucratic conception ofpeople's participation has three main characteristics: (a) people's readiness and active cooperation in fulhlling (he govemment's sterilization targets; (b) unquestioned acceptance by the people of the government view of 'small family', and (c) 'unquestioned acceptance of the family planning, programme by the people. Thus, the emphasis is on mobilisation of the people to accept the governmental programme. There is not even 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 define and demarcate the boundaries of participation in this specilic

context . Participation should ideafly be autonomous-that is decided upon.directly by the people. However, in mqny countries including some of the developed world, participation is more of the mobilised' variety. Mobilised in the sense that participation is achieved through a conscious organised effort to enlist the suppoit af the.pebple for the prograrnme. As stated earlier, participation appears to need mobilisation initially.t: lt could range frdm ;motivatiori for thb small size family to the delivery of contraceptives, organisation of campg mass meetings, etc. Thus, at one
a

levql

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

mouva acceplo{ coulq D accepto{ could be so motivated tha! helshe takes upon hinl/her the to othe$. And finbllY, volun' responsibility to spread the Mandals' etq)' rYnrcn associations tary associations (eg Youth clubsi Mahila Mandalq etc,), which should be created where they do rlot exist, could also be broughtl

into the ambit o{ family plannin$ Thug participation in family planning 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 leading 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 democratically elected body at the grassiroots level. Another institution which iould prove useful is volulntary associations at the local
leveL

noted that, 'participation is Montgomery and Essman when it produces tangible .more likely to be induced and ------J ".-'appeal t$ felt needs' (Quoted in\Kralbtz. benefits to clients ... and , as mentioned earirer, rne and Goodmarl 197 3 :37 6). U linked to the felt needs.l3 planning programme was family the felt deeds are going to be of Partici Even in our scheme efforts, however, have so an important factor. The the progra.mme to PeoPle's felt' sucaessful in far not been needs. Some experiments have ddmonstrated that this link could provide fillip to participation in fhe programme.tr would automaticallY link the A role in decision'making in ensuring people's par' to felt needs, thus, is iprogramme in any programme. This ticipation even mobilised Partic channels for providing the requires building specific
means for such particiPatioc : in the present policies and Despite all the inherent limita the objectives of peopleis Parapproaches to actuallY e has been a variety of efforts ticipation iir'family planning iencies and organisations both through oflicial and of the people into the Proto bring about a conscious in is indeed limited. the effort is gramme. While dre scale of the *hat is possible and how in many ways a Path finder and study seeks to examine this 6iihin the lndian context- The

Intductian

13

record and experience with a view to arrive at tedtativ @nclusions on thi effective modes and modalities of people's parll ticipation in family planning in India

NOTES:
I

For a detaited discussion

see

Almond and Verba (19d3) and Ecksiein

(r96r).

the.importance of pebplds participation in dvelbpment was; the beginning of plarned developmenlal efforts in l95l' Th'e lirst' recognised hve year plan accpted that 'conditions should be created to enable individuals and groirps to make their maximum contribution as citizens and in fulftlling the

?ln lndia

wiit

tu.gels

quue urruttg"-"nts for enlisting public co-operation and associsdon "' from the ver| beginningl (lir dia, 19 52: I tG47 ).
a detailed discussion see Cam(1966). Daniel Lerner has highlighted this difference in terms oftraditional and modem societis-former being non-participant and latter participant s For a dtailed 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 Yar Plan stated:'ltis apparntthatpopulation coniml can be achieved only by the reduction ofthe birthrale to the extent necessary to stabilis the population at a level consistent 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 basd on considerations olhealth and welfare of the f;mily. Family limitetion or spacing ofthe children is necessary a4d desirable in order 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 contracts participatiorl Moreover, participation for the elites has 'an instrumental rather than a primary value' (Huntington and Nelson" 1976:2&30)'
a

ofih" Plao und advancing

its objective$ therefore' it called for making ade

I For

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 of governm-ents programme. Any government programme will have little support of people if it does not try to establish a balafrce between governmental goals and people's own participotion. As pointed ou( earlier famiiy ptanning programme completely ienored p-eople s yiews l-nd perce[tion regarding size ofthe fam ily. This was reflcted in the failure ofthe Khanna efrperiment. ln I perceptrve cntrirsm or the 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 during the,emergency, and its repercussion eighteeri months later confirms the position of Huntington and Nelson (1976:38) and revehls what a misconceived programme can do to a governmcnll0 The preference for sons came out quite strongly even during our fietd work in Delhl Madhya Pradesh Tamil Nadu. Mahairashtra and Gujarat A farmer wantcd a minimum of two surviving sons, who could help him his old age. A panchai,at leader in Maharashtra said that he would nbt like to motivate a person who does not have two sons. ll Since Mamdani was making a reasselsment of lhe Khanna experimenl he was taken to be a part of the same team re{,isiting the areal2 Here it is desirable to distinguish mobifisation from mc.rbilised participation. Th former gives the impression of herding pr driving from behind toward a predetermined goal where the driven is not a choice. The latter. on the other hand" is based on persuasion. appeal to and to use a cliche. conscientisatioq 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 Vadu Budruk (a village 30 krns from Pune) and villages has rovealed thirt urban perceptions of rural needq and thc ' own felt needs do rarely converge. In fact they have a better oftheir necds which an urban mind

ii

can rarely grasp. 14 In the Jamkhed Rural Health Proiect in Maharashtra peoplc have voluntarily gone for small family, once a high mortalfty and death rate was checked. The assurance ofhealth service at door step has removed the risk in having two or three children.

Chapter

II

Objectives and Design of the Study

rrr
HE basic objective of the present study is to give concrete shape to the theoretical and policy concerns through an examinat-.on of the nature and extent of citizen's participation in family planning. The study is intended to develop specific policy options regarding the ways and methods of involving the people with a view to bring-

ing down the iertiliry rates on the basis of different kinds of e-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 participation of people in the larnily planning programme? Do
selected institutions work better for both motivation and' delivery system? What is the role of voluntary and local groups like Mahilo Mandals. youth clubs. etc.? What is the level of effective citizen participation in successful
cases a nd

3, 4. 5. 6.

whf

Who participates and who does not participate and under what conditions is the participation more effective? What are the factors behind non-participation. and apathy? What are the policy implications of people's participation both in terms of programme and administrative design to the

*uay reing the deveropment orerrective modalities of people's participation in family planning we felt that it was desirable to examine a series of successful cases of
people's participation through diflerent organisational instruments. Considering that only two broad models of citizen's par-

tffl1L?ff::li.'l?,il1

16

People's P4rticipation:in Family planning

ticipation in family planning-through panchayats ahil through voluntary agencies-are availablp in the country we . have included in our study two.case stud[es of conducting family planning activities with the help ofpanchayats and four case studies of family planning activities of differefirt voluntary agencies working . in different parts of the counrry. WE followed case study as well ai
survey methods for our study. HencN, while six cases under the two' broad models were studied a sarn$le survey of two good perfctrmance villages and two poor perfortnance villages at the first stage of sampling and of eight acceptors and four non-acceptors from good performance villages and fpur acceptors and two nonacceptors from poor performance Villages at the second stage of sampling was also undertaken. In the panchayat model Gujarat bpilies one type ofexperience in which attempts have been made io enlist people's participation through differeht oiganisational ingtruments at the Statq district taluka antl village levels. ln the sirme model Madhya pradesh typifies another experience in whicfr the village panchayats have been enlisttld recently in the deman{ generation network of family planning through awards and incefrtives. There are different sets of expprience available among the voluntary agetcies working in the freld in various parts of the country. Our aim was to choose sucbessful cases in different parts

of the country so a$ to provide a nati]onal sample as far as possible and to examine the socio-cultural vilriation in people's participation in family planning But we hqd to choosi frorr among ihe

organisations which responded fdvourably

cation. Our choice had to start with the Health and Family Welfare Trust of Tamil Nadu, which entered the early as 1959 with a five.year pilot auspices of the Governments Council of Medical Research and 'f,he Jamkhed Proiect is another remarkable results in a short span

to our communi-

igram Insdtute of Rural in the Madurai district

offanlily planning work as project under the joint and Tamil Nadu, the Indian Ford Foundation.

which has shown one decade. The Vadu Rural Health started in 1972 by the King Edward Memorial, Hospital, Pune, also shown some success. This is another kind of experience which a private agency has .tried to involve the governmental and resources. We also selected for our studv Delhi Family Planning

Objectives and Design of the

Study

l7

Associatio4 which is active in rural and semi-urban areas or the Union Territory of Delhi as it would have provided insights into the attitudeq beliefs and behaviour-patterns of the villagers living under the shadow of sprawlingmetropolis. The study ofvoluntary agencies was easier than ofpanchayat3 in Madhya Pradesh and Gujarat Selecting districts frgm States and panchayats from the districts was a difficult process. The selection of districts and panchayats on the basis of their performance in family planning was made on the advice of the State Government oflicials in both the cases. The performance of a district or panchayat in a State is normally adjudged on the basis of the fulfilment of the sterilisation targets given to them by the State Government Thug in Madhya Pradesh we selected Indore and Dhar drstricts for our study. In Indore district Sanwer PHC was recommended by the State government officials for our study. We selected

four villages Ajnod, Kankaria Pal, Khan Barodia and Darji Karadia-located in the jurisdiction of the PHC for the sample survey. Out of these four viilages. the first two were villages with good performance and the last two with poor performance. The
,fiIst-mentioned vilage, Ajnod. was awarded under the incentives.tc

panchayats scheme of the government of Madhya Pradesh. In

Dhar district we studied two good performance villages-

Umarban and Bakaner-in Bakaner PHC and one poor performance village Mandava in Nalchha PHC. The Government of Gujarat had suggested two good performance districts-Valdad and Kheda- Selection of villages from the two districts was made on thetasis of their record in family planning maintained by the district authorities. In Valsad district we selected Rabra and Kosamba panchayats (good and poor performance 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 Taluka and Bhadarenia and Harkhapura (good and poor pe'rformance resBectively) under Dawol PHC in Borsad Taluka were selected .foi Our study. Each of the voluntary agencies was studied as one unrt in terms of their activities with focus on their contribution in family planning For sample suryey villages were selected in their area of operation on the basis of performance in family planning. In New

l8

People's P,

in Family Planning nning Association is active, n. Fourvillages were selecColony and Bharat Nagar, Parbat-an area near Karol

Delhi, where New Delhi Family both rural arid urban samples were ted near Okhla-Okhla, Julana, Urban samole was taken from Bagh. The Gandhigram Institute Welfare Trust is located in Ambath Madurai district in Tamil Nadu. their main area of activity. Hence,
basis of percentage of protected

Rural Health and Family village in Athoor Block of Block also has been
selected four villaees on the
les in each of them. The com-

bination of two good perfi thupatti) and two poor perfi Munnilaikottai) villages was main Similar, Dattern was followed Health Project ofPune too. Apart villages selected were Shikrapur mance) and Jategaon Budruk and
mance) Studying the Jamkhed Project

(Chettiapatti and A.lamar(Ramanathpuram and

here we well.

studying the Vadu Rural

the study of the Project the

Phulgaon (good perforle Jagtap (poor perfor-

easy, but selection ofvillages according to usual combination of and poor performance villages was difficult Since all the lour villages studied- BavL Rajuri. Ghodegaon and Khandvimore than 50 per cent couple protection rate, we modified ou sample pattern accordingly. Our sampling pattem is'illustrated Table 2.1.

TABLE

ling Pattern
ViUagA Samplet

State I Delhi (f[

District/Proiect

New Delhi Family Planning Associatipn Rural

Okhla Julana

6:23

Urban

Than Singh 8:43 Nagar Nai Basti 8:4 Punjabi Basti 8:4' Ha,rijan Basti

Canal Colony Bharat Nagar

6:2 6:2 6:2

2. Tamil

Nadu Gandhigram Insti$te Chettipatti 8 :4 of Rural Health add Alamarathupatti 8 : 4 Family Welfare Trlrst Ramnathpuram 4:2 *A"

Objectives and Design of the Study State

19

Distict/Projea

Wllagd

Sampl?t

Munnilaikottai
3. Maharashtra Vadu Rural Health

,
8 8

Project

Shikarapur Phulgaon Jategaon Bk Pimple Jagtap

Ba.vi

8 4

a
,|

8 2

Comprehensive

Rural Health Project

Jamkhed 4. Madhya Pradesh

6 34
6 J 6 J 6 J
8

Rajuri
Ghodegaon

Khandvi Ajnoo Kankaria Pal Khan Barodia Darji Karadia Umarban

Bakaner Mandava. Rabra

lndore

8 4

+ 2

4 z 4 4

Dhar
5. Gujarat

-Valsad

Hond Kosamba.
Kheda

4
2

Alipore Piplag Bhadrenia Hathaj Harkhapur

I
8 .4

8 4

4 2

4 2

L
2.

3.

Acceptors: Non-Acceptors: The Villages with good perfoimance in lamily planning have a 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 ratio because of equal level of performance in different ireas. Since the performance ofall the villages under the project was quite high, we took the sample ratio of 6:3.

Sampling Cross.section
Table 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
per cent ur more oI protec-

:and'poor performance according to tion of eligible couples and less

couples. Two villages each were case studies on the basis oftheir

50 per cent protection

of

from each category ofthe brmance in family planning

From 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 was to interview fifty per cent males an{ Iifty per cent females in the categories of respondents. But we not alwavs successful in achieving this aim because it was not always possible to find male members during the day in most nlrral families. The males normally used to go out to fields for wofh or to weekly bazars during the day. In that case we had to imprdvise with female respondents. We have still attempted our best tq maintain the ratio. We also kept our performance for couples i/l younger age groups (in both categories) rather than middle-aged couples. This was done in view of the fact that the future demqgraphic profile ofthe country would depend largely on the family planning behaviour of the
younger couples. It was also 4ecessary

for us tci define acceptors and non-

acceptors. Our difficulty arose from the fact that it was not easy to ensure that respoldent used contr{ceptives regularly. We therefore, decided to accept only those aN acceptors who had accepted terminal methods of family planni4g We also decided to take the

couples as acceptors or non-acceptors rather than individuals. This was done .because of unpopularity of vasectomy in. rural areas,.which makes it difficult to hrtd male respondents who had been stdrilized. Thereforq if one ofthe.spouses had accepted the terminal 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) diflerent units in our sample-case $tudy, village and individual

Each case was studied on the basi$ ofihe org-anisational details available 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 these
case studies.

information on demographic dethils of the villages. The institutional information about elected and voluntary bodies and their statuq were kept in the third section Details of health care and family planning facilities were gathered in the fourth section ofthe schedulq. The fifth section dealt with education and employment, while the last section was devoted to the participatory activities of
the villagers.

schedules as well as with the qualitative data gathered by our research team. The village schedule was divided into six seitions (see appendix'A). The frrst section was devoted to the identification particulars of the village, vihile the second section elicited

Villages were studied with the help

of structured

village

The village schedule was filled up with the records available with the health and para-medical staff as well as with panchayats hnd school teachers Rest of the information was gathered with the help of the village elders. Haphazard way of kee'ping the records and vague information available with the village elders did create problems for us, but we wer still able to get most of the information Since our aim was to study people's participation in family Dlanning programme and activitieg we decided to study paiticipatory attitude of the people as well as their 'motivation for family planning with the help of a respondent schedule (see appendix 'B'). Considering that participation is a graded activity and an individual does not.like to participate in all kinds of activitieg 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 participatory attitudes were questions to test the respondents' attiiude towards participation in health and family planning activities. ' The second section was designed to tesi motivatiJn of the respondents towards family pldnning- A number of indices, like the frequency of a person's visit t<i a family planning centre, whether he took doctofs advice on family planning whether he/she was advised 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
the numberof children he./she
e used. contracptives.

children and considered ideal and whether he/ The fourth section was devo the respondents. The two sets of questionaires some modifications were made A good part of the material course of interviews with various menting plan programme at the for which no structured
she wanted more

to personal particutars of
ire pretestod 1n the tield and the light of lield response" in facl collected during the fficers responsible for impl+ ict block and village levels
was used. Similarly, alot ol interviews and discussions organisations and responsThese were collected.in the

information was collected with persons engaged with ible for success of their form ofdiscussion notes for which

schedule/questionnaire was

used our research team as well as The interviews were conducted the iqterviews were conof investigators. In with the help for this purpose on an adhoc by an investigator emp ducted also an investigator who knew basis. In lndore and Dhar

local dialect was employed

understood and spoken in these

ducted interviews. In Tamil N research team to interview any

the team knew Tamil. Hence,

with the help of Gandhigram

'Femily Welfare Trust and they villages. In Pune interviews were
c

with the help ofthe research statf Jamkhe4 the social worker of team. In Guiaral the interviews the Block Extension Educators Educator in Valsad and Kheda The field work was conducted February 1981. Indore and Dl were studied in March li8l. Madurai district of Tamil Nadu Pune aird Jamkhed Proiect were ?he districts of Bulsar and Khe
research team

Hindustani was also widely our research team also corr it was not possible for our as neither member of local investigators were hired te of Rural Health and interviews in all the four ducted bv our research team the KEM Hosprtal Pune. At project helped our research conducted with the help of and the Districi Extensibn tric6 rspectlvely. in New Delhi in January and districts of Madhya Pradesh Gandhigram. Institute in adu Rural Health. Project at ed during May-June, 1981. in Gujarat were visited by our

in

September.,

l98l

tr

Chapter UI

Voluntary Efforts in Family Planning-f : New Dethi Family Planning Association

FF

HE New Delhi Branch of the Family Planning Assirciation of India (FPAI), one of the 46:units of the FPAI in the country was established in 1962 s.ith the objectives of disseminating knowledge and education of family planning among different sections of community, promoting its adoption and practice and give counselling services to individuals and couples on fertility problem. The association commenced functioning in 1962 with the. grants-in-aid from the Ministry of Health and Family Welfare Govdrnment of India. It started with an information and Education unit a male sterilisation unit and a sterility unit for treatment of childless couples. For spread of educational and clinical services at the doorstep of residents a mobile clinic was also started In lp64 loop insertiort and in 1966 oral pill programme were rintroduced through the mobile clinic. From 1968 onwards demand for female sterilisation began to increase and a rhreq .bedded tubectomv unit 'was established in 1970 with inputs received from the headquarters of Family Planning Associatron of India. Tubectomy facilities were expanded by openirig a l0bed<led comprehensive clinic in 1972 and later to a 15 bedded clinic. The New Delhi Family Planning Association introduced pop ulation education programme in 1970 for creating awareness of

population control among young people. In 1971 when the 'bovemment of India enacted 'Medical Terminatiori of Pregnancy' for liberalising abortion, the New Delhi Family Planning

in Family Plannins ,Association arrailged for provid lplanning services were'integrated services for enhancing family/co and marriage cdunselling unit with the psycho- $exual problems result of implernrentation of

this service. In 1976 family maternity and child health unity .weffare. A family life set up in 1978 for coping up in the community as a planning programme and
in isolation was oot on population control until were launched the uar Pmgati Mandab in its
socio-economic, mater_nity
:

industrialisation
Realising that family planning likely to make the desired

some economic development.. pr Association raised a number of operational areasiin 1979 for
and child welfare programme a tance of small farhilv norm and viding services to rreet the needs utilising its volunleers and staff,

abilities in collaboration with

welfare and development In order to Eralntain

encouragng acceppare nthood For propeople the Association started experience, skills, and organisations e.ngaged in r for the commuhitv.
character of programmes, the

Association started providing rrmation and education for family planning pnd clinical ser to the people residing in Trans-Jamuna area from one unit lished in the area. ln addition to undertaki4g the various ifs activities were directed in 1980 $owards raising the sti of womea through economic ,upliftment programms by more Pariwar Pragati Mandqls. As coovpntional female involved risks and expe{rse (becausq of and cxpensive medicines), sterilisation by l4paroscopy was' proposed to be introduced

Illethod

ofWorf

Lme

and formulate suitable

and information that

a population of 2,71.000. by staff of Informatlon and rctioned proj6cts-a) Informain the ollice preriises of the

Voluntary Efrons in Family

Planning-I:

25

rAssociatio4 b) Cis-Jamuna Area comprising Anand parbdt, a ruial area of Okhla/Temur Nagar, New Delhi South-East villages and 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-Jamina
atejd-

Major activities of the Association were aimed at mobilising local community leaders for understanding needs of the comqynity, making faniily planning services available and making port with the community. The Association thus took effective measures for training local leaders, production of audio-v,iusual aids like slides, charts, posters, pamphlets, etc. to establish communication with community and establishing and keeping the supply channels functioning regularly for distribution of conventional contraceptive.
To achieve these objectives, the extension workers were instructed to make a survey of the population to identify eligible couples to compile a register of the eligible couples and acquaint thimselves with the localities preparing detailed maps. The workers
effective use of mass communicatibn measures to establish a rao-

operated at (i) macro level by arranging frlm shows, mass meeting$ cultural events and exhibition etc, and (ii) at micro levdl by group discussions, personal contacts/counselline and follow,up visits A feasibility survey was undertaken to idenilfy the acceptors of family planning and ro get themselver acquuini"d *ith the difficulties that might be faced during motivation of ' the
people.

At the individual level Extension Workers established con{acts with the households. Married members of the reproductive agegroup were. approached after the Extensiofl lvorkers classified the surveyed households into the following categories: (a) those having three or more children; (b) those with two children; (c) newly married and without a child; and

(0

sterile.

E4phasis on motivation and advice varied with each of the above categories. Thos0 in category (a) were rcported to need .stronger motivatioftnd greater altention. The Extension Worker sought the help of acceptors. local leaders and doctors in convincing suth people. Those with two children were considered potential acceptors, if convinced properly. Entirely different arguments

26

Peop le's

lartici p a t io n in Family Planning

were neaded for the

for acceptance offamily planning newly married couples and for tt

not having any child They

centre$ get themselves were advised to visit family examined and seek advice from e medical doctors. was considered very imporCredibility of Extension W The Eitension Workers. lant if the motivation was to be visits to the area. Interest of the thereforq had to maintain people was likely to wear out if emphasis was always focused etc. The programme was, on planned farnily, i es included in it to held .therefore, adjusted and new lntegration of health care le. and sustain the interest of the programmes! nutrition p es and other programmes for and families was undereconomic development of ho th planning programme. To sustakbn and supplemented'with tain interest of the people, follow- p actions of programmes were give up contraceptives after undertaken so that the couple did
some time.

Services of the Association

Clinical services in support of provided through (a) a compreh clinic funded by FPAI since Juiy. welfare centres funded by the from April, 1978. The com clinic was designed to intensify by providing all services like maternal and child health and tubectomy and vasectomy as well gnancy while the urban welfare vice. carried out IUD insertions people residing in the allocated centres was located in Raghu plex providing vasectomy mobile to visit remote pockets of Association for $ving family The NDFPAhas been inception in 1962. Introduction
such services consolidated the a broad-based care programme in additional incentives by wav of

planning programme are

1972, and (b) two urban

model family planning family ent of India with effect e model family planning e family planning programme

ion and education activities, cal services of IUD insertion as medical termination of ore-

provided information serundertook MCH work for

of the centres. One of these hola Nath Naear Comand the othet centre was kept in areas alloted to the
cover: ing MCH activity since its very

mobile clinic for undertakine on's activities by offering areas thereby providing
care to mothers before and

Voluntary Effons in Family

Planning-I:

27

after pregnancy and to their children rill rhey attained schoolgoing agE Thls approach considerably enhanbed the motivation to accept family planning The two centres that were established were manned by a VLW who provided services under the supervision of a mdeical oflicer,, equipments being provided by FPAL Immunising agents, anti anaemics and supplements were supplied by the State Gdvernment whereas medicines and dressings were purchased from FPAI grants. Routine medical check-up of expectant/nursing mothers and their children and advice (including referred) to outdoor and in-door specialised treatmen! treatrnent of minor ailments and injuries affecting women and childre4 immunisation of infantg preschool children and expectant mothers against 'specific communicable diseases like Diptheri4 Tetanus, Pertusig Polio.myolities, Small-pox, Cholera and Typhoid etc. administration of anti-anaemics (Iron and Folic Acid).and nutritional sup-

plements like Vitamin 'A' concentrate etc. made easv the motivation of expectant and nursing mothers for acceptance of family planning Health education of mothers in feeding .nutrition and other aspects ofhealth care and baby sHows to inculcate competitive spirit among- mothers and follow-up of. growth of children by maintaining weight records, etg brought in expecration of long like to existing childron" Nutritional demonstration was periodically arranged to.teach mothers simple methods of cooking presewation of fruits and vegetables so as to enhance thi nutritional status of the familv. The N DFFA Introduced ilinrcal services for chirdless couples in a place adjacent to the family planning clinic. Availability of this service under the same roof where the message for fertility control was disseminated, strengthened credibility of the NDFPA Medical check-up, investigations and treatment for appropdate cases of infertility and their follow-up by home visits by social worker enabled the Association to win the confidence of people. Increasing number of repcirted pregnancies as a result of treatment added to the credibility of the NDFPA Realising that family was subjected to considerable stress and strain as a result of rapid social change and implementation of' family planning programmg the Association established a Family Life and Marriage Counselling Centre with an objective to providing curative as well as preventive services for proper adjustment and harmony in family life. The Centrd offered services of

28

Pmple's

in Family Planning

to those manilbsting fears irained ano comdetent Psycl family planning methdds. It and anxieties in accepting di ions seminars and talks on also organised conferences. a view to prevent the adverse different aspects of family life the family and promote effect of stress sltuation in life of life. Sex education and sex adjustments for improving point for many problems of maladjustments formed the family life and marriage family life. The Association felt in the adoption of family counselling servicrs considerably planning by the people. a centre to educate the youth The Associatiorr also growing population on and regarding the prossure of neighbourhood Appreciation quality of life in homg locality in relation to basic human of the advantages of a small balanced diet persolral needs, availability of nutritious hygiene etc. were emphasized in e training courses of Young The NDFPA felt that men and women of different greatly influenced the exposure to population education potential acceptofs of familY Planning Association was ln 1975-76 the New Delhi F in terms of over-all per' adjudged the best voluntary by the National Family formance in the field of family Government of India. Planning Awards Committee of
People's Response

found mixed popular resPeople were found to The People's response, t be both enthusihsdc and according to thefrr,.varied due to varietv of factors like socioresponse was more lavoureconomic statu s qf the populatio[ moved up the socioas the able and spont4neous bottom of the scale seemed to economic scale. Many persons at they thought htat more be hostile to the programme as they added to the family children were asset to the among those who ineome. Slum dwellars were ihe of children was considered shared this idea. The cost-benefit was very low while the high as the cost bfbringing up benefits of contribution of inco to the family by the children was relatively higtr individual's response. The level of education also The Extension workers
ponse to the progfammes of the

Voluntary Eforts in Family

Planning-I:

29

lvould rear up and feed the children The 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'majority villages near Okhla Even if the degree of resistance was high ' among the Muslims, if approached in proper manner and convinced gradually and symphatetically, they also accepted the prograrome. In one of the cases, for examplg a Muslim lady approached a lady Extension Worker for IUD insertion' The

The workers had happibr experience with educated people' tack of education" they pointed ou! certainly created difficulties' Iilostile reaction normally came from those who had individualisticc ppproach to life. Some people, the family planning-woikers reporarg,red as to why the Government shou-ld be concemed if ;ed, "nett [rt.y-p[a"i"a more chiidren, as they and nof the Governinent

Worker, in order to suppress her enthusiasm, advised her against it as 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 of contraception A little apprehension was also noticed among ttie

Catholics. The family planning workers of the Association felt

that hostile and apprehensive reactions changed and even became

'

favourablg if the people were tackled with tact, sympathy- and restraint Response was not at all favourable in the organised sector' Though the management took interest to offer incentiveq it did not really make much difference' If the incentive had a long term impac! then perhaps they could become effectii'e; monetary incintives 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 welfare organised sector and lvo urban and semi'urban family

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

30

People's

in Family Planning

gxamme. Ante.natal and postcare and care of the children larly given artention. Their under five fears 0f age was l clinics in these are4s opened once weeh but door-to-door con-

tact and distribution of .continued on other days of the

by the Extension Workers

as well.

In each of the Centres, the ion has been able to overhave since gone beyond come initial resistance and apathy. health care and tamily planning d have started playing useful role in the socio-economic life o peoplg especially women in .these areas Paiwar Pragati organised by the NDFPA in 'these revolution in these areas by areas has almost broueht they claim. is amazing In. conscientizing women. The
,Anand Parbat are4 for instancq
brought down average irumber ofc in 1980. A reduction of 50 per cent
e

NDFPA claims that it

hasr

dren from six in 60s to three about two decades. Besides.

involvement of women in their status in family. Pariwar Pragati Mandal

The NDFPA decided to multlpurpose social organisation iion when they realised that the not likely to succeed unless
came forewar4 atd the women until they suffered subordinate

activities improved

insJitution was aLso aimed at p

image.

Pariwar Pragati Mandals, a women in its areas of ooeraof fertility control was realised its imoortance and not likelv to come forward in family structure. The dins a boost to their self-

Starting with sdcio.cultural

festivals and playg they switched ments, knitting woolens, preparing

like organising picnics, activities like stitching gar, pickles and syrups. The

NDFPA helped the Mandals in

accoultt, securing orders and m But the activities of the home foi long hours and soon the

ng and operating bank

finished oroducts. required. being away from others-in-law started obiecc inatine activities of the man-

ing The Extension Workers dals convened r4eetings of the

ers-itr-law. Most of the mothers-in-lawagreed to allov/ t :ir daughters-in-law to go out and look after the children in their bsence if the daughters-in-lawl family income. Some of the could add even Rs, 50 per month to member;.wanted to keep the before their eyes. In Anand

Voluntary Elforts in Family

Planning-I:

31

Parbat the local "Chaudhary" lent.space in a local dharmasala free of charge for starting a nursery school. Two young girls were employed by the Mandal on a small honorarium to look after.and teach the children.

Paiwdr Pragati Mandals not only proved an economic success, they were extremely successful in motivating not only their members but the entire family of the members. Eversinc,e the women
started augmenting lamily income their voices were heard and carried weight in their families. This also enabled them to make choice about family size. The Mandals thus proved to be catalytic agents in every sense.

Performance of NDFPA The NDFPA thus, has been able to enlist significant commuhity participation in its programme in all its ar'eas. The impact of cornmunity involvement is clearly visible on its target achievement in health and family planning held*.As compared to Delhi Administration target achievement of the NDFPA has been
very impressive In the year 1979-80, wtren the fa.mily planning prograinme had still not recovered from the stigma of the emergency,.the Associatian was able to achieve 116 per cent sterilisation target, 197 per cent IUD insertion target and 183 per cent in Conventional Contraceptives. In comparison the Delhi Administration was not able to go beyond 48,?8 and 49 percent respectively. On the otherlland, the Association's achievements exceeded targets in 1980-81 as well. The Association also turned out an impressive performance

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

32

People's

in Family Planning

only 27 fer cenfwith two to sav that the achievements It was pointed out that when of the Associatign is in anY waY its operation six-child the New Delhi branch of the FPAI family was the nogn TheY claim have brought to it down to data Two-thirds of those three. It is partial$ suPPorted bY children tvasetomized had a maximum. of lot of ground to cover. It could m children for sterilidation. This is

TABLE 3.1: Vasectomy. Number of

Age Group
(Y"r,)

to dge and

* l2L !37
47
J

Tqtal

Percenlgge 0.47

20-24 25-26
3G34

49
80

3'39
4045

4
36
10

45+
Total
lPercentage

125 170

I
J

3 67 t94 198 w 49
638
100.00

r3.s
30.41

3r.03
16.77

7.68 100.00

255

0.31 26.65 34.97 3

Looking at the vasectomy data ,literacy status of husbands and more than two-thirds of those abovg and.only 7.2 per cent of per cent were matriculate and ,kage between education and t vasectomy acceptors being literate thirds of the wives being in this cat or literate person ip easier to conv: steril-isation The full importof this we look at the tubectomy figures by to rthis discussiorl

the NDFPA for 1980'81 bY (Table 3.2) we realize that

were matriculate and

were illiterates and about 40

This data establiihes a linmy. Over 90 per cent of the highly educate( and twc, . shows that an cducated about the 4erlts of male, lata can be unoer stood when tGracv. We shall come back'

and parity (Table 3.3) conThe figures of tlrbectomies by indicated by similt figures on vasectomY. O'tier Iirms the trend ies were in 25-34 agetwothirds of women opting for tu

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 youngf age'gxoup and couples having tl'o childieir"-Wht[er th-ey sh0ukl eniphasize

TABLE 3.2: Distribution of Vasectomies During by LiteracY

Literacy
Smtus
Pencentages

1980'.'81

Wife

Husband

Percmtage

Illiterate Literate
,.Primary

2W
2
72 99

32;16
0.31

6
62 '100

7.21

tI.29
15.52

9.72
15.67

Middle Matric/ Hr- Secondary

Graduates
.above

t49
r07

23.35
16.77

l9
23r

31.19
36.21

&

Total

638

100.00

100.00

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

'(Yn)
Age Group
No.

of Childn
4+ Urr!.gsa__
106

2U24
25:29 30-34
_35-39

22

t4
4

40'44

@37 178 306 108 337 29 187 315

I

506

459

8.09 38.63 35.04

16.79 1.37

220

45+

l8 I
1310

0.08 100.00

382
,Percentage

883

29.16 67.40 100.00

34

People\

in Family Planning

thble i.4 showd that half of illiterates. One third of them were level The education level ofsuch ing at the literary status of their h per cent were illiterate, over onemiddle and about one.third were
were graduate

vasectomy or rubectomy should Extension Workers, thuq would I carefully. The factors that they m clear when we look at the vasector husbands and wives.

be carelulty decrded- The

to use their discretion more take into account would be and tubectomy by literacy of

the sterilized women

were

an{ above. It shows :

tion among illiterates and

upto middle school was thus very low Lookthough only about 20 were educated only up to A mere ten per cent of female steriliza-r
ted class.

TABLE 3.4: Literary Status of

Literacy

of Tubectomies bv and Husband

Hr,.chaid.
Percentage

Statw Illiterates Literate Prir4ary

657

50.

t7
263
185

l.
I 4.

26r t2
220
267

19.92

0.92
16.79

Middle Matric/Hr.
Secondary Graduate &

143 45

419
131

20.38 31.99
10.00

This trend is fuither confiirmed and tubectomy datq (See Tables 3.2 thirds husbands in vasectomy being than half the husbands in the tubr only upto middle. Slmilalry as wives in the vasectomy group being ,E5 per cent of the wives in the up !o middle. Interestingly, n third of both the groups. There

.we compare vasectomy

3.4). As cornpared to two-

and abovg more. we re educated to over4O per cent of the and abovq above group were educated only

group

husbands;t!61 about o_4q two implications of these

Voluntary Efibm in Family

Planning-I:

35

figures. Firstly, the bxtension Workers should carefully use their

discretion before motivating a couple for a particular terminal

method. Secondly, if vasectomy has to be popularised the illiterate and moderately educated will. require greater motivation.

People's Participation
The basic strategy of the NDFPA from the very beginning has been to enlist active co-operation of people in their programme of population control. But their major difficulty arose from the fact that family planning being a programme involving changein rep-'

roductive behaviour of human beings touched a very sensitive aspect of an individual's life. and any ingression on this aspect is
looked upon with suspicion. Realising that co-operation and participation might not be forthcoming because of these reasons, the NDFPA decided not to present it as.an isolated govemmental programme 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 NDFPA

transformed itself into active participation as MCH program me of the Association brought down infant mortality and their socioeconomic programmes not only added to income of the families but it aho had a positive impact on the status of women in its areas of operation. The conscientization of illiterate.and semi-literate

women has been able to create a lasting impact on the total

programme.

In facl the fay-reaching impact of the activities oforganisations like the NDFPA can be seen in terms of creatioq of a belief in government that a coordinated approach involving governmentalf .and voluntary agencies may be able to convert family planning from a governmental programme into people's movemenl The . large.financial contribution by the government to the NDFPA is perhaps 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 ot hill). Though anaid (pleasure) prefixes parbat, the locality does

36

People's

in Farhily Planning

The entire area looks like a not provide any pfieasure to vir unauthorised industdes and slum. A number cif authorised --.^-l-^L^^.Il to:the *:.-;66 residetrts. These are also. workhop add +^ rL- miseries of many of the residents. however, a source of livelihood I Beiig locitbd in the heart of t. Delhi metropolis, health care services are not inaccessible for th residents. Apart from the dispensary run by the Municipal Co ratio4 a numbdr of hospitals

in the city offer protection

Delhi branch of the Family provides health care and family p clinic operates on Tuesdays. The workers of the NDFPA visit the Four areas in Anand Parbat Bacti and Thansirl3 Nagar were st dom sampling for conducting a the research design. The dem planning profile 4re given in tab

serious ailments. The New Association of India also

services. Their weekly

on Educators and other four times a week

bi Basti, Nai Basti, Harijan at the lirst stage of ranle survev in accordance witi hic particulars and family
3.5.

TABLE

c Pxifile
Planning Accepton

Area

Popu-

lation

IUD Nirodh

Others Tonl % age

Punjabi Nai

Basti

4525

702 168

66

I4

63

3ll 4

Basti 8703 1518 138 1.14 67 35r Harijan 'Basti 3325 428 36 49 JJJ
Than- 13680
singh . Nagar Thansingh Nagar had the and Harijan .Basti the smallest 28 per cent of the eligible couples had 44 to 46 per cpnt protection contlaceptioIL Wa took Harijan
2182

270246' l2t g& 12

28

223

233

106

390

44

population of the four areas

Harijan Basti where onlY protecte( rest of the areas some or the other methods of .stl as gooo peflornance area
e

Voluntary Eforrs in Fainily

Planning-I:

37

because the NDFPA workers us assured us that a large number of eligible couples had agreed to accept the terminal method Table 3.6 presents numbers of serviceable couples by age of wife and number of children in four sampled areas. Of the 3583

serviceable cbuples identified by the NDFPA

in the four areag

TABLE 3.6: No of Serviceable Couples by Age of Wife and No. ofiChildren irr Sampled Arbas
No. of living children
ASe of
,

Semiceable Couplds

wife

3 4+
272 80 lt 2 380 475 305 90 25 96 154 276 220 153 38 48 108 t26 193 25 30 43 77 186 ll 14 13 28 104
822

No.

Percentage

l5-19

2U24
25-29 30-34

365 1275 899

513

r0.2
35.6
25.1

35-39

361

t70

t43 l0.l 4;l

140

Total

.801 7s6 543 661

18.4

Percentage 22.9 22.4 2l.l 152

r00

one third had more than three children Of tne rest of the t\ilothirdg about ond-third had yet to have a chil4 and the rest were almost evenly distributed between one and two children. This indicates that the crucia!. section for the NDFPA s family planning programme in this area are nearly 45 per cent who needed encouragement on spacing methods and over 36 per cent who needed notivation for terminal methods. While those with four or more children (18.4 per cent) also needed motivation for terminal methods, a majority of them were already nearing the end of reproductive age In terms of age group 15-24 seemed to be the most crucial for'spacing methods and 25-34 fior terminal methods. (mostly displaced persons from West Pakistan) with some Sikhs. Therewere3500 Hindus(77 percent) and9@ Sikhs(23 peicent) in

The entire area rvas inhabited predominantly by Hindus

38

People's

in Family Planning

Punjabi Basti 73f,3 Hindus (92 cent) and 909 Sikhs (23 per (32 percent) alrdz,4n cent) in Nai Ba*i ll26"upper schcduled caste liindus 96t per in Harijan Basti and 11,700 (13 percent) arid 1942 other Hindus (75 per cent ) and 2053 S persons (12 per cent) in Nagar. The people irt this ar6a are not active politically. Though trro national partieq the Congress and the CPl. have offices in' the are4 political, participation is to electoral participation, only a miniscgle minority is i actively in politics. The l9E0 Lok Sabha rvitnessed heaw turnout in the area which reflects political of the residents. But since both the local institutions, the tan Council and the Municipal Corpoiation of Delhi dissolved and suoerseded participation in local elecin 1980, there was no opportunity tion Absence of local bodies hi _also had adverse impact on political activity. As far as voluntary social activrties were concerned Paivar Pragati Mandals were found be very active in all the four selected areas. The New Delhi Fa Planning Associatioq in fac[ gave fillip to their activities. was one Nacftc hitar Samaj Seva Dal which was very active in iabi Basti not only among the Sikhs but also among the There was one Harijan Kalybn Samiti in Harijan Basti was found to have good influgnce over the local Harijans. I reported to work very well. The New Delhi Family Association extended its cooperation to these Samitis. . There was one Adult Education Centre working in Thansingh Nagar. About thirty to torty were reported to make use of this Centre. Harijan Basti did.no have any such organisation. Yy'orden were in the other three le Bastis were active in the NDFPA sponsored Pariwar Mandal. Puniabi Basti had the facilitv of allopathic, unani and Ayurvedic dispensarywherdas Nai d Harijan Basti had only an Nagar had an allopathic allopathic dispen$ary each. dispensary in addition to a tion centre of the Municipal Corporation. of Delhi In addition the central dispensary of the NDFPA provided treatment to the people of these localities. The mobile van dispensary came to Basti twice a week and people from adjoining areas availed of the ities. While weekly visit of a mobile dispensAry to Nai Basti ided the facility for treatmeat of ordinary illness in Anand arbat are4 people. had to go to

Voluntary Efons in Family

Planning-I:

39

bigger hospitals
medical treatment

in

the city for chronic illness or

special

The NDFPA also assisted trfa chchitar Samai Seva Dal of punjabi B4sti to maintirin a health care and family planningblinic. By offe4qg healtli care facilities the New Delhi Faniily planning Association has been able to maintain close coltacts with the peJ ple of the sample localities and mobilise peopie's participation in family planning. The NDFPA delivers the family planning services in all the four selected areas. One Extension Educator, three social workers and one volunFary worKeruslted PUnJabi Basti thnce a weekwhde one Extensiofi Educator, rwo social workers and one voluntary wofkei were reported to visit Nai Basti daily. One Extension Educator. three social workers and one voltrntary work"i lririte,t Harijan Basti twice a week while one Extension Educatot two socral workers anet one voluntary worker went round the houses in Thansingh Nagar four days in a week Thus communication between the househoids in one hand and the para-medical staffand social workers on the other was made easy.

The Extension workers identified the potential acceptors oI familyplanning by individual contact and sought the help oflocal leaders, prominent persons or members of paiwar pragati Mandals. Contacts were established at individual and gr6up
levels.

arca. Pariwar Pragati Mandals organised these meetings once a *eek in.each locality. Screening of lilms on family planning was reported to have been seen by 500 to 700 persons while smallgroup meetings were attended by 1.0 to 20 persons. Naihchittar Samaj Seva Dal maintaned a primary coeducational school in Panjabi Basti where 50 children received rudimentary educetion- Nai Basti had three primary schoolg one ofwhich 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 and girls received their elementar! schooling In Thansingh Nagar the Municipal Corporation of Delhi maintained a primary school . with several sections attended by 900 boys and girls.

For contacts at the group level lilm show and mass media were used Screening of films was popular in all the areas. Mass meetings were rrot frequen! but small group meetings wdre fre. quent they were held once in a month in rotation from area to

People's P,

in Family Planning

Characteristics of Sample

As stated earlier, the entire tional area of New Delhi Branch of Family Flanning of India in Anand Parbat was treated as a good performance area and as such eight accep. tors and four non-acceptors were lected randomly from all the four selected localities. Efforts made to have a cross-section of respondents representing ups, income brackets, caste$ occupations and literary groups the respondents in this sample were male.
Estimation of income of the of the households was. $o doubt a very difficultjob. It was not t they wanted to hide it, but being mostly self-employed, they estimated their income by months or years. Salaried peoplg owever, had no difficulw in giving out their income. Table 3.7 the distribution of annual income of the sample heads of households.

TABLE 3.7: Economic

Annual Income

of Respondents
Non-Acceptorc

(Rl
No.

Acceptors

No.
6 J J
10

Percentage

0-1000 1001-2000 2001-3000 3001-,10fl)

I
I
)
5

2 z

l3 l3
IJ
25

;
4
3 J

4001-500q
5001-6000 6001-7000 7001-8000

l6
28
J

l8
18

I
9

28 3 100

8001-9m

100

This was not a h.igh income area. majority of the respondents both acceptors and non-acceptors in low or. at the most in middle income category. The concentration of both acceptors and non'ac$eptor's (over fifty cent) was in Rs.300l -6000 bracket This falls ln the middle of ten slabs created by us for

Voluntary Eforts in Family

plannmg-I:

41

:grnpylStiglpltlposes. This shows the income range of the clientele of the NDFPA" and apparently they seem to beltriking at the nght point No wonder, they have had to put emphasis on economic unliftment programmes. TABLE 3.8: Age-Group Composition of Respondents
Age Group (Yrs)
No.

Acceplon
Percentage

Non-Acceptors
No.

Percentage 6 38

z0-24 25-29

6
50 38 6
100

l6
t2
2
32

I
6
5

30-34

i5-39 Total

JI
25
100

l6

group.

our data in this area therefore, is rikely to reveal participatory attitude of a group of persons who are crucial for family pla_nning programme. ti is atso likelti;;e revealing because 25 per cent of the non-acceptors were in 35-39 af
TABLE 3.9: Educational Levels,of Respondents

J4 age'group.

Age-wise our respondents were in 20_39 age_group. Half of the acceptors were in2S-29 agegroup and anoiher3-g peicent in 30-34 age.group. Similarly. 69 per cent of the non_accepr.i., *.r" in UJ-

'

Educational Standard
No.

Acceptors Perceniage

Non-Acceptorc
No.

Percentage 6

Illiterate Middle

4
3

l3
9

I
5

Matic/
Hr Secondary
Graduate and
above

JI
25 38

l3

q
38

l2
32

Total

lm

l6

100

42

People's

in Family Planning

More than threelburths of the s{mple respondents with education of rrqtriculation and gr levels and above belonged to planning against about twothe category of acceptors of thirds of the total flon-acceptors some levels of education. In fact t\e non-acceptors with educalion upto the middle standard and rnore formed 94 per cent of tlie sample (See Table 3.9). The locality consisted mainly of Hindus, Sikhs and scheduled caste with very few Muslim The NDFPA was able to :nlist ceoperation of all religiong groups and Hindusand Sikhs weie equally reieptive to the of family ptanning Harijans who were earlier reluctant were fi now and Hariian Basti was highly responsive to the message of family Planning

Participatory Attitudes
The reaction of the respondentb to participatory questlons i[ Anand Parbat are a of New Delhi confirms our sub-mission that participation is a graded activity. The responses indicated willing-

do something about shortages c|f esse ntial commoditie s and.. drinking water shbws their preferi:nces Similarly, their willingness to do something about'havidg a school opened or help a school teacher to gather pupils showed that the area did not have adequate. schoolirrg facilities A large majority of them also demoristrated willingness to participate in health and family planning activities (riee Table 3.10). The acceptors and non-acceptois demonstrated similar as well as different participatory attitude. pn issdes of commdn interesf they displayed qimilar attitudq,while on some critical issues the dillirence between them was noticeable. On the questions of shortage of essential commor and drinking water or aosence ofa high school apparently was no dillererice bebrcen the attihides of acceptors and nori-acceotors. DrmuaflY the 6rIptors, Similarly Ine difIsrence was not much on most ofrpolitical parucipaflon In fact more non-acceptors in election campaigns than acceptors. Not -surprisingly, on qu_estions relating to this study; ie.. those dealing with planning vtzT (68,72),8 (75, 50), 13 (9G68), 14 (93, 68) and,24 (78,50) the difference in the attitudes ofacceptors and non:accOptors is more than 20 per cent The difference is marginal only in question T which relate to visit-

ness to participate in activities accohding to preferences and needs. Willingness of over 90 per cent respondents ( ol both categories) to

Voluntary Efions in Family

Planning-I:

43

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

planning

TABLE 3.10: Participatory Attitude of',Sample Respondents

Participatory Questio ns
Percentage of Respondents

AlfirminS

Acceptan
1. If there is shortage of essential commodities (keroseng sugar, fertiliser etc) in your village/ you make efforts to ' ward, wouldcommodities availamake these ble to your village/ward ? 2. If there is shortage of drinking water in your village/ward would you make efforts to make
96

Non-Acceptors
93

100

93

it available? 3. Ifthe neighbouring village/ ward has a school, which your village/ward does not have,
would you make effods to get one opened in your village/
ward?

92

93

4. If a family planning camP is being held in a neighbouring

village/ward, would you go
there?

7l

43

5. Would you also make efforts

to get one such camP held in your village/ward? 6. lfa hlm is being shown in the neighbouring village/ ward would you'go there to see the film? 7. tf ihe film being shown in your neighbouring village/ ward is on family planning would you go there to see

75

37

7l

8'1

68

62

M
Partic ipa tory Questio ns

People's

in Family Planning
Percentage of Respondents

Afirming

Acceptor Non-Acceptors

village/wart! 9. If your villale/ward

does not

90

8l

have a health centre/

dispensary would you make efforts to get one opened in your village/ward? f 0. If the government decides to open a health centre (sub.
Centre) dispensary with

96

68

the help (material and p hysicql) of people in the village/ wdr4 would you help?

Would you like to pay tor health service? 12. Would you like to join in organising hsalth services to your vill agelward? 13. If a farhily planning centn is being oirened in the neighbouring village/ward would you go there? 14. Would you make efforts to ge{ one family platrning centre/sqbcentre opened in your village/
ward?

96
90

8'l

8l
68

o0

93

68

If

a nationaVlocal leader rs

'71

75

delivering a speech in your

62

62

Volwttary Efforts ih Family Planning-I:

45

i7. would

you lll(e to campatgrr for a party/candidate in

28
81

election?

18. Did you campaign for any pan candidate in the last election? 19. Did you vote in the last election for (a) ?anchayat, (b) State Assembly (c) Lok Sabha?

8l

8l
37

10. If the local leaders organise demonstration on rising prices or non-availability of certain commodities, would you participate in it? 21. If the VLW/VHW is not visiting your village/ward would you make complaint to the con22.
cerned officials? lf you are requested to volunteer your serviies to the gbvernment/ voluntary agency to take the health services to the peoplg would you volunteer yoursell? 23. If the school teacher in your
'

37

JI

47

37

56

93

village/ward requests you to

persuade people to send their children to school, would you help him? If the WWTYHW requests you to help in persuading and motivating people for accepting family
ZtS.

78

50.

planning would you help him If Keertan/Ramlila is organised in your village/ward., would
you attend?

78

56

Average

74

67

People's

in Family Pla4ning
25 questions was 74 for the

The average partieipadon rate acceptors and 67 for the non apparent, does not look sizeable. deal with a wide range of social ticipation rate of nori-acceptors An4 in some activities their o times even higher than the tion of this trend we would like to ween the participation rates of visible. And this as well as some cbme to them later) are planning in thi6 area.

The differencg though

reason is that the questions

political activities. The parfrom activity to activity. pation rate is very high; at Before we discuss implicaout that the difference bet-

two sets of respondents is factors (we shall for non-acceptance of family

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

it

than the acceptors and they eqial {cceptors' participation rate in three items. The obvious inference of such a trend iould be that motivation to padicipate ts not la If the reasons for their non-acceptance is understood .,it would not be difficult to persuade them to accept smallnorm. We shall discuss t]re pobsible reasons for nonwhen we analyse the data further. An over-whelming number of the acceptors and non. acceptors felt that health care and f planning sewices should be maintained and operated by the ent Only an insignificant proportion of respondents of the opinion that health caie/family planning services s be maintained and worked bythe people themselves or their This was affirmed by the replies to questions 1.9 and I 10 in the respondent schedule
that whereas 90 and 96 per cent of of non-acceptors respectively health centre/dispensary opened per cent of .acceptors and nontors and 81 and f8 per cent

to make efforts to eet a their village/ward. 90 and 8l rs respectively, in facl

showed their willingness to such services. Asked about the type of help they wanted to make for the health services, 4l per cent ofthe dent acceptors and 56 per cent of non-acceptors stated that were prepared for rendering physical help to the health servi, 25 per cent each of acceptors and non-acceptors were prepared fi r giving financial help, 34 per

voluntary Effons in Family

Planning-I:

47

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

TABLE 3.11: Help for Health Services

Type of Help Acceptors

Non-Acceptors

No.
Physical
13

Percentage

No.
9

Percentage 56

4l
25 34
100

Financial Both Physical and {inancial Total

.t

25

1l

is
16

I00

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 workers of family,planning friends/relatives etc in respect of family planning taking friends/relatives to the centre etc.
fYide dlfferences can be^noticeO in the replies to iI-quesuons grven by the acceptors and non-acceptors of family planning except the last one (see Table 3.12). Itwas natural that consultation with medical officer and availing the. faciliries provided by the family planning centre would differ considerably in case of the two categories of respondents. However, 50 per cent of the nonacceptors visited family planning centre and 75 per cent were bdvised to adopt family planning measures. Eventhough differences in rates of motivatiorl both itemwise and averagg of acceptors and ndn-acceptors is substantial, and partly exptrains the reasons for non-acceptancg scores for item I and 6 presents a ray of
hope.

Participatioq Motivation and Famity Planning

The analysis of participatory attitude and motivation of the two categories of respondents reveals significant diffdrences between

in Family .Planning

motivation than in attitude. This can be easilv explained The latter includes on on general participatory attitude as lvell whereas former sharply on family plan'ning We have already that there is significant dG ference in the participatory atti of acceptors and nonacceptors in questions relating to family planning. Narrow difference in the general partici attitudes ofthe two sets of respondents raises the. question as tO why in spite of similar participatory behavioqr one responds to family plandrrg programme and the other does not Motivatiod could be one reason but whl

TABLE 3.12: Motivation

Questions on Motivatian

Sample Respondents
Perctntage of Respondents Affirming the Q,uestion

Acceptors Non-Acceptors

Have you ever been to a planning centre? Have you ever used the facilitles provided by the family planni;rg
centre?

100 100

3.

Did you ever consult the medical officer in the dispensary/health centre/
sub-centre?

100

12

4.

Did you ever take your friendg/ relatives to the family planning centre and persuade{ them to accept family planninf
method?

84

37

5.

Did you ever take your spouse to the family planning centre? Has anyone ever advised you tb adopt family planning
measure?

l8
90
75

Voluntary Effons in Family

Planning-I:.

49

this difference in motivationl Let us look at some of the social variables for explanation We are aware ofpreference for sons in the Indian society. An analysis of percentage of sons and daughters of both categories of respondents would be one indicator of choice for family size. In our sample 65 per cent of children of acceptors were male while only 42 per cent of non-acceptors' children were female. Apparently, this was one of the reasons for non-acceptance It would be worthwhile to analyse the views of non-acceptors regarding ideal size of family and as the number of children a couple has and the number they consider ideal as well as other sociopsychological factors are likely to govern their attitude towards
contraception.

the NDPFA Though it is hazardous to make a sweeping generalisation on the basis ofa sample ofl6 non-acceptors! it certainly indicates that there still are a number of couples who con sider four children ideal for a family and have a preference for at least two sons. Grad,l.' ally but persistently the NDFPA must identity and motivate such couples for a &ater lmpact of the family plannipg prcgramme. Though this does not diminish what they have aheady achieved, this does indicate where they may have to concentrate in future. Apparenuy, monerary incentives were not sufficient inducement for the non-accefitors to chang their.views. The acceptorg

It would be worthwhile to analyse tne views of non-acceptors regarding ideal size of fanaily and the reasons for their nonacceptance of family planning measures, as the number of children a couple has and the number they consider ideal as.well .rs other socio-psychological factors are likely to govern their attitude towards contraceptio[ An analysis of the views of lGnon-acceptors in Anand Parbar (see Table 3.13) indicates that a majority ofthem considered four children as ideal number for any family. Most of them also felt that two sons were must for any family. Since a majority of our non-acceptor respondents had less than four childre4 they were all waiting for the fourth chii4 preferably 4 son Interestingly, two of the respondents felt that a family should have five children anil one of them was in fact waiting for a lifth child" One was scared of sterilisatioq one did not assign any reason and the rest were waiting for their ideal family size to materialise. The responses of the non-acceptors reveal the task ahead fior

People's PQrticipation in Family planning

TABLE 3.13: Views

Non-Acceptors

sl
No.

No. of children

Ideal family Rea size (No. of childrea)

-for

Remarks

l.

2. lM,2F
IM
4.

rwo more o sons are childlen particu- essential. larly dr son. -doWants 2 more childrien. Want$ 3 more Married three years back only. childien
Secre{ of

2}d,2F
4to5
4

sationi.

sterili-

Sterilisation
leads to weakness.

5. 2M,tF 6. llvl"2F
7. lM 8. 2M,2F
9. 10.

Wantg at least one nlore childWant$ a

son

Two sons are

essential.

3to4
4to5
A

Want$ fwo

more

-do,

childlen. Wantg one more chil4 preferably

son.

2M,2F

IF

No sf;ecific reason Wantg at least

a son. Want$ two nlore
childrfen.

ll. 1M,1F
12.

4
3

Nil

13. 2M

No ctiild though married for 6 yrs. Wantb 2 more At least one

14.

1M,2F

15. tM
16. 2M, 1F
3

Want| I more Two sons are child referablv essential. aso

childlen.
w
chil

daughter.

34 more,

Two sons, two

daughters
ideaL
ar.e

to4

Wan
da

one more
ter.

-do-

Voluntary Eflons in Family

Planning-I:

5l

on the other han4 declined that they were induced by incentive money. The respondents generally were not in favour ofincentiVe money, but thought that gifts in the form of utencils may be a good idea. The choice was generally made by both the couple and in moSt cases other family members did not influence thtj decision.

SAMPLE SURVEY IN OKHLA

The Rural Project In its rural projecq inaugurated in 1964, the NDFPA provides MCH and family planning services besides income generating activities for women for raising their socio-economic status. The project area consisted to 15 villages around OkhlaWe selected four areas from the Okhla project area of the NDFPA on rindom basis. These areas were Okhla Julen-a. Canal Colony and Bharat Nagar. Since the entire area under the NDFPA s rural project had 40 to 60 per cent protection rate, we took these as good performance areas and interviewed six acceg tors and two non-acceptors on a random basis from each of the four. The demographic particulars and family planning profile.of these areas are given in Table 3.14.

TABLE 3.14: Demographic Profile

Area

Popula- Eligible

tion

Family Planning Accepton

cquples

Vas Tub. IUD Niro- Others Total

dh

%age

Julena l3g

Okhla
Colony

5803

523

75

35

106

Canal
Bharat

t76
94
1',72

39

2l
7

530

l7
I

414 66

103

I I

320 6r.2 79 49

36

38.3
40.1

2556

t9

15

24

69

Nagar

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 protection rate at 38.3 per.cent The rest had over 40 per cent protection rate and Okhla with 61.2 per cent had the highest protection rate among the sample areas.

nearly 48 per cent, was the crueial that the NDFPA needed to e4courage in spacing methods. Ir| facl ifwe include the couples that had yet to have a child the clqster constituted nearly 60 per cent of the total serviceable couples. The 40 per cent with three and more children required motivation for terminal methods. In fac! the couples with two children also npeded motivation for terminal

methods. In terms of (wife's) agelroup 15-24 was relevant for encouraging spacing method and ),5-34 for terminal method

TABLE 3.15: No. of Servi and No. of

No. af living

Couples by Age of Wife Children

Semiceable Couplas

4+
l5-19
20-24 25-29 30-34
35-39

No.
121

Percentage 8.02 31.94

4044
Total

42 88 131 146 8164s54 2 4 11 1024

1',7

75 193 148

36 68

l7

50

16

482

87

494
273
113

JZ,tq
18.09

I 50
79
19

7.49

26
1509

r.72
100.00
100

t&

369 354 27r

351 .26

Percentase

10.87 24.4523.4,517.96

Voluntary Efforts in Familv

planning-L.

53

its ExtensionVorkerg smau group meetings were also arranged in these areas. The biggest succesg howevJr, has been the iocio. economic programmes organised by the paiwar pragati Mandals under the auspices of the NDFpA Its functions and aihievements have been of similar nature as in Anand parbat area,

three areas-Okhla Julena and Bharat Nagar-have primary schools run by the Municipal Corporation olDelhi Each of thi schools have 100 students on their rolls. Aside from the Delhi based hospitals like AIIMS or Safdarjung hospital, the areas were servcd by the mobile dispensary of the NDFPA 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 also served these areas. Apart from the dispensaries, the NDFpA looked after family planning needs of population in these areas. The sub-centre of the NDFpA at Okhla served the entire area comprising 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 strengthened the services exterded by the NDFpA and established direct contact with the local population To educate and involve more and.more people in the pro_ gramme the NDFPA periodically arranges to scieen documentaries and films on family planning and also arranges lectures by experts from time to time. Apart from house to houie contacts bv

dissolved srnce 1980, the peopie had neither the oppoftu[ity nor the enthusiasm to participate in local political affairs. Socially, however, the area was quite active. Zakjr Hussain Memorial Society .located in.Okhla organises various sociocultural activities in the area. The Society also closely collaborated with the NDFPA and the activities of the pariwar pragati Mandals organised in these areas by rhe NDFpA Apart from the services ofJamia Milia educational institutions,

Characteristics of Sampld Respondents

As stated earlier, the awarefless of family planning being high in area around Okhla due to the efforts of the NDFPd wetook the enfre area as good performance area" Thus, we randomly selected six 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

A majority of tho respondents not belong to high income group. Most of them (in both the ) belonged to low oi groups (see Table 16). Wbile some of the accep ftiddle income tors did befbng tb the high income rackets, the non- acceptor respoadents were concentrated in low and middle incomd

All our respondents in this grouo. 83 per cent of th accr

TABLE 3.16: Economic
Income Groups

bteskets.

were in the reproductrve age and 75 per cent of the notr-

of the Respondents

(Rs)

G'1000

l00l-2000
2001-3000

1
5 3

39
12

2l
t2
34
8
I 1,|

300l4un
4001-5000
5001-6000 6001-7000 7001-8000 8001-9000

8 2

25
11

9001:100(D

4 4 4
100 100

Age Groups
(Years) No.

Non-accepton

No.
45 36
13

Percentage 25 50 25

25-29 30-34 35-39

4A-44

lt
9
3

4
2

I
24

4
100

Voluntary Effons in Family acceptors were

Planning-I:

55

25'34 age group. Our data ^in this area ig therifore 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 acceptors 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).

in

TABLE 3.18: Educational l-evel'. of Respondents

Educational Standard
Acceptors
No.

Non-accepton
No. Percentage
12.5 12.5

Percentage

Illiterates Primary

I J

'4
13

Middle Matric/HS Craduate & above

Total

t4
6
24

58

is
100

I | 450 ,)

,<
100

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

in Family Planning

TABLE 3.19: Farticipatory

of the Respondents
Percentage of Respondents

Affirmtng Acceptors Non-Acceptors

l.

If there is shortase of

100

commodities (kerosene, sugar, fertiliser, etc) in your village/ ward, would you make efforts make these commodities ble in your vill agelward? 2. If there is shortage of water in your village/ward, would yog make efforts to

drinking

9l

100

make it available?. If the neighbouring village/wafd has a school which your villa$e/

83

100

ward does not have, would yoq make efforts to get one opened in your village/ward? If a fornih' nlonni-rr .omh i. If o family planning camp is being held in a neighbouring village/ward, would you go

1@.

62

79

62

62

75

7.

75

62

neighboirring village/ward u on family planning would yog

go there?

8. Would you make efforts to get the f-rlm screened in your

village/ward?

62

62

9. If your village/ward

does not

83

67

have a health bentre/dispensa{y,

Yoluntary Efforts in Family

Planninq-I:
Perc entage

57

Paniapatory Questions

of

respo nden ts

aflirmine

Accepton Non-acceptorc
would you make efforts to get one opened in your village/
ward?

10.

If the government decides to open a health centre (sub.centre)/ dispensary urith the help (material and physical) of people in the
village/ward, would you help? Would you like to pay for health
services?

91

100

ll.

87 95 8j 11

100

12. If the family planning centre is being opened in the neighbouring village/ward, would you go there? 13. Would you make efforts t6 get
one family planning centre/ subcentre opened in your

62

75

14.

village/ward? If a nationaVlocal leader is delivering a speech in your village/ward, would you attend thaP

75

t5. If a political meeting is being held in the neighbouring village/ ward, would you attend thafl 16. Would you like tg campaign for a party/candidate in
election?

62 37 25 91

75

25

17. Did you campaign tor any partylcandidate in the last 18. Did you vote in the last election 'for (a) Panchayat (b) Stare
election?

25

62

58

Assembly (c) Lok Sabha?

19. If the local leaders organise demonstration on rising priceq or non-availabi-lity of certain commodities, would you parti.
cipate

m.

the WWVHW is not visiting your village./wrir4 would you

make complaint to the cotrcerded

If

ir if

50

officials? 21. If you are requested to voluntder your services to the govdrnmenV voluntary agency to take the health services to the people, would you volunteer yourselfl 22. lf the school teacher in vour villagdward requests you to
persuade people to send their children to school, would you help him? 23. If the VLWVHW requests

50

75

95

100

help in persuading and ting people for accepting femily planning wbuld you help him? 24. If 'Keertan or Ram Leela is organised in your village/ ward, would you attend thafl

scores for acceptor$ and non-accept$rs for each ofthese questions

rgspcctivelyaie and62,79 atd6l,75 and62,62 and61,95 and 87 and 75 and E7 and 62. The d{fference in scor4 except one 62, question ivhere scores are equal ra[rges from 38 to ti. Generally

Voluntary Efrorts in Family

Planning-I:

59

ference

speaking the queitrons which are crucial to our study.do show.dif_

in

acceptnce.

attitude and this is partially responsible

f;

";;
'

But at the same tifte the data shows that even nof-dcceptors in this area ar not apathetics They are participant in nature Their flon-acceptance, thereforg is either due to sdme .appreherlsions towards family planning or other personal of domestic rlasons We sha-ll go into these socio.psychological factors laier. A majority of the respondents were prepared to help governmental or voluntary agencie!. in organising health services This rellects their.utge for a more efficient apd easily accessible health service. This data also shows that the non-acceptors in this area 'marginally score over the acceptors. While all non-acceptors respondants were prepared to render some help or the othe! 8 per cent acceptors did not want to make any kind of help (see Table 3.20). This data also corraborates our inference drawn from data on participatory attitude that the non-acceptors in this area have

t"he necessary participatory motivation to participate in activities like family planning

be mobilised

to

TABLE 3.20: Help for Health Services

Acceptor
Type oJ Help No. Percentage 20.8
No.

Non-Acceptor
Percentage
37.5 37.5

Physical

Financial 6oth None

'Total

5 10

J
J

4r.7
29.2 8.3 100.0

7 2 24

25.0

'8

100.0

We noticed substantial difference in the motivations of the two. .catqgories of respondents toward family planning The average motivation rate ofthe acceptors (89) was substantially higher than that of non-.acceptors (25). This also explains their non-accept-:

ance. Only 12 per cent of the non-acceptors admitted having visited a family planning centres, having used the facilities having

consulted the medical officer, having taken their friends or

g)

People's

larticipation in Family planning

relations to the family planning centre and having persuaded them to accept family planning arid having taken their spouse to the family planning centre (see Talble 3.21). This means that only
12

per cent of the non-acceptors re$pondents have had an interest

in the family planning programrnle and have not accepted it for reasons other than lack of A large majority of the nonacceptors (87 per cent) accepted been advised to adoDt y is it that they did not accept family planning measures. Theq
the advise? What are the reasons br their non-acceptance?

TABLE 3.21: Motivation of

e Respondents in Ol;hla
Percentage of Respondents ffirming the questions

Ques tio ns

on

M o tiv atio n
Acceptors

95

t2

3.

100

12

4. ' 5. 6.

medical officer in the dispensary/health cen trel sub-centre and seek advice on family planning? Did you ever take your friend$/ relatives to the family planning centre and persuade them to
accept family planning method? Did you ever take your spousb to the family planning
centre?

9l

t2

75

t2

Has anv one ever advised you to adopt family

75

87

planning measures?
Average

Voluntary Effons in Family

Planning-I:

6l

Let us look at the resliunses of the non-acceptors to answer

these questions. Out ofeight non-acceptors in our samplg only 50 per cent had children. This explains why halfofthe non-acceptors

in our sampls did not accept family planning. The other half was

waiting for

male child. Two

of them already had four

TABLE 3.221 Views of Non-Acceptors

Sl
No.

Number

of children

Ideal family size Reason (Number Non-Acceptance children)

of

for

Remarles

4 daughters As small number as

possible
2. J.

Wants a son

A son is must

2 daughters 34 children 2-3 children

Wants a son

4. I daughter 5.6.*
7.

4-5 childrerl at least 2

sons

A son is must No issue yel married 5 years back Does not have 2 sons are a son yet' must

2-3 childrerl at No issue ye! least I son married 9 years

back 2 sons and I

daughter

4 daughters 2 sons and I

daughter
2, at least I son

No issue ye! 2 sons arg married 3 years must back Wants at least 2 sons are

8.-

son

No issue ye( married 8

years ago

must I son is must

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

small number of children, but a son according to him

ryas

essential for a family. Three respondeiits felt that two sons were ,r.nust f<rr a family.

62

People's

in Family Planning
rtors in our sample had yet wanted at least one son Ideal ty of them was not less than

Thus, while

nave an isdug another

halfofihe nonhalf

jsize of the family apcording to three, Those who advocated two hinting at a four-children family.

the attitude ofthe non-acceptorq

to achieve its objective of b

operational areas.

children were in any case this data is any indication of NDFPA has to work harder

down fertility rate in its

Overview

The overall achievement of the NDFpA is impressive. Its strategies reveal good plannirig and organisation. It was appropriate on their part to devi{e their strategy into micro and macro approach'es. Gradu.alism in reachingf-and convincing people also helped In additior! t{e assessmeniof local needs and adjustments in emphasis of the programme to locai preference helped a great deal in enlistinglpeople's participation in their programme. Thc lield workers of the Association were always careful to remove shortcomings afid adjust the programme to the
economic programmes with that 0f family planning was anothei
needs of the people. Secondly, ihe integration of h$alth carq the integration health

nutrition and

socio_

factor for ensuting better cooferation- of the ieople. Early realisation that the family plannifirg programme in isolation dirt plannifrg programme did not ehlist pegpl{s participation epriUteO ttre NDFPA ro quickly .reorganise
needs Integration ohildren
and adJust their programlme rn accordance wrtlipoput-ai

of a broad-bhsed

especiallyJor the mothers before aird after pregnancy and for their

health care progru*-g

till they attained

words and c-arVile significanr weight in the family. Yrt* I hrrdly. rhe New Delhi Family' plannin! Association always .close cooperation with goui*-.niui agencies 1,1i*t"..d engaged in similar activities and rpfened serious cases oihealth care and family.planning to goverriment hospitals. This removed fear and .suspicion fromthe mindg of the pot"ntiui u"""pto., of

strength to the programme as it re4noved ,uspiiion from people,s mind and encouraged popular accdptance of a small family nofrn Karsing starus of women through ifirstitutions like pariwai prugati Malda\ proved {o be very effecti{,e in enhancing .participation and. mdtivation in family plannipg *h.n *o-Jrr..

school going ug{guu.'.orriderable

.ooj::

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 by qhowing iopular- feetings and mobilising non'accep,tors . acceptors of family planning The e*a-ples of the successful 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 family planning facilitated family planning services at the doorstep' immunisation of expectant mothers, infants and pre schgol children against communicable diseases, and nutritional'supplements 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 of bhildrert 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 of existing children The-first thlng that the Extension Workers of the Nbw Delhi Family 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 to families 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 ' 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
bebame easy.

families *ere large because tne ,such cases seemed to be

lesire for at least one male however being accepted in the

claim credit
The people in the operauonal an acqegs !o healfh care and They Also seem to h.ave oppo development The ITIDFPA has mobilising their participation and still making it appear as th dividends.

ce of family planning in t on the socio-psychological The small family norm was

for which the NDFPA could

ot the NDFPA thus. haVe

and family welfare services.

lceeded

ies for child and . women to a large extent in

strateg)rof persuading people

own choice has paid ggod

Chapter

-IV

Voluntarv Efforts in Family P-lanning-Il : Gandhigram Institute of Rural Health and FamrlyWelfare Trust
I HE Gandhigram Institute of Rural Health and FamilyWelfarq Trust 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 block sfaff on the one hand and involvement of the community on'the other, started in 1959. By the.middle of the 1960s' when policy makers were still groping for a strategy to m3ke this programme successfu! Gandhigram successfully experimented with the
method of coordinated involvement for implementing family planning in rural areas. With this method it brought down birih lrate substantially in Athoor Block, its area ofopbration Since then it has been providing consultancy to the Tamilnadu government as yell as training their medical officers and para'medical staff using lheir "Athoor Experience". This "Athoor Experiencel' is the baiis bf all their activities. In this chapter we shall discuss the activities of the Institute, examine their "Athoor Experience" and analyse the sample sun vey date collected from four villages in the area of the Institute's
operation.

The Institute

'

The genesrs of the Institute hes in the establishment ol Gandhigram near Ambathurai and Chinnalapatti villages in Dindigul taluka of Madurai district The same year it opened an

'

ffi

People's Participation in Family planning

tlre Ford Found4tion.

195!-64 was launched under thejoiFt auspices ofthe Government of India and Taqrilnadu Indian Cotrncil of Medical Research

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 to undertake a pilot project in Athoop Block to assess and evaluate the existing rural health services. thus, the pilot Health project

and district level officers of the Fealth and Family Welfare Departments of the southern Statls. It also trains the Medical lffic9rs and para-medical staff of fhe four southern districts of, Tamilnadu in family planning As stated earlier, the Institute was foundgd on the experience of the action-research in health and fainily planni"g u"ae, ttre eitoi Health Project It has not given up lesearch in these fields sincg and continues to conduct research 0n methodological problems in implementing programmes, tr4ining and hJalth activities under the supervision of a senior sOcial scientisl
Farnily planhing is the major of activify of the Institute in researcll training and service since 959. the year the Pilot Health Project was launched In 1962 thev k their second major assignment in the shape of the F Planning Communication Research Project The intention to develop a method for implementing family planning in areas, which would lead to .an appreciable decrease.in birth and which might be a prototype Of the programme What was envisioned was a

.{eJf.are is providing 1007o financihl ariirran"" to the Instituti which undertakes various short tent, training courses on behalfof the Government of India and the familnadu GovernmenL The Institute runs traiuing courses for tfainers, senior administrators

Family Planning Communi"atioF Research project by the Goveryment of India. With five jears of experienJe of action_ research in health and family planfing Gandhigram Institute of Rural Health and Farnily plannin! wai establish]ed in 1964 as an rnstlrutton engaged in researcb. seryice and trainine. - As a training institution it is a Central Training In-stitute under the pattem of training schemes of the Governnient of India for a{ flmily welfare. It is also { Regional Health.and Family !91tjt Welfare Training Centre under the same scheme of the Tamiinadu Govemment The Central Mfnistry of Health and Family

In

and

1962 the Gandhigram was sanctioned

Vpluntary Eforts in Family

Planning-Il:

co.ordinated apBroach-involvement of local leaders and to the extent possiblg of Block and other staff available to complement the efforts of health and family planning staff in planning and implementing eduthtion, serviceg follow up etc. The study intdnded to work out a methodol6gy for (1) motivating the people, (2) delining job functions and training needs of difrerent categories ofhealth and fainily planning workbrs and other workerg government and voluntary (3) working out in detail the manner in which family planning services should be delivere{ the administrative and technical support they need and their follow up, and (4) conducting continuous evaluation. During the

study the Institute provided family planning service s to the villages in Athoor Block After the successful completion of the projec! its main activity in family planning has been consultancy to the state government agencieg training of their para-medical staff and conducting further action-research to strengthen the methodology developed during the "Athoor Experience".
The Athoor Experience

of the population2. planning clinics had already been functioning in . .The family this area. The clinicg established as part of the Second Five year Plan in the town panchayats of Chinnalapatti and Sithiankottai in the Block in 1.958, concentrated on the popularization and distrihltion of contraceptives like the condom, diaphragm and jelly, and provided advice on pennanent methods. But the clinics could not really attract people to adopt family planning though they were staffed with'sociai workers as well to make family planning popular. A study conducted towards the close of 1961 on the functioning of the two clinics showed that less than 5.per cent of the couples needing family planning services had utilized these services. The couples who uied the clinic ser-

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

68

People's Pdnicipation in Family ptanning

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

needed family planning most,

did not make use of the clinic

or who did not belong to the corhmunity in whicir they were working
This helped the Institute to to local needs. People's their programme according to come forward and adopt family planning was little parp to them as the baseline suryey-conducted by them in 1959 for the Pilot Health Project in a sample of 459 households did an optimistic picture. The survey established that about 66 ient Hindug 57 per cent

The study pointed out three mgif reasons for the failure of the clinics : (a) the timings of the clinic fere inconvenient to people of the low income group, specially whpre both the husband and the wife worked in the field until late ifr the evening (b) most of the coupleg particularly illiterate couples, felt shy and hesitant to go tg a public place to discuss their perponal problem; and (c) communication barrier between the falpily planning workers and the community existed particularly wifli workers who were unmarried

services.

Muslims and 58 per cent Christi to-wards family planningwhile 24 Muslims and32 per cent Christians parcentage of favourable persons grcup among all the religious
per ccnt women rspondents ex'
selves of the facilities for family p

were favourably inclined cent Hindus,29 per cenl against it The maximum' located in the.25-34 age

and losmall family is good" seemed tors for favourable attitudes based on religious grounds were by merl. The Institute decided to embark

Thirty per cent men and 32 willingness to avail them"Economic condition" powerful motivating facbe family planning Objections more by women than
three pronged strategy

in

launching the projecq which involve interest,ed and infl uential dwelopment of the programme ordinated efforts of the health agency in planning and grammes and (3) use an group and mass media ap fire first major task of Gan

at evolving methods to: (l) from the village in the their villages (2) achieve co' community development various aspects ofthe pre combination of individuafor education
was to meet the organisa-

Voluntary Efforts in Family

Planning-Il:

69

planning field worker (male) for 20,ffi0 population; one Lady Health Visitor (LHV) for 40,000 population The strength of the ANM and LHV was raised in 1965 to provide one ANM for 5000 population and one LHV for every four ANMs. At the Block level, apad from one lady physiciarl one Extension Educator was appointed for ceordinating all aspects of family planning work The Government of Tamilnadu could not organise the district level organisation for family planning till 1965, and the project staffassumed this function forAthoorblock The project staffilso assumed the role of family planning field workers in the inirial stages to gain the first hand experience. Since both the PHC and the Block were involved in the worlg it was difficult to leave the organisational control to one only. Hencq a rather complex structure of organisational control was devised. The family planning field workers and computer were placed under the Block Exrension Educator (BEE), while he reported directly to the PHC medical officer. The ANMs under the three sub centres of the PHC reported to the pHC through the LH{ while the others reported directly to the BDO. The medical officer of the.PHC, however, provided technical guidance to
them.

supplemented with additional personnel for extensive lield work required to make this programme popular. Hence, it was decided to augment the strength of the Auxiliary Nurse Midwife (ANM) to establish a ratio of I : 10,000 population; to appoint one fam-ily

tional ueed of the programme; The infrastructure was available in terms of the Primary Health Centre (pHC) staff But they had to be

. Gandhigram undertook the responsiorlrty for purchasing storing and distributing condoms duringlg62-67,as tlie suppliei from the 'governmental 'sources were inadequate. The supplies werg however, channelled through the BEE. Gandhigram alio organised the transport facilities. To ensure co-ordination in the activities of the pHC and the Bloc( an Action Committee was constituted at the Block level consisting of the PHC doctor, BDO, Chairman of the panchayat Union Council, Deputy Inspector of Schools at the Block, Director of the Gandhigram Institute and representatives of the local communities. The Committee was entrusted with planning of the programme as well as with ensuring direct communication amone
healt[. family_ planning and development workers. The implel
mentation of the family planning programme and its operational

70

details were worked out in the and the Block The attendance of the othefs stbffmeeting was and ;co-ordination and it worked also'generate participation at all t All the workers recruited by the

staffmeeting of the PHC

repre sentatives of the each at

in promoting co- oPeration This arrangement couid levels

under the progxamme

were given preliminarY training three to six nronths before theY v

were called for more extensive

Gandhigram ranging from sintio the field. Later, they

depending on the nature

of

'their job. brent categories of workers. the job'funitions. The currifi eld training DeveloPment exercises and field training skills to perform tasks through ,of training To facilitate this, the was yery important Part of the area The postInstitute dweloped a field practice training phase of workers was alst closely supervised to provide any mistake they migbt them. with suppo( as well as to c PHC and Panchayat Union commit Regular staff meetings at family planning team and attended by members of health of the Block-level comBlocl planning and evaluation m bctiveness of certain methods mittees ahd demonstration of the at different levels and at dG in the field provided , rightferent stages to set the errorg if in phased manner. In The programme itself was im ovr eacn ol the initial stage six mqst responsiYe villages spread over each of jurisdiction were selected After the the family planning workey's rprogramme reached the take offsthge in the first set of villageg it was extended to a other group and thus, to the entire Block As the prrgramme was introduced to a ilxt set of villages' the earlier group received regular follow'up' One of the important advaniages of the phased implementatio[r was that weakness, if any, in thi 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 for

The curriculum for training

of

was developed in accordence culum combined both theoretical

the next sgt Involvement of the cpmmunity and training of the village leaders was .also facilit+ted because of the phased

implementation As mentioned earlier, Block-level Action Committee was tentrusted with the responsibility ffr overall planning of the pre gramme and for pdordinating acjivities witb other departdrents

Voluntary Elforts in Family

Planning-Il:

il

As a trrst step, onentatron sesslons were arranged for the PHC staf[ Block staffand Panchayat Union members, and this helped in enlisting their supporl Involvement of the staff in details of planning programme also proved to be a successful way of assuring their commitment to the programme. Thus, apart from the Action Committee meeting at about three months interval meetings 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 local adjustrnents and periodical meetings helped in reviewing and modifring them. Voluntary acceptance of the programme and involvement of the iommunity was an important part of the plan. Thus, the' Institute developed a methodology for identiSing and training leaders-both formal and informal-in family planning activi ties. Both male and female leaders as well as indigenous medical practitioners and dais were trained and used One-day training camps were conducted for the leaders. The agenda ofthe training usually consisted of two parts. In part one, discussions were held on the advantages of small family and means to achieve it In part twq the official family planling programmq and the role of community leaders was discussed and simple educational skills taught Following this joint planning was done by the community leaders and family planning stafl with the responsibilities of each clearly established Some ofthese leaders were also used as depot holders Those selected for this purpose were given a half day training in explaining the use ofcontraceptives to others and keep' ing supply records Care was taken to select the individuals who would 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 will lead to an appreciable increase in number ofcontfaceptop which in turn would lead to a decline in fertility. Itwas also assumed that the creation ofthe three conditiohs should be preceded by certain type and amount of inputs and efforts While the inputs referred to personnel, frnances and materials, effoits are iri terms of activities that have to be carried out to create the necessary conditionsDrd the programme succeed in rts goal? The evaluation of the impact of the programme by the Institute indicates that it

People's

in Family Planning

unication in family planning and (b) acceptagpe of contt and (c) reduced fertility. The KAP studies conducred by Instituie have indicaiea ttat lhe overeo percentof the

rncreased (a) knowledge 4nd

well informed about tamily plarfni

il-;#6 il;"ii;irffiHffxl:r:

Pupulation: 1,24,498
Method
1957 to 31.

Eligible Couple:
18,312 since Couples Vunently proteeted as on 31.10.1977

1977

Number

of
prttected Vasectomy
5419 5747
160 29.5 31.4 0.9, 13.0

Number Percentage
of couples
protected
6s3
20.1

Tubectomy Nirodh & other CC

3023

IUD

i60
228

0.9
1.3

2394

By all methods

r3720
S

4.8

4&

22.3

Source: GIRH & FW Trust

shows that the resident

The fertility survey carried out every six months since 1964 birth rate rggistered a decline.of 34.8 per cent during 1959-1968, from 43.1 tq 28.1 per thousand
The decline was more steep durirfg 1964-196g. In 1977 the birth rate stood at25.6 and the death ratd at 10.3. In 1980 the birth and death rates in Athoor Block were esltimated tobe23.7 and 6.7 per

thousand respectively.

Voluntary Effons in Family

Planning-Il:
120, the

73

In

1959

infant mortality in Athoor Block was

Institute

inlant mortality for rural Tarnilnadu still stands much above the
hundred mark

suryey for 1977 indicates infant mortaliry rate of 90.7.3 The

TABLE 4.2: Resident Birth and Death

Year

Ra.res

Birth Rate

Ail
India
(Rural)
1959

(Rural)

Tamil- Madurai Athoor nadu 'Dist Block

(Rural)
43.1

Death Rate

(Athoor
Block)

20.1

L9&
1965

35.s
36.1

1966
1967 1968 39.0 38.9 34.9 33.8 32.6 32.9
J I.J
3

31.6
33.8 33.8
33.C
J

t-z

1969

29.4 J.I.J a1 t 27.4

16.9 13.4 13.4

l9'10
197

32.s
31.8

38.9
35.9

1972

t974
1975 1976 t9't'1
1978

35.9
36.7 35.8

r.3

31.0 J I.U

32.7 32.1 30.9 20.4

3l.0
25.6
10.3

Source : Institute Survey

for Athoor Bloch SRS for all India. Tamilnadu and Madurai District. "Athoor Experience"

Lessons from the

and planned. lt starred with KAp study w-trich gave them a fair idea..of what.people thought about family planiing and ..small tamrly_ norm". The srudy team took note of the i.act that the two Iamlty plannlng clinics already functioning in the area did not,

There seem to be three main features of the..Athoor Experience" (a) organisation, (b) co-ordinarion, and (c) partiiipation. In Iaunching the Atho<ir progra.rimeo the tnstiiute aii noiltrow any hurry. Each and every arp"it oithe progru-rn. *", oiscussed

74

PeoPle's

in Family Planning

the reasons that led to the really attract peopie. TheY for their programme. of the ciinics so as to draw failure the programme they took all lWhile evolving the stratbgy to factors into consideration. the environmental and field to gain the first-hand ilhe project staff also worked in was launched. they also experience. Before the d created the necessary struc' the organisational needs assessed additional responsibilities ture to sustain the programme. All staffwere assumed by the which could not be met with the project staff Moreover, instead o! starting the programme in a programme, an impgrtant hurry, they decided to phase out principle of "strategic managemen , so as to know the weakness e collapses. and strengthen it in their strategy before the in every subsequent Phase. has many dimensions to it A programme like familY P among the workers in an and hence it requires coordina developmental organisaorganisation as woll as between the other. The Institute took tions on the one hand and PeoPle was to ensure co-ordination cognisance of this fact Its major was done by constituting an between the PHC and the Block tion between the stafl Action Committee and generating of the two agencios. BY inviting th Chairman of the PanchaYat Union Council to be the member o this Action Committee it also tion in the programme. opened gates for PeoPle's office.bi:arers in the ProApart from involving the
gramme, it was equally necessary involve local leaders as well as led to the idenfication and the population in the Programme. proved'immensely useful training of communitY leaders later. Besides, it was realized that ine ahead head-on with the

'family planning and talking all time about family Planning at times the project-staff might hinderthe Progtamme. Th of the local population, attended to the imrnediate health lanning. It helped them elicit rather than talking about familY over a long period people's participation as well as ence was that from the very the Another positive aspect of beginning both the PHC and the B k staff were actively involved details of this we have disat every stage of the Programme. ereforg when the Institute previous sections. cussed in to the Tamilnadu Govern: officially handed over the
ment, the two agencies in the area

not merely handed over an

ey had shared the exPerience

experience by another institution

Voluntary Efforts in Family

Planning-Il:

75

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 conducting family plannihg Its aim was to develop a methodology and a strategy, which it did with considerable success. Since then,
it has assumed the role of h consultancy agency to the governmental institutiqns as. well as a fesearch and training institute. The of course, is the "Athoor ' basis, take into account various Experience": may have occurred changes that To or that are taking place, the Institute undertook various kinds of action research projects to enrich their experience as well as to sustain people's interest in the matters of health and family planning Two research projects currently under,way iq the lnstitutg

which our research team visited are Distr'ict Development Demonstration Project (DDDP) and Integrated Development
Project 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 consultative agency to the PHCs and CD Blocks. The Institute also organises and activates Mathar Sangam (Women's Club) and Youth Qlubs in villages and works for improving environmental sanitation through 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 stipend of Rs. 300/- per month for attending to deliveries and look

after MCH programme as representatives of the PHC. The Institute also organises Orientation Training Camp for village opinion leaders, who help in health and family planning
progfammes. As consultative agency the Institute helps the PHC and the CD Block para-mbdical staff in popularising family planning as well as maintaining records for each of the villages. The Programme

Development Officer of the Institute attends the monthli meetinss in the PHCs and talks to the para-medical staff about

76

People's

in Famifi Planning

their difliculties in ihe field approach people, how to talk to In villages the Institute pits and trench latrines. They sanitation and other health prove very useful in such--rnatters is also sought Mathar Sangams
endeavour. They are more

arq tni advised on how to em, etc. people to construct soaking

taught about enviornmental
res. Village opinion leaders

ofschool teachers proved very useful in this

to such ideas. Idea also travels

fast among them.

possible to organise merely for health and planning Thereforg the fmaily te has undertaken the responsibility of eiergqsing Mat har in economic and social activities as well Every Block Tamilnadu has thirty Mathar of India- DDDP has ,Sangams, as approved by the selected ten Ma thar Sangams for Sixteen ANMs have been entrusted with the respo to energise thirty Mathar Sangams. Each Mathar Sangam about thirtv members. The 'members of the Mathar Sangams help in family planning wort 'and collect children for tion. The members are trained in tailpring and embroidery. The ees were paid a stipend ol Rs. 100 per mont[ which was la adjusted towards the cost ol sewing machine. They had to paJl Rs. 280 more. Now they eqrn about Rs.5 a day.

It is not

Integrated Development Prog_ramme

Under this programme fifteen {illages-ten experimenral and five control-have been adopted liry the Institute. The emphasis, undef this programme, is on the f rovision of basic needs-which have linkage effect on health. Uhdei this projecl community leaders (teachers, dais or caste lea{ers) and kinship leaders have been 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 out various programrnes under the proJect Students' ceoperation has

also been enlisted

in

demonstration in nutrition progra[nmes. The Institute is preparing a list Qf intervention. programmes as part of integrated health programqire. Some of these programmes
are (a)

three vilfages. They are utilised for

-environmental

sanitation,

and (c) MCH.

(!) socio-economic programmes

Voluntary Efforts in Family

Planning-Il:

':-7

(a) Environmental Sdnitation

The Institute has made attempts to ensure protected water supply to the villages. Tubewells and hand-pumps are being provided in the :villages under this programme. Scarcity of water and availability of sub-soil water at great depth are some of the problems that they are encountering Villagers are being advised and helped in constructing latrines and soaking pits. A proto-type of latrines has been prepared which does not require much space. To encourage the villagers to go for soaking pits and latrines, it has been tied up with socio-economic programmes. The Institute has arranged Rs. 2,500 loan from the State Bank oflndia for those who
agree to construct latrines. Along

with the latrine constructior\

they buy milch animal (cowor buffalo) with this amount Those who agree to construct a soak pit get a loan of Rs. 250 for a goat or sheep and Rs. 75 for a soak pit The institute has also tried to construct bore hole and trench latrines for communitv use.

(b) Socio-economic Programme

As discussed above, the programme of environmental sanitation has been tied up with socio-economic programme. Apart from this anangement, the Institute has selected some boys for industrial training The industrial training centre has been requested to provide training to these boys in small trades. The Small Industries Service Institute has been requested to train some girls in silk threading etc.

(c) MCH
Under this programme, 70 per cent to 90 per centANC has been ensured. Once a week clinic is held at two villages. These clinics provide treatment for minor ailments. Male and female volunteers are selected and trained as health workers. Earlier these volunteers

were paid some honorarium which was latQr stopped at the request of the health committee of the villages. These alinics also immunize the children. Health Committees have bgen formed in each of the villases for ensuring popular involvement The Institute has been u-bl. to achieve limited success in this direction. This is, of coursg slow but sure and gradual process. Under another project a village: Balasamundaram-has been adopted by the Institute in Pallani Block in Madurai districl One Mini 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 the building ofthe PH Sub-centre of Block A new building constructed solely with people's utiorq awaits inaguration. A land owner of the,village, living erg has made a substantial contribution The rest of the has been contributed by the people. To sum up, for prornoting li planning work the Gandhi grant Institute : ,
.

.i) developed suitable infras

i0 iit)
19 v)

reducing populatron and

vi)

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

tion;

sources of communica-

ix) orgnised educational-cum-mfni service camps; and x) educated all those other th4n the target groups who involved in decision-making process.

are

SAMPLE SURVEY
Samole Villaees Sample Villages

In
'

accordance

with our

we selected four

villages, two each with good as as two each,with poor performances in family planning It is n an easy task to judge performance of a village in a re like family planning We, therefore, decided to go by the rds and recommendations of thp Institute. Their criteria was cent of couples protected by permanent method of family p Thus, the two good perfor(45:2 per cent protected mance villages were Allamarath (M.4' couples) and Chettiapatti cent protected couples). The poor performance villages two Ramnathpuram "A'6 (4.7 per (6.8 per cent protected cent protected couples) and M couples). In each of the good perfi villages eight acceptors and four non-acceptors were in by three investigators.

Voluntary Effors in Family

Planning-Il:

with a population of

36 respondents were selected on random basis. The demographic profile of the four sample villages is given in Table 4.3 Alamarathupatti was the largest village in the sample

All the

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 Ramanthpuram had a small scheduled caste population. In rest of the villages the scheduled castes were in substantial numbers.

1335, followed

by Chettiapatti (952)'

TABLE 4;3: Demographic Profrle of Sample Villages

Demographic
Villages

Profile

Alamaro- Chettiathupatti patti

1335 1320
15

Rama.na- Munnilai' thapuram kottai

751

Total Population Hindus Christians

Scheduled Castes

952

746
746

952
125 522 430
180

751
6

605.

2t0

Male
Female Samples

710
625

382
309

43
303
118

in Repro-

197

102

ductive age grouP Couples Effectively

protected

89

80

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, but roughly 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 served by.MCH centres. Rest of the two villages-Ramnathpuram

ln Tamilnadu p-anchal'at elections were last held in 1971. Panchayats were superseded in 1977. The panchayat bodies, therefore, were non-functional in all the four villages.Onlly Alamarathupatti of the four sample villages had a farmet's co'operative and a Milk'

80

People's Pfirticipotion in Family planning

"A" and Munnilaikouai we.e serve{ only by para-medrcal statf of the govemment in the village. A.n ANM each resided in Alamarathupatti and Chettiapatti Qhettiapatti also had a Gramsew_ak residing in the village. Alaq\arathupatti was visited by a VHW every fortnighl RamnathpurNm "A" was visited by an ANM every weelq a VLW fortnight and a Health Visitor and a Hbalth. Inspector every month. Munnilaikottai was visited bv a Gram Sevak once a week and an ANM once a month. The hearest referral hospital was eight kilo metefs tiom Alamarthupatti, three kilometers from Chettipatti and Rlamnathpuram "A" and four kilometers from Munnilaikottai Bepides, each of the villages was visited regularly by the staff of the Gandhigram Institute. Family planning services in the dample villages were provided by the para-medical staffi who didtributed the constraceptives. School teachers and small shop kefpers in the villages like barpital (part of the Gandhigram instifutions) and Taluka hospital in Dindieul.
bars, tailors, etc. were appointed depiot holders for contraceptives. Clinical facilites were, however, available in pHCs Kasturba Hos-

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

cQ-r)peration.

Voluntary Efforts in Family

Planning-Il:

81

any of Very active form of participation was not reported ftom non-parmanent the viliages. Apart from accepting permanent and family planning on persistent motivation'-few accepmethods-of required' t i. fr.ip.O ttre treitth stafi moiivate non-acceptors' if planning i.opl. *.t" reporred to be helping in organising family

the noncamps and tritping experts to ccme and sp<-'ak to also reported uaa*tor. in Alamarathu pattL lulathar Sangam was ;;;*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 population specially ofthose subsisting on agrictllture' People were hesi-not beiause they wanted to hide it t*t'oirtutirrg their income; but they never made an estimate of their income' We have' but because however, accepied the statement of the respondents in this regardwhich most of them made on persistent enquiries' On the basis of the ten slabs of Rs. 1000 each prepared by us for tabulation purposes, the respondents ofthe four sample villages fall in the hrst

TABLE 4.4: Economjc Status of Respondents

Annual Income

Acceptors Percentage

lJon4
b

Percentage

Acceptors

Rs.'

0-1000

Rs. 1001-2000
Rs. 2001-3000 Rs. 3001-4000

7 t2 5
z+

29.2

50
20.8

33.4 50
8.3

I I

8.3 100.0

Total

100.0

l2

82

People's

'pation in Family Planning

i.e..

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

of them falling in the second,

The acceptors in the sample age-group. Eleven acceptors. i.e. sample belonged to 25-29 years pondent was older than 34 years.
the success of thefamily planning

family planning programme be successful only if younger couples are prorgcted by one or the ther family planning method. The non-acceptors, however, distributed in various agegroups from 20 to 44 years (see Tr e 4.5).

onged td relavively youdger per cent of acceptors in the group, while no acceptor res-, to an extent, is indicative of rkers' efforts in the area. The

TABLE 4,5: Age-Group Cotnposition of Respohdents

Age-group
Acceptors

NonAcceptors

Percentage

i5-19
20-24 25-29 30-34
35-39 40'-44

,1

ll

25

46
25

I
6

25 8.3

50
8.3

I I
2+
!.)

8.3 100.0

Total

Table 4.6 indicates educational levels of the respondents in Tamilnadu. No responden! whethei an acceptor or non-acceptor, was educated above middle school l]evel. The surprising feature is 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 oassed middle school examinations. Lookilpg from another angle, only 37 per cent of the acc6ptors were literaft (primary and middle) while 75 per cent of'the non-acceptors were literate (primary and
middle). As stated earlier, we had planne[ to include both males and females in equal propbrtion in our {ample. But we had to modify ow strategy and make ddjustments i[ the field. The main problem was of cpntacting during the day m(n who used to go out early in the moining to work in the field h{t conte back only late in the

Voluntary Efforts in Family

Planning-Il:
in

83

evening Under such circumstances we had to inverview women.

We could get the non'acceptor males and females proportions, but not the acceptors (Table 4.7).

equal

TABLE 4,6: Educational Level of Respondents

Educational
standard

Acceptor
t5
3

Percentage

Nonacceptor
J
^

Percmtage

Illiterate Primary Middle

Total

63

25
JJ.J

t2
25 100

4t.7
100.0

ai

t2

TABLE 4.7: Sexwise Distribution of Respondents

Sex

--

Acceptors Percmtage

NonaccePtors

Percentage

Male
Female

8 16

33.3 66.7 100

6 6
L2

50 50

Total

lo0

Participatory Attitude
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 different kinds-social, political and cultural activities dmonstrates this point effectively (Table 4.8). The respondents' concern for health care 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 health services to the village, (c) volunteer their services to government voluntary agency to take health services to the people.

That panrctpation is a, graded activity. and people

select

People's PQnicipation in Family planning

TABLE 4.8: Participatorv Aftitude of Respondents

Percentage of resp o nde nts aflirmint the questiorc

Acceptors No.n-acceptors

commodities (Kerosene S Fertilisbr etc.) in your would you make efforts to them available? 2. If there is shortage of water in your village, would make efforts to make it 3. If the neighbouring

l. If there is shortages of essen

4.

66

41

5.

54

4l
75

village?

6.

If a film is being shown in fthe

neighbouring village, would You
go there to see it?
87

7. If the film being shown in ypur

neighbouring 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-

66

)U
29

iary would you make efforts to get one opened in your villaee/wa[d?

Voluntary Efforts in Family Planning-Il:

J't

85

10. Ifthe government decides to open a health centre/sub-centre/dis'

'

100 100 79 79 20 91 66 62 66 91 87

100

pensary with the helP ofPeoPle the village, would You helP?

in

1l: Would you

village?

be willing to join in organising health services to your

100

12. Would you be willing to pay for health services? 13. If a family planning centre is
opened in the neighbouring village, would you go there? 14. Would you also make efforts to

91

'

83

get

25

one family planning centre/subcentre opened in your village?15. lf a nationaflocal leader rs dblivering a sPeech in Your village, would you attend that? 16. If a political meeting is being held in the neighbouring village, would you attend that? 17. Would you like to campaign for a partylcandidate in election? 18. bid you campaign for any partyl .candidatd in election? 19. Did you vote in the last election (a) Panchaya! (b) State AssemblY, and (c) Lok Sabha? 20. If the local leaders organise demonstrations on rising prices or non - availabilitY of certain commodities, would You Participate in iP 21. if the wwvHw id not visiting your village, would You make

83

50

83
91

91

75

83

complaint
officials?

to the

concerned

22.

y6ur services to the government/

lf

you are requested to

volunteer 100

100

People's

in Family Planning

23.

If the school teacher in village/ward requests you to persuade to send children to

help in persuading and motivati]ng
people for accepting family plarin-

voluntary agency to take the services to the people, would volunteer yourselfl

100

school would you help him? 24. If the VLWVHW requests you to

95

75

ing would you help him? 25. lf 'Keertan' or'Ram Lila' is organised in your village/ward would ybu attend tha0'
Average

79

83

75

7l

lhe same is true tbr their (question 23). For some reason or prepared.to make efforts to get d
centre (see responses to questions 8 their villages. Both the acceptors

fbr eoucation of thetr children they themselves were not centre or family planning d 13 in Table4.8) opened in
non- acceptors demon strated werg however, as pointed

luke-warm attitude in this reeard

out earlier, preparod to help ifeither govern4ent or a voluntary agency takes the initiative. The of immediate nbeb is also visible in their response to questi I and 2. It seems that the 'is shortage of drinkirrg water in a graver than other essential cornmodities like kerosenq sugar, tilizers etc The respondents attitude towards political participr also seemed very positive Percentage of reqpondents voting in last Panchaya! Legislative 'Assembly and Lok Sabha elections as high as 9l per cent.More their intereSt in attending for a caodidales The average score lbr and non-acceprors over 25 (75,71) shows only margiral brence between the attirudes. ltems

of

acceptors

and non-acceptors The acceptors' score were;

however. higher. But oir six items

non-acceptors equalled lhe surpassed them. Thus, the twelve items. Of the seven

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 nonFcceptors equalled one with the acceptors . and marginally pxceeded them on trvo. This creates a rather confusing scenario. but it can be explained if we look dt the data.carefully. Scores for guestions 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 of respondents 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 of the 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 health centr with the help of the people. Wg then, asked a supplemen'' tary questiotr to know what kind of help would they provide. A litlle 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 of the acceptors agreed to provide material help, while 20.8 per cent bfthe acceptorsand 25 per cent ofthe non-acceptors were ready to help both physically as well as materially. This, on the one han4 eflects 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 improvement TABLE 4.9: Help for tlealth Services
of Help Jor Heakh Semicet

Acceptor Pertentag3 Non-Accqmr Percenage

Physical Help

t4
5 5

58.4

9
2

Material Help Both

20.8
20.8 100.0

)<
100

Iotal

tz

88

People's

in Family Planning

Motivation

in terms of their visit to the fan

facilities, seeking ddvice from the 'family planning atc. Here ftain .the motivation of the accept<irs i fhe responses reveal that a visit to more looked at with suspicion. As

Motiv. ation of lhe respondents

family planning,was judged planning centre, using thc

advising others to acce.pt

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

similarity can be seen in

of acceptor$ and non-acceptors n nrng centtes and 95 and 75 per acceptors use{ the facilities. An (87 and 77 per cent respectively), advice on family planning Slightly tion of the acbeptors and-non-a persuading friend$ or relativeq ning centrg etc. The ayerage pl acceptors and non-acceptors car ference in motivation rates shows 'planning was partially responsible itemwise analysis r'eveals that thev I a family planning centre or motivation is a faotor,. there aie come to it later. In abour 30 per cent cases ihe dec either by husband or wife and in decision was taken jointly by the where husband decide{ he got hi cent got the wife sterilised Only in sion to get herself sterilised withc husband or the mother-in-law. , Except one accoptor, who tion for money, tho rest denied thcir decision to accept,.family what should be done to make I sizes the importauce of attaching planning in rural areas. Fifty per family planning adopters shouid benefits, their perception of gestd that the amount of the few of them offering iearion that

9l and 83 viiited family plancent of acceptors and nonmajority of theq consulted the doctors for difference inlhe motivatoro is visible in questions ot spouse to the family plao, of the family plannin! to 74 aqd 49. The wide diF t motivation towards family their non- acceptanca Ar
not suspicious ofgoing to rg a doctor. Thus, while factors as well We shall
ion to gc[ sten]tseo was BkeD.
70 per cent cases the In 50 per cent ofthe cases sterilised and in the 50 per case the wife took the decithe knowledge either ofthe

a percentage as

having gone for sterilisaincentive money influenced

ing But their opinion on planning popular empharnomic benefits to familv of the acceptance felt ihat provided some economic benefits varied Some sugmoney should be raised, 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-temr benefits. 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 suggsted strengthenitrg ofthese tii'o serviceg 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 rslondenb afrrminq the audtons

Acceoton Non-acce?ton

t
2.

Have you ever been to a fdrtilY

9l
95

E3

4.

planning centre? Have you ever used the facilities provided by the family planning? Did you ever consult the medical oflicer in the dispensary/health centre/ sub'centre and seek advice on family planning? Did you ever take your friends/ relatives to the family planning centre and persuade them to accept family planning
methods?

t)
75

87

5: 6.

Did you ever take youi spouse to the family planning centre? Has anyone ever advised you to adopt family planning
methods?

70
37

25
8

Average

74

49

in Family Planning
Srought out the rrnponance ol'

ted that happy

le's

acceptors

good publicity.

acceptors who can tell them that affect health adversely.e Only one

be used to motivate nonemphasised the role

panrcipauon 'Ihey suggesplanning measures do not

of

Padicipation, Motivation and Thug the data ,presented ab that the participatory attitude is

Planning
and its analysis demonstrate of a reason for differences in of the accepiors and nonplay some role. A high par-r accepto? can be to a large e Gandhigram Irstitute. It is non-acceptors in the are4 in ve not accepted family planthe level of their motiva-

the family planhing behaviour

.

acceptors\ while motivation does ticipatory attitude even for the extent attributed to the activities apparent that one reason whv spite of high participatory attitude ning is that the Institute could not tion But this in itself is not

t explpnatioo Non-acceptors

TABLE

4.ll:

Views

S/
No.

Number Desirable of number of children children accotding to the res-

pon(ent

If something
happens to ong at least the

other will

2or3
J

survive.

Has no None tr look afterDoes not like

the chil
cas

in

contraceptives.

ino

of them

Voluntary Eforts in Family

Planning-Il:

9l

l2
4.6 5.4 3. Nil 7. I 8.3
Scared of sterili-

sation

It may lead to ryeakness Eos

not like bontraceptives.

Scared of sterili-

. It'may lbad to
weakness.

sation
Has no child yet

Does not like

contraceptives Wants one more

child" Had a child only 3 Prepared to get months back and sterilised after one did not want to get year. sterilised imme. diately. Wants to have one more child Wife is pregnant Four children are ' for the fourth timE needed to help parehts in old age, Not conceived for Sterilisation foul years since affects health last child, so no
_

9.

10.: 3

lt.5
t2. 4

need Can't say,

Does not like

contraceptives"

A number of other
planning behaviour
as

factors influence an individual's family

well. Some of these factors are: the numb6r of living childre4 the number one consi.deri dEsirablg one's attitude towards.contiaception as well as a number of other socir* psychological factors. An analysii of the views of all the 12 nonl acceptors in our sample provides a clear pricture (see Table 4.1l). The da{p makes interesting reading and provides valuable insight into thb respondents' perceptions _Only four non-aoceptor respondents had more than three children and none had more than six Two had yet to have children and thpe each had one and three children All but one

92

in Family Planning

consicrcd two ot three children thought .child live was the ideal numl did not accppt for obvious

children desirablp for a family. did not use contraceptives because they did not like it Three the respondents with only one child were waiting for one or two One ofthem considered two as desirable and rest though three were desirable. Giving reasons 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 as desirable numbef but had difl reasons for non-acceptance. One ofthem had no one to look the family in case one of the 'spouses gets sterilised And he not like contraceptive either. The other ong a womarl gave to a child only three months back aqd since she did not want to sterilised immediatelv. she decided to pospone it for a year. I fourth respondent's wife was pregnant for the .fourth time and was prepared to accept ter-, minal method after the fourth. He contradicted himself by saying that four children were tial to look after parents. The two respondents with four children considered five and three as the desirable number of The first one was scared that sterilisation might cause while the second was not sure 'why, but he certainly did not like contraceptives. The one with five children considered two children desirable for farnily and did not accept family measure because she had not conceived for fouryears since last Besides she thought that sterilisation effected healtlr" And the only one with six children thought dhat a family sh have only two children. He did not accept because he did not contraceptives and thought that sterilisation caused Thug ncine of the nonrcceptors beli6ved in too large a and at least eight of them were potential acceptors.
generalizatioos on the basis It is not possible to make .of the intprviews of 12 nonr respondents. But fre can safely conclude thlt awareness ofd advantages of smallfamilY is Gandhigram Institute can gradually sPreadiug in this area a lcertainly claim sorne credit for this they have worked for this in though the situatioq still is far' the area for nearlY two decades still apprehensive about con' from ideal. A nuntber ofPeoPle traceptives and afpaid of
.

while only one person The two who did not have a ns They considered three

Volunrary Efforts in Family

Planning-Il:

93

Overview
The study of Ghandrgram Institute of Rural Health and Family Welfare Trust offers useful lessons in planning organising and implementing family planning programmes. It emphasises community involvement in population control in developing peoplds participation in family planning programme. Assessment of people's need according to local requiremearts and continuous adjustment of the emphasis of the programme according to local preferences and reactions made the people feel that the targets and strategies weie not imposed from above, but were chalked out by them. The pdect staff could gauge the reactions of the people at every stage and recti,$ the shortcomingsj if any.

Secondly, the programmes are usually implemented on the

basis of the principles of what is known in the administrative and management parlance as strategic management. There rrre four critical interventions for the success of any programme according to this concep( ('1) the formulation of a strategy for the programme

consistent with the objeetives given by the government and the environment in which it is implemented; (2) the creation or adop tion of an organisational structure that matches the programme strategy and facilitates its implementation; (3) the operation of the organisational processes of planning and monitoring performanceq and motivating and developing human resources consistent with the strateg5r and structure referred to above;.and (4).continued orch_ristration of these three types of interventions over time so that

they reinfoice one another even as environmental conditions change (Paul 1981:H-l3l). As our study of the "Athoor Experience" which is the basis of the Institute's entire worlg today, reveals that each of the interventions were used during the project to achieve 'results. It must be ipointed out liere that the application ofthe above interventions, so essential for strategic managemen! is diflicult at macro level Thirdly, the most important feature of the programme of work of the Institute and hence the lesson for the implementation of family planning is the coordination among various governmental agencies which have a role in the implmentation of a programme. The rivalry between the heads of two or more governmental agencies at one level over their status and the resulting disputes over ,rights, duiGi and jurisdiction very often tells upon ihe perfiormance of a developrirental programme. The tug of war over such

94

in Family Planning

petry issues has been reported to very common between the PHC staff and the Block staff in tt implementation of the family planning programme. The studied this aspect of rivalry ,and jealousies not onljr in the of other development prolgrammes as wel! so that proper lon is ensured between 'idepartments. To tackle this type situation the Institute evolved . the method of coordinated invo by constituting an action committee which [s the base of coordination. While the situation is far from ideal ere in Tamil Nadu, the experiment of Gandhigram Institute was successful. The result was the Institute fulfilled the targets claimed prize money. The Instituk does not have the targetapproach in famill

planning but aicepts 'cc ' as the basic obiective in fullilling the allotted targets. BV ir g block and PHC staff through coordination and thus friction between thern the Institute has been successful involving ...- both in its programmes of fertiliff and mortality The strategy ofidgnti$ing community leaderq trai them and using them for community participation in devel t projects has paid a rich dividend in fulfilllng the ob of the family planning Finally, the creation and of voluntary groups like Mathar Sangams and Youth proved that these informal
r

structures can be used successfullv

judices

tion in programqes like family p The eiperience also shows that once such institutio are create4 activated and energized it becomes much easier hannelize their efforts in different directions. Such institutions only become agents of change and accelorate the process of rural reconstruction, they also have the potential for weake: caste and religious pre-

enlisting popular participa.

if

used judiciously.

Voluntary Efrorts in Family Planning:-Il:

95

NOTtiS:
t ,t977.
2 The percentages are based on 1961 Census figures, as given to us by the Institu!e. 3 It is difiicult to surmise how has the Institute achieved a birth rate of25.6 with infant mortality as high as 90.7. But these are the figures indicated by the Institute Survey, 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.

According to the survey of the Institute, its poprilation was 1,24,498 in

Ml,l0).
6

christcned them
?

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 milch
animals. t The ove apping in the percentage is because many ofthe agceptors suggested two or three measures 9 Hereagairi the Gandhigram Institute seems to have effected th perception of

There were two villages ofthe same name in-the area. Thereforq t'he Institute

!'A'

the respondnls, This method was used by the.Institute "Athoor Ex.perience".

in

course

of their

Chapter V

Voluntary Efforts ln Family Planning- : Vadu Rural Health Project

THn vudu Rural Health
selected for
a relatively young
,s.

projec! was

Firstly, it is one of thb few health projects which with the Communitv Health Worker Scheme much befiore the ent of India recommended it in 1977 and secondly, ithas tely embarked upon the new approach of .cootdinated i ent between its staff and the medical bureaucrracv of the t of Maharashtra The project was launched in 1972 the King Edward Memorial (KEM) Hospital under the leadersfrip of Dr Banu Coyaji decided to'enlist its resources in the area (f rural health, which though a
very high priority area was a relativbly neglected field' (Coyajiet.al, 1978: Annexure). In its decade old bxistence this action-research project has been able to show somp interesting rbsults in the area

otr

study for two

of health and family planning After'achieving some success in this are4 the project is now diversi]fuing itselfin the area of ntitrition, environmental sanitation an{ rural reconstructiorL in which United Development And Reconstruction piogramme (UNDARP), another voluntary agency, is also helping the KEM Hospital. This chapter is devoted tb an indepth analysis of the Vadu Rural Health Project on the bas[s of its activities and survey
data.

THE PRPJECT
The projec! druws its name frofn the villagc Vadu Bqdrukr in Sintr 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 Hospital developed into a full fledged general hospital, offbring a wide variety ofbasic specialities to the people ofPune. the need was felt to take its facilities to the rural areas as well. Btrt considering that the health needs of the rural population are ofdifferent kind, a big hospital on the same scale would have aggravated their problems

rather than solving them. For- one thing the rural population could not have shouldered the burden of a curative medical carg and for another, distances in ruril areas being considerable with no proper trarsport and communicatiou facilities, another hospi' tal in a village would have been as good or as bad as having a hospital in a distant town or city. Thus, a different kind of expertise was noeded to operate a project on rural health. Besides, more funds 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 but also with expertise. Once the financial and technical resouices ' were availablq the village .of Vadu (Bk) in Sirur Taluk4 in an endemic drought area with low income and no community health
sprvice was selected.

The project started with the aim of providing a basic health framework for the village community, with the thrust directed towards the foltowing priority areas: a) Maternal healtlL including antenatal, perinatal and pgstnatall
care,

system of The Project only have been a'chieved medicine in the rural context, but it could at the second stage. In the first placg it was essential to provide curative services to the villagers to take care ofprevalent mortality an4 in the secon4 it was necessary to gain the confidenie ofthe local 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 community as weli as individual. The villagers responded oir both the

b) Care of children under and upto five years old' c) School health. and d) Famib Planning ' Team realised the importance ofpreventive

Peopk's

in Family Planning

lwels. At thi level bf,community, building in the heart <iithe village ,Eater on the village also dent Medical Officer with the individuat they were asked to and vaccines which they wilingly In operatiog a y programrne take into account the immediate this the project tcam fotrnd that drought for the past three years. It talk to them of health and nutri cient food to eat OXFAM agreed Scheme for under hve children in Hospital A basic supply of daily from a mix of whea! gur skim-milk and MPC powder tained from February 1973 till the the situation Though this did by a few monthg it proved an Because of the beneficial effecl of cerned, the Project staff crruld
villagers.

the Panchayat gave a stone

a small quarter

setting up the health centre. for the resi-

ty effort At the level of (token) payment for drugs

the villageg .it is essential to
of the piPople. Realising area had been in the grip of

have been pointless to when they did not have sufh: support the Efoergency Food Are4 prepared by the KEM and calories fas provided pulses, supplemented with

by OXFAfv[ was mainmorrsoon that vear eased the basic work of the Project

useful entry point

scheme on the children con-

the confidence of

the

The Working of the Centre

'rhe project declded to which consisted on the main satellite hamlets upto a few miles. was conducted and the basic Health folder which formed the
the other records

initially on Vadu Bt. alone surrounded by a number of

to'house family survey details recorded on a Familv record and the nucleus of all

cal doctor assisted by two

kept Initially the Auxiliary

functioned with a mediurse Midwives (ANM). This

lnitial work consisted of l. Mctemal Heahh .Al.te at^l

given necessary supplements and .cases were either delivered in the regular postnatal care given in referred to the KEM Hospital at oing advice was also given at this

were

i&ntifled

examined-

immunisation Normal or in their homes with case. Diflicult. cases were Appropriate family planples dibcovered by. survey contraceptive methods were

l.

Family Welfure All the eligible

wcre-giren apptopriate advice.

All

l/oluntary Efons in Family

Planning-Ill

brought within the easy reach of the villagers. In additro4 a special'camp'was held in 1976 in conjunction with the state health

authorities Vasactomies were performed at the Centre by the doctors from the KEM Hospital, and rubectomies were performed in the main hospital in Pune. 3. Underfvediare.' fhis wai based on thrice weekly clinics (which were combined with well-baby and ill-baby clinics for rural convenience), supplemented as necessary by hbme visits by the ANMs, 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 initial 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 the Cintre. b) Health: Attempts were made to ensure health care for all the underlives in the village. Their health.and weight records were 'maintained.on Morley type cards, which iq, order to encourage understanding of and participation in their chilpren's healttl mothers were ridide to keep. Gradually it became evident that malnuhition wqs widely prevalent in this group not only because

of impolaris[nent of the family, but also because of 'their

demonstrations. The Centre providedsuphelp of piementaries to the poor to avoid malnutritior with the
ignorance. Hence, elementary nutritional education were impar'

tld to mothers with

;ilffi; i.""tt.ta.,U.ir il;;il;Lookler ffirveil: ;notmafity

dgctor,
5. Tuberculosis Scheme:

al the n :il:rTJ;Jl,L..-.m,n f*f "y:t*"t'tt"a. regulirly' They *'ere-immunized

ario

schoor goi ng against in the form heatth-recori was kept in the school The teachers were requested to carefully lt to the notice of the or

and bring

#;"#;;;-ffi;

lnrs scneme was initiated in 197'l-75' All rvst3l.were X-rive4 o, pt"i'ttot '*niratov were put on to triple cases and had.sputuni'examinJ iositive trr.i' to"titt iot"tinto uvno:tr visiting tested ,d";;-Jt;n iand treated wherever necessary' To ldentifylt:].Y :19 asymptc out' could not be matic cases, a mass tt'*tv *o ttieesspry" arrartged in the firsl few Years

100
:6.

People's

in Family Planning

prevalent in villages spread Health Education: Many a dir was the onlv measure to coun to ignorance. Helrlth eduiat ;due lter the ignorancg ANMs took i the responsibility to educate precaution to be taken to their home visits tfe villagers on

avoid a particular type of group meetings. to gducate the 'teachir.rg was given by both qr at all times. Structure of Staff
.

The Centre also organized rgers. In additioq irtformal and doctors during clinics

The Project was carried out in

1972-76 the staff of the Centre

limited area till 1978. Durine

isted of a medical doctor and living in by rotation.from

two ANMs, aided by

.

fourANM

KEM Nursing School. Curative

clinics were found to be an essential pre.requisite to of the preventive programmes, but were kept to a minimum of thrice a.week A consultant Paediatrician the Centre once a week and
supervised the infant and baby a week ANMs visited homes at They, however, did make visits were considered to be amone the Centre and involved treatmeit

which functioned thrice and pre-planned intenal* visitg if necessary. Hence most important activities of follow up of cases unable .cation and propaganda for ,surveying of eligible couples ion and carg of antenatal
above mentioned functions Worker(CHW) scheme was ion of this scheme not it also led to enlargement of

to come to the clinic, health

forthcoming vaccination drives

for family planning and

cases.

This structure of the Centre and continued till the CommunityHea introduced in January 1977. The i only enlarged the staffin the proi 'its functions.

Community Health Worker

in January 1977. Th,e Government o[ India,s CHW scheme on similar lines came onlv bv the end tion of this scheme ttre area of thd "i,fr.,.", iiif, tt. irrt.oO.ro qoj;-w;r'."'riLa ,o rs vill?ges with a little over30,000 ooo|rtlaiil;ffiiluLr
ro

T.he Communi8 Health Workers (now known as Community Health Volunteers) Scheme wa, f""p._fr"A iri li. fuai r-.;""t

0..

.-,-.-1,

Voluntary

ffira

in Family

Planniig-Ill:

l0l

,vide cach villagg with the basic health care at the door step as well as 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 been giveri an additional CHW The 19 viltages in the project have been divided into six scctors Each sector has been put under two Multi purpos Wortrers (MPW), one male and one female (see figure 3.t). ffrese 39 CHWs and 12 MPWs helped the Medical Ollicer and 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 alsq these 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 in tiie vilages; (Rao and Coyaji, 19?9:3). Their function consists of(i) Maternil and child Hcalth;{ii) Family Planning (iii) lmmunization; (rv) Control bf Cpmmunicablc diseases; (v) Hgalth Educa.

i.

tionj(vr) Nutrition and Nuaition Education; (Yii) Environmental Santitation; (viii) Health and vital Statistics; and (ix) Treatment of minor 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 for prenatal mortality was found to be non-avlilabitty of doctors or

pVna'
I

ct)

a6

' 'tr.-' a>-

E,,.-

>v

r>:^
::C s l|)(4

s>-'I.-

l'r. -

?g*sx -g>-

= ()

t'-

8>i

9t (.). ! v

;.

)x-

E. EH tL< { s a { 'ail

5>oo

'trFr
U

s 8E tu s E6 b>5 E EEiI

T Er gTg
sa Rf :: at
vr#

s ;:sEiii s'F

.is 2-, ri
E
Fr-

b*-

6*rrJ*i

)*-

tl-

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2'E
.tt

v
,o0
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.n

EI!t'-

E>

g'o

c)
c,

o' cI

Yolunnry Eforts in Family

Planning-Ill:

103

nurses at the time of delivery which made the villagep dependent

upon the traditional birth attendants. Since the CHWs were within the easy reach of the villagers, it proved to be a wise step. The female CHWs soon showed fine results'in cases of
delive.ry.

But, it was obsenre4 still many deliveries rivere conduqltd at home 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 consisting ofa used razor blade for cutting the cor4 several cotton swabs and rsurgical gauzg cotton thread for tying the cord was sealed in a polythene.bag and irradicated by gamma rays along with a tiny plastic bag containing liquid soap was given to the person likely to conduct the delivery This pack costs less than a rupees. Second,lyr,thq yillagers were stimulated to provide a room to be used as Matemity Home. The roor4'was disinfected and fitted with

minimum facilities like wash b4in, delivery equipmentg

find how useful this has been

erc.

Lrcreasingiy. more and more vrllagers are offering rooms as they

(ii) Family Planning Family Planning as slated earlier, is an

integral part of this health project

Il tlierefore,

became one of the

important functions of the'CHWs. In facg they were in a bettdr position to motivate people to accepting family planning as they wbie from the same village an4 moreover, being uominee of the comrrunity, they also enjoyed their confidence. It'would, perhapg have been difficult to revive the programme so soon after thd setback it received in 1977 without the help of CHWs. (iii'1 Immunization.' Immunization of infants, children and infant mothers is an essential part of community health lt not only rbduces infant and prenatal mortality but also helps in reducing birlh-rate. This ig therefore, one of the important functions of the CHWs. The CHWs have not been trained in immunizatioq. They merely inform the parents when to get their children immunized and against what disease. They are best-suited to perform thiS tlnction because they fill up and maintain Mother. Health
Record Cards. The MPWs. however, have been trained as vaccinators as well. They.carry out most of the vaccinations in the villages. It has been possible to immunize more than 80 percent children in the

project area (iv) ContruI of Communicable

Diseases: The

CHWs have played.an

l(x

People's

furnctpation in Family Planning

imponant rcile id containing IV 'They have successfully created spreads what ard its symptoms must be taken ouce it occurs Preva_at,breding of mosquitoes The success in controllingfli1 the CHWs have become quite r type" diarrhoeas, known as F' played curcial role in prwenting infepting wells, pot disinfection, vi@es ihroughout the season ETortd by the MPw was rqasures against further ations were also carried out The CHWs have also regular trcatment of leprosy and., (v) Health Education: The most imp[rt health education to the. illustrating health messages and laken in daily lifo to prevent .inently at strateglc places These CHWS. ANMs and other health tration of health problems, their To equip the health workerg MPWs with the art to reorientation training camps I tima The invited experts taught local forms of mass media like' give health education'The camp made it more useful. (i) Nutritien and Nutrition t6nt role to play in this pro feeding progiamme was initiated help of CASd not many children 'tions came regularly. It was found gt time to hring the children CHWs provided useful help in Night blindneos among t9 project villagec The CIIWs reasoos bchind this wldespredd vcd usefu| ;n cnrnusing the r

and Diarrhoeal diseases. ousness of how Malarit, what immediate measures have also been taken to

limited Buf of infectious "'Cholefaritis".The CHWs have spread ofthis disease by dis. of Chlorine in the river side Any case of gastro-enteriti" treated arrd prwentive taken Anti-cholefa inocudseases was

helped in the detection and

firnction of CIIW is.to Besides, wall posterd

and precautions to be havo oeendisplayed promare used by the MPWs, to give graphic demons-

and treatment pecially the CHWs and the with the villagers effectively, been organised frgm time to e CHWs how they could use than','Kirtan' and'Bhajan to of the iillagers in the

'The CHWs have an imporEven though a supplementary about 500 children with the

from the under privileged

sec-,

most of the fuomen do not the Centres for feeding The

endeavour.

was quite common in all the successfully teli the viltagers se. The CHWs have alpo.pmto 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 successful in rural areas unless steps are taken to ensure environmental sanitation.-Keeping this in view, the CHWs were trained to ensure environmental sanitation in the villages. All the wells in the projectvillages are disinfected regularly twice a week Where a river is the only sourceof water, pot disinfection with chloriwat is resorted to in the rainy- season A plan'has been drawn up to provide tubewells in the villages. Thg drsposal of waste water is the source of many infections in the villages The villagers, therefore have been convinced either to constryot soalage pits or to raise kitchen gardens. Due to the persistence of the CHWq the scheme has been quite successful. Equally important is the need for sanitary latrines. Both the government'as well as the Gandhi-Smarak Nidhi came foreward with assistance. Once the assistance was available the CHWs have been able to get 125 latrines constructed in the project area. Frii) Hdahh and Vinl Statistics: This job has been entrusted to the CHWs. The regular updating of the family survey has been possibl with the help of the CHWq who regularly visit homes The availability ofthe fool proofdata helps in drawing up the right lfatery to tackle varidus problems. Apart from family dat4 the CHWs have also been able to provide the details of the male and female by age. (i) heatment of Minor Ailments: The male ane the female CHWs are proiided with simple basic medicines for giving relief to patients coming to them for treatment The medicines given to them are much less than what has been provided for in the kit recommended 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 lirst aid 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 patients wfio come to them. The patients'who do not get relief in48 hours and serious cases are referred immediately for treatmeni'to the MPWs orthe doctor depending on thd levl oftreatment required The emphasis waq however, gradually shil'ted tiom the curative care to preventive health care. The CHWs have successfully pre-

H5
vented the cases of malaria or thn help ofthe needicines

in Family PJanni4g'
ron in diarrhoea cases wiif,

tb

then

'

TheMPWs are the lust levcl CHWs. These MFWs have been timc of the launching of the CHW

givirigguidance to the trained in their role at the

TheV alsb receive con-

tinuous education at the monthl meetings -hnd special camps held from time to time. They har not yet got used to their mul,tipurpose role because of their for vertical pro
gfammes.

The Co-ordinated Involvement $pproach

operation with the goyatnmental tion Their efforts bore fniits and iq Maharashtra Government Vadu area to the KEM operation to 59 villages and tion under their Care.

in order to avoid duplicarecognition to their effortg the to entrust rural health care in thus enlarging their area oi an additional 30,000 popula

Upder this new arratrgement the PHCs and their subcentres catering to these 39 village have come under the administrative control of the KEM Though the staffrng pattern given by the govefnment has been followed theKEM Hospital has putin extra staff from its resources Similarly, while the salaries fcir.the staff and funds drugs and equipments now come from Zilla Parishad requirements are met with thc projgct funds. For CFIWs recruited under the Govemment of India Scheme by e Maharashtra Government Vadu Project they r.eceive an are paid Rs fr) only, while under honorariur-n of Rs 125, the add KEM Hbspital $imilarly, two Health Unit atVadu'Bkhad also with its own resotrrces,
As the PHCs in this area were

ill

,nal Rs 75 .coming fronr_ the Ms placdd with th Primary hired bythe KEM Hirspital

Yolunury Eforts in Famity

Planning-Ill:

l1l

in villages remained the lowest link in the chain of health carg but the role of various other para-medical staff had to be redefined. Under this rddefinition they came to be designated as Multi Fun pose Workers (MPID, rellecting an integrated approach towards health care delivery, The restructuring that resulted following entrusting of health care to the KEM Hospital has done away with the rivalry at local level, which in. other cases has proved to be one of the major impediments for the voluntary agencies Neither the medical officer has any fear of losing credentials because someone else in the same area is achieving better results than hin, nor has the project staff any apprehension about possible competitioa or tussle with the medical bureaucracy. The experiment is also useful for not only creating a demonstration effect of the staffplaced with the Vadu project but if successful it may also result in wider replicability of the experiments carried out in cooperation with the govemment

Satisfied with its cooperation with the Government of Maharashtr4 the KEM Hospital looked for larger cGoperation As the area ofoperation for the project had increased from 19 to 59 villageg need for a local referral hospital as a tind ofiotermediary between PHCs and the KEM Hospita[ was felt Thug under the Central Government scheme of hospials on onethuu (contnbution by 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 Banu Coyaji and her colleagries seemed quiie happy to have achieved a hospital for the iural population they were not happy with the cen: tralized building and stalfing plan of the Government of India There wera they felt, trro major-limitations ofthiq approach- Firstly, tbe Uujlding plan drawn up in Delhi di<t not take into accounf thelocAlneeds. And secondly, the buildingunderthe Central Plan worked out much costlier. One positive aspect of the co-ordinated involvement approach has been that the govemmenhl staffplacedwith theVadu pmject has been injected with the enthusiasm that Dr Banu Coyaji and her colleagues had ihstilled into their own stalf Gradlally, the people drawn from the medical bureaucracy of the glordrnment of Maharashtra have given up theit targel oriented appqoach and ha'|e become achievement orienteil Their coiceri to*ards health care and familj, planning is much grea'ter now than bdore.

108

in Family Planning
new arrangement was too study. Many things were still tal at Vadu Bk was still under satisfaction with the flexbut larler impaci was still to

'

However, the overall impact of early to be assessed at the time of

at thebrganisational stage. The h construction. Dr Eanu Covaii ibility shoryn by the government come. As indicated earlier that if impact of this approach would not but in larger parts of the state as

in the long rur! the

be felt in the Vadu are4

Rural Health, Family Welfare

The porformance of the Vadu

Rural Reconstruction
ural Wealth Proiect did not

health and family planningor in rural rebonstruction at the time f our visil But the project was they have moved gradually only eight years old In these from one field to another. Instead f stretching their hands fully at They admit in theii report one timg they have moved in decided to move into the area frankly that when the KEM They did not have any of rural health. they had no in rural areas eithor experience of conducting family and cautiously. Hencg they decided to move gra start with rural health in one The first step, thereforg was Unit inrhe village Vadu village. Thus, started their Primary years in the village that they Bh It is only aftor working for scheme and expand their decided to experiiment with the made their entry into the area of operation to more villages. care. Once they won pop-. field of family planning through to talk to them about the ular confidence it was not very advantages of a small family. In fac! their,advice could carry :e t\e people that they were weight only after they could con the lovernmental zeaL to get there to take care of their health. the emergency had an quiik results in family planning to talk of family planning for adverse effect and they decided some time. The impact of their earlrer is vrsrore in'the birth and death rates for tha vear 1977 and I 8. The birth rate stays at24 per death rate came down from thouSand for both the years, while in 1978. Since no record_. 13 per 1000 in 1977 to ll per th for us to assess the real rlas available for earlieryears it is th rates for Maharashtra for inrgncc But sincE the.fural live of SRS data was 26.8 those t*o years according to the
seem very impressive either

ln'

Yoluntary Efforts in Family

Planning-Ill:

109

year's were 14.5 and 11.3 according to the SRS data' which indicates that the Project is achieving slow but gradual success in the 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 iq
1978 the efforts to revitalize the family planning pro gramme was started in a low key' We do not have figures for subse qirent years and, thereforg we cannot hazard any guess regardini
1977

and27 .6,we can attribute some success to the Project in this field Similarly, the rural death rates for Maharashtra during these two

. ln

the impact
Nevertheless, we can attempt a general picture on the basis of the d-ata giyen to us on family planning activities of the projecg as well is the imoressions of our researchers. Table 5.2 indicates that sterilizatioirs,-which had become rare during 1977-78, gradually picked 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 planning activities 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 from the community in their efforts, the project staff have from time to timg organized various camps in the villages, which have been tremendous success (see Parulkar and Parulkar 1978)' Enthusing a sleeping community was not easy. It was a slow process and the project was aiming at gradual transformation of the community in

the area.

Finding that health care was part of the broadei development,

TABIJ
Year r977
1978

5.1 Birth and Death rates in the Vadu Project

BirtUI0m
24

Deatl,/In l3

24
26,7

ll

1979

t2

3$
.:
R?

o\ t. q\
cx

tl tl
el -. lco,--. ol t.l l--c.l -

I l.r
I

..t.i

t \O

el|

c'r

s
t'-

o\ F\ o\

9
I

t'

to\ I
()
C)

,s

R q\
t.\ l'.. o\

t
F

zzzt t^EEE: t r
.a$ll-stO\oOoo a.l a4 \t$ctoraral a{. . a.l
-:

t-.t I l-".rn | ttt -l--lll tll ,-. lorll or I ttl llll-ll ttl rrrtl,tl
OO\O
r+ \o c{ oq

ro

h .:
).1

o\ q\ a\ o\

|.o.o.

t) .o

rat

c{ o\

aa tal \o F ra, a.l 0o

\.'.
att

q)

.o

R o\
F\ l.\

e '- .l ol m .o..t

-..I

l-

c.r

o.r |

.-r

()
a0

o\

:-

lorvor

I l*
a.l

| l*-.a\oc{
.o o\ \o c\l c.l o\ o\ rd*a.tra)*
.O\OC.ltlC.l\i .vta)ttra)ra)d oOOoOO.n$F-t-. c{ a{

A
tr

6
>'

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q)

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"::

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A?

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(t) +

6'ct)

Yoluntary Efons in Family

Planning-IlI

ll

the project-team decided to venture into rural recohstructioqr The

tpain realized that without solving some of the immediate problems of the rural populatioq it could not talk eitler of health.or ifamily planning. For example, without increasing life expectancy of children at birtb it is difficult to convince a couple to restrict their family size. Thus,, the problem of post-natal care and under' five care arose. The problem ofunder five care led to the awareness of mal-nutrition The problem of night blindness among childrerl which is another aspect of mal-nutritio4 also came of light And
can one talk of mal-nutrition among the people who have 4t times nothing to ea0 So the team decided to help and encourage people

to raise kitchen-garden The people were told whal kind of food prevented what diseases. Gradually other problems of the community also came to the fore. Thus a new agency fo{ integrated rural developmentUNDARP-was created with several prominent citizens of Pune. .The office bearers of this agency go to villages discuss with them about their immediate felt needs and offer technical as well ls .financial help. A reyolving fund had beeS created to provide financial he.lp. The {lnance provided for a prgject is in the shape of interest free loaq which the villagers may reium back The scheme has been weil received by the villagers

TABLE 5.3. Demographic P-rofile of Sample Villages

Demogmphic

WLIIIGES
Shikrapur ;Futgaon; Jarcgaon

Profile'

Bk lfpt" Jagnp
1135
1136

'Total Population

4f,99

Hindus Muslims
Scheduled Castes Males
Females

4@l
98
91

10651069

1687 'lg2 133 823 864 232

s7(2s)
45

2409 2290
400

45 536 s29
195

70 578

558

Couples in Repro-

ductive age
Couples Effective ly Protected

2t3
5E(27)

26q67)

83(43)

Note: Figures in parantheses indicate percentage.

t12

People's P,

in Family Planning
scheme

We witnessed work on one wadi in the project area. The

in the villaee

Saras-

complained to the experts of

the UNDARP that thpy could draw water from the wells throughout, the year When they asked as to what could be done to solve the problet4 the said that there was a dry Nala near the viltrage and if a could be built there to retain rain wate( the water would down to raise the water-level in the village wells. When the UND asked the villasers to contribute, they gladly agreed to do for seven days. Anyone working after that was to be paid. scheme was prepared and when our team rgached the vi even small children were working on it witl pleasure Sev suchschemeShave been taken up and it would have its impact in the years to come.

SAMPLE URVEY
Th'e Sanple Villages
The fourvillagqs selected on the of two. good perforrnance

and two poor performaflce com ination worked out in our

research design were Shikrapur and Pimple Jagtap. The.selection basis ofthe records of performance

Fulgaoq and Jategaon .Bk the villages was made on the the 19 project villages main-

tained by the.KEM Hospita[ The two good performance Shikrapur and Fulgaon had 67 per cent and 43 per cent rotected couples respectively, whereas the hvo poor performance Jategaon and Pimple Jagtap had 25 per cent and 27 per protected couples respectively. In each of the good perf villages eight acceptors and four non-acceptors and in performance villages four acceptors and two non acceptors interviewed by our research team with the help of two social wo 'kers from the KEM Hospitat Pune. All the 36 respondents were selected on random basis. The demographic profile of th sample villages is given in 'Table 5.3. Shikraour was the village in the sample with a population of 4699, followed by arcgaon Bk (1687). Pimple Jagtap (1136) and,. Fulgaon(l9r Two villages, Fulgapn anil Pimple Jagtap had an all Hindu tion.'The.rest two had small Muslim population. had 98 Muslims while Jategaon Bkhad45 Muslims. All four villages had scheduled caste people also, the largest tration being in J ategaori-

Voluntary EfJons in Family

(133), followed by 91

Planning-Ill:

ll3

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' well..Pimple Jagtap had aTarun

Ip"railue itt ottter three villages as 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 contraceptives. 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 !usinessman end professionul. *.." reported to be more co-operative. while landliss labour, shlre croppers and service castes were less cooperative. Well-to-dq but illiterate, farmers were also reported to bi resistant to family planning In Fulgaon also similar trend was

-co-operation in Jategaon Bk ahd Pimple reported. Citizens' Jagtap was also limited to negligible. -Since little active co-operatiod came from pe'ople' processess of

lt4

in Family Planning

;participation wgre dlo limited to acceptance, which nas come more in recognition of the sincerity and services provided by the project Leaders helped in cbnti and convincing peoFle but more on request Occasionally enlightened citizens joined
them,

Our data may soem to col Hospital and its team on the

munity in its programmes (see and Parulkar, 1978). We do not intend to challenge or negat their clairn Participation is a many faceted phenomenon and it uires strange dimentions in a society like India. The communitv this area has proved its par-i ticipation potential by offering pa: chayat oflice to be used for PHU at Vadu Bk. and even buili a quarter for the medical ollicer next to the PHU building community efforts
The villages have also offered lar

the claims made by the KEM participation of the com.

ted iD the village. These indicate

they were convinced that those

could be. But.in each of these the KEM tlospital Project team approached the villagers due to politico.historical reasonq people came forward with heir contributions only when
e

for.a hospital to be construc>w participative the people

help and cooperation to were cgnyinced of their tion and participation they were asked to, and the activity ranked high by their enthusiasm in the UNDARP sponsored projects. planning somehow did not seem to rank very high among priority, Therefore, not only the'autonomous participation missing but it was also diflicult even to mobilise their ion. Since in the percep tion of mosl ol-the vilaggrs tnci c were not sullicient-ior a family, they would not even help CHWs in motivation Thuq both the kinds ofparticipation were in this lield This sup imrt the claims of the KEM H as well as our andlysis.
Sample Respondonts

and not with any ulterior motives, CII\Yg were also available bccause utility. But in no case is the helo c, voluntary. People offered help only gnly ifthey felt that they shoul4 in their priority list This is

had come only to help them

Inspite ofresortrng to random londents in both categories of vilft select a representative sample in ti group, 'educational level and ser We

ing in the selectio.n of reswe have tried our best to of economic statusr ageto make compromises at

Volunmry Efons in Family

planning-Ill:

I 15

t!tr y:

ims dU& to constraitrt ot time and willingnesb of the respoluents..

the villases

have managed a sample rellecting the cross-iection in

come out with a rough estimates of income in such caseg. Ttre acceptors fell in the eight of the eleven slabs of income we cfeated for classrficaiion purposes, whrle rne non-acceptors were dishibuted 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 both the categories (20.9 per cent and 25 percentleppectively) was from I the middle income group. The higher income gr. oup w3s also very well represented

Assesgment of rncome of our respontlentg mainly cultivators, was as difhcult in this as in other case studies. Wg however, could'

TABLE 5.4: Economic Starus of Respondents

AnnualIncome
R&

AccepnrPercentageNon-Acceptorpettentage
E

l00i

-2000

33.3
E.3

R.s 2001-3000

Re 3001-4000

8.3

[(l,

5001-6000 Rs. 6001-7000 R& 7001-8000

t
I I
2

20.9
4.1 4.1 8.3 12.5

8s

9001-t0,m0

6 I 3 2

i0.0
8.3 25.A 16.7

Rg 10,m0 & above

24

lm.0

100,0

".""@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 in2534 years agegroup. The non-acceptors, however, belonged to much vquqger age goups (Table 5.5). lf we ;an hazard a generahzauon on this .dsta (not too sweeping thgugh), it can be s-aid that accptance of permanent methods oifamity ptahning in tbis are begins only after 25 years of age and most people acJept prmanerrt qethods only by mid-thirties nre itrol-ect teae tbcrcfore had to @ncentrate o'l youtrger agefroup, todi f<iripac-

_ AMajorityortt"

TABLE 5.5: Age-group Co

Age-Group Acceptors

of the Responders
Acceptors Percentage

20-24
25-29 30-34 35-39 40,44
J

ll

2
5

4 3 3 2

33.3

25.0 25.0

t6.7

4549
50-54

)
24

Total

The acceptors in 'our sample well-distributed between illiterate and gradtrate, while the n-acceptors belonged only to twq illiterate and middle (Table 5.6). A majority of..respondents in both thi categories (41 per cent acceptors and 67 per cent non-acceptors) were illi and only a small percentage we re educated bevond matric.

TABLE 5.6: Educational

Educatioinal Acceptors

I of the Respondents
Percentage

L"vel

Illiterate Primary Middle Matric Graduate

Total

l0
'l I I
24
5

67.0

33.0

l
t2
es

We were. again only partially sexwise distribution of males and

get male and female acceptors in non'acceptors (Table 5.7). It was dent than male, who used to go out

in maintaining equal in our sample. We could proportions, but not the to find a female respon-

interviewed male and female non-

inthe moming Hence we 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

NonJ

Percentage

Acceptors

Male
Female

t2
12

50 50
100

9
12

25 75
100

Total

24

?articipatory Attitude
'The participatory protile of the sample respondents, in this area was not very encouraging Actually, only on the basis of this data and the impressions carried during collection of this dat4 thal we

ventured to contradict the position of the KEM Hospital ori the issue of participation. Moreover, this data further confirmed our contention that participation really is a'graded activity as far as people in general are concerned. They would be socially and politically actiVb only if it suited them and if they had time, not otherwise. 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 the respon{ents. The \uestions ranged from making efforts for the availability of essential commodities and drinking water, to attending fiIry shows, arranging for them, voting in. elections, attending public meetings and volunteering their services for health and fanrrly planning acuvlties. And we gor signrficandy aflirmative replies only to 13 questions, ie..roughly fifty pel The maximum participation was reported in voting for local
state and national elective bodies. Cent per cent acceptors and 9l per cent non-acceptors affrrmed that they voted in the panchaya!

the State Assembly and the. Lok Sabha elections. This is not surprising because votiirg rate had been very high in this area for all ihe three elections. Since voting in rural areas to a large extenr depends on mobilisation ofvoterg we can safely infer that people in this area can be effectively mobilised If we look carefully at the reponse pattern of question on participatory attitude, we shall get further proofofthis. As many as 58 per cent acceptors and 25 per cent non-acceptors affirmed that they would attend a public meet-

118

,People's

in Familv Planning
leadef (question 5). Atten
ded on mobilisation to a great and 25 per cent nonpersuade people to send their e school teacher (question I l)

rng addressed by a local or

dance in Such moetings also extent Furthermorg 70 per cent acceptors a{firmed that they children to school ifrequested by and 79 per cent acceptors and 25 that they would help the CHW family planning (question l2), pondents showed their willi mentioned activities, not more per ceirt non-acceptor were willing demonstration on rising prices ( than 33 per cent acceptors and 16 pared to help an agency to take (question l0). Somehow these priorities of the respondents. One with regard to joining

cent non-acceptors affirmed motivate people for accepting

a good percentage

ofthe res-

to be mobilised for the above 29 per cent acceptors and 16 join local leaders to organise ion 8). Similarly, not more cent non-acceptors were prehealth services to the people ties did not rank high in the understand their reluctance
because of ribky nature
is visible

this activity, but why so much health services? Similar ing with essential commodities
and 2).3,

of

against helping the

in the question dealdrinking water (question I

why people refuse to parwith earning two leave them with much time time to participate in some

participate in some activities and not in others? We do not have defilite answer for this questio4 as this was not within the ofour srudy. But we can certainly venture a'fuess. People ha, e a tendency to participate in activities which they think would be beneficial to them. Ifl thev thina that by participating in an no long or short-term benefit would accrue to them" thev not likely to participate We have already ilemonstrated this the basis_ of the response pattern People also get dgbilised to ie part in voting or to attend a public meeti4g etc. The mobiliz inight also be weighed in .terms of benefits. The average parti4pation rate all the items was 49 in cirse ofthe acceptors and 23 in case ofr n-acceptors. These figures par' tly explain differcnt behavi<iur of two sets of respondents. But we must maintain caution in generalisation because 75 per c6it offur non-acceptor wef females. It would
r

Lack of time is an important ticipate in many activities Their square meals for their family does for such activities. But they do activities at least And why do

ri|t;;ia ni;ii i' id,ii ii;,;ing-rr1

TABLE 5.8: Participarory Attltude of thu Resp'ondens

r16
,l ,f , i,r. ;r,:.i'lil

S/

No.

Participatory Q&estions
..,"

:. ' ;)'-:.

,,: ,

ibtfuttuge of.FeAnle

2. If a fitm is,shown in the neigh-

gotheretoseetheIilmi '
3. if the government a"aio.,

bouring villagq would you

to
rrel

29 ,' . 6 r'' rr' i r:i ilr l;jr:r': r:1' ' r' ir'33 r' , :i) r :rlr :i'

peoplein thevillase. *?..,11d,,,, r' ,.1.,t, ,1,,,,.1,,. ,,: ii:: ; li ''' "rirrr ...,:; :.., .,1. :lii :'r:i.,ii :ri 1;1,;i yori'help? you help? "'' :.' :.' 'WJurJ e. !"u be #inine to '1: " ,ru , -' foi healtli seri,ices? - '

:11" l:"lll. :entre/sub-cen disfensary with the help of the

pay

'sq ' ',

'.

1 delivering"a 1r.1.nqti9aiivis-"qt.r.ed9t
6j.i'lfa poltttcai i .:r iiii. rtile: niidhi.i 'iri'lhl:na 'rl:wobltl voilh 7.r:Did yijh vbii

speech ir,' you r

jlr,',..,,, :,, iq,,' .,,,. j

.

.'

;5;;l;,1

village, would

I o . ., 4l

120

in Family Planning Voluntary agency to take the health Service to the people, would you volunteer yourselfl

l.

the schoot teacher in your village requests you to persua{e

If

'J3 70

16

25

people to serid their children to school, would you help hiri? 12. If the WWVHW requests yoq

25

13.

to help in persuading and motivating people for acceptilg family planning would you help him? lf 'Keertan' or 'Ramlila' is organised in your village would you attend thad
Average
23

not be proper for us to draw behaviour of the husbands on wives. But if we combine their with .low participatory score of would not be wrong in assuming high on participatory scale The respondents also
dependent on either govemment r serlices As many as 44 per cent government to operate health se private agencies to do so. The

about the participatory

basis of the responses of the of family planning
they

acceptoN in the are4 we Eoo would not rank very

a tendency to be hardly voluntary agenry for health the respondents wanted the while 25 per cent wanted
also demonstrated con-

tradictory attitude with respect to ing for the health services. On the one han4 33 per cnt felt that people should pay for health services and 8 per wanted the government to shoulder this responsibility, on other, not many respondents were pre.pared to help the either physically or materially to organise health Cent per cent non-acceptors and 66.7 per cent acceptors were preparc{ to help the govemment (Table 5.9). This variation in is a little baflling and demonstrated deuendency in this A maJority of the acceptors ht taken joint decision for contraceptiorl Only one male had taken decision on his o.wn without consulting his wife one female respondent got

Yoluntary Efons in Family

Planning-Ill:

t2l

TABLE 5.9: Help for Health Services

Kind of
help

for

Accepton PercentageNon-Accepton Perceptage

heahh semices

Physical Help Material Help Both None Total

| 2 5 16

4.1

8.3

209

6.1
100

12

100 100

s0erilised without informing her

family as she thought that her

so.

mother-in-law would not allow her to do

Most of the acceptors stated that they adopted terminal method of contraception because they considered a small family easier to support and that they could take better care of their childttn But in a majority of the cases the respondents wanted at least two sons, and the number of daughters they got was imrnaterial till they could have two sons.

Motivation
Motiv.ation of the respondents, judged in terms of.their visit to centr.e, usini ,h; f""tili"r,";king advice advising olhers to very encouraging in this area- Forty five per cent of the :ir_:_r:, stated that they visited family planning'cenre ::..ptoT and 4l per cenr were advised to accept family plannini eiiher by the medical officer, or CHW, or friends and relatives-Though g3 per

. pe rl.mity planning

T:jT 9:.t

.."atiu-lfiurrr"e:"i. *",

did noi- All t#;;_ acceptors respondents had three or fou. - - ihildrerr, .lr"ept one *ho ------'-'+ !^wl had two children.
a-cceptors admitted having used the ^ facitities. provided by the famity p", ."n, admitted having consulted.and sought trr.-"Jrrc Jrirre medical 'o{ficer, and 25 per cent aid that they 6ot ifr.i,,p""* the family

lill "l^,1"-some reason orwere atso aaviseJio "alpiii.ilv nrng tor i.*acceptors rhe othei they
However, 37 per cent

prun-

pili;;;#,

planning centre for consultation

L11,. b:. absolutely reak motivation_

,rrr oon_ acceptors to these questions. was negative. Their moti;ation p.onegativs tfroigf,

it. i.rpiir.-oi

il t

.o*i'fr.'u""".pto.,

rruO

,I22

'Ieollb.*

tn' vrimlt5;'r-tutint i g

Participation], M0ii\r,idbf i

bfff

.,;4r-.[ih.respon$olt$ 6ro'n]rthe ardAs

demonstrate weaker participatory the respondents from the areas of data collected by us does to an

by the project staff in oril_isting entirely, because in the vifl'bge Vt p*rticipatory credentialir ty offi projecr We shall .hg.ahh unil of the
weak participato4i attitude and r though the project h?s achieved s

Ais far as overall oicture is concerr

aldi remalirsto bi done if faniily pJqf.l-qlrnov11r91,1.+i.-d:tttdPl.bli

ftat'l
j':
ir

1i

;i

r1': rr.r I

i-l'i

i-.- ;

i:,l

some other socie pisychological

important role in acceptance th This view ofall the l2 non-acceDto poinr of view lTat\! from

lve

thjq

, ,t'Ci.rirkt'' ,',
1r;
a.

,,

:,1;, :;t:::.;... .-.ir 'l-,r,i' .rjli i',; lii.:-'

{)l
-l.i

.,i ,:11'.r'

i -:lrr::"'

lr

1\.&

?F',, 3lv['2F: ri'

I

. r r1{'la-n?6i, Otre

i,iiirjre.

son

SO*:i: i l,:i.. "i.'1 ;r,i:

&;i,2\62F,,;,, l}d, l;E :: u, : .l::.rt'.r',' :,llt'r ! ft.:.r:, :'.ii,r il: :21\fi lF,' :,.rir ]','J${128"r rilr;liii l l;.J t:l :!:'Lrl:r. ii'l'jl 4r,,lMr,*F'i','d$ le:esi:ir''itras -J)Jii f1r..rii:,iiilwolffoiis l'':i
.i,

,-;r:,1 i:,1i:

r,.i.i!t

l,';i

;,:: i.;fi-lir't;i,'l'

lsi

;;1f

if

:,:::'6"[li

r;r"'

"'. i: md*l:r,'.hrist'Ill ji,' l1.ij'l'r" i'':': ,i"il:tltl:'1:1 r":i ir Jrli.r.iarfi 'rl of

l ia .. 1.'l; i -;;i:1,.:-;'-;;i'lr-, Tivolbrrts airijirj'f i

Not

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 r's .r1 ;.:
?lVL,,

:rr :.! !,:.:;..r,f: ...,,,:,.',, .ir:

.. ,r,.J. ,ii-

!r.t:.,r;

tir.,l

,;lti:lt':,r,::r-:;ll.

l?.rr

,: ... ..

. I{ob@dy, fii rloots. r: ;.gg6 di@ ;.,rtcll. 2F,,, At :teafi titiiid '.., ; two:sorrs," ,afterl,: dhild{co :;ifi11yi11g.4ror ,. , i, .,'r ::r.t..: ..,:.: ,::,.,She.: ..; l'r(r' Ir i.,::iC.hi&akb$tiltStiO;lS ,r r.l |, ;ii,steritbtd,.Shel rbtbtilizddri.,:.r.r.rt !r;i lrlr,:: ' ",,:' did not like i ;i- i

| , ':::._i

r'

contraceptives.

1{

't';.* il

People's

in Family Plapntng
,

had more inatr one chrlc had or more sons) and four had sons) Two of these confora family. Both had sidered two as deslrable number of sterilization One of the m three children and were prepared not keeping well and there delayed it because her elder son was sterilized Four of thcm was no one to look after him if but two ofthem should considered three adthe desirable and two daughters was prbe gons. One of tbese. with two parcd for sterilization; another one th a son and three daughters was prepared for sterilization wanted one more son: the third children ifshe was sterilized but there was no one to look after a daughter was scared of and the last one with two sons stcrilization, did uot have anyone look after the children ifshe was etcrilized and was prepared for anotber son Three nonaccqrtors considered four (2 * 2) the desirable number and aU hod bfcause they had only the three did not accept terminalthat a couple must have at one sn Two not-acceptors

All thc non:accpto$ Oaly ore bad twochildren(a son three children (all ofthem had four children (each had one or

a daughter each), seven

lcast two sons One of them was complained that there was no was sterilized and she did not said'that she would not mind

for a son and the other one to care for her children if she other contraceptives. She also more children till she war not sure what should be the sterilized. Only one respondent was he sure as to how many desirable number of children, sterilized because he was childrcn he wanied He did not scared that it would make him Thus, two important reasons for tron- acceptance were the family, wtere females thought dcsir for a second son and if thev were sterilized and that their children would be

bed-ridden f,or some time. Other not very popular. some people But an awareness of smaller couples get more children because till they had got two sons. The her team ig therefore, tougbdecline in fertility only ifthey for two sons, which invariably

of contraception were
also scared of sterilization size is also visible. Most of the would like to take chances ahead for Dr Banu Coyaji and can hopc to achieve a drastic change the strong prtferences

in four-children family.

Ovenricw
'the Vadu Project dra not seem
have created a major dent in

Voluntary Effons in Familv

Plonning-Ill:

125

the field ot lhmily planning For one ihing therr tfrust has bden more on rural health whichrmade them devote moie time in organising ig and for another, they decided to abandon the family planning dimension because of the adverse reactions creat,ed by the Emeryeacy. Moreover, they also decided to launch the CHW 'scheme at a time when the project had acquired firm base at the village Vadu Bk The CHW scheme consumed quite a bit of their energy, as they had to select, recruit and train the selected condidates It was quite an arduous and tirne consuming task to train illiterate and semi.literate persons in health care. After training the CHWs also took some time to stabilise themselves in their villages and inspire people's confrdence in them. By then the project had started diversiffing in the areas like environmental sanitation and rural reconstruction Then,. in co-operation with the Government of Maharashtra they undertook coordinated involvement approach which placed medical bureaucracy at their disposal and enlarged their area of operation- Therefiore, the project did. not have an impressive result to show at the time of our yisit Its real assessment would be possible only after a few mofe years. Thiq however, does not mean that the Vadu Rural Health Project, has nothing to offer. It does offer a variety of experience in organising rural health, which is a very complex phenomenon. The complexity of organising rural health arises, firstly, from the very enormity of the task in terms of area and population to be covered, it also arises from the relative under-development of the rural society within the overall underdevelopment ofthe society as a whole. This necessitates adjustment or, at timeg redesigning of the concept of basic health care keepin! in view the deprivation and impoverishment of the rural masses. Lastly, the complexity also arises from the 3ocio.economic structure of the village India and resulting political scenariq where any sincere effort to improve the living conditions of the rural poor is looked at bith suspicion If we look at the experience gf the Vadu Rural Health Project they have tried to tackle each of the problems gradually. In the first placQ, because of their inexperience in the frel4 they borrowed. expettise and even then they beganin a small area Their aiim initially was not merely to gain experience but also to win the confidence of the people. They also tried to create a confrdence in the community about their ovr,n potentialities They involved the com-

'

Voluntary EfJorts in Family

Planning-Ill:

127

..

Chapter VI

Voluntary Efforts in FamilyPlanning-fV : Cdmprehensive Rural Health

Projecq Jamkhed
I\O srudy of rural health care Fnd.family planning in lndia would be complete today withput taking into account the
experience of the Comprehensive $.ural Health Projecl located at Jamkhe4 a taluka town in Ahme{nagar district of Maharashtra It presents a remarkable success story in the lield ofrural health. The project popularly known amofrg the villa gers as Prakalpa,has not merely succeeded in waking up the sieepy village community to fight diseases but also in aw{kening the entire community against social-problems and injustice. We followed the general patterrf of'this study in examining the Jamkhed experience, i.e., an in-defth study ofthe project and sam.ple survey of four villages in the p;oject area. The project did not offer us much statistics; thereforf assessment of the project is based mostly on qualitative data as well as impressions of our studv team. l'T

The Project
Jamkhed is a stnall backward tafiuka in Ahmednagar' district of Maharashtra located at 75 kms frdm Ahme{nagar and about 200 kms from Pune. The sleepy towrf of Jamkhed shot into prominance in 1979 when a medical co{rple Drs. Rainikant and Mabel Arole received the Ramon Magga]tsay award for their pioneering efforts 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 couple 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 in Ahmednagar district When they planned their return to India on completion of their studies in 1970, they had started writing to prominent persons in different 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 busi4essman, was highly enthusiastic about their plans' The taluka panchayat and local officials also seemed positively responsive. Thuq this 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, Christian 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 for their-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 medicines could 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.4tit pehod ot six.4qgptll;.;f,he.4lola$,tbpp Sptjhs ans.wer, to .Sq ppc! Srtg1!fi Sq&pq{qgfnSi"g,lp*tJh.9u,9tarrrd, ryl9SliBq,VFWr ip. girfef R+[ y+lsgffi 94 l+,silqcl]aeq',l$ $qvt?rsJq sgp,e, thg Yf{w5 q5-o;
y9,4rh9g'tq;r-b.f Sttgpgss-of.t1rE.P,q9j99l!!SLehi|}c,Sedig?!e.,Ciqqaf9s

Sk;-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 have tried had someone in a the .responsibility of the aiternative the Aroles would not suggested them to entrust

Banjara (a backrrard tribe)

effective this VHW proved theY villages. They also reviewed the tned to plug anY looPholes that
The first VHW was used as the Realisins that the females decided to select only females as of the female VHW was that they or widowe4 should be able to must enjoy their confidence. VHW could como from anY caste pared to serve all castes and need to be educated indeed most proved no handicap; perhaps it that the VHW should be a resiclen and their name must be Designing training blem. Aroles had seen the first short training A little im cient for other VHWs as well Training a group of them coming munities created the fundamental ing them together. If the VHWs differences during the training been defeated. Ihe Aroles. ftere

health care to an illitrate Once the Aroles saw how to replicate this in other of the firstVHW and t have been left
for subsequent selections better in this job, they s. The criteria for selection
be middle aged, married
te with the villagers and or religion was no barrie! a religion But she must be pre in the villaga Nor did she the VHWs are nol Illiter-acy It wag however, important

of the village they were to serve

by the villagers themselves for the VHWs was not a prodoing wonders with a week's t in that would have been sufliit was easv to train one VHW. different castes and comn ofboarding and lodg not forget caste and religious whole purpose would have so arrangeil that the triinees took tums in cooKng and they wCre de to sleep under one blankbt which was especially stitched for the purpose And to free the VHWs from the the Aroles prepared blood-slides for dach ofthem an showed them on micro-scope were man-made that caste and relieious 'a week's training E attend to The VHWs were initiallv ges. The kit providedto each of essential health needs of their the VHWs contained 18 essential edicines as well as a sterilised delivery pack containing a blade and thread the 18 medicines

Volunnry Qforts

in,

Family Planning-IV:

l3J

given to them were sufficient to attend to 80 per ceat of the rural ailments Apart from the use of the l8 patent medicineg the VHWs were also trained to use some local herbs as well as what can be described ag'common-sense treatment' in mild cases of diarrhoea. $sennf and fwer. Later on to reinforce the use of herbs, the", Arolss engaged 4nAyurvdic doctor to go to each of the villages and identiff some local herbs to the VHWs. They were also trained to conduct aseptic delivery with minimum facilities (even under a tree). With the use of their sterilised pack they could bring down the number of fatal deliveries, most of which were due to cutting of the

umbilical cord by a scythe. But what were they supposed to do just in case they did not have the delivery pacl? Thcy knew that if a red-hot blade was use4 it would not create any'complication They were also told of the importance of child immunisatiorl which they were supposed to convey to the villagers. The Aroles were aware that this training was not the end but only a beginning for the illiterate and semi-literate rustic women trained as VHWs Even the rirost qualified doctors had to keep in touch with the latest derelopment in aredical science by attending conferences and interacting with their colleagues in the profession. These simple women were not likely to remember forever whatever was taught to them during a week's training Hencg a weekly meeting was organised for the VHWs All the VHWs canre to the project headquarters at Jamkhed once every week to report their worb clear their doubts and seok advice on the difficulties they faced. The meetings held in infonnal atmospherg provided a two.way education process for the Aroles and the VHWs. N6w that the project is more than a decade old, the VHWs do not have to come to Jamkhed every week They have now becn divided into groups according to seniority and geographical area.l Thus, with each weekly meeting the VHWs grew wiser and more conlident Most of them could communicate only in Marathi but they had their activities on finger tips. They look after ' the following activities : a) Care of children under five : This includes immunizatiorl nutrition and supplementary feeding and minor illnessu b) Antenatal care: Which also includes educating womn about 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.

.:..-..

':li :. .1: ; .,. j r:,,,,.i:-,;;,,.r

r to provide the pcople with ioned above. Their main .role :and ;sprea{ rrfisuch disetisdr*

successful if th$ became pospessive alrout'tbeid 4gdieal*,failpd,rbpcqnip, ., t&e}The, governrnedt p*.fa. r,to,., &eep . I their.;,41i11fuf
,

'
r

kn$uledgp:te
thpir..kpowledger trtt ug
ap

their supi:riority amoilg th

VHIV.s to.dis$ennirstb
:

a*'

fsofi

wotnqtr4ow
a safe delivery,; infpctiroq amang chitdre& if,his dancp,qn thes.r".*;d.alsg got th

VllWri,ma$y morc'olderly i nditio*s fo* coirdncdng: ,how m deal,with. diarrhBea,tri

e

onli
,

reducdd :peoplds depbn-

colrlidened ano ispecl lpmf;

thEta They:-@uldt rno.l.: have, nutrition and improving

educating ,people,; Oncoirhc iiHlrys
decided,to.use.thebn for latgsr

successful,

in checking mat-

more diverse jobs for VHWs woski thgir r curative rryork finishedr the ibacktog lin,

Tbey alsq had

rto

think of.r

found that thtig ;,ludrhadly,,anlth plained that their work was getting onotonous. The Aroles asked them. to organise Mahila Mandals and lrght against such social

.;dra$dqally fl*rdr lhpy., alsor and famiiyuplbuding and dq r.$omE: qf,,thetrl @m-

after about ;thrce:yga{s of

VolunuryEfuns in Fafiily ptanning_M

135

evils as drinking dowry, untouchability etc. They also encouraged them to.advise the women to start small trade which could aug ment their family incomes and improve thbir status in familv. Tie VHWs 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 of about 80,000. Not all the villages in these two talukas have been adopted by the Project There are already two Covernment run PHCs, eight sub-centres and two taluka dispensaries in this area. The PHCs in these two adjacent Blocts are located on two gpposite ends. Thp project has adopted the villages which fall in the'middle, far from thd two pHCs. The project starteci with only one centre at Jamkhe{ now it has five centres Besidds the one at Jamkhed, there are three centres in

dilficulties.

social worker accompanying the team meets the VHW, checks her recordg talks to her aobut her difliculties and supplies her with the medicines. The riurse or the social worker also iliets the members of the Mahila Mandal or Tarun Shetkari Mandal to know their

9!"1 p]:* Tley are located at Mahijalgaorq Koregaon and Chincholi The fifth centre is located at Mindeli in Shrivandar B9ock, There are five mobile teams-two at Jamkhed and one each atMahijalgaoq Koregaon and Chincholi Each of the teams vists about four villages every day:-two in thi: morning and two in the aftemoon. Each village is visited once a week The nurse or the

Te ll!{s, two laboratory techniciang VHWs, one in

pro]ect conslists ol six doctors, three social workers (two ma-les and one female), six.leprosy tbchnicians, six trurses, 14
two X-ray technicians and 65 every village. Neither the.soiial workerg nor the

laboratory technicians, nor the X-ray techniciads are diploma holders Each one of them has been trained by the projeci The Aroles feel that the trained and-qualified technicians and social workers might not like to stayin yiilage.,Besideg they might ask for remuneration too high for the project tq pay, The maintnaitce . staffare few. Attendants are allowed to stay with the patients. They are permitted to cook in the hospital premisses for iheniselves as well as for patients. They have instructions to keep the place clean and they do so quite willingly.

136

People's

futticipation in Family Planning

As already discusse4 the VHWb play a prvotal role in ihe pie ventive 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 capability oftheVHWs, theAroles decided nsttovisitvillages orto allow any ofthe doctors to visit villages. Locll health problems had to be tacLled by the VHWs. For any serlops problen, the patient had to visit 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 Jamkhed Even the serviccg provided il tfe villages by the Vf{Ws are not free" The charges are graded. The VHW charges 5 paise for inedicined. The same medicine givdn by a nurse costs 20 paisg and if 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 make some contribution according to his/her capacity. Those who cannot pay in casl1 do not mind paylng for the services by offering physical 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 that they.have not taken charity an4 sepondly, they also have the satisfaction of contributing for the prioject which is doing so much for them. Family planning constitutes a{ integral and essential part of the project But ,realiEiqgl the hoFtility of the villagers towards family planning the Aroles did npt start preaching small family

waited till the villagers aorm from the very beginning task bccame easier with the in then dweloped conlidence launching of the VHW scheme inl973. They used health care as .entry point for family planning rural I evelopment Once failling people gradually mortality rates death and inf,ant
stadcd accepting familY

khed rs a four-tier health care \ilhathai finatrly emrirged at rung and the nucleus of this structure. The VHW, as the io' and preventive aspects of structurq looks after the level, more. complicated health care in the villages. At the nurses and ANMs visiting the cases are dealt wlth by the tra the VHWs with medicines, villages at iagular intervals to

Voluntary Efrons in I'amily Planning-IV:

137
r

check their records and offer their advice. Complicated cases are referred to various centres to be attended by medical doctor$ At Jamkhed the Aroles themselves look at the cases referred to that centre. These three tiers are integral td the project Al the fourth levef the cases which cannot be treated in any ofthe centres and need specialised attention, are referred either to the district hospi tal at Ahmednagar or to Bombay.

Acceptance of family planning in Jamkhed has not been without the.problems faced elsewhere in the country. Acceptance of spacing methods has generally been poor all over ihe country. That is why the Government has been emphasising terminal methods. Even in terminal methods vasectomy, which is much less complicated, has not become as popular as tubectomy. These problems were faced inJamkhed Project as well. The Aroles overcame the problems gradually by organising people with the help of the VHWs. Condoms were not very diflicult to popularisg but oral' pills were not easily accepted by the rural women The illiterate women foind it too cumbersome, to keep the record and take it daily. The Aroles taught the YHWs simple method of keep ing record and asked them to undertake this responsibility for all .t}re women who accepted it A preterence for tubectomy was clearly visible in Jamkfred villages also. Once the Aroles understood the real problem behind it, they decided not to insist on vasectomy. One of the reasons liven against vasectomy is that it leads to weakness and loss of virility. Even women.give this argument and do not allow their
husbands to get sterilised.

Family planning practices today have become part of the villagers' life. Over 70 per cent of the couples ofchild bearing age are protected. The nro-children family has become the nornr. specially among the young whq apart from the womerl are the largest section nthusd by the Project Table 6.1 shows that in a mattcr of seven years the percentage of females with two or three ,:hildren going for tubectomy has gone up from 17 to ?O which is a remarkable 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 by making curative health as the entry point In fact success of the WfWs largely depended on the ground work created by the ANMs in eight villages. Later on tfoe VHWs in other villages also devoted

138

People's

in Family Planning
This becomes clear
as we comdeath rate with Maharashtra

considerrble time in curative pare rural infant hortality and and the country. Table 6.2
Jamkhed (41.1) as also rural (8.5) is much below the rates achievement has rnade the

in

ticipation ofpeople in their tance of small familv norm a

that rural infant mdrtality in death rate in the project area state and the country. This work easy by ensuring parand has made the accep
process,

TABLE 6.1.: Percentage

No. of Children
5

Females Sterilizeo
r978
9

197

6
l7
16

4
J

21

24

TABLE 6.2: Rurai lnfant M in India, Maharashtra

India
Rural Infant Mortality Rural Crude death rates

and Crude Death Rates Jamkhed compared

Maharashtra lamkhed
107.1

t22
r6.3

4t.l
8.5

(te76)

t2.5

(re76)

TAbLE 6.3: How

How Heahh Care is Met

Care is Met
1978 (%)
24.0

!y

qualified doctors By indegenous doptors By Village Health Workers

24.2
32.2 8.7 10.9 100

Did nothing
Self-medication

Total
The experiment carried out by exploded the myth that low cost
e

Aroles at Jamkhed has also health care with the help of

Voluntary Efforts in Family

Planning-llt;

139

VHWs and para medicals cuts into the practice of medical dbctors. Their experience suggests that as routine and minor ailments are treated by the para-medicals, more andmore serious cases come to the medical doctors. Their assessment in Jamkhed 4rea showed (see Table 6.3) that in seven years oftheir experiment, cases treated by qualified doctors increased by about four per cent While the VHWs took over the care of32.2 per cent cases, they mostly cut into the share ofindigenous doctors and influenced those who ignored their ailments or believed in selfinedication. The cases coming to the qualilied doctors were of a more serious nature giving them
greater

job satisfaction

From Health Project to Movement

The Jhmkhed project might have started as a Rural Health Projecq today its activities are not limited to health care alone. Along with physical ailments ofthe people. the Project has undertaken

the 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 complained that monotony was creeping into their job. They thought that by ohdnging a woman they would be able to change the entire family. They, therefore, asked the VFIWs to organise women into Mahila Mandals. Rajuree was the lirst village where Mahila Mandal was formed. Five women joined the Mahila Mandal with reluctance.

But very soorr the membership swelled to 25. They started

transmitting the message of ch ange to Mahila Mandals through the
VHWs. As expected the women first wanted to put their house in order. The Aroles were told by the VHWs that drunkard males used to come back home late at night and best up their wives and children Besides, they used to waste a good part of.their irlcome on alcohol The question was not merely of drinking it also reflected what the status of women was in rural society. On Aroles' suggestion the women organised.- They iocked up their husbands if they mis. behaved after drinking and later gave them a good thrashing before the entire village. The impact was high. Ivlbst of the males either abjured drinking or sobered top. The Mahila Mandak also encouraged their members to take up sryrall trade. Loan was pro-

cured initially form the Project and later from a hank Women started either selling vegetablg or dried fish, or poultry products,

The Project also invited agri or veterinary experts from time to time to advise the villagers. that veterinary problems were not solved merely by ilrviting experts, the Aroles got one youth in every village trained fhis also helped in solving the problem of rural unemployment Aj the villagers started setting up bio-gas plantg sorne youth were ed in that also. Few young men are also going for cottage i with the help of Khadi and Village Industries Besideg the Tarun Shakai Mandals have also succeeded in seiting up community irrigation projects by Nala bunding or diggi4g wells. With'all these activities and the level ofawareness. conscious-

ness and enthusiasm rising the project

is gradually

being

transformed into a movement Thl vilages have come alive qot only socially and culturally, but algo politically. If rhe dominant sections in the villages opposed the activities pi ther of the Mahila Mandals or of the Tarun Shetkai Maltdals, they were overthrown in the next panchayat elections. Most bf therrl" therefore. have come to tenns with realities now. The Village Khandvi did not vote.in

Zilla Parishad dlection one year, belause the elected members had not fulfilled their promise of electrijfting the village. Commudity feeling is so high in the same village that the villagers have contributed dri one-acrc plot Ilor the sdhool-going children to grow

vegetables

Volunmry Efons in Family Planning-IV:

l4l

The Aroles.stepped i.nto other sp_heres because they realised that they could not talk about health and family planning in isola-

For example, it was not enough to talk about kitchen gardeq they had to supply the plant$ Similarly. since they took a keen isterest and helped the farmers in agriculturg they had to think of ways to make irrigation more effective. Apart frorir encouraging Nala-bunding and lift-irrigatioq they

have been experimenting with sprinkle'irrigation aqd dryland farming One ofiheir former leprosy patients, who is a carpenter by professio4 has been encouraged to develop a wind-mill for

drawing water from well purely from.indegenous.and scrap material. They plan to put it dri various roads at regular intervals for demonstratio.n elfect Theii effort to use and Encourate iocal talents has further helped the project to transforri itself from a health project to a movement in w.hich wery villager in the area takes a keen interest The activities of the project have generated and diveloped the serise of participation to an extent that it seems that the fatalist, non-participant and passive rural society has disc6vEreil-i-ts4F-itsoiriipo-enfr aft o-solvelo-alproblctii$

SAMPLE SURVEY
Sample Villages
Qo,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 performance villageg 3s svs160'Tcftanfof the couples in the Project ara were effqtively protected There were villages with relatively poor perforlnance, but by no stretch of imagination could'we call them poor, because nearly all ofthem had over45 percentcouples effec' tively protected. Wg thereforg decided to study four good performaace village and interview the acceptors and the non-acceptors in the ratio of 6 : 3 in each one of tlem. Thus, the four villages selected for our sample on the advice of Dr. Mabel Arole were Khandvi (45.98 per cent protected couples), Ghodegeon (48 per cent protected couples), Rajuree (58.96 per ceiit proteited.couples) 'and Bavi {63.57 per cent protected couples). In each of the four yrilages nine respondents were interviewed by our research team

la

People's

in Family Plarining

and Khandvi (125). Onlv

males.

Bavi had 35 and25 respectively. Scheduled Caste population. R Scheduled Castes (306). followed

with the h,;rlp of the social The demographic profile of the the Table 6.4. Ghodegaon was with a population of 12g6, follc and Khandvi (523). Only Khand Ghodegaon had 109 Muslims in i

of the Project
bur sample villages is,given in largest village in the sample by Rajuree ( I 130). Bavi (8i0) had an all-Hindu population rpulation while Rajuree ano e four villages had a sizeable had the highest number of Ghodegaon (281), Bavi (168)

had more females than

TABLE 6.4: Demographic pro

Demogmphic Profile

of the Sample Villages

Villaga

Khandvi
523 523

Rajuree

Total Population Hindus Muslims SihedUed Castes Male

Female Couples in the repre

t286 rt77

I130
1095

820

79s
25 168.

l2s
241

g6

109 281

35 306
567 563

282
87

ffi
t75
84 (48)

a2
398

ductive age group

Couples effectively protected

ttJ
102 (59)

IN
8e (64)

g6)

Note: Figures in parantheses in Maharashtra has one of the the country. Jamkhed taluka is no chayats in Maharashtra, and.then villages, were last held in 1979. In strongest support bases for the created problems for the Aroles. active Mahila Mandal artd Tarun

te percentages.

ttkai Mandal. The Mahila Mandal alRajuree was the most acti of the Mahila Mandals. The membeiship of each of these betweeir 25 and 40. Except
Ghodegaon each of the villaees
a Balvadi.

active panchayat systems in ion. Elections for pan:, also in the four sample panchayats are one of the though initially they had of the four villages had

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 two

opposite ends. Therefore, all the sample villages (our sample included villages only from Ja.mkhed Block) depended for their health care needs on the Project Each one ofthem had a VHW
once a weak or

residlng in the village and was visited by the Project's mobile team afortnight The project hospital at Jamkhed was 7

kilometers frorn Khandvi, 21 kilometers from Ghodegaorl 9 kilometers form Rajuree and 14 kilometers from Bavi The government PHC at Khandvi was 2l kilometers from Ghodegaon and 23 kilometers from Bavi, but patients preferred to go to Jamkhed rather than to the government hospital or the PHC. Family planning facilities were also available at the PHC, but people had mor faith in the Project They received their supply of contraceptives also from the VHW.

Sample Respondents
We followed random sampling for the selection of the respondents in Jamkhed villages also. And, we must confesg that we faced similar difficulties in making the sample representative. As would be apparent from our data thatwe did not succeed in getting the sample we had decided on paper and had to make adjustments. One of the main adjustments, as stated earlier, was in the composition of the categories of reipondents in our sample. The local situation demanded this alteration. Similar adjustmi:nts were made in other respects as well but we have not really failed in getting a representative sample.. The respondents in the four sample villages of Jamkhed fell under seven of the eleven income slabs that we have used in this study. Neither the area nor the people were very rich. As a resuli a majority of the acceptors and non-acceptors belonged to lower economic category. Nearly 75 per cent of the acceptors and non acceptors belonged to the low income group, whereas neaiy 4.2 per cent ofthe acceptors and 8.3 per cent ofthe non-acceptors were from the high income grqup. Rest ofthe respondents-belo4ged to the middle income group (see Table 6.5). The non-acceptors in the sample belonged to relatively younger agegroup. They were distributed between 15 and 39 yeras ofagg a little over40 per cent were not older than 29 years. No acceptorwas younger 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

Annual Income
0000-1000

of the Respondents
Non- Percentage
Acceptors

Acceptors

!001-2000
2001-3000 3001-4000 4001-5000 6001-7000

ll

29.r
45.8
12.5

2
7

16.7

58.4
8.3 8.3

I
I I

I I
above

4.2 4.2

10000

&

*
100

8.3

Total

100

generalisation on the basis of this small sample would indicate that acceptance of family planning of Jamkhed begins after 25, which is natural and a majority of phe people accett it by 39. But some people still resist till they crciss thirties. The real reason of resistance would be clear when we analyse the responses of the
non-acceptors.

34.2 per cent of the sample. Thus, the acceptors were equally distributed in various age gloups (see ]Table 6.6). A feeble attempt at

TABLE 6.6: Age-group Compisition of the Respondents

AC"Cr"rp
acceptors

l5-i9
20-24 25-29 30-34 35-39

I
6
8 5

8.3

*
?s.0
20.8
16.7

2 2

16.7 16.7

4
J

q-44

JJ.J 2s.0

45-50

.+,

Total

Voluntary Efions in I'amily

Planning-IV:

145

''litrate.

acceptors (41.?%) could, afford education only till primary level. While illiterate also fonned sizeable section of the respondents in both the categorie . Looking from another angle 58.4 per cent of the acceptors and 75 per cent of the non-acceptors were

TABLE 6.7: Educational Irvel of the Respondents

Educational

AcceptonPercentage
10 12
1

Non-Percentage

sandgrd

accePtors 41.6
3

Illiterale Primary Middle Matric Graduate

25
41.7

50.0 1.2 4.2

.l

5 J

25

83

We had problems similar to other areas at Jamkhed also in maintaining equal malefemale ratic in our sample. However, we succeeded in maintaining this ratio for the non-acceptorg while the acceptors were interviewed in the ratio of I :2 (see Table
6.8).

TABLE 6.8: Sexwise Distribution of the Rbspondents

,Sg

AceeptonPercentage
8 16 33

Non-Percentage

acceptors

Male
Female

67
100

6 6

50 50
100

Total

24

l2

Participatory Attitude
Participatory attitude of the respondents in the four villages

of

the Jamkhed Project was generally higtr" Both acceptors as well as

non-acceitors showed remarkably high attitude to participate in

l.

villaga would you hllp? Wouldyou like to ioin in

health centre/sub centre,/dis sa_rywith the help ofpeople in

a

95

100

100 87

100
.91

13. If

a family planning centre is opened in the neighbouring, wontd vou go there?

62

75

14. Would you also make efforts to

.

vering a speech in your would you attend that? 16. If such political meeting is held_ in the neighbouring v would you attend thaf 17. Wouldyou like to compaign for4 partylcandidate in election? 18. Did you campaign for any partyl candidate in the last election? 19. Did. you vote in. the lasr electio4 for (a) pancha at (b) State Assembly, (c) Iok Sahha? _ 20. If the local leaders organise

- 9:ntt l).. lI a nationaVlocal leader is d

one family planning centre,/ opened in your village?

9r

9l\

9l
58

50

l6
20
100

.^

4l 9l
75

in i0 21. If the I'LWVHW is not visitipg your villagg would yori make complaint to ihe concerned
officials?

demonstration on risiirg prices or non-availability of certain commodities, would you participate

9l

95

t)

Voluntary Efons in Family

planning_IV:

A7

ses. to.different <iuestions merely shows that people iraOeO tte activities.acbording to their preferences before particiiating (see Taole 6.9).

Various sociepolitical activities_slight fluctuationsin the respon-

TABLE 6.9: Participatory Attitude of the Respondents

S Panicipatory Questions No.

Percmtages

of

respondenu

affirming the questions

Acceptors
If there is shortage of essential commodities (Keroseng Sugar, Fertilisers etc.) in your villagq would you make efforts to make these commodities available in your village? 2. If.there is shortage of drinking water in your village, would yog
make efforts to make it avd'ilable? 3. If the neighbouringvillage has a
school which yourvillage does not

Nonl
acceptols

l.

91

75

95 95 75 83 91 79 9l 87

75

75

4. Ifafamilyplanningcampisbeing held in a neighbouring yi113gq

would you go there? 5'. Would you also make efforts to one such.camp held in your
village?
a film is being shown in the neighbouring villagq would you go there to see-the film? 7. Ifthe film being shown in your neighbouring village is on family planning would you go there? 8. Would you make efforts to get the

havg would you make efforts to get one gpened in your village?

58

get

58

6. If

75

83

g3 100

filrn screened in your village? 9. Ifyour village does not have a

People's

m Family Planning

lf you are requested to your Services to thb governm voluntary agency to take the health services to the peoplg would you volunteer 23. If the school teacher in your village requegts you to persualde people to send their children to school, would you help him? L+, If the WW/VHW requlsts yoq to help him in persuading and motivating people for family planning would you
22.
him?

100

9l

25. If 'Keertan' and :Ram Lila' is organised in your villagg you attend thht2

rn in this area was in the maximum participatiop (for both acceptors and non) was visible in organising health services (Qugstions 9-11), efforts for a family planning centre (Question l4), volun service for health car6 . (Question 22) and helping VIIW motivate people for family planning (Question 24). The for education was also visible amorig the villagers ( 23). The respondents also showed partisan attitude tolvards political participation While cent fier cent acceptors and 9l per cent non-accepto$ aflirmed that thly voted in the last election for local bodieg State AssemblS and I lok Sdbha, not many had compaigned nor were interested in ing for a party or candidate. The respondeng also strong motivation to make essential commodities ble to their villages.a

Since the genesis of participa activities of the Rural Healtn

Voluntary Effons in Family

Planning-Il4

149

the non-acceprance to some extent, the nigh Score even lor rne non-acceptors indicates that there are likely to be some other reasons that have compelled them not to accept farnily planning We shall come to it later. Let us have a look at the questions relating to family planning The 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, onlyin three items the difference is substantial. In rest of the three questions the non-acceptors have equalled the acceptors in one-14 (91,91)-and exceeded them in rwo-7 (79, 83) and 13 (62,75). participatory attitude is thus, at least partially responsible for nonacceptance of a section of population in this area" That people in this area.are highly motivated to participate in socio-political activities does not need to be established anvmore. However. our data further strengthens this fact We asked tlhe respondents as to who should pay for the health and family planning service$ and in respons e 47 per cent said that people should pay, while 25 per cent wanted the government also to make contribution tbwards this. Only 28 per cent respondents thought that the government alone should pay for these services. Appreciation for thb work of the project and respect towards the Aroles came out clearly when we asked as to who should operate hdalth and family planning services. ,No less than 52 per cent 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 run these services for themselves. Their motivation to participate in health- services become very clear when -we asked what kind of help would they provide for health services. A majority of the acceptors (62.5 per cent) and 41.7 per cent non-acceptors offered physical help, 4.2 per-cent hcceptors and 16.6 per cent nonacceptors offered material help, while 33.3 per cent acceptors and !.7 p", cent non-acceptors offered both kinds of help(see

Table6.10).,

Motivation

ning at Jamkhed more rhan partic-ipation

Motivation appeared to be affecting acceptance gf family plan.

fluj^:n]!:":h

motivatioT_ of acceptors and non-acceptors looked iignificant at except for rwo questio". tq. 2;i";hich 33 per cenr rron-acceptors affirmed as against 95 per cent acceptors and

Th.';;p

between

150

Paple's

in Family Planning aflimred as against

the non-acceptors looks quite percentage rate is substantial

' 50

Q. 3, in which only 25 per cent percent acceptors) motivation

(see Table 6.ll). A large number notr- acceptors (58 per cent) also visited family planning centre they generally implied project hospital at Jamkhed), but only33 cent used the facilities (Q. 2)

strong the difference in the

it It merely shows that ning for some personal reasons perceltage of motivation of acceptors came to 72 and 48
accept

medical oflicer and soright "'ly enougfu 66 per cent of the non-acceptors replied that they p-isiraded their friends and relatives to accept family pl but they themselves did not
advice on'family planning they believed in family plaidid not accept it The average planning acceptors and non-

and only 25 per cent consulted

TABLE 6.10: Kind

Accepton

of
help

Nonacceptan
5

Percennge

Physical Material Both Total

15

4r.7
16.6

I
8

2
5

4t.7
100.0

24

t2

Thus, participation nrarginally play a role in acceptance and nonat Jamkhed. But equally
a

motivation substantially of familyplanning are sociocultural reasons

tron-acceptors, we can have

Before we analyse the responses of look at the number of male and

had While the acceptor

children and 48 per cent of female 43 per cent of male children and This seems to be an important
yet to accept famif planning when a couple whose two out of

children the respondents had 52 per cent of male the non-acceptors had per cent of female children
why some respondents have became even more apparent
we re dumb showed of family planning the deqision to adopt family spousc Only in two carcs (a

children

their rcluctance to adopt terminal Most of the respondents said planningwas tqken jointly with

Voluntary Elforts in Family

planning_IV

l5t

hale and a lbmale) the decision was taken individually.. Not only males were relucttant to go for vasecto_x b;;;l* ;i;ir wives did not want their husbands to get sterilised" ffre expfinutii generally offered by both was th;t it might leadio wJahess and loss of virility. Sinie the male had to work hard in the field and they were the main bread-winners f", th. i;;i; ;ues ulro rn".. against

il

TABLE 6.ll: Motivation of the Respondents

s
No.

Quest io ns on

M otiv atio n

Percentage affirming

Acceptors

Nonacceptors

l.

Have you ever been to family planning

centre?

87 95 50

58

3.

centre and seek advice

planning?
4.

Have you ever used the facilities pro_ the I9:a UVever family planning centre? rJlo you consult the medical officer in the dispensary/health . centre/sub

JJ
2s

on

family

Did you ever take friends/relatives io family planning centre and per_ suade them to accept family planning
the
methods?

9l

66

5.

.Iamlty planning centre? Has a1y on. ever advised you to adopt family planning?
Average

Did.you ever Jake your spouse to the

50
58

50
58

72

48

*rur,fft,X:,,'J;'-"

*xT*,il.:f#*y,T: ff:s{iTii".:Jj1".1,:,.1l;t ff are determined

by a number of socio_

152

People's

in Family Planning
factors. A prelbrence for ion$ have mentioned earlier. Our for the acceptors was larger' Jamkhed a number of resPonwith two issues, sons or was not entirely absent lt areas we studied A look at a clear picture. non-acceptor sample belonThough, the largest majoritY
41.7 per cent were dis' This may be one reason either the non-acceptors had for the second child The res' tabular form reveal the reasons

psychologipal as well as economi as against doughters, is one factor analysis shows that Percentage of than the non'accoptors' Though dents indicated that theY were daughters, a preference for a male was.no doubt weaker than manY the non- accFpt6rs resPonses will We have alreadY shown that ged to relatively Younger age(33.3 per cent) belonged to 30-40 tributed between 15 and 29 Years for non-acceptance. APart from tl vet to have a child or were ponses of the non-acceptors Put for non-acceptance (see Table 6. One respondent did not have waiting for a second child" Two of whether s-ons or daughters were others considered two sons and a six of them were Potential had truo or three children with two children considered two did not state any reason for his Five non-accePtors had three grgup with the largest number of pondents. Two of the resPondentr two children suflicient for a and a daughter were ideal and m for a daughter before he accePted was waiting for his wife to felt that three children (two least ooe son for the other) were ofthem did not state any reason

age.

cn

d vet and five others were thought that two children for a family, while three ter ideal for a familY. All planning agceptors after theY by thenr Another respondent ideal number for a familY but
acceptance. each, and this was the in this category of res'

with three children considered

One of them thought that a son for a family and was waiting planning while the other

from malnutrition. Two others and a daughter for one and at ifable for a familY. While one his non accePtance, the other

wanted one more son since

daughters. An<ither two sons and two daughters one more son before accepting

three of his children were with three children considered planning

for a fam'ily and was expecting

acceptor resPondents demonsnorm'. by the villagers in this

The responsos of the 12 trates acceptanqe of 'small

Voluntary Efons in Family ptanning_IV:

t53

TABLE 6.12: Views of Non-Acceptors

.x No.

Number

of
children

Desimble Reasons for nonnumbbr of acceptance

children
according

Remarks

toR

l, 2.

I I

Wants bne more Two children are

enough whether sons or daughters Warrts one more Two are enougtl child whether sons or
2

child

3 3M2
<t
Itvt,

(1+l)

daughters.

Wants a daughter A son and

nutrition

Wife is weak and put on

daughter are musl Will get his wife

sterilised after
check up.

Reason not stated Wants no more

2F

children.
4 Q+2)

Wants one more

son

2or3

Yet to have

lF 9.
lM

J(2il)
3 3

child
sons

_
Two sons are essential to help

Wants two more

(2+r)

10. lM

Q+r)

Wantg a son and a daughter more Wants a son and Two sons are . a daughter more .essential for shouldering family

in family affairs

responsibility.

lr.

12.

3F
3

J (2+l) Reason not stated 3 (at least Wants one son one so[)

All

the tiree are

daughters.

Note : Figures in parantheses inai"ut"

*TOuught"o

le experiment conducted bY novel and, at the same time and iamily Planning as well the Aroles in the f,relds ofrural awakening The remarkable as rural rcconstruction and over a decade a"hieu"m"nt. of the Project in a s*rort period ofjust our country are unsurfacing shows that none of the of approach is adoPted bY the mountable Provided the right are .properlY mobilised and the reso

right people and

effectiveness

exploited the Like Gandhigram and Vadu amkhed also demonstrates in planning The macro and of the micro'

by the Indian Planners absolutely imPersonal aPProach taki into account local realities, and policY makers so far does : in a vast and equallY diverse which assumes great is;wen society like ours The imPortanct of micro.level Planning

greater

Indrely depends on Personal Arolel for examPle. could

delivering health care onlY
drea and theY decided to enlarge

in a Programme

like.

mily planning whose sutcess of individuals. The with various waYs of

thev were working in a small ir aLa of operation graduallY succeeded TheY could also

when their exPeriment in one

monitor the resPonses of the

welfare programm$ The Jamkhed experiment

emphasis also so as not to annoy cious of persons coming to

and bring shifts in their who were generallY susPi any kind of develoPqegt or

likelv to succebd if PeoPle are project entered the freld of ft health care and the curative entry point for Prwentive

shows that familY Planning is health care. The Jamkhed planning through Preventive h'care services Provided the care. InitiallY 4o one talkid of

Voluntary Elfuns in Family

Planning-Iv:

155

tamity planning Once death rate and infant mortality droppetr visibly, people were gradually told and convinced aboui the advantages of a small family, and people did accept it But even here the human and personal touch was maintained Those couples who did not have sons and wanted one were not pre. ssuriied But on the informal level it was argued that the number of chances one can take to have a son was also limited" Thus,
gradually a section has emerged which boldly says that sons or on sons, two children are enough. Another significant point is tha! the Aroles did not conceive of a system of health care delivery whictr, like family planning

initially, adopted a cafetaria approach. That ig when people fell ili they came to the health centre or a medical doctor for treatment Health care they had come to provide, planned to banish diseases, first by curative measures providing relief against minor ailments
at the door-step and then through preventive measures by creating

conditions for healthy living. The system also provided health care without involving over-qualified expensive doctors. Ihe most important aspect of the Jamkhed prolect is the attempt of the Aroles to {irst win conlidence of thi rural people and then to enlist not only their co-operation but also active par_ ticipation in the entire endeavour. Whether it was evolution of the VHW-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 Tarun Shakai Mandals a formal structure of participation was also c_reated Particiption of the people in the activitiei of the project is through the VHW and the two bodies mentiored above. Lately, the panchayats haye also been infected with the participatory virus. Naturally after all an elective body like panchayat rep resents and reflects the mood of the people. WhilJ the message of change reaches through the VHW and-the office bearers.of the above bodies, the two bodies take decisions in their meetings and seek the help of rhe projecr In spite of the fact that the Aroles did not raise the question of family.planning initially and concentrated their energy on health care along gradually with the success of the VHWicheme the message-of family planning was conveyed easily and effectively. It was further reinforced when voluntary associations like Mahila Mandals and, Tarun Shatkai Mandals were constituted" In facL the

156

People's

in Family Planning

former proved to be a better because the women have to bear The three institutions-VHW

than the latter, probablY brunt of procreation Mandal and Tarun Shet effective instruments of Par' Mandal-have not only kai well as network of delivery ticipatiort birt also of motivation been an integral part of the system. The VHW, of course, health care delivery as well as I family planning She i$ not and pills, she also keeps merely a depot holder for pill She has also records ofthose women who adoPt emerged as an effective motivato for terminal methods of conin thisendeavour traeeption. She has received the Tarun Shetkari Mandals also trom the Mahila Mandals Later have also been motivators helped. The two voluntary associi
and deliverors of change. And ment in the areas has alreadY The success ofthe Jamkhed people, which has led to effictive grammes We wish we had an extent of change and develoPdiscussed at length. lies in its confidence in the participation in its pro'
scaie to measure the level

of

the data on participatory participation in this project attitude does give a glimPse of the level of participation in studied by us, the level ofpan Jamkhed Compared 3o other ticipation in the Jamkhed is much higher (For a comparative Pic' volume.). ture see Chapter IX in the be mobilised to this extent and Pa rticipation in Jamkhed did not try to impose any raised to this levcl because the their intention of providscheme on the people. Once theY ioatorv health care scheme to ing a cheap, preventive and opinion The people were peoplg they eliciited their advice a scheme came from theq it involved at every stage. Even suitable changes were made if came in the form of an advice modifioations Not only that, the peoplc suggested some as a mere health care schemq inste4d ofrigidly keeping the were introduced when the programmes of socieeconomic and opinions ofthe peo' people demand it Herb agaiq the ple were respectod or in any other programme of Whether in health care major obstacles in suPersocio-economic change one of it as a majop- roadstitions. ln fact, the Aroles also ffort to fight superstitions launch a block They had to Agaiq an active role was and misbeliefs prtevailing in the the Mahilla Mandals and the played in this effort bY the

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 with

suitable local variations. The need is to understand people and make them understand the utility of the programme. Involvement of local population in this act would only help the programme. The compulsions. imposed by the target approach is not really relished by many people. Besides a programme like family planning also goes against. deeprooted superstitions and beliefs. The Aroles rightly attempted, therefore, to counter these superstitions and beliefs, rather than to force the people into accepting the
programme.

158
NOTES:

People's Pbric:ipation in

t amily Plann.ing

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 consultation 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 VIt

Fainily Planning Througfn Panchayats- I: MadhYa Prade sh

onlv institutional structure at the local level that could sustain popuiar'participatioln in any programme is the Panchayati Raj Insiitutioqs. The lt{adhya Pradesh and the-Gujarat Governments 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 performance districts of Madhya Pradesh, lndore and Dhar' is pre-

THn

sented below.

Demographic Profile
Madhya Pradesh, the largest State in area in the Indian Uniorl has 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 of 3.1 in four years. The decline was sharper in rural sector than in urban sector. though rural birth rate still remained substantially

160

in Family Planning

hrgh. For

India on

the other

four yearq 1975-'18.

han4 five birth rete declined by

1.9

in

TABLE 7.1: Live Birth Rates

Yetir
1975

M.P. and India II75-28

1977 1978

MP
Combined Rural Urban m.3
41.7

India MP

MP. India tr4P. India

38.3 33,0 37.2 333 39.4 34.3 .36.4 34.7 32.5 27.8'30.4 21.8
P. and India l97S-iS
1977
1978

32.6

35.2 39.8 36.7 41.0 28.5 33.2

TABLE 7.2: Death Rates.in

1975

MP.'India Mp.
Combined Rural Urban
.

LIP. India LIP India

18.5 19.8 I

l.l r0.2

15.9 17.3

16.5 17.7

to.z

95

6.3 't9.4
9.6

5.0

17.0

l4;t

15.1 14.2 16.0 16.0 lE:3

9.4 9.4

9.4

Source: Sample

ol.

XIi

No. I Iune.

1980.1.

Similar trend was rellected in th rate as well Mp's death rate declined from 18.5 in 1975 to 15 in 1978-a decline of 3.4in, four years. While the death rate for India declined from 15.9 to 14.2 (mere 1.7) during the same per Both rural and urban sectors revealed similar trends for MP and India. 'Infant mortality which is usallv c with birth and dearh rates has also been higher in Mpas pared to the country as a whole. Table 7.3 illustrates this fact such a high rate ofinfant mortality a substantial decline in birth rates was difficult to expect

Delivery of Health and Family

Service
in IU.P., like anyother Srate ary Health Centres (pHCs) the para-medical stafl The

. Health andfamily planning s in India, was delivere-d through . and'their Sub-Centreg supported

.Family Plapning Through Panchayats- I:

16i

PHCs and sub-centres are looked atter by qualified medical o(ficers. In biggerPHCs there are additional medical df{icers (al times a lady) to help the medical officer'in'charge. The other stafl include a Block Extension Educator, Multi'purpose Health Workers (male and fernale), Health Assistants (malc and female), ANMs, Dais, Mass Education Officers (male and female), etc The sub-centres generally has one medical doctor,. and compounder and other maintenance staff Multi-purpose Health Workers. lt{ealth Assistants and ANM visit 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'

Combined Rural

Iadia129
139

Urban
Source :

t37 126 151 140 138 145 136 159 l5l 145 83 74 90 84 88

80
2,

Sample Registration Bulletin (Vol.

December, 1979). West Bengal.

Xllt 'No.

Note

The aggregate estimate for' India excluded Bihar and

Family Planmng work is undertaken both by the lamrly planning staff and the health staff They motivate and advise people on

family plannirig. Motivation generally.meant motivation for

vasectomy or tubectdmy, and the staffget incentive money meant for motivators. These people are partic.ularly active during the camps. The para-medical health and family planning staff is also

the 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

of a planned l'amily and create ani. awareness about the available family planning methods. Mass meetings as well als small group meetings are arranged in co.opelation with the pafrchayat officebearers as well as prominent citizen of the villa$e. Cinema shows are also organised from time to time to spread the message of family planning.
educate people about the advanta$e

Family Planniirg Performance

Though the demographic irends present an encouraging picof Madhya Fradesh, the fafuily planning programme administration in the State.is not qdite satisfactory. A major difficulty arises from the problem of distances-State capital to divisional headquarten, divisional headquarters to district head-

ture

down to 33 per thousand by 1985, thE State would need to protect an additional 16 lakh couples (Chdri 1982:19). Considering the limitations of the administration it is quile a tall order.

Mbreover, the larnily planirrflg progiamme in Madhya irto a ste[dy routine (Chad 1982:19). Chari's study shows that achiever{ents have fluctuated widely
Pradesh has yet to settle

months of the national emergencf, specially due to preponderence of male sterilizations. Only gteady trend is that of increasing use of oral pills. It would bg interesting to check what percentage of i{ has been in rural afeas. The small number itself suggests that most of it is likely to $e in urban areas. Another important trend indicatpd by Chari's srudy is steady increase since 1979-80. We shall $ome to the reasons.of this increase later. Since the inception of the family planning programme till March 1979, MP was ablp to protect 20.5 per cent of the

over the last decade. The peak achierfement years have been the 18

Famiiy Planning Through Panchayats- I:

163

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 all methods 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 the vastness 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 unfortunate impression was further strengthened during the Emergency. The governmen! therefore, faced a difhcult task ofrevitalizing the pro' gramme after 1977 because popular apathy had given place to antipathy or even hostility. lt was apparent that the family planning 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 programme by providing them monetary incentives for rural develop' ment in order to generate popular participation. The involvement of 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 figures presented by him indicate (Chari, 1982). The response of the village panchayats as well as villagers surprised the government The scheme has been renewed in gach financial years since 1979, thoulh it amounts [o giving lakhs of rupees to the panchayats as well as to the'individuals as incentive. The enthusiasms of the panchayats'is quite understandable because their own ftnancial resources are quite meagre' This gives them a chance to mobilise additional resources for developmental programmes in the villages.

Under the scheme the government has fixed sterilization targets for village panchayts. The districts have been divided into three categories (i) most resistant (ii) resistant and (iii) easy dis' tricts. Till 1980-81 the targets for each ofthose districts were 8, ll

164

and 14 sterilizations per

People's '1,000

in Family Planning

target was raised to I l; 14 and 17

ulation During l98l-82 the diflicult

ns per thousand popBesides, it was

ulatiorl making prize.winning being contemplatgd. to strike a

tubectomy and to encourage va a panchayat to ensure 50 per cent order to cualify fqr the prize. The panchayats achievrng tne 'Should a panchayat exceed the money was raised to Rs. 15,000. ing enough to exceed the target by I ded Rs 25,000. The money expected. to be utilized for develop of a school road a dispensary or fac! the State government provided for which the money should be utili could, however, mobilise lareer mental plans. Thus, by generating h panchayats, the scheme has been ticipation as well.

between vasectomv and my by makiirg it essential for tions as vasectomies in were awarded Rs 10.000. by 50 per cen! the prize if a panchayat was entelprisper cent, it would be awarto the panchayats was tal works like construction water facilities etc..In list of dwelopmental works Enterprising panchayats ifthey had bigger developthy competition among the le to create a sense of par-

fixed for the panchayats in ion that the Panchayat in the delivery network of health and family planning The panchayats' role is strictly motivational. The panchayat o bearers are supposed to cooperate with the PHC staff in ent of the targets assigaed to them. Since the office-bearers ha their roots in the local soil, it is expected that their persuasion carry more weight than thai of the government medical and medical staff. And. as the results indicatg their expectatibn not been misplaced The panchayats have succeeded in limited role assisned to
this scheme, it should not give the Rai institutions have been in
them.

'

Although sterilization targets

The results could be ascertained ing at the number ofpanchayatC in different years since the progri

three ways. Firstly, by lookh have been awarded prizes was launched^ Secondly by

looking at the family planning figu The third way, however, could be to look at the imoact of th programme on birth rate in the State. The figures for two yeafs available to us indicate a tremendous response from the rayats In 1979-80 only 250 panchayats received the prize while 1980-81 this number went

family Planning Through Panchayats-

I:

165

up to 639.'l hug.inlusr one year the pertormance ot the pancnayats

terms of numbers, had more than doubled. Looking from another angle with more and more people accepting pennanent family planning methods in the villageg impact is likely to be felt on birth rate. The family planning performance since 1979 also seems to be looking up ip Madhya Pradesh. However, it has not reachedl9T677 level, but in spite of a drastic decline in the following year, acceptance of terminal methods picked up since 1979 (Table 7.3).

iir

Similarly non-lerminal methods like IUD and condom also

became more popular than before.

It was still a little too early to make an assessment of this scheme's impact on birth rate. The Madhya Pradesh government had not made any such assessment But if the programme makes progress the way it took offand the rising enthusiasm could be sustained over the yearg declining

it is likefy that the birth

rate

will

start

Motivation and Participation

this scheme. was to create motivation at pofular participation in the family planningprogramme in the long run. As far as institutional motivation is concerne{ the prize-money has succeeded in motivating the panchayats. The limited participation offered under this scheme has led to wider participation in developmental work The panchayat officebearers who would not think of any new development project' because there never was money available were seen enthusiastically mobilising more funds for various projects'. Completion of any project seeined to be fulfilment of long-cherished drbams. In village 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 middle school 'ahd the panchayat was mobilising funds for that
The. main purpose of

the institutional as well as individual levels so as to enlist

purpose.

lndivrouat morivation and participatioq however, are much lnore complex phenomena. Motivation is governed by a number of socio-economic factors. In the case of family planning for exarnple, poverty, iiliteracy and superstition do.play their role. But

tffi

People's

in Family Plsnning
rs socio-economic structure

far more rrnportant tnan these of the rural sociery In tbri agrarian secfire unless he has two survivine sons along with high infant

y a farmer does not feel

The strong preference for has their own implications

on fertility behaviour. Therefore, while motivatioq a4d consequently participatiorL

The lure of prize and the resulting in acceptance of terminal of cases the wives were being
husbands were staying away.on weakness, loss of virility and a

operation Apparently, the indivi<lual motivating factor for accepting course. is that it did not bring family. It mattered only to the bsisting on daily wages could winnl"r is laid off. Moreover. a areas indicates that a majority of
marriages were consummated as ty,. teproductive span was quite mepntirng had more thari three were motivated more because of th

of village elders were also larle number towards sterlization and the pretext that vasectomy led.to back-ache after the
ethods. But in

tives were also not much planning One reason

of pf

tial economic benefit to a that the poor families susfor the period the breadstudy of acceptors in rural clustered in 30s. Since child as the bride attained puber-

Most of the couples in the four children Such.couples large families than because

of the incentive monEv. Generally speaking level of acceptance wbs still relatively high only in the level of taking initiative in not quite high. But our formal the villagers indicated that they participate. If their sewices were to offer the same provided they tunity to- participate were
.

n in family planning at the

in Madhya

Pradesh.-It was

villdges. Participation at the family planning was also and informal chat with willing to be mobilised to ired, they would not hesitate the time. The time and oppor-

rtant variables determining

participatiOn.

F'amily Planning fhruugh Panchayate-\.

t67

Sample Survey in Villages of Indore District

The Indore district was suggested for study by the officials <if the Government of Madhya Pradesh. As usual, the villages of the district were divided irto two groups, one with good records of family planning and anotherwith poor performance records. Two villages, Ajnod and Kankaria Pal, were selected as representatives of good performance villages while Khan Barodia and Darji Karadia represented poor performance villages. At thd second stage random selection of eight acceptors and four nonacceptors was maoe from villages of the Ajnod and Kankaria Pal

and four acceptors and two non-acceptors respondenls from villages Khan Barodia and Darji KaradiaInformation 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.with the respondents with the help of the locally recruitecl person familiar with the local dialect The village Ainod" which was nine kilometres from Sanwer PHC had 2,306 people according to 1971 Census and had i5 per cent bf eligible couples sterlized while Kankaria Pal, located 14 ' kilometres from Sanwar PHC with 1,840 people had 70 pel cent of eligible couples (men and women in equal numbers) piotected. The village Khan Barodi4 one kilometre from Sanwer PHC had
974 people (1981 Census) where 12 persons were operatod o.irt of 150 eligible couples and Darji Karadi4 four kilometres away from Sanwer'.PHC had 1,040 people (1981 Census) and 200 couples in reproductive age group. The.Family Planning work was at a very

low key on account of lack of pucta road connecting the village rvith the main road

Characteristics of Sample Villages

Demographic profile of the four sample villages in lndore district (see Table 7.4) indicatds .that the Ajnod was the largest village and Khan Barodia the smallest The population was over whelmingly llindu in all the villages, with a very small Muslim' poptilation in three villages. Each one of the villages had substantial scheduled caste population, and Kankaria Pal had a srnall tribal population as well. There were more males to females in

168

People's

in'Family Planning
brmance villages had7l and

each ofthe villages. Thp two good 70!er cent protection rat6.

TABI E 7.4: Demographic

Demagraphic Profile

e of the Sample Villages

Wlages

Ajnod' Total population Hindus Muslims

Schedul0d Caste
2,306

Darji Khah Pal Kamdia Barodia

1,359 1,064 1,002

rJ5r
20

690

974 874
100

20

49
263

500.

275*
732 627 ?10
147

Male
Female

r2w
1,100

ffi

54
200

500

in the re. productive age group

C-ouples

376
269 (71)

414 294

Couples effectively protected

f6
(18)

.d0)

ir)

85

* Includes 75 Scheduled Tribe Note: Figures in parentheses

That the villages had active the fact that they were participa schema Janpad was the forum at resentatives of the villages in minig developmental priorities in

te percenta-ges.

panchayats is obvious from

in incentiveto-panchaYats
tehsil level where the repwith bureaucrats for detervillages There was District (not elected) permanent on developmental matters. which collected and or private-located in cooperative for dis'tribu' Karadia had a Yuvak Mandal Khan Barodia was the onlY
n and a government

Advisory Committeg a represen body, to advise the Zilla Parish The sample villages had milk marketed milk to dairiesIndore. Kankaria Pal had an tion of fertilizer on loan. OnlY engaged in same social actiYities, village having a women's welfare bided Seva Sahkari Sansthan. organisation at Khan Barodia welfarg help ofnone ofthese i planning programtme.

apart from women's w.qlfare ich was engaged in child was sought in the family

Family Planning Through

panchayats-I:

169

Of the four selecti:d villages only rhe Ajrod had an Ayurvedlc dispensary and a family planning sub-centre attached to it Rest of the villages were served by thq PHC at Sanwer and its paramedical

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 supplies were irregular and inadequate. Hence most people lra.d to depend on friends visiting nearest town or cities It was not convenient for rrost of them to go and queue up at the Sa4wer PHC. , I he motivation work was the responsibility ot the paramedicali staff residing in or visiting the villages as well as the staffof CD Blocks. Ever since the new scheme was launched, gram pahchayats had become active campaigners, so much so that ihey spegt from their own resources to supplement the incentives so that they can motivate more people and win cash awards. But the campaign as well as motivation was restricted largely to termiiral methodg and as a result spacing methods were no! emphasised upon The family planning campaign particularly became vigorous during sterlization camps. It is duriug such camps {hat films on family planning were.screened and exhibition of fosterq mass meetings ard.small group meeting$ were orqanised The samfie villa-geilC<i-eaucational-iaciliry onty upto middle school level The schools had reasonably g0od attendance. The, ,enthusiasm for bettering educational facilities was witnessed in Ajnod where the Sarpanch was makitrg efforts to raise fuuds for school b*ildins. ' Eleclgrat . parucipation ln the sample viliages was also reasonably hi$. V-oting reported in papchayat elecion was 65 to s) 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.^According
Lo

{al[ Each of the Village had a CHV and a dai residing Besides

there.

f1mily plannirg advice every week ihe coopera_, ::._ttfl:-t:"9h, uon base ln all the villages was reported to be widening
gradually.

rhe sub_centre stufq ZO

f"opf"

o., uo

Sampre Respondents Like other case studies wb used random sampling for selecting our respondents in the sample villages oflndore district In spite of

170

People's

'pation in FamilY Planning

in all the income brackets e resoondents, i.e. over threemiddle income grouPs. The forirths, belonged to the lower one-fourth of the samPle. high income group formed less family planning and apathy Considering that antipathy the low income grouP and towards participation is greatest brakcet from the point ofview middle income group is also progratnme and promotion qf of success of the familY sample is justifipd The small .participation in develoPmenq ket is sufficient to get a feel of sample from the high income their views on the subject
TABLE 7"5: Economic
Incotne rangg (R.i,

Umitations of time and willinl bestto select a representative the respondents in lndore d Our respondqnts were distri (see Table 7.5). A majoritY of

ofthe iespondents, we tried our le. Let us look at theProfile of

of the Respondents:
Non-Acceptors

No.
2 6
8

Percentage
8 8 27

0-1000

t00r-2000
2001-3000 3001-4000 4001-5000 5001-6000 7001-8000 8001-9000 9001-10000

25

I I
J'

I
4
J
5

l6
13

t7
8

I I

I
1

4 4
13

:
8

10000

8 8

Total
Age'wise the acceptors we(e

100

1''

100

y concentrated in 20-39 years

to get acreptors ln younger age family is the norm in this area. and we shall deal with it on two sons. Though 46 per . cent acceptors were in 20'29 age it was not a very encourag-

group (see Table 7.6).-The < 30-39 age group (it was not group) meant that four to As we have mentioned in the in detail later, frrost peoPle

on of half the acceptors in

in our acceptor sample we had only 16 per cent respondents relevant for two-child family. The trend is further confirmed from Ithe non-acceptor sample ofwhom two-thirds were concentrated in 35-39 age group.
case

Iamily Planning Through Panchayats- I: t7r ing sign if the aim was to promore rwo-child family. Il racr rn tlie rurdl contelt 25 -29 xge group would have 3 to 4 childreL In that

TABLT 7.6: Age-group composition of the Respondents

.Age Group

(Yeari
20-24 25-29 30-34 3s-39

Acceptors
No.

Non-Acceptorc
No.

'

Percentage

Percentage

4
7

t6
30 25
25

18

r1

&44 45+
Total

I
2+

-t 4
100

867 18
t2
100

Illiteracy was endemic in this ffi college graduate. Thus, the most educated in our sample had passed matriculation or higher secondary. Half qf the u"..ptorc and one,third of the non-acceptors were illiterate. One-third of the acceptors and 59 per cent of the non-acceptors were distributed between primary and middle school educated- This shows what small number we could find ofeven high school educated persons of this area {see Table 7.7).

TABLE 7.7: Educational level of Respondents

Educational
Acceptors
No.

[zvel
Pefcentage 50
25 8

Non-Acciptors
No.

Percentage

Illiterate Primary

t2
6
2
Sec.

4
5

JJ
42

Middle Matric./Hr.

t7
8 100

4 24.

l7
,100

I 'lJ

Total

172

Pmple's

in Family Planning
of both the sexes-in

We had planned to keep equal our sample. While we largely tive with respect to the acceptors, male 'sample for the non-

in achieving*hat objechad to make do with an all(see Table 7.8).

TABLE7"8: Sex.wise
,Sex

ution of Respondents Non-Accept6n furcentige

.Acceptors
13

Male Female
Total

1l
24

54

t2
t2

100

100

Participatory Attitude
The respondonts, both and non-acceptors. demonstrated fairly strong participatory (see Table 7.9). In both the cases, average participatory was above 50-51 for accep Sors and 59 for non-acceptors. the strange aspect is stronger participatory score for nonthan for acceptors While the difference bctween the two is not very largg the fact remains that the non-accepton have a scorg and it would indicate that in spite of strong attitudg the non- acceptorij programme. But before have not participated in family drawing such a conclusion it be desirable to subject the data to further analy$es.

TABLE 7.9: Participatory

of the Respondents
Percentage alfrming the questions Acceptorc

s
No.

Panicipanry Questions

there is shortase of commoditief (keroseng fertilizers, etc.,) in your would you make efforts to these commodities availa 2. If there is shortage of water in your village, make efforts to ryake

l.

If

it

'Family Planning Through Panchayats* I:

t.
3.

t73

(t)
3" If the neighbouring village
village?

(it)
66

has a school which yourvillage does not havq would you rnake efforts to get one opened in your

91

4 If a family planning camp is being held 79

in a neighbouring village, would you go
there?

50

5.

Would you also make effort to get one camp held in your village?

such 70

66

6. 7. 8.

If a iilm is being shown in the neighbouring villagq would you go there to see the
film?

6 37 37 58 6

4l
50

If a film being shown in your neighbouring village is on family planning would you
go there?

Would you make efforts to get the film screened in your village? 9. lfthe village does not have a health centre/ dispensary would you make efforts to get one opened in your village? 10. If the government decides to open a health centre/sub-centre/dispensary with the help of the people, in the village would you
help?

4l
58

83

11.

12. Would you be willing to pay for health

Would you like to join in organising services in your village?

services? If a family planning centre is being

health 79

58 75
33

45 45 54 33

13.

opened

in the
there?

neighouring village, would you go

50

14. Would you also make efforts to get one

15.

family planning centre/sub-centre opened in your village? lf a nationaVlccal leader is delivering a

66

174

People's

.in Family Planning

td

d you'attend in your.vi[age, thaf If sucha political meeting is being held in the neighbouring villagg would you
speech

16

33

18. 19.

attend thafl Would you like to candidate in election? Did you campaign for any in the last election? Did you voto in the last

for a

partl 12
12

'41
JJ
100

/candidate
for (a)

chayat,
Sabha?

(b)

State Assem

(c)

Pan- 9l
Lok
22

20. If the local

.in it?

l,eaders organise

onstration
of:cgrparticipate

g)

on nslng pnces or nontain commodetis. would

Ifthe VLWVHWisnotvisi would you make comp
cerned offrcials?

yourvillagq
to. the con-

25

4l
58

22. If you are requested to

vices to the take the health services to the

your

ser-

25

agency to

would

you volunteor yourselP Ifthe school teacher in your

you to persuade If
the

people

requests send their people for would you

37

9l

chi.ldren to schoo[ would

24.

WIWHW requests persuading and mi

accepting Ibmily help him? If 'Keertan' or'Ramlila' is villagg would you attend
Average

help him? u to help in 50

25.

inyour 91
5I

83

59

On a closer sct'itiny we find non- acceptors have better score ,(9) both have equpl scores Ano
ponse patterir is that in spite of score than acceptors on fifteen exceeded non-acceptors only on have a slender lead of eight over

on fifteen items out of ?5 the acceptors and on one item importaht feature of the resnon-acceptors having bettel and the acceptors having iterng the pon acceptors
items. This means whenwer

Family Planning Through Panchayats- I:

175

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 a lead overthe i58,06;. ltr fo,r. out ofseven items the acceptors have substantial, while non-acceptors, and in three questions the lead is 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 of the respondents sho*s an all-male sample for the non-acceptors'

per cent .while among the Scceptors 54 per cent were male and 46 perferred to give an were femalei. Most of our female respondents 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-nses 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
Kind of help

7.10: Help

ibralealth Seh'ices

Accepton Percmtage

Non'

Percentage

acceptors

Monetary3l2.5325 9 Both Nond93'1.5211

Total
24

37

'5

5
12

4r
100

100

176

People's

in Family Planning

achieving family planning ste: 'eliergised sleepy Panchayat raj major boostto people's parti ference in -the status of wo
programme. All the respondents wanted health and family planning were not averse to providing help to_ the government in ma Only 37.5 per cent acceptors
r

targets, and had also

ions, it had yet to give a atritude. It had made no difwho are so cricial to the government to pay for and the But most of the respondents cal monetary or both kinds of

ing these services.

17

that they did not want to

health services.

per cenr non-acceptors said

any kind of help for the

tMotivation

The acCeprors had a clear

motivation. The rrotivational 'for the non-acceptors it was 37 (
respondents

over the non- acceptors in

for the acceptors was 69 while Table 7.ll). A majority of the (83. per cent acceptors and 75

ir

both the

per cent non- acceptors) were

But on their own, 87 percent a

to adopt family planning

consulted the local medical

officer for family planning and acceptors did so. But on some accept family planning. Their from the questions. They might firr terminal method" but one finds cent should.use dther facilities centre. We can explain it only motivation. 'Thug while participation did Family planning motivation did cultural reasons. Before analysing let us look at the number of male dents were male only 47 per acceptors were male. This seems non-acceptance. It will be further responses of the don- acceptop

25 per cent of the non. or the other, they did not is further ccinfirmed having reasons against going difficult to see why only 8 per by the family planning terms of apathy and lack of play any significant role in There must also be socio.of the non-acceptors, female children the respon'

of the children of the nonbe an improtant reason for

when we look at the

Participation, Motivation and Fimily Planning

The question of individuat tor in this case study as well.
emerge as a Oominant fac-' ference for sons as against

tfamlly Planning Through Panchayats- I:

177

TABLE 7.ll: Motivation of Respondents

Questia ns on Motivation

Percentage of respndents ffirming the

questions

Acceptors Non-

acceptors
JJ

l. 2, 3.

Have you ever been to a family plan-

6
54
87

4. 5. 6.

ning centre? Have you ever used the facilities provided by the family planning centre? . . Did you ever consult the medical officer in the dispensary/health centre/ sub.centre/family planning centre/ sub'centre and seek advice on family planning? Did you eyer take your friendVrelatives to the family planning centre and persuade them to accept family planlring methodf Did you ever take you spouse td the family planning centre? Has anyone ever advised you to Cbopt family planning?
Average:

25

79

50

45
83

JJ

75

69

37

daugllters comes out as one factoi. Our anaiysis shows that percentage of sons for the acceptors wab larger than the non-r
acceptors. 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 respondents considered two to three children as ideal numbr provided at least onq arid preferably two were sors. The rest livb coosidered four to be ideal number, For a majority of them expectation of lanother son was the major reason for not adopting farnily plan-

People's

in Family Planning

ning At least five of them c remarked that two sons were essential for qtability of a The responses of non-accepto respondents cleariy brings out ical factors in family planthe imoortance of the socioning This also showr that the eme of providing incentives to Panchavats in order to be sustaiir and strensthened further will

TA,BLE7.l2:
S.No.No. of children Desirable No. of children according to respondent 3

of Non-acceptors
Remarlcs

1.

2F

with a son

for
ting for n
58

One son is

2. 3. 4.

IM 2F
3M 2F

must
3*4 children

Two sons are

musl

2 sons and 2 daughters

2-3 children

1M2F

old e pregdant
ts one son

Two sons are

musL

5. lM lF
6.

2 sons and oneW

daughter

Two sons give stability to the family.

2N42F

2-3 children

ting for

by
7. 8.

2Nl

2-3 children 2-3 children

d wife ine for a

specific

IM 2F

9.
10. 11.

IM 2F 4 children
2M2F 4 children 2M2F 4 children
.

w w
so so

for

Two sons afe

necessary.

ting for a
specific

:
Two sons are
musL

tz.

lM

2F

4 children

w
a

ting for n

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. This

could be one reason why participation in the programme is still low.

Sample Survey

in Dhar District

Pradesh. on the-western fringe of the State, it has a large tribal popLocated

Dhar is a relatively backward district of Madhya

is
a

ulatio4 living in abject proverty. Terrain

agriculturally it cannot be in

difficult and rocky, so

very happy position. It also seems to

have been robbed of most of its forest wealth. It was suggested to us for study by the Health. Department of the
State. We selected two good performance and one poor perfor' mance village from a list given to us by the oflicials of the Health Department of Madhya Pradesh. Due to paucity of time we had to limit our survey only to three villages. Thus, we selected Umarban and Bakaner as representatives ofgood performance villages and

Mandwa as represersative of relatively poor performance village. As usual, eight acceptors and four non-acceptors were randomll selected dt the second stage of sampling from the two good performance villages and four acceptors and two non-acceptors were selected from Mandwa. Sample Villages Umarban and Bakaner were award-winning villages under the n-ew scheme of the Madhya Pradesh govmmenl Umarban was the largest village in the sample with a popula' tion of4,518 and Mandawawas the smallestwith 2000. A1l of them

had overwhelming Hindu population. Bakaner had a large

Muslim population as well. Scheduled Caste and Scheduled Tribe formed substantial part of the population in each village. Malefemale ratio was tilted in favour of males. Umarban and Bakaner had 4l' per cent of the eligible couples effectively protected while lvlaqdwa had oply 3l- Del aeqf couples piotected. Umarban ano Bakaner were award-wirlning villagbs, so they had active Panchayats elected in 1978. The Notified Area Committee of Mandwa was under suspehsion. Janpads at taluka level and.ZiJla Parishads at the district level were also active.

A Mahila Mandal run by the

government functioned in

People s

in Family Planning Child Welf are Organisatiorls ent was also running an three villages. But the local about the success of any

Bakaner. All the sample villages run by Panchayaits. The Mp

adult education programme in all residents did not Seem very enth

of these.

Each of the sample villages had facility of a government dis. pensary. Umarban had a miniC, while both Bakaner and Mandwa had a PHC. The pHC at' was the biggest of all. It was said to be catering to the heal needs ofabout 80,000 people. Para-medical staff posted under PHCs" served the population living deep in the rural areas.

These PHCs distributed through their staff Regular reported.in these areas through 'large meetings, display of posters. films. Sterilizalion camps were i
reported good follow-up service.

either directly or for family planning was group ineetings as well as shows and screening of. regularly held and people
of Sample Villages
Villages

TABLE 7.13: Demographic

Demographic

Prof;b
Bakaner Mandwa
2,000
1,800

Populition
Hinduq Muslims
Scheduled Caste Scheduled Tribe

4,5

5'r188

?5

3,028 I,160
560
1,458

2W
200
1,000

Male
Female

22M L9A
761

l,&0
9@
350
110

Eligible Couples
Couples effectively protected

3t2
(4rvo)

(31v")

Sample Respondonts
We managed to get a sample economic status. There were probl rural population subsisting on getting the nearest approximation.

the broad spectlum of in assessing the income of ture. But we succeeded in

Family Planning Thrcugh panchaybts_I:

lEt

TABLE 7.14: Economic Status of Respondents

Income range
(P-',)

Acceptors

Non-Acceptors

No.
l00l-2000
2001-3000
3001-,1000

Percentage

No.
I

Percentage

4001-5000

500r-@00
7001-8000

210 525s 945 3152 l5

20
100

50

l0
20
10

I
1

10000+

l0
100

Total

l0

Table7.14 shows,35 percent ofacceptors and halfol the nonacceptors were from the low-income group. Nearly two-thirds acceptors and 30 per cent non-acceptors belonged to the middleincome group; and 20 per cent non-acceptors were from high-

income brackel
years (see Table 7.15). One.lburth

Agewise our respondents were distributed between 20 and 45 ofthe acceptors and 40 per cent

TABI .E
yean

7.15 Age-group Distribution of

:Acceptors

Respondents
Non-acceplors

Age-groups

No.
20-24 25-29 30-34
35-39

Fercentage

No.

Percentage

N-44 45+

l5 420 735 630 l5 l5

20
100

I' 330 330 220 110

l0

l0

Tota\

100

182

People's

in Family Planning
20-29 years

of the non-acceptors belonged acceptors and half of the Ten per cent ofboth categories of bracket of ,1045 veats. Thoush it generalization, it seemed that terminal method of family p of age which would meant least later whether-this is bo.rne out I We also managed to get a educational level Onefifths of th ,acceptors were illiterate. Two acceptors were distributed education. One-fourth acceptors rwere high school graduates
pategories of respondents belo
7 16)

of

age. Two-thirds

were in 30-39 age group. belonged to the agehazardous to make sweeping in this area did not accept till thev were around 30 vears

ur-child family. We shall

fu-rther analysiq.

see

-sentative sample in terms of

acceptors and 30 per cent no;racceptors and halfofthe non-

primary and middle school d l0 per cent non-acceptors' only l0 per cent of both to college graduates (see Table
iLevel of Respondent!

TABLE 7.16: Educa

Non-Accepton

Na Illiterate Primary Middle Matric/Hr.

Graduate
4
5
J

No.
20
25
15

Percentage 30 30 20
10

Sec.

25

&

above

2 20

l0
100

I l0

l0
100

TABLE 7.17: Sex-wise

Acceptors

on of Respondents

NonAcceptors 70 30
100 8

Percentage

Male
Female

l4
l
20

80 20 100

Total

l0

Fantily Planning Through Panchayats- I:

183

We did not succeed in maintaining equal ratio ol male and femal respondents in our sample (Table 7.17). Among acceptors, 70 per cent wgre male and 30 per cent female, while 80 per cent non-acceptors were male and 20 per cent female.

Participatory Attitude
Looking at the responses to the drll'erent participatoryquestions. it is clear that the respondents were not very keen to participate in all the activities. The acceptors' responses varied between 23 and 100 while the variation in the rcsporises ofthe non-acceptors was I I to 100. This clearly indicated that participatory attinrde was preseht in both the categories of respondents. Greater variation. among the non-acceptors was perhaps an indication of slightly weaker spirit among them. The average score-60 lor the acceptors and 5l for the non-acceptors- also indicated this. But speaking on'tbe basis of averages, we can say that the difference was not too wide (see Tdble 7.18). Let us look at the questions relating to family planning. Ot the seven 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 a
clear edge for the acceptors. On three the difference was quite substantiaL The non-acceptors equalled the acceptors in one (13) and had slight edge over them on one (8). On the ',vholq we can say that the acceptors' participatory attitude towards family planning was

stronger in Dhar than the non-acceptors. Participation seemed to have played a role in acceptance in Dhar districl A majority ofthe respondents (80 per cent) felt that the government should run as well as pay for the health and family planning services. But people did not seem to be unaware of their own responsibilities. We asked whether they would want to render any kind ofhelp in creating or running these services. Only l0 per cent each ol'acceptors and non- acceptors said that they would not want to render any kind ofhelp. ln facl65 percent acceptors and40 pe.r cetrt non-acceptors were prepared to give both physical and mon-

etary hclp.

Motivation
Motivation also seemeu ro be affecting famrly planning acceptance in Dhar districL The acceptors generally demonstrated

I tJ4

it:rpotion in Fdmilv Planning

hisher motivalion than thc Ironthe last question. As againrt 77 pct'

tors. One clear cxarlDle is 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 r cent nou-acceptors did not adopt family plauning whilc 7lr adopt family planning ever) thou h the.,' wcre advised. The differeuce in the avetage sco r,: of th twcr. 72 and 42, is aiso quite substantial. ude of the ResPondents TABLE 7.18: FarticiPatory
PL,rcentage

of

respon'

rlent,s afftrming the

s
lJo.

PaniciPatorl' Questio

questions

Acc?ptors Non'
Acceptors

t.

I.

tial

cotrt-

fertilizers

ou make
modities

available in Your village? 2. If there is shortage of

make

85

your village, would you mak{ efiorts to

it available?
56

3. lf

the neighbouring village h which your village docs not hfve' would

you make efforts lo g3t one your village? If a family plannirrg camp is being held in a neighbouring village. fctuld you
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?

66

6t

JJ

7.

lf

the film is being sholn

I

in

Your

42

JJ

Family Planning Through Panchayats1.

r85

3.
38 61 90 80 42 33

4.

neighbouring village is on tamily planning would you go there? 8. Would you make efforts to get the fihn screened in your village? 9. If.your village does not have a health centre/dispensary/sub-centre, would you make efforts to get one opened in your village? 10. If the government decides to open a
centrelsub-centre/dispensary with the help of people in the village,

4
55

health

66

\','ould you like to join in organising health services to ycur village? 12. Would you be willing to pay for health

ll.

*ould you

help?

7j
55 33

i3. If a family planning centre is being opened in the neighbouring village.

i4.
would you go there? Would you also make efforts to get
centre/sub-centre opened in your village? 15. Ifa nationaVlocal leader is delivering a speech in your village, would you attend
that?

services?

family planning

one 52 42 33 23 23 90 3g

u
55

16. If such a political meering is being held in the neighbouring villagg would you attend that? 17. Would you like to campaign for a party/ candidate in the election? 18. Did you campaign for any part/candi date in the last election? 19. Did you vote in the last elbction for (a) Panchayat (b) State Assembly and (c) Lok Sabha?

33

II

ll
100

20. Ifthe local leaders organise demonstration on rising prices or non-availability of certain commodities, would you participate in it?

33

186

People's

rticipauon in !'amily Planning

3. 4.

2t. If the VLW/VT{W is not village, would you make co

22.

your

laint tc
90

the concerned offrcials? If you are requested to vol teer your services to the governmen untary asencv to take the health to the people, would you volunteer

2J,

If

the school teacher in

village
you

requests you to persuade

le to send

their children to school,

help him?

24. If the VLWVHW requests in persuading and motil a ior accepting family p you help him? 25. If 'Keertan' or'Ramlila' is your village, would you a
Average

u to help
people

9(t

would
66

TABLE
fype of help

Help

Health Services
Non-Acceptors

No.

lage
20
5

No.

Percentage 30 20
10 100

Physical

Monetary Both None

I l3
z
20

65

4
2

l0
100

l0

a role in Dhar district in

Both partrcipation and motlv

a

rL thus, seemed to have played

motivation plaYed much stro rally participatory attitude was between the two was not loo

tance of family planning. But role lhan participation. Gene' very high but the difference This was quite wide in motiva-

Family P.lanninz Through Panchavats - I: 187 tion. Motivation is governed by individual priority and we will have to look into individual priorities of the non-acceptors.

TABLE 7.20: Motivation of Sample Respondents

Percentage

s
Na.

of Respondents ffirming the questions

Questicns on tr'Iotivation

Acceptors NonAcceptors

l.

Have you ever been to a family

plan-

66
85

55

3.

ning centre? Have you ever used ihe facilities provided by the family planning centre? Did you ever consult the medical officer in the dispensary/health centre/sub-

JJ

90

centre/family planniag centre/subcentre and seek advice on family

planning?

Did you ever take your friends/relatives to the family planning centre and persuade them to accept lamily planning
method?

85

33

Did you ever take your spousc to the

family planning centre? Ilave any one ever advised you to adopt family planning measures?
Average

42

ll
77

6l
72

42

Participating. Motivation and 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 still much to be desired on participation fronl General participatory
picture raises optimisnr, but in order to be sustained it will require

r88

in Family Planning
before participating
1s

greater push. That people grade also clear from the data. Hence.

order to be accepte4 family

planning must relurre higher But if the preference for the so is too stron& can family planning require higher grading? An of number of sons and daughters of the acceptors and n acceptors shows that 54 per cent ofthe acceotors' children male while only47 per cent of the non-acceptors' children male. Not surprisingiy, these people did not accept family Let us look at the nonacceptors' respoqses carefully.
T.ABLE 7.21: Yiews or Non-Acceptors

S.
No.

No.

of

Desimble
No. of chil-

Chiidren

.fo,

Remarks

drcn accord' ing to

Respondents

1. 2.
.3.
4.

3M lF

2 or

Wife
Ltion

of
of
Ltion

At least qne son

1.t least 2 sons

2M2F
2M IF
ciaugh

Wants one more

J J

lM 2F
6M 3F

Wants one more Two sons are must

son
ste

5.

6. 3F 7. lM lF 8. 3M lF
9.
10.

for tion

zJ

Wants a son Wants a soll get Wife

soon

A son is must
Two sons are must

3M lF 2M2F

I or2

do-Does need

feel the At least 2 sons

There was only one family wi two children (No. 7) and they too wanted one more chil( p brably a son. There were three of them were waitirrs for one families with thtee children and more child-one for a daughrer and two for sons. Five families

Family Planning Through

Panchayats-I

189

had four children and practically all of thcm were prepared for sterilization. T'here was one family with nine childrbn (No. 5) where the husband was prepared for sterilization. A majority of the non-acceptors felt that two sons wele essential for a family. This will inevitably lead to four-child family, which is clearly reflected in the data. This shows that it is essential to tackle people at the level ol beiiefs. IVlere monetary incentives to panchayats and individuals were not going to serve the purpose. The pressure ofthe panchayat office-bearers was also not sufficient In fact, having been brought up in similar social milieu they were likely to share much of these beliefs and hence they would also have limitations in motivating people. This was cupported by our survey in Maharashtra where the Sarpanch of a village .told us squarely that he r.vould not motivate people unless they had tur'c' sons. The belief-pattern was not much differert in MP eithcr. Overview
Though it was not possib.le to judge the effectiveness of the rrrral development linked family planning being experimented in I\4adhya Pradesh in a short span of two years (we dtudied the scheme in Nlarch 1981, while it was launched in April l9Z9), it showed the promise of being a novel exoeriment worth replicating in other areas. It had enormous possibilities for population control as also of rural developtnent The scheme, however, had its

apparent limitations, which needed a thorough study and understanding if it had to be sustained and made more effective. Firstly, while it was laudable to bring panchayats into the family planning as well as developmental networ( the scheme corrtpletely ignored other voluntary associations which could have supported the efforts ofpanchayats. F-or exarnple, most ofthe villages studied by us had milk cooperatives. Some of them also had Yuvak Mandals or government sponsoredM4 hila MandaLs. But none of these were formally incorporated into the overall schene either family plannin! or of rural developmenL One wonders horv the MP government plans to ehlarge or even sustain participation without galvanising such voluntary bodies. Secondly, the role of panchayats itself was weak Two important sources from which motivaticn for participation flow; is immediate benefit accruing from an activity and e share irr

190

'pation ,n Family Planning

decision-making The system of a has taken care of the formcr but since panchayats have beeir includeci in the delivery ne iworh their task remains ly fulfilling the sterilization targets assigned to them by the S government While it is likely to dampen enthusiasm in the long rup, it is also going to neglect other Iamily planning methods. family planning programme thuq is likely to be reduced to euphemism for sterilization
programme.

Thirdly, a programme like heal not likely to be very efl'ective wi munication network U area. A large part of the State throughout the year. Many the rainy season and are accessib An4 shortage of vehicles adds difficulties. The health and farnily p tructulally weak Aside from being plaints of shortagcs of supplies. in short supply. Finally, there was an inherent targets for villages. Some smaller did not have requisite number of werq thereforq unable to ccmpe likely that in long run more and ing about this because as the have as many couples for protecti I{owever, inspite of these regarded as a good beginning of a the long run it is successful or not adaptibility of the lorver level med innovations and changes in the makers in rhe state.

care and family planning is

t good transport and com-

is not yet easily accessible

are completely cut off during only by jeep in other seasons

, this remains a neglected

to the health

department's

deparlment was also infras-

'ed there were comwere particularlv

in the system of fixing complained that they uplcs to be protected. They for the prize. Moteover. it is
panchayats stan cornplainbecome higher they

nay riot

the scheme should be ovel experimenr Whether in would depcnd largely on t.re bureaucracy' as well as thc heme brought by the poiicy

Chapter

VIII

Farnily Planning Through Panchayats-Il: Gujarat

IN 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 of a more effective panchayat system. Secondly, the panchayat system in Gujarat has bberr an integral part of the denelopmental network 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 the people's representatives and the developmental bureancracy ia close association. And, finally, the invohement of panchayat system in family planning effort as well as the irrcentive prize scheme starteci in l97l in Gujara! that is about nine years before, in Madhya 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-operatives than any other state in India ' ris would meart that community feeting was likely to be deepcr and, consequently, the level ofparticipation higherjn Gujarat than most other parts of the counlry' A study of people's participation in family planning in Gujaral therefore, assutned significance ir the context of this work
Demographic Profil
d

The demographic profile of Gujarat presents a picture of light and 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
the

People's

in Family Planning

Gujarat's populatior;fol exam le. was 33,960,905 according to 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 the two decades. Thus, while its ial growth rate was still higher than the national averagg which at24.75. the rate of reduction,was much sharper in case of 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 to jaral from 37.0 to 35.8 against 1978. It was 1.2 per thousand in 1.9 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 much sharper for rural areas than for The hieher birth rate for growth rate of population. Gujarat explains its higher Table 8.1 gives tha estimated ann live birth rates in Guiarat and

India durine

1975.78.

TABLE 8.I: Estimatecl Gujarat

ual Live Birth rates in India

t97

lv/)
Sector

1978

Gujaw India Gujarat

38.9
31.8

Gujarat India Gujarat India

.4
3 .8

Combined 37.0

Rurrl
Urban

3s.2 37.4 36.7 39.0 28.5 32.7

36.1 33.0 35.8 37.8 34.3 37.4 31.2 27.8 3l.l

(Vol.

33.3 34.7
27 .8

Sample Registration Bull

,. Similar trend was reflected in the same period. The estimated

XIV No. l Junq

1980)

from 15.4 in 1975 tc 12.7 in 1978. dcclinid more sharply than the bi

data also indidates lower death ra well as in aggregate (rural and had received a parity with the allthen" that Grriarat's decadal rate ofpopulation was higher than the national average (see Ta le 8.2). The Table 8.3 clearlv indicates tt intant :noitality of both the the All-lndia average and sexe s in jujarat was r.ruch higher

death rates in Gujarat during th rate in Guiarat came down The death rate, however, has rate. Furthermore. the SRS for Guiarat in rural areas as r) teims than for.India. And it rdia raie by 1978. No wonder,

Family Planning Through Panchayats- II:

193

of male.phildren High" infant

that rnf ant mortaliiy bf femate chlldren was much hrgDer th an that mortalit_v thus, seems to be an

impeding factor for population control in Guiarat

TABLE 8.2: Estimated Annual Death Rates in Gujarat and India

r975
1976

1977

1978

Sector

Gujarat India Gujarat India Gujarat India Guiarat India

15.4 16.6

Rural Urban

Combined

15.9 ls.3 17.3 16.0

i2.2

t0.2 11.0

15.0 16.3 9.5

14.8 t4.7 15.8 16.0

XJV, No'

t2.7
l3.B
9.4
1,

t42
15.3

11.8 9.4

9.4
1980)

Source : Sample Registration,

BulletiriVol

June

TABLE 8.3: Infant Mortality during 1973 in Gujarat

Gujarat

Male
t71
105
| 55

Female
184

Combined
177 113 161

Rural

Urban -{ll-areas Indin Rural Urban All-areas

t20
168

l4l
88

t4
90
135

:43
89

132

lJ+

Health Cbre and FamilY Plannirrg

The basic unit of health care and lamily planning delive-ry netr*ork in Gujarat, like most other States inlndia, is primary fiealth centrg assisted by sub cent:es. These PHCs and their sub'centres afe supposed to reach deep into nrral areas with the help of their para-medical staff. Tbe Medical Ofhcers remain stationed at the PHCs and pay periodic, visits to the sub-ccntres. But we were told that health and farnily planning services w:re handicapped by the shortage of nren and material. The PHCs and' subcentrei were making do with much below their sanctioned

i94

People's

in Family Planning

Gujarat had ZSt ruralfamily welfare centres attached to each of them with I rural sub-dbntres. Against sanctioned posts of 251 Medical Officers. Block. Extension Oflicers and LHV there were only each working and against sanctioned 1251 ANMs, there were 1155. Similarly, against the sanctioned posts of 7l Medical Oflicers in 70 urban family
welfare centreg only 28 appointmen had been made. Apparently, many PHCs and family welfare tres were without a Medical money bn rural health serviceg the shortage ofservices has a perpetual problem Shortage of staff and transpon vehicles er adds to the problern. The existing health services in a p ary health centre or a subcentre are utilised only by people in the adjacent villages. As l result though va$t resources are in the rural areas. their cffectiveness in cootainnent of dir disability 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 compared to all-India. These dbficienci indicate the weakness of the health care facilities rn the State. in the health and not maintained oroperly. The visits of the health carc family planning personnel ro the villages are not also very The importance of both preventive and curative aspects of h th facilities do not seem to be properly organised. Mere tion of camps and idvice of panchayat olficials for sterilizati may fullil the prescribed targets given by the Governrrenl b it can not make the family plannrng .a oeople's programme
The family record cards arg no centres, but they are far frum com

strength. According ro the Health PHCs in 250 Blocks with co

Officers and other supporting staff. In spite of investing large amount

t maintained

and given proper supplemcnt

Whether ante-natal cases .are p

a

delivery cases are attended by a ti natal care was adequately given available in the PHCs/Sub-centres. cqntraceptiYe methods are brought .villagers. Organisation of special vices of school teachers and panc
widely publicised Even the names brorrght from Ahmedabad,

y identified, examined imnfunisation. whether ed Dai and whether postnot clear from the records is not also knom if all the ith:n the easy reach of the ps lor operations and seryat officials are. however,
Surat and Bombav for

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 vaccinations are, however, reported to be an important function of child welfare programme' Health and weight records of children are incompldte in many cases. Mal-nutrition of children and mothers and impoverishments of rural masses are widely prevalent 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

ANMs

of 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 in children s health. Gradually, it becomes evident that malnutrition is widely prevalent and because of impoverishment and ignorance of rural masses infant mottality is high. Elementary nutritional education imparted by demonstration to mothers in other states go by default in Gujarat Many deseases prevalent in rural areas of Gujarat 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.Govrnment and Family Planning

Family planning performance in Gujarat picked up since 1'97i when the health and family planning administration was decentralised and incentive prize scheme was initiated. Under this arrangement the PHC staff has been placed under the Zilla Panchayal which consequently became the main administrative unil The State Govemment since then has been performing only supervisory 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 with the decentralisation provided further fillip to the programme. But after this scheme was terminbted in 1976' the famity planning performance 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 light of the set:back that the family planning programme received in

196

People\ Pa

in Family planning

gramme from the post-1977 set bac

the aftermath of the emergenry. Before reintroducing the incenti prize scheme the Government of Gujarat had tb set up fouro jectives to rejuvenate the proThese were
:

inion by reassuming commitment to family welfare e; including familyr planning i0 r'e-vitalising tle family welfare e inciuding family planning; ii0 removal of fear complex from e minds of the Governmbnt oflicials and assuring full supl and rv) enlisting the co-operation of th Government Departments, District Panchayats, Taluka anchayats and Gram Panchayats and- all voluntary local bodies as well as public leaders, ln lact resumption of the incenri prize scheme was onlv one
step to realize the aforementioned o ectives. The prizes. however, were very elaborately planned to m ivate rural and urban local bodies. bureaucratsi. doctors. mo rs as well as potential accep-

i)

creation of favourable public

tors from various sections of soci

pnzes wefe
:

Some

of the

incentive

i)

ii)
iir)

a landless labourer who ed a terminal method of family planning received a award of Rs. 300 for a housing plot; an asricultural labourer or a s former with two hectafes of land accepting terminal m od.was entitled to receive a. hundi of Rs. 50 for ourchase f khadi cloth; a motivator would get Rs. I and Rs. l0 as motivational
charges for a vasectomy and

bectomy case respectively;

ro If all the eligible couples in

factory with more than 500

v)

vi)

workers were covered under methods. the factorv' would get a cash award of 15,000 which could be used for labour welfare activities. imilarly. if 75 per cent of the couples were covered under inal methods then the factory would be entitled to Rs. 10,000; a surseon received Rs. 7 and l5 percase as incentives for vasectomy and tubectomy ively; a cash awarfl was given to staff of the PHC and urban centres which achieved 10 or sterilisations per 1000 population depending upon the tegory of the districq

Family Planning Through Panchayats-

II

197

vii) viii)

extra development grant was given to District Panchayaq Taluka Panchayal Nagar Palika and Gram Panchayat which achieved the targets and secured the best performance; and

additional incentives of Rs. 20 to sterilisation cases were given if the local body agreed to pay Rs. 10 to each Sterilization
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 oisierilization on pelcentage basis. The districts and l\{unicipal Corporations were divided into the following categories for awarding prize :

AB C

E -

Sural Bulsar Baroda, Bharuch aud Kheda. Ahmedabad, Bhavnagar, Surendra Nagar, Amroii, Rajkol IVlehsena and Junagadh. Banaskanth4 Jarnnagar. Panch Mahal and Kutch.
Dang and Gandhi Nagar. Municipal Corporations.

A first prize of Rs. 1.25 lakha was given to each of the Disrrict Panchayats of all the three categories (into which they were divided), Rs. i.00 lakh to the best of the four M.unicipal Corporations and Rs. 25,000 to the category D of District Panchayats standing firsl
First prizes of Rs.30,000 and Rs.25,0UJ were paid to each of the Taluka panchayat of categories A and B and of C and D respectively. The categorisation of Panchayats was done on ihe basis

of population. The District Panchayais presented stainless steel utensils and such other gifts to acceptors of rerrninal methods of family flan-

ning in addition to incentives given to acceptors of:

(i)
(i1)

Vasectomy- Rs. 25 (State Government) * Rs. 70 (Government of India) * Rs. l0 (Village Panchayat): Rs. 125; 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 to category I, II and III municipalities respectively for sterilisation operations. Simitrarly, category I, If and III gram panchayats wcie given Rs. 15,000, Rs. 10,000 and Rs. 5,000 respectively as fiot
prizes.

Foi post partum cases Prografnme Director. Senior Medical Officer and Medical Officer-in-c$arge was given Rs 150 each. Other elaborate systbm of distdbutibn of prizes on the basis of performance of terminal method$ of family planning was :

i)
iD

4 Presiderrts of District Pa{chayats got a Tamrapatra anc

Rs. 200 each;

iir)
iv)
v)

vi)

vii)

Four Deputy Developmenf O{ficers got Rs 200 each; Four Collectors got Rs. 200 each; Five Medical Officers and five additional medical offrcers got Rs. 60 each; of municipalities and got Rs. 50 each; Four district mhss media One Mayor of a Municipai Corporation receivtd a Tamra. ion Ta patra and Rs. 200; One Mayor of a Municipal Corporation received a Tamrapatra and Rs. 200; 18 Pramukha of Taluk Fanchayats received Rs. 175
each;

ix) x)

xi)

Taluk Adhikaries receiVed Rs. 175 each; 19 District Mamlatdars (Cfass II Oflicers) and Adminisffative Officers (Class D received Rs. 200 each; Sresth (Best) Medical Offi$er received a Tamrapatra and Rs. 175 for doing maximufr number of vasectomy cases;
18

and

xii)

19 Block Extension Officef's received Rs. 50 each.

The scheme of the Gujarat elaborate than that of Madhva

enL thus. is much more desh. Apart from involving

local bodies. both rural and it seeks to involve a whole providing them incentives. A ranee of individuals and ofhcials careful look at the awards would reveal that it seeks to enthuse institutions, individuals and by providing them approp riate kind ofincentive. Local are alwavs starved of funds. so there are developrnental funds for Impoverished sections of society have different kinds of thereforq there arc cash incentives, clothps or cash for land for them. Officials

Family Planning Through Panchayatsrequire an award to give them

a sense

II:

199

of achievemenu so there are

Tamrapatras and small cash awards for thern A very carefully worked out sch.eme indeed! It has created a sense of competition among officialg local ' bodies office bearers and urban and rural local bodies. Prizes are awarded on the basis of sterilization targets achieved by these bo{ies and officials. The level of enthusiasm has reached a stage where local bodies add from their own resources to the incentives (both cash and kind) sanctioned to them for the acceptors by the state govemment The enthusiasm particularly reached its peak during the sterilization camps, Sterilization carips which previously used'to be organised only for vasectomy are organised for women since Laparoscopic tubal ligation has become common. But the role of panchayatg particularly Gram Panchayats, is purely motivational It cannot strictly be said for the Zilla and Taluka Panchayats becausg as mentioned earlier, the PHCs in Gujarat have been placed under the administrative control ofthe Zilla Panchayats. It is little difficult to say what part the bureaucrats play and what part the elected representatives play in the
scheme. It wag howeveq pointed out to us that the programme has

'

started looking up since this arrangement.has been introduced The Gram Panchayatg however, have a very limited role, Their role is strictly motivational But they have developed stake even in this limited task because cash incentives and the prestige ofbeing a winner are involved They, thereforg actively assist the health

and family planning staff in'motivating young eligible couples Their help, we were told, was particularly beneficial in motivating reluctant sections of rural society. The pdnchayats were, howevei given no place in the delivery and distribution network . Care rs also taken to include school teachers ano prominent people of the area in this endeavour. In some places institutions like Lions Club and Rotary Clubs were also involved The prothe first quarter of l98l in Tatile 8. 9. Prevalance of tubectomy comes outclearly from the quarterly relort of Guiarat presented in Table 8. 9. Not only the trend but also the arguments were srmilar to most other areasof the countrv. Complaintsof weakness after sterilization were commoc Interes.
gress achieved with the scheme can be seen.from the progreJs

of

tingly, the woglen also expressed these views. Because tubectomv has become relatively easy and convenrenr since the introduction of laparoscopic tubal ligation, whatever little hesitation existed

People's

in Family Planning the 4th Quarter

1981

TABLE &4: Progress Januarv to Dsticy'

Corporation
Vasco-

noN
1.9.p. Condoms Tubec- Total
tomy
,724

tomy

Ahmedabad Corpn

9t7
215
73 183

2,641

2,001

269,759

Ahmedabad Dist

2,354

Amroli
Banaskantha

r,4ffi
3,027

Vadodera Corpn Vadodera Dist

Bhavnagar

996

1,t46
3,354

5ll
282
1,783

2,636
4,590

Bharuch Bulsar
Dangs

786 ts7

2,305

2,569 495 1,533 313 3,210 393 2,142 513 3,865 489 2,918 693 6,373 267 3,091 148 4,841

224,785 t27,380
r70,223 48,670

r42,390 t56,273:
13s,661

Gandhinagar
Jamnagar Junagadh Kheda

39-.
I,823

29 380
1,879

r,852

161 463

148J48
9,108 44,935

4
169 485

t36,614
168,128 526,617

4A6l
4.857

768

Kutchh
Mehsana

44 1l(1

n8
282 253
509

Panch Mahal Rajkot Sabar Kantha Surat Corpn Surat Dist Surendra Nag4r Gujarat

l t,'755 3,7'10 4423 5,674

l,7l
1 497

6,736 t,3t9
202
689
180

1,286

63

2,933 3,421 1,298 2,J87 1,426

3.2t5

3,674 1,807

3,673 s 1389 393

663 614 26r,621 281- 3r,254 122,766

164,860

88,047 154,032 89,092 249,899

1) 'r71

496 70.71'7 11,389 508,664

Source: Directorate of H Government of Gu

about it has disappeared. Laparo popular in Gujaral

th and Family

Planning

camDs nave become ver

People's Participation Like the family planning prr

the programme in Gljarat also
e

basically

elsewhere in the countrv. a target oriented

Family Planning Through

Panchayats-Il:

201

governmental programme. While the idea ol elaborate lncentive prizes is novel and it has created some enthusiasr4 it is not likely to create a suStaihed participation over time. It is quite evident from the fact that when the incentive Drize scheme was discontinued in 1976, a slump was noriced in the achievemenl Consequently it had to be resumed in 1978. 'It is true that the government has decentralised the administration and madethe district the main administrative uniL This has, as admitted by the government ofhcials, resulted in administrative effciency. But it is not likely to mobilise effective participation as in spite of the elected bodies at the district and taluka levels, the
bureaucrats headed by the District Development Officer(and the Taluka Development Olncer in talukas) have the effective say in

running the administration. Moreover, the fact that the Gram Panchayats have not been entrusted with any responsibility other than motivating people, speaks volumes about the pisconceived conceptions of participation prevailing in the governmental and administrative circles. It has not yet resulted in participation in family planning But this is not to say that people are hostile to family planning or are not prepared to be motivated. Awareness of family planning goals and methods existed. This has softened iesistance of the various sections ofsociety, though larger family needs or religious beliefs still create apathy, Fishermen, for example, were apathetic because large number of children were an asset to the family as they helped in fishing and augmented family income. Apathy was' also noticed among Muslims. The Community Health Vdlunteer(CHV) scheme proposed by the Government of lndia in 1977 was accepted and introduced in Gujarat in 1979 with the hope that it would re$ult in community involvement. lt has also had very limited success. In fac! it was pbinted out to us that most of the CHVs were not serious-about: theirwork Whatever impact it might have had on the health care delivery its impact on family planning specihlly in crearing popular 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 to create a favourable atmosphere for family planning or any other developmental programme. One of the Mahila Mandals visited,by the rdsearch team in Bulsar district was affiliated to the All-lndiat 'Weliare Board. {r arranged Socia'l for vocational training for

202 women. Its involvement in t.amilv

in Family Planning
prografifin, for exam.has not really been involved either culturalclubs or lying

.plg could really be useful. But

Similarly, youth clubs in villages idle. Milk ce.opefatives are many rgramme like family planning is It woul4 thus, be interesting to

their involvement in a proonly in Kheda district

how long a scheme based :s interest. Whether an
.

on incentive prizes would hold

approach based on targets mobilise people's participation remains an important question.

by the government would

consceintize people also

A SAMPLE
Sample villages

\rEY IN BULSAR D TRICT

S

a sample survey was in villages of Balsar district The district of Bulsar was purposively at the instance of' the Department of Health and F Welfarg Governmont of Gujarat It is in South Gujarat ranks high in family planning performance. As trsual, villages ( Rabra in luls61 block having
i685 people and 303 eligible coup

of wh-ich 165 couples (about 55 pr Hondin Chikhli block havine373 reproductive age group of which cent) were protected by family random sampling at the first sta; performance villdges. A random four non-acceptors of family stage of sampling Similarly, two villages (i) Kosa

in the reproductive age.group cent) were protected and (ii) people and 500 couples in the couples (more than 70 per ins methods were selected on as the representative of good le of eighf acceptors and was selected at the second

in Bulsar block having

population of7776 PeoPle and 1147 couples in the reproductive age gioup ofwnom 396 (34 per cent) les were protected and (ii) Afipo.e in Chikhli block having people and 807 couples in the reproductive dge.group of wh: 283 (35 percent) couples were effectively protedted as tives of poor performance villages Four random sample respondents and two nonacceptor respondents were se at the scond stage of selection. The village schedules were up through the assistance of the gram sevah tpacher and oth knowledgeable persons while

Family Planning Thrcugh

Panchayats-Il

203

the respondents schedules were tilled up by interviewing the acceptors and non-acceptors of family planning The Block Extension Officer helped the research team in interpreting the local Gujarati dialeet into Hindustani and English. TABLE 8.5: Demogrqphic Pro{ile of Sample Villages
Villages

Demographic

Prortk

Alipore
1,68s

Kosamba
1 777 7,7'.r'l 100

Total Population Hindus Muslims

Scheduled Castes Scheduled Tribe'

J,/Jl
3,731 68

4838
2,671 2,167 80 2,591 2,618

r,675

l0
1,400 820 865
303

t,728
2,1@
1,622

Male
Female Couples in Reproductive

3,9;
3,839

2220
807

500

1,t47

Age.group
Couples effectively protected

163 (54)

366 (73)

283 (35)

396

(34)

Note: Figures in parantheses indicate percentags.

There were elected bodies like Taluka Panchayats which were active and all the four selected villages had active village pan-. chayats assisting the thmily planning programme. Panchayat elections were held in 1980 in 1980. Congress(I) andJanata Parties became very active during the elections, but none of the parties had any perm:inent office in the selected villages, A Mazdoor Kalyan Kendra in Alipore was doing some social welfare work among the Harijans in the village. Milk cooperatives operated in formally without being registered.under the Cooperative Act The institutions other than Panchayats were not called open for assistance

in family planning work

The villages, Rabra and Alipore had allopathic despensaries treating the sick villagers. Difficult cases were referred to the PHC which was within a distance of 5 kilomefers an{ tothe district hospital which was 16-20 kilometers away. Out of l8 PHCs in Bulsar

2U

People's

in Family Planning

,district, Charidity PHC was Hond. The PHCs had all the were sterilised in FHCs and con
vasectomy operations were People of Alipore village made

4 kilometers of Rabra and

of family planning Women ives were distributed while in family planning camps.. of a PHC at Billimona which

was l/2 kilometor away and Bulsar PHC which was 4 kilo The MPW visited Rabra twice a in the village. The CHVs were and CHV, ANM and MPW deli lfwo ANMS and one MPW rer iAlipore where one CHV resided resided in the big village of services there. The MPW visited village panchayats were very family planning ' Screening of filrps on lamily organised, but no posters w.ere and family planning camps we planning camp was being held in visited the village in September, reported to be thin as housing pl camp. Follow- up services for from the respondents in all the the people. The Panchaydt Department ol coeducational school with 173 schools in Hond. one with 130 There was one primary co-edu students and a co.educational addition Alipore had a with 250 students; Kosamba was a government middle school also. schools numbereil I l4O girls and education. the students made schools in neighbouring villages ticipation in education was
area.
1

of Kosumba made
away.

use

of

onth while two CHVs resided rted to visit Hond twice a week
e family planning services. tamily planning services in MPW and five CHVs who ba rendbred family planning village twice a month. The in assistine motivation for

and mass meetings were ted. Small group meetings held in the villages. A family ioore when the research team 1981. But the attendance was were not distributed during the lical operati6ns were reported villages wtrere availed by

ujarat maintained a primary

in Rabra two primary

and another with 101 girls. al school in Alipore with 150 school in Kosamba . ln middle co-educational school village and had. therefore, a students enrolled in Kosamba 080 girls. Beyond middle stage of .public buses to !o to high d to a collese in Bulsar. Par-

common and active

in

the

le in the area was also high Etectoral participation of the and as many as 55 to 7O per cen per:ple in the selected villages voted in the last panchayat electi< while 50 to 60 oer cent voters

Familv Planning Througlt Panchayats- II:

205

voted in the fast State Aosembly elections and 50-55 per cent voters were reported to have voted for the last Lok Sabha. election.

Sample Respondents
Both the categories ofresporidents in Bulsar diitrict ofGuiaiat
were also selected on random ba$is. We had difficulties similar to other sample dreas in strictly adlering to the norms set by us.

lmprovisation is, thus, clearly visible inbur sample. We have still tried our best to ensure that 'he representative character of the sample is not losl The respondents fell into nine ofthe eleven slabs we created for assessing income. In spite of the difnculties faced in income assessment due to varied nature of the occupations andjobs ofthe
5espondents, we have managed a representative sample. Persons lvith low income dominated the sample; 60 per cent'bf the acceptors and half of the non-acceptors falling in this category. Middle tncome group constituted 28 per cent of the acceptors and 17 per cent of the non-acceptors. Rest in both tn'e.categories belonged to the high income group (See Table 86)' Ale-wrse we got relatively' young sample. The acceptors belohged to 15-39 groun while the non-acceptors were concen-

TABLE 8.6: Econoniic Status of the Respondents

Acceptors

Non-Acceptors

Income (Rs)

Number
00m-1000
1000-2000 3001-4000
,|

Percmtage
31

Number
2
3

Percentage

t7
25

4
J

t7 t2
4

4001-s000
5000-6000 7001-8000 8001-9000 ,9001-10000 10000 +

I
J J

:
2

t7

t2

l2
4 4 4

I
I I t2

i,
100

Total

24

100

2W

People's

in Family Planning
The largest concentratiqq ol
acceptors (50 per cent) was in group from the point of vier+

trated in 2G34 group (seeTablo 8. iboth acceptors (38 per cent) and nr p5-29 group. This is the most crui 'of family. planning , We.could not get people above lllliterarcs formed 416 per cent of the non-acceptors. The largest per cent) was among middle

for our sample and a qudrter oftht of the non-acceptors (4! educated (See Table 8.8)
Respondenfs
Non-Acceptors

TABLE 8.7:Age.group
Acceptors

Agegvup
(Ymrc)
'2U24 25-29
,30-34

Number
2 + 9
5 8

Number
l6
3E

Percentage

l5-19

6
J

22

25 50 25

l5-39

4
24

l6
100

t2

100

of the Respondents
Acceptars

Non-Acceptors

Educational Standard

Nwmber

Number

Percmtage
25

Illiterate Piimary Middle Matric Total

ll
7 J J

6
28
13

3
3

a
8 100

)5

l3
100

I
12

24

While we could maintain the non-acceptors, we could not do

l:l

'

of male and female amone for the acceptors, The accep-

tors were overwhdlininelv females See Table E.9).

Family Planning Thlough Panchayats-

II:

207

TABLE 8.9: Sex-wise Distribution of the Respondents

Sex

Acceptor
2
22
.A

Percmtage
8

Non-Abceptor
6

Percentage 50 50
100,

Male
Female

92
100

Total

t2

Participatory Attitude 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 for ihe 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 of family 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' queswe find that the acceptors have exceeded the scores ofnon-' tions acceptors in 15 out of25 itemg the non'acceptors have exceeded in the 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)

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 participation in family planning Two-thirds ofboth the acceptors and non-acceptors wanted thel

and.24(79,69) - the acceptors have a clear lead over the nonacceptors on all but one question. Thus, considering all aspects we

208

People's

in Family Planning

rlsr.b

8.ro:

of the Respondents in

Percmtage of respondents affirming the questions Panic ip a tor! Ques tio n s Acceptors NonAcceptors

l.

If there is shortage of essen

commodities (kerosene, sugar fertilizers etc) in your village, would you make efforts to these commodities available

2. If there is shortage of water in your villagg would make efforts to make it av 3. If the neighbouring village
a school which your village not hirvg would you make get one opendd in your If a family planning camp is

4
u
,le?

25

25

4.

held in a neighbouring villaX would you go\there? 5. Would you alpo, make efforts get one such camp held in your aEei! If a lilm is being shown in th neighbouring village, would ydu go there to see the lilm? urefe ro tne lrlm? 7. If a film is being shown in thel neighbouring village on famil$ plu"Ing would you go there? ,8. Would you make efforts to set the film screened in your villagi? 9. If your village does not have a health centre/dispensary would you r{rake
efforts^to get one opened in yopr village?

JJ

25

29 29 25

50

25

21

Family Ptanning Through Panchayats- II:

209 Percentage of Respondents Affirming

Participaory Questions

Questions

'

Acceotors 83 38
38

Non'

Acceptors

10. If the govrnment decides to'operi a health centne/sgb-centre/dispensary with help of people in the village, , would you help? ll. Would you like to join in organising hedlth services to your village? 12. Would you be willing to pay for health services? [3. If a family planning centre is being opened in the neighbouring village, would you go' there? [4, Would you also make efforts to get a

58 33

l7 l7 50 25 13 4 100 42

25

13

fainily planning centre/sub-cenrre opened in your village? [5. If a nationaVlocal leader is delivering a speech in your village, would you attend thaP 16. If such political meeting is being held in the neighbouring villages would you anend thail 17, Would you like to compaign for a pafiyl candidate rn ei?ction? 18. Did you compaigrr for any parry/ candidate iu the last election? 19. Did you vote in thi last election for (a) Panchayat, (b) State Assembly (c) lok Sabha? 20. If the local leaders organise deinonstration on rising prices or non-availability of certain commodities, would you participate in i0 21. If the VLW/YHW is not visiting your

75

67

33

33

92

33

50

58

Peopte's

in

lamily Planning
Percentage

ol

Panicipatory Questions

Respondmts

Afinhing
NonAccepton

Question Accepton

villagg woul<l you make the concerned officiat? 22. lf you are requested to your serrices to the voluntary agedcy to take the services to the peoplq would volunteer yoursell? If the school teacher is your requests you to persuade per send their children to school you help him? 24. If rhe VLWVHW requests help him in oorsuadingind people lor abbepilng family, v you help him? 25. If 'Keer'ran'an<l Ram Lila' is organised in your villagg attend that?
Average

63

Ct

54

/)

79

7l

75

42

39

TABLE 8.11: Help

Type of Help

Health Services
Non-Acceptor Percennge

Monetary Physical Both Don't know

l0 625 833

42

4
2

33

t7
33

4
2
100

t7
100

Total

t2

Family Planning Through

Panchaya*-Il:

2ll

gfovernment to pay lbr health services, while one-thirfl were in favour of people paying for it Not many favoured the health ser' vices being run by a private agency or a cooperative. But most of the respondents were prepared to render some kind of help or

other in running health services (see Table 8.11). Only two nonacceptors did not have any clear idea.

Motivaiion
The acceptors in this area were motivationally stronger than the non-acceptors. In spite of thb fact that most of the acceptors in the sample were females, the acceptors' overall score (59) is much higher than that of non-acceptors (40). The acceptors also lead in itemwise analysis. The non-acceptors equal the acceptors orr one item3. The last question (6) also establishes that the acceptors had better motivation than the non-acceptors. While only 71 percent acceptors adopted family planning on advice, in spiteof advicdT5 per cent non-acceptors did not adopt family planning

TABLE 8.12: Motivation of the Respondents in Bulsar District

Percentage of respondents affirming the questions Questions on Motivation

Acceptors
7l
75

Non-

Atceptors
1.

Have you ever been to a familY

50
JJ

olannine centre? hun" uol, ever used the facilities provided by the familY Planning
centre?
3.

Did you ever consult the medical officer in the dispensary/health

centre/sub-centre and seek advice

25

25

on family planning? Did you ever take Your friends/ relatives to the familY Planning centre and persuade them to accept family planning methodt

7l

42

in Family Planning
Perxmtage
Respondents Questions Questions

of

Aflirming
NonAccepton

Accepnn _
Did you ever take your family planning centre?
Has any one ever advised adopt family planning
Average
38

l7
75

7l
59

SI
No.

No. of lfual Children Familv

Remari;s

1. 1F

2.

l4lM

lF 2M, lF
2M,

Wants more ns
Wants Ine

Two sorrs are essential

more

3. 3F, IM

In case something hap pe s to one, at least one will survive.

Two sons are essential. Two sons are essential. Two sons are essential.
There is no daughter

2M,2F
2M, IF

4. lF, IM
5. 2F, IM 6. 4M

Wants more

2M,2F

Wants more Wants

more Wants da Wants more

2M,IF

7. 2F, IM
8. 2F 9. 2p,

iw,zr
2il4

in family. l'wo sons are essential, A son is mirsl

rr

Wants
least
son

tv

2ivl, I F

Hus

inM
a,ast

Familj; Planning Through Panchayats-

II

2t3

lb. lR lM

2M, lF, 2M, IF

Wants one
more son

Two sons are essential.

ll.
12.

1F,2M

Husband is

not keeping good health

lF,lM

2M,IF

Wants

Two sons are essential.

another son

Aside from participation and motivation, the non-acceptors did not adopt family planning due to socio'psychological reasons
well. As indicated by Table 8.13 most of the non-acceptors were favour of two sons. The argument was that the family needed two sons to look after it and in case of unnatural death atieast one'ion will survive. Only one acceptors did not accept family planning because he want6d a daughter. So, it is not,only preference for sons but desire for two sons that prevented people from accepting
as

family planning

Sample Survey in Kheda District

Sample Villages
A sample survey of.accepto:: and non-acceptors of family planning was conducted in villages of Kheda district As usual villages in the district were put into two groups one group with good performaice records and another wiitr poor peribrmani6 records. the district Kheda was suggested for study by the officials of the

Government of Gujarat and wag thereforq purposively selected.

cbuples (90 per cent) were protected and (ii) piplag in Nadiad Taluka having population of 3381 and 650 couples in the rep roductive age group of which 488 couples (75 per cent) were effectively protected, were randomly selected at the first stage as representatives of good performance villages. Villages (i)

Villages 1i) Harkhapura in Borsad Taluka having population 6I'' 1593 and 301 couples- in the reproductive age-group of which 273

'214

People's

in Family Planning
1984 people and442 couples
h 203

Bhadarenia in Borsad Taluka the reproductive age-group of protected and (ii) hathaj in N 3208 and76l cbuples in the couples (42 per cent). were representative of poor perform

in

couples (45 per cent) were

Taluka having population of

lve age-group

ofwhich

303

were selected randomly as villages (See Table 8.14).

TABLE E.14:

Profile

ILLAGES
Demographic Prof.le

Piplag Bhadrenia
1,593 1,593 3,381

Hathul 320
1,608 1,600 25 1,680 1,528

Total Population Hindu Muslim

S. Caste

3,330

65

5l 2N
1,661

Male
Female Couples in reproductive age group Couples effectively protected

't70
823
301

t,520
650

1,984 1,980 '4 250 987 99'7 42 203 '\. (46)

percentage.

761

273

488

303

(e0)

(75)

(40)

,NOTE: Figures in parantheses The second stbge of random selecting 8 acceptors each and 4

good performance villages and acceptors each in poor perlr Panchayats were the only e villages. Village panchayat electi Taluk:i panchayets had their became politicalfy very active Parties in the fiel$ were Janat4 B gress (I) and the llrst party won ma tions. Zilla parishad was also opened their temporary offices
the election.

as usual. consisted of acceptors each in the two acceptors each and 2 nonvillages.

e institutions in

selected

were held in-1980. So also

At that time the peoDle participated in the electibns.

Janata Party and Cpnofseats in panchayat eledat that time. All the phrties the selected villages beforc

Family Planning Thtough Panchayats- II:

215

The Yuvak Mandal" a voluntary organisation in Harkhapura

had its main function of conducting a mid-day meal programme for students in the village schools. In Piplag Mahila Mandal, a

ivoluntary women's organisation did some welfare activities among wome[ The Yuvak Mandal here also was arranging some socioeconomic and cultural programme. In Bhadrenia Mahila. Mandal organised a Balwadi for babies of working women while' the Yuvak Mandal organised some cultural programme. In the Mahila Mandal organised a Balwadi and the 'Hathaj also Yuvak Mandal arranged some cultural programmes. But there were no other social welfare organisations which were very actiie in the village. No adult education centre was notiqed in the selected villages. Milk cooperativeg however, were there in almost. every village and were supplying milk to Anand Cooperative Milk Society whose vans came everyday and collected milk from the villages centres. None of these institutions were involved in family planning work . None of the selected villages other than Hathaj which had an allopathic dispensary facility of a government hospital/dispensary/health centre of their own. The villagers made use of the health centres in adjacent villages for minor ailments. People in Harkhapura were served by Davol PHC and Piplag people by the Drstnct Panchayat PHC nearby. In case of chronic or difficult diseases people had to go over 12 kilometers from Harkhapura to ,Borsad, l6 kilometers from Piplag to Borsad. For villagers of other two villages it required travel oflO- 13 kilometers to reach a district hospital. For using a health and family planning centre people had to travel upto 10 kilometers. Motivation in family planning was done in the villages both by government agencies like the block stalf and the panchayats. One CHV each resided in the 'villages Harkhapura, Piplag Bhadrenia and Hathaj and a MPW visited the villages twice a week One ANM, in ldditioq worked in Piplag villages. In other villages ANMs came as and when
required.

vilit of the research team

cations.

Mass meetings were held in Harkhapura two months before the 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-

All the four

selected villages

had coeducational primary

schools maintained by the Panchayat DepartmenL Piplag had, in

2t6

People's

in Family Planning

addition" a middle school iment of the government of ,Hatkhapura had 129 boys and 77 ,of 150 boys and 100 girls in the p The middle ichool in Piplag had for girls The students' strength rcsearch team in tlathaj village
53

by.the Education Depart-

The primary school in

and there were provisions schools in other villages. seats for bovs and 180 seats the time of the visit of the school was 189 boys and

girls

Sample Respon{ents
Random selection of responderlts was done in Kheda as well
ttt^ .-.^-^Ll1^ ^-+ ^ --^-^-Ll-^-^l:--:+^f -^"^:r.' ^l

The respondents fell in eight of the eleven income slabs we created for the pufposes of assessmbnt We could not get people of very high income category in our spmple. As in other rural areas, diffrculties in assdssment of iscomb were faced here as well Over

eighty percent of the acceptors and two-thirds of the non' accplrtors belonged to low-incomb group. Eight percent of the
acceptors and a quarter of the nonl-acceptors belonged to middle inqpme group. The rest in toth the categories belonged to high

income group (see Table 8.15).

TABLE 8.15: Economic

ot'the Respondents
Non-Accepton Percennge

0000.'1000

r00l-2000
2001-3000

1t

)
I

2l 2l
4
4 4

4
2 2 2

33

l7 l7
t7

3001-4{n0
4001-5{n0

5ml-60m
7001-8{n0

.l

.8
8

'8(n1-9m0

Total

100

Agewise our respondents in Kheda district were distributed between l5'to44 yearc Half of the acceftors and over4O perc6-nt of the

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 4

l5-19 20-24
25.29 30-34

)
7 8
3

2l
29
33

IT
't< 33

4544
Total

l3
'
100

,)(

t2

{00

Educationally our sample was very well distributed Seventeen percentofboth categories ofrespondents were illiterate whilb tiilothirds- of the acceptors and

8 percerit each were graduates (see Table g.l7).

halfofthe non-acceptors had received primary or middle school educatiorl A quarter of the non-: acceptors and 13 percent of the acceptors were matriculatec while TABLE 8.17: Educational l-evel ofRespondents

Standads

'.4cceptors

re rcm

IAge

NonAccepprs, Fercen tage

2

Illiterbte Primary Middle Matric/H Sec Giaduate & above

Total

ll

t7
45

t7
JJ

4
2
J

4
J

t7. l3
8
100

t7
25
8

I
12

l0c

We could not maintain l:l ratio of males and femalet in our .sample Somehow females were reluctant to come fotwards and reply to o_ur questions in this area There-forg both the samples were tilteal rn favour of males- nro thircis of tlie acceptors anO tliree

218

in Family Planning'
(see Table 8:18),

fourths of the nofl-acceptors were

-TABf,E8.1E:

Sexwise

of the ResPondents

Sex

Acceptor
16 8

Malo
Female

67
JJ

75 25
12 100

Total

24

100

Participatory Attitude

The respondents of both

'tle

ticipatory aftitude. The nonthe acceptors. The average scores should not be surPrising because forefront of the white revolution but in thewhole country. The diffi
terms 6f marginal differences

showed high parshowed marginal lead over two was 66 and 67. This d district has been in the not only in Gujarat
of one can be exPlairred

in

in of the respondents.

planning (see Let us look at the questiors'retating to famrly to family planning the Table 8.19). In the seven questions felating
83)' on siit. on,rcq,o?), atso. 42)' l3(331 50). 14(33. s0)' 24(83' the nonon another three iftr.L i,.nrtirt. accgptors have lead. and t ud sotn have equalled the score on one' so' the ;;;;il';;;; ;;;;;t t* even here as well ApParentlY' some- other factors

;;-tT"; ;;,;.t

utttrtiott-u..ef tois wCre ;tt 1611eu/5-47q5$'

otherwise people ;;;;;;;;*-"cceptors in Kheda districL where socio psvchologilook into the i;;;il;ilp"rticlpatiue we shall non-acceptors

.ui iu.io.t fut.r to determine the factors behind

rnspite of high participatory attitude'

Most of the respondentswece in ravour ol the governmen. paying for the health and family plafrning seivices. However, they were not averse to helping the gpvernment or its agencies in organising health services. Except two acceptors, who were not prepared to provide any kind ofhelp, rnost ofrhe respondents were prepared to gwe phystcal, monetdry or both kinds of help (see Table 8.20).

Family Plandng Through

Panchavax-Il:

219

TABLE 8.19: Participatory Anitudes qf the Respondents

PercEntage of Respondents Afiirming

Participatory Questions

Quations

Accepnrc
1. If there is shortage of essential commoditigs (Keroseng sugar, fertilizeri etc) in your villagq would you make efforts to make these commodities available in your
village?

Non-. Acceptors

79

67

2. If there is shodage of drinking

water

79 75 79 71 63 54 50 42 96

67

in your village, would you make efforts to makb it available? 3. Ifthe neighbouring village has a school which your village does not havg would you make efforts to get one opened in your village? 4. If a family planning camp is being held in neighbouring villagg would
you go there? 5. Would you also make efforts to get one such camp held in your village? 6. If a film is being shown in the

50

58

67 58

neighbouring villagg would you go . there to see the film? 7. If the film being shown in the neighbouring village is on family planning would you go there? 8. Would you make efforts to get the. .. film screened in your village? 9. If your village does not have a health centre/dispensary would you make elibrts to get one opened in your village/ 10. If the government decides to open a

6'1

A
50

67

People's

in Family Planning
Percentage

ol

Panicipatory Que*ions

Respondmts Affirming
Questions

Acceptorc

Non
AcceptoN

ll.

health Cdntre/S"b-"*t.r/ with help of people in the would you help?

58 67 83

12. Would you be willing to pay health services?

13.

t)
33

If

a family planning centre is lieing opened in the neighbouring viflagq

50

l4
15.

would you go there? Would you also make efforts td get

one family planning centre/subcentre/opened' in your village? If a nationaVlocal leader is delliverine a speech in your village, would] you attend.that? If such political meeting is bei4g held in the neighbouring villagp,

;" JJ
6'1

50

83

16.

IL

83

17.

would you attend thaf Would you like to campaign party/candidate in election?

Ilr

42
ta

IJ
100

92

54

58

54

a
92

96

Family Planninz Through Panchayats- II:

221 Percdntage of Respondents Afirming

Panicipatory Questions

Questions

Accepton
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

Non'
AccePtors

ra*tat, to the governnGnvvoluntar'

79

83

83

83

to help in persuading and motivating peopli for accepting family planning would You helP him? 25. lf 'Keedan' and 'Ram Leela' is organised in your villagg would you attend that?
Average

86

75

66

67

TABLE 8.20: Help for Htialth Service

Nature

oflelP
Number

Percentage
JJ

Nunfter
4
5

Percentage 25
JJ

Monetary
Physical

8 7
7

Both monetary and physical None Total

29 29

42

1A

100

l2

100

Motivation
the lackr A look at the figures relating to mofivation reveals that

bfmotivationisonereasonwhysomepeopledidnotacceptfamily

in Family Planning il this aiea. The averag motivation score for acceprors came to 71, while for the nonit was only 33 (see Table ,8.21). While 96 per cent were advised to adopt familv plannin!, only 75 per cent non-acq( This is indicativc of some slacklress on the part of the para-. medical staff who work as motivators. planning

Participatiorr" Motivation and F{mily Planning

High participatory attitude arid relatively low motivation explain to some extent why some people did not adopt family planning This gives rise to the qufstion as to why motivation is
TAELE'8-JI:M-otivationoFtdmpriitespondi:ntCrn Kheda District
Percentage of Respondents ffirming

the Questions
Questions

Acceptors

l. 2. 3.

Have you ever been to a planning centre? Have you ever used the provided by the family p
centre?

t7
8

5.

6.

Did you ever consult the oflicer in the dispensary centre//sub-centre and seek on family planning? Did you ever take friends/relalives to the family planning centF dnd persuade them to accept family planning methods? Did you ever take your spouse to the family planning centre? Has anyone ever advised you tlo adopt family planning?

7l

I7

33

75

96

,75

Family Piantning Thuoush panchayats- II:

223

TASI-E ti.22: Views of the Non-Acceptors SL No. of Children

No.

l. 2F
2.

ldeal family size lM, lF

Children

Reasons

Non-

for for

Remarks

Acceptance

Waitiiig
a son
does keep

A son is essential
Husband not prepared for vaiectomy.

3M..2F 2-3

not well

3. llvl

3F - do l lvl. 2lvi,

1M 5 lJ.' 6. 2 M

4.

IF

lF

Family wants I have to bear one one more sort. more child for my family. Wants a daughter Warits a-son,

None t6 look Wints no more after the children children if she is sterilized and husband not prepared for steri-

7. rrvr. 8. 9.
10.

lF 3.

lfiltort,,.
child

lno,"

rrvr,lF
lF lM lF lF

2M,

lI\4

..

lF lF lF 4

3Jffi:Xj:

Wants at least A son is a must one son. Wants one more child.
Scared

11. 2lvt. 12. 2M,

2lvt,

of

3'or

sterilization Wife does not

keep well.

the responses of the non-acceptors to understand this phenomenon (see Table 8.22). Seven of the twelve respondents in this category were waiting fqt a e,hild. most of them for a sgn. Three of them had onlv Qne

224

in Family Planning

where the respondents had ted to get sterilized but her family wanted one more son t rest were either scarid of stenlization or were not going f6r on health grounos Preference for a male progeny was quite t in this area which kept many,

daughter. There is one interesting a son and three daughters and

from accepting family planning Oveiview

The involvement of the panchayati raj bodies had had its

panchayati
salutary effect cin the family planni[rg programme in Gujarat,the prize-money offered by the govergment to the various layers of

ryj bodies and officeis and oflice-bearers of

these

what 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 material were in shirrt supply. And, we havepoinlbdout earlierthat this was one of the biggest handicaps tha ptogamrne in Gujarat suffered from. A number of posts remained kac'ang as a result manv pHCs, were without a Medical Officerand other paramedical stafi. There were not sufficient vehicles to approach far flung vjllages. And, finally, contraceptives ivere also id 3hort supply.
.

bodies had motivated many of the{n to achievebetter results. Not, only the lure of money but the prestige ofhaving been rewarded is

In Gujara!likeln Madhya Pradfshu gram panchayats were not brought into the delivery net wofk They were assigried orily motivational role. Thus while the panchayats enjoyed even this; rolq they could not do anything wh$n cohtraceptives were in short supply. If panchayats are actively lnvolved this deficiency couldl be removed and the panchayatg could be made more responsible.

Gujarat had another similarity with h any importance to local associations. First there were not rw y local associations, and few that existed were not This completely ruled out possibility of the government or encouraging such, institutions. Even the milk which are so strong andl active in Gujara( were not ih this programme either for
Madhya. Pradesh. It. did,l not a[t di

The programme

in

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 bureaucratic and officious in nature, with emphasis on target-achievement As maintained edrlier in this study, while target is a necessary evil in this programme; unless a feeling of volition is created through the use of local' associationg it would not acquire a popular charactet and popular participaion on a large-scale would be difficult to enlist

CHAPTER D(

Family Planning and People's Participation

as is

P,snTrcrPAno'N,

wirtrIy

is a process dependent

upon people's assessment ot its i and interesi to thern The level3 of people's vary from person to person, from time to time. Most aitivity td activiry place to place people's participation,even democracies are predicated u though in practice the for people to participate may and indeed do vary. As a democratic polity India is to people's participation in development programme a$ much as in the political pro

cess. In a programme like'famili, planning the oflicial pro' nouncements have repeatedly the voluntary character of the programme. Yet as a recent stu{y points out, the family planning programme in India is not onl$ a central programme but also a highly bentralised one (Pai Panafidiker et al1983:207). Fven sp several efforts in the country'both ht the voluntary and the State levels have sought to base family fllanning activities on peoplels participation as revealed in the sid case studies reported here

Enlisting Participation in Familf Planning

The starting point ofthe present ltudies in our sample was the ofeach of the case

family planning where the .rolg was not likely to be effei

that a programme like of volition played .a crucial implemented without a large

amount of popular involvement Each of the organisations participation ard devised studie4 set out to seek understanding and made Strategies according to their ey achieved ihried degrees of adjustments as thgy went along

Family Planning and People's

Participation

227

success. But their experiences put together are rich enough to evolve a generalized approach for seeking popular participation not only in family planning but also in health, nutrition and
s.everal other developmental schemes.

The experience of the New Delhi Family Planning Association important because it provides an insight into participatory and family planning behaviour of lower and lower middle class urban and rurban population. The NDFPA divided its strategy into n-iicro and macro approaches. At the micro level the accent was on making personal contacts and involving small groups whereas at macro fevel on involving larger community. The programme took off effectively once the NDFPA decided to integrate health care. nutrition and socioeccnomic programmes with that of lamily
is

'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 were two crucial e.ements in its strategy. First, its attempt to assess and meet the unment needs of people and, second, to gradually go about propagating and popularising the programme, learning in the process about people's difficulties and objections and bringing suitable adjustments in the programme.

The Gandhigram experience in Madurai district of Tamil Nadu typilies another pioneering experience. Basing its pro. gramme on the "Athoor Experience", the Gandhigram Institute of Health and Family Welfare Trust achieved remarkable success in family planning, rural health and rural development Its experience highlights the importance of micro. level planning in enlisting people's participation in family planning programme, which facilitated local adjustments. The effective use of local leaders as ooinion-leaders and creation and fruitful utilisation of voluntary groups like Mathar Sangam and youth club is another signltlcant feature of the Gancihigram experience. However, tn
organisational terms its most significant achievement is development of coordinated involvement approach, which secureafft the help of the local PHC rind Block staff, lt also succeeded in bring.ing tdgether the staff of the PHC and the Bloch not a small achievement given the traditional problems between them. The Gan_dhigram institute also realised that ihspite of all the efforts
they made in cooperation with the medical bureaucracy, popular interest could not be sustained unless health and family planning were offered as a package along with developmental f rogrammes.

People's Panicipation in Family Planning

es and it helped rn family planning acceptance as The Vadu Rural Health Projec! of the KE.M.tlospital, pune also offers several lessons. Even its achievement in the field of participation or family p was not very impressivg yet it was not negligible either. In { negative sense it showed that such a programme cannot be successfully run frorn a long distance. The main reason for its slow progress was that its workers were Pune-based. Vadu ( Bk), where the programme originated and from it project derived its namq seemed quite participative and othbr villages seemed to be catching up. This project has also to gradualism. It also emphasied the importance of unmet or felt needs ofpeople. And above all, Vadu project albo tells us that family planning is likely to be accepted more as a part of a.package. A vital

They, therefore, launched sevcral

of Maharashtra. This exoeriof micro approach in rural health and family planning A ugh in family planning was not achieved until the death fate and infant mortalih/ rate were brought down with an eflectirie health care system that shifted focus from curative to care and the rural mass key to sriccess wi's also an awakened-to its own le. Apart from tho VHWs effort to involve more and more of two local associations trained under the project, the Mahila Mandal and Tarun Shetkari Mandal proved very useful to the programme. The Madhya Pradesh experirnlent showed that panchayats could be effectively used in developfnental programmes as well as in family planning programme..IhQ experimeht carried out under the project since 1979 for the impllmentation of family planning established the useful role which thd panchayats can play in. family planning. .Gujarat, anothr State using p4nchayats in family planning ,piogrammq also demonstrated sinf ilar featurei. The programmb
was based on rewards and incentiv0s,-ivhich were awarded on the

The Comprehensive Rural H experiment in Ahmednagar ment also highlights the effi

Project, Jamkhed. is a novel

basis of fulfilment of assigned tardets One of the important dif' ferences between the two cases is a rblatively strong panchayat sys-

Family Planning and People's

Participation

229

lirik in the chain of panchayat institutions in Gujarat Thus, while .Gujarat has definitely rnade headway in family planning pre
tem in Gujarat Unfortunately. gram panchayat is the weakest

gramme, it has yet to achieve a breakthrough. Participation level also, except in Kheda districi did not seem to be very high. Neither the cooperatives, nor any other local associations have been usedr in Gujarat in family planning programme. And family planning does 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 NDFPA
was working exclusively in the field of family planning The other three started basically as rural health projects and later ventured

into the field of family planning making it an important part of their 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. Each one of them at some stage had to initiate programmes of socioeconomic upliftment to sustain popular interest in their pro,jects.

The NDFPA is different not only because it started as a family planning 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 important respecL The exposure to urbanism makes it less resistant and more open 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 welfare package. They ieact with suspicion towards anyone talking about

their welfare Moreover, deeprooted beliefs and superstitions as

well as well-entrenched power structures also prove major

impediments, 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 .apathy itowards their surroundings. Any effort to mobilise. the hardcore 'rural masses. thereforg would have to take these factors into
accounL

Thus. Gandhigram, Vadu and Jamkhed projects started with

230

People J

in Family Planning

bigger handicaps than the

oldest of the fourvoluntary

Nf

A
the

were also far broader in scope

Their aims and objectives NDFPA Gandhigrdrn, the

out towards the close of the 1950s

in our sample for instancg set assess and evaluate the exist-

a stratery for family planof the Govetnment of Tamil started in earlv 1970s to proDle health care system to Mdharashtra. Logically, since objective of disseminating planning it should have faced greater resistanee. But, as statd ier, the difference was that it like Delhl selected a rapidly expanding was likely to face less of Of the other three, Gandhigr governmental sponsorship bureaucratic resistance because entrusted witb the responand the limited nature of its task strategy for family planning sibility of evolving a communicat had to face their share of Jamkhed and Vadu, on the other es faced some resistance suspicion. First of all" both these bureaucracy. Efficient han,arising out of suspicion of the tal agency would idling of rural health by any Therefore, suspicion some-. ?eveal chinks in their own times bordering on hostility was a very natural reaction from. also had to deal with suspithem. Secondlv. Jamkhed and V of the Panchayat officials and cion and uncooperative behavi to deal with rumours and elEcted officials. And finally, they propaganda started by and even hostile local medical fractitioners Organisers of Jamkhed and Vad]u projects dealt with this suspi sion'in entirely dilferent manner. $oth had to start in a low key to rassure the medical bureaucracy, Fanchayat officials and local lractitioners that they neither mefnt any harm to them nor did [hey intend treading.on their path. fhe Argles atJamkhed decided hot to entertain any house calls At the second stage, the Vadu proiect decided to collaborate with t$e medical buieaucracy, while the.Jar-nkhed project decided to ke$p distance and maintaina low profrle qo as not to create any c{ntroversy and strengtfren the
.

ing rural health services and to ning in the early 60s at the Nadu. Jamkhed and Vadu vide rnexpensivc ano casrly remote rural pockets in the State the NDFPA started (in 1962) with knowledge and education ol

suspibion. The strategy of the Vadu projelt had sornc similaritrj' with the

Gandhigrarn which developed the coordinated involvement' lpproach for implementing fanili planning in rurbl areas. They

Family Planning and People's Panicipation

231

decidqd to work in collaboration with the medical bureaucracy in

order'to avoid duplication. This approach paid rich dividends in ,the long run. In recognition of their efforts, the MaharaShtra Government decided to entrust niral health care in Vadu to the REM Hospital thus placing the enlire'health srqff in thls area under tne administrative control of the KEM Hospital. Pune. The Jamkhed project on the other han$ maintained its aloofness and
took care not to offend the sensibilities of the medical bureaucracy and even local medical practitioneri. tt had the locational advantage as well since its operational area lav between two distant PHCs. l he proiect also avoided any controversy that would tufii Panchayat officrals hostile to it Popular suspicion was another problem that each of the sample organisations encountered. The quality and quantity ofsuspicion, however, varied from organisation to organisation. As stated earlier, the degree of suspicion against the NDFPA was not as strong as others. The basic of suspicion was the family planning' programme which was their main objective, while in case of the other three, their basic motive itself was suspecL The main strategy to deal with lhe suspicion in each case was based on gradualism. This was to avoid any wrong step taken in haste, which might compound the existing suspicion into hostility. The NDFPA" therefore, propagated the mbssage of planned family but never forced anyone to accept any of the methods. Gradually, and persistently, they sustained their relationship with the pcople. Once few of the people came forward, the NDFPA strengthened their case by involving the acceptors. The Gandhigram on the other hand, banked on raining a set of village opinion leaders yho proved very useful. In the other two casei the grassroot app{pach paid good dividends. Their "barefoot doctors"

CHV/VHW got them the breakthrough which probably the

trained medical doctors may never have gol After they got some breakthrough 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 themselves a number of rrnanticipated activities Once the initial hurdles were crossed successfully, it"was not diflicult for the projects to take reots. Here agaiq we.notice

similarities

in their experiences, but,as in initial

stages, the

experiences were not the same. Each one ofthem was built on the popular'support that they were able to muster. They used success-

Pmple'.s
l-ul cases to rnlluence and rope

in Family Planning
reluctant and apathetic sub-

jects The grassroot functionaries vital for gaining popular confidence in each case. In the of the NDFPA the Extension Workers, in Gandhigram the opinion leaders and in Vadu and Jamkhed. tfiO CHWVHW.' The differences in each case are also quite marked. The NDFPA concentrated mainlv on planning Its other services were also meant to support i family planning programme. Operating through nine sub-centt and periodic visits of Exlension Workers it built up its The Gandhigram's main responsibilities were over when it developed a strategy for implementing health and family ing programme. Birt distinctiveness of its pxperience lies in lving an approach, sharing it with the State government es and the village opinion leaders, leaving the impleme: with the State government and itself assuming consultative The Vadu and Jamkhed pro jects distinguished by evolving a functionary for effective imple mentation of preventive care. But there are basic differences not only in these grar functionaries in the fwo projectg but also in their appropch. While Vadu has developed a hierarchy ofsuch fu ies as CHW. MPW etc.. Jamkhed has only VHW. In Vadu each village has a male dnd a female CHW, most of them li in Jamkhed each village has an illiterate womam as VHW We e already pointed out the differnce of approach in dealing local leaders and governmqntal agencies in the two projects.
Whatever the approaches and
tegies, each project aimcd at

ln

involving more and.more people ing the participation-base. Their Extension Workets. village opini meant not only to create conscioul planning among tfre peoplg but to ple to transform these into commi ,gramme which the people r on'theri Each one'of them effort to mobilise participation. It with accuracy and therefore,

programrires and enlarg-

functionaries whether
leaders or

CHWVHW, were
1

about health and fdmilv mobilise more and more peG

lty-Daseo programme

a pro-

their own and not

as.

imposed

some degree of success in its not always easy to mdasufe the degree of participation. ided of the degree of parI presents a comparative pic-

&ature of

projects is that norie oI

Family Planning and People's

thgm. could stick

Panicipritiotr

23.3

to health and/or tamlly ilannrng alone. The inadequacy of health and family planning-programmes to deal with the problems of the local people started gripping each of the projects at some stage or the other. To be precisg this was the stage when each of the projects could claim some breakthrough in the fields of health and family planning As they' received the reportsinadequacy they had to think of diversifications of their activity. The NDFPA for instancg was told by its Extension Workes that people, especially women, were increasingly.getting bored with their programmes. Having accepted their advice on family planning they had nothing more ro listen to. Since the NDFPA was catering to lower and lower middle class areas,.it decided to start some programmes of socio-economic benefit ln consultation with the local population they started a number of such programmes. Gandhigrarl on the other hand after developing and hand. ing over the methodolog5r to the Govemment of Tamil Nadu embarked ugon a number of projects with wider horizons. lt has since been experimenting with holistic rural development programmes, of which health and family planning forms a small
segmenL

of such

The Vadu prqiect also had to diversify itself.into areas of

environmental sanitation and rural health because it found that unless the project could cater to the felt-needs ofthe local people, it was difficult to sustain the programme. At Jamkhe4 the Aroles lbund that having awakened the participatory psyche of the p-eople they could not keep it confrned to health and family planning Coming to be accepted as deliverers froor disease, ignorancg
superstition and fear, they had aroused.popular expectations to a levbl where they had to get involved in other aspects of people's life The diversification of the Jamkhed project in rural health is

wideranging While there are similarities ,and variations in the nrethodo-.

.

studie{ the level of participation-. achived by them has wide variations,r These projects - the NDFPA Gandhigram andl Jamkhed - have significantly higher participatory attitudes of the people, whilb the Vadu project has rather low. This is likely to give the impregsion that the methodology and strategl adopted by the other three projects were superior to Vadu. While tfere could be some truth in this, the point should not be overstretched One.han-

logiesi strategigs,and experiences ofeach ofthe voluntary agencies

234

People's

in Family PlanninS

project themselves admitteo, dicap which the organisers ofV was that their staff was not I in the project hrea. and o@asional visits did not create kind of impact that stall location in the area could create. This i explain Vadu's weakness to and Jamkhed proxsome extent because in both the proltct area was much imity of ihe projoct headquarters also true of the NDFPA its closer. .However, this weakness visits to the area. Even if Extpnsion Workers made onli Ato its urban surroundings, one explains the srrccess of the the weak participatory one may have to look deeper to attitudes and moLivatiots aJ V Firstly, the project at the village Vadu Budruk since its inceptio4 where the centre of the project is located This is the place where the people the building of the health centre as well as the res ce of the medical officer. It is likely that individual partiqipa attitude and motivations in this village are higtr" We did not our survey in thg village. of the villages were inducte into the project after 19'17, the Most year when the CHW scheme was Thug when we conducwas only four years old ted our sunrey in l98l the Morcover. in tho meantime the embarked upon coorwith the Govemment of dinated involvement appfoach staff was ..put under the Maharashtq and the entire I Hospnal, Pune, which admrnrsrative control of the also diversified in many operatd the Vadu project The main thrust a little weak other fields. This probably made able to create and activise Secondly, the Vadu prqiect has not Mahila Mandals. youth clubs, the local voluntary associations done very successfully. It etc., which the other three plojects iq however, possible that in yer to comq this project also popular participation for becomes successful in healtll Ponchayato aqd Levels

of
and Gujarat-usiag pane had one similarity betwere based on awefds and achievement olsterilisation

Both the States-Madhya faqily planning ween the two. Both the sysl
chayats in the

incentives, the basis of awards tgrgets set_by thc respeetive $iate anel VID. This is when the simi

ts (see Chaprers between the two end$

VII

Family Planning and feople's

Participation

n5

Madhya Pradesh, ad arready elaborated earlier, had linked the awards to the panchayats to rural developmen! i.e., the panchayats must use the award money on rural development schemes. A list of various development works on which the money could be used was supplied by the govemment Gujarag on the other hand, attached no such st4ngs. It plobably assumed that the panchayats would use the money on public works. Moreover, Guiarat has an elaborate system of awards whieh included panchayat office bearers at all the three levels - villagg taluka and district - as well as the government officials. This would probably activise large number of functionaries involvdd in the family planning programme.

ing sterlisatibn targets They have not been included in the

delivery network in either of the States. This not only made their role subordinate but also took away the elerdent ofchoibe or voli-

Th . role ol panchayats in both the States was purely motivational. Theironlyjob was to help the govemment in achiev-

tion from their role.

It is probably the{arget-oriqrrted approach of the scneme in both the States that had not encouraged the local voluntary associations like Mahila Mandals ar.d Youth Clubs and brought them in the'ambit of family planning campaign. This emerges as the majorweakhess of the panchayat schemes of both the States. It
would be worthwhile to mention here that three of the four voluniary agencies studied un{ei the project had used local organi;ations successfully. The participatory achievements ot the programmes of both the
States look similar (see Sample Survey in Chapters VII and VIII) as far as the hgures are aonceroed Probably Gujarat would score over Madhya Pradesh on a few grounds. First its panchayat sys-

tem is older, more successful, and more elaborate than that of Madhya Pradesh. Second, the system of awards'and inc'entives 'being more elaborate in Gujarat the response probably would be much greater than in Madhya Pradesh-Finally, the cooperative movement is much strongei in Gujarat and soh_etimes the line dividing the panchayat and cooperative leaderships is very thin. Thug it received .thd support of coopprative movement as well Moreove! the cooperative rnovement had also helped the conscientization process.

Pmple's

in FamilY Planntng

Vbluntary Agencies Vs.

The figures
o_n

particiPatorY :

and motivations

as

well as

'the qualitative data collected by

the two models suggest that

better than the two panvoluntary agencios have done pation as woll as making in mobilising chayat models,, both programme. The Jamkplanning a popularly family the NDFPA have in fact been project, Gandhigrarn" and ,hed ,able to bring it tg a level where eligible couples have started laccepting the programme vt i. The question which arises
.is : in wnat respegts have the pver tne panchaYats?
agencres been able to score

The {irst major difference is

agencies, localised as they are with [ion, operated at the micro level.

the approach. The vpluntary relatively small area of opera'

were thus able to establish

personal and intimate contact v them the opportunity to modtol Ftratery at,every level and recti$ panchayats, o! the other han( gramme of the State government bring people to the sterilisation even to offer suggestions, let spite of panchayat involvemt relatively impersonal. 4rIverJ uuPvrrvrqr. Secondly, in each of the (or a group of persons) dedi motivated thd field workers and contact or even close relationship ing in the panchayat model. The determined by lhe Central Go pneihod of contfaception As a issued by the Ceutral government for the districtg talul [he level was worried about fullill people in the ptogramme. Such family planning programme to popnlar -r-esijtl nce lgcame ggea Thirdly;,in the panchaYat to diversify in odhei asPecti of planning part olla packager In planning departfnent is Part of

the people. This also gave programme as well as their weaknesses and faults. The part of the macro proot onlv was their role limite d to le, they were not in a position think about btrategies. Thug in the programme remained
agencies there was a person

to the

programmes who

them in establishing close

the people This was lackroad strategy rv.as the same as of effecting terminal

the sterilization targets were btoken down by the $tate and panchayat levels. Each of targets rather tharr involving ipproach also reduced the sterilization'progiamme and'
it had not been.possible development to make familY in spite of the fact that familY health {epartment, it had not

Family Plairning and P@pUs

Panicipation

n7

been 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 bxperiment did not have its plus points. It certainly had For the fint time.the grassrbot institution had been involved in a ilifficult progfamme like family planning There was considerable enthusiasm visible among the panchayat o{ficebearers in both Madhya Pradesh and Gujarat In Madhya Pradesh where the awards have been tied up with development activities, the panchayat oflicL*bearers seemed happy at the grrospect of having more developmental funds. This acted as a catalysL The importance of grassroots democratic institutions can be better understood when we realize the chinks in voluntary agen-

cies' armour. Most of thenl as already pointed ou! have a dedicated person or a grcup of them working as the motivating force. Will the impact of such agencies sustain the absence of them? Is such,a dedicated person or group based organisation replicable for the country as a whole? It is difficult to answer these questions in the affirmative. Moreover, being micro experimentq replicability of their experience is also not an easy proposition What would perhaps make replicability possible are grassroots institutions like the pancliayats. If a proper nexus could be established whereby strategies are worked out by the voluniary agencies. like Ganohigram did, and later it is passed on to the dgmocratic institutibns at the local level which of course wlll have to be strengthene{, a sustained and effective.implementation of programmes like family planning may be possible.
Bases of Popular Response
One of our important quests was to find out the general profile of the persons who accepted and participated in the family planning programme. Is there any specific agegroup which is more inclined 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 income anythi$g to qo with rnc.eased participation in family planning? Does the number of children that an eligible couple has, motivate the couple for sterilization? Does the type of occupation of a per, son affect his participation in the progrsmms2 We decided to look

238

People's

in Family Planning to these questions the largest number ofresponcent fell in this group, while group. These two groups thus sample; 25-29 age group e sample is the modal age-

dents fell in 25-29 group, Nearly3T

30 percent were in the

next ie., 30accounted for two.,,thirds of the accounting for over onethird of

group for terminal method of f planning In rural areas most couples have two children by them. ion of almost onethird in the neit age'group of30-34 reflective of the change coming ir It indicates that bulk ofthe populatiori is beginning to accept family planning after about bur children Yet the fact that about halfthe population still four or more children is dis-

quieting (see Table 9.1).

TABLE 9.1: Age-group

tion of Sample Acceptors

Group (years)

r5-19 20-24
No. of Acceptors
Percentage
.

30-34 35-39 40 + Total

1.8

428
12.7

30.0 15.5

66347

220
3.2 100.00

Table 9.2 shows that illiteracy is a major impediment to the acceptance of family planning. sample contained respondents from all categories. Though e illiterates and moderately .educated needed to be motivated a slightly mdre than a welleducated person, it would not be to say that educational level was an impediment to accep ce of family planning

TABLE 9.2: Educational lev I of Sample Acceptors

Illite- Pri rqte mary

Matid Gradu T:otal Hr Sdc ate and

above 30

f.il-b*
Percentage

7t

32,3

52 23.6

43

IJ

19.5 11.0

24

220
100.00

Famity Planning and People's Participation

239

Like illiteracy, ecoriomic stalus is also not a major impediment in the way of family planning As our data shows more than half of the acccitors belonged to low income grqup, while nearly one' third belonged to the middle income cEtegory (sde Table 9'3)' At the 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 commurrity, on the otltrer trin4 feels that two male children are essential to l"ook uft.. their interest It thus means a minimum of fourchild familv. As the economic strucrure of the rual India and the vdlues of the rural population chang{ some of these factors will recede

into background.

TABLE 9.3: Economic Status ot Acceptors

0- tnl- 2WI- 3m1- 4W1- 500r- ffi01- 7AU- 6A00+ Total run 2n0 3M 4An 5Un 6W 7m0 8000 '27 26.. 2l u315r7220 55 . Number 32 10.9 0.5 6.8 7.7 100.0 Percentage 14.5 25.5 12.3 I1.8 9.5
Table 9.4 gives us distribution of acceptors by rrumber of surviving children. If in accordance v'ith the national policy, we consider acceptors with trvo children as normal and the rest as deviang the emerging picture is notvery.encouraging 4u"O t-"tt percentage (3.2) of acceptors had only'brie child These could be cases where after acceptance, the one child died- We did not come across any couple which would accept family planning with one child. Nearly 18 per cerrt couples had two children" which is a rather low percentage. Ifthree plus are taken as deviants then the emerging picture is rather disconcerting with'nearly 80 per cent . falling in this category. Even if we separate three'child couples rfrom this category who are nearly3l per cerrt of the acceptors samplg it leaves ne4rly half the sample in the lour plus category. On the other hand nearly half the population is now bciepting ter' minal method of family planning after'three children.

An n ua I Ho

use ho ld

I ncome

24
TABLE 9.4: DisCiU by t{e Number of
S

in Family Planning.
<if Sample Acceptors

Children'

Number of Sumiving Children

No. of Couples

Percentage

7
3

39
.2 17.7

68

5 6+ Total 59 27 20 220
26.8 12.3
9.1

100.0

Levels of Participation

The most meaningful activity, and hence in family

highest stage of participation in acceptance of the programme. studies shows that efforts to broa of participation has yielded mixed has been able to attain

in any developmental toq is voluntary. And. the planning is the volunlary the discussion in our case
the base and raising the level Our sample survey data the success each ofthe efforts

from each of the case studies in raising

utilising it for family planning as - Table 9.5 presents comulative Jamkhed stalds out among the
attitude of the respondents. We
percentage of the respondents each of the sample survey). A loo

level of participatiotr and as for other programmes.

tion data (average of the

participatory questions of at the table 9.5 suggests rhat. ise studies in participttory mentioned in the case study

of Jamkhed that the extent of

generated in the project villages had mdvgmenl The success of the

and consciousness the project into a

experiment also lies in The NDFPA has also relied experiments show and this perhaps suggests weakness of the government targt- oriented approact. ; Relatively weai partrcrpatibn' ra of non-acceprors partiallt explains why some people accept planning and some do nol Eicept in Okhtra, where partici rates of both categories of respondents wel equal an4 and Khed4 where n<iiracceptors had slightly higher par n rate, iii rest ofthe cases, acceptors demonstrated stronger tory attitude than non-

involVing people in the progr on similar technique. The two relatively weaker rates of participa

Family Planning and People's

Participation

241

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 to participate in all activities. A very interesting example would be that of voting Voting in nati,onal State and local elections, compaigning for a party or a candidate as well as attehding campaign' ing for a party or a candidate as well as attending public meetings addressed by political leaders are allied activities. But not equal numbers 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 in family planning'has to be raise{ family planning should rank high among their preferehces, and this is possible only through consciontization. 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 differences 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
Acceptors

Rates of Respondents

Non-Acceptors
67 69

Anand Prabat Okhla Gandhigram Vadu

Jamkhed

74
'10 75

7r

49
83

z)
78

Indore

5l
60

Dhar
,Bulsar

,a

59 50 39
67

Kheda

66

242

peopl

in Family Planning to different activities,Table

gategones of respondents with 9.6 presents this data. Of the 25 items we have used

our respondents the siores of those of non-acceptors in nine. TABLE 9.6: Itemwise Attitudes of Sam
Question

participatory attitude of rs were trigher in 16 and us, in terms of numbers and

of Participatory
Respondents

Non\cceptors
I

{a
J.3)
2.
J. 74.7 5

Diflerence

Citical
Ratio
1.78

63.12

62.A
58.1

7291
7r.01
65.35 63.76 62.25
56.36 55.73
83.6',1

4.
5.

45.45

6.
7. 8.

9.
10.

ll.
t2. tJ,
14.

43.96 53.83 58.58 45.36 50.70 66.38

I

5.41 5.38 5.51 5.72 5.83 5.78 5.77

9.63 12.33
14.81

25.62 21.38
e.23 3.67
11.01

2.29* 2.69** .4.49t*

3.67

**

11t
0.64
1.86

5.90
5.89

5.03

0.85

77.09

J.Z5

7i.24

70.92

59.q
57.47

51.00.
61.23

4.89 5.06 5.36 5.86

6.18 5.91 6.27 .96 .88 .56

r7.30
3.86
0.31 8.40

3.53**
0.76 0.06
1.43

t<
16.

6522

69.80
56.57 42.91 42.91

4998
30.18

t7,
18. 19.

3.76 4.67 6.59

12.73

'0.61

o'7s
1.05

27.6r
91.59 58.41 51.90
68.37

2.14+

15.30
1.38

w.2l
s1.09 53.40
7

2.ffi**
0.32
1.18

20.
21.
22. ?4.

7.32
.78 .57

r;t7

l.5l 3.q
9.22 9.96
3.88

0.24' 0.59

25.

81.29 83.39 76.78

90.51

2.02*
1.99+ 0;15

73.43 '80.66

.00
.19

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 participatory attitude the acceptors went for family planning or par-

ticipated in the programme while the non-acceptors did not. Brit this would be a rather superlicial conclusion unless we look at the pata in greater depth. Alook at the critical ratios ofthe differences between the acceptors and non-acceptors reveals that it is significant only in nine items and in four it barely fell short of significance. Out of ning it is signihcant in favour ofthe non-acceptors in three. In four where. just falls short of significance it is tilted in favour ofthe accep,it itors. On five ilems it is sigrrificant at.0l level of signifrcance while on four it is significant at.05 level The fact that on sixteen out of25 questions relating to participation in social, political and cultural activities the scores of a_ccepItors and non-acceptors do not show any statistical difference might convey the impression that participatory attitude is not an important variable in acceptagpe. of family planning But this would be a hasty conclusron to draw. Ifwe loox at the questions we find that thet include a broad range ofactivities touching upon the :concerns of individuals on suqh community problems as shortages of essential commgdities, drinking w'ater, educalional opportunities health and family welfare facilitie s. While trying to
gauge the concerns

ofthe respondents the questions also sought to

judge 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 that

participatory potential exists in the community and it has not been properly tapped.Wherever it has been tapped, as in some of our 'case studies, the response has been overwhelming The fact that on three items the statistical signifrcance is in favour ofnon-acceptors also supports our argument Of the nine items on which percentage difference between acceptors and non-acceptors were found to be signifrcant six went in favour of the acceptors and thr-ee in that of non-acceptors. Of
,to
.

there six items in favour of acceptors, iter4s 4 and 5 related directly family planning programme. Acceptors showed greater willingness to

join a family planning camp being held in a neighbouring .village (item 4) and they also exhibited more willingrless to organise such a camp in their own village (item 5) than the non.acceptors. They also showed greater willingness to assist the

VLW

VHW in motivating people to accept this programme (item 24).

2+t
The acceptors' showed'a more for, maktng education'available

in Family Planning attitudd towards the need children in their own village greater willingness to help
to go to schocl (item23).

(item 3) while non-acceptors the school teacher in persuading

Non-acceptors al$o a evinced a compared to acceptors by e a party or a candidate in the

that they had compaigned for a elections (item l8)-This is an notice of Non-participants-are

political consciouness as . willingness to compaign for (item 17) and also indicating or a candidate in the last
ing phenomenon to be taken. for geffing political leverage

than for actual participation in \r'hilg participantb on the other I igrass.root activity of direct
l.evels of Motivation

planning programrGs, in the to family planning

are more interested

Participation theorists regard as importarit a factor enlarging participation base a resourbes for mobilising par[n ticipation and place of individual socieeconomic hierarchies.
The data in Table9.7 shows sharp
between motivations..

TABLE 9.7: Motliatiiin

4rea

olfte

in the StudyArea
of Respondenu

Non-Acceptors

Anand Prabat Othla Gandhigram Vadut Iamkhed lndore Dhar Fuisar Kheda

9l
89 73 72 69 72 59 74

JJ
25

49 49
3E

42
.10

25

for any statistical, analysis

of acceptors and non-.accep3ors. phy some,people accepted fdmily two Delhi arcaq qhgre thc acceptr

explains to a large exbgl and some did not.The

rts showd stiongest

Family Pnnnmg and Pople's

Panicipation

245
res-

motivatioq nad very weak motivation for the non-acceptor

pondents Moreover, their strong motivation (considering the grpe cf questions we asked to measure motivation in family plannind can be attribute4 to some extent, to their proximity with the metropolis. Aside from the two Delhi areas Gandhigrar4 Jamkhe4

Dhar and Kheda show strong motivation for acceptors The

reasons tor strong motivation at Gandhigram and Jamkhed have been explained eadier. The involvement bf Panchayats is prc,

bably responsible for raising motivation at Dhar and Kheda Kheda has additional advantage of.active milk cooperatives. But motivation among non-acceptors is high only at Gandhigram and Jamkhed and this gives these two projects an additional
advantage. We also made an itemwise comparison of the motivation of the sample respondents. The six questions on motivation were put to statistical test similar to participatory attitude. The result shows

statistically significant difference at.0l level of freedom on all but cne item (see Table 9.8).

TABLE 9.E: Itemwise Comparison of Motivation of Sample Respondents

Questian Accepton
Na

NonAcceptors

Sigma Difference Citical

Ratio
5.24
5.51 5.51

l.
2.

4.
5.

85.04 87.69 73.69 79.88

54.23

4.s3
22.20 25.00 34.77 27.50 68.,m

5.52 5.70
5.21

6. +

72.23

,m.51 7.73t 65.49 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 statistical non-significance of the last duestion which aske{ whether they were even "ddvised by any oire to accept family planning". The marginal difference shows tha{both were advised about it, but

the former accepted while the l{tter did noL How can explained but in terms of lack of fnotivation?
Overview
Participatory attitudes and in importanf factors that affi

it

be

dual motivation, thus, emerge

as two

An expanded base of participati tion which consequently, helps health, family planning and o grammes. Once unleashed, the
more and more, as demonstrated

family planning acceptance. also raiseb the level of motivamobilising the cornmunity for
and developmental pro' pation psyche demands Vadu and Jamkhed experien-

lt is thus impossible to participation. It should be

ces

a limited view of popular that not only would i would also demand more than
eiample is from Madhya seek more funds for develop-

participation help the process but family planning The mobt el

Pradesh where panchayats began

mental .activities. The modeb and processes of'

ular participation in family es are not limited. They planning and other similar which the programme has largely depend on the extent and also to the extent of appealed to the popular i popular on. This is where formal and mobilisation of e importance. In each oI informal institutlonal structures structures have played important roleour case studies these associations in case of informal structures like local vo like panchayats in cases and formal sh volqntary agencies ya Pradesh and Gujaral of governmental programmes in their utility and long term iormal structures have P While scored in terms of effectiveimportance, informal structures are replicable within the forAn{ as our study reveals, ness. mal frafnework brmal. ar,e built on a popular These structutes, formal and de to brode their base,and the base. Therefore. if no attemPt is couragement, the peoplti phrpeople are given the necessary Both sets of case studies indi' ticipate in these institutions institutions in every possible cate that people participate in

Family Planning and People's

Panicipation

247

manner. Not only do they enrol more and more people in the programme, 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 important element It is essential to understand people's attitudes before seeking their support for any programme. It would seem wrotlg to assume that popular support, which would eventually result in participatioq would come naturally for any programme. Unless properly explained and carrying necessary level of conviction, popular reaction could be apathetig suspicious or even hostile. It is also importan! in case participation is being sought in a partic'ular progratume to identi& the target group; otherwise the purpose of the programme may not be achieved. Family planning programme is likely to attract popular participation only if it is offered in a package at least with health ser-

vices. Health services are important even otherwise because acceptance of family planning is dependent on reduction in infant and child mortality rates. Also closely linked is ahte.natal and post-natal care. But as the experience of most voluntary agencies and even Madhya Pradesh panchayat scheme shows, unless family planning comes with other developmental programmes as. a package, it is not likely to sustain populat interesl An4 the developmental programmes should be such that they present solution to immediate local problems immediately. This is not possible through a riacro appro'ach. While no one would deny that broader national or State-level policies should be worked out at appropriate levels, i.t is essential.to understand that appropriate level for working out micro strategies in a diverse society sueh as ours is the local level. Thue proper emphasiS has to be placed on micro level planning As we have seen most voluntary agencies succeeded in their efforts mainly because of their consciousness of the riricro problem and because of their micro
level planning This brings us to the final point that emerges from a comparative analysis of six case studies in this chapter. We have observed that macro strategies worked out in the national or State capitals need adapatation at the local level. This could be done only if there is an effective local machinery with'sufficient autonomy. to do so. The existing local macbinery, bureaucratic as well as representatrve, have proveo unequ4l to ihrs task due to inhercnt limitations. Moreover, unlike the voluntary agencies they are also

248

in Family Planning

not capaDle or expenmentation There is therefore. a need for crear more autonomou$ organisations breate a nexus between them and
:are any

evolvmg micro strategies, more bffective and relatively

the local level and also to voluntary agencies, if there

in that, arca.

NOTES

I There are difficulties iu quantifying anl measuring a ph.'nom!-nbn likc poP ular panicipation. No quantitative scale can givc exact mcasurc of popular participalion. 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 projecl the local population did give ample evidcnpe of its parricipator.r zr'al mcdical oflicer. but whn it camc to individual attitupe and motivalionr. it ranlt'd ralhet iow on scalq (See Chartter V).

CHAPTER X

Policy Conclusions and

Recommendations
LTVER the last few years the Government of India has repeatedly stated that the family planning programme in India is based entirely on the voluntary participation of the people. Despite these policy professions, over the years very little conscious effort appears to have been made to movc in that direction. In an extremely sensitive programme like family planning the results speak fpr themselves. The acceptance of the programme is generally low in the country consequently the fertility level is disconcertingly high. The evidence of the last fewyears makes it quite evident that the family planning programme will make little headway through the prdbent bureaucratically organised system. The bureaucratic system, especially at the grassrootg inspires little conlidence even in maintaining the supply side. as many of the studies have cledriy shown. When it comes to the demand side the bureaucratic svs-

,-\

even political p.rocess.

tem is perhaps the least effective because the demand seneration for family planning is a far more complex socio-ecoiomic and

- C)n tne otherianq there is increasing evidence that wherever t[e programme is based on the participaiion of the people, ttri-response has been much better. A much larger percentage of the eligible couples accept protection even by the drastic methed ;f sterilization. And a lesser number of persons oppose the programme. 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 ot the country and the events in recent years! there is in fact little option than to seek a greater voluntary participation of the people in the family planning programme.

250

in Family Planning

i'he present stirdy was designed fino out as to what kind of desirable but more imPorparticipation ofthe people was not tantly feasible and Possible' show that without particiPaThe lindings of the study h chdnce of acceptance of the tion by the peoplg there is not study also shows that while progxamme by'the PeoPle. But it is not yet feasible given au3onomous PartiFiPation is country. At the present stage the social and polltical context of
of development of the countrY a

percentage of the PeoPle do

not autonomouslY ParticiPate in

them" While India is not an for us to accept the prsent reality

programmes meant for

in this regar{ it is necessary organising public policY in

the field of familY Planning conclusive evidence that Thc study, however, Provides in family planning whenever people do and lndeed ParticiPate tion close to them. This they are mobilized bY an agen-cY that there is a need for a po$itive PolicY leads us to the shift in the public PolicY towards conscious mobilization of the people for acceptlng familY Plal through the bureauc' Such mobiliz dtion cannot be are conlrary and racy. Indeed ParticiPation the bureaucratization the The phenomena and processes' oerhaDs PeoP lesser perhaps willl be the peoplC participation The mobilized ned through non-bureaucratic participation has thercfore to be institutions and organisations' The study of the Performance o the voluntary agencies and the of institutions are useful for panchayats suggosts that bottt

mobilizing people's partigipation in family planning However, the record ofthe voluntary bodies nder our studY is strikingly bet' than of the panchaYats. ter for mobilising PeoPle's by the restrictive Policies ol panchayats have been The to their role in mobilising the the State governrhents with as a part ofthe bureaucratic people. They werE beiflg merely
the programme. management.and organisatiQn of the voluntary otganisa. As stated earller, the Perforr us to the policY conclusion tions is strikingly superior. This they should be encouranged that wherever such agencies 'and supported a$ rnuch as Possil in mobilising PeoPle for Par' ticipating in the familY Planning rogramme Tlrey are esPeciallY effective in jnnovative exprimen tion. And such innovativeness

is

necessary

af the

Present

of the family

Planiring

Family Planning and People's Panicipation

programme. We do recognise, however,

251

that an extended role for such

bodies is not a viable all-India policy option. For a variety of reasons, the voluntary bodies thrive in limited parts of the country. They are not available in precisely the areas of,the country where they are most needed. The four case studies ofsuccessful voluntary organisations did not touch the vexacious areas oJ the country such as Bihar or Uttar Pradesh. For a conceivably long period, it is also unlikely that.such agencies will spring up in these areas or even ifthey do, thrive as they do in the western or southern parts of the 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 participation 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 system. Even the motivational role of the panchayats today is confined to pursuading eligible persons for sterilization. This is hardly 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 of the eligible couplcs. While our study regarding the elected bodies was confined only

252

People\

in Family Planning

family planning programme by

needs to make a conscious effort

to the panchayats and that roo in iujarat and Madhya pradesh, we should like,to point out that choice is indeed wider. There are several other locally elected in the rural areas.of the country which have a similar tial. In particular we feel that the elected cooperatives, the vari women's organisations, the youth clubs. the farmers orsa'nisati are all possible instruments which could help in the process of voluntary acceptance of the
r

family planning programme. Our general observatibn ib that country is varied And yet some even thrive in many parts of the co Indian political system at the faces. Such institutional ficult programme like a family p pects are more diflicult and li , A general but important policy the study is that a more Darticil political, economic and social community in the family participation is a process and encouraged, the more it is useful gramme. This conclusion deser makers and planners because the for more participation il precisely the opposite. The family one case in point These are in brief our maior several minor one$, which are The principal recommendations clusions which we list below. Srnce our basic conclusion is that family planning without recommendation is that every
encourage the process

e people. The Government involving these bodies in the

social institutional map of the

institutions do exist and

try. This is the strength of the

with whatever problems it

has to be given a role in a

dif-

ing without which the pros-

: community of people in
is also a more participative programme. In other words

which emerges from

and the more

for the family planning

it

is

the attention of ttre poticy ,lic policy- while preaching

of the programmes does

pre

programme is only conclusions. There are within the text of the studv. naturally out of these con-

ticipation should be encouraged in the motivational as weil as the supply side of the progrr Such a policy should be made an integral part ofthe national amily planning programme. t)ur. second major and crucial is thaq given the state of political and social i of the country par-

of

by the people, our first r needs to be takeri to

in thd programme. The par-

will.be no acceptanc ol

Family Planning and People's

Participation

ZS3

tieipation of the people in the family planning programme will have to be mobilized as a matter of deliberate policy. Thirdly we also recommend that the elected panchayats and the voluntary agencies are best instruments of mobilization and hence should be utilized extensively for the purpose in the family planning programme. Our fourth recommendation is that the voluntary bodies wherever they work in family planning should be given as much help and encouragement as possible without destroying their voluntary character. The fifth recommendation is that the elected bodies at the local level not only in terms ofthe panchayats, but also the cooperatives, the women's organisattons. the youth clubs. the farmers grganisations should be utilized a! extensively as possible in the process of mobilizing the people. Our sixth and Iinal recommendation is that_the process of participation by people should be encouraged as extensi!ely as possible in all programmes because we find that those who have a participative attitude generdlly participate more actively in the family planning programme.

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