Plans, without planning

The current occupant of the health and family welfare minister’s seat, Dalit Ezhimalai, too wants to prove that he is no rubber-stampminister who will clear policies without making his own inputs. So once again the much-modified draft policy is doing the rounds of yet another expert group ensuring that the earliest that the policy will see the light of day, if at all it does, would be early next year.

While health ministry officials vehemently state that the lack of a National Population Policy has not hampered or in any way slowed their functioning, the absence of comprehensive policy guidelines reflects a larger reality: that population management is no longer being considered a priority to be tackled on a war footing.

The Swaminathan panel’s recommendations never found favour with officials in the Family Welfare Department, quite simply because it proposed the setting up of a separate population commission a move which would have decimated the funds and clout of the department.

The National Agenda for Governance spelt out by the BJP and its alliance partners speaks of a “suitable and judicious mix of incentives and disincentivesfor population control”. But the experience of the health professionals in the field is that any scheme involving disincentives runs into a slew of problems, primarily because the line dividing what is termed a “disincentive” and outright coercion is often blurred.

Any target-oriented formula to curb population can only have disastrous effects as was evident with the experience of the Emergency. The excesses of the Emergency when the official machinery worked overtime to meet, and often exceed, set targets are grim reminders of the fallacy of allowing numbers to be the defining criterion.

What followed in the post-Emergency decades was a swing to the other end of the pendulum. Indecision, doubts and lethargy gripped population control programmes as the mere mention of family planning became synonymous with the excesses of the Emergency raj. Poor implementation of the existing family planning programmes were compounded by a lack of political will. While prime minister after prime minister extolled theneed to curb population growth, the institutional and financial support for putting these plans into action was completely missing at the implementation level.

It took nearly two decades for the programme to get back on track, but much damage had been done by way of a complete slowdown of the entire machinery.For example, one scheme that has taken a beating is the programme to promote family welfare, distribute literature and make contraceptives easily accessible for workers of the railways, defence and public sector undertakings. The scaling down of the operations of family planning cells in some of these organisations which employ hundreds of thousands of workers is also a reflection of the de-prioritisation of the population management agenda.

The turning point in this scenario of drift came in 1994 with the International Conference on Population and Development held in Cairo.Since Cairo, population and sustainable development, reproductive health, empowerment of women have become the key factors ofthe new thinking on population management. But these run the risk of being reduced to mere slogans unless they are integrated into an overall plan of sensible environment conservation, literacy, health and employment generation.

While the world over, demography has moved away from looking at numbers, in India this change in direction has been slow although it is now clearly discernible. And an indication of this may be the turn-around in the orientation of the programme to what is described as a “target-free” approach.

Another area of reorientation in policy that is being envisaged is a shift from women to men. The re-examination of male contraceptive options, including injectables for men, the promotion of non-scalpel vasectomies and the involvement of men in maintaining the health of the family, are all part of this new thrust that family welfare experts have suggested.

The perspective that family planning and population control cannot be viewed in isolation from other social indicators likeliteracy, infant mortality and maternal health finally shows signs of dominating policy making.

That ultimately population stabilisation can only come about through people’s realisation of the merits of the small family norm and through voluntary action, is best illustrated by the case of Kerala. Here female literacy proved to be the key to educated choices that people made in determining the size of their families.

Another significant issue in the national population debate is that of inter-state disparities. Between 1981 and 1991, the four states of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh, accounted for 42 per cent of the net increase of the country’s population. These four states also account for 40 per cent of the total population and for 48 per cent of the total number of illiterates in the country.

With fertility, infant mortality and birth rates here way above the national averages, it soon becomes evident that any dent in curbing the overall population growth can only be made bybringing social change in these four states. The situation in these four states begs a separate strategy geared for the very distinct conditions prevailing in each of them. Unfortunately, there is very little thinking being done along these lines.

Meanwhile, non-governmental organisations and women’s rights groups have moved to the frontlines of the battle against the attempts of foreign drug companies to introduce chemical sterilisation methods in this country, very often reducing large number of impoverished, illiterate women to perform the role of guinea pigs. The government’s apathy in preventing the misuse of some of these potentially-hazardous birth-control methods on unsuspecting women, reflect shades of the worst days of the Emergency.

Such approaches, in fact, are the surest way to make contraceptive use unpopular and set the country’s population programme back by decades, as the experiences of the Emergency proved. Those who preside over policy in this vital field must learn from the past tonegotiate the future.