In 1947, when India became an independent country, free from British rule, its population stood at 300 million. Today it is the second most populous country in the world, after China, with a total population of over a billion people, one sixth of the total population of the world. By the late fifties, it was becoming apparent that India’s burgeoning population was fast on the way to becoming its biggest handicap, threatening its prosperity and growth. But in the sixty years since India assumed control over its own fortunes, and in spite of having one of the oldest family planning policies in the world, it has continued to grapple with the problem of its huge population, just as it grapples with social sector failures in health and education. Alarms raised by developed nations on the size of India’s population pushed policy makers into viewing India’s population as a problem isolated from these failures. Though the investment in social infrastructure continues to be inadequate, its failure is usually attributed to the huge population rather than to an absence of vision and monetary support.

The Family Planning Fiasco

In 1970 the Government of the then Prime Minister, Mrs. Indira Gandhi, coined the catchy slogan ‘Hum Do, Hamare Do’, a Hindi phrase that means that a couple should have exactly a couple of children. In the absence of any infrastructure support for this concept, the slogan remained just that, four words and a picture of two cherubic children, one of each sex with their parents. The reality was so far removed from this picture that there was no attempt to even connect the two. The slogan arrogantly ignored the Indian preference for male children, and assumed that people, when coerced into having just two children, would be content with the gender of the children, whatever it might be. This was a patently false assumption as the alarming decline in the female male ratio, with some states recording ratios as low as below 900 females to 1000 males, shows.

Abject poverty, rampant illiteracy and an absent health sector ensured that there was very little awareness amongst the population about family size, nor adequate availability of contraceptive devices or health advice to control it. Policy makers, almost all of them from the affluent classes, chose to look upon family planning as an issue of will rather than that of health. They decided that people were simply unwilling to have smaller families, and ignored the health problems that a large part of the population faced. A high rate of child mortality (192 per thousand as against 24 for France) [1], poor immunisation, high maternal mortality and unavailability of safe and reliable contraception left people with no option but to have more children.

Infamous Emergency

Arguably the biggest disservice to family planning was done from 1975 to 1977 during the infamous Emergency declared by Mrs Gandhi, during which all civil liberties were abrogated by the state. Mrs. Gandhi’s son, Sanjay Gandhi, though having no official status, was almost running a parallel government, one of whose aims was to reduce the population size dramatically in a very short period of time. The focus on ‘target-based’ family planning was redoubled, and state governments were given targets for contraception and sterilisation, with incentives attached for achieving targets, and very strong penalties for falling short of them. The target-based approach was devolved downwards, and every district employed this approach. This resulted in an almost siege-like atmosphere where people, mostly from the poorer sections of society, the Dalits and Muslims, were forced to undergo sterilisation, this being deemed to be the most effective way of controlling the population. Of course it did nothing of the sort. On the contrary, the unhygienic and sometimes dangerous conditions in which the sterilisations were conducted led to the target group discouraging their friends and neighbours from undergoing similar operations. Coercive methods employed for controlling population was one of the reasons why Mrs. Gandhi lost the general elections that she called in 1977 after the Emergency was lifted.

Post-Emergency Debacle

The setback received to the family planning programme after the Emergency and Sanjay Gandhi’s ham-handed methods to control the population size was tremendous. Mrs. Gandhi’s defeat in the elections was interpreted to mean that any talk of population control was political hara-kiri. For more than a decade after that, almost until the Cairo Declaration, there was almost no cohesive policy on population control. This did not mean that politicians and strategists had given up their conviction that population control was only a question of incentives and disincentives. There were sporadic measures introduced to limit family size. For instance, state employees who underwent sterilisation after two children were paid an extra salary increment. At the same time, there were attempts made to debar candidates from standing for civic elections if they had more than two children. Families having more than two children were denied access to the public food distribution system, a big blow for poor people almost wholly dependent on subsidised foodgrain. Such measures served no purpose whatsoever, and it wasn’t until the Cairo Conference in 1994 recognised that family welfare was what was required, and that there was no direct method of controlling family size, that family planning in India was turned into a family health and welfare issue. The main message to come out of Cairo was the importance of female choice and the combination of raising the status of women combined with reliable primary health care, including access to a choice of contraception.

Today’s situation

While there is a decline in the rhetoric of target based population control, with only stray politicians treading that path, a lot needs to be done before India can claim to have effectively dealt with the issues surrounding population growth. Some of these issues are under government control but some others are governed by social norms which are proving hard to change in spite of rapid modernisation in all sectors.

On the government front, the record on both public health and education continues to be dismal. The total spending on public health was just 0.8 per cent of the GDP in 2005 [2], by most estimates half of what it should be. In education, the enrolment ratio went up from 77.6 per cent in 1990 to 88.8 per cent in 2005 [4], though budgetary allocations still fall considerably short of the 6 per cent that most developed countries spend. Maternal mortality is 540 maternal deaths per 100 000 live births [3] compared to 27 for developed countries. The number of people earning $1 per day is 29 per cent of the total population [5] .

While gradual progress is being made in providing for basic infrastructure by the State, social issues remain intractable, the biggest of these being the importance given to the male child, and the resultant poor health of females, right from childhood up to old age. In spite of many public service campaigns run by the government to increase the awareness about the importance of maternal health, women are still considered second-class citizens and the mindset is that health services are a privilege rather than a right for them. Secondly, the desire for a male child still drives the large majority of Indians, leading to the duel menaces of female feticide and infanticide. A higher number of pregnancies leads to a debilitating effect on the mother’s body. Thirdly, access to education is still denied to many girl children. Though child marriages are on the decline, with the government taking measures like compulsory registration of marriages to control this pernicious practice, many girl children, especially in the rural areas are withdrawn from school before the age of fifteen. Also, many state authorities like the police are complicit in conducting illegal child marriages. Fourthly, contraception is almost totally female-centric, though the decision to have a child rests with the male. This is a contradictory situation. The woman cannot decide how many children she desires. The man has the right to force childbearing on the woman for whatever reason. In India, abortion is legal, but access to safe and reliable abortion and sterilisation services still remains a distant dream for a large part of the population. Fifth, misguided religious organisations, both Hindu and Muslim, actually encourage families to produce more children, arguing that this will combat the power of the other religion! Both health and education get both State and Federal budget allocations, and there is wide disparity amongst the states in their spend in these. This combined with cultural factors has resulted in the figures for population growth varying from Western to sub-Saharan levels.

Efforts on the part of the Government combined with the services of hundreds of agencies in the non-governmental arena are making inroads into health services. But the pace of change is slow, mainly because of the slow pace of reform in education and health. There is no sense of urgency in introducing universal education or ramping up the primary health care infrastructure. In fact health for all is still a distant dream, with many rural areas still lacking first-aid clinics, let alone a qualified doctor. Families caught in the poverty trap have no wherewithal to invest in health, least of all in female health. In all this, signs of hope are emerging from the voluntary sector. Group insurance, small savings schemes, loans to the marginalised sections, all these are making a contribution to the issue of welfare and neither can the role of the media be ignored. More and more investigative reports from far-flung rural areas are bringing the issue of social sector reforms to the forefront. Perhaps this is the way in which reform in this sector will eventually happen. Key factors are female literacy and general education, and female earning power (one reason why the Grameen Bank model of Bangladesh started by Nobel laureate Muhammad Yunus is so important.) The WIN Project in Mumbai is trying to help with both these developments as well as providing primary health care and reproductive health advice.

1. www.childinfor.org
2. www.expresshealthcaremanagement.com
3. www.unicef.org
4. www.worldbank.org
5. Ibid

Sangeeta Mall is Editor of International Humanist News