Family planning in India
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The UN’s thumbs down to Islamic organisations’ claim that children are a gift from god, the antipathy of the Catholic church to family planning and the Bush Administration’s ABC strategy marks a change in the attitude towards family planning and birth-spacing. India cannot afford to keep its eyes shut.
On March 30 this year the UN Undersecretary General for Economic and Social Affairs, Mr Sha Zukong, issued a bold statement at the 42nd session of the Commission for Population and Development. Bold because there is also a public admission that donor funding for family planning services has not kept pace with requirements and resources have to be found urgently to bridge the gap. The statement is also significant because it openly negates the stand of three prominent power groups that have consistently renounced family planning and succeeded in marginalising the subject from the health agenda.
The first of these groups was the Bush Administration which consistently advocated “abstinence, be faithful, use a condom,” commonly called the ABC strategy. Sexual abstinence was to be promoted until marriage, and there was no place in that dispensation for safe sex or contraceptives. It came to a head last year when his Department of Health and Human Services attempted to redefine abortion and women’s access to contraception through a draft that required hospitals receiving federal funds to only hire medical personnel who opposed contraception, including the use of birth control pills. This was slammed publicly by Ms Hillary Clinton and the March 2009 UN statement shows abandonment of the ABC platitudes. It augurs a change in attitudes to contraception and might invigorate agencies charged with promoting family planning to stop dithering.
The UN statement also gives thumbs down to Islamic organisations that have consistently advocated that Islam’s children are a gift from god. This despite Muslim writers Avicenna (980-1037) and Al-Razi (d 923 or 924) having written about contraception methods. But because Islamic leaders have openly consistently campaigned against the use of condoms or birth control, even the more emancipated sections of Islam have failed to drive a change. A 2005 BBC report described an Islamic conference where 40 scholars from 21 countries urged making renewed efforts to promote population planning, but despite their valiant efforts, their joint declaration shied away from saying so, for fear of clergy reprisal.
And finally one has the Roman Catholic antipathy to family planning. The doctrine against contraception and contraceptives was recently iterated by the Pope while on his way to visit Africa where 21 million people in sub-Saharan countries are infected with HIV and the millions have died from AIDS, abandoning orphans to a state of destitution or death.
In India, up to nearly the last quarter of the last century lowering fertility and increasing access to contraception was an obsession. In the late 90s, after the Cairo declaration, India abandoned targets, incentives and disincentives, and rightly so. But while south-east Asian countries completed their goal of lowering fertility by steadfastly using the most imaginative approaches, successfully reducing fertility rates to middle income country levels, India paid lip service to reproductive rights but failed to provide the promised “basket of contraceptives”. The main proponents as well as donors of population programmes also changed their focus to the prevention and treatment of HIV AIDS.
NGOs that once thrived on family planning strategies found that the numbers game was no longer fashionable or fundable. Family planning lost its clout and devoid of recognition for conducting sterilization operations, much less supplying pills, IUDs and condoms the programme became irrelevant. The designers of medical curriculum likewise treated family planning as piffle. Skilled vasectomy and tubectomy surgeons did not have too many followers left, so skills in the Government health departments became scarce. The private sector never considered family planning to be a priority, with an array of more rewarding options available — abortion, amniocentesis and sex-determination tests to name three.
In India, it is currently fashionable to crow about the country’s great future because of its booming, youthful, evergreen citizenry. Rightly or wrongly, Mr Nandan Nilekani’s book Imagining India gives hope that even the laggard BIMARU States will now have an enormous opportunity to reap the demographic dividend, even as the progressive south and west India turn grey like Europe. Nowhere in his book or in other similar chronicles of India’s future is a reference to the poorest parts of the country where women are condemned to bear endless pregnancies, to be killed or incapacitated by repeated childbearing. Beyond death itself, perhaps the biggest oppression for a woman is to bring up a weak child in abject poverty and see her offspring deprived of a decent life.
Neither the lofty MDGs nor the protagonists of women’s empowerment groups have been overtly involved in promoting birth spacing — often drumming up propaganda about giving women the liberty to bear as many children as they want. No enforcement of the legal age of marriage, malnutrition, unwanted fertility, poor access to contraception, an unwillingness to audit maternal, infant and child deaths have seldom stirred the protagonists of women’s rights.
The UN statement is a change in the attitude to family planning and birth spacing. Only time will tell whether India will benefit or learn from the message and pay attention to family planning — the absence of which will deepen the ecological footprint more than carbon emissions would in the foreseeable future.