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HVK Archives: Empowerment brings acceptance of small families

Empowerment brings acceptance of small families - The Times of India

Anita Anand ()
11 July 1997

Title: Empowerment brings acceptance of small families
Author: Anita Anand
Publication: The Times of India
Date: July 11, 1997

World Population Day on July 11 is an opportunity to reflect on the shifts
and successes of population issues. This is partly due to the focus of
health programmes moving away from reducing the population to other
techniques encouraging people to have smaller families.

The plan of action adopted at the International Conference on Population
and Development in 1994 stated, "Governments are encouraged to focus most
of their efforts towards meeting their population and development
objectives through education and voluntary measures rather than schemes
involving incentives and disincentives."

China is a country that has faced a good deal of criticism for its coercive
population policies including it's one-child policy. But a lesser known
fact is that the Chinese government has made noteworthy progress in rural
areas where traditionally "many hands make light work" was the guiding
principle.

Although a national family planning policy was launched throughout China in
the late 1970s, it was not until the 1990s that a planner hit on a recipe
for success in rural areas. Xiong Xicheng, director of the Changsha
country family planning commission and the creator of the innovative
programme, says that the idea is to provide preferential economic treatment
for participants so that they can get rich ahead of others. They also
receive contraception and health care services and personal insurance to
guarantee a secure life when they are old.

"Family planning is a great policy for raising the standard of living in
the country. Yet many farmers don't understand this until they really
benefit from it," says Xiong.

In 1991, Xiong selected couples willing to have only one child, or two in
case the first-born was a daughter, from each of the 524 villages in the
country. Xiong offered priorities in contracting land, obtaining loans and
technological assistance. Participants were granted tax reductions and
considered first for employment in local government enterprises. Few
villagers, however, stepped forward. "We had to knock on doors to persuade
people," Xiong says. Young couples responded first.

A survey conducted by the Human Provincial Family Planning Commission,
shows that the birth rate in Changsha country dropped from 20.64 per
thousand in 1990 to 11.53 per thousand in 1995, while per capita annual
income rose from $100 to $250 during the same time.

India opted for a major policy shift in 1995, moving from a 'target
approach' to one of reproductive health which calls for a major overhaul of
the primary health system. The draft statement on National Population
Policy of the department of family welfare states, "A package of
reproductive health care will be delivered through the primary health care
system."

A pathbreaking initiative started by a few health professionals in the
Brihan Mumbai Municipal Corporation (BMC) is an eye-opener. The project
began as a study on the incidence of pelvic inflammatory disease (PID)
among slum women in the city. PID is inflammation of the upper genital
tract and pelvic organs.

Its main causes are vaginal infections, menstrual disorders, abortion and
incorrect contraceptive use leading to infertility, ectopic pregnancy and
chronic pain, threatening the reproductive potential and health of many
women. In May 1993, the health department of the BMC in association with
the population and reproductive health programme of the Liverpool School of
Tropical Medicine initiated a project to study the factors predisposing
women to PID.

For the social component, information about the woman's sexual history, her
partners, deliveries, abortions and contraceptive decisions needed to be
collected. Thirty auxiliary nurse midwives were chosen. Mumbai's 150
health posts cover a population of 70,000 each.

"The ANMs have to visit 60 houses every day," says training officer Swati
Pongurlekar, "and so every women becomes a case to them." During the
project ANMs had to interview women about their sexual histories. This
required that they "delearn" their past quantity-based orientation. The
transformation was enabled through 13 workshops spread over two years.

The ANMs did brief interviews with 4000 women who visited the three
hospitals for family planning, followed by 250 in-depth interviews. No
targets were set. Each ANM interviewed about four women a day, at times
less, and went back to the same women about four times.

"it wasn't possible to change our approach immediately," admits Rajni
Gawda, an ANM. "Initially, I was shy to talk about sex. We didn't
understand it isn't bad for a woman to be sexual." The women who were
interviewed said nobody had ever asked them about pain during intercourse,
ill-treatment by husbands, or painful vaginal infections. The ANMs
experienced a feeling of empowerment. Neighbourhood women began coming to
them to talk about menopause, about unfulfilled sexual urges, about
numerous hitherto "taboo" subjects.

As the needs of women were realised, so were the shortcomings of the
system. At one stage during the project, the BMC ordered the ANMs to
participate in a tubal ligation (female sterilisation) camp. This
disturbed the trainees, who realised that the system could not be changed
overnight.

However the BMC has realised that women badly need information about tests
in hospitals, side-effects of contraception, sexual health etc. While the
target approach may not be dropped completely, the health needs of women
will be looked at more concertedly.

The Chinese example shows how policies and programmes which keep in mind
the needs of people can lead to successful adoption of the small family
norm and economic empowerment. The Indian example shows that it is
possible for the government to train the health workers to be sensitive to
their clients, by better information, tools of trade, and some room for
initiative.

The reality is that no one has the answers when it comes to implementing
population programmes. The sexuality of human beings requires a subtle
approach, which can only come about with the various parties working
together. (Women's Feature Service)


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