'Family planning cannot be addressed in isolation'

Sharat Pradhan in Lucknow

Disastrous. Five years ago, the question would have been simply, utterly disastrous.

Imagine going to a rural village in the heartland of Hindustan -- um, say, in Uttar Pradesh, India's most populous state -- and asking the first woman you meet this:

"Er, madam, sorry to bother you, but what do you do about, er, family planning?"

If you were lucky, you would get away with a good thrashing. If you weren't you wouldn't -- get away at all, that is.

But this is 1997, folks. Year 2000 minus three, an year of population awareness and family planning. So it is okay if you ask the question, even in rural UP. You will get away with it, alright.

"Condoms" says 35-year-old Shamim Bano of Saivam village, matter of fact-ly, the way she would answer something on what was cooking for dinner or about going to the market, "are increasingly becoming popular here. Copper-T too has gained ground in the last five years!"

This miraculous transformation -- of naive, uneducated women into citizens who know what birth control methods are -- owes much to the State Innovations in Family Planning Services Agency. The Rs 10 billion project, aided by the United States Agency for International Development, has gone miles along UP's family planning road. Today, like Shamim, hundred of rural women here know the how, when and why of birth control.

"Of the 200 to 300 people in this village, I have motivated at least 150 to go in for birth control. And you won't believe it, of the 35 women who have accepted Copper-T, 12 are Muslims!" Shamim -- who now works for the St Mary's Polyclinic, a vibrant non governmental organisation in the field -- says proudly.

Considering that UP, till not so very long ago, refused to have anything to do with family planning, this speaks volumes about the SIFPSA. The anti-birth control feeling was so strong in the state that when, during Indira Gandhi's time, the authorities tried to popularise sterilisation, people -- not just the conservative Muslims, but men of all religions -- went hammer and tongs after her.

"Why must we prevent the birth of children? They are gifts of God," was the way they looked at it.

Hence, as late as in 1995, the state had the highest fertility rate -- of 4.5 children per woman. (In Gonda district in east UP, it was as high as 6.2). If this growth rate were to remain unchanged, UP would touch 300 million -- double its current population -- in another 30 years. Which would make it the fourth largest 'country' in the world.

With the SIFPSA coming into picture, the danger seems not as glaring. The project, which kicked off two years ago, quite successfully addresses all the fundamental issues involved in family planning -- population awareness, spacing of children, contraception... To date, the SIFPSA -- which works through a network of 45 NGOs -- has carried out interviews with over 45,000 married women in the child-bearing ages of 13 and 49, spread over 28 of the state's 70 districts (where 40 per cent of the women get married between 15 and 19 years of age). And the results are there to see.

The SIFPSA engages locals for their work -- and that too more in the nature of health workers than employees of the family planning department. Of its total Rs 10 billion funding, Rs 5 billion is to be channelised directly. The USAID would pump in the rest through the other health schemes in the state.

So far, the organisation has received Rs 560 million. Of this Rs 450 million have been been funded to NGOs. "Unlike other schemes, ours is a benchmark-oriented programme. Every bit of funding depends on the attainment of certain benchmarks, and are negotiated between the Union government, USAID and SIFPSA" says Uma Pillai, an Indian Administrative Service officer who is the backbone of the project.

"People were suspicious about us in the beginning. But once they realised we were not here to impose anything on them, they began to respond," says Ram Suresh Maurya, an SIFPSA supervisor. After their basic training, these employees attend periodical lectures by doctors and health workers to keep in touch with the latest advances. Often they would cycle miles to attend a lecture, or visit a needy family.

Neeru Varma, a 20-year-old graduation student, is perhaps the only unmarried girl to have taken up a supervisor's job with the SIFPSA project in a Lucknow village. She is a 'motivator' (who carries out her job with unusual ease) to many couples, most of them much senior to her. "Had it not been for Neeruji, I would have had my fourth child," confesses 28-year old Shakuran, "She managed to convince both me and my husband, who has never before listened to any one on the matter, to use contraceptives."

Unlike earlier family planning programmes the SIFPSA adopts a 'wholistic' approach. "Family planning cannot be addressed in isolation," Pillai observes, "Due recognition is given to the rights of individuals to make their own decisions about the size of their family as also to choose birth control methods."

Besides their work in villages, the SIFPSA has also evolved what they call 'family life education' in urban areas. Here, counsellors impart population and sexual education to the college-going young men and women. "If the momentum of population needs to be arrested, this is the right age to strike. After all, these young people are the parents of tomorrow," Pillai says. The attempt, she adds, has been received well.

The SIFPSA's approach to birth control too differs from the projects of old. It seeks to address all significant determinants of reproductive behaviour and puts family planning in an overall context of development, listing support from a variety of people, both in the public and private sectors. These include cooperatives, panchayats, the Integrated Child Development Scheme, the Indian Medical Association and the like.

The SIFPSA is also engaged in establishing improvised medicare centres (Apna Ghars). These centres are equipped with basic facilities, including disposable delivery kits, contraceptives, vitamins, iron and folic acid tablets, and are entrusted to the care of local workers. "Apna Ghars have gone a long way in reducing the incidence of tetanus often caused in infants due to the indiscriminate use of knives and even sickles for cutting umbilical cords," Pillai says.

The SIFPSA's most proud moment was when United States Ambassador Frank Wisner wrote to the USAID chief after his visit to UP in April, 1996. "The SIFPSA clinic I visited is one of the very few sites in India providing the full range of child spacing methods," his glowing letter ran, "I was impressed by the professionalism and pride of the staff and the satisfaction and gratitude of the clients."

"The day," Pillai claims proudly, " is not far when other states will replicate SIFPSA."