Holistic Approach to
term 'Family Planning' was initially coined by Margaret Sanger to
indicate 'to have babies by choice and not by chance', in her pioneering
social work promoting use of contraceptives in the slum population of
Harlem, New York in the early twentieth century (Srinivasan, 2014). In
India, it was in the All India Women's Conference in 1935 held at
Thiruvanthapuram, where it was resolved to champion modern methods of
contraception as a part of women's right to have babies by choice and
not by chance.
the first country to have a 'National Family Planning Programme' way
back in 1951. Ironically, the terms 'family planning' and 'family
welfare' were merely euphemisms for population control (Sarojini, Gupta,
Ambhore, Venkarachalam & Nandi, 2014). Srinivasan (2014) states that
there was a long held mistaken view that high population was the major
cause for all the problems in the country, and if we are able to tackle
this problem, all other problems will get solved. The government's
anxiety over population growth and the resultant coercive population
control measures invariably targeted women, especially the poor and
underprivileged through sterilisations.
inception of the family planning programme in 1952, the programme was
ensconced in a “HITTS model” (Srinivasan, 1995; as cited in Srinivasan,
2014), that is, a health department operated, incentive based,
target-oriented, time-bound and sterilisation-focused programme.
Vasectomy or male sterilisation was regarded as the central point for
fertility regulation and became an essential condition for family
planning in the country.
Evolution of Family Planning Programmes: Post the Emergency Period
government that assumed power in 1977 changed the name of 'family
planning' to 'family welfare', and aimed to reduce the target on
sterilisation through a programme of education and motivation. A revised
population policy was adopted in 1977 which was completely against
coercive sterilisation, and its approach was 'educational and wholly
voluntary'. The period after 1977 came to be known as the 'Recoil and
Recovery phase' (Srinivasan, 2014). It was here when female
sterilisation began to replace male sterilisation, and thereafter became
the dominant method of family planning in India. This was implemented
through all the sub-centres and Primary Health Centres (PHCs) in the
rural areas, without any coercion or mass camps for sterilisation, as it
was done in the earlier years. Interestingly, with increase in
tubectomies among women, fertility rates in some states showed a
decline. For example in Tamil Nadu, the birth rate fell from 33.6 in
1970-72 to 23.1 by 1989. This was another reason why female
sterilisations were encouraged on a mass scale through a camp approach,
largely ignoring other modern methods of family planning such as
condoms, oral pills, IUDs etc. (Sarojini, et.al, 2014).
International Conference on Population and Development (ICPD) at Cairo
in 1994, and the international women's movement, setting up fertility
goals and related family planning targets by putting the onus on women
was seen as an infringement of women's human rights and especially their
reproductive rights. The consensus was that population policies should
not be implemented with the sole aim of reducing fertility or birth
rates, but also consider reproductive health, reproductive rights and
Sterilisation Camp at Bilaspur, Chhattisgarh
revised population policy in place, on 8th and 10th November, 2014 four sterilisation camps were organised at Sakri Pendari, Gourella, Pendra
and Marwahi in Bilaspur district of Chhattisgarh state. Almost 140 women
were brought to these camps for sterilisation. The largest of these
camps for 33 women was conducted in a short span of 3-4 hours, with a
single laparoscope machine, in an abandoned private charitable hospital.
This was a non-functional health facility that had been abandoned for
many years. 13 women, all in their 20s or 30s died and 70 others were
left in a critical health condition after the laparoscopic sterilisation
at the camps. Among those who died were women from Dalit, adivasi/tribal
and OBC (Other Backward Classes) communities. This raised the serious
question about the careless treatment meted out to the poor and
marginalised women and the clear violations of ethical and quality norms
in the health care system.
is symbolic of the widespread apathy of the health system and the
glaring violations of accepted standards in sterilisation camps, which
have been normalised and justified as responding to a large 'unmet
need'. There was no provision for recovery rooms, and the women, just
after being operated were made to lay down on durries that were placed
in the corridors right outside the operation theatre. The women were
also discharged within an hour or two after the surgery without been
given any post-operative care. No transport facilities were provided to
help them go back to their homes.
aspect that was highlighted in this camp was the issue of consent. It is
crucial for the treating doctor to explain the procedure, the risks
involved and the alternatives available to the patient. Any surgical
activity done on the patient without his/her consent is considered as
unlawful. Some of the families did agree to sign a form before the
surgery and some said that the signatures of the woman were also taken.
Yet, this was not followed by any information dissemination to the
patient or counselling which would facilitate the aspect of 'informed
consent' by the women.
The lack of
attention paid to the needs of young couples, and to men's
responsibility for contraception is a glaring omission today. Promotion
of modern methods of contraception like condoms, which are safer and
easier to use should be encouraged. Furthermore, the promotion of
contraception through government policies should not be just directed at
married couples, but also un-married people. The need of the hour is to
have a more holistic population policy which aims at preservation of
reproductive health of all genders from all sections of the society.
Alternatives, through its functional literacy programme TARA Akshar+
bridges the literacy to empowerment connect. Not only are the women made
functionally literate, they are able to transform themselves into more
aware citizens so as to have access to their rights and entitlements. In
this pursuit, TARA Akshar+ under its mandate to empower communities has
innovated a module on health awareness which is built to fill the gap
between lack of awareness of the poor and marginalised communities on
basic health issues. A large portion of this module incorporates various
topics on women's health focusing on reproductive and sexual health.
Ambhore, V., Gupta, J.S., Nandi, S. Sarojini, N., & Venkatachalam, D.
(2014). Camp of Wrongs: The Mourning Afterwards. Retrieved from http://popdev.hampshire.edu/sites/default/files/uploads/Camp%20of%20Wrongs.pdf
Balasundaram, S. (2011). Stealing wombs: Sterilization abuses and
women's reproductive health in Sri Lanka's tea plantations. Indian
Anthropologist, 41, (2), 57-78.
Srinivasan, K. (2014). Family planning programs in India: An overview
and need for a revision (Working Paper No. 216). Madras Institute of
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