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The political determinants of fertility control policy in South Asia Calder, John Gilchrist 1982

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THE POLITICAL DETERMINANTS OF FERTILITY CONTROL POLICY IN SOUTH ASIA by John G i l c h r i s t C a l d e r B.A., The U n i v e r s i t y o f B r i t i s h C o l u m b i a , 1978 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS i n THE FACULTY OF GRADUATE STUDIES (Department o f P o l i t i c a l S c i e n c e ) We a c c e p t t h i s t h e s i s as c o n f o r m i n g to the r e q u i r e d s t a n d a r d THE UNIVERSITY OF BRITISH COLUMBIA June 1982 Q John G i l c h r i s t C a l d e r , 1982 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t o f the requirements f o r an advanced degree a t the U n i v e r s i t y o f B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and study. I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying o f t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the head o f my department or by h i s or her r e p r e s e n t a t i v e s . I t i s understood t h a t copying o r p u b l i c a t i o n o f t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be allowed without my w r i t t e n p e r m i s s i o n . Department of P o l i t i c a l S c i e n c e The U n i v e r s i t y o f B r i t i s h Columbia 1956 Main Mall Vancouver, Canada V6T 1Y3 _ . J u l y 30, 1982 Date 1 DE-6 (.3/81) - i i -ABSTRACT T h i s t h e s i s p r e s e n t s a comparison o v e r time o f the f e r t i l i t y c o n t r o l p o l i c i e s o f I n d i a , P a k i s t a n , B a n g l a d e s h , and S r i Lanka. I t i s a s e a r c h f o r c o m m o n a l i t i e s and i d i o s y n c r a c i e s among t h e d e t e r m i n a n t s o f the t h r e e major elements o f f e r t i l i t y p o l i c y , namely: ( i ) the f e r t i l i t y p o l i c y f a c t , ( i i ) s h i f t s up o r down i n t h e v i g o u r o r c o e r c i v e n e s s o f f e r t i l i t y p o l i c y , and ( i i i ) s p e c i f i c measures t a k e n t o c o n t r o l p o p u l a t i o n growth on t h e s u b c o n t i n e n t . The development o f t h e s e p o l i c i e s i s d i v i s i b l e i n t o t h r e e d i s t i n c t p h a s e s . In t h e f i r s t phase the appearance o f f e r t i l i t y c o n t r o l on t h e p u b l i c p o l i c y agenda i s e x p l a i n e d . The s h i f t i n t o the second phase -- i n which government a c t i v i t y i n t h e s e c o u n t r i e s took a d r a m a t i c u p t u r n — i s t h e n a c c o u n t e d f o r . T h i s s h i f t o c c u r r e d when i t became a p p a r e n t t h a t m o t i -v a t i o n o f f e r t i l e c o u p l e s was a t l e a s t as i m p o r t a n t as p r o v i d i n g them w i t h the means to p r e v e n t c o n c e p t i o n , and was, a c c o r d i n g l y , marked by a s u c c e s -s i o n o f " c r a s h programmes" t o a t t a i n b o t h t h e s e o b j e c t i v e s . In t h e t h i r d phase -- c h a r a c t e r i z e d by e x p e r i m e n t a t i o n w i t h p o l i c y c o n c e p t s which go beyond the t r a d i t i o n a l p r a c t i c e s o f f a m i l y p l a n n i n g -- I n d i a ' s e x p e r i e n c e w i t h c o m p u l s i o n i n f e r t i l i t y c o n t r o l p o l i c y i s d e s c r i b e d and e x p l a i n e d i n c o n t r a s t t o her own and o t h e r c o u n t r i e s ' p a s t p o l i c i e s . The whole range o f d e t e r m i n a n t s o f t h e s e s h i f t s and c h o i c e s i s d i v i d e d i n t o f i v e c a t e g o r i e s o f a n a l y s i s : environment, power, i d e a s , i n s t i t u t i o n s , and p r o c e s s . The most i m p o r t a n t o f t h e s e i s h i g h l i g h t e d f o r each s u c c e s s i v e s h i f t i n p o l i c y d i r e c t i o n . The t h e s i s a r g ues t h a t the o v e r a l l p a t t e r n o f f e r t i l i t y c o n t r o l p o l i c y - m a k i n g r e v e a l s t h a t s h i f t s i n commit-ment o c c u r r e d l a r g e l y as a r e s u l t o f c h o i c e s by i n d i v i d u a l l e a d e r s who responded to changes i n the demographic and economic e n v i r o n m e n t s and, --i n a c c o r d a n c e w i t h what t h e y p e r c e i v e d t o be p o l i t i c a l l y f e a s i b l e — a t t e m p t e d to a f f e c t t h a t e n v i r o n m e n t . - i v -TABLE OF CONTENTS Ch a p t e r I I n t r o d u c t i o n 1 F o o t n o t e s 11 C h a p t e r II The P i o n e e r i n g Phase . . 13 F o o t n o t e s 30 Chapter I I I The C r a s h Programme Phase 33 F o o t n o t e s 62 C h a p t e r IV Beyond.Family P l a n n i n g . 66 F o o t n o t e s 78 C h a p t e r V A n a l y s i s and C o n c l u s i o n s 80 F o o t n o t e s . . . 101 B i b l i o g r a p h y 102 - V -ILLUSTRATION AND TABLES F i g u r e 1 A p p r o p r i a t e Time B o u n d a r i e s o f F e r t i l i t y C o n t r o l P o l i c i e s i n I n d i a , P a k i s t a n , Bangladesh and S r i Lanka 3 T a b l e 1 Q u i n q u e n n i a l Averages o f B i r t h s per Thousand P o p u l a t i o n and P e r c e n t Change, 1950-55 t o 1975-80, by C o u n t r y 5 T a b l e 2 A l l o c a t i o n by P l a n f o r V a r i o u s S u b j e c t s : M i l l i o n s o f Rupees 16 T a b l e 3 Rate o f U t i l i z a t i o n i n F i r s t and Second P l a n s 17 T a b l e 4 M e d i c a l P e r s o n n e l i n B a n g l a d e s h , I n d i a , P a k i s t a n and S r i Lanka 35 T a b l e 5 F e r t i l i t y P o l i c y P r o p o s a l s by C r i t e r i a 67 T a b l e 6 F e r t i l i t y P o l i c y P r o p o s a l s as C o n s i d e r e d and T r i e d , and T h e i r P e r c e i v e d E f f e c t i v e n e s s . . . . 68 T a b l e 7 S t a t e w i s e S t e r i l i z a t i o n T a r g e t s , N a t i o n a l P o p u l a t i o n P o l i c y , 1976, i n Lakhs 72 CHAPTER I INTRODUCTION T h i s t h e s i s p r e s e n t s a c o m p a r a t i v e a c c o u n t o f t h e e v o l u t i o n o f the p o p u l a t i o n c o n t r o l p o l i c i e s o f I n d i a , P a k i s t a n , B a n g l a d e s h , and S r i Lanka ( C e y l o n ) . * From t h i s c o m p a r a t i v e a c c o u n t I hope to draw some con= e l u s i o n s about the r e l a t i v e i m p o r t a n c e o f the v a r i o u s f a c t o r s which work t o g e t h e r t o d e t e r m i n e t h e e x i s t e n c e o f p o l i c i e s , s h i f t s i n t h e s e p o l i c i e s , and t y p e s o f programmes i n t h e s e c o u n t r i e s . T h i s a n a l y s i s s h o u l d answer the q u e s t i o n s : What i s t h e r o l e o f p o l i t i c s i n the d e t e r m i n a t i o n o f t h e s e p o l i c i e s ? A r e the d e t e r m i n a n t s the same f o r a l l c o u n t r i e s a t a l l t i m e s , o r a r e t h e o r i g i n s and s h i f t s i n t h e s e p o l i c i e s the outcomes o f i d i o s y n -c r a c i e s o f l o c a l e n v i r o n m e n t and h i s t o r y ? I w i l l argue t h a t p o l i t i c s i n f u s e s and w i l l c o n t i n u e t o i n f u s e any a t t e m p t by governments i n t h i s r e g i o n t o a f f e c t t h e demographic p i c t u r e . By " p o p u l a t i o n p o l i c y " , c o n v e n t i o n a l l y , i s meant " o f f i c i a l measures a f f e c t i n g , i n t e n d e d t o a f f e c t , o r r e s p o n s i v e t o change i n numbers, composi-2 t i o n , o r movements o f t h e members o f any group". Such a d e f i n i t i o n i s t o o broad f o r the p u rposes o f t h i s s t u d y , embracing as i t does, n o t o n l y a government's i n t e n t i o n s to a f f e c t p o p u l a t i o n s i z e , but a l s o any a c t i o n which might i n a d v e r t e n t l y have a demographic impact o r which might have been i n f l u e n c e d by demographic change. In p r a c t i c e , p o p u l a t i o n p o l i c y on the s u b c o n t i n e n t has always meant f e r t i l i t y c o n t r o l p o l i c y . The demographer d e f i n e s f e r t i l i t y as "a measure o f t h e number o f l i v e c h i l d r e n born t o i n -3 d i v i d u a l s , c o u p l e s , o r p o p u l a t i o n s " . F e r t i l i t y c o n t r o l p o l i c y , t h e n , means - 2 -i n d i r e c t o r d i r e c t i n t e n t i o n a l measures taken by governments to r e d u c e t h e b i r t h r a t e . Why have I n d i a , P a k i s t a n , B a n g l a d e s h and S r i Lanka been ch o s e n f o r a s t u d y o f f e r t i l i t y c o n t r o l p o l i c i e s ? The c o u n t r i e s o f t h e A s i a n s u b c o n t i -nent s h a r e 26.8 p e r c e n t o f t h e d e v e l o p i n g c o u n t r i e s ' t o t a l p o p u l a t i o n . The annual r a t e s o f n a t u r a l i n c r e a s e f o r I n d i a , P a k i s t a n , B a n g l a d e s h and S r i Lanka range from 2.5 p e r c e n t o r 3.0 p e r c e n t i n P a k i s t a n and B a n g l a d e s h to 1.8 p e r c e n t i n S r i Lanka. I n d i a , which c o n t a i n s 60 p e r c e n t o f the t o t a l s u b c o n t i n e n t a l p o p u l a t i o n , l i e s between t h e s e e x t r e m e s , w i t h a r a t e 4 o f 1.9 t o 2.2 p e r c e n t . These c o u n t r i e s have a l l e x p e r i e n c e d a d r a m a t i c d e c l i n e i n m o r t a l i t y r a t e s o v e r t h e l a s t f o r t y y e a r s , and i t i s t o t h i s t h a t t h e i r r a p i d p o p u l a t i o n growth i s a t t r i b u t a b l e . P o s s e s s i n g o n l y f i n i t e r e s o u r c e s o f l a n d , w a ter and e n e r g y , t h e s e c o u n t r i e s f a c e a c a t a s t r o p h i c r e t u r n t o h i g h m o r t a l i t y l e v e l s i f p o p u l a t i o n growth i s not b r o u g h t i n t o e q u i l i b r i u m t h r o u g h the i n t e r v e n t i o n o f n a t i o n a l governments t o l i m i t f e r -t i l i t y . F o r t u n a t e l y , t h e governments o f South A s i a have been among the f i r s t i n t h e w o r l d t o r e c o g n i z e and r e s p o n d t o t h i s problerir. The f a t e o f a s u b s t a n t i a l p r o p o r t i o n o f t h e d e v e l o p i n g w o r l d , about one q u a r t e r , depends on t h e f e r t i l i t y c o n t r o l d e c i s i o n s made by t h e s e governments. T h e r e a r e s e v e r a l k i n d s o f c a s e s t u d y . I t has been s a i d t h a t the s t u d y o f s i n g l e c a s e s has not l e d t o an a c c u m u l a t i o n o f t h e o r e t i c a l p r o p o s i -5 t i o n s . P o l i c y a n a l y s t s such as H e c l o recommend the c o mparison o f d i f f e r e n t c a s e s i n o r d e r t o c a p t u r e t h e h i g h l i g h t s o f a p a r t i c u l a r p o l i c y phenomenon.^ R i c h a r d Simeon has s u g g e s t e d t h a t 7 , i f , i n a d d i t i o n t o s t a t i c c o m p a r i s o n s "over s p a c e " , one can p r e s e n t the u n f o l d i n g o f p r o c e s s o v e r a s e l e c t e d - 3 -p e r i o d o f t i m e , one i s even more l i k e l y t o advance the c a u s e o f p u b l i c p o l i c y a n a l y s i s i n t h e r i g h t d i r e c t i o n / I t has been n e c e s s a r y t o s e t c h r o n o l o g i c a l l i m i t s on the a c c o u n t s o f f e r t i l i t y p o l i c y e v e n t s under s t u d y here both i n t h e i n t e r e s t o f b r e v i t y and f o r r e a s o n s o f d a t a a v a i l a b i l i t y . P o l i c y does not s t o p a f t e r , s a y , 1972 i n S r i Lanka o r 1977 i n I n d i a , but l i t t l e has been w r i t t e n on f e r t i l i t y p o l i c y s i n c e 1972 i n t h e f o r m e r , nor has i t a l t e r e d i t s e s s e n t i a l d i r e c t i o n s i n c e 1977 i n the l a t t e r . F i g u r e 1 shows the p e r i o d s under s t u d y h e r e . I have a r b i t r a r i l y s e t the o f f i c i a l b e g i n n i n g o f f e r t i l i t y c o n t r o l p o l i c y i n a c o u n t r y as t h a t t ime when t h e s u b j e c t f i r s t began t o be d i s c u s s e d as a m a t t e r o f p u b l i c p o l i c y . 9 F i g u r e 1 A p proximate Time B o u n d a r i e s o f F e r t i l i t y C o n t r o l P o l i c i e s i n I n d i a , P a k i s t a n , B a n g l a d e s h and S r i Lanka C o u n t r y Time I n d i a 1943 1977 P a k i s t a n 1955 1978 B a n g l a d e s h .... 1972. . . 1976 S r i Lanka 1954 1972 C o mparative a n a l y s i s e n t a i l s the s e a r c h f o r and e x p l a n a t i o n o f both s i m i l a r i t i e s and d i f f e r e n c e s . I f t h e d i f f e r e n c e s between c a s e s a r e f u n d a -mental and o v e r w h e l m i n g , a s , s a y , between I n d i a and I c e l a n d , i t i s d i f f i -c u l t t o make a u s e f u l c o m p a r i s o n . But the f o u r .South A s i a n s t a t e s have much i n common. They a r e a l l l o c a t e d i n what i s c o n v e n t i o n a l l y r e g a r d e d as t h e same g e o g r a p h i c r e g i o n , the South A s i a n s u b c o n t i n e n t . They have a l l 7 4. -emerged from o v e r a c e n t u r y o f B r i t i s h c o l o n i a l r u l e . A l t h o u g h t h e v a r i e t y o f c u l t u r e s i n the s u b c o n t i n e n t i s d a z z l i n g , n e a r l y a l l have D r a v i d i a n o r Arya n r o o t s . E c o n o m i c a l l y , t h e y a r e a l l p r e d o m i n a n t l y a g r i c u l t u r a l , and sh a r e t h e i n t e r t w i n e d problems o f h i g h unemployment, low. c a p i t a l a c c u m u l a t i o n , a n d . t h a t p e r v a s i v e and i n t r a n s i g e n t complex o f s c a r c i t y o f t e n put under the r u b r i c " p o v e r t y " . Timberg has r e c e n t l y d e s c r i b e d t h r e e t y p i c a l p aths t o development i n 8 South A s i a . These a r e e x e m p l i f i e d by r e g i o n s which t r a n s c e n d n a t i o n a l b o u n d a r i e s , s h a r i n g f e a t u r e s w i t h c o u n t e r p a r t s i n n e i g h b o u r i n g c o u n t r i e s . I t i s t r u e t h a t f o r the purposes o f comparing t h e l o c a l d e v e l o p m e n t a l e c o l o g i e s o f South A s i a , Timberg's s u b d i v i s i o n s make more sense than does u s i n g n a t i o n a l p o l i t i c a l b o u n d a r i e s . S i n c e t h e f o c u s here however, i s on the a c t i o n s o f n a t i o n a l governments, t h e u n i t o f a n a l y s i s w i l l be the s t a t e i t s e l f , n o t w i t h s t a n d i n g i n t e r n a l d i v e r s i t y . C omparative a n a l y s i s o f what na.tional governments have done and a r e d o i n g s h o u l d p r o v i d e a b e t t e r under-s t a n d i n g o f f e r t i l i t y c o n t r o l p o l i c y d e t e r m i n a n t s . A l t h o u g h a g r e a t d e a l has been w r i t t e n on t h e many a s p e c t s o f f e r t i -l i t y and i t s c o n t r o l i n t h e s u b c o n t i n e n t , t h e b u l k o f the l i t e r a t u r e c o n -s i s t s o f s i n g l e - c o u n t r y a n a l y s e s which t e n d t o f o c u s on the unique demo-g r a p h i c o r p o l i c y f e a t u r e s o f ea c h . No s t u d y has at t e m p t e d a c r o s s - c o u n t r y comparison o f f e r t i l i t y p o l i c i e s i n t h i s r e g i o n . D e s p i t e t h e d i f f i c u l t i e s i n m a r s h a l l i n g t h e e v i d e n c e i n t o comparable and a n a l y s a b l e c a t e g o r i e s , t h i s a t t e m p t t o do so w i l l , I f e e l , make some c o n t r i b u t i o n t o the s e a r c h f o r u n i v e r s a l d e t e r m i n a n t s o f f e r t i l i t y c o n t r o l p o l i c y . A t the o u t s e t , one ought t o ask whether governmental p o l i c i e s i n South - 5 -A s i a have had any e f f e c t a t a l l on f e r t i l i t y . When one l o o k s a t the d i f -f e r e n c e i n f e r t i l i t y d e c l i n e s between the f o u r c o u n t r i e s , i t i s p a r t i c u l a r l y t e m p t i n g t o ask o f t h e d a t a whether o r n o t t h e i r r e s p e c t i v e p o l i c i e s can a c c o u n t f o r t h i s d i f f e r e n c e . T a b l e 1 shows t h a t c r u d e b i r t h r a t e s a r e lower i n I n d i a than i n P a k i s t a n and B a n g l a d e s h , and t h a t t h e y a r e s t i l l l o w e r i n S r i Lanka. Moreover, S r i Lanka has c o n s i s t e n t l y l e d the o t h e r s by a wide margin i n h e r r a t e o f d e c l i n e i n b i r t h r a t e s . Many minds have pon-d e r e d the q u e s t i o n o f d i f f e r e n t i a l f e r t i l i t y r a t e s as between c o u n t r i e s , p r o v i n c e s , o r d i s t r i c t s , but have been u n a b l e t o e s t a b l i s h c o n c l u s i v e l y t h a t a g i v e n d e c l i n e i n b i r t h r a t e i s the outcome o f f e r t i l i t y c o n t r o l measures, the u n i n t e n d e d consequences o f some o t h e r p o l i c y , o r whether 9 the d e c l i n e ' would have o c c u r r e d i n t h e absence o f any p o l i c y o r programme. TABLE 1 Q u i n q u e n n i a l Averages o f B i r t h s p e r Thousand P o p u l a t i o n and P e r c e n t Change, 1950-55 t o 1975-80, by C o u n t r y C o u n t r y 1950-55 1955-60 % Change 1960-65 % Change 1965-70 Bangladesh I n d i a P a k i s t a n S r i Lanka 49.1 40.5 49.6 38.5 49.9 42.7 48.8 36.6 +1.63 +5.4 -1.6 -T--4.9 48.7 42.7 48.1 34.7 -2.4 0.0 -1.4 -5.2 48 40.9 47.1 31.5 % Change 1970-75 % Change 1975-80 % Change B a n g l a d e s h I n d i a P a k i s t a n S r i Lanka -1.4 -3.6 -2.0 -9.2 47.4 38.6 47.4 28.6 -1.3 -5.6 -0.64 -9.2 47 36.9 46.6 25.9 -.,84 -4.4 -1.7 -9.4 S o u r c e : U.N. Department o f I n t e r n a t i o n a l and Economic A f f a i r s , S e l e c t e d  Demographic I n d i c a t o r s by C o u n t r y , 1950-2000: P r o j e c t i o n s As A s s e s s e d i n 1978, (New York: U.N7,-T980), pp. 131-137. - 6 -However, i t is generally agreed that fertilit y control programmes have been well worth the money invested in terms of averted births compared with average returns on investments elsewhere in the economy.^ The demographic effectiveness, that is, the real success or failure o f fertility control policies in the countries under study here must remain a matter of speculation. On the other hand, their perceived effectiveness in terms o f acceptors, birth rates, and estimated births averted will be highly relevant to the explanation o f subsequent policies. There are no theories which claim a definitive explanation o f any public, policies, but there are students of the subject who have compiled useful categories under which they can be analysed. One such, Richard Simeon, has suggested five categories which embrace the fullest possible range o f potential policy determinants. These are: environment, power, ideas, institutions, and process. The value o f each category depends upon just which policy phenomenon one is trying to explain and on how close to actual events one wishes the explanation to be. A cursory check o f the fertility control policy story in South Asia indicates that important explanatory variables are distributed throughout these categories. As Simeon points out, "environment" encompasses a broad range o f variables.^ In the cases before us, some aspects o f the environment may be more immediate than others to the fertility policy events in question. For example, the technological environment in which policy is made could be an immediate determinant i f the discovery o f an "ideal" contraceptive pre-cipitates renewed enthusiasm for fertilit y control. On the other hand, the manner in which a contraceptive device must be distributed will determine - 7 -whether o r n o t i t i s chosen f o r p r o m o t i o n . The n o n - e x i s t e n c e o f the t o o l s needed t o implement a f e r t i l i t y c o n t r o l p o l i c y w i l l be a major c o n s t r a i n t . The background economic/demographic e n v i r o n m e n t , on the o t h e r hand, may be s u f f i c i e n t t o e x p l a i n the e x i s t e n c e o f f e r t i l i t y c o n t r o l p o l i c y i t s e l f . What Simeon c a l l s "power", we might s i m p l y c a l l " p o l i t i c s " . P o l i t i c s , t h e c o n t e s t f o r "who g e t s what, when, and how", has pervaded t he i s s u e s o f 12 p o p u l a t i o n c o n t r o l i n South A s i a i n r e c e n t y e a r s . F a m i l y p l a n n i n g p r o -grammes b e l o n g under t he c a t e g o r y o f p u b l i c p o l i c i e s which a r e not demanded by t h o s e most a f f e c t e d by them, b u t , r a t h e r , a r e i m p o s e d b y governments from above. W h i l e i t i s t r u e t h a t t h e i n t e n d e d " a c c e p t o r s " o f c o n t r a c e p t i v e s e r v i c e s and s u p p l i e s seldom demanded them, i t i s not t r u e t h a t f e r t i l i t y c o n t r o l p o l i c y has been f o r m u l a t e d i n a p o l i t i c a l vacuum. The p e r s o n a l i t i e s o f i n d i v i d u a l l e a d e r s and t h e i n t e r a c t i o n o f b i r t h c o n t r o l a d v o c a c y groups and p r o f e s s i o n a l m e d i c a l a s s o c i a t i o n s w i t h government have been d e c i s i v e both i n p u t t i n g f e r t i l i t y c o n t r o l p o l i c y on the agenda, and i n d e t e r m i n i n g t h e d i r e c t i o n i t would t a k e . On the o t h e r hand, the a p p a r e n t t h r e a t t o com-munal groups o f p o l i c i e s which have t h e p o t e n t i a l t o a l t e r t h e n u m e r i c a l b a l a n c e has l e d t o t h e i r temporary removal from t h e p u b l i c p o l i c y agenda. In t h e r e a l m o f i d e a s , t h e p r i n c i p a l d e t e r m i n a n t s o f p o l i c y w i l l be found a l o n g t h e l e f t / r i g h t d i m e n s i o n and among the t r e n d s i n t h i n k i n g w i t h i n the i n t e r n a t i o n a l f a m i l y p l a n n i n g movement. Do l e a d e r s b e l i e v e i t i s the b u s i n e s s o f government t o i n f l u e n c e p r i v a t e b e h a v i o r , and i f so do t h e y f e e l t h e p r i v a t e o r t h e p u b l i c s e c t o r i s b e s t s u i t e d f o r t h e j o b ? I n s t i t u t i o n a l d i f f e r e n c e s among t h e c o u n t r i e s under s t u d y may prove to be i m p o r t a n t i n e x p l a i n i n g t h e d i f f e r e n c e s i n f e r t i l i t y c o n t r o l p o l i c i e s . - 8 -The most r e a d i l y a p p a r e n t i n s t i t u t i o n a l d i f f e r n c e s i n t h e r e g i o n a r e I n d i a ' s f e d e r a l and P a k i s t a n ' s and S r i Lanka's u n i t a r y s t r u c t u r e s of government. E q u a l l y i m p o r t a n t i n d e t e r m i n i n g what a government d e c i d e s t o do might be the d i f f e r e n c e s i n l e v e l s o f development o f t h e b u r e a u c r a t i c o r c l i n i c a l i n f r a s t r u c t u r e of a g i v e n c o u n t r y , a s , f o r example, between B a n g l a d e s h and S r i Lanka. F i n a l l y , one would e x p e c t t h e p o l i c y of a government which must r e t u r n t o t h e e l e c t o r a t e p e r i o d i c a l l y f o r a . f r e s h mandate to d i f f e r from t h e p o l i c y of a government which does not have t o do s o . In Simeon's s e n s e , t h e f o c u s on p o l i c y p r o c e s s i s c l o s e l y r e l a t e d t o t h e s t u d y of power and i n s t i t u t i o n s . I t i s the sum of t h e i n f l u e n c e o f en-v i r o n m e n t a l and i d e a t i o n a l f a c t o r s t h r o u g h g r o u p s , p o l i t i c i a n s and b u r e a u -c r a t s on g i v e n p o l i c i e s . In a n o t h e r s e n s e , p r o c e s s can be examined f o r i t s i m p o r t a n c e as a d e t e r m i n a n t . In t h i s n arrower s e n s e , p o l i c y can be e x p l a i n e d 13 by p r e v i o u s p o l i c y . In both s e n s e s , t h i s t h e s i s i s v e r y much about p r o c e s s . I t w i l l a t t e m p t t o c a p t u r e t h e i n t e r p l a y and c a u s a l d i r e c t i o n between e n v i r o n m e n t , i d e a s , i n s t i t u t i o n s and p o l i t i c s , as w e l l as t o a s s e s s t h e i m p o r t a n c e o f p o l i c i e s t o s u b s e q u e n t p o l i c i e s . A t t h e nexus of both power and p r o c e s s i n f e r t i l i t y p o l i c y - m a k i n g i n South A s i a has been t h e o b s e r v a b l e i n c r e a s e i n t h e element o f c o e r c i o n 14 i n i t s f o r m u l a t i o n and i m p l e m e n t a t i o n . A f e r t i l i t y c o n t r o l p o l i c y , t o be e f f e c t i v e , must be a b l e t o both d e l i v e r s e r v i c e s and s u p p l i e s and m o t i v a t e m i l l i o n s o f c o u p l e s t o a l t e r t h e i r b e h a v i o r . Of t h e s e two a s p e c t s o f f e r t i l i t y c o n t r o l , t h e l a t t e r has l e d t o a r i s e i n the p o l i t i c i z a t i o n of t h e p r o c e s s . As demand f o r s e r v i c e s and s u p p l i e s was met and p o l i c y - m a k e r s began 1 t o b e l i e v e t h a t what was b e i n g done was h a v i n g an i n s u f f i c i e n t impact - 9 -on demographic o r a c c e p t o r t a r g e t s , i t became n e c e s s a r y t o i n c l u d e as c l i e n t s t h o s e who would r a t h e r n o t be; t h a t i s , the v a s t m a j o r i t y o f t h e f e r t i l e c o u p l e s i n t h e p o p u l a t i o n . T h i s h a s , on the s u b c o n t i n e n t , f i r s t been a t t e m p t e d t h r o u g h propaganda, then i n c e n t i v e payments, and f i n a l l y , c o m p u l s i o n . Some c o u n t r i e s , n o t a b l y I n d i a , have gone f a r t h e r than o t h e r s i n t h i s p r o c e s s . I t w i l l be a r g u e d here t h a t what s t a n d s o u t i n the d e t e r m i n a t i o n o f t h e s e c o u n t r i e s ' f e r t i l i t y p o l i c i e s , among t h e whole c o n c a t e n a t i o n o f e n v i r o n m e n t a l f a c t o r s , i d e a s , and i n s t i t u t i o n s , has been the o c c u p a t i o n o f a commanding p o s i t i o n i n the p o l i c y o f an i n d i v i d u a l w i t h a s t r o n g c o n v i c -t i o n t h a t g r e a t e r f e r t i l i t y c o n t r o l e f f o r t was both n e c e s s a r y and p o l i t i c a l l y f e a s i b l e . The p r e s e n c e o f such an i n d i v i d u a l became an i n c r e a s i n g l y n e c e s -s a r y c o n d i t i o n a t the l a t e r s t a g e s o f t h e p r o c e s s when f e r t i l i t y c o n t r o l p o l i c y was becoming more c o e r c i v e and hence more u n p o p u l a r . The p r o c e s s whereby f e r t i l i t y c o n t r o l p o l i c y - m a k i n g i n South A s i a e x p e r i e n c e d a c o n t i n u a l e x p a n s i o n o f i t s scope and t h e r e f o r e i t s p o l i t i c i ^ : . : z a t i o n can be d i v i d e d i n t o t h r e e b a s i c p h a s e s . T h e r e was t h e i n i t i a l p i o n e e r i n g phase, d u r i n g which I n d i a s t o o d o u t as t h e main e x p e r i m e n t o r i n p o l i c y o p t i o n s . T h i s was, however, l i t t l e more than an i n t e l l i g e n c e g a t h e r i n g phase d u r i n g which governments pondered t h e p r o p r i e t y o f g e t t i n g i n t o t h e f a m i l y p l a n n i n g b u s i n e s s . T h i s phase w i l l form the s u b j e c t o f the second c h a p t e r . The second phase, o f c r a s h programmes, which i s the t o p i c o f C h a p t e r T h r e e , was marked by a r e a l i z a t i o n t h a t whether o r not f e r t i l i t y c o n t r o l p o l i c y evoked s t r o n g o b j e c t i o n s by some o f t h e government's o p p o n e n t s , i t - 10 -was a m a t t e r o f g r e a t e r urgency t h a n had h i t h e r t o been t h o u g h t . D u r i n g t h i s p e r i o d , a l l f o u r c o u n t r i e s ' governments l a u n c h e d u n p r e c e d e n t e d e f -f o r t s t o i n f l u e n c e t h e b i r t h r a t e . The t h i r d phase, d e a l t w i t h i n t h e f o u r t h c h a p t e r , was marked by a r e a l i z a t i o n by t h i n k e r s i n the f i e l d t h a t t h e scope o f p o l i c y had been a l t o g e t h e r t o o narrow and h e n c e f o r t h government programmes must go "beyond  f a m i l y p l a n n i n g " i f t h e r e was t o be any hope o f b r i n g i n g down the b i r t h r a t e enough t o make any d i f f e r e n c e t o t h e s u c c e s s o r f a i l u r e o f n a t i o n a l 15 economic development e f f o r t s . T h i s phase encompasses a g r e a t many d i s -p a r a t e p o l i c y c o n c e p t s , from i n t e r v e n t i o n i n t o t h e c o r r e l a t e s o f h i g h f e r -t i l i t y on t h e v o l u n t a r i s t i c end o f t h e range o f o p t i o n s , t o c o m p u l s o r y s t e r i -l i z a t i o n a t t h e i n v o l u n t a r y end. A l l governments have p a i d l i p - s e r v i c e t o the f o r m e r c a t e g o r y o f measures, but o n l y I n d i a has e x p e r i m e n t e d w i t h t h e l a t t e r . I n d i a ' s move from t h e c o n c e p t o f "beyond f a m i l y p l a n n i n g " i n t o a c t i o n w i l l be c o n t r a s t e d w i t h t h e n o n - o c c u r r e n c e o f such an e v e n t i n the o t h e r t h r e e c o u n t r i e s i n C h a p t e r Four. In C h a p t e r F i v e , f i n a l l y , . I w i l l p r e s e n t a c o u n t r y - b y - c o u n t r y and phase-by-phase a n a l y s i s t o show how the a c t i o n s and w i l l o f i n d i v i d u a l n a t i o n a l l e a d e r s s t o o d o u t among o t h e r l e s s i m p o r t a n t d e t e r m i n a n t s . CHAPTER I FOOTNOTES 1. I w i l l r e f e r t o t h i s c o u n t r y as C e y l o n i n t h e t e x t when e v e n t s b e i n g r e c o u n t e d o c c u r r e d b e f o r e t h e 1971 name change, and as S r i Lanka when t h e y o c c u r r e d , a f t e r . 2. H a r d o l d D. L a s s w e l l , " P o p u l a t i o n Change and P o l i c y S c i e n c e s : P r o -posed workshops on R e c i p r o c a l Impact A n a l y s i s , " i n P o l i c y S c i e n c e s  and P o p u l a t i o n , e d s . , Warren F. iTehman, H a r o l d D. L a s s w e l l , John D. Montgomery ( L e x i n g t o n : L e x i n g t o n Books, 1975), p. 117. 3. R o b e r t H. C a s s e n , I n d i a : P o p u l a t i o n , Economy, S o c i e t y (London: M a c M i l l a n P r e s s , 1978), p. 341. 4. Dorothy L. Nortman, E l l e n H o f s t a t t e r , P o p u l a t i o n and F a m i l y P l a n n i n g  Programs, N i n t h E d i t i o n , (New York: P o p u l a t i o n C o u n c i l , 1978), p. 11 5. Hugh H e c l o , "Review A r t i c l e : P o l i c y A n a l y s i s , " B r i t i s h J o u r n a l o f  P o l i t i c a l S c i e n c e 2 ( J a n u a r y , 1972): 90 and R i c h a r d Simeon, " S t u d y i n g P u b l i c P o l i c y , " Canadian J o u r n a l o f P o l i t i c a l S c i e n c e 9 (December 1976: 551. 6. Hugh H e c l o , op. c i t . , p. 88. 7. R i c h a r d Simeon, op. c i t . , p. 550. 8. Thomas Timberg, "Regions i n I n d i a Development," P a c i f i c A f f a i r s . 53 (Autumn, 1980): 643-50. 9. See, f o r example, B e r n a r d B e r e l s o n , "An E v a l u a t i o n o f t h e E f f e c t s o f P o p u l a t i o n C o n t r o l Programmes," i n P o p u l a t i o n and i t s Problems: A  P l a i n Man's G u i d e , ed. H.B. P a r r y "(Oxford: C l a r e n d o n P r e s s , 1974): 133-68; Dorothy L. Nortman, " S t a t u s o f F a m i l y Planning, Programmes i n D e v e l o p i n g C o u n t r i e s i n R e l a t i o n t o Demographic T a r g e t s , " P b p u l a t i o n  S t u d i e s 26 (March, 1972): 5-18; R.J. Lapham and W.P. M a u d l i n , " N a t i o n a l F a m i l y P l a n n i n g Programmes: Review and E v a l u a t i o n , " S t u d i e s i n F a m i l y  P l a n n i n g 3 (March, 1972) pp. 30-50; and John. R a t c l i f f e , " S o c i a l J u s t i c e and t h e Demographic T r a n s i t i o n : Lessons from I n d i a ' s K e r a l a S t a t e , " I n t e r n a t i o n a l J o u r n a l o f H e a l t h S e r v i c e s , 8 (No. 1, 1978): 123-43. " ~ 10.. T h e r e i s a l a r g e l i t e r a t u r e on t h e m o n e y - e f f e c t i v e n e s s a s p e c t s o f f e r t i l i t y c o n t r o l . See f o r example, L.G. Bower, "The R e t u r n s from Investment i n P o p u l a t i o n C o n t r o l i n Less Developed C o u n t r i e s , " Demography 5 (No. 1, 1968): 422-32. P. Demeny, "Investment A l l o c a t i o n and P o p u l a t i o n Growth," Demography 2 ( 1 9 6 5 ) : 203-32. Stephen Enke, " B i r t h C o n t r o l f o r Economic Development," S c i e n c e 164 (May 16, 1969): 798-802. J.W. L e a s u r e , "Some Economic B e n e f i t s o f B i r t h P r e v e n t i o n , " M i l bank Memorial Fund Q u a r t e r l y 45 ( O c t o b e r , 1967): 417-25 and J . L . Simon, "The V a l u e o f A v o i d e d B i r t h s t o U n d e r d e v e l o p e d C o u n t r i e s , " P o p u l a t i o n S t u d i e s 23 (March, 1969): 61-68. - 12 -11. R i c h a r d Simeon, op. ' c i t . , p. 567. 12. N a z l i C h o u c r i , "The P e r v a s i v e n e s s o f P o l i t i c s , " P o p u l i 5 (No. 3 ) : 30-44. 13. R i c h a r d Simeon, op. c i t . , p. 578. 14. Theodore L o w i , " P o p u l a t i o n P o l i c i e s and the American P o l i t i c a l System," i n P o l i t i c a l S c i e n c e i n P o p u l a t i o n S t u d i e s , e d s . R i c h a r d L. C l i n t o n and Kenneth R. Godwin ( L e x i n g t o n : L e x i n g t o n Books, 1972), pp. 25-42. 15. B e r n a r d B e r e l s o n , "Beyond. F a m i l y P l a n n i n g , " S t u d i e s i n F a m i l y P l a n n i n g 38 ( F e b r u a r y , 1969): 1-15. - 13 -CHAPTER II THE PIONEERING PHASE The Government o f I n d i a was t r u l y a p i o n e e r i n the development o f n a t i o n a l f e r t i l i t y c o n t r o l p o l i c y . The f i r s t s i g n s o f s e r i o u s i n t e n t on the p a r t o f t h e c e n t r a l government to i n t e r v e n e i n f e r t i l i t y b e h a v i o u r came wi t h t h e e s t a b l i s h m e n t o f the P l a n n i n g Commission a f t e r Independence. Nehru, who had been chairman o f the Congress N a t i o n a l P l a n n i n g Committee, became i t s . c h a i r m a n . The 1951 Census R e p o r t p o i n t e d o u t t h a t the p o p u l a -t i o n had expanded 13.2% ov e r t h e p r e v i o u s decade. A l t h o u g h money was a l l o -c a t e d f o r the purpose o f f a m i l y p l a n n i n g , the economic, p o l i t i c a l , i n t e r n a -t i o n a l and t e c h n o l o g i c a l e n v i r o n m e n t s o f t h e e a r l y p a r t o f the p i o n e e r i n g phase were g e n e r a l l y c o n d u c i v e t o a r e l a x e d a t t i t u d e toward f e r t i l i t y c o n t r o l . The economic o u t l o o k , f o r example, was buoyant, and the Food and A g r i c u l t u r e M i n i s t e r was a b l e t o p r e d i c t , i n 1953, t h a t , We s h a l l not o n l y be a b l e t o meet o u r own r e q u i r e - , ments, but i n t h e near f u t u r e , we may have a s u r p l u s . In t h e f i r s t p l a n p e r i o d , even t h o s e p r i m i t i v e c o n t r a c e p t i v e d e v i c e s which were a v a i l a b l e were eschewed by the government i n f a v o u r o f e x p e r i m e n t s w i t h t h e rhythm method. D u r i n g t h e second p l a n p e r i o d , b a r r i e r d e v i c e s were g a i n i n g a c c e p t a b i l i t y i n government c i r c l e s , b u t many p i l o t p r o j e c t s found t h a t t h e s e were i l l - s u i t e d t o I n d i a n c o n d i t i o n s . The l a c k o f an e f f e c t i v e b i r t h c o n t r o l t e c h n i q u e was a major impediment t o the l a u n c h i n g o f mass-s c a l e programmes i n t h i s p e r i o d . S t e r i l i z a t i o n , e s p e c i a l l y vasectomy, began to l o o k l i k e t h e answer i n the l a t e 1950s. Due t o the c o n t r o v e r s i a l n a t u r e o f s t e r i l i z a t i o n programmes, i t was l e f t up t o the s t a t e s t o implement them. Madras d i d s o , s e t t i n g up - 14 -a c l i n i c and even o f f e r i n g i n c e n t i v e s t o s t a t e employees t o undergo s u r g e r y 2 i n 1958. In 1959, Maharashtra- p i o n e e r e d the camp a p p r o a c h , i n which h i g h c o n c e n t r a t i o n s o f m e d i c a l manpower and equipment were b r o u g h t i n t o the t a r -g e t a r e a . The s u c c e s s o f mass s t e r i l i z a t i o n camps e v e n t u a l l y i n f l u e n c e d c e n t r a l government t h i n k i n g and the C e n t r a l F a m i l y P l a n n i n g Board e n d o r s e d the i d e a i n 1957. The H e a l t h M i n i s t e r summed up t h e change i n a t t i t u d e t o t h i s t e c h n i q u e i n 1960: We were r a t h e r d i f f i d e n t about s t e r i l i z a t i o n and vasectomy two y e a r s back, but the f i g u r e s g i v e n a r e a l r e a d y o u t o f d a t e My hon. c o l l e a g u e S h r i Dey i s h o l d i n g camps, t a k i n g members o f p a r l i a -ment, MLAs and e v e r y b o d y t o s e m i n a r s . W i t h o u t o u r h e l p p e o p l e a r e h o l d i n g s e m i n a r s on vasectomy, 30 o r 40 a t a t i m e , and when t h e y come back, t h e y a r e n o t t h e same as when t h e y went i n . 3 S t e r i l i z a t i o n had a number o f a d m i n i s t r a t i v e a d v a n t a g e s , g i v e n the t e c h n o l o g i c a l a l t e r n a t i v e s o f the t i m e . I t was the most e f f e c t i v e , method known, w i t h a f a i l u r e r a t e next t o z e r o . Male s t e r i l i z a t i o n i s a s i m p l e o p e r a t i o n r e q u i r i n g minimal equipment and f a c i l i t i e s . U n l i k e a l l o t h e r methods, i t i s i r r e v e r s i b l e and t h e r e f o r e does n o t r e q u i r e c o n t i n u o u s m o t i v a -t i o n . T h i s r e l i e v e s the b u r e a u c r a c y o f the need t o e x e r t c o n s t a n t p r e s s u r e on c l i e n t s . Follow=up c a r e , not n o r m a l l y e x c e e d i n g two weeks, imposes a l i g h t e r burden on h e a l t h c a r e f a c i l i t i e s t h a n f e m a l e s t e r i l i z a t i o n and some o t h e r methods. On the o t h e r hand, i t s t e r m i n a l and m a l e - c e n t r e d c h a r a c t e r i s -4 t i c s a r e a d i s a d v a n t a g e i n a c u l t u r e which v a l u e s f e c u n d i t y and v i r i l i t y . In I n d i a , a s , i n d e e d , i n P a k i s t a n and C e y l o n , i t was the p r i v a t e f a m i l y p l a n n i n g movement which f u r n i s h e d many o f the i d e a s which governments were t o t r a n s f o r m i n t o p o l i c y . In 1923, a group o f m e d i c a l d o c t o r s , s o c i a l w o r k e r s , j u r i s t s , and r e f o r m e r s s e t up t h e B i r t h C o n t r o l League. The League - 15 -both p r o p a g a t e d t h e movement's i d e a s and d i s t r i b u t e d c o n t r a c e p t i v e s . 3 In 1935, t h e A l l - I n d i a M e d i c a l C o n f e r e n c e a l s o p a ssed a r e s o l u t i o n i n s u p p o r t o f t h e b i r t h c o n t r o l movement, as d i d the A l l - I n d i a Women's C o n f e r e n c e . ^ I t s most i m p o r t a n t s o u r c e o f s u p p o r t , however, l a y i n the f a c t t h a t n e i t h e r o f t h e two dominant p e r s o n a l i t i e s o f t h e independence s t r u g g l e was opposed to f e r t i l i t y c o n t r o l , but d i f f e r e d o n l y p h i l o s o p h i c a l l y . J a w a h a r l a l Nehru b e l i e v e d t h a t p a r e n t h o o d ought t o be p l a n n e d , a l t h o u g h t h e i d e a o f " a r t i f i -c i a l " t e c h n i q u e s r e p e l l e d him. Gandhi b e l i e v e d t h a t b i r t h c o n t r o l was an e x c e l l e n t o p p o r t u n i t y f o r s e l f c o n t r o l . ^ In 1938 a N a t i o n a l P l a n n i n g Committee o f t h e I n d i a n N a t i o n a l C o n g r e s s , w i t h Nehru as p r e s i d e n t , recommended t h a t c o n t r a c e p t i o n be t a u g h t i n medi-c a l c o l l e g e s , t h a t t h e r e be more women d o c t o r s , n u r s e s , h e a l t h v i s i t o r s , and g o v e r n m e n t - s u p p o r t e d h e a l t h c l i n i c s o f f e r i n g b i r t h c o n t r o l , t h a t sup-p l i e s be produced d o m e s t i c a l l y , t h a t f a m i l y p l a n n i n g be p r o p a g a t e d by mass communication, and t h a t e u g e n i c s t e r i l i z a t i o n be p e r m i t t e d . A n o t h e r committee, c a l l e d t h e Bhore Committee, a l s o e n d o r s e d b i r t h c o n t r o l i n 1946. I t was somewhat more c a u t i o u s than t h e I n d i a n N a t i o n a l C ongress had been, a l l o w i n g t h a t c o n t r a c e p t i o n s h o u l d n ot be promoted by the s t a t e u n l e s s t h e r e was " s u b s t a n t i a l s u p p o r t " f o r i t from t he p u b l i c . I t f e a r e d mass r e s i s t a n c e t o b i r t h c o n t r o l promoted p u r e l y on macro-economic grounds, and t h e r e f o r e s t r e s s e d a f a m i l y w e l f a r e r a t i o n a l e f o r government m v o l vement. A f t e r i n d e p e n d e n c e , t h e f e r t i l i t y c o n t r o l b r i e f c o n t i n u e d t o be c a r r i e d by the P l a n n i n g Commission, w i t h Nehru a t i t s head. The f i r s t p l a n , from 1951 to 1956, a l l o c a t e d a b o u t 6.5 m i l l i o n rupees to f a m i l y p l a n n i n g . - 16 -T h i s was 6.5% o r the whole h e a l t h budget. About 1.4 m i l l i o n rupees were a c t u a l l y s p e n t . B a s i c r e s e a r c h was c a r r i e d o u t , and t h e s t a p l e i n t e l l i g e n c e -g a t h e r i n g t o o l , the Knowledge A t t i t u d e P r a c t i c e (KAP) s u r v e y was i n s t i t u t e d . The main f i n d i n g o f the F i n a l R e p o r t on P i l o t S t u d i e s on t h e Rhythm was t h a t t h r e e q u a r t e r s o f the c o u p l e s under a s t u d y i n two e x p e r i m e n t s wanted to l e a r n how t o p r e v e n t c o n c e p t i o n . However, o n l y 13.6% o f t h e s e c o u l d o r would l e a r n t h e rhythm method. I t was d e c i d e d t h e r e f o r e t h a t f o r t h e second p l a n , t h e r e would be a more a c t i v e programme f e a t u r i n g non-rhythm methods. D e s p i t e t h i s R e p o r t ' s c a l l f o r a more a c t i v e r o l e f o r the c e n t r a l government i n t h e second p l a n , i t c o n t i n u e d t o see i t s e l f as a c o o r d i n a t o r g and a d v i s o r , w i t h the more p r o g r e s s i v e i n i t i a t i v e s coming from the s t a t e s . Budget a p p r o p r i a t i o n s i n d i c a t e d the p a s s i v i t y o f the government's a t t i t u d e s d u r i n g the f i r s t two p l a n s : TABLE 2 A l l o c a t i o n by P l a n f o r V a r i o u s S u b j e c t s : M i l l i o n s o f Rupees F i r s t Second T h i r d F o u r t h F i f t h S u b j e c t P l a n P l a n P l a n P l a n P l a n 1. F a m i l y 6.5 50 270 950 520 P l a n n i n g 2. H e a l t h 1400 2240 3410 10009 3. 1 as % o f 2 .5% 2.22% 7.9% 8.71% 12.72% 4. A c t u a l 1.6 22.9 70.1 E x p e n d i t u r e 5. % o f 25% 46% 43% A l l o c a t i o n S o u r c e : T . J . Samuel, " A l l o c a t i o n and U t i l i z a t i o n o f R esources f o r P o p u l a t i o n C o n t r o l i n I n d i a , " I n d i a n J o u r n a l o f Economics, 46 (No. 182): 245. F i f t h P l a n f i g u r e s from A l a k a Malwade Basu, " F a m i l y P l a n n i n g : Numbers Game Goes On," Economic and P o l i t i c a l Weekly, 16 (No. 1 4 ) : 630. - 17 -Not o n l y d i d F a m i l y P l a n n i n g g e t ah e x t r e m e l y low a l l o c a t i o n o f f u n d s , but the r a t e o f u t i l i z a t i o n i t s e l f was q u i t e low. T h i s was not t h e c a s e w i t h a l l p o l i c y a r e a s , as T a b l e 3 i n d i c a t e s . TABLE 3 Rate o f U t i l i z a t i o n i n F i r s t and Second P l a n s Items o f E x p e n d i t u r e Rate o f E x p e n d i t u r e F i r s t P l a n Second P l a n F a m i l y P l a n n i n g 25% 46% A g r i c u l t u r e 81% 93% I r r i g a t i o n and Power 101% 95% I n d u s t r i e s 68% 120% T r a n s p o r t 105% 94% S o c i a l S e r v i c e s 135% 96% So u r c e : Samuel, i b i d . , 260 T h i s u n d e r u t i l i z a t i o n has been a t t r i b u t e d i n l a r g e p a r t t o the l a c k o f i n i -t i a t i v e a t the s t a t e l e v e l i n o r g a n i z i n g f a m i l y p l a n n i n g programmes, t o t h e r e d tape which r e n d e r e d i t p r a c t i c a l l y i m p o s s i b l e f o r p r i v a t e o r g a n i z a t i o n s to o b t a i n g r a n t s , and t o the s e v e r e s h o r t a g e o f d o c t o r s . ^ In t h e c e n t r a l c a b i n e t t h e r e was c o n s i d e r a b l e d i s a g r e e m e n t about what p r i o r i t y ought t o be g i v e n t o f a m i l y p l a n n i n g . T h e r e was, i n a d d i t i o n t o th e " n a t u r a l " v s . "mechanical d e v i c e " c o n t r o v e r s y , a l a c k o f a p p r e c i a t i o n o f t h e g r a v i t y o f the p o p u l a t i o n problem. The I n d i a n M e d i c a l A s s o c i a t i o n (IMA) had, from t h e b e g i n n i n g , an i m p o r t a n t , u s u a l l y o b s t r u c t i v e , r o l e t o p l a y i n f e r t i l i t y p o l i c y f o r m u l a t i o n . When, f o r example, i t was s u g g e s t e d d u r i n g t h e p e r i o d i c r e v i e w o f the medi-c a l t e r m i n a t i o n o f pre g n a c y law, t h a t a b o r t i o n c o u l d be made an i n s t r u m e n t o f - 18 -f e r t i l i t y c o n t r o l p o l i c y by b r o a d e n i n g i t s a v a i l a b i l i t y , t he A s s o c i a t i o n ' s p o s i t i o n was always t h a t i t must be r e s t r i c t e d to f u l l y e q u i p p e d h o s p i t a l s . I t argued t h a t i t was n o t a s u i t a b l e method o f f e r t i l i t y c o n t r o l because o f the i n a d e q u a c y o f h e a l t h f a c i l i t i e s . ^ The main i s s u e , however, was the q u e s t i o n o f q u a l i t y v e r s u s q u a n t i t y o f h e a l t h manpower. The IMA a d v o c a t e d the e x p a n s i o n o f h i g h l e v e l m e d i c a l e d u c a t i o n and was opposed by t h o s e who b e l i e v e d i n g i v i n g l i m i t e d t r a i n i n g t o l a r g e numbers o f p a r a p r o f e s s i o n a l s . The IMA's members' models were w e s t e r n , and i t r e g a r d e d any a t t e m p t a t i n t r o -12 d u c i n g p a ramedics as an a t t e m p t t o b r i n g "second c l a s s m e d i c i n e " t o I n d i a . The c o n t e n t i o n t h a t h e a l t h f a c i l i t i e s were i n a d e q u a t e was, o f c o u r s e , c o r r e c t . H e a l t h manpower p o l i c y , however, c o n t r i b u t e d t o t h i s i n a d e q u a c y . A t the t i m e o f i n d e p e n d e n c e , the r a t i o o f d o c t o r s t o p o p u l a t i o n was 1: 6,300, w i t h t h r e e - q u a r t e r s o f t h e s e d o c t o r s l o c a t e d i n t h e c i t i e s . The r a t i o o f 13 h e a l t h v i s i t o r s t o p o p u l a t i o n was 1: 400,000. I f s u f f i c i e n t numbers o f c l i e n t s were to be r e a c h e d , s u b - p r o f e s s i o n a l m e d i c a l workers would have to be g i v e n some t r a i n i n g i n l a r g e numbers. Indeed, i n 1949 I n d i a had about 30,000 l i c e n c i a t e p h y s i c i a n s . T h i s l e v e l had been a b o l i s h e d on the recommen-d a t i o n o f t h e H e a l t h S u r vey and Development Committee i n 1946. T h i s recom-mendation was s u p p o r t e d by A m r i t Kaur ( t h e m i n i s t e r o f h e a l t h ) , t h e IMA, and t h e C e n t r a l H e a l t h C o u n c i l . P r o p o s a l s t o t r a i n paramedics have J. c r o p p e d up r e p e a t e d l y i n s ubsequent d e c a d e s , but have always been quashed i n I n d i a by t h e m e d i c a l p r o f e s s i o n a l s who have dominated t h e M e d i c a l C o u n c i l o f I n d i a . A n o t h e r p o t e n t i a l s o u r c e o f s u p p o r t , o p p o s i t i o n , o r i n f l u e n c e i n t h e f o r m u l a t i o n o f f e r t i l i t y p o l i c y was t h e i n t e r n a t i o n a l a i d donor a g e n c i e s . - 19 -The i n t e r n a t i o n a l e n v i r o n m e n t , however, d i d n o t s u p p o r t I n d i a ' s a t t e m p t s i n t h e e a r l y 1950s. WHO was i n t e r n a l l y d i v i d e d on t h e m a t t e r . However, i n t h e second p l a n p e r i o d , t h e F o r d and R o c k e f e l l e r F o u n d a t i o n s o f f e r e d f u n d s f o r r e s e a r c h i n demography, communication, and m e d i c i n e . What e f f o r t s i n t h e f i e l d o f f e r t i l i t y c o n t r o l t h e government o f I n d i a made d u r i n g t h e f i r s t two p l a n s c o u l d n o t have been made w i t h o u t t h e p e r c e p -t i o n on t h e p a r t o f h e r n a t i o n a l l e a d e r s , Nehru i n p a r t i c u l a r , t h a t t h e r e was a p o p u l a t i o n problem, t h a t not o n l y economic development but a l s o f e r -t i l i t y c o n t r o l were l e g i t i m a t e a r e a s o f c o n c e r n f o r government, and t h a t t h e i n s t r u m e n t f o r achievement o f lower b i r t h r a t e s l a y i n the i d e a s f u r -n i s h e d by t h e v o l u n t a r y b i r t h c o n t r o l movement. The r a p i d d i m i n u t i o n o f i d e o l o g i c a l i n h i b i t i o n s r e g a r d i n g t h e l a t e s t methods o f c o n t r a c e p t i o n i s i l l u s t r a t e d by t h e s e remarks i n t h e D r a f t Second P l a n : The l o g i c o f f a c t s i s u n m i s t a k a b l e and t h e r e i s no doubt t h a t under t h e c o n d i t i o n s p r e v a i l i n g i n coun-t r i e s l i k e I n d i a , a h i g h r a t e o f p o p u l a t i o n growth i s bound t o a f f e c t a d v e r s e l y t h e r a t e o f economic advance and l i v i n g s t a n d a r d s p er c a p i t a . G i v e n the o v e r a l l s h o r t a g e o f l a n d and o f c a p i t a l equipment r e l a t i v e t o p o p u l a t i o n as i n I n d i a , t h e c o n c l u s i o n i s i n e s c a p a b l e t h a t an e f f e c t i v e c u r b on p o p u l a t i o n growth i s an i m p o r t a n t c o n d i t i o n f o r r a p i d improve-ment i n incomes and i n l e v e l s o f l i v i n g . 14 The b e l i e f t h a t r a p i d p o p u l a t i o n growth had a d e l e t e r i o u s e f f e c t on economic development was r e i n f o r c e d i n t h e minds o f I n d i a n p l a n n e r s by the p u b l i c a t i o n o f C o a l e and Hoover's P o p u l a t i o n Growth and Economic Development i n Low Income C o u n t r i e s Q.958).^ T h i s book, which used I n d i a as i t s t e s t c a s e , had a t e l l i n g impact on I n d i a n p o l i c y - m a k i n g , and completed t h e s h i f t i n t h e u n d e r l y i n g p h i l o s o p h y o f f e r t i l i t y p o l i c y f r o m f a m i l y w e l f a r e t o n a t i o n a l w e l f a r e . A t t h i s t i m e t o o , t h o s e who h e l d t h e b e l i e f s o f G a n d h i , - 20 -such as i n t h e b e n e f i t s o f a b s t i n e n c e o r i n t h e a n t i - c a r c i n o g e n i c p r o p e r t i e s o f semen, were c o m p l e t e l y e c l i p s e d by t h o s e who f a v o u r e d t h e r a t i o n a l p l a n -n i n g a p p r o a c h . ^ T h e r e were two a s p e c t s o f the i n s t i t u t i o n a l c o n t e x t w h i c h were r e l e -v a n t t o p o l i c y - m a k i n g i n I n d i a d u r i n g t h e p i o n e e r i n g phase. These were the c o u n t r y ' s f e d e r a l s t r u c t u r e and i t s d e m o c r a t i c system. For r e a s o n s o u t l i n e d e a r l i e r , p o p u l a t i o n c o n t r o l was c o n s i d e r e d a h e a l t h m a t t e r , and was t h e r e -f o r e on t h e c o n c u r r e n t ( c e n t r e - s t a t e ) l i s t . T h i s meant t h a t e i t h e r the c e n t r e o r t h e s t a t e s were f r e e t o i n i t i a t e f e r t i l i t y c o n t r o l programmes. However, because most o f t h e s t a t e s were r e l u c t a n t t o implement schemes q u i c k l y i f a t a l l , t h e c e n t r e , which had f i n a n c i a l c o n t r o l , dubbed f a m i l y p l a n n i n g a " c e n t r a l l y s p o n s o r e d scheme". Most s t a t e s tended t o implement 17 schemes which were d e s i g n e d by the c e n t r e . One may speak, t h e n , o f I n d i a ' s " f a m i l y p l a n n i n g programme" w i t h a f a i r d e gree o f c o n f i d e n c e t h a t t h e r e was some u n i f o r m i t y t h r o u g h o u t the s t a t e s . In I n d i a , an i m p o r t a n t i n s t i t u t i o n , and one w h i c h , f o r most o f t h e h i s t o r y o f t h e s u b c o n t i n e n t , s e t s t h a t c o u n t r y o f f from P a k i s t a n and B a n g l a -d e s h , (though not from S r i Lanka) has been t h a t o f f a i r e l e c t i o n s . A l t h o u g h the c o u n t r y , e s p e c i a l l y i n t h e e a r l y p e r i o d , was dominated by the Congress P a r t y , I n d i a n l e a d e r s have found t h e i r a b i l i t y t o impose u n p o p u l a r p o l i c i e s more l i m i t e d t h a n t h o s e i n c o u n t r i e s where t h e y have n o t had, p e r i o d i c a l l y , t o o b t a i n f r e s h mandates from t h e p e o p l e . T h e r e i s no e v i d e n c e , however, t h a t p o l i c y - m a k e r s d u r i n g t h e i n t i a l phase o f f e r t i l i t y p o l i c y - m a k i n g i n I n d i a c o n s i d e r e d e l e c t o r a l i m p l i c a t i o n s o f t h e i r d e c i s i o n s . - 21 -P a k i s t a n emerged from t h e t u r m o i l o f the B r i t i s h w i t h d r a w a l from I n d i a . I t s r a i s o n d ' e t r e was t h a t i t s h o u l d become a homeland f o r ~ the Muslims o f t h e s u b c o n t i n e n t . P a k i s t a n ' s e n e r g i e s were t a k e n up from 1947 t o 1957 i n a s e a r c h f o r a w o r k a b l e c o n s t i t u t i o n , and p o l i t i c a l i n s t a b i l i t y up t o t h i s l a t t e r d a t e p r e c l u d e d c o n c e n t r a t i o n on f e r t i l i t y c o n t r o l . T h e r e were c o n s t a n t changes o f c a b i n e t s , prime m i n i s t e r s , and a m u l t i p l i c i t y o f p a r t i e s . Proponents o f a s t a t e founded on I s l a m i c t h e o -l o g y were pushed to the background by t h e s e c u l a r and m o d e r n i s t s t r e a m o f i n f l u e n c e d u r i n g t h i s p e r i o d , but c o n s e r v a t i v e p a r t i e s such as the Jamaat-i - I s l a m i c o n t i n u e d t o be v o c a l . T h e r e were m i n i s t r i e s and a g e n c i e s s e t up whose nominal r o l e was p l a n n i n g and economic development, but t h e s e d i d not have t h e p o l i t i c a l o r f i n a n c i a l r e s o u r c e s t o a c c o m p l i s h much. The a s p e c t o f t h e p o p u l a t i o n i s s u e which was s a l i e n t t o the Government o f P a k i s t a n d u r i n g the e a r l y 1950s was the problem o f p o s t - p a r t i t i o n m i g r a t i o n . P a k i s t a n had ended up w i t h a s u r p l u s o f two m i l l i o n p e r s o n s , o r s i x p e r c e n t o f the west 1 p wing, and by 1951 one q u a r t e r o f P a k i s t a n c o n s i s t e d o f r e f u g e e s . The s a l i e n c e o f the problem o f n a t u r a l p o p u l a t i o n i n c r e a s e was f u r t h e r r e d u c e d by the a p p a r e n t l y modest growth found by t h e 1951 c e n s u s , which 19 showed a growth r a t e o f o n l y 1.4%. No prime m i n i s t e r o r p r e s i d e n t i n Pakistan.came o u t i n f a v o u r o f f e r t i l i t y c o n t r o l d u r i n g t h e 1950s. T h e r e were, however, groups both i n f a v o u r o f f e r t i l i t y c o n t r o l , and a g a i n s t . g o v e r n m e n t i n t e r v e n t i o n i n t h i s a r e a . In 1953 t h e F a m i l y P l a n n i n g A s s o c i a t i o n o f P a k i s t a n was o f f i c i a l l y i n a u g u r a t e d . I t s main s o u r c e o f p r o p u l s i o n was t h e group o f upper c l a s s women who had a i d e d i n r e f u g e e r e l i e f f o l l o w i n g p a r t i t i o n . In 1955 a t the - 22 -b e g i n n i n g of t h e f i r s t f i v e y e a r p l a n , t h e s e women e x e r t e d s u f f i c i e n t p r e s -s u r e on t h e i r kinsmen i n government t o have i n c l u d e d i n t h a t p l a n an a l l o -20 c a t i o n o f a Rs. 500,000 s u b s i d y f o r t h e A s s o c i a t i o n . N e g a t i v e f o r c e s i n c l u d e d c e r t a i n ulema, who preached a g a i n s t f a m i l y p l a n n i n g as a v i o l a t i o n of A l l a h ' s w i l l and t h e r e was some o r g a n i z e d o p p o s i t i o n from the r e l i g i o u s 21 p a r t i e s . The i n s t i t u t i o n a l c o n t e x t i n P a k i s t a n d i f f e r e d from t h a t of I n d i a i n two r e s p e c t s . P a k i s t a n was a t w o - p r o v i n c e u n i t a r y s t a t e . F a m i l y p l a n n i n g was a s u b j e c t o f t h e M i n i s t r y of H e a l t h , L abour, and S o c i a l W e l f a r e and was a d m i n i s t e r e d by t h e c e n t r a l government. The r e was a C e n t r a l F a m i l y P l a n n i n g C o u n c i l which was i n t e n d e d t o f o r m u l a t e p o l i c y recommendations f o r t h e m i n i s -22 t e r . A l l b r a n c h e s o f t h e a d m i n i s t r a t i v e m a c h i n e r y , i n c l u d i n g the H e a l t h s t r u c t u r e , were s e v e r e l y a t t e n u a t e d as a r e s u l t o f t h e m i g r a t i o n f o l l o w i n g p a r t i t i o n . At t h e end o f t h i s p i o n e e r i n g phase i n I n d i a and P a k i s t a n , t h e n , l i t t l e had been done t o a c t i v e l y i n f l u e n c e the b i r t h r a t e . P r o g r e s s had been made i n a c q u i r i n g " p o l i c y knowledge"., t h a t i s , g o v e r n i n g e l i t e s i n both c o u n t r i e s had been shown by the e f f o r t s and l o b b y i n g o f p r i v a t e f a m i l y p l a n n i n g groups and by p i l o t p r o j e c t s and a t t i t u d e s u r v e y s t h a t t h e r e was l e s s h o s t i l i t y t o f a m i l y p l a n n i n g than t h e y m i ght have t h o u g h t , and t h a t 23 t h e r e was a l a t e n t demand.for some f a m i l y p l a n n i n g s e r v i c e s . * * * * * * C e y l o n , as i t was then c a l l e d , a p p e a r e d t o have one of the h i g h e s t r a t e s of n a t u r a l i n c r e a s e i n t h e r e g i o n i n 1958. The most a p p a r e n t d i f f e r e n c e between C e y l o n and P a k i s t a n and I n d i a i s the r e l a t i v e s i z e of C e y l o n . In - 23 -1958 i t had t e n m i l l i o n p e o p l e , as compared w i t h I n d i a ' s p o p u l a t i o n o f f o u r hundred m i l l i o n , and P a k i s t a n ' s p o p u l a t i o n o f 85 m i l l i o n . C e y l o n ' s p o p u l a -24 t i o n was, however, packed i n t o an i s l a n d the s i z e o f I r e l a n d . - Moreover, C e y l o n ' s e t h n i c c o m p o s i t i o n was and i s a more f e r t i l i t y p o l i c y - r e l e v a n t f a c -t o r t h a n i t has been i n I n d i a o r even P a k i s t a n . About s e v e n t y p e r c e n t o f t h e p o p u l a t i o n i s S i n h a l e s e , t w e l v e p e r c e n t i s C e y l o n T a m i l , and t e n p e r c e n t i s I n d i a n T a m i l . The S i n h a l e s e a r e B u d d h i s t , w h i l e the T a m i l s a r e H i n d u . The economy o f C e y l o n was buoyant i n t h e p e r i o d f o l l o w i n g the Korean war due t o h i g h commodities p r i c e s , , and t h i s may i n p a r t e x p l a i n t h e g o v e r n -ment's i n a c t i v i t y i n t h e f e r t i l i t y c o n t r o l a r e a . C e y l o n d i d n o t adopt a p u b l i c n a t i o n a l f e r t i l i t y c o n t r o l p o l i c y u n t i l 1965. P r i o r t o t h a t t i m e , however, t h e government o f . C e y l o n had made p o l i c y by d e f a u l t , by p e r m i t t i n g a g r e a t d e a l o f freedom o f a c t i o n t o p r i v a t e groups and p o p u l a t i o n a c t i v i s t s . A C a nadian g y n e c o l o g i s t , Dr. Mary I r w i n , d e v o t e d h e r l i f e t o the p r o m o t i o n o f m a t e r n a l and c h i l d w e l f a r e and t o a h o s t o f o t h e r w e l f a r e o r g a n i z a t i o n s , i n c l u d i n g t h e F a m i l y P l a n n i n g A s s o c i a t i o n . T h i s became t h e F a m i l y P l a n n i n g A s s o c i a t i o n o f C e y l o n (FPAC) i n 1953. The World Bank ( t h e n I n t e r n a t i o n a l Bank f o r R e c o n s t r u c t i o n and D e v e l o p -ment) r e p o r t e d t h a t a demographic/economic c r i s i s was i n e v i t a b l e i n C e y l o n u n l e s s the b i r t h r a t e d i m i n i s h e d . I t recommended i n 1953 t h a t government h e a l t h c e n t r e s be used t o p r o v i d e f a m i l y p l a n n i n g s e r v i c e s and t h a t v o l u n -25 t a r y o r g a n i z a t i o n s be g i v e n s u b s i d i e s . T h i s found f a v o u r w i t h t h e then Prime M i n i s t e r , Dudley Senanayake, but n o t h i n g was done, as he l o s t o f f i c e i n 1953 f o r h a v i n g r e d u c e d the r i c e s u b s i d y . The FPAC was g i v e n a n e g l i g i b l e g r a n t o f Rs. 2000 i n 1954. Subsequent - 24 -Prime M i n i s t e r s s u p p o r t e d t h e f a m i l y p l a n n i n g movement w i t h modest s u b s i -d i e s and minimal p u b l i c i t y . The FPAC was a l s o s u p p o r t e d by t h e I n t e r n a t i o n a l P l a n n e d Parenthood F e d e r a t i o n , Oxfam, t h e P o p u l a t i o n C o u n c i l and U.S. :AID. In 1958 the Sweden/Ceylon p i l o t p r o j e c t was i n a u g u r a t e d a t t h e r e q u e s t o f the FPAC and t h e Government o f C e y l o n . In i t s e a r l y y e a r s i t proved i n e f f e c -t i v e both i n d e r i v i n g s c i e n t i f i c a l l y v a l i d f i n d i n g s and i n r e d u c i n g f e r t i l i t y . I t d i d , however, p r o v i d e a n u c l e u s from which t h e government c o u l d b u i l d i t s own programme, s h o u l d i t d e c i d e t o do so i n subsequent y e a r s . What i s o f i n t e r e s t i n t h e p o l i t i c s o f p o p u l a t i o n i n t h e f i r s t phase o f f e r t i l i t y p o l i c y i n C e y l o n i s n o t so much the e f f e c t i v e n e s s o f t e c h n i q u e s , which were as p r i m i t i v e t h e r e as e l s e w h e r e , but t h e r o l e which t h e g o v e r n -ment p e r m i t t e d v o l u n t e e r o r g a n i z a t i o n s and f o r e i g n a g e n c i e s t o p l a y . T h i s was u n d o u b t e d l y due t o t h e s e n s i t i v i t y o f t h e government to p o t e n t i a l c r i -t i c i s m mounted by spokesmen f o r t h e two main e t h n i c g r o u p s . In C e y l o n , the danger was t h a t f e r t i l i t y c o n t r o l c o u l d blow up i n t o a communal p o l i t i c a l i s s u e . . , T h a t t h e r e was a p e r c e p t i o n o f a p o p u l a t i o n problem which c o u l d not be r e s o l v e d by economic development a l o n e and a p a r t i a l i t y on t h e p a r t o f g o v e r n -i n g e l i t e s t o f a m i l y p l a n n i n g as t h e s o l u t i o n d e s p i t e t h e i r p o l i t i c a l : i n h i b i t i o n s i s shown by remarks found i n a l l t h r e e p l a n n i n g documents o f :the p e r i o d . In the Short-Term Implementation Programme of. 1962, d r a f t e d f o r S i r i m a v o B a n d a r a n a i k e , two s c h o o l s o f thought were mentioned. One was san-_ g u i n e about t h e p r o s p e c t o f p o p u l a t i o n and the o t h e r r e g a r d e d the i m p l i c a -t i o n s o f r a p i d p o p u l a t i o n growth as s e r i o u s . The d r a f t c o n c l u d e d t h a t the l a t t e r was the c o r r e c t . v i e w . In 1962 Mrs. B a n d a r a n a i k e r u l e d t h a t f a m i l y p l a n n i n g s h o u l d be i n t e g r a t e d w i t h m a t e r n a l and c h i l d h e a l t h programmes. - 25 -She o r d e r e d "more e d u c a t i o n a l work" f o r t h e Department o f H e a l t h S e r v i c e s . The I n t e r i m Report o f t h e P l a n n i n g C o u n c i l ( 1 9 5 7 ) , and the Ten Year P l a n 27 o f 1959 had a l s o s t r e s s e d t h e i m p o r t a n c e o f the p o p u l a t i o n problem. P o p u l a t i o n ' s most o b v i o u s m a n i f e s t a t i o n as a problem was i n the w o r k f o r c e p r o j e c t i o n s , which showed up an enormous need f o r new j o b s -- about one hundred thousand per y e a r from 1961 to 1981 — i f c u r r e n t t r e n d s were to c o n t i n u e . A l l o c a t i o n s however, were not made f o r f e r t i l i t y c o n t r o l o f any k i n d . C e y l o n , l i k e I n d i a , d i f f e r e d from P a k i s t a n i n h a v i n g t h e i n s t i t u t i o n s o f p e r i o d i c e l e c t i o n s , a r e l a t i v e l y e x p e r i e n c e d b u r e a u c r a c y , and g e n e r a l l y more p o l i t i c a l s t a b i l i t y . I t s h a r e d w i t h I n d i a and P a k i s t a n the mandate f o r economic development t h r o u g h p l a n n i n g . Due t o the commodities p r i c e - r e c e s -s i o n , however, government by economic p l a n had g i v e n way a l m o s t c o m p l e t e l y 28 t o government by c r i s i s management. Health, under which a c t i v e f e r t i l i t y p o l i c y would have f a l l e n , had t h e r e been any, was c o n t r o l l e d by t h e c e n t r a l government i n C e y l o n . * * * * * * The p o s t - i n d e p e n d e n c e c o n t e x t o f f e r t i l i t y p o l i c y - m a k i n g i n B a n g l a -desh resembled t h a t o f P a k i s t a n and I n d i a i n many r e s p e c t s . The p r e - e x i s t i n g f e r t i l i t y c o n t r o l programmes had been wiped o u t o r d i s c r e d i t e d , so t h a t the government had, v i r t u a l l y , to b u i l d from a z e r o base. As w i t h the o t h e r c o u n t r i e s , t h e r o o t s o f t h e h i s t o r i c a l c o n t e x t went back b e f o r e t h e a c h i e v e -ment o f i n d e p e n d e n c e . However, t h e i n t e r n a t i o n a l , t e c h n o l o g i c a l , and i d e a t i o n a l en'vironments from which the f i r s t phase emerged were t h o s e which p r e v a i l e d i n the 1960s, n o t , as f o r the o t h e r s , t h o s e which had p r e v a i l e d i n - 26 -the B r i t i s h c o l o n i a l p e r i o d . The f i r s t phase, from 1972 t o 1975, was marked by what has been c a l l e d by an o b s e r v e r o f South A s i a n a f f a i r s , a "mouse o f a p o p u l a t i o n 29 p o l i c y " . The government r e g a r d e d the p o p u l a t i o n i s s u e as e x t r e m e l y p o l i t i c a l l y s e n s i t i v e : no v i g o u r c o u l d be shown l e s t i t appear t o resemble 30 t h e c o m p l e t e l y d i s c r e d i t e d P a k i s t a n i programme o f the p r e v i o u s decade. A l t h o u g h - t h e P l a n n i n g Commission i n i t s f i r s t f i v e y e a r p l a n r e c o g n i z e d the g r a v i t y o f the p o p u l a t i o n problem, and t h i s was r e i t e r a t e d by M u j i b i n a speech g i v e n i n June 1972, t h i s was t h e o n l y r e f e r e n c e he i s known to have made to t h e i s s u e , and he was known to be i n d i f f e r e n t t o the problem a t b e s t . H i s m i n i s t e r f o r F a m i l y P l a n n i n g was opposed t o f a m i l y p l a n n i n g i n p r i n c i p l e . A f t e r l i b e r a t i o n , he i n s t r u c t e d h i s workers to c e a s e p o p u l a t i o n c o n t r o l a c t i v i t i e s a l t o g e t h e r , a r g u i n g t h a t , "We have had enough k i l l i n g , 31 enough o f s l a u g h t e r " . The f a m i l y p l a n n i n g b r i e f i n t h i s phase had t o be c a r r i e d by the P l a n n i n g Commission and i n d i v i d u a l f a m i l y p l a n n i n g e n t h u s i a s t s and a s s o c i a -t i o n s . Both were e x t r e m e l y r e l u c t a n t t o t a k e a f o r c e f u l s t a n d . The F i r s t Annual P l a n (1972-1973) p r o j e c t e d an e x p e n d i t u r e which r e p r e s e n t e d about 1.06 p e r c e n t o f a l l e x p e n d i t u r e s f o r t h a t y e a r . I t s t a t e d t h a t p o p u l a t i o n c o n t r o l s h o u l d be t h e number two p r i o r i t y a f t e r a g r i c u l t u r a l development. T h i s was, however, to be a " s e r i a l " p r i o r i t y . One member put i t t h i s way: When we say t h a t p o p u l a t i o n c o n t r o l s h o u l d be o u r second p r i o r i t y , what we mean i s thatwe w i l l spend the next f o u r o r f i v e y e a r s c o n c e n t r a t i n g on a g r i -c u l t u r e and then we w i l l t a k e up p o p u l a t i o n c o n t r o l i n a b i g way. For t h e p r e s e n t , we r e a l l y haven't had time t o t h i n k a b o u t i t -- b e s i d e s i t i s p r o b a -b l y a s u b j e c t t h a t i s b e s t l e f t i n the background u n t i l o u r p e o p l e a r e r e a d y f o r i t . " 3 2 - 27 -T h e r e were a number o f f a m i l y p l a n n i n g e n t h u s i a s t s o u t s i d e government i n B a n g l a d e s h , some e x p e r i e n c e d i n p o p u l a t i o n work done as e a r l y as the 1950s. The FPAP o f E a s t P a k i s t a n became the F a m i l y W e l f a r e A s s o c i a t i o n o f B a n g l a d e s h . I t s members were e a g e r t o see B a n g l a d e s h adopt a more comprehen-s i v e p o p u l a t i o n c o n t r o l p o l i c y , but t h e r e was a consensus t h a t the i s s u e was enormously p o l i t i c a l l y s e n s i t i v e , a n d : t h a t any a t t e m p t to use even p e r -33 s u a s i o n and propaganda o r i n c e n t i v e s would s e t back t h e i r c a u s e ; The p o l i t i c a l atmosphere o f t h e 1972-1975 p e r i o d was c h a r a c t e r i z e d by rampant c o r r u p t i o n , f a c t i o n a l i s m w i t h i n t h e many p o l i t i c a l p a r t i e s , i n -c l u d i n g t h e dominant Awami League, and c h r o n i c breakdown i n law and o r d e r . The F a m i l y W e l f a r e A s s o c i a t i o n o f B a n g l a d e s h was o b l i g e d t o t u r n down an o f f e r from A u s t r a l i a t o fund an e x p a n s i o n because i t s e x e c u t i v e s knew t h e money would c o r r u p t i t s own w o r k e r s , and t h e r e b y r e n d e r the A s s o c i a t i o n no 34 more e f f e c t i v e . T h e r e was no p a r t i c u l a r l y s t r o n g i d e o l o g i c a l o r i e n t a t i o n i n government: I t was moderate, . s e c u l a r , believ.ed'i'n"the mixed economy, and was a l l e g e d l y g u i d e d by t h e e s s e n t i a l l y p e r s o n a l i s t i c c r e d o o f " M u j i b b i s m " . The i n s t i t u t i o n a l i s s u e which p r e - o c c u p i e d the p e r s o n n e l o f the Department o f F a m i l y P l a n n i n g was t h e i r i n t e g r a t i o n w i t h the H e a l t h M i n i s t r y -- a r e o r g a n i z a t i o n which made them mere a d j u n c t s and o c c a s i o n e d a l o s s o f s t a t u s and pay. -* * * * * * T h e r e does n o t , up t o t h i s p o i n t , appear to be any dynamic i n I n d i a , P a k i s t a n , C e y l o n o r B a n g l a d e s h p o i n t i n g i n e v i t a b l y t o an i n c r e a s e d c o e r c i v e -ness i n f e r t i l i t y c o n t r o l p o l i c y . There was p r o g r e s s i n I n d i a , P a k i s t a n and - 28 -C e y l o n i n t h e n e g a t i v e sense t h a t o b j e c t i o n s t o t h e i d e a o f f e r t i l i t y c o n t r o l p o l i c y were r a p i d l y b e i n g d i s p e l l e d among e l i t e s . In a l l f o u r c o u n t r i e s , . however, governments were committed on paper a t l e a s t t o t h e a l l e v i a t i o n o f p o v e r t y t h r o u g h economic development. They b e l i e v e d t h a t p o p u l a t i o n growth would r e t a r d t h i s . P i l o t p r o j e c t s and s u r v e y s c o n t i n u e d t o be done. Because t h e y tended t o b e . c o n d u c t e d i n urban o r o t h e r w i s e w e l l - f a v o u r e d l o c a t i o n s , f i n d i n g s were o p t i m i s t i c , and governments t h e r e b y r e c e i v e d an e x a g g e r a t e d n o t i o n . o f the 35 ease w i t h which programmes might a t t a i n t h e i r g o a l s . I t i s p o s s i b l e t o speak i n g e n e r a l terms o f I n d i a , P a k i s t a n , and C e y l o n i n t h e f i r s t h a l f o f the 1960s and Bangladesh i n the f i r s t h a l f o f the 1970s as b e i n g i n r o u g h l y t h e same p l a c e i n t h i s p r o c e s s . Taboos ab o u t the p u b l i c d i s c u s s i o n o f p o p u l a t i o n i s s u e s were s l o w l y d i s a p p e a r i n g i n a l l f o u r c o u n t r i e s . Nehru and Ayub were a d d r e s s i n g p o p u l a t i o n c o n f e r e n c e s . However, i n C e y l o n . and' B a n g l a d e s h , w h i l e p l a n n e r s r e c o g n i z e d the i m p l i c a t i o n s o f r a p i d p o p u l a t i o n growth, Mrs. B a n d a r a n a i k e k e p t a low p r o f i l e on the i s s u e , "and.Mujib • a p p a r e n t l y a s s i g n e d . a . Tow p r i o r i t y to f e r t i l i t y c o n t r o l . P o l i c y went f a r t h e s t \ i n I n d i a both be-cause o f h e r head s t a r t and because a n a t i o n a l l e a d e r was a b l e t o o v e r r i d e her t h e p l e t h o r a o f c o n f l i c t i n g o p i n i o n s w i t h i n h i s government. There i s l i t t l e e v i d e n c e t h a t t h e r e was v e r y s t r o n g o p p o s i t i o n from communal g r o u p s , p o s s i b l y because a t t h e p i o n e e r i n g l e v e l o f a c t i v i t y i n I n d i a , f a m i l y p l a n n i n g programmes had n o t d e m o n s t r a t e d any p o t e n t i a l f o r r e d u c i n g t h e i r numbers. The d i f f i d e n c e shown by C e y l o n and Bangladesh d u r i n g the f i r s t phase seems unwarranted and one can o n l y s u r m i s e t h a t i t a r o s e from " a n t i c i p a t e d o p p o s i t i o n " from communal - 29 -groups i n the f o r m e r and from post-war l o a t h i n g f o r a l l t h i n g s r e d o l e n t o f P a k i s t a n i n the l a t t e r . The e v i d e n c e coming o u t o f t h e p i o n e e r i n g phase as a whole shows t h e im p o r t a n c e o f h a v i n g both a s t a b l e p o l i t i c a l e n v i r o n m e n t and a n a t i o n a l l e a d e r who i s f a v o u r a b l y d i s p o s e d t o f e r t i l i t y c o n t r o l . I t was t h e s e e l e -ments which were l a c k i n g i n P a k i s t a n , C e y l o n and B a n g l a d e s h . By t h e end o f the p e r i o d , governments were d i s c o v e r i n g t h a t o p p o s i t i o n was e i t h e r not as g r e a t as t h e y had a n t i c i p a t e d o r were coming t o t h e c o n c l u s i o n t h a t t he s o l u -t i o n t o economic and o v e r p o p u l a t i o n problems was more i m p o r t a n t than such o p p o s i t i o n . By 1965, I n d i a , P a k i s t a n , and C e y l o n , and by 1975, B a n g l a d e s h , were ready t o t a k e a c t i o n . - 30 CHAPTER II FOOTNOTES 1. R u s h i k e s h M. Maru, " P o p u l a t i o n P o l i c y F o r m u l a t i o n and I m p l e m e n t a t i o n i n I n d i a and t h e P e o p l e ' s R e p u b l i c o f C h i n a , " i n T h e • O r g a n i z a t i o n ' o f  F a m i l y P l a n n i n g Programs: I n d i a , C h i n a , C o s t a R i c a , V e n e z u e l a ,  Lebanon. I n t e r d i s c i p l i n a r y Communications Programs:, O c c a s i o n a l Mono-gr a p h , No. 8, S m i t h s o n i a n I n s t i t u t i o n , (Washington, D . C , 1976), p. 21. 2. I b i d . , p. 28. 3. Lok Sabha Debates. S e r i e s 2." XLIL.. : ( A p r i l . 1960), p. 10,008. 4. Maru, op. c i t . , p. 18. 5. Kami a Mankekar, V o l u n t a r y E f f o r t s i n F a m i l y P l a n n i n g : A B r i e f H i s t o r y , (New D e l h i : A b h i n a v , 1974),p. f<32. 6. Maru, op. c i t . , p. 23. 7. I b i d . , p. 100. 8. I b i d . , p. 25. 9. I b i d . , p. 22. 10. T . J . Samuel, " A l l o c a t i o n and U t i l i z a t i o n o f R esources f o r P o p u l a t i o n C o n t r o l i n I n d i a , " I n d i a n J o u r n a l o f Economics, 146 (No. 182),:p. J245.' 11. Maru, op. c i t . , p. 47. 12. I b i d . , p. 90 and Robert C a s s e n , I n d i a : P o p u l a t i o n , Economy, S o c i e t y , (London: M a c M i l l a n P r e s s , 1978), p. 201. 13. Mary F. B i s h o p , From ' L e f t ' t o ' R i g h t ' : A P e r s p e c t i v e on t h e Role o f  V o l u n t e e r s i n F a m i l y P l a n n i n g i n t h e West and South A s i a , (UBC, M.A. T h e s i s , 1971), p. 110. 14.. quoted i n Maru, op. c i t . , p. 22. 15. A . J . C o a l e and E.M. Hoover, P o p u l a t i o n Growth and Economic Development  i n Low Income C o u n t r i e s , ( P r i n c e t o n : P r i n c e t o n U n i v e r s i t y P r e s s , 1958). 16. B i s h o p , op. c i t . , p. 123. 17. Maru, op. c i t . , p. 118. - 31 -18. S h a h i d J a v e d B u r k i , "Food and F e r t i l i t y : F o r m u l a t i o n o f P u b l i c P o l i c y i n P a k i s t a n , " i n P r o l o g u e t o Development P o l i c y and P o p u l a t i o n  P o l i c y : The P a k i s t a n E x p e r i e n c e , I n t e r d i s c i p l i n a r y Communications Program, P o p u l a t i o n P l a n n i n g D i v i s i o n , M i n i s t r y o f H e a l t h and S o c i a l W e l f a r e , Government o f P a k i s t a n , c o - s p o n s o r s , Background Papers Work-shop/Seminar 13, F e b r u a r y 4-8, Peshawar, P a k i s t a n , p. 15. 19. B i s h o p , op. c i t . , p. 207 and M. S h a r i f , "Outlook f o r Government A c t i o n i n F a m i l y P l a n n i n g i n P a k i s t a n , " i n R e s e a r c h i n F a m i l y P l a n n i n g , ed. C l y d e V. K i s e r ( P r i n c e t o n : P r i n c e t o n U n i v e r s i t y P r e s s , 1962), p. 142. 20. T i n e B u s s i n k , "Major A s p e c t s o f F a m i l y P l a n n i n g i n P a k i s t a n , " i n I n t e r d i s c i p l i n a r y Communications Program, P r o l o g u e to Development • P o l i c y and P o p u l a t i o n Po 1 i c y : The P a k i s t a n E x p e r i e n c e , bp. - c i t . - , p. 43. 21. T.E. S m i t h , e d . , The P o l i t i c s o f F a m i l y P l a n n i n g i n the T h i r d World, (London: Geo. A l l e n , 1973), p. 45. 22. B u s s i n k , op. c i t . , p. 37. 23. F o r a t e n t a t i v e e x p l o r a t i o n o f t h e c o n c e p t o f e l i t e knowledge see R i c h a r d C l i n t o n , "The D e c i s i o n a l Environment: Knowledge and A t t i t u d e s o f E l i t e s as a D e t e r m i n a n t o f P o p u l a t i o n Growth R e d u c t i o n P o l i c i e s , " i n C o m p a r a t i v e P o l i c y A n a l y s i s : The Study o f P o p u l a t i o n P o l i c y D e t e r m i n a n t s  i n D e v e l o p i n g C o u n t r i e s , ed., R. Kenneth Godwin ( L e x i n g t o n : L e x i n g t o n Books, 1975), pp. 143-57. F o r an e x p o s i t i o n o f the d i s t i n c t i o n between p o l i c y knowledge and s c h o l a r l y knowledge, see Warren F. Ilchman,-" P o p u l a t i o n Knowledge and P o p u l a t i o n P o l i c i e s , " i b i d . , pp. 217-67. 24. Arne K i n c h , "A P r e l i m i n a r y R e p o r t from the Sweden/Ceylon F a m i l y P l a n n i n g P i l o t P r o j e c t , " i n C l y d e V. K i s e r , e d . , op. c i t . , p. 85. 25. B i s h o p , op. c i t . , p. 172. 26. S.U. K o d i k a r a , " F a m i l y P l a n n i n g i n C e y l o n , " i n S m i t h , op. c i t . , p. 307. 27. C.C. de S i l v a , e d . , A H i s t o r y o f F a m i l y P l a n n i n g i n S r i Lanka, (Colombo: F a m i l y P l a n n i n g A s s o c . o f S r i Lanka, 1978), p. 150. 28. I b i d . , p. 158. 29. Marcus F r a n d a , " R e a l i s m and t h e Demographic V a r i a b l e i n the B a n g l a d e s h F i v e - Y e a r P l a n , " American U n i v e r s i t i e s F i e l d S t a f f R e p o r t s , 17 (No. 6, May, 1973): 1. 30. I b i d . , p. 2. 31. Marcus. F r a n d a , ."Perceptions o f a P o p u l a t i o n P o l i c y f o r B a n g l a d e s h , " American U n i v e r s i t i e s F i e l d S t a f f R e p o r t s , 12 (No. 2, J a n u a r y , 1973): 2. - 32 -32. F r a n d a , (May, 1973), op. c i t . , p. 5. 33. I b i d . , p. 7. 34. F r a n d a , ( J a n u a r y , 1973), op. c i t . , pp. 8; 9. 35. P.M. B l a i k i e , " I m p l i c a t i o n s o f S e l e c t i v e Feedback i n F a m i l y P l a n n i n g R e s e a r c h f o r P o l i c y - M a k e r s i n I n d i a , " P o p u l a t i o n S t u d i e s , 26 (No. 2 ) : 434-37. - 33 -CHAPTER I I I THE CRASH PROGRAMME PHASE The p o i n t i n i t s h i s t o r y when a c o u n t r y e n t e r e d i t s c r a s h programme phase i s n o t measurable i n a s c i e n t i f i c a l l y p r e c i s e way. S i n c e one o f the purposes o f t h i s t h e s i s i s t o e x p l a i n the t r a n s i t i o n from one phase t o a n o t h e r , c e r t a i n c o n v e n i e n t earmarks f o r i d e n t i f y i n g t he i n i t i a t i o n o f the c r a s h programme phase a r e s e t o u t h e r e : i ) The i s s u e o f p u b l i c s t a t e m e n t s t o the e f f e c t t h a t government i s f i r m l y committed t o f e r t i l i t y r e d u c t i o n , u s u a l l y by s e t -t i n g c r u d e b i r t h r a t e t a r g e t s and, i i ) The a l l o c a t i o n o f s u b s t a n t i a l l y more money and o t h e r r e s o u r c e s to t h e p u r s u i t o f t h e s e g o a l s . A l t h o u g h I n d i a , P a k i s t a n and C e y l o n embarked on t h e i r i n i t i a l phases a t d i f f e r e n t t i m e s , l a r g e l y as a r e s u l t o f the d i f f e r e n t c i r c u m s t a n c e s s u r -r o u n d i n g t h e i r a t t a i n m e n t o f ind e p e n d e n c e , a l l began the second phase i n 1965. I t i s t r u e t h a t I n d i a g a i n e d w o r l d renown f o r i t s f a m i l y p l a n n i n g e x p e r i m e n t s as e a r l y as 1953, b u t , a l t h o u g h t h e s e were u n p r e c e d e n t e d , the degree o f e f f o r t even r e m o t e l y n e c e s s a r y to a f f e c t b i r t h r a t e s was not re a c h e d u n t i l the l a u n c h i n g o f t h e IUD programme i n 1965. L i k e w i s e , P a k i s t a n gave o n l y token s u p p o r t t o f a m i l y p l a n n i n g i n i t s f i r s t p l a n (1955-1960). There was a p i c k u p i n momentum i n 1964 when Ayub Khan's i n t e r e s t was s t i m u l a t e d , and t h i s i n t e r e s t l e d t o the announcement o f th e N a t i o n a l P o p u l a t i o n P o l i c y i n 1965, when Ayub i n c l u d e d f a m i l y p l a n n i n g i n h i s e l e c t i o n campaign. The i n t e n s i f i e d P a k i s t a n i f e r t i l i t y c o n t r o l p o l i c y , as i t was p r a c t i c e d i n E a s t P a k i s t a n , s h a t t e r e d d u r i n g t h e 1971 c i v i l war, l a y moribund i n - 34 -B a n g l a d e s h u n t i l t h e changes i n government i n 1975 put an A y u b - s t y l e 2 m i l i t a r y man i n t o o f f i c e . The SLFP government o f C e y l o n i n d i c a t e d an i n c r e a s i n g i n t e r e s t i n c o n t r o l l i n g f e r t i l i t y , b u t d i d n o t c o n s i d e r i t p o l i t i c t o t r a n s l a t e t h i s i n t o a c t i o n . Not u n t i l t h e ad v e n t o f the UNP government i n 1965 d i d C e y l o n have an o f f i c i a l f e r t i l i t y c o n t r o l p o l i c y . By 1965, c o n d i t i o n s were " r i p e n i n g " f o r a p r o n o u n c e d ' s h i f t o f both i n t e n s i t y and d i r e c t i o n o f n a t i o n a l f e r t i l i t y c o n t r o l p o l i c y i n I n d i a , P a k i s t a n , and C e y l o n . Changes i n t h e t e c h n o l o g i c a l , i n t e r n a t i o n a l , demo-g r a p h i c and economic c i r c u m s t a n c e s s u r r o u n d i n g f e r t i l i t y p o l i c y were o c c u r -r i n g . In B a n g l a d e s h d u r i n g t h e M u j i b p e r i o d from 1972 to 1975, i t i s d i f -f i c u l t t o d i s c e r n , e x c e p t f o r the f r i g h t e n i n g p o p u l a t i o n growth r a t e , any e n v i r o n m e n t a l d e t e r m i n a n t s f a v o u r a b l e to a s t r o n g s h i f t . What was needed was a p r e c i p i t a n t . T h i s was t o come i n P a k i s t a n , C e y l o n and Ba n g l a d e s h i n t h e i n t e r v e n t i o n o f n a t i o n a l l e a d e r s , and i n I n d i a seemed t o emerge from the ' d i s c o v e r y ' o f the IUD. The a c t u a l measures chosen were the outcomes o f i n s t i t u t i o n a l and t e c h n o l o g i c a l c o n s t r a i n t s p r e v a i l i n g d u r i n g the phase. No s t a t i s t i c s a r e a v a i l a b l e which a r e e a s i l y comparable f o r the p e r i o d s an q u e s t i o n and which g i v e an i d e a o f t h e s e governments' c a p a c i t i e s t o r e a c h the masses o f r u r a l c l i e n t s t h r o u g h c l i n i c a l l y o r i e n t e d c r a s h programmes. The f o l l o w i n g t a b l e , however, does show t h a t S r i Lanka s t a n d s s e v e r a l o r d e r s o f magnitude above, and Bangladesh s e v e r a l o r d e r s below the a v e r a g e a b i l i t y o f t h e s e c o u n t r i e s ' governments t o r e a c h t h e i r c i t i z e n s , i f one assumes t h a t t h e "urban b i a s " i s u n i f o r m i n a l l c a s e s . - 35 -TABLE 4 M e d i c a l P e r s o n n e l i n B a n g l a d e s h , I n d i a , P a k i s t a n and S r i Lanka C o u n t r y Bangladesh (1976) I n d i a (1974) P a k i s t a n (1977) S r i Lanka AVERAGE P o p u l a t i o n H o s p i t a l Beds 4,868 1,465 1,903 334 2,142 P o p u l a t i o n P h y s i c i a n s 14,178 3,961 3 , 6 0 0 ( e s t ) 4,007 6,436 P o p u l a t i o n Nurses 51,679 6,735 8,002 2,013 17,107 S o u r c e : WHO World H e a l t h S t a t i s t i c s , Geneva, 1979, v. I l l , 1978. H e a l t h P e r s o n n e l and H o s p i t a l E s t a b l i s h m e n t s , pp. 61, 74, 83. Real governmental commitment t o f e r t i l i t y c o n t r o l d i d not b e g i n i n I n d i a u n t i l t h e T h i r d P l a n (1961-1966).. P o l i c y - m a k e r s r e a l i z e d t h a t c l i n i c s were too s p a r s e and too p a s s i v e to r e a c h enough c l i e n t s . T h i s l e d t o the " e x t e n s i o n e d u c a t i o n " a p p r o a c h . More f i e l d s t a f f , more s u p p l i e s , b e t t e r s t a t i s t i c s and b e t t e r management were n e c e s s a r y f o r t h i s s t r a t e g y . L o c a l " g r a s s r o o t s " o r g a n i z a t i o n s a t the d i s t r i c t and s u b - b l o c k l e v e l s were c r e a t e d to implement the p l a n . I t was a t t h i s t ime t h a t c r u d e b i r t h r a t e f i g u r e s as t a r g e t s began to be mentioned i n p l a n s . The t a r g e t f o r the programmes accompanying the t h i r d p l a n was a r a t e o f 25 by 1973, down from a . c u r r e n t ( i n 1961) 40 b i r t h s per t h o u s a n d s . In 1965 a C a b i n e t Committee on F a m i l y P l a n n i n g was formed. T h i s c a l l e d - 36 -f o r r a i s i n g the p r i o r i t y o f the f a m i l y p l a n n i n g programme. As shown on T a b l e 2, the b u d g e t a r y a l l o c a t i o n f o r f a m i l y p l a n n i n g jumped from 2.22 p e r c e n t t o 7.9 p e r c e n t o f o v e r a l l h e a l t h a l l o c a t i o n , and the r a t e o f u t i l i z a t i o n a l s o r o s e . In t h e t e n y e a r s between 1965 and 1975, the government o f I n d i a l a u n c h e d a s u c c e s s i o n o f " c r a s h programmes", each based on h i g h c o n f i d e n c e i n and s t r e s s on a s i n g l e t e c h n i q u e . In 1965, the IUD was t r i e d and b e l i e v e d t o have f a i l e d . Then s t e r i l i z a t i o n ( m o s t l y vasectomy) d r i v e s were mounted. These s t e r i l i z a t i o n d r i v e s u s u a l l y i n v o l v e d the one-time c o n c e n t r a t i o n o f d o c t o r s and c l i n i c a l equipment i n a s i n g l e s i t e , c a l l e d a "camp". By g o i n g o u t t o t h e v i l l a g e r s , r a t h e r than w a i t i n g f o r the v i l l a g e r s t o come to t h e f a c i l i t i e s , many more c l i e n t s were r e a c h e d . The number o f a c c e p t o r s o f s t e r i l i z a t i o n began t o d e c l i n e around 1970, b u t t h e t e c h n i q u e was g i v e n a new l e a s e on l i f e w i t h a m o d i f i e d camp approach i n which r e l a t i v e l y l a r g e sums (Rs. 100) were p a i d t o a c c e p t o r s , a g e n t s , and d o c t o r s . A t t h i s time a l s o , t h e condom was promoted w i t h some s u c c e s s t h r o u g h a h i g h p r e s s u r e s a l e s campaign. In the mid-1960s some changes o c c u r r e d i n I n d i a ' s economic and demo-g r a p h i c e n v i r o n m e n t s . A sense o f u r g e n c y began to pervade the P l a n n i n g Commission and m i n i s t r i e s c o n c e r n e d w i t h t h e economy i n New D e l h i . T h i s was p a r t l y t h e r e s u l t o f the 1961 Census R e p o r t , which i n d i c a t e d t h a t n e t p o p u l a t i o n growth f o r the p r e v i o u s decade had been 21.6 p e r c e n t . T h e r e was a n e a r l y c a l a m i t o u s famine i n B i h a r i n 1965, and a c r o p f a i l u r e t h e f o l l o w i n g season as w e l l . There was l e s s c o n f i d e n c e than t h e r e had been i n the p r e v i o u s decade i n I n d i a ' s a b i l i t y t o d e v e l o p her economy w i t h o u t - 37 -f i r s t , o r s i m u l t a n e o u s l y , c o n t r o l l i n g her p o p u l a t i o n growth. The i n t e r n a t i o n a l e n v i r o n m e n t had a l s o changed by t h i s t i m e , becoming h i g h l y f a v o u r a b l e t o f e r t i l i t y c o n t r o l . Meanwhile the t e c h n o l o g i c a l e n v i r o n -ment seemed to be c h a n g i n g . The IUD, as p r e v i o u s l y m e n t i o n e d , l o o k e d l i k e a major b r e a k t h r o u g h , and t h e r e were o t h e r s i n the o f f i n g . L e a d e r s i n many c o u n t r i e s were b e g i n n i n g t o r e a l i z e t h a t p o p u l a t i o n growth c o u l d not be l e f t to t a k e i t s own c o u r s e . In 1963, Nehru i n d i c a t e d a s h i f t i n h i s t h i n k i n g on the s u b j e c t , t e l l i n g t h e F i r s t A s i a n P o p u l a t i o n C o n f e r e n c e (December 10, 1963) t h a t p o p u l a t i o n p o l i c y had been i n a d e q u a t e : I c o n f e s s t h a t we ( i n I n d i a ) have not succ e e d e d r e m a r k a b l y and t h e growth o f p o p u l a t i o n i n t h i s g r e a t c o u n t r y i s r a t h e r a l a r m i n g . 5 A t t h e same t i m e , l e a d e r s were l e s s a p p r e h e n s i v e , :due t o the absence o f any n e g a t i v e mass r e s p o n s e t o f a m i l y p l a n n i n g programmes. The programmes a c q u i r e d g r e a t e r p r e s t i g e and t h e r e f o r e p r i o r i t y i n 1965 by r e c e i v i n g t h e a c t i v e i n t e r e s t o f two o u t s t a n d i n g members o f the government. These were C. Subramaniam, M i n i s t e r o f Food and A g r i c u l t u r e , and Asoka Mehta, Deputy Chairman o f the P l a n n i n g Commission and l a t e r M i n i s t e r o f P l a n n i n g . I t was t h e s e men who had formed the C a b i n e t Committee on F a m i l y P l a n n i n g . ^ S u s h i l a Nayar, M i n i s t e r o f H e a l t h , who had a n e g a t i v e a t t i t u d e towards f e r t i l i t y c o n t r o l , was r e p l a c e d i n 1966 by Dr. S. Chandra-s e k h a r , a demographer and b i r t h c o n t r o l e n t h u s i a s t . The IUD e p i s o d e i l l u s t r a t e s the manner i n which the i n t e r a c t i o n between f o r e i g n donor a g e n c i e s , I n d i a n m e d i c a l and b u r e a u c r a t i c e l i t e s , and t h e i r c l i e n t e l e d e t e r m i n e d what was to become a t y p i c a l p a t t e r n . In 1964 a d e l e -g a t i o n o f I n d i a n g y n e c o l o g i s t s and f a m i l y p l a n n i n g e x p e r t s a t t e n d e d an - 38 -i n t e r n a t i o n a l c o n f e r e n c e i n New York f e a t u r i n g t h e IUD.' They r e t u r n e d c o n -v i n c e d t h a t t h i s was t h e b r e a k t h r o u g h t h a t would make mass b i r t h c o n t r o l •<• p o s s i b l e a t l a s t . A t the same t i m e , a U.N. a d v i s o r y m i s s i o n v i s i t e d I n d i a and s t r o n g l y a d v o c a t e d the pro m o t i o n o f the IUD. I t was g i v e n t op p r i o r i t y by t h e C e n t r a l H e a l t h M i n i s t r y t o the e x c l u s i o n o f o t h e r methods. The IUD programme r e a c h e d a maximum o f a c c e p t o r s i n 1966-67 and then ex-p e r i e n c e d a d e c l i n e t o l e s s than h a l f t h a t l e v e l by 1973-1974. Of t h o s e women who a c c e p t e d the l o o p , a r a t h e r low p e r c e n t a g e r e t a i n e d them compared w i t h r e t e n t i o n r a t e s found i n d e v e l o p e d c o u n t r i e s . Word o f cramps and b l e e d i n g , which had s e r i o u s o v e r t o n e s o f c o n t a m i n a t i o n and i m p u r i t y i n I n d i a n c u l t u r e , q u i c k l y n u l l i f i e d t h e i n i t i a l l y n e u t r a l a t t i t u d e o f the c l i e n t p u b l i c t o the IUD. The low r e t e n t i o n r a t e had been p r e d i c t e d by I n d i a n Korean, and Taiwanese f i e l d t e s t s , y e t t h e programme was c o n s i d e r e d a f a i l u r e . Some s c h o l a r s have a r g u e d t h a t the s t r a t e g y was adopted and then dropped t o o q u i c k l y , b e f o r e i n e v i t a b l e k i n k s i n the d e l i v e r y and f o l l o w - u p system c o u l d be remedied. When i t became e v i d e n t t h a t t h e IUD was l o s i n g ground, a second U.N. a d v i s o r y m i s s i o n i n 1969 r e v i e w e d i t s p r o g r e s s and c a l l e d f o r a r e d e s i g n o f the programme w i t h b e t t e r p l a n n i n g q and i m p l e m e n t a t i o n . The government, however, was d i s p i r i t e d and the IUD's r e p u t a t i o n had been damaged. A p p r e h e n s i o n t h a t a g i v e n t e c h n i q u e , such as the IUD, was not g a i n i n g the e x p e c t e d number o f a c c e p t o r s , and t h a t c o n s e q u e n t l y t h e r e was l i t t l e hope o f a s i g n i f i c a n t impact on t h e b i r t h r a t e , l e d some o f f i c i a l s t o c o n -c l u d e t h a t a new method must be f o u n d . O t h e r s t h o u g h t , meanwhile, t h a t t h i s new method must be combined w i t h more f o r c e f u l methods o f m o t i v a t i o n . A - 39 -number o f s t a t e s e x p e r i m e n t e d w i t h m i l d :coercion..as e a r l y l a s - 1966. U t t a r P r a d e s h l a u n c h e d a " m u l t i - a g e n c y f o r t n i g h t " i n which employees from a l l government a g e n c i e s were r e q u i r e d t o " m o t i v a t e " a quota o f vasectomy c l i e n t s on p a i n o f pay dockage o r o u t r i g h t d i s m i s s a l . D a l a i ( " b r o k e r s " ) , who b r o u g h t i n c l i e n t s i n r e t u r n f o r payment from h a r r i e d o f f i c i a l s , c o n t r i b u t e d to t h e low demographic a p p r o p r i a t e n e s s o f t h e . s t e r i l i z a t i o n c a s e s . The too young and the too o l d . were br o u g h t i n , and t h e i r age r e c o r d s were f a l s i f i e d where p o s s i b l e . ^ In 1967 a p r o p o s a l t h a t i n v o l u n t a r y p o p u l a t i o n c o n t r o l be i n t r o d u c e d t h r o u g h t h e use o f one hundred rupee payments was withdrawn under a "storm o f q u e s t i o n s " . ^ T h i s p r o p o s a l was so u n a c c e p t a b l e p o l i t i -c a l l y , t h a t some h i g h - l e v e l p e r s o n n e l were t r a n s f e r r e d w i t h i n t h e D e p a r t -ment o f F a m i l y P l a n n i n g . N e v e r t h e l e s s , a one hundred rupee i n c e n t i v e payment was used i n 1972 i n t h e Ernakulum vasectomy f e s t i v a l , and i t was h a i l e d as an o u t s t a n d i n g s u c c e s s . T h i s i n d i c a t e s t h e s h i f t i n t h i n k i n g both by p o l i t i c i a n s and economic and h e a l t h p l a n n i n e r s , which had t a k e n p l a c e as. a„.result o f t h e e x h a u s t i o n o f i d e a s and p a u c i t y o f r e s u l t s i n t h e i n t e r v e n i n g f i v e y e a r s . The condom campaign's r e s u l t s had d e c l i n e d , IUDs were w i d e l y r e g a r d e d as u n s u i t a b l e i n I n d i a n c o n d i t i o n s , and t h e one method which had not become the c e n t r e o f a c r a s h programme, the ' o r a l ' p i l l , was t h o u g h t t o be too complex 12 f o r s e l f - a d m i n i s t r a t i o n by t h e I n d i a n woman. In the c r a s h programme, phase, v o l u n t a r y o r g a n i z a t i o n s , a l t h o u g h s t i l l a c t i v e , were e c l i p s e d by t h e m u l t i - and b i - l a t e r a l : i n t e r n a t i o n a l donor a g e n c i e s . These a g e n c i e s do n o t seem t o have had much i n f l u e n c e on whether o r n o t major s h i f t s i n t h e v i g o u r o f p o l i c y took p l a c e , but t h e y d i d have - 40 -some impact on p a r t i c u l a r measures c h o s e n . I t was the F o r d F o u n d a t i o n (from 1963 t o 1967) and U.S. AID ( f r o m 1966 to 1972) which were most im-p o r t a n t t o t h e s e c h o i c e s i n t h e second phase. F o r d had been i n I n d i a s i n c e 1951, but i t s i n v o l v e m e n t i n f a m i l y p l a n n i n g w o r k . c u l m i n a t e d i n 1966. Due to the o p u l e n t l i f e - s t y l e s o f the F o r d c o n s u l t a n t s , and t o the i n e v i t a b l e mismatch which o c c u r r e d due t o d i f f e r i n g b u r e a u c r a t i c c u l t u r e s , d i s t r u s t and a n i m o s i t y f o r t h e Americans grew to t h e p o i n t i n 1966 where some i n t e l l e c -t u a l s and I n d i a n p o l i t i c i a n s , i n c l u d i n g one c a b i n e t m i n i s t e r , denounced t h e F o u n d a t i o n i n P a r l i a m e n t . The F o r d F o u n d a t i o n g r a n t s had exceeded one m i l l i o n d o l l a r s , o f which a q u a r t e r had gone t o f a m i l y p l a n n i n g . However, t h i s was never more than t e n p e r c e n t o f t h e e n t i r e f a m i l y p l a n n i n g budget - 13 f o r one y e a r . The stamp o f American a i d was found on the ad campaign f e a t u r i n g t h e re d t r i a n g l e , and on the c o n t r a c e p t i v e m a r k e t i n g programme f o r d i s t r i b u t i o n o f N i r o d h condoms t h r o u g h f i v e l a r g e m a r k e t i n g f i r m s . The condom campaign was the o n l y one to be c o n d u c t e d l a r g e l y o u t s i d e the p u b l i c s e c t o r . The condom a l s o had s e v e r a l advantages o v e r o t h e r methods. I t i s cheap, h a r m l e s s , l a r g e l y c o n f i d e n t i a l , m a l e - o r i e n t e d where males make t h e i m p o r t a n t d e c i s i o n s i n t h e h o u s e h o l d , and i t s r e a c h i s not r e s t r i c t e d t o t h a t o f the government h e a l t h network. F u r t h e r m o r e , i t does n o t l e a d t o permanent i n f e r t i l i t y . and t h e r e f o r e a p p e a l s t o y o u n g e r c o u p l e s . S a l e s were kept h i g h by a h i g h powered ad campaign, t h e i n f o r m a l l e a d e r o f which was a m a r k e t i n g s p e c i a l i s t 14 from M.I.T. by t h e name o f P e t e r S. K i n g . S a l e s r o s e up t o 1973, when the N i r o d h ' s p o p u l a r i t y plummeted. T h i s was due t o the d i s c o n t i n u a t i o n o f the s a l e s campaign and the r e d u c t i o n o f t h e p r i c e - s u b s i d y . - 41 -As i n the f i r s t phase o f I n d i a ' s f e r t i l i t y p o l i c y p r o c e s s , the p e r s o n a l p r e f e r e n c e s o r a v e r s i o n s o f I n d i a ' s Prime M i n i s t e r p l a y e d an i m p o r t a n t r o l e i n d e t e r m i n i n g s h i f t s i n d i r e c t i o n . Nehru had g i v e n some.-support t o f e r t i l i t y c o n t r o l p r i o r t o h i s d e a t h . N e i t h e r Prime M i n i s t e r S h a s t r i , nor Mrs. Gandhi were a t a l l v o c a l i n t h e i r s u p p o r t , however. By t h e e a r l y 1970s s e v e r a l groups had been formed t o oppose f a m i l y p l a n n i n g , and Mrs. Gandhi's awareness o f t h e s e , i n c o m b i n a t i o n w i t h a p o s s i b l e r e a c t i o n a g a i n s t the American a g e n c i e s ' e x c e s s i v e z e a l f o r f e r t i l i t y c o n t r o l , may e x p l a i n her r e -15 t i c e n c e . The s u c c e s s i o n o f c r a s h programmes c o n t i n u e d d e s p i t e a l a c k o f o u t -f r o n t s u p p o r t from Mrs. Gandhi. Then, a l t h o u g h she had r e a s o n t o remain s i l e n t on t h i s i s s u e , she underwent a t u r n a b o u t i n 1973. I t i s t h o u g h t t h a t she and h e r a d v i s o r s were shaken by t h e 1971 Census R e p o r t , which was p u b l i s h e d a t the same time t h a t f o o d , p e t r o l e u m , and o t h e r r e s o u r c e 1 f> s h o r t a g e s a ppeared imminent. Mrs. Gandhi's appointment o f Dr. Karan S i n g h , a man g e n e r a l l y c o n s i d e r e d e f f e c t i v e as w e l l as p o p u l a r , marked a s h i f t t o more v i g o r o u s and s o p h i s t i c a t e d , i f n o t more a c t i v e , f e r t i l i t y c o n t r o l p o l i c y . ^ A t the B u c h a r e s t World P o p u l a t i o n C o n f e r e n c e , S i n g h advanced, on 18 b e h a l f o f I n d i a , a " b a l a n c e d and r e a l i s t i c " p o s i t i o n . He p o i n t e d o u t t h e d e l e t e r i o u s e f f e c t o f r a p i d p o p u l a t i o n growth, and emphasized t h e n e c e s s i t y f o r i n t e g r a t i o n o f development and p o p u l a t i o n c o n t r o l . The D r a f t F i f t h P l a n (197.4-1979), bearing his stamp, c a l l e d f o r a g r a d u a l i s t a p p r o a c h . T h e r e was a r e c o g n i t i o n t h a t the programmes o f p r e v i o u s y e a r s had been r u s h e d and t h a t a s l o w e r b u i l d - u p w i t h l e s s v i s i b l e r e s u l t s would be more e f f e c t i v e i n - 42 -the l o n g r u n . 1 : 7 The P l a n e n v i s i o n e d t h r e e " c r a s h programmes", even though the term had l o s t most o f i t s c o n n o t a t i o n o f f o r c e o r urgency by t h i s t i m e . The f i r s t programme was t o l a u n c h the development o f a b i r t h c o n t r o l method u n i q u e l y s u i t e d to I n d i a n c o n d i t i o n s . Such a method would have to be non-t e r m i n a l , r e q u i r e no m e d i c a l f o l l o w - u p o r m e t i c u l o u s a t t e n t i o n o f the u s e r , ' nor r e q u i r e bathroom f a c i l i t i e s o r p r i v a c y . I t was r e a l i z e d t h a t no method, no m a t t e r how e f f e c t i v e , would be adopted so l o n g as t h e l a r g e f a m i l y r e -mained an i n s t i t u t i o n . The government pr o p o s e d t h e r e f o r e t o promote t h e " s m a l l - f a m i l y norm" w i t h renewed e n e r g y , u s i n g a l l propaganda media, p r o f e s -s i o n a l o r g a n i z a t i o n s , and so on. The t h i r d "programme" was the r e o r g a n i z a -t i o n o f t h e s t r u c t u r e o f t h e H e a l t h and F a m i l y P l a n n i n g s e r v i c e network. Ideas may e x i s t l o n g b e f o r e t h e y a r e t r a n s f o r m e d i n t o p o l i c y . The World P o p u l a t i o n C o n f e r e n c e l e n t p o l i t i c a l l e g i t i m a c y t o i d e a s w hich t h e s o c i a l s c i e n c e s had been d e v e l o p i n g s i n c e a t l e a s t the p r e v i o u s decade. There were two streams o f t h o u g h t on f e r t i l i t y c o n t r o l . The " s o f t o p t i o n " , e x e m p l i f i e d by t h e I n d i a n s t a n d a t the World P o p u l a t i o n C o n f e r e n c e i n 1974, i n v o l v e d i n d u c i n g f e r t i l i t y d e c l i n e by m a n i p u l a t i n g t h e known c o r r e l a t e s o f low f e r t i l i t y . The " h a r d " s t r e a m went beyond t h e c o n v e n t i o n a l v o l u n t a r i s -t i c f a m i l y p l a n n i n g by d i r e c t l y a p p l y i n g i n c e n t i v e s and d i s i n c e n t i v e s . Dr. S i n g h chose t h e f o r m e r approach when he p r o c l a i m e d t h a t "Development (was) t h e b e s t c o n t r a c e p t i v e " . S t a t e d as v a g u e l y as t h i s , i t was no b e t t e r than the hope e x p r e s s e d d u r i n g t h e 1950s t h a t development must p r e -cede f e r t i l i t y d e c l i n e . T h i s t i m e , however, i t was known t h a t e d u c a t i o n l e v e l s and f a m i l y s i z e c o r r e l a t e d h i g h l y and t h a t where f e r t i l i t y i s low, 20 i n f a n t m o r t a l i t y i s a l s o low, and t h e s t a t u s o f women i s h i g h . - 43 -The " h a r d " stream had a l s o been c o n s i d e r e d as e a r l y as t h e p i o n e e r i n g phase i n I n d i a . The h i g h - l e v e l H e a l t h S u r v e y and P l a n n i n g Committee ( M u d l i a r Committee) had recommended an e x p a n s i o n o f c o n v e n t i o n a l a p p r o a c h e s to f e r t i l i t y p o l i c y t h r o u g h f a m i l y p l a n n i n g . However, a m i n o r i t y went on to urge s t e p s which were a s i g n i f i c a n t d e p a r t u r e from c o n v e n t i o n . These were: ( i ) graded t a x p e n a l t i e s b e g i n n i n g w i t h the f o u r t h b i r t h ; ( i i ) removal o f income t a x d i s a d v a n t a g e s f o r s i n g l e p e r s o n s ; ( i i i ) no m a t e r n i t y b e n e f i t s . f o r t h o s e who r e f u s e d t o l i m i t t h e i r progeny; ( i v ) l i m i t i n g government s e r v i c e s , l i k e f r e e e d u c a t i o n t o no more than t h r e e c h i l d r e n per f a m i l y ; (v) e n l i s t i n g h e l p o f a l l government employees i n p r o m o t i n g f a m i l y p l a n n i n g and ( i v ) p e r m i t t i n g a b o r t i o n f o r s o c i o - e c o n o m i c r e a s o n s . 21 These recommendations were made i n 1961. The most s i g n i f i c a n t i n s t i t u t i o n a l change d u r i n g I n d i a ' s second phase was the u p g r a d i n g o f the s t a t u s o f F a m i l y P l a n n i n g . E x p e r t s i n t h e P l a n n i n g . Commission's e v a l u a t i o n o f 1965 had recommended t h a t much more a d m i n i s t r a t i v e and f i n a n c i a l a u t h o r i t y was needed. They c a l l e d f o r a C e n t r a l F a m i l y P l a n -n i n g O r g a n i z a t i o n t o be g i v e n semi-autonomous s t a t u s w i t h i n t h e H e a l t h M i n i s t r y . In the e v e n t , i t was n o t g i v e n semi-autonomy, but i t was made a D i r e c t o r a t e and i t s c h i e f t e c h n i c a l o f f i c e r was g i v e n t h e t i t l e o f Commis-22 s i o n e r o f F a m i l y P l a n n i n g . F a m i l y P l a n n i n g was g i v e n department s t a t u s and s y m b o l i c f u l l p a r t n e r s h i p w i t h h e a l t h . When Mrs. Gandhi took o f f i c e i n J a n u a r y 1966, t h e m i n i s t r y was renamed " M i n i s t r y o f H e a l t h and F a m i l y •Planning". W i t h i n the. government o f I n d i a as a whole, however, t h i s p o l i c y a r e a , as a " s o c i a l p o l i c y " had r a t h e r low p r i o r i t y i n comparison w i t h 23 a r e a s such as i n d u s t r y . - 44 -One must, moreover, be c a u t i o u s about a t t r i b u t i n g any s i g n i f i c a n c e t o changes made i n o r g a n i z a t i o n a l a r r a n g e m e n t s . In the heyday o f F o r d and AID, " i n s t i t u t i o n b u i l d i n g " was a prime d e s i d e r a t u m . An American p u b l i c a d m i n i s t r a t i o n e x p e r t d e s i g n e d two I n d i a n i n s t i t u t i o n s . One, the N a t i o n a l F a m i l y P l a n n i n g I n s t i t u t e (NFPI) was to do r e s e a r c h and t r a i n i n g i n f a m i l y p l a n n i n g , w h i l e t h e N a t i o n a l I n s t i t u t e o f H e a l t h A d m i n i s t r a t i o n (NAHAE) was t o deal, w i t h p u b l i c h e a l t h . These n a s c e n t i n s t i t u t i o n s each had t h e i r be-h i n d - t h e - s c e n e s American p u b l i c h e a l t h a d m i n i s t r a t o r s . N e i t h e r the NFPI 24 nor t h e NAHAE has s i n c e a p p e a r e d i n t h e f e r t i l i t y p o l i c y l i t e r a t u r e . Fondness o f form, a q u a l i t y o b s e r v e d i n I n d i a n b u r e a u c r a c y , may w e l l a l s o be common t o t h o s e i n o t h e r c o u n t r i e s o f the r e g i o n . When s p e a k i n g o f a v i g o r o u s as opposed to weak p o l i c y , i t i s w i s e t o b e a r i n mind t h a t the v i g o u r may o n l y be v e r b a l d e s p i t e a p p e a r a n c e s to t h e c o n t r a r y . The gap between a c t i o n and i m p l e m e n t a t i o n has been a t t r i b u t e d t o a p a u c i t y o f i n s t i t u t i o n a l l e v e r s , c h r o n i c i n any poor c o u n t r y , but many o b s e r v e r s have commented on t h e penchant i n I n d i a t o r e g a r d r i t u a l as an end. John Kenneth G a l b r a i t h , when he was U.S. Ambassador to I n d i a , remarked: I had l o n g been i n D e l h i b e f o r e I r e a l i z e d how u r g e n t would be t h e d i s c u s s i o n o f F a m i l y P l a n n i n g . . . a n d how s l i g h t would be t h e c o n s e q u e n c e s . The d i s c u s s i o n was an a r t form. The r e a l i t y was the absence o f any l e v e r s f o r moving the g r e a t v i l l a g e mass...the absence, on o c c a s i o n , even o f t h e means o f communication w i t h the I n d i a o f t h e m i l l i o n s . 2 5 T h i s penchant f o r f o r m r e s u l t s i n a p l e t h o r a o f p l a n s , p a p e r , m e e t i n g s , and s e m i n a r s . The law passed o r t h e funds a l l o c a t e d become an end and a s o l u -26 t i o n r a t h e r than a means. - 45 -The 1960s was a decade d u r i n g which P a k i s t a n undertook many a m b i t i o u s development p l a n s . A l t h o u g h Ayub Khan was s t r o n g l y d e v e l o p m e n t - o r i e n t e d from t h e time he came t o power i n 1958, f e r t i l i t y p o l i c y c a n n o t be s a i d t o have r e a c h e d the second phase u n t i l 1965, when he made f a m i l y p l a n n i n g a p a r t o f h i s e l e c t i o n p l a t f o r m . P r i o r t o t h i s , t h e M i n i s t r y o f H e a l t h , under i t s budget a l l o c a t i o n o f Rs. 30.5 m i l l i o n , had made c o n t r a c e p t i v e s a v a i l a b l e t h r o u g h i t s m a t e r n a l and c h i l d h e a l t h c e n t r e s . These, however, w e r e . s p r e a d e x t r e m e l y t h i n l y , and r e a c h e d v e r y few P a k i s t a n i v i l l a g e r s . F or 1965-1970, however, t h e M i n i s t r y r e c e i v e d 394.2 m i l l i o n r u p e e s , o f which 37 p e r c e n t 27 was meant f o r f a m i l y p l a n n i n g . In s h o r t , r e s o u r c e commitments jumped s i g n i f i c a n t l y . A l o n g - r a n g e ' P e r s p e c t i v e P l a n (1965-1985) was drawn up i n which the government assumed i t p o s s i b l e t o l o w e r t h e b i r t h f r o m 50 t o 25 i n 20 y e a r s . A r a t e o f 40 was t h e r e f o r e c o n s i d e r e d an a p p r o p r i a t e t a r g e t f o r 1970. D u r i n g the T h i r d F i v e Year P l a n (1965-1970), however, o n l y 18.2 p e r c e n t o f the 28 F a m i l y p l a n n i n g a l l o c a t i o n was s p e n t . The IUD, as i n I n d i a , was h a i l e d as t h e i d e a l c o n t r a c e p t i v e . A new f i e l d o r g a n i z a t i o n was s e t up t o r e a c h and m o t i v a t e t h e v i l l a g e r s o f P a k i s t a n . U n l i k e I n d i a , t h e t r a d i t i o n a l b i r t h a t t e n d a n t , o r d a i was deemed the f r o n t l i n e m o t i v a t o r . Her d u t i e s were to m o t i v a t e c o u p l e s , d i s t r i b u t e c o n v e n t i o n a l d e v i c e s , and t o b r i n g i n IUD a c c e p t o r s t o t h e c l i n i c s . She was t o r e c e i v e a monthly s a l a r y o f Rs. 15 p l u s a t w o - a n d - a - h a l f rupee bonus f o r each IUD a c c e p t o r . Of t h e maximum s t r e n g t h o f f i f t y thousand hoped f o r , o n l y 36,000 were h i r e d because o f poor performance and c o n s t a n t q u i t t i n g . S u b s e q u e n t l y 1,400 male workers were h i r e d p a r t - t i m e t o a p p r o a c h - 46 -male v i l l a g e r s . They r e c e i v e d q u a d r u p l e t h e s a l a r y o f the d a i s . T h e r e were a l s o about 1,200 f a m i l y p l a n n i n g o f f i c e r s , c l e r k s , d i s p e n s e r s , and so on, to c o n t a c t v i l l a g e l e a d e r s and promote f a m i l y p l a n n i n g t h r o u g h p u b l i c i t y . T h i s was q u i t e r e m i n i s c e n t o f t h e I n d i a n e x t e n s i o n e d u c a t i o n programme, which had been t r i e d i n 1964 and then abandoned. An Impact S u r v e y was c o n -d u c t e d i n 1968-1969. I t found t h a t a l t h o u g h e i g h t y p e r c e n t o f the women i n t e r v i e w e d were i n f a v o u r o f f a m i l y p l a n n i n g , o n l y f o u r p e r c e n t were p r a c t i c i n g i t . S i n c e 64 p e r c e n t d i d n o t know anyone i n t h e l o c a l i t y t o whom the y c o u l d go f o r a d v i c e and d e v i c e s , t h e i n f e r e n c e was r e a c h e d t h a t t h e m o t i v a t i o n a l programme had f a i l e d t o r e a c h most p o t e n t i a l c l i e n t s . N e v e r t h e -l e s s , p l a n n i n g f o r t h e F o u r t h F i v e Year P l a n (1970-1975) was p r e d i c a t e d on t h e a s s u m p t i o n t h a t the programme must have r e d u c e d t h e b i r t h r a t e by 1.8 29 p o i n t s . By t h e end o f t h e T h i r d F i v e Year P l a n , d i s i l l u s i o n m e n t had s e t i n both w i t h t h e d a i system and the IUD. The government c o n c l u d e d t h a t t h e d a i p r o -gramme had f a i l e d because i t was c o n t r a r y t o the d a i s ' i n t e r e s t s t o p r e v e n t b i r t h s so l o n g as t h e i r c ompensation from t h e i r t r a d i t i o n a l p a t r o n s exceeded t h a t o f f e r e d by t h e programme t o p r e v e n t b i r t h s . A l t h o u g h t h e s e women seemed n a t u r a l l y s u p e r i o r t o c i t y p e o p l e i n a r o l e i n which t h e y had t o win the t r u s t o f the v i l l a g e r s , t h e i r low s o c i a l s t a t u s was a major d i s a d v a n t a g e , as was a l s o the f a c t t h a t , as women, t h e y would f i n d i t i m p o s s i b l e t o con-v i n c e o r even speak t o men i n the p a t r i a r c h a l h o u s e h o l d . The IUD programme, i n which had been i n v e s t e d so much hope and money, as i n I n d i a , e n j o y e d a w i d e s p r e a d jump i n a c c e p t o r s , and then soon s u f f e r e d m a s s i v e d i s c o n t i n u a t i o n due t o a l a c k o f f o l l o w - u p s e r v i c e s . P a k i s t a n ' s - 47 -c r a s h programme phase, t h e n , appeared t o r e p l i c a t e t h a t o f I n d i a . D u r i n g the p e r i o d 1969 t o 1972, f a m i l y p l a n n i n g and p o p u l a t i o n i s s u e s were v i r t u a l l y i g n o r e d i n P a k i s t a n by a l l l e v e l s o f government, due t o p o l i -t i c a l t u r m o i l . In 1972, a Two Year Scheme was p r e p a r e d w i t h a budget of Rs. 204 m i l l i o n . The government hoped t o i n t r o d u c e a " p o p u l a t i o n b i a s " i n t o a l l a r e a s of p o l i c y , and i n k e e p i n g w i t h t h i s more u n i v e r s a l a p p r o a c h , the F a m i l y P l a n n i n g D i v i s i o n of t h e Department of H e a l t h was renamed the P o p u l a t i o n P l a n n i n g D i v i s i o n . A commercial d i s t r i b u t i o n system was s e t 30 up t o pursue the p o l i c y of " i n u n d a t i o n " . Condoms were the c e n t r e - p i e c e , and p i l l s were a l s o d i s p e n s e d w i t h o u t p r e s c r i p t i o n . P r i c e s were n o m i n a l , and s u p p l i e s were f u r n i s h e d by U.S. AID. The problems of c o u p l e - m o t i v a t i o n and government s h o r t n e s s o f o u t r e a c h were d e a l t w i t h by a programme c a l l e d t he C o n t i n u o u s M o t i v a t i o n Scheme CCMS). F i r s t p i l o t e d i n S i a l k o t i n 1969, t h e government hoped t h a t t h i s scheme would overcome some of t h e major d e f i c i e n c i e s of t h e t h i r d p l a n . I t would use male/female teams of " m o t i v a t o r s " one member f o r a c c e s s t o each p a r e n t . Each team was t o c o v e r a " c i r c l e " of t e n t o s i x t e e n thousand (!) p e r s o n s d u r i n g a . t h r e e - m o n t h - l o n g c i r c u i t . I t was f i n a l l y p o s s i b l e t o t r y t o i m p l e -ment t h e scheme i n 1972 a f t e r the s e c e s s i o n of Bangladesh and t h e u p h e a v a l s of t h e Indo-Pak war had s u b s i d e d . I t i s w o r t h w h i l e r e c o u n t i n g t h e CMS e p i s o d e f o r t h e s e r i o u s gaps i t r e v e a l s , b e t w e e n s t a t e d i n t e n t i o n s and a c t u a l f i e l d b e h a v i o u r . A s t u d y by a German s c h o l a r , D i e t r i c h B r u n i n g , was p r e c i -31 p i t a t e d by t h e a p p a r e n t waste of condoms and p a l l s . A c c o r d i n g t o the P a k i s t a n F e r t i l i t y S u r v e y , one p e r c e n t o r 11.8 m i l l i o n men used condoms, whereas t h e "off-take" f i g u r e s s u p p l i e d by t h e P o p u l a t i o n P l a n n i n g d i s t r i b u t i - 48 -d i v i s i o n i n d i c a t e d t h a t i f a l l condoms which were b e i n g g i v e n o u t were b e i n g used, 10.5 p e r c e n t o f e l i g i b l e males must be u s i n g them. The i m p l i c a -t i o n s were t h a t 90 p e r c e n t o f t h e condoms d i s t r i b u t e d i n P a k i s t a n i n 1975 were not b e i n g used f o r c o n t r a c e p t i o n . The s u r v e y found t h a t workers were c o n c e n t r a t e d i n the c i t i e s and t h a t the m a j o r i t y were a b s e n t from v i l l a g e s when t h e i r t o u r s c h e d u l e s i n d i c a t e d t h e y s h o u l d have been t h e r e . Nine p e r -c e n t o f m o t i v a t o r s were p r e s e n t where t h e y ought t o have been. O n l y e i g h t p e r c e n t o f t h e v i l l a g e s s u r v e y e d had been v i s i t e d on s c h e d u l e , 46 p e r c e n t had been v i s i t e d by p o p u l a t i o n p l a n n i n g p e r s o n n e l o f some k i n d i n the p r e -v i o u s y e a r , 21 p e r c e n t had been v i s t e d between one and e l e v e n y e a r s p r e -v i o u s l y , and 25 p e r c e n t o f t h e v i l l a g e s had never been v i s i t e d ! B r u n i n g ' s c o n c l u s i o n was t h a t : Frequency o f v i s i t s t o p a r t i c u l a r v i l l a g e s and c l i e n t s seems to be d e t e r m i n e d by the p e r s o n a l l i f e o f the mo-t i v a t o r more than by g o a l s o f the programmes.32 A t t h e b e g i n n i n g o f t h e c r a s h programme phase i n P a k i s t a n , t h a t i s , the mid-1960s, p e r c e p t i o n s o f economic s t r e n g t h were more o p t i m i s t i c then t h e y were i n I n d i a . I t was t h o u g h t t h a t P a k i s t a n ' s "Decade o f Development" under the d i r e c t i o n o f Ayub, then h a l f o v e r , was c h a l k i n g up a more "impres-33 s i v e r e c o r d " t h a n I n d i a ' s was. The r e t u r n s from t h e 1961 c e n s u s , however, had i n d i c a t e d a d i s t u r b i n g l y h i g h r a t e o f n a t u r a l i n c r e a s e . The r e t u r n s from the t h i r d c e n s u s , not a v a i l a b l e u n t i l 1972, i n d i c a t e d t h a t t h e r e had been no drop i n the c r u d e b i r t h r a t e , which p e r s i s t e d a t the l e v e l o f f i f t y p er t h o u -sand d e s p i t e t h e crash,programmes o f the 1960s. As i n I n d i a , the p a t r o n a g e and u n e q u i v o c a l s u p p o r t — o r i t s absence — o f a n a t i o n a l l e a d e r proved o f paramount i m p o r t a n c e i n d e t e r m i n i n g the - 49 -l a u n c h i n g o f P a k i s t a n ' s second phase o f f e r t i l i t y p o l i c y . A t a s e m i n a r o r g a n i z e d by the F a m i l y P l a n n i n g A s s o c i a t i o n o f P a k i s t a n c a l l e d P a k i s t a n ' s P o p u l a t i o n Quake ( 1 9 6 4 ) , Ayub K*an expounded h i s view: I f n o t h i n g i s done t o check t h e r a t e o f p o p u l a t i o n growth, I shudder t o t h i n k what w i l l happen a f t e r a few d e c a d e s . My o n l y c o n s o l a t i o n i s t h a t I s h a l l not be t h e r e to f a c e t h a t s i t u a t i o n . But my c o u n t r y and my p e o p l e would be f a c e d w i t h i t . And the coming g e n e r a t i o n s would not f o r g i v e us f o r l a n d i n g them i n such a bad mess.34" Because P a k i s t a n was a " c o n s t i t u t i o n a l a u t o c r a c y " , Ayub was a b l e to t a k e a more f o r t h r i g h t s t a n d on f e r t i l i t y p o l i c y and t o implement programmes 35 which were l e s s s e n s i t i v e to o p p o s i t i o n than c o u l d Mrs. Gandhi. For example, i n P a k i s t a n , due t o the weakness o f the P a k i s t a n M e d i c a l A s s o c i a -t i o n , p a ramedics were p e r m i t t e d t o do IUD i n s e r t i o n s . The d i s r e g a r d f o r t h e views o f t h e m e d i c a l p r o f e s s i o n had r e p e r c u s s i o n s many y e a r s l a t e r , when the B h u t t o government t r i e d t o r e - i n t e g r a t e h e a l t h s e r v i c e s and f a m i l y p l a n n i n g . 36 The d o c t o r s remained c o l d t o the i d e a . T h a t g r e a t e r p o l i t i c a l s e n s i t i -v i t y was d e s i r a b l e even i n the absence o f d e m o c r a t i c c h e c k s t o p r e s i d e n t i a l power was shown i n the a n t i - A y u b a g i t a t i o n s o f 1968-1969, when f a m i l y p l a n n i n g c e n t r e s were made t a r g e t s o f s t o n e - t h r o w i n g mobs. T h i s i n s e n s i t i v i t y to the human impact o f f e r t i l i t y c o n t r o l p o l i c y was e v i d e n t from the b e g i n n i n g o f t h e second phase i n P a k i s t a n . The fundamental c o n c e p t u a l o r i e n t a t i o n o f the p o l i c y was e x p r e s s e d by Mr. Enver A d i l , t he new Commissioner o f F a m i l y P l a n n i n g , 1965, when he s a i d t h a t " F a m i l y p l a n n i n g 37 i s e s s e n t i a l l y an a d m i n i s t r a t i v e m a t t e r . " Immense sums went i n t o the p e r i o d i c r e - o r g a n i z a t i o n o f programmes w i t h the assumption t h a t i t one k i n d 38 o f o r g a n i z a t i o n d i d n o t work, a n o t h e r would. When at t e m p t s t o - i n f l u e n c e - 50 -the demand s i d e o f c o n t r a c e p t i o n , such as the C o n t i n u o u s M o t i v a t i o n Scheme, f a i l e d , ways were sought t o e f f e c t improvements on the s u p p l y s i d e t h r o u g h such programmes as " i n u n d a t i o n " , i n which v a s t shipments o f s u p p l i e s were br o u g h t i n t o the c o u n t r y , o r the computer-based I n f o r m a t i o n Systems on Con-39 t r a c e p t i v e Movement (ISCM), which attempted to m o n i t o r the f l o w o f s u p p l i e s . P a k i s t a n ' s f e r t i l i t y c o n t r o l p o l i c y i n the 1970s appeared t o d r i f t ' from one programme to a n o t h e r w i t h o u t any p a r t i c u l a r l y d r a m a t i c o r u r g e n t s h i f t s i n s t r e n g t h o r p h i l o s o p h y . The government was aware o f the i n t e l l e c t u a l c u r r e n t s subsumed under the "development i s the b e s t c o n t r a c e p t i v e " s l o g a n , but t h i s l e d n o t t o i m p l e m e n t a t i o n o f programmes which would a f f e c t p e o p l e , but t o the s e t t i n g up i n 1973 o f the D e m o c r a t i c P o l i c y A c t i o n Research C e n t r e ( D P A R C ) . ^ The f r e q u e n t m o d i f i c a t i o n o f i n s t i t u t i o n a l arrangements was a- v v e s t i g e of; U.S. AID's " i n s t i t u t i o n b u i l d i n g " i n I n d i a i n the p r e v i o u s decade. * * * * * * C e y l o n e s e f e r t i l i t y c o n t r o l p o l i c y a l s o e n t e r e d i t s second phase i n 1965. T h i s was l a r g e l y due t o the p r o - f a m i l y p l a n n i n g views o f Dudley Senanayake, who came to power i n t h a t y e a r . P r e v i o u s l y , governments had been i n c r e a s i n g l y s y m p a t h e t i c t o t h e i d e a o f f a m i l y p l a n n i n g f o r the purpose o f h e a l t h , but had n o t y e t had the c o u r a g e t o t a k e an u n c o n d i t i o n a l s t a n d i n f a v o u r o f f a m i l y p l a n n i n g f o r t h e purpose o f f u r t h e r i n g demographic g o a l s . By 1963, economic i n d i c a t o r s had become q u i t e d i s c o u r a g i n g , and t h e r e was, i n f a c t , a per c a p i t a d e c l i n e i n r e a l g r o s s n a t i o n a l p r o d u c t i n t h a t y e a r . ^ The Sweden/Ceylon p r o j e c t d e m o n s t r a t e d (whether f a l l a c i o u s l y o r n o t) what c o u l d be done. The c a b i n e t d e c i d e d to d i s s e m i n a t e f a m i l y p l a n n i n g - 51 -s e r v i c e s t h r o u g h t h e a l r e a d y e x i s t i n g m a t e r n a l / c h i I d h e a l t h network, 42 which was q u i t e . w e l l d e v e l o p e d . A t a r g e t o f r e d u c i n g t h e b i r t h r a t e from 33 t o 25 i n t e n y e a r s was s e t . A l l p r i v a t e c l i n i c s , i n c l u d i n g the Sweden/Ceylon o f f i c e i n Colombo were c o n v e r t e d t o government o u t l e t s . By 1970, t h e government, which had been a s s e r t i v e l y p r o v i d i n g c o n t r a -c e p t i v e s e r v i c e s , and, as w e l l , mounting v a r i o u s communication programmes to p r o p a g a t e t h e i r use, began to back-pedal and, i n f a c t , even r e d u c e d i t s f i n a n c i a l s u p p o r t f o r f a m i l y p l a n n i n g . The r e a s o n , o f c o u r s e , was the imminent e l e c t i o n , p r i o r t o which the government wish e d t o r e d u c e i t s v i s i -b i l i t y as. a t a r g e t o f the e t h n i c p o l i t i c i a n s i n the o p p o s i t i o n . In k e e p i n g w i t h t h i s d e s i r e , t h e F a m i l y P l a n n i n g Bureau was changed to "Maternal and C h i l d H e a l t h Bureau". C e y l o n a l s o had i t s IUD programme, but t h e r e i s some e v i d e n c e t h a t i t s r e s u l t s were q u i t e d i f f e r e n t from t h o s e i n I n d i a and P a k i s t a n . A s u r v e y c a r r i e d o u t between May 1967 and November 1968 o f IUD a c c e p t o r s showed a d i s -43 c o n t i n u a t i o n r a t e o f 0.7 p e r c e n t . T h i s was i n marked c o n t r a s t t o the d i s -c o n t i n u a t i o n r a t e s found i n I n d i a , which r e a c h e d the f i f t y p e r c e n t l e v e l . . The P r e e t h i (condom) and M i t h i ( p i l l ) commercial d i s t r i b u t i o n scheme, begun i n 1973, e n j o y e d a r a p i d r i s e i n s a l e s comparable t o . t h a t i n I n d i a 'a N i r o d h 44 m a r k e t i n g scheme. A l t h o u g h S r i Lanka's r a t e o f n a t u r a l i n c r e a s e as w e l l as c r u d e b i r t h r a t e were t h e l o w e s t i n the r e g i o n , t h e r e were and a r e f e a t u r e s o f the p o l i -t i c a l e n v i r o n m e n t which have made i t s government more s e n s i t i v e t o the s p e c t r e o f r a p i d p o p u l a t i o n growth and a n t i - f e r t i l i t y p o l i c y b a c k l a s h . S r i Lanka's government has had a s t r o n g e r commitment t o p r o v i d i n g a w i d e r range - 52 -o f goods and s e r v i c e s t o i t s c i t i z e n s than have the o t h e r c o u n t r i e s . H 0 A l t h o u g h t h e r e has been o s c i l l a t i o n i n t h i s commitment a c c o r d i n g t o which p a r t y was i n power, the government o f the day has always been e x p e c t e d t o p r o v i d e c e r t a i n minimum l e v e l s o f h e a l t h c a r e , t r a n s p o r t a t i o n , e d u c a t i o n , and so on. The impact o f p r o j e c t e d r a t e s o f p o p u l a t i o n i n c r e a s e on the R i c e S u b s i d y Scheme a l o n e , f o r example, e s t i m a t e d a c c o r d i n g t o a " h i g h growth" p r o j e c t i o n , was t o r a i s e c o s t s by 108 p e r c e n t o v e r s e v e n t e e n y e a r s b e g i n n i n g i n 1971. A c c o r d i n g t o t h e "low growth" p r o j e c t i o n , by c o n t r a s t , 46 the c o s t o f the Scheme was e x p e c t e d t o i n c r e a s e by o n l y 60 p e r c e n t . W h i l e S r i Lanka p l a n n e r s have been s e n s i t i v e , t o the harmful e f f e c t s o f p o p u l a t i o n growth on the economy, p o l i t i c i a n s have been, i n p r e - e l e c t i o n y e a r s , v e r y s e n s i t i v e t o the damage t h a t f e r t i l i t y p o l i c y c o u l d do t o t h e i r p r o s p e c t s . T h i s has been due t o the e l e c t o r a l s i g n i f i c a n c e which the main communal d i v i s i o n i n C e y l o n e s e s o c i e t y between S i n h a l e s e B u d d h i s t s and T a m i l Hindus has t r a d i t i o n a l l y had. C.C. D e S i l v a , i n h i s h i s t o r y o f F a m i l y P l a n n i n g i n S r i Lanka, remarks t h a t : I t i s a c u r i o u s f a c t t h a t p r a c t i c a l l y a t e v e r y e l e c t i o n s i n c e 1960 o r s o , one o f t h e main p l a n k s o f t h e o p p o s i -t i o n a t t a c k on the government misdeeds was the l a t t e r ' s encouragement o f F a m i l y P l a n n i n g : w h i c h e v e r s i d e was o u t , a t t a c k e d the one t h a t was i n ; . . . a s soon as t h e y ( t h e v i c t o r s ) have s e t t l e d down t o the b u s i n e s s o f g o v e r n i n g t h e y r e a l i z e t h a t F a m i l y P l a n n i n g i s an i n -e l u c t i b l e p r e - o p t i o n . ^ 7 In I n d i a , t h e r e were groups who spoke o u t a g a i n s t f a m i l y p l a n n i n g , but t h e government's r e s p o n s e t o t h e s e was t h e s i l e n c e p r o p e r l y a c c o r d e d to c r a n k s . Moreover, t h e e l e c t o r a t e t h e r e has t r a d i t i o n a l l y been d i v i d e d a l o n g many more l i n e s t h a t t h o s e o f r e l i g i o u s community. In C e y l o n , e t h n i c / r e l i g i o u s spokesmen were t a k e n s e r i o u s l y . P r i o r t o the May 1970 e l e c t i o n , / - 53 -f o r example, t h e m i n i s t e r o f h e a l t h d e c l a r e d : S i n h a l e s e and T a m i l s must keep t h e i r r a c e s growing To f u l f i l l t h i s n o b l e t a s k , t h e i r women s h o u l d be p r o v i d e d w i t h a l l f a c i l i t i e s t o p r o p a g a t e the r a c e s . 4 8 These remarks, and o t h e r l i k e them, so c o n t r a d i c t o r y t o t h e avowed aims o f t h e N a t i o n a l P o p u l a t i o n P o l i c y o f 1965, were u t t e r e d t o r e a s s u r e t h o s e who b e l i e v e d the c l a i m s o f p r o m i n e n t S i n h a l e s e clergymen such as Mahanayake '. . T h e r a s and t h e Reverend Madihe P a n n a s i h a . The a t t a c k on f a m i l y p l a n n i n g i n C e y l o n was more vehement, s u s t a i n e d , and o r g a n i z e d than i n I n d i a o r P a k i s t a n . As i n I n d i a , t h e most v o c a l opponents came from the r e l i g i o n o f the dominant m a j o r i t y , and not from m i n o r i t i e s , as one might e x p e c t . One S i n h a l e s e clergyman d e c l a r e d t h a t f a m i l y p l a n n i n g was g o i n g t o undermine the e t h n i c c o m p o s i t i o n o f t h e c o u n t r y due t o d i f f e r e n t i a l r a t e s o f a c c e p t a n c e : Owing to t h e methods o f b i r t h c o n t r o l now b e i n g p r a c t i s e d , i n a n o t h e r hundred y e a r s time the • m a j o r i t y community would be n o n - S i n h a l a and t h e S i n h a l a r a c e would be r e d u c e d t o t h i r d p l a c e . 4 ^ These p r e p o s t e r o u s views p r o b a b l y had l e s s i n f l u e n c e on p o l i c y than t h e y d i d on the e l e c t i o n s t a t e m e n t s o f p o l i t i c i a n s , however. A f t e r the v i c t o r y o f Mrs. B a n d a r a n a i k e i n 1970 t h e government resumed i t s i n t e r e s t i n promoting f a m i l y p l a n n i n g , t h i s time under the c a c h e t o f m a t e r n a l and c h i l d w e l f a r e . I t s t r e s s e d i n i t s s t a t e m e n t s t h a t i t would be even-handed, t h a t i s , i t would work a l s o i n Tamil a r e a s , and urged t h a t t h e F a m i l y P l a n n i n g A s s o c i a -t i o n o f S r i Lanka do t h e same. O p p o s i t i o n from e t h n i c / r e l i g i o u s spokesmen l o s t what s a l i e n c e i t had when a t r u l y s e r i o u s c h a l l e n g e a r o s e t o the government's e x i s t e n c e i n 1971. The JVP i n s u r r e c t i o n o f A p r i l o f t h a t y e a r was b e l i e v e d to have been l a r g e l y - 54 -economic i n i t s w e l l - s p r i n g s . The p a r t i c i p a n t s i n t h a t r e b e l l i o n had been l a r g e l y young men and women under t h e age o f 25, and the r e l a t i o n s h i p between growing unemployment and bottom-heavy age s t r u c t u r e i n S r i Lankan s o c i e t y p r e c i p i t a t e d renewed e f f o r t s on t h e p a r t o f the government to d e v e l o p t h e economy and dampen the b i r t h r a t e . The f i v e y e a r p l a n o f 1972-1976, d r a f t e d d u r i n g t h e a f t e r m a t h o f the i n s u r r e c t i o n , s k e t c h e d i n g e n e r a l terms the government's renewed i n t e r e s t i n e x p a n d i n g s e r v i c e s and i n t e g r a t i n g them w i t h M a t e r n a l / C h i l d H e a l t h . 50 T h e r e was no m ention o f m o t i v a t i n g new c l i e n t s , however. Mrs. S i v a O b e y e s e k e r e , t h e Deputy M i n i s t e r o f H e a l t h , s t a t e d u n e q u i v o c a l l y t h a t f e r t i -l i t y must be r e d u c e d , and done f o r demographic/economic r e a s o n s : T h e r e i s no d i l l y d a l l y i n g on t h i s q u e s t i o n . E i t h e r we p r a c t i s e f a m i l y p l a n n i n g now and a r r e s t the p r e -s e n t r a t e o f 370,000 b i r t h s per y e a r o r f a c e t h e p r o s p e c t o f more d i f f i c u l t t i m e s ahead.51 Mrs. B a n d a r a n a i k e d i d n o t , however, speak o u t on the s u b j e c t . The i n f l u e n c e o f the f o r e i g n a i d a g e n c i e s a f t e r 1965 seemed t o f o l l o w the p a t t e r n e l s e w h e r e i n t h e r e g i o n . The F o r d F o u n d a t i o n gave g r a n t s t o the P o p u l a t i o n C o u n c i l o f New Y o r k , which i n t u r n a i d e d the F a m i l y P l a n n i n g A s s o c i a t i o n o f C e y l o n . In the l a t e 1960s, U.S. AID would have been the predominant donor, had i t s h e l p not been d e c l i n e d by t h e S r i Lankan g o v e r n -ment f o r the same p o l i t i c a l r e a s o n s which prompted i t s c a u t i o n i n p romoting f a m i l y p l a n n i n g i n p r e - e l e c t i o n y e a r s . T h e r e i s no e v i d e n c e o f the e f f e c t , d e s p i t e s u b s t a n t i a l sums g i v e n , o f f o r e i g n donors on e i t h e r t h e t h r u s t o f f e r t i l i t y p o l i c y o r measures c h o s e n . Of t h e t h r e e i n s t i t u t i o n a l d e t e r m i n a n t s which we a r e e x a m i n i n g , namely, p a r l i a m e n t a r y democracy, f e d e r a l s t r u c t u r e s , and b u r e a u c r a t i c c a p a c i t y , t h e - 55 -f i r s t has a l r e a d y been c o n s i d e r e d . S r i Lanka's h e a l t h p o l i c y , l i k e P a k i s t a n ' s , was f o r m u l a t e d and implemented t h r o u g h t h e c e n t r e . F a m i l y p l a n n i n g programmes were not s u b j e c t e d t o f r e q u e n t o r g a n i z a t i o n a l e x p e r i m e n t a t i o n as t h e y have i n I n d i a and P a k i s t a n , but remained a p a r t o f t h e e x i s t i n g h e a l t h network. F o l l o w i n g t h e 1970 e l e c t i o n , t h e c o a l i t i o n government o f Mrs. B a n d a r a n a i k e made i t c l e a r t h a t f a m i l y p l a n n i n g f a c i l i t i e s s h o u l d c o n t i n u e t o be an i n t e -g r a l component o f t h e f a m i l y h e a l t h s e r v i c e . S r i Lankan governments have g e n e r a l l y d e s i r e d t o m a i n t a i n a low p r o f i l e . In any c a s e , t h e y have not had t o b u i l d a s e p a r a t e f a m i l y p l a n n i n g o r g a n i z a t i o n because t h e h e a l t h network, as adumbrated i n T a b l e 4, was a l r e a d y c a p a b l e o f r e a c h i n g f a r more c l i e n t s than t h a t i n P a k i s t a n , I n d i a , o r Bangladesh.. H e a l t h has had a h i g h e r s t a t u s among m i n i s t r i e s i n S r i Lanka, a c c o r d i n g t o some a c c o u n t s , than i t has had 52 i n I n d i a , P a k i s t a n , o r B a n g l a d e s h . However, t h e a l l o c a t i o n f o r f a m i l y p l a n n i n g , as a p e r c e n t a g e o f t h e h e a l t h budget, has been about two p e r c e n t 53 (1968-1969). T h i s p u t s S r i Lanka l o w e r than I n d i a and P a k i s t a n f o r t h i s i n d i c a t o r . Comparison o f a l l o c a t i o n , i n any c a s e , o n l y i n d i c a t e s i n t e n d e d p r i o r i t y , and not t h e e f f e c t i v e n e s s o r w i l l w i t h which money i s s p e n t . * * * * * * B a n g l a d e s h e n t e r e d a phase o f a s s e r t i v e f e r t i l i t y p o l i c y f o r the second time ( t h e f i r s t t i m e h a v i n g o c c u r r e d when i t was E a s t P a k i s t a n ) i n .1975. P e n e t r a t i o n o f t h e c o u n t r y s i d e by any k i n d o f f e r t i l i t y c o n t r o l programme d i d not r e a c h p r e - i n d e p e n d e n c e l e v e l s u n t i l t h i s t i m e , when changes i n l e a d e r s h i p l e d t o a renewed s u p p o r t f o r f e r t i l i t y l i m i t a t i o n . ' By 1975, the B a n g l a d e s h economy was d e t e r i o r a t i n g r a p i d l y due t o f l o o d s and the breakdown o f a d m i n i s t r a t i v e a u t h o r i t y . On J a n u a r y 25, 1975, P a r l i a m e n t amended - 56 -the 1972 c o n s t i t u t i o n , making Prime M i n i s t e r M u j i b P r e s i d e n t o f the c o u n t r y . On June 7, P a r l i a m e n t was c o m p e l l e d t o make B a n g l a d e s h e f f e c t i v e l y a one-p a r t y s t a t e . The e n t i r e government was t o be s u b o r d i n a t e d t o t h i s p a r t y , c a l l e d BAKSAL,.' the e x e c u t i v e o f which c o n s i s t e d l a r g e l y o f M u j i b ' s f a m i l y . M u j i b s u b s e q u e n t l y a b o l i s h e d a l l o p p o s i t i o n p a r t i e s , and a l t e r e d o t h e r i n s t i -t u t i o n s sueh*as t h e c o u r t s and t h e p r e s s - s o t h a t t h e y would be s u b s e r v i e n t ,;" 54 . .. - -to him. In May 1975, a Bangladesh N a t i o n a l P o p u l a t i o n P o l i c y Seminar was h e l d i n which r e p r e s e n t a t i v e s from t h e f o r e i g n a i d donor a g e n c i e s a t t e n d e d . The government r e s o l v e d to make a " s t i l l g r e a t e r " e f f o r t a t t h a t t i m e . To t h i s end, the b u d g e t a r y a l l o c a t i o n f o r p o p u l a t i o n p l a n n i n g was r a i s e d from W p e r c e n t o f a l l e x p e n d i t u r e s f o r t h e Annual Development Programme f o r 1975 t o 2.4% f o r 1976. B e g i n n i n g i n September 1975, t h e r e was a s e r i e s o f m i l i t a r y coups and c o u n t e r - c o u p s which put Z i a u r Rahman i n e f f e c t i v e command o f B a n g l a d e s h . A l t h o u g h t h e Ba n g l a d e s h P o p u l a t i o n P r o j e c t , begun under t he M u j i b government a t t h e p r o d d i n g o f t h e donor a g e n c i e s , had been i n i t i a t e d i n 1974, i t began t o p i c k up momentum i n l a t e 1975 under t h e Z i a government. P o p u l a t i o n was g i v e n a p r i o r i t y equal t o t h a t o f f o o d s e l f - s u f f i c i e n c y . In J a n u a r y 1976, t h e r e was a n a t i o n - w i d e " I n t e n s i v e F a m i l y P l a n n i n g Week" t o i n f o r m , m o t i v a t e , and d e l i v e r c o n t r a c e p t i v e s . T e a c h e r s , government e x t e n s i o n w o r k e r s , and model f a r m e r s j o i n e d w i t h f a m i l y w e l f a r e workers i n an at t e m p t t o r e a c h e v e r y h o u s e h o l d . T h e r e was a l s o , i n 1976, an a t t e m p t t o improve and expand m a t e r n a l and c h i l d h e a l t h - b a s e d f a m i l y p l a n n i n g d i s t r i b u t i o n , and l a r g e numbers o f - 57 -men and women were h i r e d f o r t h i s p u r p o s e . D i s t r i b u t i o n o f condoms, p i l l s , and IUDs i n c r e a s e d by 100 p e r c e n t . T h i s i n c r e a s e has been a t t r i b u t e d 55 l a r g e l y , however, t o t h e v e r y low l e v e l s p r e v a i l i n g i n p r e v i o u s y e a r s . T h e r e i s no doubt t h a t Z i a ' s e n t h u s i a s m f o r f e r t i l i t y c o n t r o l was a c r u c i a l f a c t o r i n t h i s upsurge i n a c t i v i t y . He e x h i b i t e d , however, t he same n a i v e t e t h a t Ayub had about t h e ease o f m o t i v a t i n g c l i e n t s . In 1980, f o r example, he spoke o f p l a n s to i n c r e a s e t h e number o f s t e r i l i z a t i o n s from the then c u r r e n t 25,000 per month t o l e v e l s o f 100,000 o r 200,000. He avowed t h a t "our p e o p l e want t o do i t , but we don't have t he c a p a c i t y t o s t e r i l i z e " . On a n o t h e r o c c a s i o n he d e s c r i b e d t h e r e a c t i o n t o h i s e x h o r t a -t i o n s a t a p u b l i c m e e t i n g : I t o l d them t h a t you have g o t t o do f a m i l y p l a n n i n g — two c h i l d r e n — and I t o l d them, r a i s e y o u r hands. And a l l t h e men, women, and c h i l d r e n r a i s e d t h e i r hands. Now, many p e o p l e n e c e s s a r i l y d i d n o t under-s t a n d what I s a i d . But t h e y r a i s e d t h e i r hands. When t h e y go back, t h e y w i l l ask t h e i r f r i e n d s , 'why d i d I r a i s e my hand?...and t h e y w i l l want t o do i t You s e e , now we have m o t i v a t e d t h e people.56 I d e o l o g i c a l l y , Z i a ' s v i c t o r y o v e r h i s r i v a l s i n 1975 r e p r e s e n t e d ascendancy o f development t h r o u g h a i d o v e r M a o - s t y l e a u t a r c h y ; a path 57 f a v o u r e d by h i s r i v a l Abu T a h e r . A l t h o u g h t h e trauma o f l i b e r a t i o n and subsequent c a l a m i t i e s had l e f t l i t t l e c h o i c e as to which road c o u l d be t a k e n , Z i a ' s open e s p o u s a l o f a i d dependency p r o b a b l y gave t he donor a g e n c i e s g r e a t e r leeway than t h e y need have been g i v e n i n d e t e r m i n a t i o n o f CO t h e o r g a n i z a t i o n a l a s p e c t s o f f e r t i l i t y p o l i c y and programmes. The I n t e r -n a t i o n a l Development A s s o c i a t i o n ( I D A ) , t h e development arm o f t h e World Bank, n e g o t i a t e d a p o p u l a t i o n p r o j e c t c o s t i n g $45 m i l l i o n . B i l a t e r a l p o p u l a t i o n a g e n c i e s . c o u l d not agree w i t h t h e approach o f t h e IDA, which - 58 -f e a t u r e d a complex mix o f programmes i n v o l v i n g f i v e d i f f e r e n t m i n i s t r i e s . The IDA was w i l l i n g t o d i r e c t b i l a t e r a l p r o j e c t s , but the o t h e r major donor, t h e U n i t e d N a t i o n s Fund f o r P o p u l a t i o n A c t i v i t i e s , would not s u r r e n d e r the autonomy n e c e s s a r y f o r c o o r d i n a t e d a c t i v i t i e s , and u l t i m a t e l y t h e y mounted . s e p a r a t e p r o j e c t s . The World Bank, chairman o f t h e A i d B a n g l a d e s h C o n s o r t i u m , was p a r t i -c u l a r l y d i s s a t i s f i e d w i t h the arrangement whereby t h e P o p u l a t i o n P l a n n i n g D i v i s i o n would be p l a c e d w i t h i n the M i n i s t r y o f H e a l t h , on t h e grounds t h a t t h e h e a l t h b i a s would e x c l u d e o t h e r m i n i s t r i e s which ought t o be i n c l u d e d i f an a l l - o u t e f f o r t were to'.be mounted. The IDA, t h e r e f o r e , d i c t a t e d h i g h - l e v e l a p p o i n t m e n t s — u s u a l l y p r e f e r r i n g t o de-emphasise t h e h e a l t h b i a s — and attempted to s t i p u l a t e which f u n c t i o n s would be performed by which m i n i s t r i e s . The B a n g l a d e s h Government was c o m p e l l e d t o a g r e e t h a t the p a r t o f t h e p r o j e c t f i n a n c e d by IDA s o f t l o a n s s h o u l d be s u b j e c t t o f r e q u e n t 59 s e a r c h i n g r e v i e w s , p r e s c r i p t i o n s f r o m which would be b i n d i n g . * * * * * * In a l l f o u r o f t h e s e c o u n t r i e s , t h e a d o p t i o n o f s t r o n g e r n a t i o n a l f e r t i l i t y c o n t r o l p o l i c i e s f o l l o w e d t h e i n t e r v e n t i o n by s t r o n g l e a d e r s i n what t h e y p e r c e i v e d t o be a wor s e n i n g demographic and economic s i t u a t i o n . The measures c h o s e n , both t e c h n i c a l and o r g a n i z a t i o n a l , were d e t e r m i n e d by what l o o k e d b u r e a u c r a t i c a l l y and p o l i t i c a l l y f e a s i b l e , and by outcomes o f t h e t r i a l and e r r o r o f p r e v i o u s programmes. Upon a c l o s e r e x a m i n a t i o n o f the p e r i o d j u s t p r e c e d i n g the a c t u a l l a u n c h i n g o f more v i g o r o u s programmes t h e r e a p p e a r s to have been a p e r i o d o f " t h o u g h t " on t h e p a r t o f key l e a d e r s . Ayub's c o n c e r n about p o p u l a t i o n and - 59 -h i s i n t e r e s t i n i t s c o n t r o l was e v i d e n t as e a r l y as 1959, w h i l e Nehru, i f h i s a d d r e s s a t the A s i a n P o p u l a t i o n C o n f e r e n c e i s a t r u e r e f l e c t i o n o f h i s t h i n k i n g , showed h i s h e i g h t e n e d i n t e r e s t . In C e y l o n , t he q u e s t i o n o f p o p u l a t i o n began t o appear i n p l a n n i n g documents i n 1962 and 1963, and i n Ba n g l a d e s h , t h e r e was some d i s c u s s i o n o f f e r t i l i t y c o n t r o l p o l i c y i s s u e s i n e a r l y 1975 under M u j i b ' s new o n e - p a r t y s t a t e . The S r i Lankan c a s e i l l u s t r a t e s t h a t no m a t t e r how d a u n t i n g f e a r s o f p o l i t i c a l o p p o s i t i o n t o f e r t i l i t y c o n t r o l p o l i c y may be, t h e y w i l l be o v e r -come' where o v e r p o p u l a t i o n o r o v e r l y r a p i d p o p u l a t i o n growth a p p e a r s u f f i -c i e n t l y f o r m i d a b l e . A l t h o u g h both major p o l i t i c a l p a r t i e s were a t t u n e d t o th e p o l i t i c a l i m p l i c a t i o n s o f e x c e s s i v e f o r t h r i g h t n e s s on the q u e s t i o n o f f e r t i l i t y c o n t r o l , once i n o f f i c e , t h e y were w i l l i n g t o take a s t a n d . Dudley Senanayake, who showed h i s i n t e r e s t i n f e r t i l i t y c o n t r o l as e a r l y as 1953, was t h e f i r s t t o i n i t i a t e a N a t i o n a l P o p u l a t i o n P o l i c y when he r e t u r n e d t o o f f i c e i n 1965. Under t h e m i l i t a r y governments o f post-1975 B a n g l a d e s h , f e r t i l i t y c o n t r o l p o l i c y r o s e from i t s - moribund s t a t e under t he Awami/BAKSAL government t o a t l e a s t the l e v e l o f e f f o r t which had been a c h i e v e d under t he P a k i s t a n i r e g i m e . Once t h e i n s t i t u t i o n s o f f e r t i l i t y c o n t r o l p o l i c y a r e i n p l a c e , f o r example, the Department o f F a m i l y P l a n n i n g i n I n d i a , o r the P o p u l a t i o n P l a n n i n g D i v i s i o n i n P a k i s t a n and B a n g l a d e s h , i t does n o t appear t o have r e q u i r e d a dynamic l e a d e r t o keep them t h e r e , , and o n l y a d i r e c t p o l i t i c a l , upheaval t o d i s l o d g e them. F o r example, t h e p o p u l a t i o n p o l i c y o f the UNP government i n S r i Lanka was c o n t i n u e d by i t s s u c c e s s s o r a f t e r 1970, even though Mrs. B a n d a r a n a i k e h e r s e l f d i d not take a v o c a l r o l e i n i t s p e r p e t u a t i o n . - 60 -I n d i a ' s h e i g h t e n e d f e r t i l i t y c o n t r o l p o l i c y a f t e r 1965 seemed to c o n t i n u e i n d e p e n d e n t l y o f Mrs. G a n d h i , who was p a s s i v e i n r e g a r d t o the i s s u e u n t i l 1973. E x c e p t f o r the h i a t u s o f war, the government o f P a k i s t a n a l s o c o n -t i n u e d t o d e v o t e the same a p p r o x i m a t e o r d e r o f r e s o u r c e s t o i t s f e r t i l i t y c o n t r o l programmes. J u s t as t h e a t t e n d a n c e o f a prominent l e a d e r a t p o p u l a t i o n c o n f e r e n c e s , the p u b l i c m a n i f e s t a t i o n o f " t h o u g h t " / p r e c e d e d s h i f t s i n f e r t i l i t y c o n t r o l p o l i c y a c t i o n i n P a k i s t a n ( 1 9 6 4 ) , I n d i a ( 1 9 6 3 ) , C e y l o n ( e a r l y 1960s) and Bangladesh ( e a r l y 1975), the B u c h a r e s t C o n f e r e n c e o f August 1974 was a h a r b i n g e r o f a new p l a t e a u i n t h i s p o l i c y a r e a . W i t h o u t d e n y i n g the v a l u e o f c o n v e n t i o n a l f a m i l y p l a n n i n g a p p r o a c h e s , the C o n f e r e n c e r e g i s t e r e d some "new" c o n c e p t i o n s about the p r e c o n d i t i o n s n e c e s s a r y f o r mass a c c e p t a n c e o f s m a l l f a m i l y norms. The consensus was t h a t the " s o f t " path t o m o t i v a t i o n t h r o u g h improvement i n q u a l i t y o f l i f e and hence m o d i f i c a t i o n o f f e r t i l i t y 60 d e c i s i o n c a l c u l a t i o n s o f c o u p l e s was the answer. As I n d i a , P a k i s t a n and C e y l o n t r a n s l a t e d the i d e a s o f t h e i n t e r n a t i o n a l b i r t h c o n t r o l movement i n t o p o l i c i e s i n the e a r l y 1960s, a government o f t h e 1970s would be l i k e l y t o draw from the i d e a s p r e v a i l i n g a t the time i f i t f e l t t h a t a change i n p o l i c y were n e c e s s a r y . Such a " n e c e s s i t y " would be p e r c e i v e d by a l e a d e r who b e l i e v e d t h a t demographic and economic t r e n d s c o n -s t i t u t e d a s u f f i c i e n t l y u r g e n t c r i s i s t o w a r r a n t more r a d i c a l i n t e r v e n t i o n . I f h i s government had a l r e a d y g i v e n t h e c o n v e n t i o n a l f e r t i l i t y p o l i c y m o t i -v a t i o n a l a p p r o a c h e s o f a d v e r t i s i n g , i n c e n t i v e payments and c a n v a s s i n g a t h o r o u g h t r y , he would be l i k e l y to c o n c l u d e t h a t o n l y t h e s e new a p p r o a c h e s h e l d hope f o r f u r t h e r r e d u c t i o n i n t h e b i r t h r a t e and r e n d e r h i s c o n c l u s i o n s i n t o a c t i v e programmes. I n d i a q u a l i f i e d a c c o r d i n g t o t h e s e c r i t e r i a . Mrs. Gandhi e x p e r i e n c e d a change i n t h i n k i n g and a p p o i n t e d a v e r y a b l e m i n i s t e r . T h i s man, Karan S i n g h , p r o c e e d e d t o change t h e emphasis o f I n d i a ' s f e r t i l i t y c o n t r o l p o l i c y t o one more i n l i n e w i t h the i n t e l l e c -t u a l c u r r e n t s o f the t i m e . 62 CHAPTER I I I FOOTNOTES 1. F a z l u r Rahman and Luke T. Lee, " P a k i s t a n , " i n P o p u l a t i o n and Law:  A Study o f t h e R e l a t i o n s Between P o p u l a t i o n Problems and Law, e d s . Luke T. Lee and A r t h u r L a r s o n (Durham: Rule o f Law P r e s s , 1971), p. 131. 2. F o r the s i m i l a r i t i e s between the two strongmen, s e e , f o r example, M a n c h e s t e r G u a r d i a n Weekly, 124 (No. 23, June 7, 1981), p. 1. 3. N i c h o l a s J . Demerath, B i r t h C o n t r o l and F o r e i g n P o l i c y , (Mew York: Harper and Row, 1976), p. 66. 4. R o b e r t C a s s e n , I n d i a : P o p u l a t i o n , Economy, S o c i e t y , (London: M a c m i l l a n P r e s s , 1978), p. 146. 5. I n t e r n a t i o n a l P l a n n e d P a r e n t h o o d News, 122 ( F e b r u a r y , 1964). 6. John P. L e w i s , " P o p u l a t i o n C o n t r o l i n I n d i a , " P o p u l a t i o n B u l l e t i n , 26 (Nov. 5, 1970): 15, 22. and Demerath, op. c i t . , p. 69. 7. Uday C. D e s a i , " P r o f e s s i o n a l P o l i c y Making: The Case o f I n d i a n P o p u l a -t i o n P o l i c y , " I n d i a n J o u r n a l o f P u b l i c A d m i n i s t r a t i o n , 22 (No. 4, O c t . - D e c , 1 9 7 6 T 699": 8. C a s s e n , op. c i t . , p. 164. 9. I b i d . , p. 156. 10. R o b e r t E. E l d e r , " T a r g e t s v e r s u s E x t e n s i o n E d u c a t i o n : The F a m i l y P l a n n i n g Programme i n U.P." P o p u l a t i o n S t u d i e s , 28 ( J u l y , 1974): 252, 258, 260. 11. C i t e d i n B e r n a r d B e r e l s o n , "Beyond F a m i l y P l a n n i n g , " S t u d i e s i n  F a m i l y P l a n n i n g , 38 ( F e b r u a r y , 1969): 5. 12. C a s s e n , op. c i t . , p. 164. 13. M a r g a r e t W o l f s o n , Changing Approaches t o P o p u l a t i o n Problems, ( P a r i s : OECD, 1978), p. 51. 14. Marcus F r a n d a , " M a r k e t i n g Condoms i n I n d i a : The N i r o d h Program," American U n i v e r s i t i e s F i e l d S t a f f R e p o r t s , 16 (No. 8, A u g u s t , 1 9 7 2 ) : 1. 15. T.E. S m i t h , ed., The P o l i t i c s o f F a m i l y P l a n n i n g i n the T h i r d W orld, (London: Geo. A l l e n , 1973), p. 43 and Marcus F r a n d a , " M i l i t a n t Hindu O p p o s i t i o n t o F a m i l y P l a n n i n g i n I n d i a , " American U n i v e r s i t i e s F i e l d  S t a f f R e p o r t s , 16 (No. 11, S e p t . , 1972), p. 2.Much o f t h e o p p o s i t i o n a p p e a r e d t o be g e n e r a t e d by one man, Mr. S u d h i r Hendre, a wealthy Bombay businessman. - 63 -16. Marcus F r a n d a , " S h i f t s i n Emphasis i n I n d i a ' s P o p u l a t i o n P o l i c y , " American U n i v e r s i t i e s F i e l d S t a f f R e p o r t s , 18 (No. 7,, S e p t . , 1974): 1. 17. I b i d . , p. 1. 18. I b i d . , p. 2. 19. C a s s e n , op. c i t . , p. 174. 20. Demerath, op. c i t . , p. 144. 21. I b i d . , p. 65. 22. I b i d . , p. 75. 23. I b i d . , p. 72. 24. Quoted i n i b i d . , 112. 25. I b i d . , p. 82. 26. T i n e B u s s i n k , "Major A s p e c t s o f F a m i l y P l a n n i n g i n P a k i s t a n , " i n P r o l o g u e t o Development P o l i c y and P o p u l a t i o n P o l i c y : The P a k i s t a n  E x p e r i e n c e , I n t e r d i s c i p l i n a r y Communications Program, P o p u l a t i o n P l a n -n i n g D i v i s i o n , M i n i s t r y o f H e a l t h and S o c i a l W e l f a r e , Government o f P a k i s t a n , c o - s p o n s o r s , Background Papers Workshop/Seminar 13, F e b r u a r y 4-8, 1975, Peshawar, P a k i s t a n , p. 23. 27. I b i d . , p. 44. 28. I b i d . , p. 46. 29. I b i d . , p. 51. 30. I b i d . , p. 52. 31. D i e t r i c h C. B r u n i n g , P o p u l a t i o n P l a n n i n g i n P a k i s t a n , ( E s c h b o r n : Deutsche G e s e l l s c h a f t f u r T e c h n i s c h e Z u s a n m e n a r b e i t , 1977), pp.- 7,,28. 32. I b i d . , : p . 31. 33. J a s o n L. F i n k l e , "The P o l i t i c a l E n vironment o f P o p u l a t i o n C o n t r o l i n I n d i a and P a k i s t a n , " i n P o l i t i c a l S c i e n c e i n P o p u l a t i o n S t u d i e s , e d s . , R i c h a r d L. C l i n t o n , W i l l i a m S. F l a s h , and R. Kenneth Godwin ( T o r o n t o , L e x i n g t o n Books, 1972), p. 107. 34. Quoted i n Mary F. B i s h o p , From ' L e f t ' to ' R i g h t ' : A P e r s p e c t i v e on t h e  R o l e o f V o l u n t e e r s i n F a m i l y P l a n n i n g i n the West and South A s i a " ( U n i v e r s i t y o f B r i t i s h Columbia, M.A. T h e s i s , 1971), p. 211. - 64 -35. F i n c k l e , op. c i t . , p. 109. 36. Warren C. R o b i n s o n , " F a m i l y P l a n n i n g i n P a k i s t a n 1955-1977," P a k i s t a n Development Review, 17 (No. 2 ) : 243. 37. I b i d . , p. 241. 38. I b i d . , p. 243. 39. I b i d . , p. 242. 40. I b i d . , p. 240. 41. S.L). K o d i k a r a , " F a m i l y P l a n n i n g i n C e y l o n , " i n T.E. S m i t h , op. c i t . , p. 307. 42. I b i d . , p. 309. 43. O.E.R. Abhayaratne and C.H.S. Jayewardene, F a m i l y P l a n n i n g i n C e y l o n , Colombo: Colombo A p o t h e c a r i e s , 1968), p. 109. 44. C.C. d e S i l v a , ed., A H i s t o r y o f F a m i l y P l a n n i n g i n S r i Lanka, (Colombo: F a m i l y P l a n n i n g A s s o c i a t i o n o f S r i Lanka, 1978), p. 58. 45. K o d i k a r a , op. c i t . , p. 295. 46. G a v i n W. Jones and S. S e l v a r a t n a m , P o p u l a t i o n Growth and Economic  Development i n C e y l o n , (Colombo: Hansa, 1972): C h a p t e r 7. 47. C.C. d e S i l v a , op. c i t . , p. 118. 48. Quoted i n S.U. K o d i k a r a , op. c i t . , p. 312. 49. Quoted i n i b i d . , p. 311. 50. I b i d . , p. 316. 51. Quoted i n C.C. d e S i l v a , op. c i t . , p. 141. 52. L.A. Simeonov, B e t t e r H e a l t h f o r S r i Lanka, (WHO R e g i o n a l O f f i c e f o r S o u t h e a s t A s i a ) , p. 15. 53. Jones and S e l v a r a t n a m , o p . . ; c i t . , T a b l e 55, p. 217. 54. Marcus F r a n d a , "The Bangladesh Coup," American U n i v e r s i t i e s F i e l d  S t a f f R e p o r t s , 19 (No. 15, September, 1975): 4] 55. L i n c o l n C. Chen and Z a k i r H u s a i n , " B a n g l a d e s h , " i n F a m i l y P l a n n i n g i n  t h e D e v e l o p i n g World: A Review o f Programs, ed., W a l t e r B. Watson (New York: P o p u l a t i o n C o u n c i l , 1977), p. 32. - 65 -56. Marcus F r a n d a , "Bangladesh N a t i o n a l i s m and Z i a u r Rahman's Presidency;: I n t e r n a t i o n a l E n t a n g l e m e n t s , " American U n i v e r s i t i e s F i e l d S t a f f R e p o r t s , (MF-2-81): 2, 3. See a l s o R obert S. An d e r s o n , " I m p r e s s i o n s o f B a n g l a d e s h : The Rule o f Arms and t h e P o l i t i c s o f E x h o r t a t i o n , " P a c i f i c A f f a i r s , 49 ( F a l l , 1976): 443-76. 57. Marcus F r a n d a , " Z i a u r Rahman's B a n g l a d e s h : P o v e r t y and D i s c o n t e n t , " American U n i v e r s i t i e s F i e l d S t a f f R e p o r t s , (MF-9-79): 1. 58. Marcus F r a n d a , (MF-2-81): 2 and Jack P a r k i n s o n , J u s t F a a l a n d , and Nurul I s l a m , e d s . , A i d and I n f l u e n c e : The Case o f B a n g l a d e s h , (Hong Kong: M a c M i l l a n , 1981), p. 186. 59. I b i d . , p. 160. 60. W o l f s o n , op. c i t . , pp. 19-22. - 66 -CHAPTER IV BEYOND FAMILY PLANNING In 1969, B e r n a r d B e r e l s o n , D i r e c t o r o f the P o p u l a t i o n C o u n c i l o f New York, c o i n e d a p h r a s e which was t o demarcate n i c e l y the c o n c e p t u a l boundary i n t h e f e r t i l i t y c o n t r o l f i e l d : "beyond f a m i l y p l a n n i n g " . In the a r t i c l e b e a r i n g t h i s p h r a s e as i t s t i t l e , he r e c o r d e d the c o n v i c t i o n t h a t the t r a d i t i o n a l v o l u n t a r y f a m i l y p l a n n i n g approach had not been e f -f e c t i v e i n l i m i t i n g p o p u l a t i o n growth.* He then p r o c e e d e d t o . r e v i e w a l l o f t h e f e r t i l i t y c o n t r o l measures which had been proposed o v e r the y e a r s , some o f which had been t r i e d i n the c o u n t r i e s under s t u d y h e r e , and some which had n o t . H i s a r t i c l e i s u s e f u l because o f the e x h a u s t i v e n e s s o f h i s l i s t . We can use t h i s l i s t , t h e n , t o a s c e r t a i n f o r a g i v e n t i m e , which a l t e r n a t i v e s were l e f t to the South A s i a n c o u n t r i e s . The l i s t lumps t o -g e t h e r what I have c a l l e d " s o f t " and " h a r d " t y p e s o f measures o f f e r t i l i t y c o n t r o l , and r a n k s them a c c o r d i n g to such c r i t e r i a as s c i e n t i f i c r e a d i n e s s , p o l i t i c a l v i a b i l i t y , and a d m i n i s t r a t i v e f e a s i b i l i t y . H i s t a b u l a t i o n o f t h e s e measures and t h e i r l i k e l y c r i t e r i a , r e p r o d u c e d o v e r l e a f , p r o v i d e s f o r the s t u d e n t o f the s u b j e c t a u s e f u l map o f the f e r t i l i t y p o l i c y u n i v e r s e . By 1975, I n d i a , P a k i s t a n , S r i Lanka, and Bangladesh had e i t h e r c o n -s i d e r e d o r t r i e d many o f t h e s e p r o p o s a l s . None had, however, t r i e d t o impose i n v o l u n t a r y f e r t i l i t y c o n t r o l ( c a t e g o r y B ) . Measures under c a t e g o r y E, t h a t i s , t a x and w e l f a r e i n c e n t i v e s and p e n a l t i e s , would not a p p l y to South A s i a n c o u n t r i e s where t h e m a j o r i t y o f c i t i z e n s do not pay income t a x e s . TABLE 5 Fert i l i ty Policy Proposals By Criteria Measure A: Extension of voluntary f e r t i l i t y control B: Establishment of involuntary f e r t i l i t y control C: Intensified Educational Campaigns D: Incentive Programmes E: Tax and Welfare Benefits and Penalties F: Shifts in Social and Economic Institutions Scientif ic Readiness high low high high high high G: Pol i t ical Channels high and organizations H: Augmented research high efforts Polit ical Viabi l i ty high on maternal care, moderate to low on abor-tion low moderate to high moderately low moderately low Administrative Feasibil i ty uncertain in near future low moderate to high I: Family Planning Programs generally moderate to high but high could use improved technology low high low low to moder-ate generally high, low but low on some specifics low high moderate to high Economic Capability maternal care too costly; for local bud-get; abortion feasible Ethical Acceptabil ity high for maternal care: low for abor-tion high probably high low to moderate low to moderate generally low moderate high high low Presumed Effectiveness moderately high high generally high moderate low to high low to moderate generally high, but uneven moderately low high high uncertain uncertain high, over long run uncertain uncertain uncertain SOURCE: Bernard Berelson, "Beyond Family Planning", Studies in Family Planning, No. 38, Feb. 1969, p. 11 TABLE 6 Fert i l i ty Policy Proposals as Considered and Tried, and Their Perceived Effectiveness c 1974 Proposal Considered Tried Tried and Thought Ineffective Predicted Polit ical Viabi l i ty I: Family Plan-ning Programmes A&F: Maternal care, status of Women, other social / economic Insts. Changed D&E: Tax Benefits, Penalties, Incentives B: Involuntary Infert i l i ty Control all India Pakistan (Sri Lanka)* India Pakistan none al l no no (S.L. )* India Pakistan none India none India none high high moderately low low *Sri Lanka had already arrived at a point where such measures had been taken. Because they were not necessarily intended to induce lower f e r t i l i t y , they were not, by definit ion, f e r t i l i t y policy. - 69 -As T a b l e 6 i l l u s t r a t e s , a l l c o u n t r i e s had implemented programmes o f c o n v e n t i o n a l f a m i l y p l a n n i n g but o n l y I n d i a had a r r i v e d a t the c o n c l u s i o n t h a t t h e r e were no more t e c h n i q u e - c e n t r e d c r a s h programmes t o t r y . A l l c o u n t r i e s had c o n s i d e r e d " s o f t " measures, and S r i Lanka had a l r e a d y a r r i v e d a t a p o i n t where such measures, whether o r not s p e c i f i c a l l y implemented i n o r d e r t o i n d u c e d e c i s i o n s t o have fewer c h i l d r e n , had been t a k e n . M o r e o v e r , S r i Lanka's b i r t h r a t e by 1975 was v e r y near the t a r g e t s e t i n 1965 under t her N a t i o n a l P o p u l a t i o n P o l i c y ( T a b l e 1 ) . S p e a k i n g s t r i c t l y from the s t a n d -p o i n t o f i d e a s , t h e n , and assuming t h e y were p o l i t i c a l l y and e c o n o m i c a l l y c o s t l e s s , I n d i a , B a n g l a d e s h and P a k i s t a n had the a l t e r n a t i v e o f i n t r o d u c i n g s o f t o p t i o n s and S r i Lanka had t h e c h o i c e o f i m p r o v i n g on i t s q u a l i t y o f l i f e s t i l l f u r t h e r i f i t w i s h e d t o a c c e l e r a t e i t s b i r t h r a t e d e c l i n e . However, Ba n g l a d e s h and P a k i s t a n , a g a i n , d i s r e g a r d i n g the p o l i t i c a l v i a b i l i t y o f such a c t i o n s , had e i t h e r n o t t r i e d i n c e n t i v e s o r had not found them i n -e f f e c t i v e , and c o u l d t h e r e f o r e t r y them o r keep on u s i n g them. On the o t h e r hand, I n d i a had t r i e d c a t e g o r y D i n i t s s e v e r a l permuta-t i o n s , and f o u n d i t i n s u f f i c i e n t l y e f f e c t i v e . A l t h o u g h P a k i s t a n , Bangladesh and S r i Lanka were n o t known to have c o n s i d e r e d c o m p u l s i o n , some I n d i a n 2 s t a t e s were known t o have a t t e m p t e d m a r g i n a l l y c o e r c i v e t a c t i c s i n 1966. I f the governments i n t h e s e c o u n t r i e s were r e s o l v e d t o t a k e f u r t h e r , , more v i g o r o u s a c t i o n i n t h e f e r t i l i t y c o n t r o l a r e a , then i t would appear t h a t any o f them might pursue t h e l a t e s t i n d i r e c t s o c i a l / e c o n o m i c i nducements, b u t o n l y I n d i a would be, l i k e l y t o t r y b o t h t h e s e and/or i n v o l u n t a r y f e r t i l i t y c o n t r o l . T h a t t h e r e was a commitment on t h e p a r t o f the government i n I n d i a , - 70 -i n t he p e r s o n s o f Mrs. Gandhi and Dr. Karan S i n g h , t o t a k e the s o f t o p t i o n o f f e r t i l i t y c o n t r o l was e v i d e n t as e a r l y as the B u c h a r e s t C o n f e r e n c e , when Dr. S i n g h made h i s famous d e c l a r a t i o n . In the same month as t h a t c o n f e r -ence, Mrs. Gandhi s e n t a l e t t e r t o e v e r y s a r p a n c h , o r head man, i n each o f I n d i a ' s 570,000 v i l l a g e s , u r g i n g l o w e r b i r t h r a t e s . She a p p e a r e d t o s h a r e her h e a l t h m i n i s t e r ' s g r a d u a l i s t view o f f e r t i l i t y c o n t r o l , as i s shown by her e x p l a n a t i o n f o r r e d u c e d a l l o c a t i o n s f o r c o n v e n t i o n a l f a m i l y p l a n n i n g : A l l workers o f the f a m i l y p l a n n i n g movement do not always f u l l y a p p r e c i a t e t h e i n t e g r a l r e l a t i o n s h i p between g e n e r a l development and f a m i l y p l a n n i n g . When we r e a p p o r t i o n e d some funds t o s t r e n g t h e n o u r r u r a l h e a l t h s e r v i c e s , and t h e r e was a r e d u c t i o n i n t he p e r c e n t a g e o f t h e f u n d s a l l o c a t e d under t h e s e p a r a t e head o f f a m i l y p l a n n i n g , t h e r e was an o u t -c r y . T h i s was m i s r e p r e s e n t e d by t h e i n t e r n a t i o n a l p r e s s t o s u g g e s t t h a t we were g i v i n g up o u r f a m i l y p l a n n i n g programmes.3 Her i m p o s i t i o n o f an Emergency on June 26, 1975 gave no h i n t o f the d i r e c t i o n subsequent f e r t i l i t y p o l i c y , i f any,would t a k e . I n i t i a l l y , she showed no i n t e r e s t i n p o p u l a t i o n i s s u e s . P o p u l a t i o n was not mentioned among the 'Twenty P o i n t s ' , a l i s t o f p r i o r i t i e s p u b l i s h e d s h o r t l y a f t e r her d e c l a r a -t i o n . In f a c t , the P o p u l a t i o n C o u n c i l o f I n d i a was f o r c e d t o s h u t down i n 4 1975 f o r want o f p u b l i c o r p r i v a t e s u p p o r t . F e r t i l i t y c o n t r o l became a m a t t e r o f i n t e r e s t t o the government i n F e b r u a r y 1976, a f t e r i t was i n c l u d e d by Mrs. Gandhi's son S a n j a y as one 5 component o f h i s u n o f f i c i a l 'Four P o i n t Programme'. Then, i n A p r i l 1976, Karan S i n g h announced a new N a t i o n a l P o p u l a t i o n P o l i c y which appeared t o be a b l e n d o f both s o f t and hard t y p e s o f f e r t i l i t y c o n t r o l . I t q u i c k l y became a p p a r e n t , however, t h a t i t was t h e l a t t e r t ype which would be put i n t o p r a c t i c e . The p o l i c y s t a t e m e n t spoke o f the n a t i o n a l i m p e r a t i v e o f c u r b i n g - 71 -p o p u l a t i o n growth: To w a i t f o r e d u c a t i o n and economic development to b r i n g about a drop i n f e r t i l i t y i s n o t a p r a c t i c a l s o l u t i o n . The v e r y i n c r e a s e i n p o p u l a t i o n makes economic development slow and more d i f f i c u l t o f a c h i e v e m e n t . The time f a c t o r i s so p r e s s i n g , and the p o p u l a t i o n growth so f o r m i d a b l e , t h a t we have to g e t o u t o f t h i s v i c i o u s c i r c l e t h r o u g h a d i r e c t g a s s a u l t upon t h i s problem as a n a t i o n a l commitment. Most o f t h e measures o u t l i n e d i n t h e s t a t e m e n t r e f l e c t e d the l a t e s t t h i n k i n g i n p o p u l a t i o n p o l i c y - m a k i n g , and c o u l d have been used as a model i n any c o u n t r y o f t h e s u b c o n t i n e n t . S t a t e a l l o c a t i o n s o f f i n a n c e , f o r m e r l y based on p o p u l a t i o n o f the s t a t e s , were f r o z e n a t 1971 l e v e l s and f a m i l y p l a n -n i n g p e r f o r m a n c e was to be one c o n s i d e r a t i o n i n the a l l o c a t i o n o f r e s o u r c e s from t h e c e n t r e to the s t a t e s . Female e d u c a t i o n , n u t r i t i o n , and b a s i c h e a l t h s e r v i c e s were g i v e n some i m p o r t a n c e . N u p t i a l i t y p a t t e r n s were to be i n f l u -enced by r a i s i n g the minimum age a t m a r r i a g e t o e i g h t e e n f o r f e m a l e s and twenty-one f o r m a l e s ; t h e r e was t o be a " p o p u l a t i o n e d u c a t i o n " component.in s c h o o l c u r r i c u l a ; a l l government departments were to be i n v o l v e d i n the f a m i l y p l a n n i n g d r i v e ; l a r g e r monetary i n c e n t i v e s were to be made a v a i l a b l e to a c c e p t o r s o f s t e r i l i z a t i o n ; Z i l l a and Panchayat S a m i t i s , t e a c h e r s , c o o p e r -a t i v e s , o r g a n i z e d l a b o u r , p r i v a t e p o p u l a t i o n groups were a l l to be b r o u g h t i n t o the f e r t i l i t y c o n t r o l d r i v e . These i d e a s had been e x p r e s s e d b e f o r e . Where t h e new p o l i c y d e p a r t e d from p r e v i o u s ones was i n two c o m p u l s o r y measures. The f i r s t was t h e p e r -m i s s i o n g i v e n t o t h e s t a t e s t o make s t e r i l i z a t i o n c o m p u l s o r y . The second was the c o m p u l s o r y s t e r i l i z a t i o n imposed on t h o s e employees o f the c e n t r a l government who had a s p e c i f i e d number o f c h i l d r e n , and t h e p e r m i s s i o n g i v e n s t a t e governments t o impose t h e i r own s m a l l f a m i l y norms on t h e i r "employees. - 72 -I t was t h e s e l a t t e r c ompulsory measures which became the predominant f e a t u r e s o f t h e new p o l i c y . A l t h o u g h M a h a r a s t r a was t h e o n l y s t a t e t o i n i t i a t e p as-sage o f a co m p u l s o r y s t e r i l i z a t i o n b i l l , many s t a t e s now had the a u t h o r i t y t o pursue t he vasectomy t a r g e t s which had been a s s i g n e d them t h r o u g h t h e whole s t a t e b u r e a u c r a c y , and w i t h o u t t h e i r h a v i n g t o s t i r t h e i n n e r m o t i v a -t i o n o f p o t e n t i a l c l i e n t s . The p u b l i c i n many p a r t s o f I n d i a were r e q u i r e d t o produce a s t e r i l i z a t i o n c e r t i f i c a t e b e f o r e p e r m i t s , l i c e n s e s , and so on would be g i v e n . T e a c h e r s ' s a l a r i e s were w i t h h e l d f o r i n a d e q u a t e r e c r u i t m e n t o f a c c e p t o r s . The C e n t r e f i x e d a n a t i o n a l t a r g e t o f 4.3 m i l l i o n . S t a t e w i s e a l l o c a -t i o n o f t a r g e t s -was "worked o u t by t h e C e n t r a l F a m i l y P l a n n i n g C o u n c i l . These were " s c i e n t i f i c a l l y " d e t e r m i n e d and were t h o u g h t t o r e q u i r e s t u p e n -dous e f f o r t s t o a c h i e v e . N e v e r t h e l e s s , under t he p r e s s u r e s mentioned above, t h e s e t a r g e t s were s u b s e q u e n t l y r a i s e d by a number o f s t a t e governments. T a b l e 7 shows how v a r i o u s s t a t e s r a i s e d t a r g e t s a s s i g n e d them: TABLE 7 S t a t e w i s e S t e r i l i z a t i o n T a r g e t s , N a t i o n a l P o p u l a t i o n P o l i c y , 1976, i n Lakhs (1 l a k h = 100,000) A c h i e v e d S t a t e A s s i g n e d R a i s e d To A p r i l - O c t o b e r 1976 B i h a r 3 6 2.04 Haryana .52 2 .79 M a h a r a s h t r a 5.62 12 5.16 Himachal Pradesh .315 1 .5 Madhya Pradesh 2.675 7 7.43 R a j a s t h a n 1.75 3.5 2.92 Punjab .465 2.5 .66 U t t a r Pradesh 4. 15 5.55 West Bengal 3.92 11 7.312 D e l h i .29 1 S o u r c e : Columns 1 and 2, Government o f I n d i a , Commission o f I n q u i r y i n t o  M i s u s e o f Power D u r i n g Emergency (Shah Commission), 1977, v o l . I l l ( f i n a l ) , p. 154. Achievement f i g u r e s from B. Ghosh, " I n d i a ' s Popu-l a t i o n P o l i c y : An A p p r a i s a l , " Demography I n d i a , 7 ( 1 , 2, 1978), p, 45. - 73 -D e s p i t e t h e i n a b i l i t y o f most s t a t e s to a c h i e v e t h e i r r e v i s e d t a r g e t s , t h e r e was an u n p r e c e d e n t e d r i s e i n numbers o f v a s e c t o m i e s p e r -formed t h r o u g h o u t I n d i a . The t a r g e t s e t by the M i n i s t r y o f H e a l t h o f 4.3 m i l l i o n f o r 1976-1977 was exceeded by September 1976, and most s t a t e s o v e r f u l f i l l e d t h e i r o r i g i n a l q u o t a s / D u r i n g t h e 1976-1977 p e r i o d 8.25 m i l l i o n p e o p l e were s t e r i l i z e d , most o f them between J u l y and December 1976. Coup l e s e s t i m a t e d t o be " p r o t e c t e d " r o s e from 14% to 21% f o r I n d i a as a whole T h i s accomplishment was t h e outcome o f the p e r s o n a l p r e s s u r e e x e r t e d by S a n j a y G a n d h i , t h r o u g h t h e a l t e r a t i o n o r b y p a s s i n g o f the form a l c h a n n e l s o f p u b l i c p o l i c y f o r m u l a t i o n and i m p l e m e n t a t i o n . The d e v e l o p m e n t - o r i e n t e d measures o f t h e N a t i o n a l P o p u l a t i o n P o l i c y were i g n o r e d i n p r a c t i c e , and the e n t i r e a r r a y o f h e a l t h , p o l i c e , and o t h e r government m a c h i n e r y was put a t h i s d i s p o s a l . The Lok Sabha, which had r e a c t e d t o p r o p o s a l s o f s e m i - c o e r c i v e measures i n 1966,with a "storm o f q u e s t i o n s " had been r e d u c e d t o r u b b e r stamp s t a t u s . P o l i c y d i r e c t i v e s were i s s u e d from t h e Prime M i n i s t e r ' s O f f i c e , w h e r e i n r e s i d e d Mrs. Gandhi's " k i t c h e n c a b i n e t " o r i n n e r c i r c l e o f c l o s e a s s o c i a t e s . C l o s e s t ,to [ her .was S a n j a y , t o whom she o f t e n r e f e r r e d v i s i t i n g s t a t e C h i e f M i n i s t e r s . He e n j o y e d i n f o r m a l d o m i n a t i o n o f the Congress 9 P a r t y , and for m a l c o n t r o l o f t h e Youth C o n g r e s s . The r e v i s e d t a r g e t s were r e c e i v e d by t h e C h i e f M i n i s t e r s , who passed them on t o each department down the c h a i n o f command t o t h e D i s t r i c t C o l l e c t o r s , o r D i s t r i c t M a g i s t r a t e s a t the l o w e s t 1 eve!.*P Orders t r a h s m i t t e . d to the s t a t e s l e f t no room f o r e q u i v o c a t i o n , as they;had done under a l l o f t h e p r e v i o u s regimes-.'''''' S a n j a y ' s c r u c i a l r o l e a t the t o p o f this..column o f p r e s s u r e i s i l l u s t r a t e d by memos such as t h i s one from t h e - 74 -J o i n t D i r e c t o r o f F a m i l y P l a n n i n g t o v a r i o u s D i s t r i c t O f f i c e r s : I w i s h t o i n f o r m you t h a t S h r i S a n j a y Gandhi i s v i s i t i n g M a h a r a s t r a S t a t e about O c t o b e r 28, 1976 and t h e C h i e f M i n i s t e r d e s i r e s t h a t b e f o r e t h e v i s i t o f S h r i S a n j a y G a n d h i , M a h a r a s t r a S t a t e must have co m p l e t e d 5 l a k h s s t e r i l i z a t i o n s . You w i l l a p p r e c i a t e t h e s e r i o u s n e s s w i t h which the C M . has i s s u e d i n s t r u c t i o n s , and, t h e r e f o r e , though t h e ^ t a s k i s s t u p e n d o u s , we s h a l l a c h i e v e t h i s o b j e c t i v e . Where S a n j a y ' s w r i t ran s t r o n g , t h e n , r e v i s e d t a r g e t s and the z e a l w i t h which t h e y were pursued were h i g h e s t . Where s t a t e governments en-• j o y e d i n d e p e n d e n t bases o f power, such as i n K e r a l a , Kashmir, and Tamil Nadu, t h e y were a b l e to moderate o r r e s i s t t h e p r e s s u r e f o r p e r f o r m a n c e . The s t r e n g t h o f t h e Gandhis appeared t o depend v e r y much on l i n e a r and c u l -t u r a l d i s t a n c e from D e l h i . " F a m i l y p l a n n i n g " performance was most d r a m a t i c (and r e p r e s s i v e ) i n t h e H i n d i h e a r t l a n d o f Haryana, U t t a r P r a d e s h , and 13 Madhya P r a d e s h . I t s i n t e n s i t y dropped o f f beyond t h i s r e g i o n . E v i d e n c e o f t h e r e p r e s s i v e n e s s o f the s t e r i l i z a t i o n d r i v e i s l a r g e l y a n e c d o t a l , but does add up t o more than the i s o l a t e d i n c i d e n t s c l a i m e d 14 f o r i t by Mrs. Gandhi on B r i t i s h t e l e v i s i o n . T h e r e i s e v i d e n c e t h a t the Haryana a u t h o r i t i e s , f o r example, used p o l i c e s y s t e m a t i c a l l y t o round up v i l l a g e r s . The C h i e f M i n i s t e r , B a n s i L a i (a member o f t h e i n n e r c i r c l e ) chose t o a p o l o g i z e , r a t h e r than deny t h e h i g h handedness o f h i s s t a t e g o v e r n -ment's s t e r i l i z a t i o n campaign i n t h e J a n u a r y 1977 e l e c t i o n campaign. T h e r e were i n c i d e n t s o f v i o l e n t r e s i s t a n c e i n New D e l h i i n which an undetermined number o f p e o p l e d i e d , and i n M u z a f f a r n a g a r , U.P., where 20 t o 25 p e o p l e -were k i l l e d . Most o f t h e d e a t h s were t h e r e s u l t o f " p o l i c e f i r i n g s " , b u t 15 s e v e r a l were t h o s e o f o f f i c i a l s a t t h e hands o f i r a t e v i l l a g e r s . T h e r e were, as w e l l , a number o f deaths due t o p o s t - o p e r a t i v e s e p s i s . - 75 -In September 1976, t h e government o f f e r e d Rs. 5000 ( p e r c a p i t a annual income f o r I n d i a i s about Rs. 1000) t o t h e f a m i l i e s o f t h o s e who d i e d w i t h i n t e n days of s t e r i l i z a t i o n . Of t h e 900 c l a i m s , 700 were, by 1979, p a i d o u t by the J a n a t a government. I t i s d i f f i c u l t t o t e l l how many deaths a c t u a l l y o c c u r r e d as a consequence o f t h e s t e r i l i z a t i o n o p e r a t i o n s , but i t i s i n t h e o r d e r o f t h r e e f i g u r e s . The p o l i c i e s p r o m u l g a t e d by t h e M i n i s t r y o f H e a l t h and F a m i l y P l a n -n i n g had v e r y l i t t l e t o do w i t h what became the major f e a t u r e s of f e r t i l i t y c o n t r o l p o l i c y under t he Emergency. I t s impotence a l s o meant t h a t i t c o u l d not moderate the a g g r e s s i v e n e s s of t h e i n f o r m a l c e n t r e of power. Whether o r n o t t h e r e was a w i l l to do so i s q u e s t i o n a b l e . On the one hand t h e M i n i s t r y on many o c c a s i o n s s e n t c i r c u l a r s and memos t o t h e s t a t e governments u r g i n g them not t o o v e r s t r a i n ^ themselves o r - u s e c o e r c i o n of any t y p e . On the o t h e r hand, i t ne v e r p u b l i s h e d a code of a c c e p t a b l e b e h a v i o u r . * 7 An agency of t h e C e n t r e , c a l l e d t h e I n t e l l i g e n c e Bureau, i n i t s F a m i l y P l a n n i n g Programmes:  An Assessment (September 24, 1976), b r o u g h t up the problem o f e x c e s s i v e z e a l on t h e p a r t of t h e s t a t e governments i n r a i s i n g t a r g e t s . I t a l s o a i r e d t he m a t t e r of r e s i s t a n c e from c l i e n t s i n some s t a t e s . T h i s c i r c u l a r was bro u g h t t o t h e a t t e n t i o n of Karan S i n g h by h i s H e a l t h S e c r e t a r y , Gian P r a k a s h , who s u g g e s t e d a m e e t i n g . T h e r e i s , however, no r e c o r d o f any me e t i n g . Indeed, t h r o u g h o u t 1976, t h e M i n i s t r y c o n g r a t u l a t e d t h o s e s t a t e s which exceeded t h e i r o r i g i n a l t a r g e t s . In December, t h e government, i n C e n t r e C a l l i n g , an organ of the M i n i s t r y of H e a l t h and F a m i l y P l a n n i n g , c o n g r a t u l a t e d i t s e l f on t h e p r o g r e s s of t h e programme. Meanwhile, the H e a l t h S e c r e t a r y a d d r e s s e d a.meeting o f s e n i o r . o f f i c e r s o f t h e H e a l t h Department vof the Government of B i h a r . I t was d e s c r i b e d by a p a r t i c i p a n t as - 76 -"the most u n p l e a s a n t meeting h e l d a t t h e s t a t e level'.'. The S e c r e t a r y u p b r a i d e d t h e C h i e f M e d i c a l O f f i c e r s f o r i n a d e q u a t e p e r f o r m a n c e , s a y i n g i t "amounted t o a c r i m i n a l and a n t i - n a t i o n a l a c t " t o d r a g one's f e e t on 18 the s t e r i l i z a t i o n i s s u e . E x c e p t f o r token d i s c l a i m e r s , t h e n , the M i n i s t r y a p p e a r s t o have been s u b s e r v i e n t t o t h e f e r t i l i t y c o n t r o l hawks w i t h i n t h e Emergency government. The f i n a l s h i f t i n f e r t i l i t y c o n t r o l p o l i c y under t h e Emergency was, o r c o u r s e , i t s t e r m i n a t i o n . D e s p i t e p r e s s c e n s o r s h i p and t h e s y c o p h a n t i c r e l u c t a n c e o f t h e government's i n t e l l i g e n c e a g e n c i e s t o b e a r bad news, t h e above-mentioned i n c i d e n t s o f b a c k l a s h c o u l d n o t escape i t s a t t e n t i o n . N a t u r a l l y enough, because a l l government m a c h i n e r y was b e i n g used i n the s t e r i l i z a t i o n d r i v e , n e g l e c t e d a r e a s began t o r e q u i r e a t t e n t i o n . M a l a r i a was r e t u r n i n g , and t h e h e a l t h system c o u l d not c o n t i n u e to d i s r e g a r d i t i n -d e f i n i t e l y . Moreover, t h e i n c r e a s e d f e a r and s u s p i c i o n , w i t h which any s o r t o f o f f i c i a l who e n t e r e d t h e c o u n t r y s i d e began t o be viewed r e n d e r e d o t h e r t a s k s u n r e l a t e d t o t h e s t e r i l i z a t i o n campaign i m p o s s i b l e t o p e r f o r m . I t a p p e a r e d , t h e n , t h a t the s t e r i l i z a t i o n campaign was a d m i n i s t r a t i v e l y i n -19 f e a s i b l e , as w e l l as p o l i t i c a l l y so. The f i n a l blow to c o e r c i v e n e s s i n f e r t i l i t y c o n t r o l p o l i c y was d e a l t by t h e I n d i a n e l e c t o r a t e i n t h e J a n u a r y 1977 e l e c t i o n . I t was a campaign i s s u e , and i s known t o have been a major f a c t o r i n the d e f e a t o f the Con-g r e s s government. In t h o s e s t a t e s where t h e s t e r i l i z a t i o n d r i v e s had been 20 s t r o n g e s t , t h e Congress p a r t y l o s t h e a v i l y . The J a n a t a government promised never to use c o e r c i o n i n f a m i l y p l a n n i n g a g a i n . Because i t had c a p i t u l a t e d on t h e Congress P a r t y f a m i l y p l a n n i n g - 77 -r e c o r d , t h e J a n a t a government was e x p e c t e d t o be a n t i - f a m i l y p l a n n i n g . In f a c t , i t appeared t h a t the programme might be r e d u c e d t o the l e v e l s o f t h e 1950s when Raj N a r a i n , a champion o f s e x u a l a b s t i n e n c e , was . a p p o i n t e d M i n i s t e r o f H e a l t h and F a m i l y W e l f a r e ( t h e name was changed by the J a n a t a government). However, I n d i a ' s f e r t i l i t y c o n t r o l p o l i c y m a c h i n e r y was not disman-t l e d . The J a n a t a government was s i l e n t on p o p u l a t i o n i s s u e s f o r i t s f i r s t y e a r i n power, and t h e D r a f t S i x t h P l a n ( 1 9 7 8 - 1 9 8 3 ) ^ d i d not view r a p i d p o p u l a t i o n growth as a problem. I t d i d , however, i n c r e a s e the F a m i l y P l a n n i n g budget by 50 p e r c e n t o v e r l e v e l s earmarked by t h e p r e v i o u s p l a n . I m p l e m e n t a t i o n , however, was weak. F o l l o w i n g t h e Emergency vasectomy d r i v e s , a c c e p t a n c e o f a l l t y p e s o f c o n t r a c e p t i o n had been e x t r e m e l y low. M o r a r j i D e s a i , who took o v e r Raj N a r a i n ' s p o r t f o l i o i n l a t e 1978, i s s u e d s t a t e m e n t s e m p h a s i z i n g h i s p e r -s o n a l b e l i e f i n f a m i l y p l a n n i n g , and d u r i n g 1978-1979, t h e r e were f a m i l y p l a n n i n g f o r t n i g h t s , "months", " q u a r t e r s " , and s o o n . The J a n a t a government d i s i n t e g r a t e d f o r r e a s o n s q u i t e u n r e l a t e d t o f e r t i l i t y c o n t r o l p o l i c y , and Mrs. Gandhi swept to v i c t o r y i n J a n u a r y 1980. She r e s u r r e c t e d the- Twenty P o i n t s , none o f which was c o n c e r n e d w i t h p o p u l a -t i o n . N e i t h e r she nor her son S a n j a y , b e f o r e h i s death i n June 1980, made v e r y many r e f e r e n c e s t o f a m i l y p l a n n i n g , a l t h o u g h t h e i r views on t h e i s s u e 21 were s t r o n g l y f a v o u r a b l e . - 78 -CHAPTER IV FOOTNOTES 1. B e r n a r d B e r e l s o n , "Beyond F a m i l y P l a n n i n g , " S t u d i e s i n F a m i l y -P l a n n i n g , 38 ( F e b r u a r y , 1969): 1-15. 2. R o b e r t E. E l d e r J r . , " T a r g e t s v s . E x t e n s i o n E d u c a t i o n : The F a m i l y P l a n n i n g Programme i n U.P.," P o p u l a t i o n S t u d i e s , 28 ( J u l y , 1974): 252, 258. 3. I n d i r a Gandhi's a d d r e s s t o the N a t i o n a l P o p u l a t i o n C o n f e r e n c e , 1974; quoted i n D. B a n e r j i , "The P o l i t i c a l Economy o f P o p u l a t i o n C o n t r o l i n I n d i a , " i n P o v e r t y and P o p u l a t i o n C o n t r o l , eds. L a r s Bondestam and S t a f f a n B e r g s t r o m ( T o r o n t o : Academic P r e s s , 1980), p. 85. 4. Marcus F r a n d a , " I n d i a ' s Double Emergency Democracy, P a r t I I : R e a c t i o n s and A d a p t a t i o n s , " American U n i v e r s i t i e s F i e l d S t a f f R e p o r t s , 18 (December 1975): 11. For the government's a t t i t u d e t o v o l u n t a r y o r g a n i z a t i o n s , see a l s o , V.A. Pai P a n a n d i k e r , R.N. B i s h n o i , and P.P. Sharma, F a m i l y  P l a n n i n g Under the Emergency: P o l i c y I m p l i c a t i o n s o f I n c e n t i v e s and  D i s i n c e n t i v e s , ( D e l h i : R a d i a n t , 1978), p. 77. 5. D a v i d s o n R. Gwatkin, " P o l i t i c a l W i l l and F a m i l y P l a n n i n g : The I m p l i c a -t i o n s o f I n d i a ' s Emergency E x p e r i e n c e , " P o p u l a t i o n and Development Re- view, 5 ( 1 , March, 1979): 35. The o t h e r p o i n t s were a d u l t l i t e r a c y , dowry a b o l i t i o n , r e f o r e s t a t i o n and e q u a l i t y among c a s t e s . 6. R o b e r t C a s s e n , I n d i a : P o p u l a t i o n , Economy, S o c i e t y , (London: M a c M i l l a n P r e s s , 1978), p. 182. 7. M i s r e p o r t i n g i s not t h o u g h t t o have been a major problem. See Gwatkin, op. c i t . , note 38. T a b l e 7 a c h i e v e m e n t f i g u r e s a r e from C e n t r e C a l l i n g . 1 1 ( 1 , 2 ) , r e p r o d u c e d i n B. Ghosh, " I n d i a ' s P o p u l a t i o n P o l i c y : An A p p r a i s a l , " Demography I n d i a , 7 ( 1 , 2, 1978): 45. 8. Gwatkin, op. c i t . , p. 49. 9. James E. Kocher, " P o p u l a t i o n P o l i c y i n I n d i a : Recent Developments and C u r r e n t P r o s p e c t s , " P o p u l a t i o n and Development Review, 6 ( 2 , June 1980): 309, no. 19. 10. G w a t k i n , op. c i t . , pp. 39, 40. 11. I b i d . , p. 41. 12. Government o f I n d i a , Commission o f I n q u i r y i n t o M i s u s e o f Power D u r i n g Emergency (Shah Commission), Volume I I I ( f i n a l ) . - 79 -13. Gwatkiri, op. c i t . , p. 55, no. 24. 14. c i t e d i n C a s s e n , op. c i t . , p. 181. 15. Gwatkin, op. c i t . , p. 181. 16. I b i d . , p. 47. 17. C a s s e n , op. c i t . , p. 185. 18. Shah Commission, p. 157. 19. Cassen,.op. c i t . , p. 187. 20. Myron Wein e r , I n d i a a t t h e P o l l s : The P a r l i a m e n t a r y E l e c t i o n s o f 1977, (Washington: American E n t e r p r i s e I n s t i t u t e , 1978), C h a p t e r 6. 21. Kocher, op. c i t . , p. 305. - 80 -CHAPTER V ANALYSIS AND CONCLUSIONS The purposes o f t h i s t h e s i s a r e t o d i s c o v e r the i m p o r t a n c e of each component of the mix of d e t e r m i n a n t s o f the f e r t i l i t y p o l i c y f a c t , o f the p a r t i c u l a r f e r t i l i t y c o n t r o l measures c h o s e n , and of s h i f t s i n p o l i c i e s . While the u n d e r l y i n g r e a s o n f o r f e r t i l i t y c o n t r o l p o l i c y i s s i m p l e , p a r t i -c u l a r measures chosen a r e the outcomes of a m u l t i p l i c i t y of d e t e r m i n a n t s . The c o e r c i v e n e s s of t h e s e p o l i c i e s , and the s h i f t s i n p o l i c y , w i l l be shown i n t h i s c h a p t e r t o a r i s e from the a c t i o n s of l e a d e r s . These l e a d e r s , - I w i l l show, do n o t a c t e n t i r e l y o u t of p e r s o n a l p r e d i s p o s i t i o n s , but i n f a c t a r e t h e m s e l v e s i m p e l l e d o r c o n s t r a i n e d by t h e i r p o l i t i c a l c i r c u m s t a n c e s . The fundamental d e t e r m i n a n t o f f e r t i l i t y c o n t r o l p o l i c y t h r o u g h o u t a l l phases has been o v e r l y r a p i d p o p u l a t i o n growth. The p e r c e p t i o n t h a t p o p u l a t i o n growth has been e x c e s s i v e stemmed from the p o w e r f u l urge among l e a d e r s t o overcome the p o v e r t y which has g r i p p e d t h e i r c o u n t r i e s from time immemorial. T h i s urge was p a r t i c u l a r l y s t r o n g on the p a r t of p e o p l e such as the Nehrus, Ayub, Z i a u r Rahman, and S r i Lanka's l e a d e r s . They were i n -f l u e n c e d by p l a n n e r s , l a r g e l y e c o n o m i s t s , who c o u l d see t h a t g a i n s i n GNP of 3-5% were e a s i l y wiped o u t by p o p u l a t i o n growth r a t e of 2.5-3.5% per y e a r . S i n c e p o p u l a t i o n growth i s the outcome, l a r g e l y , of an e x c e s s of c h i l d b i r t h s o v e r d e a t h s , and s i n c e d e a t h c o n t r o l has been a "moral impera-t i v e " , and c h i l d b i r t h i s t h e outcome of c o n c e p t i o n , the l o g i c a l p o l i c i e s to i n i t i a t e seemed to be t h o s e which f a c i l i t a t e d c o n t r a c e p t i o n and persuaded c o u p l e s t o have s m a l l e r f a m i l i e s . - 81 -In phase one, the t e n e t s o f the f a m i l y p l a n n i n g movement a l r e a d y f i t t e d t h e g o a l s o f government up t o a p o i n t -- t h a t i s , the r i g h t o f e v e r y c o u p l e t o d e c i d e f o r th e m s e l v e s how many c h i l d r e n t o have. T h i s c o n c e p t was i n k e e p i n g w i t h t he d e m o c r a t i c i d e a l s w i t h which t he South A s i a n g o v e r n -ments began and was a p p l i c a b l e as p o l i c y as l o n g as one assumed t h a t p a r e n t s would e l e c t to have fewer c h i l d r e n once they had c o n t r o l o f t h e i r own f e r -t i l i t y . The r e a l i z a t i o n t h a t t h i s a s s u m p t i o n was wrong marked the p a s s i n g o f phase one. One q u e s t i o n posed i n t h i s t h e s i s i s , "what caused t he governments i n the s u b c o n t i n e n t t o a c t when t h e y d i d ? " The economic and demographic e n v i r o n -ments which I n d i a , P a k i s t a n , and C e y l o n i n h e r i t e d a f t e r independence were b r o a d l y s i m i l a r , y e t they adopted f e r t i l i t y c o n t r o l p o l i c i e s a t d i f f e r e n t t i m e s . The o u t l o o k f o r f o o d s e l f - s u f f i c i e n c y i n I n d i a was t h o u g h t t o be good and t h e commodities and t e r m s - o f - t r a d e o u t l o o k i n C e y l o n were a l s o b r i g h t . In P a k i s t a n , due t o u n d e r c o u n t i n g , t he r a t e o f p o p u l a t i o n growth was not as a l a r m i n g as i t was t o some o b s e r v e r s i n I n d i a and C e y l o n . T h e r e , l e a d e r s were aware t h a t t h e i r p o p u l a t i o n s were growing r a p i d l y , but t h e r e was no unanimous r e c o g n i t i o n t h a t t h i s was a problem. C e y l o n and P a k i s t a n gave sma l l g r a n t s t o t h e i r r e s p e c t i v e f a m i l y p l a n n i n g a s s o c i a t i o n s , b ut o n l y I n d i a o p e n l y engaged i n f a m i l y p l a n n i n g work. The I n d i a n l e a d i n t h e 1950s can be a t t r i b u t e d t o t h e h i s t o r i c a l advantage she had i n d i s c u s s i n g f e r t i l i t y c o n t r o l as a m a t t e r o f p u b l i c p o l i c y under t he Bhore committee and the Congress P l a n n i n g Committee p r i o r t o indep e n d e n c e . D u r i n g the p i o n e e r i n g phase, h a v i n g a l e a d e r who was f o r t h r i g h t l y f a v o u r a b l e t o f e r t i l i t y c o n t r o l was e q u a l l y i m p o r t a n t as the d u r a t i o n o f h i s - 82 -incumbency. In Ceylon, S.W.R.D. Bandaranaike and Dudley Senanayake were aware of the implications of population growth, and were partial to fer-t i l i t y control. Neither was in power long enough to translate this in-terest into public policy. It is possible that communal sensitivities would have precluded this anyway, but i f so, there is no evidence that ethnic spokesmen were aroused by this issue at that time. In Pakistan, the ques-tion was far down on its l i s t of preoccupations and similarly, in Bangladesh from 1971 to 1974 the situation was too turbulent for the government to con-sider fertility control policies. In India, fertility control policy had .. the chance of receiving consistent and concerted attention from the bureau-cracy during the long period of Nehru rule throughout the pioneering phase. The levels of activity of private family planning associations appear to parallel those of their governments. India had the oldest and most active movement beginning in the early 1930s and this activity continued after in-dependence. Ceylon had a few population activists in the same period and the Ceylon government lent them token support, following their formation into the FPAC in 1954. Likewise, in Pakistan, where there was probably the weakest private family planning movement, the government began to support the Family Planning Association in 1955. In Bangladesh, the remnants of the erstwhile FPAP lay low during the pre-1975 (and post-1975) period. Nevertheless, Mujib (and of course Zi'aur Rahman): made ..remarks favourable, to fertility control, which suggests that by the 1970s, private associations had outlived their role as advocate, breaker of inhibitions, and politically safe surrogate dispenser of family planning services for governments. It is difficult then, to discern whether the activities of these groups are a - 83 -cause o r a r e s u l t o f f e r t i l i t y p o l i c y a d o p t i o n by governments o r m e r e l y a c o n c u r r e n t e v e n t . I t was d u r i n g the p i o n e e r i n g p h a s e : a l s o , t h a t p o p u l a t i o n p o l i c y was f i r m l y s e t i n t h e d i r e c t i o n o f f e r t i l i t y c o n t r o l t h r o u g h m e d i c a l c l i n i c s . T h i s was due both t o t h e a d o p t i o n by governments o f the f a m i l y p l a n n i n g move-ment's i d e a s , and t o t h e c o n s t r a i n t s of contemporary t e c h n o l o g y . The condom was the o n l y e x t r a - c l i n i c a l method t h a t was t e c h n i c a l l y and o r g a n i z a t i o n a l l y f e a s i b l e d u r i n g the p i o n e e r i n g phase. Mass d i s t r i b u t i o n o f t h e condom d i d not o c c u r u n t i l t h e l a t e . 1 9 6 0 s i n I n d i a , P a k i s t a n and C e y l o n , which l e n d s c r e d e n c e t o t h e a c c u s a t i o n s of " c l i n i c a l b i a s " d u r i n g the e a r l y y e a r s . * The c l i n i c a l a p p r o a c h was f a v o u r e d by t h e f a m i l y p l a n n i n g movement,-whose s t a t e d g o a l was f a m i l y w e l f a r e and not p o p u l a t i o n c o n t r o l . T h i s g o a l was s h a r e d by the governments of I n d i a , P a k i s t a n and S r i Lanka d u r i n g the f i r s t phase. T h a t the m o t i v e s f o r d o w n p l a y i n g demographic o b j e c t i v e s were p o l i t i c a l was shown by t h e c o n c l u s i o n of t h e Bhore Committee, which was t h a t o n l y f a m i l y w e l f a r e was a p o l i t i c a l l y s a f e g o a l . A p o l i t i c a l c onsensus around t h i s goal among I n d i a n e l i t e s was p o s s i b l e , whereas t h e goal of p o p u l a t i o n growth r a t e r e d u c t i o n was too b a l d f o r some: members i n the e a r l y y e a r s . The p r e - and p o s t - i n d e p e n d e n c e governments t h e r e f o r e a d o p t e d the p h i l o s o p h y of t h e movement, as w e l l as the c l i n i c a l a p p r oach which accompanied i t i n I n d i a . G e n e r a l l y , t h e p a r t i c u l a r t y p e s of measures taken t o d e a l w i t h t h e p o p u l a t i o n problem i n a g i v e n c o u n t r y were d e t e r m i n e d by methods a v a i l a b l e , the l i m i t s of o r g a n i z a t i o n a l and i n f r a s t r u c t u r a l f e a s i b i l i t y , and t h e per-, s o n a l s e n s i b i l i t i e s and p r e d i l e c t i o n s o f p a r t i c u l a r l e a d e r s . I n d i a began - 84 -e x p e r i m e n t a t i o n w i t h t h e rhythm method a f t e r independence because m e c h a n i c a l methods were r u l e d o u t by t h e Prime M i n i s t e r and h i s m i n i s t e r o f h e a l t h . Meanwhile, and s u b s e q u e n t l y , t h r o u g h p i l o t p r o j e c t s and a t t i t u d e s u r v e y s , i t was f o u n d than non-rhythm methods were not o b j e c t i o n a b l e t o the c l i e n t e l e p u b l i c , and by 1959, i n I n d i a , t h e s e e x p e r i m e n t a l l e d the government to con-c l u d e t h a t v a s e c t o m i e s were f e a s i b l e , both s u r g i c a l l y and a d m i n i s t r a t i v e l y , and t h a t , most i m p o r t a n t l y , t h e r e was a demand f o r them. Because I n d i a was the p i o n e e r and t h e o t h e r c o u n t r i e s l a g g e d b e h i n d , t h e y were a b l e t o l e a r n from I n d i a ' s e x p e r i e n c e and t h e r e b y c a t c h up t o I n d i a on t h e t e c h n o l o g i c a l f r o n t by 1965. In t h e second phase, governments s e t n a t i o n a l b i r t h r a t e t a r g e t s , and mounted a s u c c e s s i o n o f t e c h n i q u e - c e n t r e d programmes. These were pushed w i t h the most v i g o u r i n I n d i a and P a k i s t a n and w i t h the l e a s t i n C e y l o n . They amounted to l i t t l e more than d e c l a r a t i o n s by P r e s i d e n t Z i a u r Rahman o f B a n g l a d e s h . I t i s n o t a g r e a t d i s c o v e r y , t h e n , t o f i n d c r a s h programmes f a l l i n g s h o r t o f l e a d e r s ' e x p e c t a t i o n s i n I n d i a and P a k i s t a n , but not i n S r i Lanka, where t h e gap between e x p e c t a t i o n s and p e r c e p t i o n s o f f a i l u r e was s m a l l e s t . The major e n g i n e b e h i n d t h e renewed v i g o u r f o r f e r t i l i t y c o n t r o l i n B a n g l a d e s h , Z i a u r Rahman, was a s s a s s i n a t e d i n 1981, and s u b s e q u e n t d e v e l o p -ments t h e r e a r e an open q u e s t i o n . In S r i Lanka t h e r e have a l s o been f l u c t u a -t i o n s i n f e r t i l i t y p o l i c y , but t h i s has not been due t o e x c e s s i v e a m b i t i o n s and f a i l u r e s , but r a t h e r , has been an outcome o f the e l e c t o r a l c y c l e . Both P a k i s t a n and C e y l o n d e c l a r e d n a t i o n a l p o p u l a t i o n p o l i c i e s i n 1965 w h i l e I n d i a committed a s u b s t a n t i a l r i s e i n r e s o u r c e s , up from 3.49% o f the h e a l t h budget (1956-1966) t o 9.7% f o r the annual p l a n b e g i n n i n g i n 1966, and - 85 -l a u n c h e d a major programme -- the IUD scheme -- the same y e a r . The remark-a b l e c o n t e m p o r a n e i t y o f these e v e n t s l e a d us t o l o o k f o r e n v i r o n m e n t a l f a c t o r s which a l l may have s h a r e d . A l l t h r e e had completed d e c e n n i a l cen-c u s e s two t o f o u r y e a r s p r e v i o u s l y , the d a t a o f which may have r e q u i r e d a few y e a r s t o t r i c k l e up t o p o l i c y - m a k e r s . I t i s known i n I n d i a ' s case t h a t p o p u l a t i o n growth between 1951 and 1961 had alarmed p l a n n e r s . I n d i a a l s o e x p e r i e n c e d a s e r i o u s d r o u g h t and c r o p f a i l u r e i n the mid-1960s. In B a n g l a -d e s h , t h e r e was a l s o c r o p f a i l u r e and famine i n 1974, j u s t p r i o r t o the d e c l a r a t i o n o f r e s o l v e t o c u r b p o p u l a t i o n growth. In a l l f o u r c o u n t r i e s , economic problems b r o u g h t home t o governments t h a t the p o p u l a t i o n / r e s o u r c e b a l a n c e was n o t g o i n g t o improve w i t h o u t much g r e a t e r e f f o r t and more r a d i c a l i n t e r v e n t i o n . There are two a s p e c t s o f t e c h n o l o g y and o r g a n i z a t i o n a l approach t o con-s i d e r . B i r t h c o n t r o l t e c h n i q u e s t h e m s e l v e s were d e t e r m i n a n t s o f both programmes and p o l i c i e s . Programmes c e n t r e d on a p a r t i c u l a r method o f b i r t h c o n t r o l were chosen b e c a u s e , l i k e Mount E v e r e s t , t h e s e t e c h n i q u e s were " t h e r e " . Moreover, one t e c h n i q u e , the IUD i n I n d i a .in 1964 - 1965, was i t s e l f a c a t a l y s t f o r the renewal o f a moribund f e r t i l i t y c o n t r o l p o l i c y . There i s no e v i d e n c e t h a t new d e v i c e s p l a y e d t h i s r o l e t o n e a r l y t h i s e x t e n t i n the o t h e r c o u n t r i e s . The IUD seems t o have been chosen n o t j u s t because o f u r g i n g s by f o r e i g n e x p e r t s , but a l s o because o f i t s n o v e l t y . In P a k i s t a n , t h e r e was an a c c e n t on improvement o f management and l o g -i s t i c s . T h i s took the form o f " i n u n d a t i o n " o f the d i s t r i b u t i o n network o f the P o p u l a t i o n P l a n n i n g D i v i s i o n w i t h condoms and l a t e r w i t h p i l l s . The s e a r c h f o r a d i s t r i b u t i o n s y s t e m , f i r s t t h r o u g h d a i s , aWd then t h r o u g h male - 86 -f a m i l y p l a n n i n g workers was n o t j u s t t he outcome o f an American f i x a t i o n w i t h such i d e a s , a l t h o u g h t h i s was u n d o u b t e d l y i m p o r t a n t , but was due a l s o to t h e absence o f an e f f e c t i v e c l i n i c a l network and, i n the c a s e o f the p i l l , which was g i v e n w i t h o u t p r e s c r i p t i o n , t o an absence o f a s t r o n g m e d i c a l a s s o c i a t i o n . By t h e same t o k e n , S r i Lanka has n o t seen t h e need t o b u i l d e x t r a - c l i n i c a l o r g a n i z a t i o n s because o f t h e o u t r e a c h c a p a b i l i t y o f i t s e x i s t i n g h e a l t h s t r u c t u r e . In s h o r t , i n the m a t t e r o f measures t a k e n , governments do what i s f e a s i b l e and keep on d o i n g what t h e y have been. What d i f f e r e n c e s do the v a r i a t i o n s f o u n d i n t h e s e c o u n t r i e s ' i n s t i t u -t i o n s make d u r i n g the second phase? I n d i a s t a n d s o u t as an i n s t i t u t i o n a l anomaly d u r i n g t h e f i r s t two phases i n r e s p e c t o f i t s f e d e r a l s t r u c t u r e . H e a l t h and F a m i l y P l a n n i n g was e f f e c t i v e l y a c o n c u r r e n t s u b j e c t . T h i s gave t h e s t a t e s g r e a t e r autonomy i n t h i s p o l i c y a r e a , y e t s i n c e t h e c e n t r e c o n t r o l l e d a l l o c a t i o n o f f i n a n c e s f o r programmes, i t c o u l d keep t h e upper hand. However, f e d e r a l i s m d i d g i v e t h e s t a t e s a g r e a t e r freedom e i t h e r t o i n n o v a t e o r d r a g t h e i r f e e t i n a c c o r d a n c e w i t h l o c a l p r e f e r e n c e s and c o n d i -t i o n s than d i d t h e c o r r e s p o n d i n g p r o v i n c e s i n P a k i s t a n o r d i s t r i c t s i n C e y l o n . More i m p o r t a n t t o the a s s e r t i v e n e s s , o r p o l i t i c a l w i l l b e h i n d f e r t i l i t y p o l i c y than t h e f e d e r a l / u n i t a r y d i s t i n c t i o n ?appears t o be t h e d i f f e r e n c e s f o u n d i n d e m o c r a t i c freedoms o v e r t i m e and s p a c e . Ayub and Z i a , both m i l i -t a r y men, were l e s s h e s i t a n t than Nehru and Mrs. Gandhi ( b e f o r e 1976) and the B a n d a r a n a i k e s about i n i t i a t i n g a c t i o n p o l i c i e s which had w i t h i n them s t r o n g m o t i v a t i o n a l programmes. Both strongmen, d e s p i t e e f f o r t s t o b u i l d l o c a l sup-p o r t b a s e s , were e s s e n t i a l l y top-down r u l e r s i s o l a t e d from the e a r l y - w a r n i n g - 87 -s i g n a l s o f f a i r e l e c t i o n s . L e f t / r i g h t o r i e n t a t i o n s o r p o s t u r e s i n governments d i d not appear t o be r e f l e c t e d i n t y p e s o f f e r t i l i t y c o n t r o l p o l i c i e s c h o s e n . P r o f e s s e d l y s o c i a l i s t regimes such as Mrs. Gandhi's o r Mrs. B a n d a r a n a i k e 1 s appeared t o emphasize government s o l u t i o n s w h i l e i n i t i a t i n g commercial d i s t r i b u t i o n schemes as w e l l . "Free e n t e r p r i s e " regimes such as Ayub's o r Z i a ' s and Senanayake's a l s o gave a major r o l e t o government, w h i l e a l s o p romoting commercial d i s t r i b u t i o n o f s u p p l i e s . On the o t h e r hand, Ayub, Z i a u r Rahman, Senanayake, (and S a n j a y , i n phase t h r e e ) were a l l more r i g h t - w i n g than t h e i r p r e d e c e s s o r s , and a l l were i n s t r u m e n t a l i n p u s h i n g c r a s h programmes. F o r e i g n a i d donors d i d not i n f l u e n c e the broad d i r e c t i o n o f f e r t i l i t y p o l i c y . However, t h e y i n f l u e n c e d the t y p e s o f o r g a n i z a t i o n a l a p proaches t a k e n by governments. T h i s i m p r i n t has been h e a v i e s t i n B a n g l a d e s h , where o v e r h a l f o f t h e government budget was e x t e r n a l l y f u n d e d , and the l e a s t i n I n d i a , where l i t t l e o v e r t e n p e r c e n t o f f a m i l y p l a n n i n g a c t i v i t y was e v e r funded by f o r e i g n d o n o r s . In a l l c a s e s , the " f e r t i l i t y p o l i c y f a c t " and t h e v i g o u r o r l a s s i t u d e w i t h which i t was p u r s u e d o r i g i n a t e d from w i t h i n . One would e x p e c t communal s e n t i m e n t s t o be i m p o r t a n t d e t e r m i n a n t s o f any p o l i c y which had the p o t e n t i a l f o r a f f e c t i n g t h e c o m p o s i t i o n o f a p o p u l a t i o n . In a l l f o u r c o u n t r i e s whose e v o l v i n g p o l i c i e s have been des-c r i b e d h e r e , t h e r e were r e l i g i o u s , e t h n i c , o r r e g i o n a l elements who were opposed t o f e r t i l i t y c o n t r o l because o f t h i s ; p o t e n t i a l . In I n d i a , a v e r y s m a l l number o f Hindu e x t r e m i s t s were m i l i t a n t l y opposed t o f e r t i l i t y c o n-t r o l . In P a k i s t a n , t h e o n l y a p p a r e n t o p p o s i t i o n came from the J a m a a t - i - I s l a m i - 88 -on moral grounds. In S r i Lanka, S i n h a l e s e B u d d h i s t : c l e r g y m e n were q u i t e v o c a l i n t h e i r o p p o s i t i o n , w h i l e i n B a n g l a d e s h , the government f e a r e d t o t a k e any s t a n d i n i t s i n i t i a l phase because o f the a s s o c i a t i o n o f f e r t i l i t y c o n t r o l w i t h P a k i s t a n i f e r t i l i t y c o n t r o l p o l i c i e s and g e n o c i d e . Yet i n o n l y one o f t h e s e c o u n t r i e s , S r i Lanka, i s t h e r e any s u b s t a n -t i a l e v i d e n c e t h a t communal s e n t i m e n t s were an i m p o r t a n t d e t e r m i n a n t o f f e r t i l i t y c o n t r o l p o l i c y . Why t h i s was so w i l l emerge from an e x a m i n a t i o n o f each c a s e i n t u r n . F i r s t l y , i n S r i Lanka, the r e l i g i o u s and e t h n i c d i v i -s i o n s were h i g h l y c o n g r u e n t . An absence o f c r o s s - c u t t i n g c l e a v a g e s r a i s e d the s a l i e n c e o f t h i s s i n g l e d i v i s i o n t o p o l i c y - m a k e r s . A l t h o u g h the S i n h a l e s e Buddhi'st segment, which i n f a c t d i d t a k e t o f e r t i l i t y c o n t r o l s l i g h t l y more r e a d i l y than t h e Tamil p o p u l a t i o n , c o m p r i s e d 70% o f a l l S r i Lankans, c o u l d n o t r e a l i s t i c a l l y e x p e c t t o be outnumbered w i t h i n any r e l e -v a n t h i s t o r i c a l t i m e - f r a m e , t h e i r p e r c e p t i o n o f an o v e r l y numerous Hindu Tamil p o p u l a t i o n may have been d e r i v e d from t h e r e g i o n - w i d e p e r s p e c t i v e , w i t h i n which t h e y c o r r e c t l y viewed t h e m s e l v e s as a m i n o r i t y . In p o l i t i c s , p e r c e p t i o n s , though f a l s e , have r e a l c o n s equences. The q u e s t i o n r e m a i n s , however, as t o why t h e b a c k l a s h from the p o t e n t i a l impact o f f e r t i l i t y c o n t r o l p o l i c i e s on the e t h n i c , r e l i g i o u s , o r r e g i o n a l c o m p o s i t i o n o f p o p u l a t i o n s i n the o t h e r c o u n t r i e s d i d n o t become a r e a l c on-s i d e r a t i o n i n t h e f e r t i l i t y p o l i c y - m a k i n g p r o c e s s t h e r e . In I n d i a , a l t h o u g h about 80% o f t h e c o u n t r y was Hindu, the Hindus d i d a c c e p t . f a m i l y p l a n n i n g more r e a d i l y than M u s l i m s , and t h e r e was no d e a r t h o f Hindu/Muslim a n t i p a t h y , t h i s was seldom m a n i f e s t i n o p p o s i t i o n t o f e r t i l i t y c o n t r o l p o l i c y d u r i n g t h e second phase. When t h e r e were some m a n i f e s t a t i o n s , as i n D e l h i d u r i n g t h e - 8,9 -emergency, means whereby o p p o s i t i o n . ( o n the p a r t o f M u s l i m s , who i n t h i s c a s e were t h e ones who b e l i e v e d t h e m s e l v e s the v i c t i m s , ) c o u l d a f f e c t p o l i c y had been suspended. L i k e w i s e , i n P a k i s t a n , a l t h o u g h t h e f i s s u r e was r e g i o n a l and e t h n i c , and numbers were c l o s e l y b a l a n c e d between t h e e a s t and west wings, t h e r e i s no e v i d e n c e t h a t f e r t i l i t y c o n t r o l p o l i c y was a f f e c t e d by t h i s c l e a v a g e , which o t h e r w i s e i n f u s e d P a k i s t a n i p o l i t i c s from t h e time o f i n d e p e n d e n c e . One can i n f e r , i f t h e low v i s i b i l i t y o f t h e C o n t i n u o u s M o t i v a t i o n Scheme i n West P a k i s t a n i n t h e 1970s i s any. i n d i c a t i o n o f t h e g e n e r a l a b i l i t y o f the Govern-ment o f P a k i s t a n t o r e a c h p o l i t i c a l l y s i g n i f i c a n t numbers o f c l i e n t s , t h a t t h i s was due t o the s h o r t n e s s o f r e a c h o f .the P a k i s t a n i programmes. In Bangladesh,, t h e r e i s no r e c o r d o f t h e dominant Muslim m a j o r i t y (88%) f e e l i n g t h r e a t e n e d by the d w i n d l i n g Hindu m i n o r i t y . C o n v e r s e l y , t h e r e i s no e v i d e n c e t h a t Z i a took i n t o a c c o u n t t h e s e n t i m e n t s , i f any, o f the Hindus o r o t h e r m i n o r i t i e s i n f o r m u l a t i n g h i s f e r t i l i t y c o n t r o l p o l i c y . In I n d i a , P a k i s t a n , and S r i Lanka, t h e r e were communal p o l i t i c i a n s who were w i l l i n g t o make p o l i t i c a l use o f any p o l i c y which a f f e c t e d t h e i r f o l l o w e r s , -but o n l y i n S r i Lanka and I n d i a , where, n a t u r a l l y enough, numbers were more i m p o r t a n t because t h e r e were h o n e s t l y c o n d u c t e d e l e c t i o n s , d i d t h e y e x p l o i t t h e i s s u e o f f e r t i l i t y c o n t r o l p o l i c y . In t h e e v e n t , o n l y t h o s e i n S r i Lanka succ e e d e d i n i n f l u e n c i n g t h e i r government's p o l i c i e s a t a l l . I t would seem, t h e n , t h a t even where communal r i v a l r i e s e x i s t , f e r t i -l i t y c o n t r o l p o l i c y does n o t n e c e s s a r i l y become a t a r g e t o f communal spo k e s -men, nor does the government n e c e s s a r i l y heed them. Whether t h i s o c c u r s depends upon t h e s e n s i t i v i t y o f t h e government to feedback mechanisms such - 90 -as e l e c t i o n s , upon whether o r n o t communal ism has i n the p a s t r e g u l a r l y been a major e l e c t o r a l f a c t o r , and on t h e v i s i b i l i t y o f f e r t i l i t y c o n t r o l programmes. The a c t u a l p o t e n t i a l o f f e r t i l i t y c o n t r o l programmes to a f f e c t the r e l a t i v e s i z e o f v y i n g communal groups i s l e s s i m p o r t a n t than t h e p r e -e x i s t e n c e o f p o l i t i c i z e d communal r i v a l r i e s . Outcomes, e i t h e r i n t h e form o f s u c c e s s e s o r f a i l u r e s i n r e a c h i n g a c c e p t o r s , o r i n t h e form o f b a c k l a s h o r i t s absence from t a r g e t p u b l i c , have been i m p o r t a n t to t h e d e t e r m i n a t i o n o f subsequent p o l i c i e s . V o l u n -t a r y s t e r i l i z a t i o n and s t e r i l i z a t i o n camps i n I n d i a and condom d i s t r i b u t i o n programmmes everywhere were t h o u g h t s u c c e s s f u l and have t h e r e f o r e been con-t i n u e d . The p r o c e s s d u r i n g the c r a s h programme phase has been one o f 2 " l e a r n i n g by d o i n g " . S i n c e a g r e a t d e a l was t r i e d i n I n d i a , as compared w i t h Bangladesh and S r i Lanka, a g r e a t d e a l more was l e a r n e d t h e r e . One o f t h e most i m p o r t a n t t h i n g s l e a r n e d i n I n d i a f o r the p u r s u i t o f subsequent programmes was t h a t t h o s e t e c h n i q u e s r e q u i r i n g c o n t i n u o u s m o t i v a t i o n d i d not w o r k . w e l l . T h i s l e d t o t h e s t r e s s on s t e r i l i z a t i o n i n t h a t c o u n t r y . Both I n d i a and P a k i s t a n r e c o g n i z e d and began a t t a c h i n g i n c r e a s i n g i m p o r t a n c e t o m o t i v a t i o n once the i n a d e q u a c y o f t h e t r a d i t i o n a l i d e a l s o f v o l u n t a r i s m i n f a m i l y p l a n n i n g were r e a l i z e d . I n d i a mounted a s p e c i a l m o t i v a t i o n campaign i n 1964, w i t h i t s i l l - f a t e d " e x t e n s i o n e d u c a t i o n " scheme and P a k i s t a n d i d so b e g i n n i n g i n 1969, w i t h i t s C o n t i n u o u s M o t i v a t i o n Scheme. The v a l u e o f t h e s e un-s u c c e s s f u l schemes was i n showing t h a t d i f f e r e n t a p p r o a c h e s and more e f f o r t were g o i n g t o be n e c e s s a r y i f the masses o f t h e p o p u l a t i o n were t o be r e a c h e d . I n d i a l o s t a l l i n h i b i t i o n about p a y i n g i n c e n t i v e money by the e a r l y 1970s. One does n o t r e a d o f c r a s h programmes i n S r i Lanka because - 91 -o f the extreme p o l i t i c a l s e n s i t i v i t y o f the i s s u e . Yet a n o t h e r , p r o c e s s -r e l a t e d , r e a s o n , however, i s t h a t s u c c e s s f u l programmes such as i t s IUD scheme were n o t abandoned i n t h e s e a r c h f o r newer and more e f f e c t i v e methods, but were r a t h e r , c o n t i n u e d u n o b t r u s i v e l y . While t h e S r i Lankan government- had good p o l i t i c a l r e a s o n s f o r not announcing g r a n d i o s e and u n a t t a i n a b l e demographic t a r g e t s ( t h e b i r t h r a t e t a r g e t o f 25 by. 1975 was, f o r whatever r e a s o n , n e a r l y a t t a i n e d ) , t h e I n d i a n government was i n the h a b i t o f s e t t i n g i m p o s s i b l e t a r g e t s i n a l l economic a r e a s , i n c l u d i n g p o p u l a t i o m p l a n n i n g . The a r b i t r a r y s e t t i n g o f u n a t t a i n -a b l e t a r g e t s was done o u t o f a " p o l i t i c a l need d e s i g n e d to g e n e r a t e o p t i -3 mism and e n t h u s i a s m " . - B a n g l a d e s h ' s Z i a , who l a u n c h e d h i s c o u n t r y i n t o a phase where t h e r e was a t l e a s t the p o s s i b i l i t y o f more e f f e c t i v e programmes, seemed, w i t h h i s p a t e n t l y u n r e a l i s t i c o v e r e s t i m a t e o f t h e l a t e n t demand f o r f a m i l y p l a n n i n g s e r v i c e s , t o be d u p l i c a t i n g the h i g h t a r g e t - s e t t i n g h a b i t which I n d i a s u f f e r e d from. I f government c a p a c i t y and p o p u l a r demand f o r c o n t r a c e p t i v e s e r v i c e s were so f a r s h o r t o f c a r r y i n g programmes towards t h e s e demographic t a r g e t s , and the o r d e r o f a l l o c a t i o n f o r p o p u l a t i o n c o n t r o l i n S r i Lanka, B a n g l a d e s h and P a k i s t a n has been around 1.5 t o 3 p e r c e n t o f t h e h e a l t h budget, and i n I n d i a up t o t e n p e r c e n t , one i s c o m p e l l e d t o ask why, i f t h e s e t t i n g o f t a r g e t s was n o t t o be c o m p l e t e l y m e a n i n g l e s s , governments d i d n o t spend a g r e a t d e a l more. There a r e two e x p l a n a t i o n s f o r t h i s . The f i r s t i s t h a t f a m i l y p l a n n i n g had a v e r y low p r i o r i t y and t h e r e f o r e t h a t i t s proponents l a c k e d , r e l a t i v e t o t h o s e who c o u l d e x e r t p r e s s u r e f o r o t h e r e x p e n d i t u r e s , adequate p o l i t i c a l w e i g h t . B u d g e t a r y b a t t l e s o c c u r b e h i n d c l o s e d d o o r s , but - 92 -t h e a l l o c a t i o n and e x p e n d i t u r e f i g u r e s seem t o speak e l o q u e n t l y . A n o t h e r p o s s i b l e e x p l a n a t i o n , which does not e n t i r e l y e x c l u d e the f i r s t , and one which i s borne o u t by t h e s u b s t a n t i a l u n d e r e x p e n d i t u r e i n both P a k i s t a n and I n d i a i n . t h e e a r l y y e a r s , i s t h a t t h e government i n f r a s t r u c t u r e was s i m p l y i n a d e q u a t e t o a b s o r b any more f u n d s . T h i s c o u l d a p p l y t o I n d i a , P a k i s t a n and B a n g l a d e s h , where, f o r example, t r a i n e d w o r k e r s , e s p e c i a l l y f e m a l e w o r k e r s , who would be i n d i s p e n s i b l e f o r a d m i n i s t e r i n g f e m a l e - s p e c i f i c c o n t r a c e p t i v e s , o r even e d u c a t i n g and m o t i v a t i n g w i v e s , were i n c h r o n i c s h o r t s u p p l y . In f a c t , t h e g r e a t r i s e i n e x p e n d i t u r e s , as compared w i t h p r e v i o u s y e a r s i n I n d i a , o c c u r r e d when c r a s h programmes o f f e r i n g i n c e n t i v e payments were l a u n c h e d . The dispensing o f c a s h i n c e n t i v e payments d u r i n g vasectomy d r i v e s , n a t u r a l l y enough, produced the f e w e s t b o t t l e n e c k s t o e x p e n d i t u r e . To t h i s p o i n t , I have summarized what t h e s e c o u n t r i e s have done d u r i n g t h e i r second p h a s e s , and h i g h l i g h t e d t h e r o l e s o f c o n t e x t (economic, demo-g r a p h i c , and t e c h n o l o g i c a l ) ; i n s t i t u t i o n s ( f e d e r a l i s m , i n f r a s t r u c t u r e ! , and d e m o c r a t i c ) , i d e a s ( i d e o l o g y ) and p r o c e s s ( s u c c e s s , f a i l u r e and g o a l s ) . I have shown how t h i s mix o f d e t e r m i n a n t s has i n f l u e n c e d measures c h o s e n . The f i r s t c a t e g o r y o f a n a l y s i s , e n v i r o n m e n t , a p p e a r s to be i m p o r t a n t i n d e t e r m i n i n g when a s h i f t to s t r o n g e r p o l i c y took p l a c e , w h i l e a l l the r e s t appear t o have been i m p o r t a n t i n e x p l a i n i n g d i f f e r e n c e s i n measures c h o s e n . N o t w i t h s t a n d i n g the common e x p e r i e n c e s o f s c a r c i t y c r i s e s c o u p l e d w i t h f r i g h t e n i n g census r e p o r t s , which p o i n t t o the p r i m a c y o f ' c h a n g i n g c o n t e x t as a d e t e r m i n a n t , the o c c u r r e n c e s o f s p e c i f i c p o l i c y s h i f t s have had a p o l i t i c a l c a u s e . Environments a l o n e c a n n o t i n d u c e p o l i c y changes, nor can l e a d e r s a l o n e . The demographic/economic o u t l o o k was worse i n P a k i s t a n than - 93 -i n I n d i a d u r i n g t h e p i o n e e r i n g phase, y e t I n d i a l e d P a k i s t a n by about f i v e y e a r s . L i k e w i s e , t h e economic/demographic envi r o n m e n t i n pre-1975 B a n g l a -desh c r i e d o u t f o r i n t e r v e n t i o n , y e t no one i n t e r v e n e d . The f a c t t h a t S r i Lanka's b i r t h r a t e has always been much lower than t h a t o f her n e i g h b o u r s d i d n o t d e t e r her l e a d e r s from f o r m u l a t i n g a N a t i o n a l P o p u l a t i o n P o l i c y when th e y f i n a l l y p e r c e i v e d t h e r i s k s o f d o i n g n o t h i n g as g r e a t e r than t h e p o l i -t i c a l r i s k s o f d o i n g so m e t h i n g . The p o p u l a t i o n / r e s o u r c e b a l a n c e o r im-b a l a n c e must be p e r c e i v e d as a c r i s i s by a l e a d e r who i s i n command o f the p o l i t y , o r who i s c l o s e t o t h o s e who a r e . He ( o r she) w i l l t hen i n i t i a t e s h i f t s i n f e r t i l i t y p o l i c y which he w i l l implement t h r o u g h e x i s t i n g i n s t i t u -t i o n s . T h i s i s s u p p o r t e d by the e v i d e n c e from f o u r o f f i v e f e r t i l i t y p o l i c y e v e n t s r e c o u n t e d h e r e . In C e y l o n (1965) and Ban g l a d e s h ( 1 9 7 5 ) , s i g n i f i c a n t s h i f t s i n f e r t i l i t y p o l i c y f o l l o w e d t h e r i s e t o power o f new l e a d e r s . In P a k i s t a n (1965) and i n I n d i a , when Mrs. Gandhi had a change o f v i e w s , s h i f t s i n p o l i c y were s t i m u l a t e d by l e a d e r s who had- been i n " o f f i c e f o r a bout s i x y e a r s . Whether change o f regime o r change o f mind o p e r a t e d i n t h e s e c a s e s , t h e impetus o r i g i n a t e d from n a t i o n a l l e a d e r s . In the anomalous c a s e , ( I n d i a , 1965), a s u b s t a n t i a l r i s e i n commitment t o f e r t i l i t y p o l i c y o c c u r r e d a t t h e end o f Nehru's l i f e and d u r i n g L a i Bahadur S h a s t r i ' s b r i e f i n t e r l u d e . N e i t h e r was a f a m i l y p l a n n i n g "hawk", a l t h o u g h Nehru began making some s t r o n g l y f a v o u r a b l e s t a t e m e n t s i n 1963. H i s appointment o f two e n e r g e t i c and a b l e o f f i c e r s i n d i c a t e s t h i s r e s u r g e n c e o f i n t e r e s t . In the t h i r d phase, I n d i a was t o assume, a t any r a t e , t h e p a t t e r n which the o t h e r t h r e e c o u n t r i e s f o l l o w e d i n t h e i r second p h a s e s . The r o l e o f l e a d e r s h i p i n t h e g e n e r a l p a t t e r n o f t h e f e r t i l i t y p o l i c y - m a k i n g p r o c e s s - 94 -on t h e s u b c o n t i n e n t i s r e n d e r e d c l e a r e r by e x a m i n a t i o n o f t h i s t h i r d phase i n I n d i a . The c r i t i c a l p o i n t i n t h e s u c c e s s i o n o f the phases o f f e r t i l i t y c o n-t r o l p o l i c y was a t t h e p o i n t i n t h e c r a s h programme phase, when a l l t e c h n i q u e s were e i t h e r i n t r o d u c e d o r r u l e d o u t o f the q u e s t i o n as i m p r a c t i -c a b l e ( s u c h as t h e p i l l i n I n d i a ) and a l l d e m o c r a t i c methods o f p e r s u a s i o n were e s s a y e d and j u d g e d i n a d e q u a t e t o stem a r a t e o f r e p r o d u c t i o n which was t h r e a t e n i n g t o wreck "time-bound" t a r g e t s o r were g o i n g wrong due t o mal-a d m i n i s t r a t i o n o r o t h e r c o m p l i c a t i o n s a s s o c i a t e d w i t h i m p l e m e n t a t i o n . A t t h e c u t - o f f t i m e s s e t down on page 3, S r i Lanka's b i r t h r a t e was a t the 1975 t a r g e t , P a k i s t a n was s t i l l e x p e r i m e n t i n g w i t h l o g i s t i c a l and a d m i n i s t r a t i v e , c o n t r o l s , and B a n g l a d e s h ' s p o l i c y - m a k e r s were s t i l l s t r u g g l i n g w i t h t h e c h a l l e n g e o f r e a c h i n g her n i n e t y - m i l l i o n p e o p l e w i t h any f e r t i l i t y c o n t r o l programme a t a l l . I n d i a , however, a g a i n i n the l e a d , had r e a c h e d the above d e s c r i b e d j u n c t u r e by 1973. The vasectomy camp method had l o s t i t s appeal because o f i t s c o s t ; f a t a l i t i e s had o c c u r r e d i n t h o s e a r e a s where the government c o u l d l e a s t a f f o r d t h e f a l l o f t h i s method i n t o d i s r e p u t e ; and the s u s p i c i o n had a r i s e n t h a t demographic g o a l s were b e i n g s u b v e r t e d t o an u n a c c e p t a b l e e x t e n t by m i s r e p o r t i n g and middlemen. A t the same t i m e , a l l o t h e r d e v i c e s i n c l u d i n g IUDs and condoms, a l t h o u g h s t i l l a v a i l a b l e , were not seen as the " s o l u t i o n " t o t h e problem o f t a r g e t a c h i e v e m e n t . I t was a t t h i s p o i n t , when t h e a l a r m i n g 1971 census r e s u l t s came i n , and t h e economy was b e l i e v e d to be q u i t e s i c k , t h a t Karan S i n g h i n t r o d u c e d h i s "beyond f a m i l y p l a n n i n g p r o -p o s a l s . The i d e a t h a t development must pr e c e d e b i r t h r a t e d e c l i n e s had been - 95 -c i r c u l a t e d b e f o r e i n I n d i a , as w e l l as i n P a k i s t a n and S r i Lanka d u r i n g the f i r s t phase when p r o s p e c t s were b r i g h t e r . T h i s p h i l o s o p h y d i f f e r e d from t h a t o f t h e 1950s, however, i n the f e r v o r w i t h which the I n d i a n government embraced i t . T h i s f e r v o r was, p e r h a p s , a measure o f t h e d i s s a t i s f a c t i o n w i t h methods t r i e d by I n d i a t o d a t e . A l l f o u r c o u n t r i e s were exposed to the i d e a s which were t h e h i g h l i g h t o f t h e B u c h a r e s t c o n f e r e n c e o f 1974. I n d i a went f a r t h e s t i n s t a t i n g i t s i n t e n t i o n s t o go beyond f a m i l y p l a n n i n g by r e -c o r d i n g them i n t h e F i f t h P l a n , the p o p u l a t i o n p r o v i s i o n s o f which bore the stamp o f Karan S i n g h . The p r o v i s i o n s f o r f e m a l e e d u c a t i o n , l a t e m a r r i a g e , more w i d e s p r e a d m a t e r n a l / c h i I d h e a l t h , minimum needs, and so on, however, were not implemented, and so do n o t f a l l under the d e f i n i t i o n o f f e r t i l i t y c o n t r o l p o l i c y g i v e n i n C h a p t e r 1. As an a i r i n g o f i d e a s , however, i t m i g h t have been a h a r b i n g e r o f r e a l s h i f t s i n f e r t i l i t y p o l i c y . The f i n a l s t a g e o f t h e p r o c e s s , and the l a t e s t t h i n k i n g on f e r t i l i t y c o n t r o l , t h e r e f o r e , f o r e t o l d o f a major s h i f t i n f e r t i l i t y p o l i c y a c t i o n both i n s t r e n g t h and d i r e c t i o n . As i n most o f the p o l i c y e v e n t s r e c o u n t e d i n e a r l i e r c h a p t e r s , a key l e a d e r i n t e r v e n e d i n 1976 t o shape t h e s t r e n g t h and n a t u r e o f t h i s s h i f t . T h i s o c c u r r e d when Mrs. Gandhi a l t e r e d the i n s t i -t u t i o n a l s t r u c t u r e o f I n d i a so as t o make her own o f f i c e the e x c l u s i v e c e n t r e o f power, s u b o r d i n a t e d p a r l i a m e n t , e l e v a t e d - t o : p r e e m i n e n c e h e r son S a n j a y , . an u n e q u i v o c a l f a m i l y p l a n n i n g "hawk", and suspended f r e e e l e c t i o n s and i n o t h e r ways b l o c k e d o p p o s i t i o n and c r i t i c i s m . A l t h o u g h democracy had been suspended under the Emergency, f e r t i l i t y c o n t r o l was not i n Mrs. Gandhi's Twenty P o i n t Programme. T h i s s u g g e s t s t h a t p o p u l a t i o n i s s u e s had been pushed back down t o a p o s i t i o n o f low p r i o r i t y i n her mind. I f f e r t i l i t y c o n t r o l - 96 -c o n t r o l p o l i c y were t o e x p e r i e n c e an upsurge, and the t h e s i s t h a t l e a d e r -s h i p i s t h e key v a r i a b l e i s c o r r e c t , some one n e a r l y equal i n power t o Mrs. G a n d h i : w o u l d have to p r e c i p i t a t e i t . S a n j a y f u l f i l l e d t h e l e a d e r s h i p r e q u i r e m e n t , p u s h i n g t h e d e v e l o p m e n t a l i s t measures o f t h e N a t i o n a l P o p u l a t i o n P o l i c y promulgated by Karan S i n g h t o the background. S a n j a y ' s methods d u r i n g t h e Emergency were a t t r i b u t a b l e a l m o s t e n t i r e l y t o l e s s o n s which he and t h e s u b o r d i n a t e s i n h i s c h a i n o f command had drawn from I n d i a ' s p a s t e x p e r i m e n t s . These were the e f f i c a c y o f s t e r i l i z a t i o n d e l i v e r e d t h r o u g h camps and c l i n i c s , and m o t i v a t e d t h r o u g h c a s h payments. To t h i s he added the t a c t i c o f c o m p u l s i o n . The maintenance o f such a p o l i c y , a f t e r e v i d e n c e began t o come i n t h a t i t was e n c o u n t e r i n g c o n s i d e r a b l e r e s i s t a n c e , may be e x p l a i n e d by the s c a t -t e r e d and a t o m i s t i c n a t u r e s o f both i n f o r m a t i o n and o p p o s i t i o n . The m u z z l i n g o f t h e p r e s s and t h e sycophancy o f t h e government's i n t e l l i g e n c e wings a l s o c o n t r i b u t e d t o i t s d e a f n e s s . But as i s shown by the q u i c k b a c k p e d a l i n g by some p o l i t i c i a n s when an e l e c t i o n was c a l l e d , t h e s u s p e n s i o n o f t h i s u l t i -mate fe e d b a c k mechanism was t h e most i m p o r t a n t e x p l a n a t i o n o f a l l f o r the c o n t i n u a t i o n o f c o m p u l s i o n i n f a m i l y p l a n n i n g . Both P a k i s t a n and B a n g l a d e s h e x p e r i e n c e d the r i s e o f m i l i t a r y men who a b o l i s h e d p a r l i a m e n t a r y i n s t i t u t i o n s , y e t n e i t h e r r e s o r t e d t o c o m p u l s i o n i n f e r t i l i t y c o n t r o l . ' Both r e c o g n i z e d t h e need f o r p o p u l a r a p p r o v a l , and s o u g h t i t by f o r m i n g t h e i r own p a r t i e s and b u i l d i n g l o c a l governments. The d e m o c r a t i c h i s t o r y o f I n d i a may have meant t h a t the Emergency government had i n s u f f i c i e n t e x p e r i e n c e w i t h d i c t a t o r s h i p . The n o v e l t y o f power w i t h o u t o p p o s i t i o n i n t h e p a r l i a m e n t a r y sense may have b l i n d e d the i n n e r c i r c l e t o - 97 -the e x i s t e n c e o f e x t r a - p a r l i a m e n t a r y o p p o s i t i o n . The c a l l i n g o f f a i r e l e c t i o n s , i f not the Emergency f e r t i l i t y c o n t r o l p o l i c y , was t h e r e f o r e , , a p o l i t i c a l " b l u n d e r " o f . m a j o r p r o p o r t i o n s f o r which Mrs. Gandhi and S a n j a y were r e s p o n s i b l e . H i t h e r t o , l e a d e r s , i n c l u d i n g Mrs. G a ndhi, had been more w i l y i n t h e i r c a l c u l a t i o n s b e f o r e l a u n c h i n g v i g o r o u s c r a s h programmes.. Mrs. Gandhi had f a v o u r e d the " s o f t " p o l i t i c a l l y f e a s i b l e path t o f e r t i l i t y c o n t r o l b e f o r e she suspended a l l d e m o c r a t i c r i g h t s and expunged the o p p o s i t i o n from the Lok Sabha. A f t e r w a r d s , she ( w rongly) b e l i e v e d t h a t she was p o l i t i c a l l y a b l e t o i n i t i a t e more c o m p u l s i v e measures. L i k e w i s e , i n P a k i s t a n , i t was n o t u n t i l Ayub had gone th r o u g h the l e g i t i m i -z i n g r i t u a l o f a p r e s i d e n t i a l e l e c t i o n t h a t he commenced the N a t i o n a l P o p u l a t i o n P o l i c y o f 1965. S r i Lankan l e a d e r s renewed t h e i r s t a n d on f e r t i -l i t y c o n t r o l when t h e y were l e a s t v u l n e r a b l e t o a t t a c k on t h e i s s u e f r o m o p p onents; namely, a f t e r t h e y had a t t a i n e d o f f i c e . From the b e g i n n i n g o f h i s r u l e , Z i a u r Rahman s t r o v e t o s u p p r e s s t h e Awami/BAKSAL o p p o s i t i o n as w e l l as d i s s i d e n t f a c t i o n s o f t h e armed f o r c e s by s u s p e n d i n g t h o s e c h e c k s which remained to u n h i n d e r e d e x e r c i s e o f p r e s i d e n t i a l power. He t h e r e -upon i n i t i a t e d t h e t y p e s o f f e r t i l i t y c o n t r o l p o l i c i e s which h i s p r e d e c e s -s o r , M u j i b , had f e a r e d t o do, e i t h e r . . b e c a u s e o f i n d i f f e r e n c e o r p o t e n t i a l o p p o s i t i o n . T h e r e i s , t h u s , a p a t t e r n t o f e r t i l i t y c o n t r o l p o l i c y f o r m u l a t i o n and i m p l e m e n t a t i o n i n t h e s e f o u r c o u n t r i e s , one w hich f o l l o w s t h e r i s e and f a l l o f government p e r c e p t i o n s o f the demographic/economic e n v i r o n m e n t . In a l l f o u r c o u n t r i e s , r i s e s i n p o l i c y a s s e r t i v e n e s s o c c u r r e d i n r e s p o n s e t o o v e r l y r a p i d p o p u l a t i o n growth. T h e i r c a t a l y s t s , however, were the i m p o s i t i o n o f - 98 -the w i l l s o f i n d i v i d u a l a c t o r s t o a l t e r t h i s e n v i r o n m e n t . We have l o o k e d a t t h e i n c e p t i o n s o f f e r t i l i t y c o n t r o l p o l i c y i n f o u r c o u n t r i e s , major s h i f t s i n the same f o u r , and a n o t h e r major s h i f t o f q u a l i t a t i v e l y d i f f e r e n t p r o p o r t i o n s i n one o f them. The f i r s t s t i r r i n g s o f f e r t i l i t y c o n t r o l p o l i c y seem t o be l e s s t h e outcomes o f p e r s o n a l whims than o f a c o m b i n a t i o n o f t h e u r g i n g s o f i n t e r e s t g r o u p s , the p o s t - i n d e p e n -dence urge t o m o d e r n i z e , and t h e absence o f o p p o s i t i o n . Out o f the t o t a l o f f i v e s h i f t s ( t h r e e i n 1965 and two i n 1975) as I have c o n s t r u c t e d them from t h e h i s t o r y o f f e r t i l i t y c o n t r o l , i t i s u n l i k e l y t h a t f o u r o f them would have o c c u r r e d w i t h o u t the a c t i v i t i e s o f t h e i r r e s p e c t i v e p r e c i p i t a n t s i n t he p e r s o n s o f Dudley Senanayake, Ayub Khan, Z i a u r Rahman, and S a n j a y Gandhi. The s h i f t by I n d i a i n t o a s t r o n g e r p o l i c y i n 1965 d i d not depend on t h e i n i t i a t i v e o f a s i n g l e p e r s o n a l i t y , b u t r a t h e r , on t h e c a t a l y s t o f g a d g e t r y and the atmosphere o f u r g e n c y . T h e r e were, f o r each o f t h e major i n i t i a t i v e s i n f e r t i l i t y p o l i c y , a l s o c o r r e s p o n d i n g t e r m i n a t i o n s i n S r i Lanka, P a k i s t a n , and I n d i a . These were due t o t h e f a l l o f governments i n P a k i s t a n (1969) and I n d i a ( 1 9 7 7 ) . In S r i Lanka t h e p o l i c y was t e m p o r a r i l y t e r m i n a t e d i n a n t i c i p a t i o n o f e l e c t i o n s . The d e c l i n e s o f t h e v a r i o u s c r a s h programmes i n I n d i a between 1969 and 1975 p r e s e n t a g a i n e v i d e n c e c o n t r a r y t o the g e n e r a l i z a t i o n t h a t f e r t i l i t y c o n t r o l programmes d e c l i n e f o r p o l i t i c a l r e a s o n s . The p e r i o d i c d e m o r a l i z a t i o n o f the M i n i s t r y o f H e a l t h and F a m i l y P l a n n i n g , which stemmed from p e r c e p t i o n s o f f a i l u r e and l e d t o the c e s s a t i o n o f one m e t h o d - o r i e n t e d programme a f t e r a n o t h e r , a p p e a r s t o e x p l a i n t h e s e t e r m i n a t i o n s . The c a s e o f I n d i a p r i o r t o t h e Emergency s u g g e s t s t h a t i n comparison w i t h t h e o t h e r - 99 -c o u n t r i e s , i t s f e r t i l i t y p o l i c y - m a k i n g p r o c e s s was t h e l e a s t p o l i t i c a l and t h e most "mature" d u r i n g t h o s e phases. T h i s c a n , o f c o u r s e , a l s o be e x p l a i n e d by the s t a b i l i t y o f r u l e . In the o t h e r c o u n t r i e s t h e f r e q u e n t changes i n government and o t h e r u p h e a v a l s meant t h a t i t was i m p o s s i b l e t o c a r r y many p o l i c i e s t h r o u g h t o i m p l e m e n t a t i o n and u l t i m a t e s u c c e s s o r f a i l u r e , as i t was i n I n d i a . I d i o s y n c r a c i e s o f h i s t o r y and l o c a l i t y a r e i m p o r t a n t , and t h e y i n f l u -enced t h e manner i n which governments went about t r y i n g to l i m i t p o p u l a t i o n growth. The s a l i e n t i d i o s y n c r a c y i n P a k i s t a n was t h e American i n f l u e n c e ( i n u n d a t i o n and "management"), i n B a n g l a d e s h , the i n f l u e n c e o f m u l t i l a t e r a l donor a g e n c i e s (on t h e i n s t i t u t i o n a l s t r u c t u r e ) , and i n S r i Lanka the i n f l a m -mable communal s e n t i m e n t s which k e p t f a m i l y p l a n n i n g c o n f i n e d t o m a t e r n a l and c h i l d h e a l t h c l i n i c s . In I n d i a one c a n n o t so h a n d i l y g r a s p any s i n g l e predominant m e a s u r e s - r e l a t e d output,; u n l e s s i t was the t e n d e n c y o f the b u r e a u -c r a c y t o become o b s e s s e d w i t h some " q u i c k f i x " which was then j u s t as com-p u l s i v e l y abandoned. The outcome o f I n d i a ' s head s t a r t , i n c o m b i n a t i o n w i t h t h i s penchant f o r one s i n g l e - m e t h o d programme a f t e r a n o t h e r , was t h a t by 1977, she had a c c u m u l a t e d such a depth and b r e a d t h o f e x p e r i e n c e t h a t her l a t e r e x p e r i m e n t s were more outcomes o f p r o c e s s than i n any o t h e r c o u n t r y . The f i n a l e x p e r i m e n t i n t h i s s t u d y , the s a l i e n t f e a t u r e o f which was i t s c o e r c i v e n e s s , was, above a l l , an outcome o f the l e a r n i n g p r o c e s s i n the minds o f I n d i a ' s t o p l e a d e r s h i p . S a n j a y and h i s s u b o r d i n a t e s drew from the l e s s o n s o f t h e p a s t and came up w i t h vasectomy camps, t o which t h e y added t h e component o f p o l i c e power. The l e s s o n s which f u t u r e governments o f I n d i a o r t h o s e o f h e r n e i g h b o u r s c o u l d draw from t h i s e x p e r i m e n t c o u l d be t h a t - 100 -c o e r c i v e f e r t i l i t y c o n t r o l i s p o l i t i c a l l y u n f e a s i b l e , o r , i t c o u l d be t h a t i f one has c o n t r o l o f t h e a p p r o p r i a t e i n s t i t u t i o n s , p a r t i c u l a r l y t h e e l e c -t o r a l p r o c e s s , t h a t i t i s f e a s i b l e . However, t he p a t t e r n which has emerged from t h i s s t u d y i n d i c a t e s t h a t many o t h e r c o n d i t i o n s would have t o be f u l -f i l l e d b e f o r e c o e r c i o n i s a t t e m p t e d . These a r e the c o i n c i d e n c e o f a " f a m i l y p l a n n i n g hawk" i n a p o s i t i o n o f u n a s s a i l a b l e s e c u r i t y a l o n g w i t h a n a t i o n - t h r e a t e n i n g demographic/economic c r i s i s and a b e l i e f t h a t a l l o t h e r l e s s c o e r c i v e methods o f p e r s u a s i o n have been t r i e d and have n o t worked o r w i l l n o t work. Such a c o i n c i d e n c e i s p o s s i b l e , though i m p r o b a b l e , i f o n l y because t h e b a c k l a s h from I n d i a ' s m i s c o n c e i v e d e x p e r i m e n t i n c o e r c i o n has shown a l l l e a d e r s t h a t i t does not work e i t h e r . - 101 -CHAPTER V FOOTNOTES 1. Uday C. D e s a i , " P r o f e s s i o n a l P o l i c y - M a k i n g : The Case o f I n d i a n P o p u l a t i o n P o l i c y , " I n d i a n J o u r n a l o f P u b l i c A d m i n i s t r a t i o n , 22 (No. 4, O c t . - D e c , 1976): 6 9 T 2. 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