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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  in 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 t h e 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 requirements  this thesis  British  it  freely available  for  f u l f i l m e n t of the  f o r an a d v a n c e d d e g r e e a t t h e U n i v e r s i t y  of  agree that  i n partial  Columbia, I agree t h a t f o r reference  permission  the Library  shall  and study.  I  that  copying or p u b l i c a t i o n  f i n a n c i a l gain  shall  Department  of  P o l i t i c a l Science  The U n i v e r s i t y o f B r i t i s h 1956 Main Mall V a n c o u v e r , Canada V6T 1Y3 .  DE-6  (.3/81)  J u l y 3 0 , 1982 1  of this  I ti s thesis  n o t be a l l o w e d w i t h o u t my  permission.  Date  thesis  s c h o l a r l y p u r p o s e s may be g r a n t e d by t h e h e a d o f my  understood  _  further  f o r extensive copying of t h i s  d e p a r t m e n t o r by h i s o r h e r r e p r e s e n t a t i v e s . for  make  Columbia  written  - ii -  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 search  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 to c o n t r o l p o p u l a t i o n growth on t h e subcontinent. 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 phases.  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 —  is  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 both 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  successive  shift in policy direction.  The t h e s i s a r g u e s 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 commitment 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 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 .  to be p o l i t i c a l l y f e a s i b l e  —  --  - iv -  TABLE OF CONTENTS  Chapter I  Introduction Footnotes  1 11  Chapter II  The P i o n e e r i n g Phase . . Footnotes  13 30  Chapter I I I  The Crash Programme Phase Footnotes  33 62  C h a p t e r IV  Beyond.Family Planning Footnotes  Chapter V  A n a l y s i s and C o n c l u s i o n s Footnotes.. .  Bibliography  .  66 78 80 101 102  -  V  -  ILLUSTRATION AND TABLES  Figure 1  Table  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  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  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  16  Table  3  Rate o f U t i l i z a t i o n i n F i r s t and Plans  Second  17  Table  4  Medical Personnel i n Bangladesh,  India,  P a k i s t a n and S r i Lanka  35 67  Table  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  Table  6  Table  7  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 Statewise S t e r i l i z a t i o n Targets, National P o p u l a t i o n P o l i c y , 1976, i n Lakhs  ....  68 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 the 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 the 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 . the q u e s t i o n s : policies?  T h i s a n a l y s i s s h o u l d answer  What i s the 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 these  Are 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 the 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 to a f f e c t the 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, c o m p o s i 2  t i o n , o r movements o f t h e members o f any g r o u p " .  Such a d e f i n i t i o n i s t o o  broad f o r the p u r p o s e s o f t h i s s t u d y , embracing as i t d o e s , not 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 m i g h t i n a d v e r t e n t l y have a demographic impact o r which m i g h t have been i n f l u e n c e d by demographic change. the s u b c o n t i n e n t  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  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 dividuals, couples, or populations". 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 the 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 c h o s e n f o r a study 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 the A s i a n nent share 26.8 p e r c e n t o f the d e v e l o p i n g c o u n t r i e s ' t o t a l  subconti-  population.  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. total subcontinental  I n d i a , w h i c h c o n t a i n s 60 p e r c e n t o f the  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 to 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  dramatic  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 the 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 .  Possessing only f i n i t e  r e s o u r c e s o f l a n d , w a t e r 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 tility.  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 the 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 study 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 tions.  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 m p a r i s o n 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 suggested  that , 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 7  "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 the 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 events under study here b o t h 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 data 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 , say, 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 the 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 . shows the p e r i o d s under s t u d y h e r e .  Figure 1  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 i m e when the 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 .  Figure 1  9  A p p r o x i m 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 , B a n g l a d e s h and S r i Lanka  Country  Time  India 1943 Pakistan 1955 B a n g l a d e s h .... S r i Lanka 1954  1972. 1972  . . 1976  1977 1978  C o m p a r a t i v e 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 , say, 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 . much i n common. They a r e a l l as the same g e o g r a p h i c  But the f o u r .South A s i a n s t a t e s have  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 i o n , the South A s i a n s u b c o n t i n e n t .  regarded  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 t h e 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 Aryan 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  s h 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  accumulation,  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 p u t 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 paths 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  boundaries, sharing features with counterparts i n neighbouring c o u n t r i e s . It i s t r u e t h a t f o r t h e purposes o f comparing t h e l o c a l e c o l o g i e s o f South A s i a , Timberg's  developmental  s u b d i v i s i o n s make more sense than does  using national p o l i t i c a l boundaries.  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 t h e s t a t e i t s e l f , notwithstanding internal d i v e r s i t y .  Comparative 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 understanding o f f e r t i l i t y control p o l i c y determinants. 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 t h e 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 t h e unique demog r a p h i c o r p o l i c y f e a t u r e s o f each.  No s t u d y has attempted 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 . 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  Despite the d i f f i c u l t i e s  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 attempt 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 t h e s e a r c h for universal determinants o f f e r t i l i t y control p o l i c y . A t t h e o u t s e t , one ought t o a s k 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 t h e 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 t h e 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 account 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 t h a n 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.  M o r e o v e r , S r i Lanka has c o n s i s t e n t l y l e d t h e o t h e r s by  a wide m a r g i n 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 t h e 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, t h e u n i n t e n d e d c o n s e q u e n c e s 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 a b s e n c e 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 A v e r a g e s 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 Country Bangladesh India Pakistan S r i Lanka  Bangladesh India Pakistan S r i Lanka Source:  1950-55  1955-60  % Change  1960-65  % Change  1965-70  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  -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  % Change -.,84  -4.4 -1.7 -9.4  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 Y o r k : U.N7,-T980), pp. 131-137.  - 6 -  However, i t is generally agreed that f e r t i l i t 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 i s , the real success or failure o f f e r t i l i t y 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. ideas, institutions, and process.  These are:  environment, power,  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 f e r t i l i t y 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 f e r t i l i t y 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 precipitates renewed enthusiasm for f e r t i l i t 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 tools  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 m a j o r c o n s t r a i n t . The background e c o n o m i c / d e m o g r a p h i c e n v i r o n m e n t , on t h e o t h e r hand, may be s u f f i c i e n t to explain the existence o f f e r t i l i t y control p o l i c y i t s e l f . What Simeon c a l l s "power", we m i g h t s i m p l y c a l l " p o l i t i c s " .  Politics,  the c o n t e s t f o r "who g e t s what, when, and how", has p e r v a d e d t h e 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 .  Family planning  pro-  grammes b e l o n g under t h e 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 n o t demanded by those 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.  While i t i s true that the intended "acceptors" o f contraceptive  s e r v i c e s and s u p p l i e s seldom demanded them, i t i s n o t 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 t h e agenda, and i n d e t e r m i n i n g the d i r e c t i o n i t would t a k e .  On t h e o t h e r hand, t h e 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 numerical b a l a n c e has l e d t o t h e i r t e m p o r a r y removal from t h e p u b l i c p o l i c y agenda. In t h e realm 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 t h e 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 t h e  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 they f e e l the 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 study may p r o v e to be i m p o r t a n t  i n explaining the differences i n f e r t i l i t y control 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 to 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 to 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 c r a t s on g i v e n p o l i c i e s .  bureau-  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 narrower 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 . process.  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  I t w i l l a t t e m p t to 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 subsequent  policies.  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 couples to a l t e r t h e i r behavior.  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 to a r i s e i n the p o l i t i c i z a t i o n of the process.  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 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 1  -  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 to 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 not be; t h a t i s , the v a s t m a j o r i t y o f the f e r t i l e c o u p l e s i n the p o p u l a t i o n . been attempted  T h i s has, on the s u b c o n t i n e n t ,  through p r o p a g a n d a , then i n c e n t i v e payments, and  first  finally,  compulsion. 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 process.  I t w i l l be argued here t h a t what stands o u t i n the  determination  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 the whole c o n c a t e n a t i o n environmental  of  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  of  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 feasible.  politically  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 the 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  unpopular.  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 the main e x p e r i m e n t o r policy options.  in  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 the p r o p r i e t y of g e t t i n g i n t o the family planning business. the second  T h i s phase w i l l form the s u b j e c t o f  chapter.  The second p h a s e , o f c r a s h programmes, which i s the t o p i c o f  Chapter  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 the 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 u r g e n c y than had h i t h e r t o been t h o u g h t . 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 launched  During  unprecedented e f -  forts to influence the b i r t h rate. 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 t h e 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 t h e 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 e n d . 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, b u t 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 latter.  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 t h e other three c o u n t r i e s i n Chapter Four. present a country-by-country  In C h a p t e r F i v e , f i n a l l y , . I w i l l  and phase-by-phase a n a l y s i s t o show how t h e  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 important  determinants.  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.  Robert H. Cassen, I n d i a : P o p u l a t i o n , Economy, S o c i e t y 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. 9.  10..  (London:  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. 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. " ~ 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 to Underdeveloped 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 t h e A m e r i c a n 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 I I 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 t h e development o f national f e r t i l i t y control policy.  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 t o 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 with t h e e s t a b l i s h m e n t  o f t h e P l a n n i n g Commission a f t e r Independence.  Nehru, who had been c h a i r m a n o f t h e C o n g r e s s N a t i o n a l P l a n n i n g became i t s . c h a i r m a n .  came  Committee,  The 1951 Census R e p o r t p o i n t e d o u t t h a t t h e p o p u l a -  t i o n had expanded 13.2% over t h e p r e v i o u s d e c a d e .  A l t h o u g h money was a l l o -  cated f o r the purpose o f f a m i l y planning, 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 t h e 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 b u o y a n t , and t h e 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 n o t o n l y be a b l e t o meet o u r own r e q u i r e , ments, b u t i n t h e n e a r 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 those p r i m i t i v e c o n t r a c e p t i v e  devices  which were a v a i l a b l e were eschewed by t h e 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.  During 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 t h e l a u n c h i n g o f masss 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 t o l o o k l i k e t h e answer i n the l a t e 1950s.  Due t o t h e 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 t h e 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 to s t a t e employees 2 i n 1958.  to undergo s u r g e r y  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 get area.  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 the i d e a i n 1957.  endorsed  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 are already out of date 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 everybody to 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 to 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 .  Unlike a l l other  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 tion.  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 o t h e r methods.  and some  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 s s e d 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 t h e 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 t h e 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 i n d e p e n d e n c e 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 , b u t 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 " techniques  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  excellent opportunity f o r s e l f control.^ 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  Congress,  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 medic 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 supp l i e s be p r o d u c e d 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 c o m m u n i c a t i o n , 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  National  C o n g r e s s 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 o t 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 h e 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 g r o u n d s , 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 t h e 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 t o 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 t o f a m i l y  planning.  - 16 -  T h i s was 6.5% o r the whole h e a l t h b u d g e t . a c t u a l l y spent.  About 1.4 m i l l i o n rupees were  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 the 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 Report on P i l o t S t u d i e s on the 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 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 . would l e a r n the rhythm method.  wanted  However, o n l y 13.6% o f t h e s e c o u l d o r  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 the 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 Report'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 the 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 : First Plan  Subject  Third Plan  1.  Family Planning  2.  Health  3.  1 as % o f 2  4.  Actual Expenditure  1.6  22.9  70.1  5.  % of Allocation  25%  46%  43%  Source:  6.5  Second Plan  1400 .5%  M i l l i o n s o f Rupees Fourth Plan  Fifth Plan 520  50  270  950  2240  3410  10009  2.22%  7.9%  8.71%  12.72%  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 Resources 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 E c o n o m i c s, 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. 14): 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 , b u t 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 n o t t h e c a s e w i t h a l l p o l i c y areas, as Table 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  Family Planning Agriculture I r r i g a t i o n and Power Industries Transport Social Services Source:  F i r s t Plan  Second P l a n  25% 81% 101% 68% 105% 135%  46% 93% 95% 120% 94% 96%  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 t h e l a c k o f i n i t i a t i v e a t t h e 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 t h e 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 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 . the " n a t u r a l " v s . "mechanical  about what  There was, i n a d d i t i o n t o  device" controversy, a lack of appreciation  of the g r a v i t y o f the population 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 important, u s u a l l y o b s t r u c t i v e , r o l e t o play i n f e r t i l i t y p o l i c y formulation. 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 t h e m e d i c a l t e r m i n a t i o n o f pregnacy l a w , 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 , the 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 equipped  hospitals.  I t argued t h a t i t was not 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 b e c a u s e o f the inadequacy  of health f a c i l i t i e s . ^  The main i s s u e , however, was  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  the  advocated  the e x p a n s i o n o f h i g h l e v e l medical 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 r a m e d i c s 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 " to 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 , correct.  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 to t h i s  inadequacy.  At the time 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 the c i t i e s . 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.  The r a t i o o f  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 medical w o r k e r s 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. 30,000 l i c e n c i a t e p h y s i c i a n s .  Indeed, i n 1949 I n d i a had about  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 the H e a l t h S u r v e y and Development Committee i n 1946.  T h i s recom-  m e n d a t i o n 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 and the C e n t r a l H e a l t h C o u n c i l .  IMA,  P r o p o s a l s to t r a i n p a r a m e d i c s have J.  cropped up r e p e a t e d l y i n s u b s e q u e n t d e c a d e s , but have always been quashed i n I n d i a by t h e medical p r o f e s s i o n a l s who have dominated the M e d i c a l  Council  of India. 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 the 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 the i n t e r n a t i o n a l a i d d o n o r a g e n c i e s .  - 19 -  The i n t e r n a t i o n a l environment, i n t h e e a r l y 1950s.  however, d i d n o t s u p p o r t I n d i a ' s  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 .  attempts 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 funds f o r r e s e a r c h i n demography, c o m m u n i c a t i o n , 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 p r o b l e m , t h a t n o t o n l y economic development b u t 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 the i n s t r u m e n t f o r a c h i e v e m e n t o f lower b i r t h r a t e s l a y i n t h e 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 d o u b t 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 count 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 e r c a p i t a . G i v e n t h e 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 improvement 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 d e v e l o p m e n t 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 t h e 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  the 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 from f a m i l y w e l f a r e t o national welfare.  A t t h i s time 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 the 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 ning  approach.^ 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 -  vant 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 the p i o n e e r i n g phase. 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.  These were the  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 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 .  there-  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 to 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 to 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 degree 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 the 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  Bangla-  desh, (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 .  Although  the c o u n t r y , e s p e c i a l l y i n the e a r l y p e r i o d , was d o m i n a t e d 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 to 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 than t h o s e i n c o u n t r i e s where t h e y have not had, p e r i o d i c a l l y , to o b t a i n f r e s h mandates from the p e o p l e .  There 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 considered e l e c t o r a l implications of t h e i r decisions.  - 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 withdrawal India.  from  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 the 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 taken 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 control.  There 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 the s e c u l a r and m o d e r n i s t stream 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 Jamaati - I s l a m i c o n t i n u e d t o be v o c a l . whose nominal  There were m i n i s t r i e s and a g e n c i e s s e t up  r o l e was p l a n n i n g and economic d e v e l o p m e n t , 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 to a c c o m p l i s h much.  The a s p e c t o f  the p o p u l a t i o n i s s u e which was s a l i e n t to 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  w i n g , 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 reduced by the a p p a r e n t l y modest growth found by the 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 P a k i s t a n . c a m e 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 the 1950s.  T h e r e were, however, g r o u p s 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 area.  intervention in this  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  inaugurated.  I t s main s o u r c e o f p r o p u l s i o n was the 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 . Negative forces 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 parties. 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  unitary state.  Family  planning  was a s u b j e c t o f the M i n i s t r y of H e a l t h , L a b o u r , 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. T h e 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 w h i c h 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 the m i n i s 22 ter.  A l l b r a n c h e s o f the 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 partition. 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 , 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 .  then,  Progress  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 they m i g h t 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 .  Ceylon's 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 . -  popula-  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 is Indian Tamil.  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 Hindu.  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 war due to h i g h commodities  Korean  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 not 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 to 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 Canadian 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 her l i f e t o the  promotion  of maternal 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  Develop-  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 . Prime M i n i s t e r , Dudley  T h i s found f a v o u r w i t h t h e then  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 reduced 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  Planned 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 . It 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 to do so i n subsequent  years.  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 of 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 .  This  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 issue. . ,  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 ing e l i t e s to 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  Sirimavo Bandaranaike,  Implementation  Programme of. 1962, d r a f t e d f o r  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 . l a t t e r was the c o r r e c t . v i e w .  The d r a f t c o n c l u d e d t h a t the  In 1962 Mrs. B a n d a r a n a i k e  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 maternal  ruled that family  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 the 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 the P l a n n i n g C o u n c i l (1957), 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 the importance o f the p o p u l a t i o n p r o b l e m . 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  workforce  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 hundred thousand per y e a r from 1961 to 1981 — continue.  one  i f c u r r e n t t r e n d s were to  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 the 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 through p l a n n i n g .  Due to the c o m m o d i t i e s 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  completely  28  to 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 desh resembled  context of f e r t i l i t y policy-making i n Bangla-  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 , the r o o t s o f the 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 independence. i d e a t i o n a l en'vironments  However, the 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 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 policy". 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 a p p e a r t o resemble 30 the 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 d e c a d e . 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 p r o b l e m , 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 the 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 to the  problem  at best. 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 principle.  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 w o r k e r s to cease 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 tions.  Both were e x t r e m e l y r e l u c t a n t to 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 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 .  about  It stated that population  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 d e v e l o p m e n t . 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 our 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 the 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 our people are ready 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 1950s.  i n p o p u l a t i o n work done as e a r l y as the  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  Bangladesh.  I t s members were e a g e r t o see B a n g l a d e s h a d o p t 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 c o n s e n s u s t h a t the i s s u e was e n o r m o u s l y 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 the 1972-1975 p e r i o d was  characterized  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 the 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 the dominant Awami League, and c h r o n i c breakdown i n law and  order.  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 to 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 the 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  allegedly  g u i d e d by the e s s e n t i a l l y p e r s o n a l i s t i c credo 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 loss of  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 , a p p e a r to be any dynamic i n I n d i a , P a k i s t a n , Ceylon 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 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 .  coercive-  T h e r e 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 the 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 the 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 to the a l l e v i a t i o n o f p o v e r t y through economic d e v e l o p m e n t .  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. to be.conducted  Because they  tended  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 w h i c h 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 i n t h e f i r s t h a l f o f the 1960s and Bangladesh  Ceylon  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 about 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 countries.  Nehru and Ayub were a d d r e s s i n g p o p u l a t i o n  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 implications  o f r a p i d p o p u l a t i o n growth,  p l a n n e r s r e c o g n i z e d the Mrs. Bandaranaike  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 to  fertility  control.  conferences.  kept a  assigned.a. Tow  priority  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 her 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 the 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 demonstrated  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.  shown by C e y l o n and Bangladesh  The d i f f i d e n c e  d u r i n g the f i r s t phase seems u n w a r r a n t e d 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 t h e 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 Pakistan 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 i m 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 , Ceylon 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 n o t as g r e a t as they 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 h e 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 opposition.  problems was more i m p o r t a n t  than such  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 r e a d y 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 Implementation 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 Monog r 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 : (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.  :  A Brief History,  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 Resources 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 ' to ' 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 Workshop/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 , 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 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 Comparative 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 , ed., 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 , 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, 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):  (Colombo:  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 m e a s u r a b l e 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 t h e  purposes o f t h i s t h e s i s i s t o e x p l a i n t h e 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 h e 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)  ii)  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 t h e 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, 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 at 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 t h e d i f f e r e n t c i r c u m s t a n c e s 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 independence, 1965.  sur-  a l l began t h e second phase i n  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  experiments  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 t o a f f e c t b i r t h r a t e s was n o t r e a c h e d u n t i l t h e 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 t h e announcement o f 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 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 p u t 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 Ceylon 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 controlling f e r t i l i t y , but d i d not consider i t p o l i t i c into action.  to translate this  Not u n t i l t h e a d v e n t o f t h e UNP government i n 1965 d i d Ceylon  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 ring.  surrounding  f e r t i l i t y p o l i c y were o c c u r -  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 t o 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 t h e 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 environmental  determinants favourable to a strong s h i f t .  was a p r e c i p i t a n t .  What was needed  T h i s was t o come i n P a k i s t a n , Ceylon and B a 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 t h e IUD. The a c t u a l measures chosen were t h e 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 t h e 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 t h e 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 these governments' c a p a c i t i e s t o reach t h e 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 stands s e v e r a l o r d e r s o f m a g n i t u d e above, and B a n g l a d e s h s e v e r a l o r d e r s below t h e a v e r a g e a b i l i t y o f these c o u n t r i e s ' governments t o reach 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 Medical Personnel i n Bangladesh,  Population H o s p i t a l Beds  Country  I n d i a , P a k i s t a n and S r i Lanka  Population Physicians  Population Nurses  Bangladesh (1976)  4,868  14,178  51,679  India (1974)  1,465  3,961  6,735  Pakistan (1977)  1,903  3,600(est)  8,002  334  4,007  2,013  2,142  6,436  17,107  S r i Lanka AVERAGE Source:  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 the T h i r d P l a n (1961-1966).. P o l i c y - m a k e r s  realized that 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 . "extension education" approach.  T h i s l e d to the  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 . "grassroots"  Local  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 time t h a t crude 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 m e n t i o n e d 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  thousands.  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.  This called  - 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 to 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 also rose. 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 . t o have f a i l e d .  Then s t e r i l i z a t i o n  In 1965, the IUD was t r i e d and b e l i e v e d ( 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 out to 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 to 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 to 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 through 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 demographic environments.  A sense o f urgency 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 .  This  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 net 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 .  There  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 h e r 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 t h e 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 m a j o r 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 t h e 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 t h e 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 n o t succeeded 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 great country i s rather alarming.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 t h e a b s e n c e 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 t h e 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 t h e P l a n n i n g Commission and l a t e r Minister of Planning. on F a m i l y P l a n n i n g . ^  I t was t h e s e men who had formed t h e C a b i n e t  Committee  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. C h a n d r a 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 w h i c h t h e 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 conference  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 •<•• possible at last.  A t t h e same time,  a U.N. a d v i s o r y m i s s i o n  visited  I n d i a and s t r o n g l y a d v o c a t e d t h e p r o m o t i o n o f t h e IUD. I t was g i v e n t o p 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 t h e e x c l u s i o n o f o t h e r methods. The IUD programme reached a maximum o f a c c e p t o r s i n 1966-67 and then exp 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 those  women who a c c e p t e d t h e 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 . 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  Word o f cramps and  o f contamination  and i m p u r i t y i n  Indian c u l t u r e , q u i c k l y n u l l i f i e d the i n i t i a l l y neutral 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 t h e 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 K o r e a n , and T a i w a n e s e 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 failure.  Some s c h o l a r s have a r g u e d t h a t t h e s t r a t e g y was a d o p t e d 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 t h e d e l i v e r y and f o l l o w - u p system c o u l d be r e m e d i e d .  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 g r o u n d , 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 t h e programme w i t h b e t t e r  planning  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 t h e 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 a s t h e IUD, was n o t 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.  Uttar  -  Pradesh launched a "multi-agency  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 .  Dalai ("brokers"),  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 the 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 brought 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 through the 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  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 the ment o f F a m i l y  politiDepart-  Planning.  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 in the Ernakulum vasectomy f e s t i v a l , and i t was h a i l e d as an success.  outstanding  T h i s i n d i c a t e s the 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 taken p l a c e as. a„.result o f the 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 the 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 the one method w h i c h 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 thought to 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  still  a c t i v e , were e c l i p s e d by the 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 agencies.  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 w h e t h e r  o r not m a j o r s h i f t s i n the 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 chosen.  I t was the Ford  Foundation  (from 1963 to 1967) and U.S. AID ( f r o m 1966 to 1972) which were most imp o r t a n t to t h e s e c h o i c e s i n t h e second phase.  Ford 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 Ford c o n s u l t a n t s , and to 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 the Foundation i n Parliament.  The Ford F o u n d a t i o n g r a n t s had exceeded  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 .  one  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 f-o r one y e a r . 13  budget  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 red 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 conducted 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.  harmless,  I t i s cheap,  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 to 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 not l e a d to 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 to younger 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 14 from M.I.T. by t h e name o f P e t e r S. K i n g . N i r o d h ' s p o p u l a r i t y plummeted.  specialist  S a l e s r o s e up to 1973, when the  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 to 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 ticence. 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 to 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 thought  t h a t she and her 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 appeared 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 to 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 not more a c t i v e , f e r t i l i t y control 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, 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 .  on  He p o i n t e d out 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  the 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 .  There  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 d e v e l o p m e n t 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 the 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 proposed t h e r e f o r e t o promote the  " s m a l l - f a m i l y norm" w i t h renewed energy, u s i n g a l l propaganda m e d i a , 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 the 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 they 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 h i c h 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 d e c a d e . 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 the known c o r r e l a t e s o f low f e r t i l i t y .  The "hard" stream 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. Singh chose the former approach when he p r o c l a i m e d t h a t "Development (was) the 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 the 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 the 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 Survey 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 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 .  approaches  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 . were:  These  ( i ) graded tax 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 tax 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 ; b e n e f i t s . f o r t h o s e who r e f u s e d to l i m i t t h e i r progeny;  ( i i i ) no m a t e r n i t y (iv) limiting  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 to no more than t h r e e c h i l d r e n per family;  (v) e n l i s t i n g h e l p o f a l l government employees i n promoting  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 21  reasons.  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 .  Experts i n the Planning.  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 Ministry.  In the e v e n t , i t was not 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 Commis22 sioner of Family Planning.  F a m i l y P l a n n i n g was g i v e n department  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 .  status  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". area,  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  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 23 a r e a s such as i n d u s t r y .  with  - 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 Ford 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 the 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, with p u b l i c h e a l t h . hind-the-scenes  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-  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 the NAHAE has s i n c e a p p e a r e d i n the 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 Indian bureaucracy,  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 .  may w e l l  When s p e a k i n g  of  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 bear 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 the c o n t r a r y . between a c t i o n and i m p l e m e n t a t i o n  The  gap  has been a t t r i b u t e d to 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 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.  have  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 the 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 the 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 f o r m . The r e a l i t y was the a b s e n c e 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 a b s e n c e , on o c c a s i o n , even o f the means o f communication w i t h the I n d i a o f the m i l l i o n s . 2 5 T h i s p e n c h a n t f o r form 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 seminars.  The law passed o r the 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 plans.  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 cannot be s a i d to 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 his e l e c t i o n p l a t f o r m .  P r i o r to t h i s , the 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 through i t s maternal and c h i l d h e a l t h c e n t r e s .  T h e s e , however,  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 .  were.spread  For 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  significantly. 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 to lower t h e b i r t h from 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.  During  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  spent.  The IUD, as i n I n d i a , was h a i l e d as the 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 the v i l l a g e r s o f Pakistan.  U n l i k e I n d i a , the 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 to the c l i n i c s . was t o r e c e i v e a m o n t h l y 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 bonus f o r each IUD a c c e p t o r .  Of the maximum s t r e n g t h o f f i f t y  hoped f o r , o n l y 36,000 were h i r e d b e c a u s e o f poor performance quitting.  Subsequently  She  rupee thousand and c o n s t a n t  1,400 male w o r k e r s were h i r e d p a r t - t i m e t o  approach  - 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 t h e 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 o n , 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 which had been t r i e d i n 1964 and then abandoned. ducted i n 1968-1969.  programme,  An Impact S u r v e y was c o n -  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 t h e 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 they 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 reached 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 t h e 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 points. 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 t h e IUD. The government c o n c l u d e d  that the dai pro-  gramme had f a i l e d because i t was c o n t r a r y t o t h e 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 s o l o n g as t h e i r c o m p e n s a t i o n 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 these 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 people i n a r o l e i n which they had t o win the t r u s t o f t h e 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  disadvantage,  as was a l s o t h e f a c t t h a t , as women, they would f i n d i t i m p o s s i b l e t o c o n v i n c e o r even speak t o men i n t h e 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 .  Pakistan's  - 47 c r a s h programme phase, t h e n , appeared to 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 to 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 Rs. 204 m i l l i o n . all  of  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 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 . and s u p p l i e s were f u r n i s h e d by U.S.  P r i c e s were n o m i n a l ,  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 the 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 . 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 (!) during a.three-month-long  I t would  circuit.  persons  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 behaviour.  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 to 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 . 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.  Nine p e r Only 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 !  Bruning'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 mot 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 thought 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 "impres33 s i v e r e c o r d " than 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 per thousand 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  seminar  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 (1964),  Ayub K*an expounded h i s view:  I f n o t h i n g i s done t o check the r a t e o f p o p u l a t i o n g r o w t h , I s h u d d e r t o t h i n k what w i l l happen a f t e r a few decades. 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 take 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 to 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 , paramedics 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 Bhutto 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 to the i d e a .  That greater p o l i t i c a l  sensiti-  v i t y was d e s i r a b l e even i n the a b s e n c e o f d e m o c r a t i c checks to 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 the 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 , the 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 not work, a n o t h e r would. When attempts 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 Continuous 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 through 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  brought 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  Con39  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  to 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 strength or philosophy.  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 not to 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 to the s e t t i n g up i n 1973 o f the Democratic Centre (DPARC).^  Policy Action  Research  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 a r r a n g e m e n t s 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 the 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  of  h e a l t h , but had not y e t had the courage to take 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 the 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 demonstrated what c o u l d be done.  (whether f a l l a c i o u s l y o r not)  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 through 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 w h i c h was q u i t e . w e l l d e v e l o p e d . from 33 to 25 i n ten y e a r s was s e t .  A t a r g e t o f r e d u c i n g the b i r t h r a t e 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 to government o u t l e t s . By 1970, the government, w h i c h 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 propagate  t h e i r use, began to back-pedal  f i n a n c i a l support f o r family planning.  and, i n f a c t , even reduced i t s  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 to w h i c h the government w i s h e d t o reduce 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 keeping  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 Health 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 survey  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 to 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 reached 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 marketing  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 crude b i r t h r a t e were the 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 to 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 .  Sri  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 to 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 to 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 to 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 "high growth" p r o j e c t i o n , was to 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 to 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 . While 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 to their prospects.  T h i s has been due to 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 Tamil 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 : It i s a curious f a c t that p r a c t i c a l l y at every 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 pre-option.^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 to 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 .  M o r e o v e r , 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 to 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 races. 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 to 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 prominent S i n h a l e s e clergymen T h e r a s and t h e Reverend Madihe P a n n a s i h a .  such as Mahanayake '. .  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 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 .  dominant  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 to 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 the 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 the 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 the 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 50 T h e r e was no m e n t i o n o f m o t i v a t i n g new c l i e n t s , however.  Health.  Mrs.  Siva  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 d e m o g r a p h i c / e c o n o m i c 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 the 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 not, however, speak out 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 the r e g i o n .  The Ford F o u n d a t i o n  gave g r a n t s to  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 Association  of Ceylon.  Planning  In the l a t e 1960s, U.S. AID would have been the  p r e d o m i n a n t d o n o r , had i t s h e l p not been d e c l i n e d by the 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 w h i c h prompted i t s c a u t i o n i n p r o m o t i n g family planning in pre-election years.  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 the 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 the 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, parliamentary  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 , the  - 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 through the 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 to 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 they 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 the 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 , the c o a l i t i o n government o f Mrs.  Bandaranaike  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 to be an i n t e g r a l component o f the 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 , they have not had  to 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 the 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 to some a c c o u n t s , than i t has had 52 in I n d i a , P a k i s t a n , or Bangladesh. 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 the h e a l t h b u d g e t , has been about two p e r c e n t 53 (1968-1969). indicator.  T h i s puts S r i Lanka lower than I n d i a and P a k i s t a n f o r t h i s 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 .  ****** Bangladesh  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 time 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 the 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 pre-independence  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 the Bangladesh  1975,  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 t h e 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 o n e 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,.' t h e 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 t o 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 e n d , t h e 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 p u t 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 B a 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 h e 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. 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 .  P o p u l a t i o n was 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 a t t e m p t t o r e a c h every household. 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  maternal  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 purpose. and IUDs i n c r e a s e d by 100 p e r c e n t .  D i s t r i b u t i o n o f condoms, p i l l s ,  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 h e 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 t o 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 p e r month t o l e v e l s o f 100,000 o r 200,000.  He  avowed t h a t " o u r p e o p l e want t o do i t , b u t we don't have t h e c a p a c i t y t o sterilize".  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 meeting: I t o l d them t h a t y o u 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 unders t a n d what I s a i d . B u t 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 through a i d o v e r M a o - s t y l e a u t a r c h y ; 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 path  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 t o 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 h e 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 .  Bilateral  p o p u l a t i o n a g e n c i e s . c o u l d n o t 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 m a j o r d o n o r , the 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 they mounted . separate p r o j e c t s . The World Bank, c h a i r m a n o f the A i d B a n g l a d e s h C o n s o r t i u m , c u l a r l y d i s s a t i s f i e d w i t h the a r r a n g e m e n t whereby the P o p u l a t i o n  was  parti-  Planning  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 the 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 p e r f o r m e d 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 agree 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 from 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 , the 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 the 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 w o r 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 the 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 "thought" on the p a r t o f key l e a d e r s .  Ayub's c o n c e r n a b o u t p o p u l a t i o n  and  - 59 his 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 address a t the Asian Population Conference  i s a true r e f l e c t i o n o f  his 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 h e q u e s t i o n o f p o p u l a t i o n began t o a p p e a r i n p l a n n i n g documents i n 1962 and 1963, and i n Bangladesh,  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 political  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, they 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 formidable. the p o l i t i c a l  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  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 t h e 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 to 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  Bangladesh,  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 its- moribund s t a t e under t h e Awami/BAKSAL government t o a t l e a s t t h e 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 h e Pakistani  regime.  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, t h e 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 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 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 a p p e a r 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 t h e 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 M r s . Bandaranaike  h e r s e l f d i d n o t 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. Gandhi, 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.  Except 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 con-  t i n u e d to devote the same approximate  order of resources to 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 the a t t e n d a n c e o f a prominent  leader at population  conferences,  the p u b l i c m a n i f e s t a t i o n o f "thought"/ preceded 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 . o f conventional f a m i l y planning approaches, "new"  Without d e n y i n g the v a l u e  the C o n f e r e n c e r e g i s t e r e d some  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  s m a l l f a m i l y norms.  of  The consensus was t h a t the " s o f t " path to m o t i v a t i o n  through 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 the 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 the 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 cons 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 the 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 approaches  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  thorough 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  approaches  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 the 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 to 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 minister.  T h i s man, Karan S i n g h , proceeded t o change t h e emphasis  of  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 S t u d y 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: R u l e 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 t h e 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 Y o r k : H a r p e r and Row, 1976), p. 66.  4.  Robert Cassen, India: 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, Oct.-Dec, 1976T  8.  P o p u l a t i o n , Economy, S o c i e t y , (London:  Macmillan  699":  C a s s e n , op. c i t . , p. 164.  9. 10.  I b i d . , p. 156. 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 , 1 9 7 4 ) : 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 P r o b l e m s , ( 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 ) :  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 t h e T h i r d W o r l d , (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.  1.  - 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 , " A m e r i c a n 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.  20.  Demerath, op. c i t . , p.  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 . ,  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 : D e u t s c h e 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 Zusanmenarbeit, 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 v i r o n m e n t 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 the 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 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.  174. 144.  112.  :  - 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, 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.  (Colombo:  - 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 o b e r t S. A n 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 J a c k 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 phrase 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 the 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 phrase 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 proceeded  to.review a l l  o f the 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 . his l i s 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  of  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 "hard" 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 ranks 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 .  His t a b u l a t i o n of  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 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 . 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 (category B).  had e i t h e r con-  None had, however, t r i e d to impose Measures under c a t e g o r y E,  t h a t i s , tax 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 the 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 F e r t i l i t y Policy Proposals By Criteria Scientific Readiness  Measure  Political Viability  Administrative Feasibility  Economic Capability  Ethical Acceptabil ity  Presumed Effectiveness  A: Extension of voluntary fertility control  high  high on maternal care, moderate to low on abortion  uncertain in near future  maternal care too c o s t l y ; for local budget; abortion feasible  high for maternal care: low for abortion  moderately high  B: Establishment of involuntary fertility control  low  low  low  high  low  high  C: Intensified Educational Campaigns  high  moderate to high  high  probably high  generally high  moderate  D: Incentive Programmes  high  moderately low  low  low to moderate  low to high  uncertain  E: Tax and Welfare Benefits and Penalties  high  moderately low  low to moderate  low to moderate  low to moderate  uncertain  F: Shifts in Social and Economic Institutions  high  generally high, but low on some specifics  low  generally low  generally high, but uneven  high, over long run  G: P o l i t i c a l Channels and organizations  high  low  low  moderate  moderately low  uncertain  H: Augmented research efforts  high  moderate to high  high  high  high  uncertain  I:  generally moderate to high but high could use improved technology  moderate to high  high  high  uncertain  Family Planning Programs  SOURCE:  Bernard Berelson, "Beyond Family Planning", Studies in Family Planning, No. 38, Feb. 1969, p. 11  TABLE 6 Fertility  Proposal  I:  Family Planning Programmes  A&F:  Maternal care, status of Women, other s o c i a l / economic Insts. Changed  Policy Proposals as Considered and T r i e d , and Their Perceived Effectiveness c 1974  Considered  all  Tried  all  Tried and Thought Ineffective  Predicted P o l i t i c a l Viability  India  high high  India Pakistan (Sri Lanka)*  no no (S.L.)*  none  D&E:  Tax Benefits, Penalties, Incentives  India Pakistan  India Pakistan  India  B:  Involuntary Infertility Control  none  none  none  moderately low  low  * S r i 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 d e f i n i t i o n , 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 " m e a s u r e s , 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 .  Moreover,  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 ) .  Speaking 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 they were p o l i t i c a l l y and c o s t l e s s , I n d i a , Bangladesh  economically  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 wished 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, Bangladesh  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  viability  o f such a c t i o n s , had e i t h e r not 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 permutat i o n s , and found 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 .  Although Pakistan,  and S r i Lanka were not known to have c o n s i d e r e d c o m p u l s i o n ,  Bangladesh  some I n d i a n 2  s t a t e s were known t o have attempted 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 to take f u r t h e r , , more v i g o r o u s a c t i o n i n the f e r t i l i t y c o n t r o l a r e a , then i t would a p p e a r t h a t any o f them m i g h t pursue the 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  inducements,  but o n l y I n d i a would be, l i k e l y t o t r y both t h e s e a n d / o r i n v o l u n t a r y f e r t i l i t y control. T h a t t h e r e was a commitment on the p a r t o f the government i n I n d i a ,  - 70 -  i n the persons o f Mrs. Gandhi and Dr. Karan S i n g h , to take 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 d i a ' s 570,000 v i l l a g e s , u r g i n g lower b i r t h r a t e s .  i n each o f  She appeared 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 reduced 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 w o r k e r s 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 the 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 our 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 the 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 the i n t e r n a t i o n a l p r e s s to s u g g e s t t h a t we were g i v i n g up our 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 .  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 .  Initially,  she  P o p u l a t i o n was not m e n t i o n e d 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 tion.  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 to 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 Singh 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 to 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 the l a t t e r type which would be put i n t o practice.  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 population 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 not 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 through 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 the measures o u t l i n e d i n the statement 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 the s u b c o n t i n e n t .  State a l l o c a t i o n s of finance, formerly  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 ning  performance  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 the 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 to e i g h t e e n f o r females  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 d e p a r t m e n t s 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 , 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  cooper-  brought  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 the 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 compulsory measures.  The f i r s t was the p e r -  m i s s i o n g i v e n t o the s t a t e s t o make s t e r i l i z a t i o n compulsory. was the compulsory  The  second  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 the 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 small 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 o m p u l s o r y measures which became t h e p r e d o m i n a n t 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 a s -  sage o f a c o 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 t h e a u t h o r i t y t o pursue t h e vasectomy t a r g e t s which had been a s s i g n e d them through t h e whole s t a t e b u r e a u c r a c y ,  and without t h e i r having t o s t i r t h e inner motiva-  tion o f potential clients.  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 p r o d u c e 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 s o 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  recruitment  of acceptors. 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 dous e f f o r t s t o a c h i e v e . these t a r g e t s  and were thought t o r e q u i r e  stupen-  N e v e r t h e l e s s , under t h e p r e s s u r e s m e n t i o n e d above,  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  State  Statewise S t e r i l i z a t i o n Targets, National Population P o l i c y , 1976, i n Lakhs (1 l a k h = 100,000) Achieved Assigned R a i s e d To A p r i l - O c t o b e r 1976  Bihar Haryana Maharashtra Himachal Pradesh Madhya Pradesh Rajasthan Punjab U t t a r Pradesh West Bengal Delhi Source:  3  .52 5.62 .315 2.675 1.75 .465 4. 3.92 .29  6 2 12 1 7 3.5 2.5 15 11 1  2.04 .79 5.16 .5 7.43 2.92 .66 5.55 7.312  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 During Emergency (Shah C o m m i s s i o n ) , 1977, v o l . I l l ( f i n a l ) , p. 154. A c h i e v e m e n t f i g u r e s from B. Ghosh, " I n d i a ' s Popul 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 t o 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 t h e 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 overfulfilled their original quotas/  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. C o u p 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% t o 2 1 % f o r I n d i a as a whole T h i s accomplishment was t h e outcome o f t h e 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 t h e f o r m 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 t h e 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 p u t 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 " h a d been r e d u c e d t o r u b b e r stamp status.  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 M r s . 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 associates.  C l o s e s t ,to h e r .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  state Chief Ministers.  [  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 t h e Congress 9  P a r t y , and f o r 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 t h e 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 t h e l o w e s t 1 eve!.*P  Orders t r a h s m i t t e . d  to t h e 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 t h e t o p o f this..column of pressure 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 -  Joint Director o f Family Planning to various 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 a b o u t 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 c o 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 t h e 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 t h e 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 a p p e a r e d 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 " p e r f o r m a n c e 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 .  Evidence of the repressiveness  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 , b u t 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 .  There i s evidence 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 villagers.  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.  There  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 u n d e t e r m i n e d 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 t h e 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  of the s t e r i l i z a t i o n operations,  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 promulgated 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 t h e 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 h e Emergency.  I t s impotence a l s o meant t h a t i t c o u l d  not moderate t h e 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. o r n o t t h e r e was a w i l l t o do so i s q u e s t i o n a b l e .  Whether  On t h e 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 n o t 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 . o t h e r hand, i t never 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  On t h e  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), brought up t h e 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 h e 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 brought 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 . meeting.  T h e r e i s , however, no r e c o r d o f any  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 t h e 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, t h e 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 of v  the Government of B i h a r .  I t was  described  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 m e e t i n g h e l d a t the s t a t e level'.'. upbraided  The  Secretary  the 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 drag 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 .  Except 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 to the f e r t i l i t y c o n t r o l hawks w i t h i n the 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 the Emergency or course, i t s termination.  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  was,  sycophantic  r e l u c t a n c e o f the 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, the 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 not e s c a p e 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 .  Malaria  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 definitely.  M o r e o v e r , 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  other  t a s k s u n r e l a t e d t o the 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 .  It  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  by the 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 .  dealt  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 Cong r e s s government.  In those s t a t e s where the 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 , the Congress party l o s t h e a v i l y . n e v e r 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  The J a n a t a government promised  again.  Because i t had c a p i t u l a t e d on the C o n g r e s s P a r t y f a m i l y  planning  - 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 to 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 m i g h t be reduced 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 g o v e r n m e n t ) . 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 dismantled.  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 the D r a f t S i x t h P l a n (1978-1983)^did r a p i d p o p u l a t i o n growth as a p r o b l e m .  not view  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 the p r e v i o u s p l a n . Implementation,  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  his per-  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  soon.  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 to 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 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 tion.  1980. popula-  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 to 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 the 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.  Robert 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 Bergstrom ( 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 , " A m e r i c a n 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.  Davidson R. G w a t k i n , " 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 Review, 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.  Robert Cassen, 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 thought t o have been a m a j o r p r o b l e m . See G w a t k i n , 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.  G w a t k i n , 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 Misuse o f Power D u r i n g Emergency (Shah C o m m i s s i o n ) , 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.  G w a t k i n , 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 W e i n 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, ( W a s h i n g t o n : 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 p u r p o s e s 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 are 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 year.  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, t h e t e n e t s o f t h e 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 , t h e 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 themselves how many c h i l d r e n t o have.  This concept  was i n k e e p i n g w i t h t h e d e m o c r a t i c i d e a l s w i t h which t h e 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 t o 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 tility.  The r e a l i z a t i o n t h a t t h i s assumption was wrong marked t h e p a s s i n g  of 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 h e 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 times.  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 h e r a t e o f p o p u l a t i o n growth was n o t 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 .  There, leaders  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 , b u t 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  small 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 u t 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 c a n 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 h e Bhore committee and t h e Congress P l a n n i n g Committee p r i o r t o independence. D u r i n g t h e 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 t h e 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 fert 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 consider f e r t i l i t y control policies.  In India, f e r t i l i t y control policy had ..  the chance of receiving consistent and concerted attention from the bureaucracy 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 independence.  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. the erstwhile  In Bangladesh, the remnants of  FPAP lay low during the pre-1975 (and post-1975) period.  Nevertheless, Mujib (and of course Zi'aur Rahman): made ..remarks favourable, to f e r t i l i t y 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 d i f f i c u l t 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 concurrent  event.  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 the 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 through m e d i c a l  clinics.  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 movement's i d e a s , and t o the c o n s t r a i n t s of c o n t e m p o r a r y 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 the condom d i d  not o c c u r u n t i l the 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 approach was f a v o u r e d by the f a m i l y p l a n n i n g movement,-whose s t a t e d goal 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 goal  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 downplaying  demographic o b j e c t i v e s were p o l i t i c a l  was shown by the c o n c l u s i o n of the 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 consensus  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 the 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 adopted the p h i l o s o p h y  of the movement, as w e l l as the c l i n i c a l approach which accompanied i t i n India. 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 to d e a l w i t h the 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 the 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 the rhythm method a f t e r i n d e p e n d e n c e because m e c h a n i c a l methods were r u l e d o u t by the 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 , through 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 found than non-rhythm methods were not o b j e c t i o n a b l e to 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 conc 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. B e c a u s e 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 , they were a b l e to 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 to I n d i a on the 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 p h a s e , 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 Bangladesh.  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 L a n k a , where the 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 smallest.  The m a j o r 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  in Bangladesh,  Z i a u r Rahman, was a s s a s s i n a t e d i n 1981, and subsequent  ments t h e r e a r e an open q u e s t i o n .  develop-  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  ambitions  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-  cuses 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 to 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 .  India also  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 intervention. 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 consider.  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  other  countries.  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 istics.  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  the P o p u l a t i o n  Planning  D i v i s i o n w i t h condoms and  l a t e r with  network pills.  of 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 the outcome o f an American  fixation  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 association.  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 governments  taken,  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 Ceylon. 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 , b o t h 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  -  signals of fair elections. 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 a p p e a r 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 s appeared t o 1  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 schemes as w e l l .  distribution  "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 r o m o t i n g commercial d i s t r i b u t i o n o f s u p p l i e s .  On t h e 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 b r o a d d i r e c t i o n o f f e r t i l i t y policy.  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 p r o a c h e s  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 t h e 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 , t h e " 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 of 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 population.  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 d e s -  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 e l e m e n t s 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 trol.  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 t h e 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 to 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 control policy. of each c a s e i n t u r n .  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  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 to 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 . p e r c e p t i o n s , though f a l s e , have r e a l  In p o l i t i c s ,  consequences.  The q u e s t i o n r e m a i n s , however, as to 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 cons i d e r a t i o n i n the f e r t i l i t y policy-making process there.  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 Muslims, and t h e r e was no d e a r t h o f Hindu/Muslim  antipathy,  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 the ones who b e l i e v e d themselves  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 s u s p e n d e d . 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 the e a s t and west w i n g s , 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 the time o f independence.  One  can  i n f e r , i f the low v i s i b i l i t y o f the Continuous M o t i v a t i o n Scheme i n West P a k i s t a n i n the 1970s i s any. i n d i c a t i o n o f the g e n e r a l a b i l i t y o f the G o v e r n 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. Bangladesh,, t h e r e i s no r e c o r d o f the dominant Muslim m a j o r i t y 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 .  In  (88%)  Conversely, there 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 the s e n t i m e n t s , i f any, o f the Hindus or other m i n o r i t i e s i n formulating his f e r t i l i t y control p o l i c y . In I n d i a , P a k i s t a n , and S r i L a n k a , 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 they e x p l o i t the 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 the e v e n t , o n l y t h o s e i n S r i Lanka succeeded  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 men,  nor does the government n e c e s s a r i l y heed them.  spokes-  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 the government to feedback mechanisms such  - 90 -  as e l e c t i o n s , upon whether o r not 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 the 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 the 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 the 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 a b s e n c e 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  policies.  Volun-  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 continued.  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 " . w i t h Bangladesh  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  and S r i Lanka, a g r e a t deal more was l e a r n e d t h e r e .  o f the 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  One  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 work.well.  T h i s l e d t o the 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 importance  to  m o t i v a t i o n once the inadequacy o f the 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 Continuous M o t i v a t i o n Scheme. 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 approaches  The v a l u e o f t h e s e unand more e f f o r t  were g o i n g to be n e c e s s a r y i f the masses o f the p o p u l a t i o n were t o be reached.  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 not r e a d o f c r a s h programmes i n S r i Lanka b e c a u s e  - 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 w h a t e v e r 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 areas, including populatiomplanning.  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 out 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 " . -  Bangladesh'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,  Bangladesh  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 to 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 not 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 to 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 .  Budgetary 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 .  Another  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 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 .  simply  T h i s c o u l d a p p l y to 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 female 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 supply.  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 fewest 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 phases, 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, demog 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 ,  appears 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 chosen. 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 primacy  of'changing  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 cause. leaders alone.  Environments  a l o n e cannot i n d u c e p o l i c y changes, nor can  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 years.  L i k e w i s e , t h e economic/demographic environment  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 h e r n e i g h b o u r s d i d n o t d e t e r h e r 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 they 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 something.  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 t h e p o l i t y , o r who i s c l o s e t o those who a r e .  He ( o r she) w i l l then 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 through e x i s t i n g i n s t i t u tions.  T h i s i s s u p p o r t e d by t h e 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  events recounted here.  In C e y l o n (1965) and Bangladesh  (1975), 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 f o r about s i x y e a r s .  in  "office  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 t h e  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 a p p o i n t m e n t 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 t h e 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 t h e 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 phases.  The r o l e  of l e a d e r s h i p i n the general pattern o f the f e r t i l i t y policy-making  process  - 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  in 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 cont 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 t h r e a t e n i n g t o wreck "time-bound"  was  t a r g e t s o r were g o i n g wrong due to mal-  administration or other complications a s s o c i a t e d with implementation.  At  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. of i t s c o s t ;  The vasectomy camp method had l o s t i t s appeal  because  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 posals.  The i d e a t h a t development must p r 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 the 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 the 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 the h i g h l i g h t o f the B u c h a r e s t c o n f e r e n c e o f 1974.  India  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 the 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 . more w i d e s p r e a d  The p r o v i s i o n s f o r female e d u c a t i o n , l a t e m a r r i a g e ,  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 not 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 Chapter 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 the 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  recounted  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  insti-  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 an u n e q u i v o c a l  h e r son S a n j a y , .  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 Twenty P o i n t Programme.  in  Mrs. Gandhi's  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.  If f e r t i l i t y control  - 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. Gandhi would :  have to p r e c i p i t a t e i t .  Sanjay f u l f i l l e d the l e a d e r s h i p requirement, pushing the developmentalist 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 contributed to i t s deafness.  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 f e 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 compulsion i n f a m i l y planning. 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 to 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  opposition.  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 n d h i , 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  vigorous  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 expunged the o p p o s i t i o n from the Lok Sabha.  r i g h t s and  A f t e r w a r d s , she ( w r o n g l y )  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 not u n t i l Ayub had gone through 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 from o p p o n e n t s ; namely, a f t e r they 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  of  h i s r u l e , Z i a u r Rahman s t r o v e to s u p p r e s s the 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 the armed f o r c e s by s u s p e n d i n g  those checks  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 the 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  predeces-  s o r , M u j i b , had f e a r e d t o do, either..because 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 opposi t i o n . T h e r e i s , t h u s , a p a t t e r n to 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 implementation  i n these four c o u n t r i e s ,  and  one w h i c h f o l l o w s the 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 d e m o g r a p h i c / e c o n o m i c 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 response to 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  environment.  We have l o o k e d a t the 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 m a j o r 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 the 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 dence urge to m o d e r n i z e , and t h e a b s e n c e o f o p p o s i t i o n .  post-indepen-  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 the persons o f Dudley Senanayake, Ayub Khan, Z i a u r Rahman, and Gandhi.  Sanjay  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 , but r a t h e r , on the c a t a l y s t o f g a d g e t r y and the atmosphere o f  urgency.  There were, f o r each o f the 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 L a n k a , P a k i s t a n , and I n d i a . 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  These (1977).  In S r i Lanka the 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 elections.  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 to 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  method-oriented  programme a f t e r a n o t h e r , appears 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 . 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  The c a s e o f  w i t h the 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. by the s t a b i l i t y o f r u l e .  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  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  (inundation  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 comp 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 h e 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 t h e 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 f r o m I n d i a ' s m i s c o n c e i v e d shown a l l l e a d e r s t h a t i t does n o t work e i t h e r .  e x p e r i m e n t i n c o e r c i o n has  - 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 Population P o l i c y , " Indian Journal o f Public A d m i n i s t r a t i o n , 22 (No. 4, O c t . - D e c , 1976): 69T  2.  Nurul I s l a m , Development S t r a t e g y o f B a n g l a d e s h , ( O x f o r d : Queen E l i z a b e t h House, 1978), p. 65. F o r a t r e a t m e n t "of t h e e v o l u t i o n o f p o l i c y as a l e a r n i n g p r o c e s s , see Hugh H e c l o , Modern S o c i a l P o l i t i c s i n B r i t a i n and Sweden: From R e l i e f t o Income M a i n t e n a n c e , (New Haven: Y a l e , 1974), Chapter 8.  3.  Robert Cassen, 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 , 1978), p. 214.  - 102 -  BIBLIOGRAPHY  P o l i c y S c i e n c e and P o p u l a t i o n L i t e r a t u r e B e r e l s o n , B e r n a r d . "Beyond 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.  Studies i n Family Planning  Bower, L.G. "The Return 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. «  C l i n t o n , R i c h a r d L.; F l a s h , Wm. 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