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The Mirage of Choice in Family Planning: Case Study from Odisha

 

By- Leena Uppal, Centre for Health and Social Justice

The Times of India, on July 11, 2013 carried a one page advertisement on ‘small families’ and mooted India‘s achievements in achieving replacement level fertility to about 44%.  It also advertised the various contraceptives available in PHC and with the ASHAs. This advertisement assumes that parents select their family size in more or less the same way as they choose consumer durables.

Such messaging is unfortunately not telling of the deeply ingrained social inequalities that exist in India. It is hard for the common people to really understand the implications and impact of the strategies that family planning programmes utilize in their repertoire of programmes to promote birth control.  In my recent visit to Odisha on 22-26 June, I understood how family planning is reinterpreted by the states and how it is being pushed across to reach the replacement level fertility.

When interviewing health officials in Odisha they applied a quick mathematical calculation to exemplify how Expected Level of Achievement (ELA-0.4% of the Mid Year population of the district) is calculated and applied as target for contraceptive needs of people. This calculation was applied to all districts and targets were set to satisfy the contraceptive needs of the population. In fact in the district of Khurda in monthly meeting held on 12.04.203 during the review of FW & MCH, the Chief District Medical Officer has praised blocks like Balugaon, Banpur, Tangi, Haldia, Mendhasal CHC and has expressed deep dissatisfaction against low performing blocks like Janti CHC and had specially warned them to perform well.

Realistic development through micro plans based on community needs assessment of contraceptive needs, which is a mandate in National Rural Health Mission is completely missing, and in many places Village Health and Sanitation Committees otherwise known as Gaon Kalyan Samitis are not functioning though they have reportedly been set up.

Family planning programme and the target to be reached is planned at the state level.  The state PIPs have also included district wise ELA (targets set) for female sterilisation, IUD insertion, CC users and OP users, which is eventually shared with the Ministry of Health and Family Welfare for approval. The approved PIP 2012-2013 has projected the following expected level of achievement for the thirty districts of Odisha:

Sl. No. Name of the districts Mid-year population 2013

Expected Level of Achievement

Sterilisation I.U.D. insertion C.C. Users O.P Users
1 Angul 1302433 5210 6642 11071 6512
2 Balasore 2385765 9543 12167 20279 11929
3 Baragarh 1509749 6039 7700 12833 7549
4 Bhadrak 1546836 6187 7889 13148 7734
5 Bolangir 1721229 6885 8778 14630 8606
6 Boudh 455444 1822 2323 3871 2277
7 Cuttack 2683485 10734 13686 22810 13417
8 Deogarh 321044 1284 1637 2729 1605
9 Dhenkanal 1222364 4889 6234 10390 6112
10 Gajapati 589190 2357 3005 5008 2946
11 Ganjam 3604038 14416 18381 30634 18020
12 Jagatsinghpur 1155032 4620 5891 9818 5775
13 Jajpur 1873393 7494 9554 15924 9367
14 Jharsuguda 595782 2383 3038 5064 2979
15 Kalahandi 1628485 6514 8305 13842 8142
16 Kandhmal 751494 3006 3833 6388 3757
17 Kendrapara 1472064 5888 7508 12513 736
18 Keonjhar 1858961 7436 9481 15801 9295
19 Khurda 2332428 9330 11895 19826 11662
20 Koraput 1422737 5691 7256 12093 7114
21 Malkangiri 638050 2552 3254 5423 3190
22 Mayurbhanj 2581664 10327 13166 21944 12908
23 Nawarangpur 1263794 5055 6445 10742 6319
24 Nayagarh 985011 3940 5024 8373 4925
25 Naupada 624177 2497 3183 5606 3121
26 Puri 1743553 6974 8892 14820 8718
27 Rayagada 992491 3970 5062 8436 4962
28 Sambalpur 1069796 4279 5456 9093 5349
29 Sonepur 677837 2711 3457 5762 3389
30 Sundargarh 2138995 8556 10909 18181 10695
  ODISHA 43147321 172589 220051 366752 215737[1]

 

The above table does reflect the seriousness of the targets in official words ELA set and the need to reach it.

The government of Odisha recently organised events around World Population Day on July 11.  On this occasion the key districts and Medical Officers of these districts were felicitated in the following categories:

  1. Best performing Districts in sterilization operations for the year 2012-13. (3 Awards)

 

  1. Best performing Districts in sterilization operations for the population fortnight (11 to 24 July, 2012). (3 Awards)

 

  1. Best performing Districts in Male Sterilization operations for the year 2012-13. (3 Awards).

 

  1. Best performing Surgeons in Minilap Operations during the year 2012-13. (3 Awards).

 

  1. Best performing Surgeons in Laparoscopic operations for the year 2012-13. (3 Awards).

 

  1. Best performing Surgeons in Male Sterilization operations for the year 2012-13. (3 Awards).

 

  1. Best performing Surgeons in FDS for the year 2012-13. (3 Awards).

 

  1. Best performing NGO in mobilizing sterilization cases in population fortnight (11 to 24 July 2012). (1 Award)

 

Coincidently two districts Malkangiri, Koraput are predominantly tribal districts (with the tribal population being around 50% or more) and Anugul which has 11.6% of tribal population are the districts which won the award for their performance in sterilisation operation. All these three districts have crossed the stipulated 100% female sterilisation targets set in 2012-13[2].

The % of achievement in these districts is as follows:

Best three districts on sterilisation performance (2012-13) Malkangiri (138.27%)

Koraput (109.08%)

Angul (106.09%)

 

Best three districts for conducting vasectomy operations (2012-13)

(in nos.)

Koraput (650)

Mayurbhanj (546)

Rayagada (282)

 

Best three districts on sterilisation performance during World Population Day 2012 Bhadrak (125.45%)

Malkangiri (91.15%)

Dhenkanal (76.67%)

Source: Directorate of Family Welfare, Odisha

The fact that no award was being provided for distribution of other contraceptives like IUCD, or oral pills or condoms does signify the seriousness with which sterilisation is being promoted.

The Ministry of Health and Family Welfare continues to link welfare of individuals, national economy and environment benefits with smaller families i.e. two child families. One of the senior health official of government of India Dr. Sikdar did share in one of the meetings that family welfare has moved away from a camp based approach to fixed day services for women in CHC, evidences from the field  however suggests otherwise and does imply that family planning services rarely addresses the gender barriers or addresses the special needs of the marginalised communities.

It seems to be true that the health care providers and the health system continue to limit people’s family planning options to sterilisation in the belief that people cannot be relied on to practice temporary methods effectively. This trend is especially a matter of concern since in the Family Planning Summit 2012; the international community took an enormous stride towards rectifying the human rights violation faced by women and girls globally. India committed to providing greater access to modern contraceptives.



[1] Distribution of ELA on Family Welfare for FY 2013-2014 are enclosed as Annexure I.

 

[2] Government order on state awards for WPD fortnight 2013, duly signed by senior family welfare department officials attached as Annexure II.

 

(annexures avilable on request )

 

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