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:

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:

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.

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