The family planning program in India was launched in 1952. In fact, India was the first country to have such a programme. But at the current growth rate, the country’s population will surpass that of China by 2024. No wonder then many experts believe that India’s family planning program has been a failure.

Poonam Muttreja, executive director, Population Foundation of India ( PFI), talks to Gunjan Sharma about why India’s family planning program has not produced the desired results.
 
It has been over 60 years since the family planning program was launched in India. But we are still struggling to control the population. Why?

Twenty states in India have performed well on this front, but some others such as Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Haryana have performed particularly badly. Poor indicators such as low literacy rate, lack of awareness about family planning, poor health infrastructure have prevented them from achieving the target fertility rate.
 
Even today about 23 percent of girls get married at less than 18 years of age,  and only 28 percent of women can take a decision about their health. States such as Kerala saw a rapid decline in population because they had invested in their health facilities and education in the 1980s. What also has not helped matters is the fact that the country spends only 4 percent of its meagre health budget on family planning.
 
The government has recently introduced new methods of contraception. Do you think it will help?
 
Yes, it has introduced three new methods of contraception recently, but it will not help unless there is a change in societal norms. Our neighbor, Bangladesh, not only raised the age of marriage for women but also worked towards improving the literacy rate and creating jobs for them. Bangladesh, Indonesia, and Sri Lanka introduced injectable contraceptives eight years back, which India has introduced now. The government has still not introduced implants, which is such a popular method everywhere else.
 
Recently some MPs demanded that India should implement a two-child policy. What is your opinion?
 
It is a terrible mindset. We don't need such a coercive policy -- disincentivizing everyone who has more than two children may backfire. They are trying to copy China, but they don't realise that China invested in women's education and empowerment in many ways.

If India goes for a two-child norm, it will further bring down the sex ratio. What is needed is education--- awareness about how having fewer children improves a family's health, its educational and economic status. We have observed that families that don't lose a child to a disease or malnutrition go for two children only. But those who do are likely to have 3-5 children.

The country needs to intensify its efforts to reduce child mortality. There is a need to engage with husbands, mothers-in-law to change a family’s behavior towards women's health and reproductive rights. And, most importantly, we need to empower women so that they can take a decision about their health. In China, a couple is counseled about family planning when they come to register their marriage. We, too, need to be more innovative with our family planning program.
 
Do you think the Emergency came as a setback to the family planning program?

Well, it kind of brought infamy to vasectomy-- a procedure which can otherwise play an important role in making family planning program a success.  Now there is a need to break taboos associated with vasectomy.

Today, the reality is only 0.3 percent men go for vasectomy. Now India doesn't have many doctors who can perform a vasectomy.  Though the government gives incentives to those who opt for the procedure,  it has not done enough to bust myths such as a man loses his libido, virility after the procedure.  People need to be sensitized more about it.
 
The government often offers sterilization procedures in camps in rural and semi-urban areas. Do you think it is safe to do so?

We are strongly against this practice. We submitted a report after 2013's Chhattisgarh incident, where 13 women died in a sterilization camp, but unfortunately, the change is so slow.

I believe that these services should be provided on a fixed day at the nearest health center so that a woman can make use of the facility as soon as she decides to adopt a family planning method.
 
Though a number of agencies and organizations are working on family planning, there are communities such as Mewat in Haryana, one of the most backward regions in India, where nothing has changed. What do you think is the reason?

Some communities are closed to the idea of change and need focused attention; a lack of political will prevents a change in such communities.
 
What do you think we need to do considering that the family planning programme seems to have failed to produce the desired results?

Firstly, the government needs to evaluate the family planning programme, where we have gone wrong if it requires any course correction.

Secondly, the government has to relook at the meagre budget allocation for this programme, which I believe requires more trained health workers. Besides, there has to be more political will to change things in states such as UP and Bihar, which are not using even 40 percent of this small budget allocated for the programme.