Patriarchal Demography: Tracing India's History
Demographers have laid the groundwork for the development of population control policies in Third World countries, and continue to wield immense influence. They set the criteria for reductions in the birth rate and increases in the number of couples to be 'protected' from conception through the use of contraception. They calculate the numbers of 'births averted' from contraceptives that are distributed. Demographers also determine which contraceptives will lead to a larger decline in birth rates and, thereby, determine strategies for family planning programmes. Their influence over the selection process can be seen in the choice of female sterilization rather than reversible methods for men and women such as diaphragm and the condom. Female (rather than male) sterilization is chosen, because the patriarchal nature of society makes it easier to 'promote' female methods. Consequently, demographically driven family planning programmes promote patriarchy.
Countries with high population growth rates have high proportions of their population that are poor. They also have higher rates of unemployment, illiteracy, morbidity, infant and child mortality, maternal mortality and infectious diseases. Citing these facts, the demographers have argued that there is a direct correlation between the growth rate of the population and the miseries of the people. They reason that this situation can be altered by controlling fertility through the use of contraception, and thereby reducing the rate of growth of population.
The Annual Report of the World Bank (1990), which has 'Poverty' as its theme, shows that in spite of tremendous overall improvements in health, nutrition and education, progress has been uneven. The poor continue to suffer from illiteracy, sickness, malnutrition and early death. "The decision to have many children can be a sensible response to poverty" (World Bank 1991, p.31). In conclusion the Bank (1991, pp. 81-82) points out that, "low wages (especially for women), inadequate education and high infant mortality - all linked to poverty - contribute to high fertility rates and thus to rapid population growth." Coercive family planning programmes are no substitutes to investing in human capital, and even when having fewer children is of interest to the women, they must have access to safe and effective means to regulate their fertility.
The root cause of the problem is the unequal access to resources and power. The world's poor- some 1.1 billion people - earn just 2 percent of the world's income, 3.3 billion fall in the world's middle income category. The Consumer Class - around 1 billion - take 64 percent of the world's income - 32 times as much as the poor. The Bank therefore says, "To avert the shameful prospect, governments, in cooperation with the international community, must make long term commitment to improving the social infrastructure that serves the poor" (1991, p. 89). The key elements of such a commitment are clear- provide the basic services that the poor need the most- make the existing services more 'effective'. Unfortunately, the Human Development Report (UNDP) shows that the ratio of the incomes of the world's richest 20 percent population to those of the poorest 20 percent has gone up from 30:1 in 1960 to 59:1 in 1989.
In spite of strong evidence that mere reductions in birth rate cannot assure better life for a substantial proportion of the population, demographers argue for demographic transition as an objective to be achieved at any cost. Dr. K. Srinivasan, a well known demographer and ex-director of a World Bank project and then of UN-GOI Institute for Population Sciences, praises the coercive programme carried out during the political emergency in India, when 8.26 million sterilisations were performed in a short span during 1976-77. Commenting on the slowing down of that programme due to strong national and international criticism, Srinivasan says, "From a retrospective analysis-it seems that India made a sacrifice in terms of delayed demographic transition, and possibly socio-economic development, to safeguard her people's democratic rights. It is doubtful whether a compulsion in family planning programme can ever be implemented in India within the present political structure or that centrally specified demographic goals can be imposed on the states."
Srinivasan is not alone in providing moral support to coercive family planning programmes. There are other demographers who hold similar views. Among them is Dr. Ashish Bose, founder member of the Indian Association for the Study of Population. Bose says, "The main reason for the success of the Indonesian model is the excellent military style logistic in running the programme. In India we have an overdose of democracy." It is therefore not surprising that the population policy drafted by the committee chaired by the agricultural scientist, Dr. M. S. Swaminathan, and of which Dr. Bose was a member, had suggested use of the army for implementing the Indian family planning programme.
The example of the family planning programme in India can highlight population policies in operation and the situation of the people. India adopted a family plan1ling programme at the national level in 1951. It is significant that the programme was called 'family planning' and not 'birth control' as was the case with the only other programme -that of IPPF (International Planned Parenthood Federation), in existence at the time. This change in name is convenient to the population lobby and has been used for the programmes in all the countries even when in reality the programmes concentrate on reducing the birth rate. The official statement about the Indian programme says, "family planning services are offered as part and parcel of the overall package of health services, particularly, the maternal and child health and nutrition activities. " And yet even the objective of the National Health Policy, in a country that has many health problems, is to "reach a replacement level fertility (NRR1) by the year 2000 A.D." Corresponding goals laid down are: Crude Birth Rate of 21, Crude Death Rate of 9, Infant Mortality Rate of below 60, Effective Couple Protection Rate of 60 percent and Life Expectancy at Birth of 64 years. The government has not presented an official health policy after 1983, though the above mentioned population policy was drafted in 1994 which met with a lot of resistance from women's groups and is not yet accepted.
As the main target is the birth rate, all efforts are made to reduce it. Japan's experience shows that after liberalising the laws on abortion, the birth rate dropped dramatically. Inspired by this experience, the government of India passed a law making abortions legal. It is significant to note that this law was termed as Medical Termination of Pregnancy (MTP) Act of 1971. In this context the statement in the official publication, "though this (MTP) is a health measure, it can supplement family welfare planning," gives away the real motive in passing the Bill.
Abortion policy in India is described as liberal, and yet it must be noted that women cannot get abortions on demand and they are available only if the woman fulfils the conditions laid down in the law. The MTP Act does not accept abortion as a woman's right. The woman has to approach a doctor for the decision to terminate her pregnancy. The law mainly protects the interests of the medical profession. After the law was passed, inducing an abortion does not expose the doctor to a legal action. Also, the current provisions in the Act can be easily altered and the access to abortions can be made more difficult for women.
Maternal mortality in India, estimated to be 420 for urban areas and 380 for rural areas, is one of the highest in the world, and comparable only to some of the poorest African countries. A major reason is the fact that women are denied adequate nutrition and health care right from their births, consequently they have poor physical growth. It is observed that social discrimination leads to a smaller proportion of girls (3 girls versus 7 boys out of ten) showing normal growth. The health of women further suffers since they continue being neglected during adolescence. Women therefore need medical help during delivery and many of them undergo Caesarians. Accepting these facts, the National Health Policy of 1983 set goals for all pregnant women to be provided with ante-natal care and all deliveries to be attended by trained staff. However it is observed that over 83 percent of the rural and 42 percent of the urban women do not receive trained attendance during deliveries, according to National Family Health Survey (NFHS) 1993. This neglect leads not only to the deaths but to increased morbidity among the survivors. For each maternal death there are 17 mothers who suffer serious damage to their health. This high rate of maternal mortality is often used as a justification for family planning, yet family planning that is targeted at reducing higher order births is no solution to the health risks that women and their children face, because it is seen that risks differ very little by the order of the birth. (NFHS, 1993)
Even now when it is widely accepted that women's empowerment is crucial to improving the status of women, population control programmes do not address issues of patriarchal control. Studies show that women continue being married-off young. As many as 54.2 percent of women in ages 20 to 24 were married before 18 years, and this in spite of the law prohibiting marriages before age 18. This practice is prevalent even in a much publicised and so-called progressive state like Kerala and the percentage of such marriages in Kerala is 19.3, i.e., about one in five girls. (NFHS, 1993)
Demographers were unhappy about the small reduction in the birth rate. The Sixth Five Year Plan, therefore, had a new objective of NRRI for the national family planning programme. NRR refers to the number of daughters a mother will have. Restricting the number of daughters was expected to limit the number of women - the child-bearers - in the population. ' It must therefore be noted that the bill preventing amniocentesis for detecting the sex of the foetus took a full nine years to become the law.
To bring about population stabilization the demographic target is now set at replacement level fertility. "Replacement level fertility is the level at which each woman, on average, is replaced by one daughter, which occurs at approximately a TFR of 2.1 children per woman." (NFHS, 1993, p.93) NFHS points out that the Indian TFR has come down from 5.2 in 1971 to 3.39 because of the control of fertility. NFHS also reports that the average age at sterilisation of women has come down to 26.6 years and 73 percent of the couples are sterilised before the wives reach age 30. Raising the age of marriage would be a welcome change as it will give more opportunities for women to spend time for continuing in education as well as looking for economic activities. It is also known that such girls will plan their families. However the reduction in TFR in India has been achieved not by improving the status of women but by coercing them to control their fertility. NFHS also reports that almost 20 percent of the pill users, about the same proportions of IUD users, 23 percent of the sterilised women and 19 percent of the sterilised men had complaints of physical problems because of the methods they were using.
In view of the objective of each woman having 2.1 children, and assuming that the woman will be survived by one daughter it will be interesting to see what the NFHS reports on the survival chances of the children in this high mortality country. The survey reports that the average number of children born was 3.1 and those surviving was 2.6 i.e. a loss of 16.13 percent of the children. The chances of surviving vary by state, but it has to be noted that even for Kerala the number born is 2.5 and the number surviving is 2.3. Mortality for girls is higher than that for boys. So it should be obvious that having 2.1 children will not ensure that a mother will be survived by one daughter.
In calculating the TFR it is assumed that today's young women will survive till they complete their reproductive span and it is also assumed that their child bearing will have the same pattern as their elder sisters. It should be obvious that these assumptions cannot be supported by reality. Mortality in India is high and it is higher for women. In the ages of 15 to 35 the death rates for women are higher by 33 percent than those for men in the same ages. Women will also not be bearing the same numbers of children as their elder sisters - because there has been a change in attitudes and women are being sterilised at ages much below 30.
Crude Birth Rate
The number of births in a year divided by the total population in that year.
Infant Mortality Rate
The number of deaths during the first year of life for every 10,000 live births.
The average number of years a newborn infant can expect to live under current mortality levels.
Maternal Mortality Rate
Number of deaths directly due to pregnancy or child-birth, occurring during pregnancy or within 42 days of the delivery. (The number of deaths per 100,000 live births).
Net Reproduction Rate 1 (NRRl)
The average number of female children that will be born to the female babies who were themselves born in a given year. A value of one means the next generation will be only replaced.
Total Fertility Rate (TFR)
An estimate of the average number of children that would be born to each woman if the current age-specific birth rates will remain constant.