From Sterilisation to Sexual Education: Family Welfare Policies in India

As of 2013, Indias population density index rates at 421, far outstripping most of its South
Asia counterparts for the aggregated amount of people living per square kilometer of land
(The World Bank Group 2015). High population density in any area typically translates into a
pressing pressure on a nations resources, exacerbated by time-constrains and the inability of
the land and existing infrastructure in meeting the needs of the booming population (Narain
1968; Thompson 1965). Understanding the impact of a booming population as challenges to
resource management and economic development, Indias government has tackled the issue
of population overgrowth with various policy campaigns over the last century, impacting not
just Indias social domain but its political scene as well, with effects of the backlash from
aggressive population control campaigns spilling over into its political scene. Accompanied
by the gradual shift in Indias governance structure, the inclusion of social science research to
inform policy planning has translated into a gradual shift away from the initial population
control outlook to an arguably, more holistic and less repressive approach on the countrys
family welfare and planning.
BEFORE 1947: PRE-INDEPENDENCE YEARS
Population control and family planning in India was a budding area of interest in the years
leading up to its independence in 1947, with many Indian nationals and British governing
officials recognising the severe consequences of their countrys population growth.
Precipitated by the predications of high rate of population growth as the primary cause of
persistent famines in India by Thomas Malthus, a Professor on political economy from
England, Indias approach to its overpopulation issue was oriented towards resolving its food
supply and resource-centric problems. Harkavy and Roy (2007) argued that such a
Malthusian (pp.301) outlook infused British and Indian nationals approach towards Indias
population growth for subsequent generations, explaining the pragmatic and results-oriented
policies by the Indian government over the century in their post-independence years.
Preceding the firsts of Indias population control campaigns, The Bengal Famine Inquiry
Committee prediction of Indias population growth by another 100 million between the years
of 1945 to 1960 underscored an urgent need for the British colonial powers and Indian
government to deal with the overpopulation issue (Hakvary and Roy 2007). In 1947, after
Indias independence from Britain, The National Programme of Family Planning was
officially adopted by the Indian government, marking the genesis of government-led,
population control and family planning campaigns over the next century.
FIRST PHASE OF POPULATION CONTROL: 1952-1957
Prior to the start of the first five-year plan of its family planning campaign, the Population
Policy Committee chaired by the Minister of Health was appointed alongside the creation of a
Family Planning Cell in the Office of the Director General of Health-Services, marking the
Indian governments commitment to managing its population overgrowth issue.
Within the first phase of its population control campaign, a significant addition was the
introduction of foreign assistance in 1955. By recruiting large numbers of American technical
expertise with the intended goal of collaborating with their Indian counterparts, The Ford
Foundation contributed to Indias population control strategies by providing the Indian
government with technical assistance over its policy planning considerations. The Ford
Foundations aid in 1955 reflects a cornerstone in Indias history of family planning policies,
marking the involvement of foreign assistance from various Western organizations and the
impact on shaping the governments approach to family planning policies.
In the first phase of its population control programme, the Indian government adopted a
clinic-based approach and allocated Rupee 6.5million dollars to fund its population control

campaign. Setting up The Family Planning Association of India in 1949, Lady Rama Rau
oversaw the nation-wide implementation and distribution of an estimated 4,000 birth control
clinics across India, offering all available contraceptives such as condoms, diaphragms, and
vaginal foaming tablets and a focus on natural family planning in line with the previous
Gandhian ideology. However, the opening up of birth control clinics proved a largely
ineffective response to the booming population growth, being largely passive and only
offering birth control alternatives without the simultaneous education of the larger Indian
public on the pressing nation need to achieve lower fertility rates.
SECOND PHASE OF POPULATION CONTROL: 1956-1967
The second phase of the family planning effort extended the clinic-based, policy-centric
approach characteristic of the first phase. Focusing on outreach and awareness, the Indian
government sought to achieve a lower birthrate through education and communication with
the public this time round. By sending out family planning workers on house-to-house visits
to educate and motivate couples to accept family planning methods, the replacement of the
previous clinic-based approach to a population-based, public health outreach approach was
accompanied by the setting up of family planning institutions by private agents Freymann and
Raina. Their joint institution, the Gandhigram Institute of Rural Development and Family in
the south of India, marked pioneering efforts in relation to population-based family planning
in India.
Freymann and Rainas institute focused on short-termed studies of program implementation
and social factors surrounding contraceptive acceptance, and its findings confirmed the
inefficiency of clinic-based approaches over population-based alternatives. Adopting the
institutes suggestion in the mid 1960s, the Indian government reorganized its family planning
campaign around a population-based, outreach approach rather than its previous clinic-based
strategy, including offering monetary incentives for medical undergraduates to join the nationwide campaign as medical personnel after graduation (Narain 1986). However, such efforts
proved to be largely ineffective, as birthrates continued to climb as indicated by the 1971
census.
THIRD PHASE OF POPULATION CONTROL: 1970-1980
In a bid to halt the climbing fertility rates, and spearheaded by Chief Secretary of Madras
Presidency R.A. Gopalswami, the Indian government adopted an aggressive stance in pushing
for vasectomies to achieve their target aim of 25 births per 1,000 persons in the population.
Coupled with monetary incentives up to a months equivalence of income for the average
Indian national, vasectomies became one of the defining features of the Indian family
planning initiative as sterilisation across the nation was carried out (McCarthy 1997; Harkavy
and Roy 2007). From the perspective of the Indian residents, the governments vasectomy
camp (Gwatkin 1979:33) sterilisation policy initiative took a partial coercion slant as many
local government officials were actively involved in many of the vasectomy campaigns
(Harkavy and Roy 2007).
Inspired by the success of the vasectomy camps in the long line of Indias family planning
initiatives, many Indian states raised sterilization targets and introduced even more pervasive
methods in order to meet their goals. From withdrawing public food rations from couples with
more than three children in Bihar, compulsory sterilisation for couples with more than
children in Uttar Pradesh and Maharashtra (Gwatkin 1979; Harkavy and Roy 2007), family
planning initiatives in the 1970s took on an oppressive slant, employing the use of physical
and social coercion on the large majority of the Indian public. The estimated total of
sterilisations conducted within the year following April 1975 amounted to 8.26million,
accounting for more than half of the sterilization cases performed worldwide (Gwatkin 1979;
Narain 1986).

FROM POPULATION CONTROL TO FAMILY PLANNING

The oppressive nature of the Indian governments attempt in population control of the 1970s
led to nation-wide dissent amongst the public on Indira Ghandis governance, creating a
backlash that ended her political career in January 1977 (Gwatkin 1979; Harvarky and Roy
2007). Even though the existing family planning programmes were not abolished, politicians
begun to approach the issue of family planning with caution and revised existing policies to
incorporate a more democratic approach in the late 1970s.
Although the bureaucracy viewed academics as troublemakers (Harvaky and Roy
2007:318) previously, the contribution of social science research to informing population
issues were enhanced by the formation of The Population Foundation of India, a nongovernmental institution dedicated to funding high-quality social research studies on studying
the impact of the India governments national family planning programmes. The growing
dissent amongst the public in the 1970s led to a realization of the governments problematic
policy-based approach of the previous few decades, as well as the need to redefine their
approach to the issue of overpopulation in India. The Indian governments transition towards
prioritizing needs and the opinions of their subjects was finalized in the official renaming of
the Ministry of Health and Family Planning to the more inclusive title, Ministry of Health and
Family Welfare.
Changing their previous attitude to the role of academics in policy formation, the Indian
government incorporated the Gandhigram Institutes findings on the association between
delayed ages of marriage and lower fertility rates in their policy alterations, in conjunction
with improved educational and job opportunities for girls to ensure that child marriage does
not remain the only viable option for impoverished families in India (Barua, Waghmare, &
Venkiteswaran 2003; Rag, Saggurti, Balaiah & Silverman 2009). The official minimum age
of marriage was raised to 18 years of age for females, and 21 years of age for males (Harvaky
and Roy 2007).
The Indian governments shift towards a more democratic, less aggressive approach towards
family planning in India can also be seen through their initiative of the All-India Hospital
Postpartum Programme to provide postpartum birth control options to recently-delivered
women. Basing their policy formulation on two American physicians findings that recently
delivered women were more receptive to receiving birth control methods, the newly revised
integrated approach (Gwatkin 1979:41) to programmes sought to situate family welfare and
planning at the heart of all other governmental policies and to encourage family planning
without coercive or oppressive regimes. Such policy shifts towards more client-centered
services and provision of welfare in governmental policies informed by social science
research is likely to meet citizens reproductive needs within the broader discourses of
achieving Indias demographic goals (Koenig, Foo & Joshi 2000).
CONCLUSION
Being the first country in the world to implement family planning policies in lieu of its
population overgrowth concerns, Indias pioneering approach to its overpopulation issue has
undergone a series of changes in both outlook and method of implementation. The inclusion
of social science research in the policy formulation process bears much promise for India in
future, in the hopes of bridging socio-cultural differences and reducing policy-implementation
gaps between Indias various states and central policy-makers from the government.

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