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Emergency Contraception : Global Activity

Application of family planning technologies in rural areas
– Dr N H Antia, FRCH, Pune

The development of a decentralized, graded, community-based and people- operated healthcare system offers a unique opportunity to deliver a variety of family planning related technologies in a safe, cost- effective and humane manner which ensures a day to day close monitoring of users, almost like in an extended family, albeit with a high level of technical and counselling skills. A singular advantage of such a highly personalized system is the dispelling of mistrust and fear associated with a top-down centralized family planning initiative with layouts and the achieving of effectiveness within costs that are affordable. Family Planning technological initiatives also need to be supported by a continuous education programme extending to the grassroot level.

I am not a specialist in contraception, but like all people of this country, I am concerned about the increasing population. When we think of India, we actually have to think of two countries, one is India and the other is Bharat, we have to think of its one billion people, we have to think of 1 million small inhabitations, with 70% population living in villages. Even 50% of urban population is really rural migrating from villages due to urbanization and is living in city slums. That is why I say that we really have two countries totally different in their way of living.

Besides, there are tremendous differences between different states. Compare the State of Kerala with any BIMARU state. Kerala is not small with a population of 30 million, but with a per capita expenditure of US $ 15/annum they have achieved health indices very much like USA, spending $25,00/capita/annum. Even the amount of money spent is not important, it is how you spend it, that is important. In BIMARU states, the population is steadily rising, but you have to constantly hunt for women with multiple children to undergo sterilization. On the contrary, in Kerala, you have sometimes to stop women with two children from undergoing sterilization till the younger is at least 3-4 years old. Even Punjab is as rich as Kerala, but a high infant mortality prevents family planning. When you go across the harbour of Mumbai, you find that every second child is still dying, and that is why they want children and not contraception. We have to understand why the poor in BIMARU states want more children while in the State of Kerala, you have to stop them from undergoing sterilization.

The nation has given up the idea of coercion. How can you have health, when the health has been converted into illness, and illness into a lucrative business? The rich are grossly over-medicated, 30% of illnesses are iatrogenic in nature and poverty in villages prevents even adequate food intake. Still 20% of household expenditure of poor is being diverted to the doctor’s fee.

What have health specialists to offer to the population? they only bring in technology coming from the West, who believe that technology can solve all problems. Population is not a health problem; it is a social and developmental problem which has been converted into technology. Minor improvements in economic status can bring a remarkable change in population. Education is important, as it has a ‘Cascade Effect’. Female education is more important, since she will educate the child, and will do better resource- management, as well as it will lead to her empowerment.

Now Panchayat Raj has the power transferred to them. It has to be made a people’s programme. Information may also be transferred in their hands. Most women are craving for education for themselves and for their children. It is important to talk about education rather than technology. It is a social problem, and a political will can solve the problem. I am not afraid of technology, but of misuse of technology. It will not be possible to deliver any good, unless information and social involvement is there.

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