How India's six child family became three
#1
http://www.thestar.com/news/world/india/...came-three
How India's six-child family became three
June 12, 2010

Rick Westhead


Oldest of four children, 16-year-old Amruta is determined not to have any more than one or two children, pictured in her house in a local slum called Goutam Nagar, in Agra, India this afternoon.
AGRA, INDIA—Amruta, a shy teenager with large eyes and a pretty smile, sleeps on the dirt floor of her family's home in a gritty slum, survives on a single meal each evening and hasn't attended school in seven years because her father can't afford it.

In a city overrun with rich foreigners flocking to see the Taj Mahal, it's safe to say Amruta has learned to keep her dreams realistic.

But there's one thing on which she won't compromise.

When she turns 18 in two years and her parents find her a husband, Amruta says she will insist she isn't required by her new family to have more than two children.

“A small family is a happy family,” she said one afternoon this week, scrambling to watch her siblings and stretch a band of leather for her father, a local whip maker.

Activists and social workers say Amruta isn't alone. Throughout India, many young women nowadays would prefer to have small families. The number of children an Indian woman bears has fallen to around 3.0, down from 3.78 in 1990 and 6.0 in 1950. Public-health experts say those figures could tumble even further if contraceptives were more widely available.

Here in Uttar Pradesh, India's largest state with 180 million people, 29.3 per cent of married women use condoms, birth-control pills or other forms of contraception, well below the country's 48.5 per cent national average, according to India's National Family Health Survey.

Meenakshi Jain, a director with the Urban Health Initiative in Lucknow, the state's capital, says the challenge isn't making women aware of contraceptives. Rather, it's helping them access them.

Amruta's family dynamic illustrates the challenges public-health workers face.

Her parents, Bharat and Devli, who estimate their ages at 35, married in 1993 when Devli was 18. A year later, Devli delivered their first baby, Amruta, who was born on the floor of their four-metre by four-metre single-room shanty. They would have four more children, three of whom survived infancy.

Now, Bharat, whose family of five gets by on the $1 a day he makes selling whips, says he knows what should be done.

While his father had 12 children and encourages Bharat to expand his own family, Bharat says he knows he needs to have a vasectomy. But Devli won't let him.

“My father is of traditional thinking and had children when food prices were cheap,” Bharat said, sitting under a gnarled tree as his wife cut onions for their dinner. “Now everything is expensive and you can see that I haven't given a good education or diet to my children. I would have the sterilization but she is worried that something will happen to me during the procedure and then who will feed my children?”

Scooping a wad of betel nut from a small silver tin, Devli smiled and nodded. “Maybe I'll go do it instead,” she said, peeking out from under a red-and-white head scarf. “But when do I have time?”

Jain said the couple's situation sounds familiar. “We have to help people understand these services are safe,” she said, adding many women don't understand that female sterilization is a 10-minute procedure and women are discharged from the hospital after half a day.

There's mounting evidence that contraception is once more an important part of the political discourse here.

India has 1.1 billion people and is expected to eclipse China as the world's most populous nation by 2050. There are concerns over how the country will manage its staggering population.

At a meeting convened by the Ministry of Health and Family Welfare in New Delhi, government officials said they want to rekindle family-planning efforts with increased program funding, bolstering programs like Jain's that champion the use of contraceptives.

“Family planning had fallen off the radar,” said Aparagita Gogoi, a public-health specialist who attended the May 5 meeting. “The ministry made it clear it's back on the map.”

Dr. Amarjit Singh, executive director of India's national population stabilization fund, a branch of the Ministry of Health, said family planning is a government priority after more than two decades of tepid attention. Indian politicians remained loath to tackle issues such as sterilization or population control after former prime minister Indira Gandhi's scandalizing forced-sterilization program during the late 1970s.

“People just stopped talking about it after the period of emergency,” Singh said.

But lately, the federal government's interest in contraception has been rekindled. There's a greater realization in government, Singh said, that maternal and newborn health will be improved if women wait longer to have children and space out their kids.

The federal government's move follows the recent lead of several states.

The eastern state of Assam, for instance, has made a breakthrough coaxing men to have vasectomies. Last year, 15,000 men had the procedure done in Assam, up from 1,500 the previous year. A key has been winning over Muslim men by highlighting how the Koran and other holy texts encourage men to father only as many children as they can support, Dr. J. Ekka, a public-health official, said in an interview.

In Bihar, another huge Indian state, the birth rate has dipped thanks at least in part to activists who have aggressively encouraged young couples to wait at least two or three years before starting a family.

And in Andhra Pradesh, in India's south, poor people who are sterilized after two children receive front-of-the-line treatment for benefits such as housing, real estate, wells and government loans.

Still, the family planning field remains rife with challenges.

In Uttar Pradesh, for instance, where the average mother gives birth four times during her child-bearing years, chief minister Kumari Mayawati has built a political empire with the support of the country's Dalits, or lowest-caste citizens. Reducing the size of families would effectively eat into her vote bank, Singh said.

Channi Begum, a community health worker with a local agency in Agra that promotes family planning, spends her days navigating the potholed lanes and open sewers of a slum called Goutam Nagar, dishing advice on everything from condoms to birth-control pills and vasectomies.

There are times Begum and her colleagues need to explain to new wives that condoms can be used just once and intrauterine devices, more commonly known as IUDs, can't slip up into their stomachs.

“The key is the mother-in-law, she is the gatekeeper,” Begum said confidently on a recent sun-parched afternoon. “Some are aggressive and say, ‘Why are you in our homes, what, are you going to feed us?' But we explain that the new wives shouldn't be having kids too early because it affects the whole family's economic situation.”

Walking through the slum, past men lounging on string charpoys and goats and chickens darting about the streets, Begum stopped at the home of Babli Singh, a 32-year-old with four children and is five months pregnant with her fifth. She asked her husband, a rickshaw driver, for permission to be sterilized after her last baby, but he refused.

Begum and others have failed in repeated attempts to win him over. “He says he doesn't want us to spoil his wife,” Begum said.

Others resist for other reasons.

“Some men don't like vasectomies because they think the procedure is castration,” said Rashmi Mohandy, a veteran public-health worker who accompanied Begum. “Some don't like their wives having sterilization because they think their women can be unfaithful and they will never know it. There's a culture of silence around that.”

Breaking for her rounds, Begum met with a group of colleagues for a chat about neighbourhood families. After 30 minutes, she prepared to head out.

But first the group rehearsed a song, prepared by the health-care workers to sing as a group at public ceremonies.

“Have two children only, small families only. You can have pills.

Motivate your husband, motivate your mother-in-law, Make them understand.

You can go for injectibles, condoms, pills, And you'll be able to give your children good clothes.”
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#2
I recall the 'hum doh hamare doh' campaign which used to be painted on public transport buses years ago.
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#3
(13-Jun-2010, 06:48 PM)Sajit Wrote: I recall the 'hum doh hamare doh' campaign which used to be painted on public transport buses years ago.

Sajith, this is going on a tangent, but what you said reminded me of something. Those ads used to appear on Doordarshan, which was the only TV channel around back in the 80s. I do love the fact that we have all these new channels around today, but the ads are gone. There is not enough incentive in the system for private companies to telecast public service announcements (PSAs), especially with all the money to be made showing just about anything else. This is evidence that there needs to be a balanced approach in government.

Modern libertarians often gloss over certain premises that Adam Smith was talking about in his theories, and instead focus their full attention on his metaphor of the 'invisible hand of the market'. The requirement for such a system to work is that there be absolute equality in opportunity and freedom from oppression. The truth is that the hand is mathematically accurate, but to exist it needs a fantasy world. Adam Smith's whole point of using that phrase was to point out that there needs to be some force that makes sure that the conditions of equality are met, but this entire part is usually omitted in modern libertarian literature. A real free-market requires a free society. A free society is one that is informed and involved in the governing of their own lives. This is, to me, the fundamental role of government in a democracy. It is the role of providing the citizens with the information that they need to deal with each other under the system of law. In the modern world, this job also involves promoting the essential implications of science and reason as well. 'Hum doh hamare doh' was a product of scientific and humanistic thinking. Spreading this information and keeping the people informed was a very important job.

As the government's role has been replaced by private companies, some of essential services needed to balance the needs of a well-functioning social system have been essentially shut down. This has allowed religion (among other often superficial social replacements) to take over the role of the government in these areas (in India, and also in the US). Meera Nanda has a good explanation of this in her latest book. My point here is that although all governments are perpetually fighting the tendency towards corruption, they do seem to have a role to perform when it comes to playing referee between private entities, and in making sure that there is information available to the consumers (citizens) for people to make informed choices in life.

This is a balanced perspective and is often misunderstood on both sides of the political spectrum.
"Fossil rabbits in the Precambrian"
~ J.B.S.Haldane, on being asked to falsify evolution.
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#4
The inverse relationship between economic well-being and reproductive rate. Of course, this is only about correlation. Determining the actual causal factors is much more complicated.

[Image: birth-rate-and-gdp-per-capita.jpg]
"Fossil rabbits in the Precambrian"
~ J.B.S.Haldane, on being asked to falsify evolution.
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#5
Some reports say that hunger and malnutrition in India are not because of the lack of food for the huge populations, but the lack of facilities to get the food to the people who need it.

I found this series of videos by the Population Research Institute pretty educative: http://www.youtube.com/watch?v=vZVOU5bfHrM (see all 3 linked videos).

But I feel the real problem with India is the concentration of cities. It is going to go up to 800 million in the next 25 years according to http://www.business-standard.com/india/n...m/98021/on ! I guess that is more than half of what the population will be during that time.
Aditya Manthramurthy
Web Administrator & Associate Editor
Nirmukta.com
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#6
Quote:Some reports say that hunger and malnutrition in India are not because of the lack of food for the huge populations, but the lack of facilities to get the food to the people who need it.

I haven't had time to check out your links yet (I will soon) but your observations are spot on. We were actually having this discussion on facebook before we moved it here. Here is part of a comment that I made on facebok:

"At this very moment hundreds of millions of people are starving around the world- literally dying because they have no food to eat- while billions of tons of fresh farm produce is being converted into animal feed and biofuel. Hundreds of thousands of tons of food is thrown away in the developed world every day. Lack of food is not why people are dying of starvation. Lack of management of food is (and apathy, but that's another issue)."

So this is an international problem that is related to globalization on one level and prioritizing of self-interest on another. The problem is that the unregulated markets model encourages and even requires extreme wealth disparity, which makes it financially untenable to make food (and other resources including health care and education) equally available to all, thus re-inforcing the disparity and creating a feedback that perpetuates insidious social, political and moral dilemmas. In the case of India, the transportation infrastructure is so bad that it becomes even more essential that we not rely on models of food distribution that involve too much transportation. Today only a small portion of Indians regularly consume food items that were processed in a factory somewhere thousands of miles away. If the day arrives when all Indians consume like Americans do today, either our population must drop a whole lot or we must develop different (and more efficient) ways of producing and distributing food.

Quote:But I feel the real problem with India is the concentration of cities.

I really dislike the cities in India today. But I hope that someday we might have well-managed and energy-efficient cities with plenty of clean air, trees and life. From an environmentalist's perspective, cities are healthier for the planet. We just have to learn to make them healthy for us people. Everyone including the Chinese (who pollute almost as much as the Americans do) are working on this. IMO, this change will happen over time through education and science. I think that someday our population will stop growing and we will have diversified and localized energy sources, both on-grid and off. We will have efficient and well-functioning social services based on precise computerized models to manage the various needs of the city. Cities will produce their own food and energy, and the pressure will be on us (or on our children, more likely) to allow nature to recuperate after we finally cease destroying it.
"Fossil rabbits in the Precambrian"
~ J.B.S.Haldane, on being asked to falsify evolution.
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#7
Sid Singh had posted this link on Demograhic Transition and feels India will move into stage 3

http://en.wikipedia.org/wiki/Demographic_transition
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#8
(18-Jun-2010, 08:50 AM)Sajit Wrote: Sid Singh had posted this link on Demograhic Transition and feels India will move into stage 3

http://en.wikipedia.org/wiki/Demographic_transition

Thanks Sajith and Sid. I've read about the demographic transition, and India is already considered a stage 3 country, technically speaking. But the problem seems to be that without programs to educate women (and men) and to address the situation through PSAs, the birth rate decline slows down (i.e., the rate at which babies were being born was still dropping, but not as fast as before). This is a problem because death rates are still declining exponentially, thanks to the fact that hundreds of millions are slowly coming out of poverty. For example, even from the last census there is ample evidence that the 90s saw a decrease in the drop in the birth rate when compared to the years prior to Manmohan Singh's shift in policy: http://www.prb.org/articles/2002/decline...slows.aspx
Obviously the government programs were doing a good job, even if the people were poorer. Of course, I am not arguing that everything was better off. I feel the trick is to combine ideas form ideologically opposed economic and political schools, find the best combination of governing tools that work for India, and build an informed (educated) as well as economically well-off society!

The models presented in the wiki article are much more modern and empirically sound than the Malthusian model, a special case of the economic resources based models that Adithya's ideas on facebook were reminiscent of. All modern sociologists agree that economic growth combined with education is what reduces reproductive rate.

Edit: Sajith, I noticed that the wiki article actually mentions what I said above about the decrease in birth rate decline. It linked to another page about something called the Demographic trap, which seems to be a formal representation of what I've said. Again, I understand that these are models but I think these models are being tested using observational data. See here: http://en.wikipedia.org/wiki/Demographic_trap

From the article:
Quote:The country's economic growth from the transition stage ends up being used to support the needs of the exploding population instead of economic and social development. As a result, the country cannot proceed to the final stage, post-transition, and remains in the 3rd stage. What may happen instead, as predicted indirectly by Thomas Malthus, is a Malthusian collapse, in which famine and disease ravage the country's population, lowering numbers dramatically.
"Fossil rabbits in the Precambrian"
~ J.B.S.Haldane, on being asked to falsify evolution.
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#9
(18-Jun-2010, 08:50 AM)Sajit Wrote: http://en.wikipedia.org/wiki/Demographic_transition

Very interesting, but definetely simplistic albeit a good starting point..
The Wiki itself says As with all models, this is an idealized picture of population change in these countries. The model is a generalization that applies to these countries as a group and may not accurately describe all individual cases

Western European countries violated normal pattern by plundering other countries' natural resources during centuries of colonialism. And good portions of their populations migrated to the New World (American continents). Also, the initial conditions of the countries themselves is not factored in. It appears that India/China/Indonesia had massive head starts in population in 1AD itself.. when the whole world was in Stage 1.
http://desip.igc.org/populationmaps.html
These initial conditions can easily create runaway effects.

But I fully agree that India could be stuck in Stage 3 and headed for the Demographic Trap.
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has - Margaret Mead
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