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(2) 人間科学研究. Vol.19, No.1 (2006). offering a one‑shot solution to the problem of the high rate of fertility in India. It was IUDs in the 1960s, vasectomy in the 1970s and tubectomy in the 1980s, where administrators, family planning workers and politicians put all their efforts into achieving the stipulated 'target by any hook or crook method. Thus, the program, which needed a delicate touch of social nurturing, became a game of sheer numbers (Govt. of India, 1978, 1982; Wadia, 1984). A number of clinics were opened during the first two plan periods (195ト61) to provide contraceptive services, especially for women at clinics through socially‑trained female workers. Moreover, during the third plan (1961‑66), the "clinic approach" was shifted to an "extension approach to provide information to all eligible couples about every contraceptive method offered by the program. However, from the early 1960s until the 1990s, the family planning management program of the country was hindered by government determined targets for contraceptive acceptance. Such an approach to achieve the targeted demographic goals received various criticism. Some of the reasons for the criticism, besides others, may be seen in the perspectives of the following weaknesses (cited in Tawari et ah, 1999) of the family planning programs:. Lack of holistic Lack of involvement Totally government based program. approach. Lack of need. Only women targeted for contraception. based program. Weaknesses of the Family Planning Program. +一一. iiiii I. /. Poor follow up. Poor counsel!∩9. Services. Target achievement had become a means to an end in itself rather than a guide. Nevertheless, several other factors contributed to India's paradigm shift. Government health workers were often apprehensive about reaching numerical targets and over‑reported the amount of contraceptive acceptance in their assigned area. Consequently, their pre‑occupation with targets fostered a lack of concern for the quality of care they provided to the family planning acceptance. Not soon enough, a major national policy shift occurred in 1994, after the Cairo conference, where a "Target‑Free Approach," was announced in 1996. This approach eliminated nationwide mandated targets for contraceptive acceptance, but continues to allow for locally determined targets at the community level, where grassroots workers were assigned targets for their service areas after assessing the needs of clients (Ashord, 2001). However, all efforts and increased five ‑14‑.
(3) Family Planning in India : Approaches and Achievements. yearly plan budgets on the program have not significantly slowed down the population growth of the country. There were/are some social constraints for not achieving the desired demographic ;oals of the country. In brief, these factors and related impacts have been: (i) Illiteracy‑ Lack of awareness and knowledge of FP methods & their use, belief in old traditional values'of having more children, (n) Poverty ‑ Belief in the system of dowry, fear of not gaining wealth from the marriage of children, (iii) Male dominated society‑ Low status of women, less importance given to women in decisions about them and household matters, emphasis on having more children, (iv) Sociaトculture‑religious Customs & taboos‑. Social insecurity, lack of interest in FP programs,. desire and preference of son, (v) Old age insecurity‑ Son preference ( Yadava,2003). After all the ups and downs demographic profiles indicate that India has entered into the third phase of demographic transition i.e., from a level of high birth rate ‑ high death rate" to a level qf "moderately high birth rate ‑ low death rate". Unmet need of family planning is currently increasing among married women who are not using any method of contraception but do not want any more children or want to wait for sufficient time before having another child. The main objective of this paper is to present a detailed account of India's family planning (FP) program and its related issues. The issues are discussed in the contexts of (i) historical experiments undertaken on family planning in India (1952‑1961), (ii) enforcement period of Family Planning (196ト1977), (iii) a changing and accelerating approach of FP (1977‑1994), (iv) new population policy and developments of FP( 1995 onwards), (v) current population dynamics of the country, and (vi) some concluding remarks.. 2. Family Planning during 1952‑1961 : An Historical Experiment Even before independence, a committee known as the Iヨhore Committee was set up in 1946 to. look into matters related to health and family planning programs in the country, though records show that birth control clinics have been functioning in the country since 1930. After analyzing reports the Government of India launched a nation‑wide family planning program m 1952, making it the first third world country to do so. As it has been mentioned in the introductory section, the family planning programs passed through several stages and it took nearly two decades to reach full maturity and countrywide coverage. The decade of the fifties was mostly a preparatory phase with the establishment of a few clinics and the distribution of educational material, training and research. The first Five Year Plan of the country allocated a sum of Rs. 6. 5 million for this job, but most of. it remained unspent (Wadia, 1984). As said above, the main work during this period related to the establishment of family planning services, and to provide public education and the training of personnel. Some of the significant moves of the government during this period towards family planning programs were to set up, among others, a Contraceptive Testing Laboratory (now the Institute for Research in Reproduction) and a Central Family Planning Demographic and Training Research Center (currently known as the International Institute for Population Studies). These Centers, no doubt, have acquired premier status. In 1959, the government declared its support for all methods of family limitation including sterilization. By 1961, there were 4, 165 family planning clinics in the country and program expenditure went up from Rs. 6. 5 million in. the first plan to Rs. 21. 6 million in the second plan period (Wadia, 1984).. ー15‑.
(4) 人間科学研究. Vol.19, No.1 (2006). 3. Family Planning during 1961‑1977 : An Enforcement Period India's family planning program accelerated its efforts during the sixties and seventies. One of the objectives of the sixties, apart from the promotion of family welfare services, was that of reduction in the population growth rate. The government set up a Central Family Planning Board (later called Council) as the apex advisory body consisting of all the Health Ministers of the States and Union Territories, representatives of some leading voluntary organizations like FPAI, IMA and others as its members, to provide a forum where the views of voluntary bodies on FP could be directly heard by the government. However, due to the slow pace of the program, demands came for more resulトoriented efforts. Consequently, during the third Five Year Plan (1961‑66), family planning was declared as the very centre of planned development. An immediate result of this was that the emphasis shifted from the clinic approach to the extension education approach"motivating people's acceptance of the small family norm". A new Department of Family Planning in the Ministry of Health was also created in 1966. During 1969‑74, the government gave top priority to the FP program and it was made an integral part of maternal and child health (MCH) activities of the primary health centers (PHCs) and their sub‑centers. An All India Hospital Postpartum Program and the Medical Termination of Pregnancy (MTP) were introduced in 1970 and 1972 respectively. Moreover, the tempo generated for the program towards sterilization during the third plan period was further accelerated, and additional emphasis was placed on the "camp approach for carrying out sterilizations. Introduction of methods like condoms, IUD, and later on oral pills, a "cafeteria approach" was established and a general momentum was build up for such methods to reach a larger segment of the people and far remoter regions. The Medical Termination of Pregnancy Act was also passed during this period in 1971. Ideas of incentives and disincentives of various types also came into existence during this period. The result of all these efforts were that the percentage of couples protected by family planning which was estimated t0 3. 0 percent in the third planJumped to 14. 0 in the fourth plan (1969‑74). However, the 1971 census of the country revealed that hardly any impact had been made on the birth rate. India‑s First National Policy on Population came up in April 1976. The legal minimum age of marriage was increased from 15 to 18 years for females and 18 to 21 years for males. A long‑term demographic goal was adopted by the country to reduce the net reproduction rate (NRR) to one, TFR to 2.3 and the crude birth rate to 21 by 2000. The publication of this population policy greatly helped to highlight and increase family planning activities in general. At the same time, the government also enunciated a 20‑point program for its socio‑economic development where the promotion of FP programs has been one of its objectives. Nevertheless, the plan period (1974‑79), witnessed a dramatic rise and fall of family planning acceptance in India. Performance of the family planning program during the years 1976‑77 was, no doubt, the best ever realized in the history of a population program in any country, with a total of 8. 26 million sterilizations. But unfortuǹately, the strong impetus and vigor that the program had acquired was marred by overkill in some places, mostly in Northern India. The outcry raised by politicians and others politicized the program as an election issue and it became a major cause for the ruling party losing the election. Consequently, the family planning program almost. collapsed. and. less. than. ‑a. million上sterilizations. ‑16‑. (one‑eighth. of. the. previous. year). were.
(5) Family Planning in India : Approaches and Achievements. performed during 1977‑78.. 4. Family Planning during 1977‑94: A Phase of Ups and Downs As mentioned in the previous section, a disastrous forcible sterilization campaign during 1975‑ 76 led to the defeat of then ruling Congress in the 1977 election, In June 1977, the new (Janata Party) Government that came into power formulated a new population policy, ruling out compulsion and coercion in all preceding programs. At the very beginning of the first term of this new government, the program suffered a serious setback and became a victim of political controversy and collapsed completely in 1977‑78. No doubt, this was the turning point responsible for the predicament that the country is now facing with a burgeoning population. However, the new Janata Party Government affirmed its support for family planning and announced its own National Policy in March 1977. The Ministry of Family Planning was renamed "Family Welfare". Nevertheless, this new policy was hardly any di仔erent from the previous one, except putting extra emphasis on a purely voluntary basis. In spite of its efforts, the program was not able to pick up momentum till the end of the seventies. Consequently, the percentage of couples protected, which had risen to 23. 5 per cent in 1976‑77 fell to 22.4 per cent in 1978‑79 and to 22. 3 percent in the following year. In 1980‑81 it again reached 23. 7 percent (estimates based on the 1981 Census). The sixth (1980‑85), seventh (1985‑90) and the eighth plans (1990‑95) viewed demographic goals from a wider perspective. It was realized that a desired birth rate could not be achieved without concomitant improvements in the conditions of the standard of living, especially infant and child mortality. Targets were redefined and the policy, which aimed to achieve a NRR of unity by the year 2000 shifted to 2006‑2011. The National Health policy of 1983 emphasized the need for "realizing the small family norm through voluntary efforts and moving towards the goal of population stabilization" and reiterated India's commitment to attain a status of Health for All by2000A.D. During this period, the National Development Council appointed a Committee (headed by Dr. M.S. Swaminathan) on population to formulate a National Population Policy for taking a "long term holistic view of development, population growth and environmental protection", to"suggest policies and guidelines for formulation of programs and "a monitoring mechanism with short, medium and long term perspectives and goals' (Planning Commission, 1992).. 5. Family Planning from 1995 Onwards : Developments On the eve of the 50th anniversary of India's Independence, then Prime Minister Mr. I.K. Gujral promised to announce a National Population Policy. In 1997, Cabinet approved the draft National Population Policy with the hope that it would be placed before parliament. However, the document could not be placed in parliament due to mid‑term dissolution of the Lok Sabha. In the meantime the International Conference on Population and Development, Cairo, September, 1994 provided an opportunity to pursue a family planning reform agenda with the national government, and the evidence generated from several years of discussions provided the impetus to overhaul the program (Ash ford, 2001). The Cairo conference recommended that the aim of the family planning program must be to enable couples and individuals to decide freely and responsibly on the number and spacing of their children and to have the information and means ‑17‑.
(6) 人間科学研究【Vol. 19, No.1 (2006) to do so and to ensure informed choices and make available a full range of safe and effective methods (Ministry of Health and Family welfare). In light of the Cairo conference another round of consultations were held during 1998, and a draR on National Population Policy was discussed and presented to the experts in November, 1999. After rigorous deliberations and suggestions, a fresh draft was submitted to Cabinet and a new National Population Policy (NPP‑2000) came into existence in March, 2000. The new NPP‑2000 affirms the commitment of the government towards voluntary and informed choice and the consent of citizens while supporting availing reproductive health care services and the continuation of the target free approach in administering family planning services. Some of the objectives of the NPP 2000 are to address the unmet needs for contraception, health care infrastructure, and to provide integrated service delivery for basic reproductive and child health care. NPP‑2000 addresses the need to bring down the total fertility rate (TFR) to a replacement level (TFR‑2. 1) and the crude birth rate (CBR) of 21 per thousand of the population by 2010. Other objectives of NPP‑2000 are to reduce the infant mortality rate to below 30 per 1000 live births and the maternal mortality rate to below 100 per 100, 000 live births. It has also put forward. a long‑term objective of population stabilization by 2045 (Padmanabhan, 2000, Westley and Retherford, 2000). Most of the Indian states have also formulated their own population policies taking care of the framework of the NPP‑2000 and are trying their best to achieve the first step in this direction, which is the goal of replacement fertility. During this period another round of the nationally representative sample survey National Family. Health. Survey‑II. (NFHS‑II)蝣(1997‑98). also. took. place.. According. to. NFHS‑II. (1998‑99). almost. all currently married women (99 percent) knew at least one modern contraceptive method. Women wereねmiliar with female sterilization (98 percent), followed by male sterilization (89 percent), the pill (80 percent), IUDs, and condoms (both 71 percent). Nearly one‑half (48 percent) of currently married women were found to be using contraception, up from 41 percent reported. at the time of NFHS‑I (1992‑93) (Westely and Retherford, 2000). It was also found that a majority of women currently using modern methods obtained family planning services from government sources (70 percent) followed by private medical services (17 percent), shops or other sources (5 percent) and NGOs (1 percent). The condom is perhaps one of the most easily available male contraceptive methods in India. But the wastage of condoms has been found to be very high. Sample data taken in three northern Indian states Haryana, Maharastra and Uttar Pradesh, showed overall wastage was about 63 percent. In fact in some of the PHCs the wastage was estimated to be more than 80 percent. The opinion of users was noted consistent with the opinion of service providers regarding the poor quality of Nirodh (Nangia, et al. 1998).. 6. Recent Demographic Trends : Fertility and Family Planning As mentioned in the introductory section, the fertility in India is continuing to decline. India, with a total population of more than lbillion (1. 027 billion; Indian census, 2001) has a total fertility rate of about 2.85 with a crude birth rate of 25 per 1,000 0f the population (NFHS‑II, 1998‑99). Table 1 provides some demographic population trends of the country, especially during the 20th century. It shows that a population of about 0.24 billion at the beginning of the 20th century ‑18‑.
(7) Family Planning in India : Approaches and Achievements. reached about one billion at the end of the century. Both birth and death rates declined from a high level of49.2 and 42.6 in 1911 to 24.8 and 8.9 per thousand of the population respectively in 2001 (Indian Census, 2001).. Table 1 Trends in Some Demographic Indices: India 1901‑2001 Y ear. P o p u la tio n. A V e ra g e a n n u a l. C ru d e. C ru d e. S e x R a tio. (in m i…0 n ). e x p o n e n tia l g ro w th. B irth. D e a th. (F e m a le s p e r. R a te. R a te. 10 0 0 m a ー e S). ra te 190 1. 2 3 8 .4. 972. 19 11. 2 5 2 .1. + 0 .5 6. 4 9 .2. 4 2 .6. 964. 192 1. 2 5 1 .3. ‑ 0 .0 3. 4 8 .1. 4 7 .2. 955. 193 1. 2 7 9 .0. + 1 .0 4. 4 6 .4. 3 6 .3. 950. 194 1. 3 1 8 .7. + 1 .3 3. 4 5 .2. 3 1 .2. 94 5. 19 5 1. 3 6 1 .1. + 1 .2 5. 3 9 .9. 2 7 .4. 946. 19 6 1. 4 3 9 .2. + 1 .9 5. 4 1 .7. 2 2 .8. 941. 19 7 1. 5 4 8 .2. + 2 .2 0. 4 1 .2. 1 9 .0. 930. 19 8 1. 6 8 3 .3. + 2 .2 2. 3 7 .2. 1 5 .0. 934. 19 9 1. 8 4 6 .4. + 2 .1 4. 3 2 .5. l l .4. 927. 20 0 1. 1 0 2 7 .0. + 1 .9 3. 2 4 .8. 8■ 9. 933. Source : Registrar General of India, Census figures.. Table 2 gives the status of various states and union territories in terms of total fertility rate and the percentage of current contraceptive use. It was found that the current use of modern family planning methods among currently married women also increased from NFHS‑I to NFHS‑II, i.e., during a gap of 5‑6 years from 1992‑93 to 1997‑98 except the percentage of male sterilization and IUD (Table3). It was found that female sterilization continues to be a dominant form of contraception in the country (NFHS‑II, 1998‑99). It was found that 16 percent of all currently married women have a need for contraception which was not being met (Table2). Among younger women (aged 15‑24), unmet needs were found to be even higher as compared to others. Majority (94 percent) of this unmet need was found for spacing and varies from state to state. It was, among major states, the lowest at 7 percent in Punjab to the highest at 25 percent in Uttar Pradesh and Bihar (NFHS‑II, 1998‑99). From Table 2 , it is obvious that the total fertility rate (TFR) was directly related with the current use of contraception among currently married women and the unmet need for family planning. States and union territories with a higher percentage of current use of contraceptive methods provided lower values of TFR and in these states, of course, the percentage of unmet need for family planning was also found to be higher as compared to other states. For example, the values of TFR in four large northern states (Uttar Pradesh, Bihar, Madhya Pradesh and Rajasthan) were respectively 3.99, 3.31.3.49 and 3.78, much higher than the national level (2.85), but the percentages of current use of contraceptive for these states were 28. 1, 24.5, 44.3 and 40.3 ‑19‑.
(8) 人間科学研究 Vol.19, No.1 (2006 Table2. S tate ∪n i0 n T e rritory. &. Some Demographic and Family Planning Indices in Various States and Union Territories of India M e an A g e a t M a rrlag e (fe m a le ). C u rre nt U Se of C o ntra ‑ ce ptiv es (% ). T o ta Fe rtility R a te. C P R m. o up le rote ctio n ate ‑ by all etho ds. U nm e t N ee d fo r Fa m ily P la n ning. (% ) IN D IA. 19 .7. 4 8 .2. 2 .85. D e lh i. 2 1.9. 6 3 .8. H a rya na. 19 .8. 6 2 .4. H im a nch al‑ P ra de sh. 22 .1. Ja m m u K as hm ir. 22 .5. 4 6.2. 15 .8. 2 .4 0. 2 7.0. 13 .4. 2 .88. 4 9 .4. 7● 6. 6 7 .7. 2 .14. 4 6 .9. 8● 6. 4 9 .1. 2 .7 1. 14 .4. 2 0 .0. 66 .7. 2 .2 1. 6 5 .6. 7■ 3. 4 0 .3. 3 .78. 3 6 .1. 17 .6. N o rth. &. P u njab. 2 2 .1. R ajastha n. 18 .3. C e ntra l M ad hya ‑ P rad es h. 18 .9. 4 4 .3. 3 .3 1. 4 5.9. 16 .2. U ttaト P rad es h. 19 .0. 28 .1. 3 .99. 38 .0. 2 5 .1. B iha r. 18 .8. 2 4 .5. 3 .4 9. 2 1.2. 2 4 .5. O rissa. 2 1.2. 46 .8. 2 .4 6. 3 7 .6. 15 .5. W e st B e ng a l. 19 .6. 66 .6. 2 .2 9. 32 .2. l l.8. 2 6 .5. Ea岳 t. N o rth ea st A ru na cha l‑ P ra de sh. 2 1.6. 35 .4. 2 .52. 14 .0. A ss a m. 2 1.7. 4 3 .3. 2 .3 1. 15 .2. 17 .0. M a n ipu r. 2 5 .4. 38 .7. 3 .04. 17 .8. 2 3 .6. M e g ha laya. 2 3 .0. 20 .2. 4 .57. 4■ 7. 3 5 .5. M iz ora m. 2 4 .1. 57 .7. 2 .89. 34 .3. 15 .5. N a ga la nd. 23 0. 30 .3. 3 .77. 8■ 2. 3 0 .2. S ikk im. 2 1.9. 53 .8. 2 .7 5. 2 1.5. 2 3 .1. G oa. 24 .8. 4 7 .5. 1 .77. 2 3 .9. 17 .1. G uja rat. 20 .2. 59 .0. 2 .72. 52 .8. 8 .5. M a ha raStra. 19 .8. 60 .9. 2 .52. 4 9 .3. 13 .0. A nd hra‑ P ra de sh. 18 .3. 59 .6. 2 .25. 5 2 .8. 7■ 7. K a rna ta ka. 20 .1. 58 .3. 2 .13. 56 .3. ll .5. K e ra la. 2 1.5. 63 .7. 1 .96. 3 9 .6. ll .7. T a m ilN ad u. 皇 0■ 9. 52 .1. 2 .19. 5 0 .4. 13 .0. W e st. S o u th. Source : National Family Health Survey‑ll (1997‑98).. ‑20‑.
(9) Family Planning m India : Approaches and Achievements respectively, lower values than the national level (48. 2). Moreover, the percentage ofunmet need for family planning in these states was found higher than other states with few exceptions. Table3provides information about current use of modern contraceptive methods among currently married women aged 15‑49 in two National Family Health Surveys, i.e., NFHS‑I and NFHS‑II conducted in 1992‑93 and 1998‑99 respectively. Table3. Current Modern Contraceptive Use among Cu｢rently Married Women Aged 15‑49. F am ily P la nn ing M e tho d. P e rce nta ge C urre nt■ y U sing N F H S ‑1. N F H S ‑2. A n y M o de rn M etho d. 3 6 .5. 4 2 .8. Fe m ale S te rHiz atio n. 2 7 .4. 34 .2. M a e S te rihza tio n. 3■ 5. 1■ 9. P…. 1■ 2. 2■ 1. IU D. 1■ 9. 1■ 6. ′2 ■ 4. 3 .1. 4■ 3. 5■ 0. 4 0 .8. 4 7 .8. C o nd o m A ny T ra ditio n a lM e tho d T o tal. Source : Westley and Retherford (2000) and NFHS‑II (1998‑99). A correlation matrix (Table4) shows a very significant relationship (‑0. 763; P<0. 01) between TFR and current contraceptive (CC) use among currently married women, i.e., the higher the contraceptive use the lower the value of TFR. TFR was found to be highly and positively associated (0.715 ; P<0. 01) with the unmet need for family planning (UNFP). However, both CC and UNFP are found to be highly and negatively correlated仁0.893; P<0.01). To predict the value of TFR with the help of current use of contraceptive (CC), a regression equation may be used as follows ;. 世om Table 2).. TFR‑ ‑ 0. 038(CC) + 4. ,. Tab】e4. M atrix Total Fertility ′ R ate ◆ M ean A ge at M arriage. Total R ate. Fertility. 1. Corre】ation Matrix. M ean A ge M arrlage. at C urrent U se of U nm et Need for C ontraceptives Fam ily Planning. ‑0.13 1. ‑0.763. 0.7 15. 1. ‑0.058. 0.302. 1. ‑0.893. C urrenト U se of C ontraceptives. 1■. U nm et N eed for Fam ily Planning ‑21‑.
(10) 人間科学研究 Vol.19, No.1 (2006) In this case the R‑square was found to be 0.582. This means that current contraceptive use explains about 58 percent of the TFR of the country. Trends in family planning acceptance in the country after the eighties and the amount of expenditure provided by the government for the family planning/welfare services are shown in Appendix Tables 1 & 2. Though the absolute number of FP acceptance has increased during this period but the proportion increase in FP acceptance has not been significant. It is also worth mentioning that increment undertaken in the area of expenditure on family welfare services has not been significant as compared to the total national budget for various five year plan periods, apart from a few plans at the beginning. The government allocated larger budgets for family planning programs and health services during the fourth (1969‑74), seventh (1985‑90) and ninth (1997‑2002) plan periods in comparisons to other plans.. 7. Evaluation of Family Planning Programs and Concluding Remarks This review study reveals that India's family planning program has been associated with numerous misconceptions. One of them has been its strong perception in the minds of people towards sterilization where it has been equated with birth control. Its welfare concept only came into existence two‑three decades a托er its inception. However, an effective solution to the population problems of the country, above all lies in its sOClO‑economic development, needless to mention that the key for the success of any population policy should be an objective towards a better standard of living and for rapid socio‑economic development. Thus, the basic population issues of the 21st century may be the solution to these problems. The future course of fertility transition in the country, no doubt, may depend on the performance of the four large Hindi speaking northern states of Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh (inclusive of three newly formed states of Jharkhand, Chhattisgarh and Uttaranchal) as these states together account for nearly 40 percent of the country's total population. These states lag behind considerably on various social and economic development indicators, and as a consequence not only is the rate of fertility relatively higher in these states, but the changes in these states also appear to be at a slower pace. This has drawn special attention from social scientists, policy makers and planners of the country and other international agencies (Ram and Agrawal, 2003). During the last three decades, India has seen a transition in the age of marriage from the childhood (i.e. a very early age) to the adolescent years. Evidence shows that there are over 13 million married women under the age of 18, the legal age of marriage (Sharma, 2000). This implies that the Marriage Act of 1978 seems to have had no significant impact on the age of marriage, especially in rural India. Therefore, in order to bring about a rise in age of marriage, a congenial social change is needed wherein teenagers are able to accommodate modern ideas before they become parents. Findings of NFHS‑2 on actual and desired fertility levels have important policy implications. In societies where the desired rate of fertility is high, family planning programs need to address the attitudes of women and their husbands towardねmily size. On the other hand, in societies where the desired fertility is lower than the actual fertility, programs need to look at the availability and quality of family planning services and to identify the reasons why women are having more ‑22‑.
(11) Family Planning in India : Approaches and Achievements. children than they would prefer (Westely and Retherford, 2000). As discussed above, the unmet need for contraception was found to be relatively higher among young women who would be the primary clients for spacing methods. Women, particularly young women, who were in the process of family building expressed a strong need to space their births, yet few were using spacing methods. Thus an outreach effort needs to be made to help young women and men to understand how the available spacing methods would help in meeting their desired fertility level. Moreover, efforts need to be made to involve the private sector for the promotion of spacing methods, in general, and condom use, in particular. Studies have indicated that son preference is now declining in almost all states and socio‑ economic groups. For India as a whole, the ideal sex ratio (the ratio of ideal number of sons to ideal number of daughters) fell from 1. 43 to 1. 35 during the six years between NFHS‑land NFHS‑ 2. Nevertheless, ideal sex ratios are still much higher than the biological norm of 1.05. This difference implies that considerable potential exists for further increase in the level of sex‑ selective abortion in the country. This potential is greatest in states that currently have very strong son preference (Mutharayappa, et al, 1997; Retherford and Roy, 2003).. REFERENCES Ash ford, L. S., 2001, "New Population Policies: Advancing Women's Health and Rights. Population Bulletin, PRB, Vol.56, No.l. Brown, G. E., Jain, A. K., Laing, J. E. and Jansenll, W. H.,1982, Analysis oflndia's Population‑ Policies and Programs, Population Council, Thailand. Chandrasekaran, C, 1999, The Life and Works of a Demographer: An Autobiography, New Delhi, Tata McGrau‑Hill. Chandrasekhar, S., 1967, India's Population: Facts, Problem and Policy, Delhi, Meenakashi Prakashan. ESCAP, 1982, Population of India, New York, United Nations. Government of India, 1972, Country Statement for India: Second Asian Population Conference, Tokyo, 1‑13 November, 1972, New Delhi. Government of India, 1978, Central Calling, March 1978, Department of Family Welfare. Government of India, 1982, Yearbook 1980‑81, Ministry of Health and Family Welfare. Government of India, Census of India, 1991, Provisional Population Totals, Series‑I, New Delhi. Government of India, 2000, National Population Policy‑ 2000, Ministry of Health and Family Welfare, New Delhi. Gwatkin, D. R., 1979, "Political Will and Family Planning: The Implications of India‑s Emergence Experience', Population andDevelopmentReview, 5: 1, pp.29‑59. Joshi, B. K.,1999,"On Political Constraints to the Development of Uttar Pradesh", Paper presented at the Roundtable Conference on Population Stabilization and Related Development Issues m Uttar Pradesh during Jan. 8‑9, Lucknow. Mamoria, C. B., 1965, Population and Family Planning in India, Allahabad, Kitab Mahal. Mutharayappa, M., Choe, M. K., Arnold, F. and Roy, T. K., 1997, "Son Preference and Its Effect on Fertility in India", NFHSReports, No. 3 (March). Nangia, P., Singh, S. K., Ram, F. and Pandey, A., 1998, Use and Wastage ofNirodh in Three Selected States of lndia (Haryana, Maharastra and Uttar Pradesh), International Institute for ‑23‑.
(12) 人間科学研究. Vol.19, No.1 (2006). Population Sciences, Mumbai. National Family Health Survey, 1992‑93 and 1998‑99, Bihar, Madhya Pradesh, Rajasthan and Uttar Pradesh Reports, International Institute for Population Sciences, Mumbai. National Family Health Survey, 1992‑93 and 1998‑99, India, International Institute for Population Sciences, Mumbai. Pai P., V. A. and Umashankar, P. K., 1994, "Fertility Control and Policies in India , in Jason L. Finkle and C. Alison Mclntosh(eds.), The New Politics of Population: Conflict and Consensus in Family Planning, New York, Population Council, pp.89‑104. Planning Commission, 1952, The FirstFive YearPlan:1951‑56, New Delhi. Planning Commission, 2001, Indian Planning Experience: A Statistical Profile, New Delhi. Padmanabhan, B. S., 2000, Population Policy 2000‑Population and Development , Yojana, Vol. 44, No.8. Population Council of India, 1963, The Singur Study , Studiesin FamilyPlanning, Vol. 1, 1‑4. Rama, B. L., 1988, Population Policy, Delhi, B. R. Publishing Corporation. Raina, B. L., 1990, Family Planning in India: Prevedic Times to Early 1950's, New Delhi, Commonwealth Publishers. Ram, U. and Agrawal, P. K., 2003, "Madhya Pradesh: Prospects and Constraints of Achieving Replacement Level Fertility by 2010", Paper presented in Seminar on "Critical Issues in the Implementation of Madhya Pradesh Population Policy during Jan. 23‑25, Bhopal, India. Registrar General and Census Commissioner, India, 1994, Sample Registration System, New Delhi. Registrar General and Census Commissioner, India, 1995, Sample Registration System, New Delhi. Retherford, R. D. and Roy, T. K., 2003, "Factors Affecting Sex‑selective Abortion in India , NFHS Bulletin, No.17 (January).. Samuel, T. J., 1966,"The Development of India's Policy of Population Control', MilbankMemorial Fund Quarterly, January. Sharma, K., 2000, "Adolescent Motherhood , PEN‑Population and Family Life Education, Vol.24, No.3. Srinivasan, K., 1999, "From the Editor's Desk: The Indian Mode of Fertility Transition , DemographyIndia, Vol. 28, No.l. Talwar, P.P., 1999, "Organizational Issues in Family Welfare Program , Paper presented at the Roundtable Conference on Population Stabilization and Related Development Issues in U.P., Lucknow, Jan. 8‑9. Tawari, K., Dwivedi, V. N., Joshi, L. M. and Pant, H.,1999, "Imperative of Involving Panchayat Raj Institutions in Population Stabilization ', Paper presented at the Roundtable Conference on Population Stabilization and Related Development Issues in U.P., Lucknow, Jan. 8‑9. Visaria, L. and Visaria, P., 1998, Reproductive Health in Policy and Practice: India, Washington, D C, Population Reference Bureau, 1998.. Wadia, A. B., 1984, "The Family Planning Program in India : The Non‑governmental Sector', The Journal ofFamily Welfare, Vol. 30, No.4. Wadia, A. B., 2001, The Lightis Ours: Memoir andMovements, London, IPPF. Westle, S. B. and Retherford,‑.R. D., 2000了̀New Survey Measures: Fertility､and Family Planning ‑24‑.
(13) Family Planning in India : Approaches and Achievements Trends in India , Asia‑Pacific & Population Policy, No.55 (October). Yadava, K. N. S., 2003, "Some Social Constraints in Delaying Fertility Reduction in U.ttar Pradesh State of India , Paper presented in the Annual Conference of Population Association of America, Los Angeles, U.S.A., March 27‑29.. Appendix‑1 Chronological Stages in the Family Planning Programs in India. 1930 : The Bhangi Samaj (a women's organization) Bombay established a family planning clinic. 1946 : Appointment of Bhore Committee (The Committee on Health, Survey and Development of the Government of India). 1949 : Establishment of Family Planning Committee (FPC). 1950 : FPC renamed as Family Planning Association of India (FPAI). 1951 : Planning Commission includedねmily planning in the Health Chapter of the First Five Year Plan, 195ト56. 1952 : Launched First family planning program in the country. 1953 : Establishment of a Population Committee for Demographic Research. 1971 : Medical Termination of Pregnancy Act. 1975‑77 : Emergency Period. 1976 : First National Population Policy. 1977 : Modifications in the National Population Policy, 1976. by the New (Janata Party ). Government at the Centre. Family Planning Program is renamed as Family Weiねre Program. 1978 : Child Marriage Act. 1983 : National Health Population came into existence and emphasized the need for a separate National Population Policy. 1986 : Second National Population Policy. 1991 : Appointment of a committee by the government to work out on the National Population Policy. 1992‑93 : National Family Health Survey‑I included information on family welfare programs and achievements. 1994 : Cairo Conference. 1996 : Target‑free Approach. 1997 : A fresh draft was prepared on the National Population Policy. 1997‑98. :. National. Family. Health. Survey‑II. took. place. and. included. various. welfare programs and achievements. 2000 : National Population Policy came into existence in March‑2000.. ^o. information. o′n. family.
(14) 人間科学研究 Vol.19, No.1 2006 Appendix Table 1 Family Planning Acceptance by Methods‑ All India (Figures in thousands) Y ea r. S terilization s. IU D .In serー. E q u iv ale n t. E q u iv a len t. T o ta l. tio n s. C ondom. O ra l. A c ce p ta n c e. U se rs. U sers. E q uiv ale n t S ten h z a‑ tio n s. 1. 2. 19 80 ‑8 1. 2 ,0 5 3 (3 1.6 ). 6 2 8 (9 .7 ). 3 ,7 1 8(5 7 .3 ). 9 1 (1.4 ). 6 ,4 9 0. (1 0 0 .0 ). 2 ,4 7 9. 19 8 5 ‑8 6. 4 ,9 0 2 (2 5 .9 ). 3 ,2 7 4 (1 7 .3 ). 9 ,3 8 7 (4 9 .6 ). 1 ,3 5 8 (7 .2 ). 18 ,9 2 1 $ (10 0 .0 ). 6 ,6 6 5. 19 9 0 ‑9 1. 4 ,12 6 ( 15 .1). 5 ,3 7 0 (1 9 .6). 14 ,7 3 5 (5 3 .9 ). 3 ,12 5 (l l .4 ). 2 7 ,3 5 6. (1 0 0 .0 ). 7 ,0 82. 19 9 1‑9 2. 4 ,0 9 0 ( 15 .9 ). 4 ,3 8 6 (1 7 .1 ). 13 ,8 7 5 (5 3 .9 ). 3 ,3 6 6 (13 .1). 2 5 ,7 1 7. (1 0 0 .0 ). 6 ,6 9 7. 19 9 2 ‑9 3. 4 ,2 8 6 (15 .9 ). 4 ,74 0 (1 7 .5 ). 1 5 ,0 0 4 (5 5 .5 ). 3 ,0 0 1 (l l .1). 2 7 ,0 3 1. (1 0 0 .0 ). 7 ,0 3 3. 19 9 3 ‑9 4. 4 ,4 9 7 ( 14 .0 ). 6 ,0 1 7 (1 8 .7 ). 17 ,2 8 3 (5 3 .8 ). 4 ,3 0 2 (13 .4 ). 3 2 ,0 9 9 $ ( 10 0 .0 ). 7 ,9 4 1. 19 9 4 ‑9 5. 4 ,5 8 0 ( 13 .5 ). 6 ,7 0 2 (1 9 .8 ). 17 ,7 0 7 (5 2 .3 ). 4 ,8 7 3 (14 .4 ). 3 3 ,8 6 2. (1 0 0 .0 ). 8 ,3 3 9. 19 9 5 ‑9 6. 4 ,4 2 2 (13 .1). 6 ,84 8 (2 0 .4 ). 17 ,2 9 7 (5 1 .4 ). 5 ,0 9 1 (15 .1). 3 3 ,6 6 8. (1 0 0 .0 ). 8 ,2 3 5. 19 9 6 ‑9 7. 3 ,8 7 0 (12 .1). 5 ,6 8 1(1 7 .7 ). 17 ,2 1 4 (5 3 .8). 5 ,2 5 0 (16 .4 ). 3 2 ,0 1 5. (1 0 0 .0 ). 7 ,3 0 3. 1 9 9 7 ‑9 8. 4 ,2 3 9 (12 .6 ). 6 ,1 7 3 (1 8 .4 ). 1 6 ,7 9 6 (5 0 .0 ). 6 ,3 9 5 (19 .0 ). 3 3 ,6 0 3 $ ( 10 0 .0 ). 7 ,9 4 0. 1 9 9 8 ‑9 9. 4 ,2 0 7 (12 .1). 6 ,0 8 3 (1 7 .5 ). 1 7 ,4 4 8 (5 0 .3 ). 6 ,9 4 4 (2 0 .0 ). 3 4 ,6 82. (1 0 0 .0 ). 7 ,9 7 5. 1 9 9 9 ‑0 0. 4 ,5 9 5 (12 .5 ). 6 ,2 0 0 ( 16 .9 ). 1 8 ,1 3 5 (4 9 .4 ). 7 ,7 4 7 (2 1 .1). 3 6 ,6 7 8. (1 0 0 .0 ). 8 ,5 3 0. 2 0 0 0 ‑0 1. 4 ,7 3 5 (12 .9 ). 6 ,0 4 6 (1 6 .5 ). 1 8 ,2 0 2 (4 9 .7 ). 7 ,64 0 (2 0 .9 ). 3 6 ,6 2 3. Note:. 3. 4. P ill. 5. b. (1 0 0 .0 ). 7. 8 ,6 1 0. Sum of the figures given under Cols. 2, 3, 4 & 5 may not ta‖y with the figures. under Col. 6 due to rounding off. Equivalent Sterilizations have been calculated by a revised formula by adding the number of Sterilizations, 1/3 the number of IUD Insertions, 1/18 the number of Equivalent Condom Users and 1/9 the number of Equivalent Oral Pill Users. Figures in brackets indicate percentage to total acceptance for each year.. Source : Department ofFamily Welfare, Ministry of Health & Family welfare, India.. ‑26‑.
(15) Family Planning in India : Approaches and Achievements Plan Appendix Tab】e2 Outlay on Health and Family Welfare in Different States and Union Territories. P erio d. T o ta l P lan. %. (R s. in C ro re s). o f H e alth to T o ta l. % o f F am ily W e lfa re to T o ta l. T h ird P la n. (19 6 1‑6 6 ). 8 ,5 7 6 .5. 2 .6. 0 .3. A n n u a l P la n (19 6 6 ‑6 9 ). 6 ,6 2 5 .4. 2 .1. 1● 1. F o u rth P la n. (19 6 9 ‑7 4 ). 1 5 ,7 7 8 .8. 2● 1. 1● 8. F ifth P la n. (19 74 ‑7 9 ). 3 9 ,4 2 6 .2. 1◆ 9. 1.2. A n n u a l P la n. (19 7 9 ‑8 0 ). 12 ,17 6 .5. 1● 8. 1● 0. S ix th P la n. (1 9 8 0 ‑8 5 ). 9 7 ,5 0 0 .0. 1 .9. 1■ 0. 1 8 0 ,0 0 0 .0. 1● 9. 1 .8. 19 9 0 ‑9 1. 6 1 ,5 18 .1. 1 .6. 1● 3. 19 9 1‑92. 6 5 ,8 5 5 .8. 1● 6. 1● 3. 4 34 ,10 0 .0. 1◆ 7. 1■ 5. 8 5 9 ,2 0 0 .0. 1● 4. .6. S ev e n th P la n (19 8 5 ‑9 0 ) A n n u a l P la n s. E ig h th P la n N in th P la n. (19 92 ‑9 7 ) (1 9 9 7 ‑2 0 0 2 ). Source : Ministry of Health and Family Welfare.. ‑27‑.
(16) 人間科学研究 Vol.19, No.1 (2006. インドの家族計画一方法と成果‑ 嵯峨座晴夫, Alok KUMAR. 抄. 録. 本稿は､インドの家族計画プログラムとそれに関連する諸問題をとりあげて論じることを目的とする｡イ ンドにおいて出生率の低下が遅れた根本の理由は､家族計画に関する政策が度々変更されたことにある｡ 20 世紀中葉(1952年)という早い時期に､世界で初めて国家レベルの家族計画が着手されて以後､インドの家 族計画プログラムは､設定された目標が社会的､経済的､政治的な諸困難のためにいつも達成されることが なかったので､その目標が度々変更されてきた｡そのことが､家族計画の実施に大きな影響を与え､その結 果そこに浮沈の歴史が形づくられることとなった｡本稿では､このインドの家族計画プログラムの変動過程 を分析し､そこでの問題点と今後の課題を明らかにする｡ここでは､主としてインド政府の資料､人口セン サス結果､人口動態統計､全国家族健康調(NFHS)､ユニセフの資料などを用いて分析を進める｡その結果､ 家族計画プログラムの実施に当たっては中央政府と州政府の協力のもとに､人口増加を抑制し人々の生活水 準を上昇させるために､マクロとミクロのレベルの両面から目標達成へ向けての更なる努力が必要であるこ とが指摘される｡. ‑28‑.
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