Health needs political commitment

Published: Thursday 15 September 2005

-- From population control to reproductive health; Malthusian arithmetic by Mohan Rao Sage Publications New Delhi 2004

Why do most medical graduates feel that India's biggest public health problems are population explosion or aids, and not high infant, child and maternal mortality rates? Why don't tuberculosis, malaria and hunger figure in their list of acute health problems afflicting people in the country? Why is family planning (read population control) regarded as the panacea for many of the nation's problems? And if indeed it is the solution, why has the family planning problem fallen short of all its objectives? Such questions have bothered me in my quest to unravel the mysteries of our public health system from a feminist perspective.

Answers The book under review answers them with systematic clarity. The first and second chapters of Population control to reproductive health explore the evolution and growth of the family-planning programme. It looks at the ideological underpinnings of the population control programme -- its Malthusian and neo-Malthusian underpinning foundations and some of the politics that moulded it. The third chapter provides us with disturbing data -- or rather the lack of it -- on who are the poor, on how does income, occupation, land holding, caste and class relate to family size. The book then looks at the paradigm shift in the population debate after the 1994 international conference on population and development (icpd) in Cairo, Egypt -- reproductive health and rights have a key role in sustainable development. The fifth chapter brings out the anomalies and the chief contradictions of the post- icpd phase: there is genuine commitment to reproductive rights, but years of coercion take a long while to disappear.

In a nutshell, the book's key message is that the country's public health system has always been dissociated with a political vision. The book ends with a serious message of caution: let us not forget our histories.

More data, please Mohan Rao writes eloquently. However, the book leaves one craving for more data -- particularly because the author has access to tomes of documents. But then one should not complain much. From population control to reproductive health should appeal to a broad spectrum: the academia, non-governmental organisation workers, the donor community, the media and feminists. It also has much relevance for those who work our public system -- crucial as they are, I wonder if they would pay any heed to it.

Anyhow, many have already found the book useful. For instance, workers of the ngo Care India foundation have found this book a good guide while working on the organisation's reproductive and child health nutrition programme. The programme targets seven million mothers and children in 10 states of the country.

The donor community with its diverse political interests and ideological stands, too, have found the book worth a read. Representatives of the New-Delhi based National Foundation of India have appreciated the theoretical underpinnings of the book, but feel that it's high time these should be translated to concrete action at ground level. Field workers of the us- based David and Lucile Packard feel that the book has little to offer by way of policy directives. They complain that Mohan Rao devotes much space to ideological posturing.

My friends and comrades in the women's movement have loved the book. It's relevant for women's organisations across the board: ranging from Sanhita in Kolkata (an organisation that focuses on advocacy programmes for gender mainstreaming with various social segments including youth, police and corporate houses) to the New Delhi-based International Council for Research on Women (a research-based international ngo for whom it's a wonderful challenge to translate the theoretical underpinnings of the book to concrete work).

ut will the book's understanding translate into concrete work at ground level? One waits for answers.

Sreela Das Gupta is with the International Council for Research on Women, New Delhi

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