Organization for Change: A Systems Analysis of Family Planning in Rural India.

Abstract

This is an examination of the implementation of family planning in the rural areas of northern India during the early 1970s. The information is based on surveys of villagers in rural Allahabad Division and workers in rural health centers and interviews with administrators and officials at the district and state level of the Ministry of Health. The material level of living is low for most of the population in Allahabad few villagers have been exposed to extensive formal education or to contacts with the outside world. Average age at which wives begin to live with their husbands is less than 15 years and begin to bear children before age 18. Infant mortality rate was 200/1000 birthrate was above 50/1000 for 1967-71. A basic reason for high fertility is the role which children play in the lives of parents. A superficial awareness of family planning methods is widespread among the village population but there is very little actual use of contraceptive methods; no more than 14% of the respondents were currently using or have ever used a contraceptive method including abstinence and rhythm method. Only 3.7% were using IUDs or male/female sterilization. Many of the findings support the conclusion that organization and client related factors explain the low use of contraception. Studies on the district and state level show that the majority of the family planning extension staff of the rural primary health care (PHC) centers are not working at expected levels. The nature of family planning programs motivation background training support and organization are discussed. Some problems which are identified are the size of the population the frequent shifts in responsibility changes in approach to family planning pressures of poverty discrepancies between targets and achievements use of coercive techniques. Although there has been expansion of the PHC network the family planning program as a whole has not met with great success. Only an approach that is attentive to the interelatedness and variety of client and organization related factors will help in understanding how the system should work. 3 general guidelines to be followed are: 1) the strategy for client transactions to be chosen has to be suited to the client population 2) the organizing strategy has to be suited to client strategy and 3) organizing strategy has to be suited to the institutional and political context within which it is implemented.