It is evident which gives details of the number of family planning acceptors by methods since 1956, that the family planning programme has had several ups and downs, specially when sterilization is considered.
The number of sterilizations increased from 7,153 in 1956 to 1.84 million in 1967-68 after which the figure declined to 1.33 million in 1970-71. When mass vasectomy camps were organized in 1971-72 and 1972-73, 2.19 million and 3.12 million sterilizations respectively were performed in these two years.
In 1973-74, there was a bad slump; with only 942 thousand sterilizations because the camp approach was abandoned.
What was distressing was the fact that the performance in 1973-74 was worse than the performance in 1966-67. In 1974-75; however, there was some recovery, and 1.35 million sterilizations were performed.
The achievements in the field of family planning, specially as related to sterilization, during the two years 1975-76 and 1976-77, when the country was in a state of national Emergency, were spectacular.
In 1975-76, 2.67 million sterilizations were performed; an increase of 95.5 per cent over the achievement of 1974-75; and this figure suddenly shot up to 8.26 million in 1976-77, more than three times the number done in the previous year.
The break-up of these figures into male and female sterilizations is also quite revealing. While in 1975-76, 54 per cent of the sterilizations were performed on males; in 1976-77 this percentage was 75.
It is also revealing that the number of vasectomies done in 1976-77 was more than four times than in the previous year; the number of tubectomies was about twice the number done in the previous year.
In the year 1977-78, there was a definite slump, with less than a million sterilizations done, hardly one-fifth of which were vasectomies, indicating that vasectomy had lost favour with the people.
In 1978-79 there was some recovery with 1.5 million sterilizations done, about one-fourth of which were vasectomies. In 1979-80, only 1.8 million sterilizations were done and in 1980-81, though the performance may be said to have improved slightly, a little more than two million sterilizations were done.
Sterilization has definitely gained lost ground with 4.18 million sterilizations done in 1989-90. During the period 1990-91 to 1996-97, the number of sterilizations has ranged from 4.09 million (1991-92) to 4.57 million (1994-95).
It may, however, be pointed out that vasectomy has not yet gained lost ground and continues to be much less favoured than female sterilization.
As for the IUD, there were 9.1 lakh insertions in 1966-67; the highest mark ever reached till 1982-83, was when more than a million IUD insertions were done.
The popularity of the IUD after 1966-67 slumped, reaching its lowest level in 1972-73, with only 3.5 lakh insertions. The year 1973-74 showed some slight improvement, with 3.7 lakh insertions. In 1974-75, there was a further rise, with 4.3 lakh insertions.
Though during the period of the Emergency, the IUD programme also recorded some improvement over the previous years, with 6.1 lakh insertions in 1975-76 and 5.8 lakh insertions in 1976-77, it never reached the level of the performance of 1966-67, when the IUD was first introduced in the programme till 1982-83.
After the lifting of the Emergency, as in the case of sterilization, the IUD programme also slumped with only 3.3 lakh insertions, the lowest level ever reached since the IUD was introduced in the programme. In 1978-79, there was some recovery, with 5.5 lakh insertions.
The year 1979-80 recorded a further improvement in the IUD programme, with 6.3 lakh insertions, whereas in 1980-81 there was again a slight fall with 6.2 lakh insertions.
The IUD now appears to have gained popularity with 7.5 lakh insertions done in 1981-82 and 2.56 million in 1984-85. Since then, the IUD has done very well with 4.94 million insertions done in 1989-90.
Since 1991-92, the number of IUD insertions has been steadily increasing, reaching the figure of 6.85 million in 1995-96, with a slight fall in 1996-97 (5.68 million).
As for users of conventional contraceptives, mainly Nirodh, the numbers have generally been on the increase, with about 14 million users of Condom in 1989-90. In the 1990s, up to 1996-97, this figure has ranged between 13.88 million (1991-92) and 17.7 million (1994-95).
In recent years, the users of oral contraceptives have also been on the increase, with about 3 million such users in 1989-90. In 1996-97, this figure over-reached the five million mark 5.25 million).
The achievements of the family planning programme can also be assessed on the basis of the extent to which targets laid down for different methods of family planning were reached. The mechanism of setting such targets leaves much to be desired.
For the purposes of this discussion, however, it is enough to point out that except for the two years of the Emergency (1975-76 and 1976- 77) it was only in 1971-72 that the target for sterilization was over-reached (105.2 per cent), and this was the year when the mass vasectomy camps were organized.
Up to 1975-76, the achievement ranged between 41.6 per cent in 1973-74 to 67.7 per cent in 1974- 75. The period of the Emergency warrants special consideration.
In 1975-76, 107 per cent of the target had been reached, the performance being close to that of the year 1971-72, when mass vasectomy camps were organized (105 per cent). In the year 1976 77, 192 per cent of the target had been reached.
In the year 1984- 85, this percentage was 70. The performance has since increased and in 1989-90, this percentage was 77.
During the period 1990-91 to 1995-96, the achievement ranged between 71.1 per cent (1990- 91) and 86.8 per cent (1993-94). Since 1996-97, method wise targets have been discontinued.
An examination of the service statistics reveals an extremely interesting picture. Several States, especially in North India and North East India, which had till then never done well in family planning, suddenly began to show spectacular results, especially in so far as the implementation of the sterilisation programme was concerned.
A comparative picture of their performance may be studied on the basis of the figures for 1974-75, and 1976-77. In 1974-75, the percentage achievement of sterilisation targets for the States of Bihar, Madhya Pradesh, Uttar Pradesh and West Bengal were 13.2, 31.2, 26.7 and 35.6 respectively.
For the year 1976-77, the corresponding percentages were 2290.0, 374.3, 209.4 and 224.3 respectively. These same States also recorded phenomenal percentage increases in 1976-77 over their previous year’s performance in terms of the actual operations performed: 782.2, 792.8, 550.7 and 526.4 respectively.
Those States which, in 1974- 75, had achieved almost cent per cent or even higher percentages of their sterilisation targets also did much better in 1976-77, except Kerala, where the target was not achieved, and Tamil Nadu, which registered only a slight improvement.
The performance of other States in terms of the percentage of target achievement in 1974-75 and 1976-77 respectively were as follows: Gujarat, 139.5 per cent and 425.3 per cent; Maharashtra, 125.3 per cent and 153.5 per cent; Punjab 95.2 per cent and 299.8 per cent.
The nation’s capital, Delhi, surpassed all other areas with sterilisation target in 1976- 77. The percentage increases in 1976-77 over the previous year’s sterilisation performance for selected States were: Delhi, 515.4 per cent; Haryana, 281.6 per cent; Punjab, 162.6 per cent; Tamil Nadu, 110.5 per cent; Gujarat, 107.2 per cent.
On the other hand, Maharashtra (41.0 per cent) and Kerala (31.9 per cent) did not show any marked improvements over their previous year’s sterilisation performance.
The position in 1988-89 indicated that among the major States, the following had exceeded their targets: Uttar Pradesh, Haryana, Kerala, Madhya Pradesh, Punjab, Tamil Nadu.
In 1994-95, among the bigger States Gujarat, Kerala, Madhya Pradesh, Maharashtra, Punjab and Tamil Nadu had exceeded the target and in 1995-96, Gujarat had just managed to reach its target and Punjab had overreached it.
For the IUD, the highest achievement of the targets was 104.9 per cent in 1986-87 and the lowest was 32.6 per cent in 1977-78. Over the years, the achievement of the targets for users of conventional and other contraceptives has been on the increase, with 1987-88 (105.5 per cent) recording the peak.
Since 1979-80, targets have been set separately for equivalent oral pill users, and the highest mark reached so far was in 1986-87 when the achievement was 182.9 per cent.
During the period 1990-91 and 1995-96, the achievement for condom users ranged between 81.3 per cent (1994-95) and 91.1 per cent. For the same period, the achievement for oral pill users ranged between 83.5 per cent (1995- 96) and 127.0 per cent (1991-92).
It may be noted that in 1995-96, method specific targets were not fined for Kerala and Tamil Nadu as well as one or two districts in other States on 1 March 1996, all targets were withdrawn from the entire country.
Another method of assessing the effectiveness of the family planning programme is to take into account the number of persons “currently protected” by various methods of family planning for directly arriving at this number, survey data are required, but it is difficult to undertake repeated surveys at regular intervals on a nationwide basis.
In India, a simple methodology has been developed to arrive at the number of coupled currently protected on the basis of the service statistics that are routinely collected in the course of the implementation of the family planning programme.
The number of couples currently protected by sterilisations is obtained from the total number of sterilisations performed since the inception of the programme after allowing for attrition due to mortality and ageing.
This methodology takes into account (a) the latest age distribution of the acceptors, and (b) the latest estimates of joint survival ratios
of husbands and wives in different age groups.
For IUD, in addition to ageing and mortality, attrition due to pregnancies and expulsions has also to be taken into account. The annual attrition rate for IUD acceptors is assumed to be 37.6 per cent.
For conventional contraceptives and other methods, the number of “equivalent” conventional contraceptive users is taken as “currently protected” for that year, with no carry-over effect, since protection lasts only during the period of use.
The number of equivalent users is computed on the assumption that each user would require 72 Nirodhs per year. For foam tables, too, 72 is the accepted figure. Three tubes of jelly and one diaphragm per year are assumed to be the requirements of users of the diaphragm and jelly method.
For users of oral contraceptives, 12 cycles of pills are considered to be the requirements for one year. By dividing the total pieces/cycles distributed in one year the number of users of a particular method is arrived at.
Though the validity of these assumptions may be questioned on several grounds, they form the basis of an easy method of computing the number of users on the basis of the number of distributed pieces/cycles of a particular contraceptive.
The number of effectively protected couples is arrived at by multiplying the number of couples currently protected by the factor of use-effectiveness of the method.
The use-effectiveness for sterilisation, IUD, equivalent conventional contraceptive users and equivalent oral pill users is taken as 100 per cent, 95 per cent, 50 per cent and 100 per cent respectively.
It is evident from Table 14.6 that the progress of the programme on the basis of “currently protected” couples is not very satisfactory. By 1996-97 only 51.2 per cent of the 162 million couples in the reproductive ages was “currently protected” by some method of family planning.
The major share went to sterilisation (29.6 per cent), with IUD and equivalent other contraceptives accounting for only 7.8 per cent and 13.5 per cent respectively of these couples. The percentage of effectively protected couples was 45.4 in 1996-97.
The impact of the family planning programme may also be determined by estimating the number of births averted by it, which in broad terms is equal to the difference between the fertility that would have occurred if family planning had not been practiced and the actual fertility of the acceptors of different methods of contraception.
The official estimate is that since inception of the programme up to 1996-97 a total of 212.21 million births were averted as a result of the family planning programme.
The impact on the birth rate is the ultimate objective of the family planning programme. The total number of births as obtained through the Sample Registration Scheme has indicated a definite downward trend, both in rural and urban areas.
The decline in the birth rate is in no way spectacular. The crude birth rate, which was 39.0 per thousand in rural areas in 1968, declined to 34.3 per thousand in 1977.
In urban areas, it declined from 32.6 per thousand in 1969 to 27.8 per thousand in 1977. In 1989 the birth rates of rural and urban areas were 32.0 and 25.0 respectively. The combined birth rate of the country in 1989 was 30.5.
According to the Sample Registration System the crude birth rate was 28.1 per thousand in 1994-96. The only heartening feature of this picture is that the decline has actually set in and that the first decline in the birth rate is usually the most difficult to achieve. It is necessary for the decline to occur at a much faster rate than at present.