The work for family planning was begun in the first five-year plan period and the Government of India allotted Rs 65 lacs for the family planning program. On the advice of experts, the rhythm method was tried, which somehow did not succeed.
In the Second Five Year Plan period the Government has allotted nearly Rs 5 crores for the same purpose. This time the emphasis is laid on the use of contraceptives (Mechanical and chemical) for family planning. The limitations of contraceptives had lead us to think and make efforts to evolve an oral tablet for contraception.
The time has taken its toll all right. While we are still considering an effective method for family planning the country is burdened by an additional 5 millions of human beings.
The rhythm method was not successful because it was difficult to understand and still more difficult to practice.
Contraceptives have limitations, because in the rural population, which is living in huts, privacy and bathroom facilities are both lacking which are very essential if contraceptives have to be properly used. The oral contraceptive tablet will be an ideal thing if and when achieved.
Surgery (sterilization in women and men) has a place in the family planning program by way of stopping further additions. It is not still practiced widely for various reasons, religious, sentimental, fear of loss of sexual strength and also for the want of facilities for surgery in the rural areas.
On an average, 39.3 % of the world population is below the age of 14 years, 53.5% of the population is between 15 to 55 years i.e. in the reproductive phase, and 8.2 % over 55 years. Of this 53.5 % in the reproductive phase in India, there are a very small percentage of those who have less than three children. The reasons for this are obvious and as follows:
Fertility of women in India is high as compared to women in other countries. Fertility in Indian women rises sharply up to the age of 24 years.
An average Indian woman gives birth to 6 to 7 children during her reproductive period.
Marriage is a rule in India. No physical or other disability prevents marriage. The disabled and the diseased, even lepers, also get married. Economic factors do not hinder marriage, and marriage is solemnized in all economic classes.
Early marriage is a rule except in the higher strata of society. Marriage takes place very often before 14 in girls and before 18 in boys. Within 4-6 years of married life many of the people are blessed with three to four children. Thus at a comparatively younger age in India the people attain an ideal family of 5 to 6. But this is not the end, the family goes on increasing. With the increasing family the physical and economic problems come up. Dissatisfaction in family life crops up with the ever-increasing family.
Abstinence and available contraceptive measures are tried and knowledge is sought for the prevention of conception. Insufficient knowledge of the use of the contraceptives, faulty contraceptives, lack of privacy in the house, and emotional factors etc, lead to subsequent failures and further conceptions.
Efforts are made to get rid of unwanted pregnancies. The methods may vary from the use of indigenous drugs to internal manipulations. Few approach the medical practitioners, but most of them eventually seek help from quacks when the trained doctors are not willing to oblige by doing illegal abortions. Pregnancy may be terminated or may not and then there is a great physical and mental strain. Thos who succeed in getting the pregnancy terminated, fall into similar circumstances again and again. The best of the methods and aids for spacing children are tried but the results are so variable, leading to much embarrassment and mental distress. These ultimately reflect on their health. The outlook in life changes and the living standards go down for economic reasons.
The problem of family planning has two different aspects, which must be clearly distinguished, namely the social and medial. (1) The first should be entrusted to the social service organisations who should carry out family planning publicity and mobilize public opinion for family planning. They should attempt to flood the medical centers with those who seek advice and help for family planning. (2) For the second, the medical center should be responsible for giving proper advice and help to the people, who may come to seek advice for child spacing, conception control, sterility and sex problems.
The administration should assess the success of the social service by the number of people attempting to see advice and help. The efficiency of the medical help should be assessed by follow up amongst those advised and helped.
It is gratifying to note the help given by the Government and the progress made on the research of oral contraceptives, by various workers, particularly Dr. Sanyal. A successful trial of the oral contraceptive with phosphorylated hespridin has been and reported by Dr. Sieve (1952)
Research in the field of surgery should also be encouraged under the Genito-urinary surgical units for better and specific measures for the said problem. Sterilization in men will be a quick and convenient way, to help those who no more need and desire children. From the literature available on the subject of sterilization in man (which dates back to 1830) and from the experimental, clinical and the follow up work, done by the author in the last seven years, it is proved beyond doubt that if cases are properly selected and the operation is performed carefully, no unfavorable physical, mental of sexual after effects will take place. There is still much to be investigated on this subject, and the author is now experimenting on the use of vasoligation which may help in spacing the children, as in some cases of simple ligation, restoration of continuity will take place and sterility may not be permanent.
Religion, sentiments and feelings should not come in the way of an effective family planning program. We otherwise will have to start afresh at the end of the Second Plan in a different direction, and the past. Even now if we are not able to solve the problem of over population, another few years will make conditions impossible. It is recommended that those who have three or four children must get themselves operated on for permanent sterility, which is quite harmless and safe.