Debating India

FAMILY PLANNING

From Here To Maternity

Saumya Roy

Monday 12 July 2004

Rs 250 a month if you don’t get pregnant. This radical scheme is showing results. Will it sustain?

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Abhijit Bhatlekar

Rampyari comes to work wearing the anklets she bought with her own money from her first bank account. She is part of a small group of women in these tribal villages of Chhindwara in Madhya Pradesh that is driving the ’entrepreneurial’ venture of Boston-based computer engineer Hridayesh

Gupta. The deal is dramatic enough: if the women promise not to get pregnant, Gupta pays them Rs 250 a month. They also get increments for following best practices like delaying pregnancy for a year. And, on the flip side, get laid off for having over four children.

In the neighbouring Seoni district’s Saliwada village, more than 70 women in nine-yard saris and oversized nose rings arrive in snaking lines to put their thumb prints (most can’t write their names) across assorted forms at a quarterly "verification camp," which completes one year of the programme. The first time 14 were pregnant. This time too 14 are pregnant, but the number of women enrolled is up from 260 the first time to 360 now, suggesting a drop of a third in the number of pregnancies.

How this has happened is anybody’s guess. There are no clinics here and medical facilities are meagre although midwives in many project-areas say the use of contraceptives has gone up. Gupta now wants the government to adopt his "business model" within its family planning policy, and has submitted his proposal to the ministry of family welfare. He says this is one way to engage people in a policy that makes, to use his business jargon, services and products available to them but does not make it in their interest to use any of them: "People are very smart. They do something if it is profitable for them. We need to give them a reason to do it," he says. Gupta insists the drop in the number of pregnancies has come because he has provided opportunities for women to perform, just the way US salaries brought out the best in Indian software engineers.

Yet his argument is actually the opposite of government policy, which focuses on providing women with access to quality healthcare, an increasing awareness and education. That’s why Dr M.C. Watsa, president of the family planning association of India, questions the basis of Gupta’s project: "It’s a fire-fighting measure, which may work in the short term but not in the long term. The money should be used to provide better facilities to these women." Adds Dr Saroj Pachauri of the Population Council, an international NGO: "Women want to limit family size and they want to space out children but they have very little access to health services."

Meanwhile, all of Gupta’s clients in Seoni carry bank passbooks. Some are literally buzzing with stories of how far these passbooks have taken them. The balances of a few hundred or a thousand rupees in their passbooks show how it has helped them cut through a maze of tradition, in just a few months. For some, though, their families must be overcome before they get the empowerment that comes with a bank account.

Janakpuri is the only pregnant woman in her group at a three-day camp spread over two locations. She has a daughter and her mother-in-law curses her for not having a son. Janakpuri says she’ll have no more children if she now has a son, but will keep trying if she has a daughter. She has not told her husband that her pregnancy means she will not get money for a year. But she wants the child because in this battle of money versus her honour in the family, money is knocked out.

Clearly, Gupta will have to negotiate a social minefield as much as he does bank balances for the scheme to be really successful. For some women, the scheme is altering the balance of domestic power. Many women said their husbands and mothers-in-law cannot anymore afford to fight with these new holders of the pursestrings."Aajkal mard thoda dab gaye hain" (nowadays the men have got suppressed a little), says Jamunabai, a midwife in Chhindwara’s Chopna village.

Sadiq Agwan, who runs the project for Gupta, says some husbands have come to reclaim the wives they had earlier abandoned on grounds of infertility after they heard of their wives’ new found wealth. "Earlier our husbands never used to listen to us because they said we were of no use, now we have more of a say in family decisions," says Dulari, who could rustle up the Rs 1,300 for her daughter’s treatment.

Dulari had borrowed from a moneylender to treat her daughter, which she now gleefully says she doesn’t need. While their husbands do ask for money for alcohol or cigarettes, the women are learning to say no. It is part of a huge learning curve for these tribal women, who say they were initially scared that if they put their money in banks they might not get it back.

So while Gupta says his programme does not include any awareness or education and excludes men because "it is the women who are the clients and the implementers," there is indeed a role for men and a role for education.

In fact, in the villages where Agwan and his NGO, Prayas, have been operating for a long time, addressing both men and women, the drop in birth rate has been dramatic. In nearby villages where they have not, the rate has actually increased. In the early days, couples came together for the lectures and even now the women say they go back home and recount the "chota parivar" line to their husbands and other family members.

But the scheme is not without its detractors. Pachauri, for instance, interprets this somewhat differently: "There is an unmet demand for limits on family size, but the need to have sons is also pushing women. There is no need for such (monetary) incentives."

Meanwhile, Gupta has a don’t-ask, don’t-tell policy on how women limit their families. He says his experiment, on which he has spent more than $25,000 (Rs 11.47 lakh) of his own money, has seen success that has eluded most Indian planners. In fact, he is now set to move on to the next phase of the project which he likens to a clinical trial.

For this phase, he has submitted a proposal that the government should work with 40,000 women in five locations and is willing to leave his job in the United States and administer the project in India, pro bono, for two years. After that, he thinks it should be run as part of a government policy where selecting eligible women and dispersing money will be done through centralised data centres, much like call centres.

So Rampyari and Hridayesh Gupta may seem like unusual collaborators where Gupta is spending to pare down families and she just wants her mother-in-law to understand. The collision of their worlds has brought surprise results and many firsts. Two hundred and fifty rupees is a significant sum in an area where a panchayat member may earn just Rs 150 a month. There is no doubt that the cash and the leverage of a bank account have the power to alter the lives of these women and their families for the better. But is the reward a woman gets for not becoming pregnant a fair price for giving up an element of control over her body? That’s an uncomfortable question, and even a better quality of life can merely hint at an answer.

P.S.

Saumya Roy In Chhindwara and Seoni, Madhya Pradesh

in Outlook India, Monday, July 12, 2004.

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