The majority of health workers in the field of reproductive health are women. And why should this be so?
Population is a subject close to the hearts of most politicians. The remark by Prime Minister Narendra Modi on population explosion set off a royal kerfuffle, with the usual arguments about sinister plots to target minorities on the one hand, and the need to limit numbers on the other. This has been an endless and boring debate for years on end. One point of view is that a young population will bring demographic dividends; the other is that we will be overrun by people making demands on scarce resources. On the face of it, all said and done, we are doing fairly well on the population front in many states. The numbers are steadily dropping without any coercive tactics. But in some states, the total fertility rate is still high and not falling fast enough. Yet, the debate on population rarely goes beyond the numbers game. It is talked about in abstract terms. There is grand talk of the cafeteria approach, an array of contraceptives to suit different people, but these are neither easily available nor are they even understood by many couples.
The reason why family planning has not been as successful as it could have been is that there has been no concept of involving people in the planning, and because the focus has been far too much on women. Women, in many of the more populous regions, don’t have control over the size of their families.
Instead of fretting about population, we should address the major lacuna in the programme. One is the lack of involvement of men. They rarely feature in the planning process, either as recipients of reversible contraception or as health workers.
The majority of health workers in the field of reproductive health are women. Why should this be so? When it comes to discussing contraception, it would be far better, especially in rural India, if there were more male workers to talk to men, in what is inherently a patriarchal set up. It would be desirable, but impractical, to expect women to engage men and discuss reversible contraception and spacing.
By and large, men tend to be apathetic to the health issues which affect women from child bearing. In a society where the male child is still prized, many women are forced to undergo repeated pregnancies until the desired number of sons is born. This could change if there were a meaningful interaction with men on the need for a healthy mother, and the practicalities of limiting the family in economic terms. Male workers could play a huge role in changing perceptions on the girl child, and on maternal and child health. It has so far been seen largely as the woman’s domain and the focus of maternal health has been on the woman. How many men understand the need for proper nutrition for women during pregnancy and childbirth? These are issues that should be moved out of the female domain and discussed with men. For this, we need greater involvement of men, both at the planning and execution-level.
Family planning, which focuses only on women, and is executed largely by women workers, will not yield the appropriate results. Male workers can convince men of the need for institutional deliveries and inform husbands of the need to be involved in childcare. When men change their behaviour, it is likely that attitudes towards family size and contraception will also change. It is up to the government to make it attractive for men to join as health workers in reproductive health. It should not be viewed as a job suitable only for women. More innovative communication has to be brought into play to encourage men to take up these jobs. After all, men have no hesitation becoming workers in other fields of health.
The dynamic women and child minister, Smriti Irani, whose communication skills are second to none, should take this up as a challenge. We have nothing to lose but our numbers.