In 1995, the Government of India initiated the Reproductive and Child Health Programme (RCH) as part of an ambitious plan to revamp its population policy and family planning program. Drawing upon the UN-sponsored International Conference for Population and Development (ICPD) held in Cairo in 1994, the RCH provides for meeting a broad range of reproductive health needs for women in a manner that is respectful of individuals' human rights.
I wanted to study the RCH to evaluate its political significance. Here is a policy that seemingly promotes a rights-based rhetoric-gender equity and individual well-being-accompanied by language of human rights, informed choices, empowerment, and quality care that is alien to the cultural context of India. My research focused on the way health providers and policy makers in the Indian state of Kerala translate rhetoric into local practice. Do they find the human rights framework beneficial in their medical practices involving women's reproduction? Is the human rights discourse helping to improve women's reproductive freedom in India?
What I found through my interviews with health workers during 1997-1998 is that the government of India has adopted the language of human rights in its population policy, but that it is just a form of tokenism. There was a contradiction in the way health workers interpret the idea of rights. At one level, they were enthusiastic that people would be able to better exercise reproductive freedom under this policy. One senior government consultant said that the program meant that "at least there is no more coercion.…Women make the choices." The medical doctors in rural health posts that I talked to echoed this sentiment. According to one doctor, "We are giving importance to quality rather than quantity. Before, the numbers were important….Now the rule is, whatever we do, we do it well."
However, this marked shift in language-the focus on the "individual", "individual rights" and "individual choices"-is tempered by concern that India's population still needs to be stabilized. The policy documents note that "...the RCH Programme will seek to provide relevant services for assuring Reproductive and Child Health to all citizens. However, RCH is even more relevant for obtaining the objective of stable population for the country." One senior official told me that the "two-family norm is a Government of India policy….[T]hat has not changed." In fact, subsequent to the implementation of the RCH, the government came up with a new catch slogan to propagate the idea of a one-child family: "One is Fun."
Do population control efforts necessarily infringe upon individual reproductive rights? I found that individual medical professionals interpret these potentially conflicting objectives through their own understanding of where individual rights end and the state's developmental objectives begin. One official explained, "couples are given…freedom of choice-freedom for informed choice." A nurse told me, "When we interact directly with the public, we have to provide according to their need. We won't compel them. Now those with two children we don't need to compel. Only if there is three or more we should compel them, we should try to bring them around [to accept contraception]." A senior bureaucrat in Kerala told me that under the programme the state would "let them (people) make their choices," but where fertility rates are unnaturally high, "the earlier style of advocacy and persuasion" is likely to continue. This persuasive style, as I found out in my interviews, involves giving only limited information to clients. The official pointed out, "As of now we have not planned that we will be talking about the possible side effects of IUD insertion. They (grassroots workers) are not going to scare people off by saying that."
Some might argue that this is merely an example of government propaganda and not coercion. I object to the position that an action cannot be a violation of human rights unless it has been sufficiently "coercive." The extreme instances that we hear about in China and Indonesia are not the only infringements upon individual reproductive welfare. For instance, many Third World states reward people for accepting contraception. This policy may seem innocuous. Yet "encouraging" people to accept contraceptives without being open about the consequences or side effects constitutes a rights violation.
The ICPD, upon which India's new population policy is based, makes this clear. It legitimized the transnational women's health movement that emphasized access to health care, informed choices, and control over one's own body. The Programme of Action of the Conference was embedded in the language of empowerment, personal well-being, and freedom of individuals (especially women) in matters of reproductive decision-making.
India was among the 184 countries that ratified the ICPD resolutions and subsequently began to review the foundations on which its population policy was conceptualized. But the findings of my study of the RCH show that India hasn't lived up to its commitment. Despite the rhetoric of human rights, women are still seen as reproductive vehicles of the state and society. The pervasive ideologies underlying current delivery of reproductive health are not easy to displace. But if human rights in reproductive health are to be meaningfully applied to benefit the most vulnerable segments of society-particularly women-it is time for India to interpret its international commitments in a way that no longer sidelines women's needs.