ABSTRACT

ADOPTION OF A NEH'CONTRACEPTIVE IN URBAN INDIA:
ANALYSIS OF COMMUNICATION AND FAMILY DECISION-MAKING PROCESSES

by Dinesh Chandra Dubey

This study focuses upon systematically studying, analyzing and under-
standing of the innovation acceptance behavior of the people in one of the
most personal, sensitive and vital areas of their lives, family planning.
Two social processes, decision-making and communication, have been empha-
sized because of their crucial importance for all types of social change.
Decision-making, given the presence of several possible alternative solu-
tions to a difficult situation, leads to social and technical innovation.
And formal and interpersonal communication influence individual roles,
make change decision possible and provide social meaning to innovative
behavior of individuals and groups in the society. This explains the em-
phasis put on these two processes in this study. The ultimate aim of the
study is to understand better and thereby increase the possibilities of
manipulating more effectively the general acceptance of family planning.

Repeatedly family planning surveys in India have shown that while
most pe0ple in India prefer small families, very few of them actually
succeed in realizing this goal. By concentrating on the analysis of
decision-making and communication behavior of those who have accepted the
innovation of family planning, the study indicates possible variables

1

2 Dinesh Chandra Dubey

which may be of particular importance for stimulating positive response
towards the above stated goals of both the peOple and the family planning
program of the country. This approach makes the study of interest to stu-
dents of the diffusion process, particularly of family planning, and to
the change agents working in thfls field.

The particular family planning innovation studied here is p0pularly
known as IUD and stands for Intra-Uterine Contraceptive Device made out of
plastic in the form of a loop. The area of study consists of three colo-
nies of middle-class government employees in New-Delhi, India. These
colonies happen to be among the areas in the country where IUD was first
used by the existing family planning clinics. The unit of analysis has
been the family with the wife and the husband as main actors exhibiting
positive contraceptive behavior, both between themselves and the immediate
society. This implies a microscosmic view of the problem of pOpulation
growth as Opposed to a macroscosmic view with which demographic surveys
are usually concerned.

The general theoretical and methodological strategy for this analysis
consists in the application of diffusion framework as used in studies of
acceptance in agricultural and public health fields. An analytical model
based on the models of Hill and Meier was deve10ped to conceptualize phases
of acceptance, variables of importance to the study, and deve10p the inter-
view schedule used in the study. Interviewing involved reconstructing the
sequence of events leading to acceptance of IUD on the part of IUD users
as accurately as possible. Actual date of IUD acceptance and identifica-
tion data were collected from the three family planning clinics serving
the colonies under study. The data could be gathered from only 182 out of

the 263 IUD users as per clinic records.

3 Dinesh Chandra Dubey

Most of the families studied belong to the moderate income groups of
the working and middle classes. 0n the average, they had 3.2 living chil-
dren, and out of the whole group only 5 percent did not have any living
son. ~A little more than half of the women were married between 13-18 years,
and the mean for the whole group was seventeen years. On the average, they
had lived twelve years of married life before accepting IUD. The modal age
groups for acceptance of the device were 25-29 and 30-34 years for women
and men, respectively. About 82 percent of them did not want any more
children. In terms of some key demographic variables, our group is com-
parable to a relatively much larger study consisting of about 6000 cases
of family planners from a similar population.

It was found that husbands and wives utilized different sources of
information at the information-receiving-gathering, and evaluating stages.
At the "first awareness" stage the individual learns of the existence of 2
the new idea or practice. About three-fourths of the wives were reported

to have become first aware of IUD through personal face to face sources,

’"w

mainly change agents. An equal prOportion of husbands became first aware

"u—

of it through mass media.

At the "interest" stage the individual collects more information in
order to learn more about the innovation. At this stage personal sources
of information were found to be the main sources for additional informa-
tion for both the wives and husbands. However in terms of personal loca-
lite and personal cosmOpolite sources, it was found that localite sources
*were used most extensively by both the wives and husbands. Personal cos-
rnOpolite sources were differentially used by the two, and wives were said
to have used them as sources of additional information about twice as

:Erequently as husbands.

4 Dinesh Chandra Dubey

Mass media ranked as second important source of additional information
for husbands. Among the various mass media sources, new3papers and journals.
accounted for almost all the responses. Other sources, such as posters,
exhibitions and radio were rarely given as sources of additional information.
For wives mass media was found to be of negligible importance as a source
of additional information.

During the evaluation stage, the individual perceives and considers
the advantages and disadvantages of the innovation for himself. At this
stage, personal sources of information were found to be most important in
the case of both the wives and husbands. Within the broad category of
personal sources, wives depended more on personal cosmOpolite sources--
change agents--and husbands on personal localite sources--particularly
relatives--for evaluative information.

Mass media was of second importance for such information in case of
husbands, and it was of almost no significance to wives at the evaluation
stage. At the evaluation stage we found the presence of a high degree of
mutual exchange of information between the wives and husbands. There was
a high degree of convergence in the perceived advantages, the quality most
preferred, by husbands and wives.

In brief, then, we noticed that while husbands tend to use both the
mass media and personal sources of information with varying degrees of
emphasis at different stages, wives seem to maintain a consistent trend
of heavy dependence on personal sources, especially of cosmopolite nature.
‘Use of mass media in case of wives and personal cosmOpolite sources--change
agents--in case of husbands was insignificant. However, this trend of ]

isolation of wives from the mass media and of husbands from personal

5 Dinesh Chandra Dubey

cosmOpolite sources seems to be largely compensated for by the evidence of
a high degree of mutual intercommunication between the two inside the
family. This was interpreted as the Operation of a varient of the two-step
flow of communication where each member of the couple acts as the opinion
leader for the other in relation to those communication sources which, due
to some reason, were not used by the other. This working of the two-step
flow was seem as a possible explanation of effectiveness of both the types
of communication sources.

Generally in these days of mass media our data highlighted the impor-
tance of personal communication sources. These were found to be crucial
for women all through the process.

In the general area of decision-making, it was found that, with the
exception of seven percent of cases, both the wive and husband were in-
volved in decision-making. However, the final decision in about 50 percent
of the cases was made by the wife, in about 44 percent of the cases by the
husband, and in the remaining both were equally involved. A remarkable
absence of concentration of final decision-making authority in the male
figure within the families goes counter to the general belief which regards’
the husband as the only decision-making power within the Indian family
system.

we found that friends, neighbors, and other users had an important
role in decision-making. One significant finding was that while friends
*were consulted by both the husbands and wives, consultation with neighbors
arm.users was exclusively limited to wives at the decision-making stage.

In about 66 percent of the cases the reSpondents reported consulting

rather IUD users and at least in two-thirds of such cases this consultation

6 Dinesh Chandra Dubey

was done by the wife alone. On an average, each of the users studied
claimed to have influenced one more IUD user.

This group of IUD users was divided into two groups according to
stages involved in decision-making. In the case of the larger group con—
sisting of about 80 percent of cases, the decision was limited to changing
to a more effective method from a less effective one. In the case of the
other group it involved first accepting the idea of family planning as
good for their situation and then selecting the IUD to fulfill the goal
of family size limitation.

Lastly, in this group of IUD users a majority of respondents had
high aspirations for their children's education (96.5%), credited effort
orientation for their present position in life (77.9%), were reading
printed mass media (76.4%), had modern ideological orientation to life
(61.6%), owned and used modern articles (60.5%), and had a non-ritual
religious orientation (46.8%). In brief, the greatest favorable influence
amongst the above variables was exerted by aspirations for children's edu-
cation and least by religious orientation. Ritually oriented people were
likely to accept IUD as frequently as those who were not so oriented to

religion.

ADOPTION OF A NEW CONTRACEPTIVE IN URBAN INDIA:

ANALYSIS OF COMMUNICATION AND FAMILY DECISION-MAKING PROCESSES

By

Dinesh Chandra Dubey

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY

Department of Sociology

1967

TABLE OF CONTENTS

List of Tables .

List of Figures
List of Appendices
Acknowledgements

Chapter
I. INTRODUCTION . . . . . . . .
About the Intra— Uterine Contraceptive Device

Background of the Family Planning Program in India -

I. National Population Policy--Its Growth-
II. National Program . - a . A . .
III. Progress and Achievement

IV. Project or the Study Area

Need for the Study .

II. THEORETICAL AND METHODOLOGICAL ASPECTS OF THE STUDY .
Review of Theory and Proposed Theoretical Frame
Statement of the Problem
The Basic Unit of Analysis
Methodology of the Study .
Proposed Analytical Model
The Respondents . .
Location of the Study
Number of Respondents - . .
Plan for Collecting Information .
Identification of Cases .
Interviewing Schedule .
Interviewing Situation
Interviewing Experiences
Image of the Investigator .
Confidential Nature of Information
Time: The Problem of a Long Schedule.
Communication . . . . . . . . .
About the Questions

III. DEMOGRAPHIC CHARACTERISTICS .
Age at Marriage
Age at Acceptance .
Duration of Married Life .
Number of Living Children
Living Sons .
Desire for More Children .

ii

Page

iv
vi
vii
viii

OOCDO‘UJUJHH

45
45
46
47
48
49
50

iii

Income . . . . . . . . . . . . . . . . . . . . . . . . 51
Education . . . . . . . . . . . . . . . . . . . . . . 52
Summary . . . . . . . . . . . . . . . . . . . , . . . 54
IV. ‘ COMMUNICATION . . . . . . . . . . . . . . . . . . . 57
Contents of this chapter . . . . . . - . . . . . . - - 57
Awareness--first knowledge and its sources . . . . - 58
Interest--additiona1 information and its sources . - - 64
Evaluation-~the most liked quality and its sources - . 64
Discussion . . . . . . . . . . . . . . . . . . . . . . 72
Summary. . . . . . . . . . . . . . . . . . . . . . . . 78
V. DECISION-MAKING . . . . . . . . . . . . . . . . . . . . 80
Contents of this chapter . . . . . . . . . . . . . . . 80
Concept of decision-making . . . . . . . . . . . . . . 82
Husband's and wife's roles . . . . . . . . . . . . . . 88
Role of friends and neighbors . . . . . . . . 90
Current users and their role in decision- -making . . . 91
Previous family planning status . . . . . . . . . . . 93
Discussion . . . . . . . . . . . . . . . . . . . . . . 95
Summary . . . . . . . . . . . . . . . . . . . . . . . 105
VI. MODERNITY IN CONSUMPTION AND VALUE ORIENTATION . . . . . . 107
Contents of this chapter . . . . . . . . . . . . . . . 107
Position on written communication network . . . . . . 110
Consumption of modern articles . - . . . . . . . . . - 113
Religious beliefs of acceptors . . . . . . . . . . . . 116
Personal control vs. fate orientation . . . . . . . . 119
Aspirations for education of children . . . . . . . . 122
Modern vs. traditional orientation . . . . . . . . . . 125
Summary . . . . . . . . . . . . . . . . . . . . . . . 127
VII. SUMMARY AND CONCLUSIONS - - . . - - . - . . . - - . - - - . 129
Overview . . . . . . . . . . . . . . . . . . . . . . . 129
Main Findings . . . . . . . . . . . . . . . . . . 132
Limitations of the Study . . . . . . . . . . . . . . . 136
Suggestions for Further Research . . . . . . . . . . . 137

Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

LIST OF TABLES

Table Page
1. Ideal Family Size as Reported in Some Selected Surveys

in India . . . . . . . . . . . . . . . . . . . . . . . 17
2. Average Number of Children Born to a Woman of 45 Years

and Above in Selected Regions of India . . . . . . . . 18
3. Age at Marriage - “Omen . . . . . . . . . . . . . . . . . 46
4. Age of Husbands and Wives at the Time of IUD Acceptance . 47
5. Duration of Married Life . . . . . . . . . . . . . . . . 48
6. Acceptance and Number of Living Children . . . . . . . . 49
7. Number of Living Children . . . . . . . . . . . . . . . . 50
8. Number of Living Sons . . . . . . . . . . . . . . . . . . 50
9. Desire for More Children . . . . . . . . . . . . . . . . 51
10. Income of Husbands . . . . . . . . . . . . . . . . . . . 52
11. Education of Wives and Husbands . . . . . . . . . . . . . 53
12. Comparison of Some Demographic Characteristics . . . . . 55
13. Time Sequence of Receiving First Information . . . . . . 61
14. Sources of First Information of Wives and Husbands . . . 63
15. Sources of Additional Information of Wives and Husbands . 65
16. Most Preferred Qualities of IUD for Husbands and Wives . 67
17. Sources of Information of Husbands and Wives for Most

Preferred Quality . . . . . . . . . . . . . . . . . . . 68
18. Total Use of the Three Sources of Information . . . . . . 69
19. Distribution of Total Mention of Three Communication

Media According to Adoption Stages . . . . . . . . . . 70
20. Involvement of Either Both or One Member in Decision-Making 90

iv

21.

22.

23.

24.

25.

26.

27.

28.

29.

30.

31.

32.

33.

34.

35.

36.

37.

38.

Final Decision Makers
Consultation with Friends and Neighbors in Decision-Making
Consultation with Current IUD Users in Decision-Making

Distribution of Acceptors According to Use of Other
Methods Before IUD Acceptance .

Distribution of Respondents According to Desire for
More Children .

Distribution of Acceptors According to Whether Last
Child Was Wanted or Not .

Communication Scores of IUD Acceptors .

High, Medium and Low on Communication .

High and Low Around Group Average on Communication Network
Use of Modern Consumer Articles

High and Low on Modern Consumer Items Around Group
Average .

Religious Orientation of IUD Acceptors

Effort vs. Fate Orientation Of IUD

Educational Aspirations .

Modern vs. Traditional Ideological Orientation

Rank Order of Variables According to Percent Scoring High
AdOption Period Analysis: Speed of Decision-Making .

Diffusion Table .

90

91

92

94

94

95

111

112

113

114

115

118

122

124

126

128

150

155

LIST OF FIGURES

Figures Page
1. Conceptual Analytical Model Specifying the Interrelation-

ship of Selected Variables in Fertility Planning . . . 28
II. Stages and Use of Media . . . . . . . . . . . . . . . . . 71
III. Stages of Decision-Making . . . . . . . . . . . . . . . . 87

vi

ACKNOWLEDGEMENTS

The author is deeply grateful to Dr. Harvey Choldin, Assistant Pro-
fessor and the thesis director, for his invaluable guidance through all
the stages Of the work. He is grateful to Dr. Charles P. Loomis, Research
Professor, for guiding the fieldwork in India, and critically evaluating
the manuscript and making useful suggestions. He is also thankful to Dr.
Douglas Ensminger, Dr. Moye Freymann and Dr. Katherine Freymann for pro-
viding basic ideas, and making suggestions for develOping the research
design.

The author is highly grateful to Col. B. L. Raina, Director of the
Central Family Planning Institute, New Delhi, for providing the time for
completing the study and to the Government of India, the Ford Foundation
and the Central Family Planning Institute for the necessary financial
assistance for the study.

The author wishes to express his gratitude to Dr. Jay W. Artis, Dr.
Donald W. Olmsted and Dr. Charles P. Loomis for having worked on the author's
guidance committee. The author is grateful to Dr. William H. Form and Dr.
John Useem who as heads of the Department of Sociology at Michigan State
University made it possible to work in the department and finish the study.

Last but not least, the author is grateful to Dr. Carl C. Taylor for
providing the inspiration and motivation to the author to engage in socio-

logical research and study.

viii

CHAPTER I
INTRODUCTION

.About the Intra-Uterine Contraceptive Device: The term "IUD" stands for
”Intra—Uterine Device" and largely explains its meaning. It is a contra—
ceptive device of high effectiveness in preventing conception and is at
the center of the study reported here. Since its stone—age invention,
centuries ago, the device has undergone various stages Of change—~cotton,
silk, steel and gold. Ultimately, the modern plastic age put its stamp
on it. Today it is generally made of plastic (polyethylene).

In terms of its shape, it has moved from round solid pebble to a
steel ring, to plastic bow, to large and small spiral and to large and
small 100p Of inexpensive plastic. The device is inserted with the help
of a plastic inserter inside the uterine by'a qualified doctor who has
been trained for insertion. Before the insertion takes place each case
is medically examined. There is not always a medical followaup program
attached to this. In the program described in this study each woman is
free to report and consult the doctor whenever she feels the need to do
so. Once inserted, the device can stay in place for several years. As
regards its mechanism of work, this is-still a problem for medical exp
ploration. In practice, medical authorities believe that it prevents
fertilization, however, how it does so is not certain.

In India, first interest in the device can be traced back to May,
1962, when some high ranking delegates from India participated in a

l

conference on the IUD, sponsored by the Population Council in New YOrk.
As a result of this interest the first clinical study of IUD'WaS

started in June, 1962, in India. In December, 1962, government appointed
a study group to consider and recommend on the suitability of the IUD as
a family planning method. This group felt that the stage was not yet
reached to recommend the use of the IUD for general use and suggested
more clinical studies.

As a result, during the period 1962—64 about fifty clinical studies
were set up in different parts of the country. Based on the results of
these studies, the "Advisory Committee on Scientific Aspects of Family
Planning" recommended on January 5, 1965, that the ”IUD is safe, effec-
tive and acceptable and should be made available through all medical and
health centers."

The government accepted the recommendation and the national family
planning program moved quickly to organize itself for IUD service. The
Delhi housing colonies studied in this investigation happened to be some
of the few places in the country where the program of IUD insertion
started first on a significant scale.

Fbr countries like India the IUD holds a great promise. The nature
of the practice recommended has long since been recognized as an impor-
tant factor in the acceptance of any innovation. One of the several felt
needs of the Indian family planning program during the last fifteen
years has been the lack of a simple, cheap, effective, acceptable and
"one-time" contraceptive method. The IUD has all these advantages. In

addition, it is technically one of the most effective methods. It is

easily reversible and its after effects are minor in nature and can be

treated easily. The only possible difficulty may be the scarcity of lady

doctors in the country to insert the device.

Background of the Family Planning Proggam in Indig: This part deals with
the background of the study and relates it to the overall picture of
demographic dynamics of the Indian sub-continent. The details fall into
four main sub—sections:

I. Population Policy

II. Program

III. Progress
IV. Project Area

I. National Population PolicygyIts Growth

Before independence (1947) India had no national population policy
in the sense of having a deliberate and purposive goal to maintain or
change the natural trend Of national population growth. However, this
pre—independence era did produce some pioneers like Dr. R. D. Karve and
P. K. Wattal who brought this problem to the attention of the masses and
the government. Also, it was during this period that one of the states
in the Union--Mysore--opened the first government operated birth-control
clinic in the world. The National Planning Committee of the Indian
National Conference was the first political party to strongly support
promotion of family planning as a state policy.

After independence, when the Congress Party came into power, the vital
role Of’population control in the overall planned develOpment of national
economy was fully recognized by the government. Unrestricted population
growth was viewed as a serious threat to all national development efforts.

The sub-committee on family planning of the Planning Commission strongly

recommended that family planning should be recognized Officially. The

nation's first Five-Year Plan stressed that measures aimed at reducing
fertility should form part of the national public health program. The
alarming growth rate of 21.6 percent and a total population of 361 mil-
lion as revealed by the 1951 Census imparted increased significance and
urgency to the problem of numbers. In 1953 the Planning Commission came
out with a four-point policy on the problem. It directed that the family
planning program in India should:

a. Obtain an accurate picture of factors which contribute to
rapid increase of population.

b. Gain fuller understanding of human fertility and the means
of regulating it.

c. Devise ways of educating the public.

d. And make family planning advice and service an integral
part of the services in hospitals.

Experience of this first adventure Of providing services to the
peOple by the government revealed absence of any strong organized opposi-
tion to the government for taking effective steps and organizing programs
in this field.

Thus encouraged, the government laid additional emphasis on family
planning in its Second Five-Year Plan. The financial allocation, which
was 6% million RS. (one 0.8. dollar is equal to 7.5 Rs.) in the First Plan,
'was raised to 50 million Rs. in the Second Plan. Action was also initiated
to develop organizational structure at the National and State levels.
1Hhe major activities emphasized in the Second Plan were:

a. Education about family planning through use Of mass media.

b. Provision Of clinical referral services, in urban and rural
areas.

0. Training of personnel.

\n

d. Provision of supplies

e. Research

In terms Of organization, posts of State Family Planning Officers
were created in the States, and a Director Of Family Planning was ap-
pointed at the center. The number of family planning clinics was fur—
ther increased. During this period there were 1379 rural and 757 urban
clinics in the country.

The Third Plan in 1961 came out with a most realistic statement in
this field when it declared the goal Of stabilizing the growth of the
pOpulation to be at "the very center Of planned development." A pro-
vision of Rs. 2697.57 Lakhs was made for the family planning program dur-
ing the Third Plan, with a program ceiling Of Rs. 50 crores (500 million).
In addition, declarations were made by responsible members of the Com-
mission that hence forth finance will be no limitation to the program.

Fbr the first time, an overall national goal was set up by the
Director of Family Flaming in his repOrt (1962-63) which said, "The
proposed main goal from now on is to accelerate the rate of adoption of
family planning so as to reduce the birth rate in India to 25 births per
1000 population by 1973." The time target was, however, modified later
to the reduction of the birth rate to 25 births per 1000 population as
early as possible.

In short, over these 15 years Of three Five-Year Plans there has
‘been a rocketing growth and development of the National Population Policy.
The government of India has consciously firmly committed itself to develop

the program with the Objective of making family planning "a way of life"

for the masses in as short and reasonable a time as possible.

II. National Program

'While the policy got crystallized and defined at the national level,

what happened to the program? How did it deve10p? What problems are

involved? These and similar other aspects will be dealt with in this

section.

In order to have an Objective picture, it is worthwhile to

state a few baseline facts of the situation.

a.

b.

C.

e.

g.

Fbr centuries Indians have been emphasizing and blessing
norms of high fertility and large families as prime values.

Illiteracy, isolation and physical distances involved are
enormous, restricting fast and easy family planning commu-
nication between the different parts of the country.

The size of the problem, involving almost every adult mem—
ber, in itself creates an unparalleled situation. NO com-
parable example Or model in the world was available where
any national government had faced similar problem in the

past.

Several levels are involved in the development and execution
szicountryawide program. India has a federal type of govern-
ment and health which includes family planning is a trans-
ferred subject. Moreover, the whole program at all the
levels is voluntary.

The task of developing a huge national organization and man-
ning it with trained and skilled personnel.

No indigenous source of manufacturing contraceptives and
absence of any established distribution channel to reach
its teeming millions.

Need to depend on conventional family planning contracep-
tives which are largely complex and lead to very difficult
and low acceptability from a population which is relatively
very simple, and less developed.

Naturally, in view of the above given elements in the situation, the

pace Of developing a national family planning program could not match the

fast growth of national policy and accelerated financial allocations to

iuuilement it. And yet the national program has developed steadily and

firmly so that by the end of the Third Plan it has all the essential
elements of an on-going program. It started by systematically gathering
the facts of the situation in the First Plan, by developing a basic core
of a national organization complex for providing and administering train-
ing and resources in the Second Plan, and by focusing on spreading of
knowledge and services to_millions of peOple all over the country in the
Third Plan. Of course, there have been gaps and delays. ‘All the allo-
cated money has not been spent; all the states did now show the same
concern with the problem; posts remained vacant due to paucity Of skilled
personnel like doctors and nurses; all the training centers did not come
up as planned; difficulties of supplies were frequent; organizational
bottlenecks were experienced; and differential response was received from
different communities; but the attempts proved worth the stake. The pro-
cess continued. The national program developed step by step as is evi-
dent by the program's operational goals stated during the Third Plan. The
report Of the Director (1962—63) states that "The Operational goals of
the program will be to create, fbr 90 percent of the married adult popu-
lation Of India, the three basic conditions needed for accelerating the
adoption of family planning by couples: group acceptance. knowledge about
family planning and available supplies.” To achieve this, organizational,
financial, personnel and other facilities were provided in developing the
rustional program. The role Of the extension education approach was re-
cxxmnended, volunteer leaders' positions were recognized, and statistical

axxi research support was provided to the program.

III. Progress andAghievement

The picture gets still more dim when one comes to think Of this
phase Of the situation in terms of its effects on overall birth rate.
NO significant trend Of fertility decline has been Observed in the coun-
try Or any of its sizable parts till now. Singur pilot project area was
the first to indicate fall in the birth rate during the period 1956-61.
The birth rate for the experimental population was reduced by about 18
percent from the 1956 level of birth rate or by about 14 percent, when
compared to the 1961 birth rate Of the control population. Analysis of
births in Bombay has shown that birth rate is about 27 per thousand, as
compared to 40 for the country as a whole. GandhiGram pilot project
area, where the program has been given its best chance, claims to have
brought a declining trend in the birth rate in some of its villages.
Similarly careful observers suspect a declining trend in some other urban
areas. But all this needs to be systematically established and documented.

When we consider the amount of work done during these years, the

picture becomes hopeful and encouraging.

a. India has started manufacturing contraceptives--rubber, che-
mical, and IUD--within the country itself. In 1957 avail-
ability Of rubber contraceptives was 7.116 millions. The
same figure stood at 30.297 million in 1962. The Off-take
figure for this contraceptive was 0.062 million in 1956.

This reached 7.875 million in March, 1963.

b. In 1963 (January) 6774 rural and 1667 urban family planning
service centers were operating, giving free advice and
supplies.

c. Educational material—-posters, pamphlets and folders--to

the extent Of 1,09,54,000 was produced in all the main
regional languages.

d. About 27483 regular and short term skilled workers-—doctors,
health visitors and social workers--were working for the
program by the end of March, 1963. During the same period,
27483 persons were given training (regular and short term)
for working in the program.

e. From January, 1956, till March, 1963, 3,95,870 persons, in-
cluding 2,42,371 males and 1,53,499 females were reported
to have been sterilized.

f. In January, 1965, IUD was added to the list of contraceptives
and was made available through family planning clinics. Sim-
ultaneously, its manufacture was started in the country.

IV. Prgject or the Study Area
This brings us to the last sub—section of the background factors.
This will briefly describe the organization of family planning clinics
and the procedure adopted for giving IUD services to the people in the
areas covered by this study. Very briefly, the colonies will also be
described.

As already stated, Delhi was one Of the first few places where the

IUD program was organized on a wide scale. All the C.G.H.S.--Contribu-
tory Government Health Scheme--clinics in the city provide this service.
This study deals with three of such clinics. At the time of the study,
the staff Of each of these clinics consisted of a part-time qualified
lady doctor, two full-time female family planning extension workers, one
part-time male social worker, one attendant, and a part-time clerk. In
two of these clinics, the doctor was available twice a week, and in the
third once a week. On these fixed days IUD insertion was undertaken. On
other days, the work was so organized that somebody was always available

in the clinic for supply and advice, while others carried out educational

programs in the community. Each clinic is fully equipped for IUD insertion

10

and medical examination. Before insertion each case in medically ex.
amined. At the time of insertion, a case card is made which contains
information on the name, address, age, number of children, date of inser-
tion, type and size Of loop and remarks of the doctor. Each case is also
recorded in the family planning register. There is no follow-up phogram
attached to this, but each woman is free to report and consult the doc-
tor whenever she feels the need to do so.

These clinics are situated in three residential colonies built by .
the government for its workers. The colonies are planned to be self-
sufficient communities. All the services, like schools, medical center,
playground, market, community hall, and parks are provided in each colony.
Two of these colonies provide accommodation for all grades--Class I to IV;-
Of government Officers, while one does not provide for Class I Officers.
TheSe Officers enjoy different levels Of facilities and living space
according to a fixed rule. All the houses are pucca, two-storied build-
ings and are well connected by motorable lanes and roads to the rest of
the city. These three colonies are roughly at a distance of three miles
from the Kutub-Minar, a historical landmark of the city of Delhi and are
spread over on either side of a major highway over a distance of four

miles.

jNeed.fOr’the Study: John Kenneth Galbraith has Observed that in every
country there are two classes of people: those who see the ultimate prob-
]xmn and warn and those who see the immediate problem and act. The former

1
six; the prophets and philosophers. The latter are the Operators. This

lJohn Kenneth Galbraith, "cited by" John D. Rockefeller, III, in
FamrfilyjPlanning and Population Programs, eds. Bernard Berelson, et al.,
opening remarks, p. 4.

11

study is concerned with neither. It goes a step further and emphasizes
a third class of people, usually referred to as target-group in social
change literature. It concerns itself with "actors" towards whom the
phrophecy of prophets and the organization and services of the Opera-
tors are directed. It concerns itself with how these actors interpret
the prophecy and act to avail or not to avail of the services Offered
by'Operators.

Galbraith is said to have further Observed that the population prob-
lem must now be put in the hands of the operators. In this study we
assume that, while the above shift is very important and long overdue, it
may not be enough. In order to be a successful operator, one must cor-
rectly perceive those upon whom he operates.. To produce the desired re-
sult, then, emphasis must be transferred further down to actors who
actually matter in the final acceptance of change. SO long as family
planning continues to be considered as a voluntary act of millions of
free individuals--and the trend seems to be so—-contributions of the opera-
tor would remain heavily tied down to the ways in which his services and
messages are received, understood and perceived as cogent and reasonable
by the actors. Use of such services would be further.limited by the ways
individual families are organized in relation tb-communication, authority
and decision-making. And lastly, Operator's efforts would be modified
by actor's orientation to life--current and aspired--both for themselves
and for those whom they bring into this world. These aspects of actors'
lives with respect to the processes of family growth therefore become'the

Ilegitimate concern of this study.

12

The case for the viewpoint of the target-group appears so simple and
obvious that it tends to be neglected or regarded as trivial when compared
with matters of policy and organization. Even granting the above view,
nobody can deny the importance Of the viewpoint of actors in the accep-
tance of any change. Particularly in situations where the concern is with
"early” success rather than eventual success, the role of the target-
group becomes crucial in accounting for the difference between success
today and success tomorrow, and between success at minimum cost and suc-
cess at the cost of greater human misery, social disorder and suffering.

.Several studies in the general area Of social changehave demonstra-
ted the necessity and usefulness of understanding the point of view Of
the target-group. The failure to introduce improved corn in Mexico and
the Japanese method of paddy cultivation in India are cited as two exam-
ples, out of several, in the agricultural field.2 This has been found
true also in the field of public health. Some examples are: "Water Boil-
ing in a Peruvian Town,"3 "A Cholera Epidemic in a Chinese Town,"u and
"Diptheria Immunization in a Thai Community."5 That a similar situation

prevails in the field of family planning should not therefore be a surprise.

 

2

Anacleto Apodaca, "Corn and Custom: Introduction Of Hybrid Corn to
Spanish-American Farmers in New Mexico," Human Problem in Technological
Change, ed. Edward H. Spicer, pp. 35—40.

3Edward‘W’ellin, "Water Boiling in a Peruvian Town," Health, Culture
arui Community, ed. Benjamin D. Paul, pp. 71-106.

Francis L. K. Hsu, "A Cholera Epidemic in a Chinese Town," Health,
Chilture and Community, ed. B. D. Paul, pp. 135-154.

5L. M. Hanks, Jr., Jane R. Hanks, et a1., "Diphtheria Immunization
111 a Thai Community," Health, Culture and Community, ed. B. D. Paul,
pp . 155-188 .

13

Stycos' study Of "Birth Control Clinics in Crowded Puerto Rico" illustrates
effectively the importance of the factor of "context of change."6 What

is really surprising is the fact that this is true not only of the devel-
Oping countries, but also of the more developed countries so far as family
planning is concerned. Studies by Rainwater,.And the Poor Get Children,7

8
and Family Design, illustrate this best in the case of U.S.A.

 

If so, the social scientist with his insights into human behavior
could contribute a great deal by focusing on the viewpoint of the target-
group. Curiously enough, with the exception of some demographers, social
scientists have shown only a casual interest in this area. This lack Of
curiosity is further compounded when one considers their contributions
to diffusion studies in the field of agriculture and public health. In
these fields they have demonstrated the applicability of their theoretical
concepts and soundness of their methodology. This study is an attempt to
explore the family planning field with the help of the above concepts and
methods. However, this is done with the full realization of the fact
that human fertility is a very complex phenomenon and that more knowledge
in this field can result only from a multiplicity of several research
efforts.

A question can be raised at this point on the relevance of making

diffusion studies in family planning on the grounds of a rich and reliable

6J. M. Stycos, "Birth Control in Crowded Puerto Rico," Health, Cul-
ture and Community, ed. B. D. Paul, pp. 189—210.

7Lee Rainwater, And the Poor Get Children, preface, p. 9.

8
Lee Rainwater,_§amily Design, pp. 15-20.
9Ibid., p. 17.

 

‘\

.

 

l4

fund of knowledge and generalizations already available. While this is
true, a strong case can be made for such studies in family planning be—
cause of its peculiar nature. Very few past studies deal with such an
intimate and private aspect of human life as sex and progeny. Family
planning is very closely linked with the emotional core of personality.
It is deeply rooted into the social structure of every society through
the institutions Of family, marriage, religion, social norms and customs,
and codes of interpersonal social behavior. And lastly, unlike many items
of diffusion which have been studied till now, it concerns almost all the
members of every society. Viewed thus, the study of diffusion in family
planning really offers an opportunity for further confirmation, verifica—
tion and modification of the already available knowledge in the diffusion
field. According in Bogue, in our knowledge of diffusion in family plan-
ning lies the nature to one of the most difficult and urgent problems of
the present day'world.lo He regards diffusion as the key to the problem
Of population. Application of the diffusion framework to family planning
therefore becomes still another focus of this study.

Further, it is hoped that a highly valuable body of knowledge could
be gradually built in the field of family planning by the above suggested
approach. Much can be learned about the ways families view and face the
'basic facts of biological procreation, about the processes Of attitude
formation and decision-making regarding the vital events of life, and

:about how they make choices between different alternatives impinging upon

 

10 ,
Donald J. Bogue, who spoke on general importance of diffusion studies

art the annual meetings of the American Sociological Association, Miami
Beach, Florida, August, 1966.

15

family growth and size. Out of the several aspects of family planning
we need to know more about the "family" part Of it. This study seeks to
emphasize the family component of the program by attempting to focus on
the dynamics of interaction between the wives and husbands in relation to
this aspect of their lives.

In the end it is believed that, as in the case Of agricultural devel-
Opment so also in this field, such a body of knowledge would prove of
great help to the Operators and their action program by rendering their
approach more realistic, less costly and more effective. The ultimate
result being our achieving more efficiently something today which might

have been possible somehow tomorrow.

 

. . .s Nth 9» s u
.\ a s v I a .l 3. . s... ~

 

CHAPTER II

THEORETICAL AND METHODOLOGICAL ASPECTS
OF THE STUDY

Every study in its planning phase is concerned with two important
problems: (1) a need Of an appropriate theoretical frame of reference,
and (2) suitable methodology. In this chapter, we would be largely con-
cerned with these two main aspects of our study. Interrelating the two
aspects will be the discussion of a conceptual and analytical model which
is used in this study to formalize the major variables, their interrela-
tionship, the related methodological concepts and the resulting organiz—
ing guidelines for analysis and presentation of the findings.

In the section on theoretical aspects we will be concerned broadly
with defining the problem, briefly stating the position Of theory in the
field of demography, indicating some basic ideas and concerns which
guided the study, and finally designating the unit of analysis. In method-
ology, our concern will be to describe in detail the mechanism Of identi-
fying the respondents, developing the tools of research, the procedure
Of'collecting information, and lastly the limitations Of the study re-
sulting from various theoretical and methodological decisions.

Review of Theory and Proposed
Theoretical Frame
Statement of the Problem: Several demographic studies and surveys prior

ix) this have shown that Indian couples favor a limited family size of

16

L h ...1.

17

about three to four children.11 This is relatively more true of urban
areas. Table 1 below illustrates this with the help of the findings of
some selected surveys in India.

TABLE 1

Ideal Family Size as Reported in Some Selected Surveys in India

 

 

Survey and Source Ideal Family Size
a

National Sample Survey — sixteenth round - urban 3.2

Bangalore City - wife responseb 3.6

Calcutta Study of Contraceptive Prevalence -
middle class clerks, etc.c 2.6

Fertility Growth Through Contraception -
Delhi Govt. Clinics - majority of those who had
3 pregnancies reported to F. P. Clinics 3.0

Family Planning in Selected Villagese 4.0

Survey Of Ferpility and Mortality in Poona District -

city median 3.4

 

aC. Chandrasekaran, "Recent Trends in Family Planning Research in India,"
Familnglanni g and ngulation Prggrams, eds. B. Berelson, et al., p. 553.
bRonald Freedman, "Norms for Family Size in Underdeveloped Areas,"
The Proceedings of the Royal Society, B, Vol. 159 (1963), p. 235. This
article is also reprinted by The University of Michigan Population Studies
Center, Reprint NO. 16.

cDonald J. Bogue, "Some Tentative Recommendations for a Sociologically
Correct...," Research in Family Planning, ed. Clyde V. Kiser, p. 504.

d

S. N. Agarwala, Fertility Control Through Contraception, p. 28.

eThe Demographic Section of the Institute of Economic Growth, Family
Planning in Selected Villages, p. 24.

fBogue, p. 504.

11
B. L. Raina, Family Planning Programme:Rgport for_;962-63, p. 12.

18

This trend is further supported by the fact that in 1964 about 63.4%
of the national population did not want any more children.

Studies in India have also revealed that, while there is almost a
universal desire to have a family Of limited size, a large majority of
people and up with a much larger family than what is desired. Thisnis
best illustrated by Table 2, based on the estimates Of the Registrar-

1
General Of India 1951 Census Report, 3

TABLE 2

Average Number of Children Born to a Woman of 45 Years and Above
in Selected Regions of India

 

Regions of India No. of Children

 

Travancore-Cochin 6.6
East Madhya Pradesh 6.1
North-West Madhya Pradesh 6.3
South-West Madhya Pradesh 6.6
Two Groups of Districts in West-Bengal (in each case) 6.3

 

According to Bogue, both in urban and rural areas the actual average
family size is between six and seven children were born per married woman

14
above fortyafive years of age. In the 1961 Census, the percentage of

 

12The Indian Institute of Public Opinion, "Family Planning," Monthly

Public Opinion Surveys, 9 (March, April, 1964), p. 6.

13K. C. K. E. Raja, "Family Planning in Relation to the Population
.Problem and Community Welfare," in (Proceedings of) Second All Indian Con-
_ference on Family Planning, p. 25.

14
Bogue, p. 504.

l9

births of the sixth order and above was estimated to be about 22.8%15

This gap in actual and desired family size is further confirmed when
we look to estimates of the extent of use of family planning methods
other than abstinence. According to the National Sample Survey Of Indian
Statistical Institute Calcutta (1963), only 5 percent of the husbands in
urban areas with wives below fortyafive years had ever practiced a family
planning method.16 The United Nations' Mysore Population Study reported
the use Of family planning methods by only 4 percent of the couples in '»
Banglore city.17 The Indian Institute of Public Opinion (1964) concluded
that in urban areas only 14.6 percent of men and 13.1 percent of women
said they had ever practiced family planning. In rural areas the corres-
ponding figures were 10.8 for men and 3.1 for women.18

The above analysis brings into focus in unmistakable terms the dif—
ference in the actual and desired family size. This difference, which
is considerable indeed, measures the gap between the desire and action
of about ninety million couples who are in the reproductive age-group and
who together constitute India's most baffling problem of incessant popu-
lation growth. According to the 1961 census, India’s population was
439.2 million and the same is now estimated to have crossed the 500 mil-
lion mark .

If, on the one hand, the desire for small family is so much evident,

land.On.the other, the actual family size so large and family planning

 

1
5B. L. Raina, "India," in Berelson, et a1., 9p. cit., p. 112.

l6Chandrasekaran, p. 555.
17
Ibid., p. 555.

8 ,
The Indian Institute of Public Opinion, op. cit., p. 19.

20

practice very low or rare, what can be the factors necessary to bring
about convergence between the two? This is in very broad terms the prob-
lem of central concern to this study.

There cannot be any one simple answer to this question. And yet,
in terms of action programs the success of work in this field depends on
our success in identifying one by one all the possible factors that
account in creating this gap. The usual factors which immediately come
to one's mind are: (1) lack of service organization, (2) lack Of infor—
mation about the methods and available services, and (3) lack Of suitable
family planning methods. This reasoning is indicated by the fact that
family planning programs now under way in most of the developing countries
place great emphasis upon the "knowledge and service" theory.19 The
assumption is that if these barriers are somehow overcome, there would be
an automatic mass acceptance Of family planning. While this seems to be
largely true, this does not seem to exhaust all the possible factors re-
sponsible for the problem. For example, areas could be identified in
urban centers of the country where services have been available free and
information is claimed to be sufficient by the agency, and yet, the accep-
tance is far below the expectations as implied in the assumption. The
fact that the situation does not change radically even after the intro-
duction of IUD in such areas calls for a search Of other possible factors
which may be partly responsible for family planning acceptance. If some

of these additional factors could be identified and their relationship

 

1
9Donald J. Bogue, "Family Planning Research: An Outline of the

Field," in Berelson, et a1., op. cit., p. 727.

21

to acceptance understood and appreciated, it would help in giving addi-
tional direction for action programs and go a step further in reducing
the gap between desire and action.

In this search for additional factors and better understanding of
already recognized factors, the importance Of the target-group, its pat-
terns of behavior and its action potential have long been recognized as
important in social sciences. Diffusion studies in particular are very
much concerned with these aspects from the point Of view of the target-
groups. They have studied problems such as: how information is diffused
in the group, how it reaches the units concerned, how these clues are
perceived and interpreted, how decisions are made, and what types of
orientations accelerate or slow down the processes of acceptance of agri-
cultural innovations. It would therefore be quite reasonable to expect
the presence Of similar factors and processes in acceptance of family
planning. Unfortunately very little has been done by way Of research in
this area of family planning. This may be largely due to the fact that
intensive family planning research, within the general field Of demo-
graphy, is hardly ten years old.20 In developing countries like India,
research in this field is still in its infancy and systematic studies in
the diffusion processes of family planning innovation leaves much to be
desired. Viewed thus, our broad problem becomes further specified in
terms Of studying diffusion processes of family planning in target-groups
vcithin the theoretical frame available to us from a large body of agri-

cultural diffusion studies in sociology. The specific theoretical concepts

 

ZOIbid., p. 734.

22

derived from this body Of knowledge have been reviewed and defined in the
context Of this study in relevant chapters and they will not be discussed

here in the abstract. This will also avoid unnecessary repetition.

The Basic Unit of Analysis: Human fertility is a very complex phenomenon.
It is the result of several factors, spread over from the smallest human
unit--the individual-~to the largest-~the nation or community Of nations.
This means that several units of analysis are available to researchers

in this field. Out of these, three--the individual, the family and the
societya-have been most frequently used. Generally speaking, all the
three differ in their focus and theoretical and methodological orienta-
tions with some degree of over-lapping. Those who study the society
generally depend on demography for theoretical orientation, seek their.
data by the census method, and are concerned with larger problems Of food,
employment, housing and national planning. Generally they furnish a
broad perspective which makes it evident that fertility contrOl is neces-
sary and urgent for human welfare. Some typical examples of this type
are: (1) "Population Growth and Economic Development in Low Income Coun-
tries" by Coale and Hoover, and (2) "Mbdern Science and the Human Ferti-
lity" by Meier. Those who focus on the individual generally tend to
follow psychological orientation, adopt clinical depth interviewing as
their important method of data collection, and focus more intensively on
the individual's personality, his peculiar sex life, and unique life ex.
periences. The typical example of such an approach are the studies of

Rainwater-~And the Poor Get Children and Family Design. There are others

who take the family or community as the unit, follow largely the sociological

23

methods Of field interviewing, and emphasize the processes and concepts
of social interaction, human behavior and communication. Typical exp
amples of this approach are: (1) study of Stycos, ”Family and Fertility
in Puerto Rico," (2) Hill's study of "Family and Population Control,"
and (3) Bogue's study Of "written Communication for Birth Control." As
already pointed out, there is frequent over-lap but the dominant char-
acteristic Of different studies generally shows up on closer examination.

In brief, then, the problem of human fertility takes on one research-

able formulation in the case of individual, another in the case of the
family, and still another when nation or nations are the unit of analysis.
The second (family) approach has been selected for this study because of
several theoretical and practical reasons:

(1) It comes closer to author's theoretical and methodological
orientation.

(2) Family forms a close link between the unique micro level of the
first type and the aggregate or macro approach of the third
type, and yet gives us an ample scope to concentrate, Observe
and analyze the central sociological concepts.

(3) The selection of the family as a unit also helps in providing
some theoretical frame in a field which is noted for a lack of
theory and where contributions in the form of descriptive
analysis predominate.21 Kiser, while reviewing the theoretical
strengths of some of the classical studies—~the Indianapolis

Study, Hill's study in Puerto Rico and the Princeton Study;—

 

V

21 .
.Ronald Freedman, "American Studies Of Family Planning and Fertility:

A.Ileview of Major Trends and Issues," in Kiser, Op. cit., p. 211.

I

24

concluded that the effort to arrive at a single organizing
theory failed in each case and the researchers had to be satis-
fied with independent isolated variables and their descriptive
analysis.22 Selection of the family as a unit comes to us as
a great help through the available fund of theoretical knowl-
edge Of sociology in general and family sociology in particular.
Because the family is a small social group, it lends itself to
the systematic approach of sociology. Family studies bridge
the gap between the conceptual extremes of the culture at one
pole and of the individual at the other, making possible Ob-
servation of both culture and personality as they are interre-
lated in real life.23 This view Of family enabled us to identify
the following four areas of interest to this study:

(a) Communication to and within the family

(b) Decision-making

(c) General orientation of the head of the family to life

(d) Demographic and related aspects of family growth
Once this was done, several theoretical concepts such as roles,
authority, communication stages and linkage, and orientation
to life became available as tools for analyzing family planning

behavior of the families studied. These and other concepts

22
Clyde V. Kiser, "The Indianapolis Study of Social and Psychological

Factors Affecting Fertility," in Research in Family Planning, pp. 161-162.

2
3Oscar Lewis, "The Culture of Poverty," Scientific American (October,
1966), pp. 20-21.

25

used in the study have been defined and described further in
the text of the thesis;

In adopting the above approach we are supported by Bogue
who has advocated a differentiation between demographic and
family planning research. According to him, "Family planning
research identifies explicitly the sociological and psychologi-
cal knowledge that is needed tO 'solve' the world's population
problem and sets out on a long trail of producing it. The
raison d'etre for family planning research is the recognition
that none of the theories or hypotheses being explored by tra-
ditional demography can provide the basis for stepped-up 'crash'
programs for fertility reduction."24 Bogue's "setting out on
a long trail" argument hints toward a possibility of some future
theoretical break-through in family planning research through
sociology and psychology. But as of today, researchers, in-
cluding this one, will have to depend on the descriptive analysis
of independent variables seen as systematically related within
some sociological unit which is the family in this case.

(4) Normally it is within the family as a social and biological
unit that decisions are made concerning procreation.25 There-
fore, any study which focuses on the analysis of action and

processes of acceptance must concern itself with the family,

 

24
4 Bogue, "Family Planning Research...," in Berelson, et a1., op. cit.,
p. 72 .

5 .
Richard L. Meier, Modern Science and the Human Fertility Problem,
p. 129.

26

once the organizational problems of service and the medical
problem of suitable methods have been reasonably well taken
care of.

(5) In addition to the above, several practical reasons of select-
ing the family as a suitable unit of study have been pointed
out by Hill. According to him, "It is the unit of planning,
choice making and action. It is capable Of serving as a refer-
ent in several conceptual systems of theory. It is accessible
for empirical Observation and investigation and it is the unit
of medical and education services in matters of fertility con-
trOl.'"26 In brief, then, by selecting the family as a unit of
study, we have further Specified our problem in terms Of the

target-group unit and appropriate theoretical orientation.

Methodology of the Study
Prcposed Analytical Model: The first step in methodology was to develop
an analytical model illustrating the conceptualization of the problem, the
major blocks of variables and their possible interelationship with the
family as an integrating force.

Given the dearth of coherent theory in the field, developing a model
‘becomes a difficult job. 'We had to depend on available, middle-range,
existing generalizations which apply to distinct levels Of social units
such as groups, communities and societies. In this study, family is

'viewed as a small group interacting both within itself and with the larger

 

“— _

26
Reuben Hill, J. Mayone Stycos and Kurt W. Back, The Family'and Popu-
lfgtion Control: A Puerto Rican Emperiment in Social Change, pp. 28-31.

27

society. At this level of analysis, family-in-society, initial reconnais-
sance of the existing literature, showed that two models focusing on in-
teraction processes within the family were available. These are the
interaction model of Hill27 and the dynamic model of Meier.28 On closer
analysis of these two models it was felt that the two were basically the
same and involved practically the same common variables Of decision mak-
ing, communication, and demographic and general value orientation. These
variables also happen to be of interest to agricultural diffusion studies
in general and to this study in particular. The main difference within
these two models seems to be mainly related to the fact that the inter-
action model tends to emphasize more the family as the unit, and the
interaction processes in it, while the dynamic model focuses more on

the family as related to the larger society.

For the purposes of this study, a more simplified model based on the
above two was developed and is illustrated in Figure 1 on the next page.
The main difference between our model and the two discussed above lies
in the fact that, unlike them, we are not concerned with the individual
action level where perhaps the factors of service and method become most
crucial because action is a given fact in our study design as we are con-
cerned with acceptors of family planning alone.

This model has been used in three ways in this study:

First, it helped in conceptualizing the major variables and associa-

ted processes involved in family planning action from the point Of view

 

2
7Ibid., pp. 218-240.

28
Meier, Op. cit., pp. 134-136.

28

Figure 1

Conceptual Analytical Model Specifying the Interrelationship
of Selected Variables in Fertility Planning

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

S / Value x\
0
0 8‘3X gents
Gefl tlo
c _ __ ._ ”N
/ skim ' N
I 9P5 ' 12m A
\ l 2 3 / E l
E 'A\
generalized generalized generalized -~:
T past fertility current life future life : '
experience style orientation u.
I . .
| I
__ : ,
,LL . 1.1L 5 3L ' I
I
F specific diffusion to / attitude I :
family (_______9 family about / development ' .
A size family limi- / evaluation ,’,
tation pos- / of alterna- ”’ ’
M sibilities / tive desired . .
[ family size , ’. ’
I . ’
6 , C ’
L 1’ ’
decision 3”
Y H <'-> W , 3
making . c ’

‘t':>C1c1F4<:k+tj=:»4

 

 

 

 

 

individual

action

 

29

of the target-group. Such a conceptualization, in turn, helped in devel-
Oping relevant diagnostic questions and provided theoretical justification
for their inclusion in the interview schedule, which was the main tool of
collecting information.

Secondly, this analytical model laid open several theoretical con-
cepts related to each major block of variables. Thus, in spite of a
lack of an over-all organizing theory, it made possible the study of the
block of variables in some interrelated way, and greatly enhanced our
understanding of the dynamics of the processes and variables involved in
family planning acceptance, in spite Of the fact that they refuse to be
closely knit together in a systematic theory capable Of generating speci-
fic researchable hypotheses.

Lastly, the model is used in the analysis, organization and presenta-
tion of the findings of this study. Thus, questions considered in decision-
making--block six--constitute the chapter on decision-making and questions
of block five dealing with communication, evaluation of means and ends
and developing of specific attitudes towards them go together to make
the chapter on communication. Similarly blocks one, two and three com-
pose the chapter On value orientation, and the chapter on demographic
characteristics takes into account the responses to questions in blocks

four and one of the model.

The Respondents: It has already been explained that the purpose of this
study was to find out the WHY and HOW Of family planning from the point
of view of the target-group by focusing on certain selected variables
and their interrelation within the family as a unit. The use potential

of knowing this for improving action program was also emphasized.

30

In order to meet the above two expectations, it was necessary to
limit the study to units which have undergone the different phases of
acceptance so that their experiences could be studied with definite bene-
fit to future programs. Hence, a decision was made to study only those
who have accepted family planning. But this decision brought another
problem of defining acceptance which has proved very elusive to researchers
in this field. Balfour has emphasized the need to differentiate between
the opinion of the researcher and the Observed fact so far as acceptance
of a method is concerned.29 Verification by observation is impossible
in this area of one's private life. Reliance on reaponses could be biased
when the respondent knows no one could check it and therefore he is tempted
to give the expected answer to please the researcher. Further, respon-
dents in developing countries like India have no experience of survey-
interview-situation.30 Under these difficult circumstances researchers
have tended to define acceptance in different ways, ranging from professed
interest, through acceptance of teaching and materials, to ever-user,
continued-user and effective-user.31

This study was fortunate to be undertaken at a time when IUD--intra
uterine device made of p1astic--program had been in operation for about
ten months. It was therefore decided to study acceptance of IUD because

in this case acceptance was more definite, and its continued and effective

 

29
Marshall C. Balfour, "Comparative Acceptability of Different Methods
of Contraception," in Kiser, Op. cit., p. 373.

0
3 Harvey M. Choldin, A. Majeed Khan and B. Hosne Ara, "Cultural Com-
plications in the Fertility Survey," pp. 13-14. (Unpublished)

1
Balfour, op. cit., p. 384.

31

use more assured because of its one time semi-permanent nature. Further,
as it could be had only from certain designated sources, the fact of
acceptance could be established objectively. Another strong reason to
study only IUD acceptors was the promise it holds for easing population
problems in developing countries like India. This decision to study
only IUD acceptors, then, became an additional specification of our

stated broad problem.

Location of the Study: This brings us to the selection Of areas where

 

the study was to be carried out. Three colonies--Kidwai-nager, Andrews-
gang and Shri-Niwas-Puri--of middle-class government servants in New
Delhi were selected on the following criteria:
(1) These were easily approachable to the researcher, in view of
time and other resources available to him.
(2) These colonies also happen to be those where mass use of IUD--
as different from the experimental use--was first started.
(3) All the three selected colonies are served by the same family
planning agency and by similar clinical set-up.
(4) Lastly and perhaps the most important consideration was the
fact that in these colonies family planning program has been
in operation for several years under Optimum favorable condi-
tions in respects to the factors of general organization, infor-
mation and availability of methods. This meant that here we
could have a more thorough and comprehensive situation to Ob-
serve the target-group vieWpoint in acceptance Of family planning.
But for these advantages we had to pay the price in terms of the

general applicability of our findings, which had to be limited to these

32

colonies and perhaps similar others in the country. However, this in no

way minimizes the value of the resulting insights in this most important
and least investigated area Of the target-group interaction and its tre-
mendous relevance for practical family planning programs. Such compro-
mises in research studies, rather than being the exception, tend to be a
matter of a general rule. What is more important for the researcher is

his awareness to these limitations resulting from compromises.

Number of Respondents: The previous two decisions about studying only
IUD acceptors and in the three government colonies influenced very much
the problem of deciding the number of cases to be studied and the pro-
cedure of selecting them. When the possibility Of the number Of cases

to be studied was viewed with the above two decisions, it soon became
Obvious that given the rate of acceptance of IUD and the size Of colonies,
the cases would be so limited as to make sampling unnecessary. The other
possibility of including more colonies was considered and given up on the
basis of limited time and material resources available to the study. It
was therefore decided to study all the 182 cases who had accepted IUD
'through these clinics and who reside in the colonies.32 This meant limi-
tations on the use of possible statistics, but as the focus of the study
'was to find out general pattern of the process of acceptance, it was felt
'that the use Of simple descriptive statistics should be acceptable as the

2According to clinic records, 263 women took IUD. However, 81 cases
(30%) had to be dropped because they could not be contacted on the grounds
surfli as, "wrong address," "moved out," "could not be contacted," and "hus-
baxui not knowing use of IUD by his wife," In another study done by S. N.
Agarwala under similar conditions the loss was estimated to be 21$ at the
clinic l’evel.

33

second best indicators of broad trends at this initial stage of the IUD
program. In the course of time, when the cases would be more numerous
or more resources were available to include other colonies, it would be

much easier to follow this study with a more rigorous design.

Plan for Collectingglnformation: In deciding upon the strategy Of col-
lecting information, several situational and cultural aspects were con-
sidered by the researcher before he could develop a suitable mechanism
to get the information necessary for the purposes of this study.

First, we decided that the general approach would have to be one
calling for the cooperation of the respondents to reconstruct the sequence
of events as accurately as possible. This approach meant a heavy reliance
on the recall ability of the respondents. _We had to view this decision
against the problem of possible lapse in recall. Several factors indicate
that this problem existed at a minimum in this study. First, the smooth
and easy way in which the respondents replied to the questions showed that
it was not a serious problem. Secondly, IUD had been in use only for ten
months and most people accepted it in the latter half of this period.
Thus, for most of them acceptance of IUD was less likely to be a fact of
a dead and distant past. The fact that most Of the respondents were
literate, that the question of limiting the family was treated by them as
a serious problem and that the agency has maintained a continuous infor-
mation program of IUD in these colonies, reduced further the chances of
lapse in recall very much.

The next question to which consideration was given concerned the

loroblem of deciding as to who should be interviewed in each family. Three

34

alternatives were available. Following the practice of interviewing the
women which has almost become a tradition in fertility studies, or alter-
natively to interview husbands or both Of them. Several considerations
led to the decision to interview husbands as the "agent" for the whole
family.33 First Of all, we were not concerned in great detail about the
fertility and pregnancy histories of the families, which is an area where
women's information is supposedly more reliable as compared to their
husband's. Secondly, this supposed advantage of interviewing women is
being questioned more and more by empirical studies. Poti's study3 in
India and Yankey's study35 in Pakistan indicate higher chances of more
information and also reliable one from the husbands as compared to wives
in most areas of interest to family planning research even when women
investigators are used to collect information. Berelson, reviewing several
fertility surveys all over the world, found striking similarity between
the responses of wives and husbands.3 In addition to these empirical
evidences, one would expect husbands to verbalize more accurately and
completely because of their higher education and greater orientation to
the outside world. This will be particularly more true of developing
countries like India. Lastly, the fact that for this study the investi-
gator was male weighted heavily in favor of deciding to interview husbands

.as agents of their families.

 

33Indianapolis study treated wives as reporting agents for their
families. Hill, op. cit., p. 28.

L,
3 S. J. Poti, et a1., "Reliability of Data Relating to Contraceptive

Practices," in Kiser, Op. cit., pp. 51-67.

35David Yankey, et a1., "Husbands' vs. Wives' Responses," Pomlation
Studies (July, 1965), pp. 29-43,

36Bernard Berelson, "KAP Studies on Fertility," p. 661.

35

Another related problem was the question of availability of husbands
as compared to wives for interviewing. In places where women employment
is low, their availability for an interview is much greater than men who
are employed outside the home. Having made the choice to interview the
husbands, we had to decide to carry out our interviewing on holidays when
husbands could be expected at their homes. In addition to this, inter-
views were also done during odd hours of the night. Another aspect Of
this problem was that limited availability of husbands meant repeated
visits per interview. In some cases as many as eleven visits were made

for one interview.

Identification of Cases: A study of the working of family planning
clinics in these colonies revealed that clinics maintain a six by four
inch card on each woman who had accepted IUD from the clinic. This card
contains information about names of wife and husband, their home address,
number and sex of children, age of wife, description of IUD used and date
of insertion. This much information was considered more than enough to
locate the house and identify the couple. It was therefore decided to
duplicate these cards and use them for identifying the cases. In addi-
tion to this an attempt was made to check the details of residence Of the
cases from the records of estate Offices in each colony. However, this
was given up as the records in the estate Office were found to be defi-

cient for the purposes of this study.

InterviewinggSchedule: A schedule37 was used for collecting the data of

this study. It was developed in five parts having several questions in

 

37See Appendix 2.

36

each area of concern to the study. These areas were: (1) general infor-
mation, (2) demographic characteristics, (3) diffusion of information to
and within the family, (4) general orientation to life of these families,
and (5) decision making in the family (see the model). This schedule was
pretested in a similar population outside the three colonies covered in '
this study. The final schedule which emerged after taking account of the
pretesting experience contained sixty-one questions so arranged as to
cause the least possible problem to the informants in reconstructing the
general sequence Of events as experienced by them. This_means inter;
mixing questions from different areas, but every care was taken to in-
clude all the areas and relevant questions in each one of them in the
fhmlsdwmfle.

SO far as the nature of questions was concerned, some Of them were
structured while others were Open-ended depending upon the nature of exp
pected response and experience in pretesting. Thus, the final schedule
was a semi-structured tool providing for probes and questioning in depth

wherever necessary.

Interyiewing Situation: Because of the nature of the study, careful con-

 

sideration was given to the problem Of introducing the investigator and
the study to the respondents. After trying various alternatives, a suit-
:able statement was evolved which became the first part of each schedule.
.As a.result of our experience, we are convinced that the statement served
cmir purpose of establishing appropriate rapport with respondents.

Another aspect of the interviewing situation was the problem of

{Irivacy. In the case of this study, our decision to interview the

37

respondents in their homes reduced this problem to privacy from sons,
daughters, and relatives, if any. The apartments are small. Only one
room is Open to the outsider. This room also serves as the drawing room
Of the family, study room of the adults, playroom of the children and
bedroom of the old members of the family. ‘Without going into details as
to how the situation was faced, it would be sufficient to mention that
most Of the interviews involved this problem and that each case needed a
different strategy to ensure privacy Of interview. Roughly about one and
one-half hours was required for interviewing one respondent. In addition
to this, about half an hour was required for locating the house, identify-
ing the respondent and securing his consent for the interview.

In conclusion, it must be frankly stated that no attempt is made here
to create the impression that once the above decisions were made the re-
search and data collection became a smooth and pleasant job. On the con-
trary, several unanticipated problems were faced during the course of the

study. A brief discussion of some of these follows.

InterviewingExperiences: One of the aims Of all the investigators in
field research is to plan in advance all possible situations that may
arise in interviewing. In spite of this, unexpected things happen and
upset his plan of work. Several factors such as differences in the per-
ceptions of respondents, questions about the identity of the interviewer,
uncertainties of interview situations and problems of communication, may
cause such upsets of his field program. In this study an attempt was
:made to minimize such events through pretesting, but still deviations

(accurred. Rather than ignore such experiences an attempt is made to

38

document some of these for the benefit of those who might face similar

situations in the future.

Image Of the Investigator: This study made use of a factual statement to
introduce the investigator and the study to each respondent. And yet,
perhaps because of the nature of the device, the respondents continued to
regard the investigator as a medical doctor. This was natural because

IUD is inserted by doctors in the clinics and hospitals. The question,
"Are you a doctor?" was put to the investigator by some bold respondents.
Many continued addressing the investigator as doctor. In order to correct
the situation, at some appropriate stage Of the interviewing process, it
was explained to them that the investigator works with doctors and is not
a doctor himself. This seemed to satisfy the informants, and also estab-

lished his right to ask questions about IUD.

Confidential Nature of Information: Studies in family planning deal with
information which is usually regarded as strictly personal in most socie-
ties. In the case of some, talking about sex is a taboo. Sanctions Of
decency and good taste are used to prohibit sharing information on such
topics. In the case of certain persons, it can be a highly emotional ex-
perience. Generally speaking, the more backward the group, the higher
the sanctions. In such situations, unless the confidential nature of the
infbrmation is assured, one runs the risk of missing a lot of information.
Another aSpect of this problem is to interview the reapondents pri-
vately. The problem of outsiders was partly solved by interviewing the

respondents at their homes. However, the difficulty of maintaining

39

privacy from their sons, daughters and relatives continued. The apart-
ments Of respondents are small and only one room is open to the outsider.
This room is also the only common room for the whole family. Obviously,
only a highly skilled interviewer could meet the demands of such situa-
tions. 'Without going into details of how this problem was faced, it would
be sufficient to state that the majority Of interview situations in this
study involved this difficulty and that each one of these needed a differ-

ent strategy.

Time: The Problem of a Long Schedule: Roughly, about one and a half hours
was required for each interview. Interviewing women perhaps could have
reduced this difficulty partly, but the decision of this study involved
interviewing husbands. Because of the reasons already explained, this
very much enlarged the problem. Several steps were taken to keep this
difficulty to a minimum.

First, immediately after the introduction, the investigator made in-
quiries about the health of his wife since she started using IUD. This
made the inquiry look purposive and entirely for the benefit of the in-
formants. Some were keen to collect additional factual information about
IUD and this was provided to them whenever inquired. This sense Of the
inquiry being to their advantage was further increased by emphasizing the
fact that as a result of their sharing the information, the IUD program
would be further improved so that it could be of use to others in the
society. These implicatiOns had the effect of his agreeing for the inter-
‘viewu The decision to do most of the interviewing on holidays further re-

chlced this problem. Lastly, each respondent was given the option of fixing

40

the interview some other day in case he could not give the required time
right away. The fact that only a few took advantage Of this alternative
leads one to think that the procedure used to minimize this unexpected
difficulty worked very well.

However, the problem of non-availability of the respondents for the
initial contact remained a major problem. This involved on an average
three visits per respondent and resulted in the loss of so many working
hours. But in circumstances where there is no other way of establishing

the first contact this difficulty had to be lived with.

Communication: Language was not a problem in this study. Everybody could

 

talk Hindi or English and the investigator knew both the languages. The
difficulty appeared in another form. It is usual in a group to use several
terms for the technical name of any innovation. IUD being new, so many
terms, ring, coil, thread, challa, three year plan of not having children,
and five year injection of not having children, were in use. This meant

a very careful investigation to establish the fact that the respondent

was using IUD. If one was not alive to this, so many cases would have
been classified as "wrong information or address from the clinic" and
wasted. In this study, therefore, before starting the interview, the

common identity of the family planning method--IUD--was first established.

About the Questions: Going back and reviewing the questions used could
be a great help in analysis and interpretation Of the data. Some of the

troublesome questions would be considered here.

41

nggger Month (9-10): Normally in a salaried class such as this one
would expect to get this information easily. Experience showed that
even in the case Of a fixed income group it is a very tricky question
and needs several sub-questions to get to more realistic information.
The problem is caused by so many types of cuts implemented at the source
and by several other types of direct and indirect benefits included in

the pay-packet based upon the individual status of each worker.

What State Do Ybu Belong_(Q-l3): In the Opinion of the ennumerator this
was a poor question. It allowed informants to interpret it differently
as there was no clear cut definition of "belonging." The result was that
many of the respondents said they belonged to a state which is in
Pakistan, some Of them interpreted it to be the state of birth, and a

few of them responded to it in terms of a state where they hold property
rights. In addition to these, there were several additional variations.
A correct way would have been to define it more concretely so that the
reliable information could be obtained. Hence for the purpose of the

study, this information will be treated as lost.

How Lonngave YOu Been Marriedy(Q—l4): This question proved a blocker in
the smooth flow Of the interview as it made informants do some calcula-
tion. After some interviews, it was found that for most of them it was
relatively easy to give the year of marriage and very frequently the date
and month also. Hence in the rest of the schedules the year of marriage
‘was asked and calculation of number of years was done in the office by

the enumerator .

42

‘Have Ybu Influenced Any And If Yes How Many (Q-44): Respondents expressed
difficulty in giving answers to the second part of this question. The
emphasis in this part was to obtain that number about which the respon-
dent was sure. The respondent's difficulty was that generally people
consult before having IUD but do not necessarily inform about the fact

of having taken the device. To avoid any guessing, only such numbers

were recorded about whom they had definite information. On second thought,
the investigator now feels that it would have been better to take intel-
ligent guesses of the respondent as a sufficient answer to this question.

The degree Of reliability insisted upon was not called for.

Practice Of Family Planning Before IUD, The Method(s) Used and Regularity

Of Use (Q-45, 46): The last two aspects of the questions created various

 

difficulties. Fbr example, over a period of time people change from one
family planning method to another. Some methods are used in combination.
In the case of several respondents, the meaning of the term "regularity"
remained undefined. And lastly, the questions did not provide for plan-
ned spacing of children. Therefore, the information collected on the

type of method used and regularity of use is not used.

'What Other Things About IUD YOu Liked_(Q-29): This was a probe question
to list all possible qualities of the device which entered in decision
making process. Looked at from the informant's point of view, experience
leads the investigator to feel that perhaps this was pushing him too far
for recalling all the possible good qualities. It seems a process of
selective perception operated which made the informant see and remember

only those specific qualities of the device which met their need or

43

problem and the rest were just blocked out of memory. This also explained
why the most important quality was mentioned very easily while other
qualities made him pause, think and rationalize. The other difficult

task involved in the question was to relate the qualities to sources of
information. Obviously this was a hard exercise. Keeping in view the
above difficulties and the poor response to this question, the investi-

gator feels justified in not using this information.

‘Questions On Projection Into Future (Q-52, 5311522: Frequently the in-
formant would ask toward the end Of the interview how these and other
questions (54, 55, 59-60) are related with your study of IUD? This led
to developing answers for such situations on the spot. Some of those who
belonged to the lowest grade of employment had to be stimulated by exam-
ples to construct imaginary situations and then respond to questions.
Another difficulty was that the range of response in some cases was
simply beyond the closed response categories provided in the schedule.
Perhaps a provision for recording free responses would have been better.

But such cases were not large enough to cause any concern.

Questions Requesting Information On Wives From Husbands (Q-24, 30-31,
34-35, 401 42-43): As already explained, this was the second best alter-
native available to the investigator. Theoretical reliability of infor-
mation from secondary sources can be questioned. However, the investi-
gator thought it better to work on his hunch that the decision of family
planning acceptance should largely be a joint decision requiring frequent

interaction and sharing of information and opinions between the couple.

If so, the advantage should be taken for seeking information on wives

4h

from the husbands on this special problem under investigation. After
having interviewed the respondents, the investigator feels that his hunch
was definitely the best compromise within the situation. ‘With the excep-
tion of a couple of cases, the response to such questions came easily and
confidently from the husbands, which largely negates the objection dis—
cussed above. éartly the level of sophistication and the style of life

of the respondents was also responsible for this outcome.

CHAPTER III
DEMOGRAPHIC CHARACTERISTICS

Some demographers view demography as the numerical portrayal of
human population represented by certain types of statistics. These sta-
tistics represent two main aspects of the behavior of any population: the
composition of the aggregate and changes that occur during some period of
observation.38 In this chapter we are concerned with the composition
aspect, while in the chapters following this, we would be largely con-
cerned with the change aspect and its related processes as experienced
and revealed by the group of IUD acceptors under study.

In dealing with the structure or the composition of this group we
would be mainly concerned with factors such as age, education, number of
living children, number of living sons, age at marriage, duration of mar-
ried life and desire for additional children. With the help of these
statistics we would present a descriptive numerical portrayal of the cases

'under study.

:Age at Marriage: The distribution of women by their age at marriage showed

that nearly 55 percent of them were married between 13-18 years of age
38George'W'. Barday,_Technigues of Population Analysis, p. 2.

1+5

46

(Table 3). The mean age of women at marriage was seventeen years which

39

is fairly close to the figures for urban areas in India.

TABLE 3

Age at Marriage - women*

 

 

Age Group in Years No. Percent
Under 13 14 8.0
13 — 14 20 11.4
15 - 16 47 .26.9
17 - 18 31 17.7
19 - 20 29 16.6
21 - 22 20 11.4
23 and above All __f_3_£_

Total 175 100.0

 

*Variations in the number of responses in this table and others in
the study are because of unavailability of reSponses from all the respon-
dents on all the questions.
Age at Acceptance: The average age of women at the time of IUD acceptance
worked out to be about 29.3 years and that of husbands 35.4 years (Table 4).
Nearly 56 percent of the women accepted the device when they were below

thirty years of age, and at this time about fortyaseven percent of their

husbands were below thirty-five.

 

39S. N. Agarwala, Fertility Control Through Contraception, p. 15.

47

The table below gives the distribution of the respondents (wife and
husband) by their age. It is significant to note that almost no women
accepted the device before the age of twenty, and after the age of thirty;
nine. The modal age group was 25-29 in the case of women and 30-34 in the
case of the husband. This may be largely due to the fact that husbands

seem to be older on an average by about five years.

TABLE 4

Age of Husbands and Wives at the
Time of IUD Acceptance

 

 

 

 

Age Group in Years Wives Husbands
No. Percent No. Percent
Under 19 0 0.0 0 0.0
20 _ 24 30 16.3 1 0.5
25 - 29 71 39.2 18 9.9
30 - 34 49 27.0 66 36.6
35 - 39 31 17.0 54 29.9
40 - 44 1 0.5 34 18.8
45 - 49 o 0.0 7 3.8
50 and above ___9 0.0 __l __Q;§
Total 172 100.0 181 100.0

 

Duration of Married Life: On the average, the acceptors have lived

twelve years of married life before acceptance of IUD. The frequency

 

40
Ibid. , p. 14.

48

distribution of the respondents according to number of years of married

life is given in Table 5.

TABLE 5

Duration of Married Life

 

 

 

Duration in Years No. Percent
Under 5 14 8.0
5 - 9 52 29.7
10 - 14 52 29.7
15 - 19 39 22.3
20 - 24 14 8.0
25 - 29 3 1.7
35 - 39 1 0.6
50 and above __11 0.0

Total 175 100.0

 

From the above table it is clear that about 60 percent of the couples
have been married between five and fourteen years. Further, a small per-
centage of families accepted the device before five years and after nine-
teen years of married life. The acceptance was maximum when the married
life duration was between five and fourteen years. Acceptance was almost
negligible after twentyafour years of married life. (Women were probably

infertile by then.)

Number of Living Children: Table 6 shows that most of the acceptors be—

longed to medium and high parity groups in terms of living children. Nearly

49

71 percent of them had three or more children. Khan and Choldin in their
study in East Pakistan found 75 percent of family planners having three

or more children.

TABLE 6

Acceptance and Number of Living Children

 

 

Category No. Percent
Low (up to 2) 51 28.0
Medium (3 or 4) 89 49.0
High (5 and above) _42 23.0

Total 182 100.0

 

When we classify the respondents according to number of living chil-
dren, we find that these couples had an average of 3.2 living children
at the time of IUD acceptance. Nearly 63 percent of the couples had up
to three living children, while nearly 28percent had up to two living

children. Very few of the respondents had no or one living child (Table 7).

Living Sons: In this group of family planners nearly 5 percent had no
living sons while 95 percent had one or more living sons. About 76 per-
cent had one or two living sons, and the percentage of those having three
or more sons drops down to about 19 percent, suggesting a desire to have

one or two living sons as important for this group (Table 8).

 

“1A. Majeed Khan and Harvey M. Choldin, "New Family Planners in Rural

East Pakistan," Demography, Vol. 2, p. 5.

 

50

TABLE 7

Number of Living Children

 

 

 

 

 

Living Children No. Percent
0 0 0.0
1 7 3.8
3 64 35.2
4 25 13.8
5 and more _42 23.0

Total 182 100.0

TABLE 8
Number of Living Sons

Living Sons No. Percent
O 9 [+09
1 65 35.7
3 or more _24 18.8

Total 182 100.0

 

Desire for More Children:

dents according to their desire for more children.

Table 9 below gives the distribution of respon-

It is clear that a

very high percentage (82%) of the people in this group think they have

reached or exceeded the desired family size.

About 100 respondents said

51

that their youngest living child was not desired by either of them. In
other words in using IUD the goal of most of the couples was to close the
family rather than space the children. Only 18 percent accepted IUD for

spacing future births.

TABLE 9*

Desire for More Children

 

 

Desire for Next Child No. Percent
Don't want 147 82.1
Want within 3 years 4 2.3
Want between 3 - 5 years 16 8.9
Want after 5 years _12 ._é;Z

Total 179 100.0

 

*The National Sample Survey (sixteenth round) conducted in urban
areas found that among husbands who had 3 living children, about 9 per-
cent expressed a desire for more children; 70 percent did not desire more;
and about 10 percent were indifferent.

Income: Most of the families under study belong to the moderate income

groups of the working and middle classes. 0n the average, husbands earned
42

281 rupees per month. Roughly about 49 percent of the respondents were

earning between 200-349 rupees per month. Table 10 shows the distribution

of income for this group of respondents.

 

About 7.5 rupees equal one dollar.

52

TABLE 10

Income of Husbands

 

 

 

Monthly Income Rs. No. Percent
Under 100 0 0.0
100 - 149 34 18.8
150 — 199 12 6.6
200 - 249 26 14.4
250 - 299 33 18.4
300 - 349 29 16.2
350 - 399 12 6.7
400 - 449 13 7:3
450 - 499 21 11.6
500 and above __9 0.0

Total 180 100.0

 

Education: It has been pointed out earlier that this study deals with
persons who are employed by the government of India and its related offices
in Delhi. Some minimum literacy is generally expected for all government
positions.

Table 11 below gives the distribution of husbands and wives accord—
ing to their education. The population studied is much more literate than
'the population of Delhi in general.

Nearly 80 percent of the women were literate and had attended a

:school. About 28 percent of them had studied up to middle school, that is,

53

had eight years of education. Twenty—three percent of the women had high

school education, and about 7 percent of them attended college or a uni-

 

 

 

versity.
TABLE 11

Education of Wives and Husbands

Education Categories Wives Husbands
No. Percent No. Percent

Illiterate 36 20.2 5 2.7
Primary 38 21.3 9 4.9
Middle 50 27.9 22 12.2
High School 42 23.4 56 30.9
Graduate 12 6.7 68 37.6
Post Graduate __;1 0.5 _21. 11.2

Total 179 100.0 181 100.0

 

In the case of husbands, about 97 percent of them had attended some
school and were literate. Out of these literate persons, as high as 80
percent have studied up to high school or more.

In this last section of this chapter an attempt is made to compare
the demographic characteristics of our respondents with those of a simi-
lar study largely covering the same category of respondents, that is,
white collar government servants, belonging to moderate income groups of

the working and middle classes, living in similar government colonies,

54

and served by the same family planning agency. This would give us a com-
parative idea of our respondents.

This study was done in 1960 by S. N. Agarwala of the Demographic
Research Centre, Institute, of Economic Growth, Delhi University, entitled
"Fertility Control Through Contraception."43 His survey involved a study
of 5912 family planning cases and covered eight GHSSun clinics as compared
with three GHSS clinics in this study. One of the clinics is common to
both the studies. Table 12 below compares some of the key demographic
variables of the two surveys.

Similarity between the demographic characteristics of the cases in
two surveys is striking. The difference in mean monthly income is per—
haps largely due to inflation resulting in increased dearness allowance of
government employees. This suggests our cases are fairly representative
of family planners in such colonies and further strengthens the findings

of this survey.

Summary: In brief, the following main demographic traits characterize
this group of IUD acceptors.

Most of the families belonged to educated moderate income groups of
the working and middle classes. All of them belong to service class and
live in government built two or three room apartments. 0n the average
they had 3.2 living children, and out of the whole group only 5 percent

did not have any living son.

ujAgarwala, op. cit., pp. 11-43.

GHSS stands for ”Government Health Service Scheme." This scheme
is organized by the government of India for its workers. In addition to
other health problems, it is also responsible for providing family plan—
ning services. '

55

TABLE 12

Comparison of Some Demographic Characteristics*

 

Characteristics Agarwala's Dubey's

 

Survey Survey

(1960) (1965)
l. WOmen's average age at marriage l7 l7
2. Average number of living children 3 3

3. Percent accepting family planning

after 24 years of marriage 2 2

4. Percent having 3 living children 62 63

5. Mean age of women 27 29

6. Mean age of men 32 35
7. Duration of married life (Agarwala's

figure refers to effective married life) 10 12

8. Percent literate husbands 99 97

9. Percent literate wives 89 80

10. Percent women married at age 15—20 73 60

11. Mean monthly income in rupees 214 281

12. Cases studied 5912 182

13. Sources of information clinic clinic

records records

only & inter—

views

 

*Figures have been rounded off to full numbers.

A little more than half of the women were married between age 13.18
while the mean for the whole group was seventeen years. On the average

they had lived twelve years of married life before accepting IUD. The

56

model age groups for acceptance of the device were 25.29 and 30-34 for
women and men respectively. By this time most of them had either reached
or exceeded the desired family size, and 82 percent of them did not want
any'more children. In other words, they were keen to close the family.
About 28 percent of them were low-parity women.

In terms of some key demographic variables our group is comparable
to a relatively much larger study consisting of about 6000 cases of family
planners from a similar pOpulation. To some extent this further strengthens

the findings of our study and enhances its applicability to family planners

in such populations.

CHAPTER IV
COMMUNICATION

Students of diffusion seem to be convinced of the central role of
communication processes in the acceptance of innovations. Some of their
major contributions, such as, adoption stages, opinion leaders, two-step
flow of information, and importance of primary relationships in accep-
tance of change relate to communication processes.

Fast and effective transmission of family planning messages to the
Indian masses seems to hold the key to India's population problem. Bogue
has the following to say about the present condition and future importance
of communication in family planning:

We sincerely believe that communication with the masses about

birth control has been a neglected area of family planning

programs all over the world... People must not only be made

aware of the existence of such centers (family planning clinics)

but they must be stimulated to use them, or to visit pragate

physicians or other sources of information to get help.

We are, therefore, concerned with certain aspects of communication
in this study; 'We are concerned as to (1) how the acceptors get the first
information, (2) what steps they took to collect additional information,
and (3) how they got the crucial information which made them favor IUD.

Further, we will also see and analyze the information-collecting behavior

 

45

Donald J. Bogue and Veronica Heiskanen, How to Improve Written
Communication for Birth Control, p. 2.

57

58

of husbands and wives, in what respect they differ and how they comple-
ment each other's efforts. Lastly, we will examine not only the use sig-
nificance of different communication media in relation to the three dif-
fusion stages of "awareness," "interest," and "evaluation;" but also
compare the communication media according to their importance, taking

the responses of wives and husbands together for the acceptance process

as a whole.

Awareness: Innovation adoption is not a one act operation. It is a pro-
cess comprised of several steps or stages.“6 Diffusion studies without
exception recognize awareness as the first stage in the process. It
signifies the entering of the innovation into the cognitive map of the
individual. The individual is exposed to the innovation for the first
time and may not have complete information about it. According to Rogers,
the primary role of the awareness stage is to initiate the sequence of
later stages that lead to eventual adoption or rejection of the innova-
tion.

Agricultural diffusion studies have widely documented differential
use and importance of communication media according to stages in the
adoption process. On the basis of the findings of these studies the fol-
lowing two generalizations can be made about the diffusion of information
at the awareness stage:

A __A_.

46Herbert F. Lionberger, Adoption of New Ideas and Practices: A Sum-
mary of the Research Dealing with the Acceptance of Technological Change
in Agriculture, with Implications for Action in Facilitating Social Change,
passimé See also NCRS Sub-committee, How Farm People Accept New;;deas,
PP- 3- .

“7Everett M. Rogers, Diffusion of Innovations, p. 82.

 

59

1. Impersonal mass media have been found to be the most frequently
quoted source of first information.

2. Cosmopolite sources of information predominate at the awareness
stage and local sources of information are important at the
evaluation stage.“9

In general, family planning difoSion studies also treat family plan-

ning acceptance as a process involving several stages. Lionberger has
applied the five stages concept to family planning. However, because of
the recency of interest in family planning diffusion studies, there is
not much to document.50 Bogue, while accepting the stages concept, has
slightly modified them. He refers to four stages in family planning ac-
ceptance: (1) Awareness and interest, (2) Information-gathering, evalua—
tion, and decision to try, (3) Implementation, and (4) Adoption and con-

51

tinued use. The dominant trend seems to make use of the stages concept
rather than revalidate or modify the concept in line with family planning.
As a result, while one finds isolated mention of one or another stage in

various studies, there is no systematic treatment of stage by stage dif—

fusion process in any one single family planning diffusion study.

 

“81mm, p. 99.

49Ibid., p. 102. In this study, personal cosmopolite sources refer to
the personal sources of information outside the system, such as, the clinic
staff. Personal localite sources refer to the personal sources within the
system, such as, friends, neighbors, relatives, and users. Mass media in

this study includes printed material, exhibitions, and radio.

50Everett M. Rogers and Erwin P. Bettinghaus, "Comparisons of Generali-
zations from Diffusion Research on Agricultural and Family Planning Inno—
vations," paper presented at the American Sociological Association, Miami
Beach, August, 1966, pp. 7-8.

51Bogue and Heiskanen, op. cit., pp. 7—20.

60

. . 52
For making people aware of family planning, experience in Japan

53

and experiments in Taiwan and in Indiasu have made use of impersonal

mass media and found it to be effective. In Taiwan and India local sources
of information have also been found to be more influential. This seems

to be at variance with the findings of agricultural studies, but this
difference in findings is more apparent than real. Firstly, these studies
are not concerned with final acceptance. And secondly, the agriculture
studies do maintain that when the process has been initiated by cosmopolite

sources, the early majority, late majority, and laggards55 tend to get

their first information from localite sources of information.

SURVEY DATA
In this study acceptance of IUD for family planning is considered a
joint action of the wife and the husband. Each couple is confronted with

the twin goals of having enough and not having too many. In such a

 

52Minoru Noda, "Contraception in Japan: Problems of Motivation and
Communication," in Research in Family Planning, ed. Clyde V. Kiser,
pp. 563-569.
53

T. C. Hsu, et a1., Taiwan Population Studies CenterfiAnnual Report,

1262-63, pp. 26—6.
4

5 K. V. Ranganathan, K. Srinivasan, and Betty Mathews, "India: The

Use of Community Leaders to Promote Family Planning," Studies in Family

Planning, Vol. 13 (August, 1966), pp. 6-7.

55Diffusion studies have been classified into five categories on the
basis of time of adoption. The first 2.5 percent are called "innovators,"
and the next 13.5 percent are classified as "early adopters." This group
is followed by "early majority" and "late majority," each accounting for
34 percent of adopters, respectively. The last group is known as "laggards."
Here the reference is to the last three categories.

56NCR Sub-committee, Adoption of New Farm Ideas: Characteristics of
Communication Behavior, Vol. 13 (October, 1961), p. 9.

61

situation, where a small group (in this case a two-person group) rather
than an individual is involved in acceptance of an innovation, it will be
of interest to know which partner was first to know of the new family
planning method and how husband and wife differed in their sources of in-

formation.

Who Became Aware First: In this section awareness will refer to the first

 

information obtained about IUD. The table below indicates the sequence
in which the first information was received within the family. Wives seem

to lead husbands in receiving the information first.

TABLE 13

Time Sequence of Receiving First Information

 

 

 

Who Received First Frequency Percentage
Husband received first 80 43.9
Wife received first 96 52.8
Both received together 6 3.3

Total 182 100.0

 

Sources of Information: Although the couple is the unit of acceptance

 

for IUD, the two individual members are different personalities having
different roles. In addition to sex and role differences, there are dif—
ferences in age and in formal education. It would therefore be reasonable
to expect differences in their sources of first information. The men in-
terviewed in the colonies indicated eight sources of information: (1) Clinic

Staff, (2) Friends and Neighbors, (3) Users of IUD, (4) Relatives,

62

(5) Newspapers and Journals, (6) Posters and Handouts, (7) Exhibition,
and (8) Radio. For purposes of analysis, these categories have been
further grouped into three categories of: (1) Personal CosmOpolite,
(2) Personal Localite, and (3) Mass Media. This classification scheme
is developed from the ideas of Rogers and Meynen,57 and Wilson and Gallup.
In this study Personal CosmOpolite sources refer to the personal
sources of information outside the system, such as, the clinic staff.
Personal Localite sources refer to the personal sources within the system,
such as, friends, neighbors, relatives, and users. Finally, in this
study mass media will include printed material, exhibitions, and radio.
Table 14 shows that the sources of first information for wives and
husbands are different. Approximately three-fourths of the women re-
ceived first information from cosmOpolite sources--staff working for the
clinics as change agents. The same proportion of men were receptors of
information from mass media--new5papers and journals (one category ac-
counting for 65% of the cases). Personal localite sources come out as a
weak second, and of equal importance to both the sexes. The very low
contribution of radio, exhibitions, posters and handouts in mass media,
and users and relatives in localite sources as a means for first infor-

mation should be noted.

 

57E. M. Rogers and W. L. Meynen, "Communication Sources for 2, 4-D

Weed Spray Among Columbian Peasants," Rural Sociolegy, 30 (1965), pp. 213-
219. See also, Man Modan Sawhney, "Farm Practice AdOption and the Use of
Information Sources and Media," paper presented at the American Sociologi-
cal Association, Miami Beach, August, 1966, p. 5.

58M. C. Wilson and Gladys Gallup, Extension Teaching Methods and
Other Factors that Influence Adoption of Agricultural and Home Economics
Practices, pp. 3-4.

 

 

 

63

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n
.Umuucwmcoo
ma mousom umuww ecu xaco xpsum mwsu CH .wucmncommmu mEOm >9 Gm>flw mmB condom mco :msu muozw

 

---- ---- u--- u--- ---- ---- .......... non umnumwon Loom

 

 

00H 00.H 00.0 00.0 00.0 01.0 mm.0 a0.0u 00.Na - a000 mums
N001 Nmm.u emm.u $00.0 $00.00 $00.0 $00.1 N00.au ama.0 A000 eamnmsm
mcoHu muSOpcmm mamcu306 muonswwmz mwmum
Hmuoe Oatmm uwnwnxm mumumom muwamamBmz mo>wumamm whom: mpcmwum UHGHHU
ouHHoaoEmoo
mace: mam: muwamooq Hmcomumm HmGOmumm wouamomm

 

mmpcmamsm cam mm>H3 mo coHumEuowcH umuflm mo mmousom

sa mqm<e

64

Interest Stage: Interest is defined here as an attempt to collect addi-
tional information about IUD. We are concerned here as to who got more
enthusiastic about the device and how each member of the couple went
about collecting additional information. When asked if they tried to
collect additional information, only 110 or 53.13% of the husbands re-
plied in the affirmative. The remaining did not make any attempt to get
additional information and relied on their wives or did not reply to the
question. As against this, 138 or 67.3% of the wives collected addi-
tional information. Table 15 gives the distribution of the wives and
husbands, who collected additional information, according to the sources
of information. This table indicates that personal localite sources are
the most important sources for additional information for both the wives
and the husbands. In the case of husbands, mass media, which was most
important at the awareness stage, takes second place and similarly per-
sonal cosmopolite sources, which were most important for wives at the
awareness stage, are of second importance.

One can conclude that mass media remains the most insignificant for
wives at both the stages of awareness and interest, and personal cosmo-
polite remain of third importance for husbands at both the stages of

awareness and interest.

Evaluation Stag_: Following Rogers' definition, evaluation in this study
means mentally recognizing the advantages of the innovation under con-

sideration. Respondents were asked about the advantages they saw in

 

9Rogers, Diffusion of Innovation, p. 83.

 

65

 

 

 

0.000 0.0 0.0 0.0 0.0 0.0 0.00 $.00 0.00 Am0uv mm>us
0 000 $0.0 $0.0 $$.H $0.00 $0.0 $0.0 $0.00 $0.00 Aouuv 00000000
mcoHu musopcmm mHmGOSOh muonswfimz wmmum
Hmuoa 00pmm uflnwsxm mumumom mumamam3mz mm>wumfimm meow: mccmwum UHEHHU
muwaoaoEmoo
mate: mmmz muwamuoq Hmcomumm Hmcomumm muanmomm

 

mvcmnmsm cam mm>03 mo cowumEu0mcH Hmcowuwcp< mo mmounom

ma mqm<H

66

the IUD (before using it) that made them accept it and how they came to
know of such advantages.

Table 16 gives the most preferred qualities for husbands and wives.
The very high degree of agreement between wives and husbands as to the
most preferred quality is to be noted in this table. Also, the two quali-
ties of "no botheration" and "sure" seem to be equally important for both
the wives and the husbands. This table is highly indicative of the fact
that in spite of their collecting information with different degrees of
interest and from different sources at the preceeding two stages of
”awareness" and "interest," there is exchange of information resulting
into high degree of convergence between the ideas of each member of the
couple at this evaluation stage. This is in line with Hill's interac-

60

tional model of family planning acceptance as found in Puerto Rico Study.

So far we have examined the sources of information at the awareness
and interest stages. Now we will examine the sources of information of
wives and husbands at the evaluation stage. Table 17 gives the sources
of information for most liked quality of IUD for wives and husbands. This
table shows, that the evaluation stage, personal localite sources remain
the most important for husbands followed by mass media and personal cosmo-
polite sources. For women personal cosmOpolite sources, which were the
most important at the awareness stage, once again become the most impor-

tant source for evaluation followed by personal localite. Mass media re-

mains of least significance to women.

 

6O
Reuben Hill, J. Mayone Stycos, and Kurt W. Back, The Family and Pepe-
lation Council: A Puerto Rican Experiment in Social Change, pp. 142-144.

67

umu0w mco can L003

.0mc00quE

wC00mmp mum v3 one: 050 .mucmncommmu each 00 Umd00quE was >000m30 mco dmnu mquk

 

 

 

0.000 N.0 N.m 0.00 0.0m 0.00 0.m Aqm0v mm>03
0.000 N0.m $0.0 No.00 Nm.mm N0.mm $0.0 00000 mecmnmnm
mCOmmmm um0so0uumm
0muOH nonuo C0 wc0£uoz 0000mum>mm musm coHumumLuom oz 0m05umz
000 00 0000020 emuucmmum 0002 000000000

 

kmw>03 0cm mpcmnmsm now 000 mo mm0u00m50 wmuuowoum umoz

00 mqm<H

68

 

 

 

0.000 0.0 0.0 0.0 0.0 0.00 0.0 0.0 0.00 A0000 00>0:
0.000 $0.0 $0.0 $0.0 $0.00 $0.00 $0.0 $0.0 $0.00 00000 00000000
mc00u musovcmm m0mc0300 0000:0002 wwmum
0muOH 000mm u000£xm mumumom muoamam3mz me>0uM0mm mumma mwcm0um o0c00u
mu00omoEwoo
«0002 0002 mu00mooq 0mcomuwm 0mcomumm mm0uowmum0

 

mu00mso vmuumwmum umoz pow mm>03 0cm mpcmawsm mo :00umfiuowc0 mo mmousom

m0 m0m<H

69

Thus far we have analyzed information seeking behavior of husbands

and wives in terms of three adoption stages.

At this stage of analysis

an attempt will be made to find out the most frequently used information

media during the whole process, taking into account both the male and

female preferences together.

tant trends relating to communication media use.

Total Use of the Three Sources of Information*

TABLE 18

Table 18 brings out the following impor-

 

Sources of Information

Husband's
Frequency
of Mention

Wife's
Frequency
of Mention

Total

 

No. Percent

No. Percent

No. Percent

 

Personal Cosmopolite (274) 53 19.34 221 80.65 274 37.95
Personal Localite (300) 151 50.33 149 49.66 300 41.55
Mass Media (148) 141 95.27 7 4.72 148 20.49

 

*Only first mentioned sources of information are considered.

First, we see that the use of all the three media was significant.
In other words, between the couples all the three media were used fairly.
Ihnong the three sources of information, the most widely used media
was "personal localite" sources. "Personal cosmopolite" was second in
importance, while the mass media was last in importance (Table 18).

Secondly, as indicated by the table, personal localite sources are
Inost equally used by husbands (50.33%) and wives (49.66%). Unlike per-

sonal cosmopolite and mass media, they do not tend to show any sex bias.

70

Thirdly, personal cosmopolite sources seem to have been more ac-
cessible to females than to males. And similarly, mass media seems to
have been more accessible to husbands as compared to wives.

Having found out the frequency of use of these three types of infor-
mation media, we will now attempt to find out the role of each of these
media in the stages of adoption under consideration. Table 19 shows that
for awareness stage the most frequently used communication source is per-
sonal cosmopolite--change agent--followed closely by mass media and per-
sonal localite sources. For interest and evaluation phases, localite
sources seem to be most apt and used most frequently. Figure 11 shows

the above trend.

TABLE 19

Distribution of Total Mention of Three Communication
Media According to AdOption Stages

 

AdOption Stages

 

Information Sources Awareness Interest Evaluation
(Total of Wives and (No. Times (No. Times (No. Times
Husbands Mention) Mentioned) Mentioned) Mentioned)

 

No. Percent No. Percent No. Percent

 

Personal Localite (300) 40 23.0 135 54.5 125 41.8
Personal CosmOpolite (274) 77 44.0 83 33.5 114 38.2
Mass Media (148) 58 33.0 30 12.0 60 20.0

 

 

 

Total (722) 175 100.0 248 100.0 299 100.0

 

71

FIGURE II

Stages and Use of Media

Awareness Stage

O......OOOOCOOCOOCOOOOOCO 000000000000000000000 O

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

l

I

I

I
J}
(I)
on

I

I

 

 

++++++++
++ 38.2+++
++++++++

+
+
+

 

 

x + + + I

XXXX.

R'x’x + + + I

 

 

 

- - 23.0 - - <----Personal Localite Sources .

+ +4+ + + + + + + + + + .

+ + + + 44.0 +‘+ + + + <----Personal CosmOpolite Sources .

+ + + + + + +-+ + + + + + ...... .............................

x x x x x x x x x x

x x x 33.0 x x x x <----Mass Media Sources .

x x x x x x x x x x ....................................... ...

Interest Stage

------- 54.5 § - - - - <--Personal Localite Sources

++ +++ ++++ +

+ + + 33.5 + + + + <---—Personal CosmOpolite Sources .

++++++++++IOOCO ...... ...... ..... ......OOOOOOOOOOOOOO

x x x

12.0 <----Mass Media Sources

XXXOOCCOOOOOIOOOOOOO. ...... 0.. O O ........ O ......... 00....

Evaluation Stage

<----Personal Localite Sources .

O.......O...’......COOCOOOOOOOO.

<----Personal CosmOpolite Sources .

0.0.0.000... 000000000000 ......OOOOOOOOO

20.0 x x <----Mass Media Sources
x x x x .........

......OOOOOOOOOOOOO ....... 00....

61

Out of the two widely supported generalizations based on several

studies, the second one stating that the "cosmopolite sources of

 

1
See page 59 for details.

72

information predominate at the awareness stage and local sources of in-
formation are important at the evaluation stage" is fully validated.
Further, our data suggest refinement of the first generalisation by pro-
viding for the role of the change agent along with the mass media as
equally important sources for creating awareness. This role of change
agent is to be particularly noted in two types of situations. First
where the innovation is technically complex, and secondly where it makes
an excellent fit with some already accepted role within the society. Be-
cause of the special nature of IUD, we are in a position to suggest this

refinement.

Discussion: The Delhi Colony data revealed that wives became aware of

 

IUD first. There can be two possible explanations for this. First, this
might be a function of the family planning programs organized in the colo-
nies.‘ As already described, the clinics are heavily biased in favor of
female workers. With the exception of a part-time family planning male
social worker, all the staff in the clinics are female. Secondly, the
clinic work hours are the same as the work hours of the male pOpulation
of the colonies. As all the male residents work outside the colonies,
the female clinic field workers are more likely to contact the female re-
sidents of the colonies. Thus, both the work organization and clinics'
staffing pattern are more favorable for women contacts.

However, this does not explain why males failed to know of IUD ear-
lier through mass media which were simultaneously and very extensively
used by the change agency during the time of the study. The second pos-

sible reason is in terms of the male and female roles within the family.

73

Child bearing and rearing is both biologically and socially a role of
women. This is much more so in urban India where female employment is
almost insignificant. Thus, due to the intimate closeness of family plan-
ning to women and because of this being their major area of concern, the
wives could be expected to become aware of IUD earlier than husbands.

This second explanation seems to be reasonable and enjoys wide theoreti-
cal support. The findings of other chapters of this study also support
this.

Table 14 reveals a sex bias for the sources of information at the
awareness stage. Three-fourths of the husbands became aware of IUD
through mass media, while an equal prOportion of wives became aware of
it through personal cosmOpolite--change agent--sources. Thus, while both
the sources are important in making the couple aware of IUD, they tend to
specialize on sex lines. Perhaps the relatively low education of wives
and their restricted role inside the family results in their reduced
ability to appreciate impersonal, universally oriented, one-sided, written
or vocal mass information sources. The reverse seems to be the case for
husbands, who seem to use more impersonal, indirect sources of information.
After all, they (men) are less directly related to childbearing and through
it to family planning. At least this seems to be their perception of the
role. This perception of husbands seems to be further sharpened and
socially reinforced (unconsciously) by the work organization and staffing
pattern of the change agency. This results in the observed sex differ-
entials in information sources at the awareness stage.

The interest stage was defined in terms of attempts to get additional

iJrformation on IUD. It was Operationalized in this Study by the relative

74

amount of interest shown in the device and how additional information was
collected. In 105 cases (63.5%) husbands admitted that more additional
information was collected by their wives. In sixty-two cases (36.5%)
husbands said they took more interest in seeking additional information
as compared to their wives. This leading participation of the wives is
consistent with the trend and the explanation documented at the awareness
stage.

We see in Table 15 that for both the husbands and wives personal
localite sources become most important for collecting additional infor-
mation. This is consistent with the findings of several agricultural
diffusion studies, where it has been repeatedly validated that friends,
neighbors, users, and relatives become very significant for collecting
and reinforcing information derived at the awareness stage largely through
personal and impersonal cosmOpolite sources which by definition belong
outside the social system of the individuals. Relevance of the innova-
tion to the social system can only be ascertained through such members
within the system with whom the individual participates. This would also
explain the second and third positions of personal cosmopolite and mass
media sources as indicated in this table.

Tables 16 and 17 deal with the evaluation stage which was defined as
Inentally weighing the advantages of the innovation. The first of these
two tables reveals an unusually high degree of convergence as to the two
most preferred qualities--"sure" and "no botheration"--of IUD. The pro-
portion of males and females favoring the two qualities is also remarkedly
equal. In other words, there is not only the unanimity regarding the two

qualities, but it is further extended to each quality in almost the same

75

proportion by both the wives and husbands. This is a very strong indica-
tion of the presence and importance of wife—husband discussion at the
evaluation stage. This also supports the assumption of this study that
family planning is a joint concern of both the wives and husbands.

In order for this discussion to take place between the couple, each
must formulate, at least tentatively, his or her own preference based on
their respective sources of information and thinking. Table 17 gives
the sources of husbands and wives for the most liked quality. It indi-
cates that while husbands depend more on personal localite sources, wives
made the most use of personal cosmOpolite or expert change agents at the
evaluation stage. .Hhen this trend is considered along with the intense
mutual discussion between the wife and husband, it seems reasonable to
assume that husbands, while remaining psychologically aloof from women
experts of the clinics, made use of them through their wives. Very fre-
quently husbands replied that they learned of the advantages of IUD through
their wives who discussed it with the clinic staff. This was in addition
to the husbands seeking Opinion and help from personal localite and mass
media sources. After all, when experts combine the role of change agent
one also runs the risk of overselling the innovation on the part of the
expert. No wonder, therefore, that husbands concentrated on personal
localite and impersonal authority of mass media while wives gathered the
xnost information from experts at the evaluation stage. Between the two
of them they had ideal conditions to evaluate IUD from their own point
of view.

As a matter of fact, in this whole drama of IUD acceptance, a modified

form.of two-step flow of communication is in evidence coming as it were

76

from two directions. The opinion leaders Of the larger social system are
replaced by the two actors making a small social system of the family.
Each actor becomes an opinion leader for the other and receives and trans-
mits the information from channels which are not readily available to the
other. As in the two-step flow hypothesis, Opinion leadership here is
treated as a function of receiving and transmitting the information by
virtue of strategic position of the individual in the group structure
which makes him more accessible to certain channels of information. In
other words, husbands receive and make available to wives information from
mass media from which structurally the wives seem to be cut Off.

Our data goes a step further and indicates the presence of a two-step
flow from personal cosmopolite or experts to wives and through them to

62

the other partner equally concerned in the decision. This we could
find because wives seem to be structurally more Open and accessible to
expert Opinion (because of the reasons already discussed) as compared to
husbands in this field of family planning. In place of mass media the
message originates from personal cosmOpolite--expert-—sources, reaches
wives who are structurally accessible to them and who by virtue Of this
function act as the Opinion leader for transmitting this information to
husbands who are equally involved in the decision.

In the last section of this chapter we have done two things. First,
‘we have merged the male and female responses of all the three stages to

rank the three communication sources according to their ranked importance

in the whole adoption process. And, secondly, by merging the male and

 

2
James P. Bebermeyer and Everett M. Rogers, "Mass Media and Inter-
permnonal Communication in National Development," pp. 18-19. (Unpublished)

77

female responses for each stage we have tried to find out the importance
of each of the three communication sources in each stage. In other words,
we have tried to rank the communication sources according to their impor-
tance as determined by their frequency of use and their importance by
stages of adoption.

In Table 18 our survey data indicate that personal localite sources
are the most frequently used sources of information considering adoption
process at all stages. Personal cosmopolite--change agent--rank second
and mass media as third in use importance. It seems the peculiar nature
of the personal localite sources make them apt or amenable for use in all
the three stages and by both the sexes which probably explains their first
rank.

The use of personal cosmopolite sources is relatively restricted
first because of the particular organization of the clinics, and secondly
because Of the knowledge of the fact that they may have vested interest
in the acceptance of the innovation. In general, their use tends to be
regulated according to the need of the expert Opinion for an innovation
and the technical level of the group. The mass media use tends to be
limited because of their impersonal nature and also because of the low
level of education in developing countries.

Different sources are used differentially at different stages: Table
19 and Figure II reveal that for the awareness stage, personal cosmopolites
rank first, mass media second, and personal localites third. It further
indicates that for creating and satisfying interest and helping in the
evaluation, personal localite sources rank first. It seems that while

they lack in initiating innovation acceptance, they become more important

78

when somebody interested approaches them for further information and eval-
uation. In other words, family planning innovation differs from other
innovations inasmuch as one does not feel socially secure and acceptable
as to how other members of his group would feel about his taking the in-
itiative in a matter so private and socially controlled. Perhaps this
may be overcome a little in the case of a very small intimate contact
group. In short, the rewards of being the innovator and socially recog-
nized as such are uncertain in this field, which explains the predominant
role of personal cosmopolite sources-~change agent--in creating awareness
and the important function of the personal localite in creating and satis-
fying interest and helping in the evaluation. After all, tO own a modern
article like a radio and be known as its owner is certainly socially re-
warding in terms of higher social status, while this may or may not be so

in the case of family innovation.

Summary: In conclusion then, our data bring into focus the following
points as seen in IUD acceptors covered by this study.

(1) In IUD acceptance we found that the division of role on sex
basis has a significant bearing on the information receiving,
gathering and evaluating processes. In a majority of cases
wives were more active than husbands who seem to be satisfied
in getting involved and being informed by their wives at dif-
ferent stages. Whereever such mutual involvement is possible,
the chances of innovation acceptance seem to be high. At least
this was the dominant trend in our study.

(2) It sharply brings into focus the overall general importance of

personal localite sources in the diffusion process of family

(3)

(4)

(5)
(6)

79

planning information. Their potential of use across the sexes
and in all the three acceptance stages was noted.

It was found that both the cosmOpolite sources of information
(mass media and change agent) and the localite sources of in-
formation played Specific function in IUD acceptance. The first
largely created awareness and the second sources were credited
at the information and evaluation stages.

It was noted that in the acceptance of IUD the cosmopolite
sources (mass media and change agent) were successfully mediated
by personal communication between wives and husbands to produce
acceptance. This supports the observation of Bebermeyer and
Rogers that "mass media exposure is only an arbitrary beginning
of a diffusion process; the ultimate consequences in part depend
on the configuration and nature of sociometric networks beyond
the points of contact."63 In this study the network of husband-
wife communication contacts within the social system of the family
was found to be important for acceptance.

The role Of expert or change agent was found to be significant.
A modified form of Operation of the two-step communication flow

was evidenced in this study.

 

63

Ibid., pp. 18-19.

CHAPTER V
DECISION-MAKING

In the communication chapter we were mostly concerned with diffusion

--from the source to the potential users--of the innovation with emphasis
. . 64
on the sources and processes of information. In this chapter, we are
concerned with the adoption of the innovation by the individual or indi—
viduals (in this case the couple) and emphasis would be placed on the
.. . 65

deCiSion-making factors and processes.

The immediate decision as to the size of the family is generally

66 . .. .

made by the concerned couple. In this deCiSion, the couple is largely
motivated, guided, and helped by specific social norms of the group to
which the couple belongs and by the institutional structure of the larger
society. In other words, decision-making can be conceptualized at any of
the following three levels: the larger society, the immediate kinship

group, and the concerned couple. In demographic literature, the three

levels of conceptualization are termed as: Structural model of Davis and

 

4Everett M. Rogers, Diffusion of Innovation, pp. 12—20.

65
Ibid., pp. 77-78.

66Lee Rainwater, And the Poor Get Children, p. 20. Reuben Hill, J.
Mayone Stycos, and Kurt W. Back, The Family and Population Control: A
Puerto Rican Experiment in Social Change, p. 162. Donald J. Bogue and
Veronica Stolte Heiskanen, How to Improve Written Communication for Birth
Control, p. 2. Ronald Freedman, "Norms for Family Size in UnderdevelOped
Areas," in The Proceedings of the Royal Society, B, Vol. 159 (1963),
pp. 225-226.

80

81

67 68
Blake, Normative model of Freedman, and Interaction model of Hill,

Stycos and Back.69 The normative model partakes (overlaps) Of both the
first and the third model.70

Any full analysis of decision-making in the family planning field
should therefore involve consideration of all the three levels and the
corresponding models. Such a task would be beyond the scope of any one
study. In this study we are largely concerned with the third level of
decision-making. Our focus is on the couple primarily because all action
programs in this field take the couple as the target unit and also be-
cause Our data are largely a result of such an actual program. However,
in focusing on the last level, we may indirectly also deal with the other
two levels in as much as they are made operative through the decisions
and behavior of the couple. This view would mean our considering the
above three levels as forming a continuum of decision-making, while at
the same time keeping our attention focused on a level which is relatively

easy for empirical observation.

 

67Kingsley Davis and Judith Blake, "Social Structure and Fertility:
An Analytic Framework," Economic Development and Cultural Chagge, IV
(April, 1956), pp. 211-235. Description of this model can also be found
in Seymour Martin Lipset and Neil J. Smelser (eds.), Sociology: The Pro-
gress of a Decade, pp. 356-377.

8Ronald Freedman, "The Sociology of Human Fertility: A Trend Report
and Bibliography," Current Sociology, X/XI (2), (1961-62), p. 41.

 

9Hill, Stycos and Back, p. 220. A statement of this model can also
be found in Reuben Hill, Kurt W. Back, and J. Mayone Stycos, "Family Struc-
ture and Fertility in Puerto Rico," Social Problems, Vol. 3, No. 2 (Octo—
ber, 1955), p. 93.

70
H. Yuan Tien, "Modernity and Maternity: The Sociology of Fertility

Change," p. 2. (Unpublished) This paper also gives a brief comparison of
the three models referred to in this study.

 

82

When we say we would be mostly concerned at the interactional level
of the wife and husband, we mean to cover only some aSpects of the per-
sonal and motivational aspects of the situation, as experienced and con-
sidered by the couple in reaching acceptance decision. In personal fac-
tors we would be concerned with the husband and wife and how the two
together made the decision. We would be analyzing the importance Of
significant others--primary group members--who might or might not influ-
ence decision-making processes. In motivational factors, our interest
would be limited to the consideration of specific family size goals of
the couples and their past family planning status. In addition to this,
because of the specific importance of current users, both in diffusing
information and influencing decision-making processes of potential accep-
tors, we would be concerned with the current user's role in influencing
decisions of respondents under study.71 We would in turn also try to

find out how the acceptors in this study influenced others.

CONCEPT OF DECISION-MAKING
Agricultural Diffusion Studies: The five stages of the adoption process
--awareness, interest, evaluation, trial and adOption--in this field are
well known and congruent with almost all the research findings of the past.
.As a result, their purely arbitrary nature and conceptual purpose tends
tx>'be minimized.72 While the stages fit well in most cases their arbitrary

natnire suggests that they would fit only partially in several other cases.

 

71
Bogue and Heiskanen, Op. cit., pp. 3-6. Also see, Bernard Berelson
arui Ronald Freedman, "A Study in Fertility Control," Scientific American

(May, 1964), pp. 10-11.

72
Rogers, Op. cit., pp. 76-120.

83

Another characteristic of the stages concept is that they are mainly
descriptive of stages and imply a natural order of events--the preceding
stage leading to the one following.7 AS one moves on this five stage
continuum, one gets the impression that the end stages of the continuum
are more or less taken for granted. For example, in several studies the
stage of acceptance unlike that of awareness is more or less taken for
granted and the fact of acceptance is simply mentioned. .Why this is so,
can only be speculated. Perhaps because the agricultural studies are
largely concerned with "improved practices"--rep1acing something which is
already accepted and used-~"acceptance" is supposed to follow provided
”awareness" and "interest" have been taken care of. An exception to this
general trend is found in the studies of Wilkening and Straus and certain
others who have focused on decision-making processes involved in accom-
plishing acceptance as implied by the term "acceptance stage." If SO,
the situation in fields like family planning would be different. SO far
as developing countries are concerned, family planning is not simply a
problem of replacing some old technique by a new efficient one, but in-
volves both acceptance of new goals and selection of appropriate means
under a given situation. Thus, while it recognizes the need of diffusion
of ideas, it imparts Special significance to social—psychological processes
and personal and Situational motivational factors that go in individual's

decision—making processes at the "acceptance" stage.

 

Ibid., pp. 76-120. In this chapter we are using the term "function"
in the descriptive sense as Rogers has used it. According to him at the
present time there seem to be five main functions involved in the adoption
process and each of these is assigned to a stage.

84

In the preceding chapter on communication we have examined the three
stages of "awareness," "interest," and "evaluation." In this chapter we
are concerned with the stages of "trial" and "acceptance," under the
label of decision-making, to analyze the processes rather than merely
describe them. In agricultural studies, the "trial" Stage is character-
istically one of Small scale use by the potential adOpter or his observa-
tion of use under conditions which Simulate those of his own situation,
and "acceptance" implies full or one hundred percent use. Because of
the peculiar nature of IUD which is a one time application in full, the
closest one can get to the trial stage is to use some other acceptor as
a relevant empirical reference. Similarly, full or one hundred percent

use has to take place in the first application of the device itself.

Family Planning Diffusion Studies: Relatively speaking, little work has

 

been done with decision-making and related diffusion Stages in family
planning. Partly this is because of the recent interest in this field,
and partly because of the different and difficult nature of the field.75
Generally in all the societies it is very private, highly emotional,

rigidly controlled by society's norms of religion, custom, and behavior;

in almost all cases it touches the very core of individual personality

and social structure. This makes it altogether different from agricul-

tural practices.

 

74Joe M. Bohlen, "Adoption and Diffusion of Ideas in Agriculture,"
in Our Changing Rural Society: PerSpectives and Trends, ed. James H. Copp,
p. 269.

 

Bernard Berelson, "KAP Studies on Fertility," in Family Planning
and Population Programs, p. 655.

76Donald J. Bogue, who Spoke on general importance of Diffusion
Studies at the annual meeting of the American Sociological Association in
Pfiami Beach, Florida, August, 1966.

85

Lorimer has Observed that "acceptance is Sharply defined for only
one method: sterilization. With all other methods there are various
degrees of acceptance, ranging from professed interest through acceptance
of teaching and materials, to continued and effective use."77 Chandrasa-
karan emphasizes many processes involved in contraceptive acceptance.
Balfour points to the need of recognizing various stages of acceptance
between the initial interest and continued and effective use.79 Bogue
has highlighted the importance of subjective relevance of family planning
idea and objective empirical evidence in relation to potential users as
the crucial factors in acceptance decision-making. It seems, after one
has known all that is necessary to know, one is faced with the problem to
transfer and apply to one's own Situation that which is true in general
for others. According to Bogue, "Perhaps the best explanation for the
apparent inconsistency between almost universal acceptance of birth con-
trol and, at the same time, wideSpread lethargy and negligence with regard
to adoption and use is lack of awareness that this is something that

8
applies to one's self personality..." Similarly, Hill in his Puerto
Rico study came to the conclusion that accuracy and adequacy in the pro-
cesses of empathy and consensus within the family largely eXplain success

81
or failure in family planning. Rainwater largely supports Hill's findings

 

77Marshall C. Balfour, "Comparative Acceptability of Different Methods
of Contraception," in Research in Family Planning, ed. Kiser, pp. 383-384.

78
Ibid., p. 384.

79Ibid., p. 386.

 

80Bogue and Heiskanen, Op. cit., p. 20.

81Hill, Stycos, and Back, Op. cit., p. 162.

86

in his U.S. study.82 In brief, therefore, we come to the conclusion
that, unlike agricultural studies, the acceptance stage is regarded as
very important in family planning, and that processes and factors in-
volved in acceptance decision-making are very crucial for promotion of

family planning practices.

Decision-Making in This Study: The above short review of studies in agri-
cultural and family planning fields with a focus on acceptance decision-
making brings out the following two points:

(1) While the agricultural studies emphasize the description of
activities of the stages of adOption, family planning studies
lay relatively greater Stress on the processes involved in
fulfilling these.

(2) Acceptance decision which tends to be taken for granted, if
previous stages are taken care of, in agricultural studies be—
comes most crucial for family studies.

In this Study we have tried to reconcile the activity-process dilemma,
first by accepting the well known five stages and then dividing them into
two major blocks or Stages of the decision-making process. In doing so,
we have tried to synthesize: (a) Roger's interpretation of decision-
making as a particular example of learning theory involving the two stages
of: (l) incorporating first stimulus as meaningful followed by (2) repetiv
tion of interaction in a more and more improved way; (b) the distinction

between innovation and improved practice as used by some agricultural

 

82
Lee Rainwater, Family Design: Marital Sexualitynyamily Size, and

Contraception, pp. 15-17.

87

diffusion students and by Barnett;83 (c) and the two stages of initial
and continued acceptance as observed by demographers.

The following diagram illustrates these integrated concepts of decision
-making along with the descriptive-function and process stages giving the

differentiating and unifying characteristics.

 

 

FIGURE III
Awareness Interest Evaluation Trial Acceptance
B Activity Stages 1 L 1 L ii
A Learning Continuum .L_ 1
C Process Stages: Stage I
Decision-making related
C-I Process Stage I Communication Dominant,_,,to.di$tant,factor$ ,,,,,

 

Stage II

C-II Process Stage II Communication,re$tricted.,Decision-Making Dominant
within the family

 

Characteristics of the two Stages of decision-making:

Stage I Stage II
1. More concerned with diffusion—— 1. More concerned with adoption de-
from the source to potential cision during which one remaps
users.84 the general Situation in the

light of specific situation.

 

 

2. Diffusion takes place between 2. Acceptance is an individual family
persons. matter.
83H. G. Barnett, Innovation: The Basis of Cultural Change, pp. 7-10.
84

Rogers, p. 13. Also see Bogue and Heiskanen, p. 8.

85
Rogers, pp. 76-86. Also see Bogue and Heiskanen, p. 8.
Rogers, pp. 13-14. Also see Bogue and Heiskanen, pp. 8-9.

87
Rainwater, And the Poor Get Children, p. 20. Also see Hill, Stycos
and Back, The Family and Population Control, p. 162.

 

 

88

Stage I Stage II
3. Communication and its so gees 3. Learning and proper role playing
are important processes. within the8§oncerned units more
important.
4. Concerns with first knowledge 4. Concerns with Specific goal means re-
and setting up of tentative lationships and continued decision
generalized goals. making for efficient learning.

Such a schema allows us to consider the personal, social, motivational
and value variables of concerned acceptors in decision-making for family
planning acceptance, while at the same time retaining the five stage con-
cept. In doing so, besides adOpting a helpful analytical scheme to the
Special needs of family planning, we are being suggestive of differences
in emphasis between adoption stages in agriculture and in family planning.
By relating the two decision-making stages to the learning continuum, we
are simultaneously emphasizing the basic overall similarities between the

two .

SURVEY DATA
Husband-Wife Role: For the purposes of this study we are treating the
wife and husband as constituting a small group concerned with family plan-
ing. In any interaction group there are role relationships~-both behavioral
and attitudina1--among its members. When this relationship is such that
the behavior of any one of the interacting persons or any combination of

them affects the other in the same way with respect to goal attainment,

 

88
Rogers, pp. 16-17. Also see Bogue and Heiskanen, pp. 2-6.

8
9Rogers, pp. 76-78. Also see Bogue and Heiskanen, pp. 8-9.
Bogue and Heiskanen, p. 7.

91
Ibid., p. 8.

89

it is termed a cooperative role relationship. In our survey an attempt
is made to find out how far the cooperative role relationship in decision-
making holds good in the case of IUD acceptors. First we will try to
know how far both are involved in decision-making. This would be one in-
dication of cooperative role relationship. However, this would not be
enough because in spite of joint involvement, the final decision may lie
with one who is traditionally vested with authority in the family group.
Thus, joint involvement may merely be a facade and final decision-making
authority may be unduly biased in favor of either one of the two members
of this small group. In this survey we would, therefore, also try to find
out whether the decision-making authority is evenly distributed between
the wife and husband or favors either one of them.

A question was asked of each informant emphasizing as to who between
the two made the final decision even when, in such a Situation, usually
both are involved. A typical answer was "both were involved," except in
cases where the wife went ahead by herself, accepted the device, and in-
formed the husband afterwards as to what she had done. In such a case,
the response was: "My wife had it and informed me only afterwards." In
the case of the typical answer, the respondents were told that even in
situations where both are involved, somebody makes the final decision and
the other accepts; they were asked, "Who was this 'somebody' in your case?"
Responses to this question are analyzed in Table 20.

But this high degree of joint involvement may be either a mere cour-

tesy to the other member or may be an attempt to impress the interviewer.

 

2
9 Theodore M. Newcomb, Ralph H. Turner and Philip E. Converse, Social

Psychology: The Study of Human Interaction, pp. 351-352.

90

TABLE 20

Involvement of Either Both or One Member in Decision—Making

 

 

 

No. Percent

Both were involved in decision-making 169 92.8
Wife made the decision alone, had the

device and informed husband afterwards 13 7.2

Total 182 100.0

 

As already explained, such reSponses were further probed and Table 21
below indicates as to whom between the two had the final say in the matter.
Table 21 indicates a remarkable absence of concentration of final decision-

making authority in favor of any one member of the small family group.

TABLE 21

Final Decision Makers

 

 

 

Final Decision Maker No. Percent
Husband 75 44.4
Wife 84 49.8
Both 10 5.8

Total . 169 100.0

 

Role of Friends and Neighbors: In the communication chapter, we found
that friends and neighbors imparted confidence to the messages sent into
the system by outside cosmopolite sources like mass media and the change

agent. The outside news became the inside concern of enough importance

91

to get serious consideration from the individual members. In this sense,
they acted predominantly as confidence creating communication media. Ac-
cording to Bogue, friends and neighbors also act as sources of legitima-
tion in decision-making regarding acceptance of family planning. To as—
certain this, a set of Specific questions was put to the informants with
reference to their actual decision-making and the possible contribution

of friends and neighbors to it. Table 22 presents the reSponses to this
set of questions. This table indicates that between the couple there is

significant use of primary group sources at the time of decision-making.

TABLE 22

Consultation with Friends and Neighbors in Decision-Making

 

 

 

Consultation Husband 'Wife

NO. Percent No. Percent
Consulted friends 72 42.8 103 61.6
Did not consult friends 96 57.2 64 38.4
Consulted neighbors 15 8.9 94 56.3
Did not consult neighbors 153 91.1 73 43.7

 

Current Users and Decision-Making: It has been already indicated that

 

the greatest need of the individual in decision-making is to have some
Objective empirical reference. According to Rainwater, anxiety is the

93
major concern of couples at this stage. Because the technique of IUD

 

3
Balfour, Op. cit., p. 376.

92

cannot be checked by sight, there is much uncertainty about its use. .People
would need strong reassurance which can best come from those who are al-
ready using it. This led us to investigate the role of current IUD users

in decision-making of the new acceptors. We asked each of our respondents
whether he or his wife consulted any user at the time of deciding to try
IUD. Table 23 gives the distribution of responses received on this ques-
tion. Approximately two-thirds of those who responded consulted an IUD

user sometime during decision-making and such consultation was largely

carried out by the wives.

TABLE 23

Consultation with Current IUD Users in Decision-Making

 

 

 

Consultation No. Percent
Somebody or both consulted user: 111 65.6
Wife consulted user (87) (78.3)
Husband consulted user (12) (10.8)
Both consulted user (12) (10.8)
None talked to user 58 34.4
Total 169 100.0

 

Another way to ascertain definite impace of users was to ask IUD ac-
ceptors in the study as to the number of persons they think they have in-
fluenced to accept IUD. To eliminate guess work, respondents were told
to consider only such cases as they could name and about whom they think
that it was because of their influence that they took IUD. In all 180
respondents replied to this question. Out of these, seventy persons (38.5%)

claimed to have influenced 240 new IUD users. One hundred and ten persons

93

(51.2%) said they did not influence any. Taking the whole group into con-
sideration, this gives an average of 1.3 new users for every user studied

in this study.

Previous Familnylanni g Status: In this Study previous family planning
status--position of reSpondent on the acceptance continuum-~is regarded
as another important consideration influencing the acceptance decision.
We have already delineated two stages--acceptance of the idea and con-
tinuous attempt to improve ends-means relationship--of acceptance.

In Situations as represented by our colonies where family planning
program was already in action even before the introduction of IUD, one
would expect two types of groups. The first consisting of those who would
be required to undergo both the stages, of accepting the idea of family
planning, and adopting efficient means (IUD) to achieve it. The second
group would consist of persons who have not only accepted the idea but
have either tried or are trying some means to achieve it. In the case of
the second group, IUD, being most compatible and least threatening to
their basic idea structure, would be relatively easily accepted by them.
For the first group, it would be a more difficult process in as much as
they would be normally required to change their basic idea structure,
formulate new goals, and adOpt IUD as a means to achieve it.

Given the above considerations, one would normally expect that a
large prOportion of IUD acceptors in our survey would belong to the second
group requiring change from a less efficient to a more efficient means.
With this view, the survey included a set of questions relating tO family
size goals and family planning practice so as to ascertain those who sim-

ply accepted another improved practice and those who in accepting IUD

94

underwent both the stages of accepting the overall need and idea of family
planning, and adOpting an efficient means to accept it. Tables 24, 25

and 26 deal with the responses to this set of questions.

TABLE 24

Distribution Of Acceptors According to Use
of Other Methods Before IUD Acceptance

 

 

 

 

Use of Other Methods No. Percent
Have used or using other contraceptives before IUD 147 80.7
NO other contraceptive used before 35 19.3
Total 182 100.0

TABLE 25

Distribution of Respondents According
to Desire for More Children

 

 

 

Desire for Children NO. Percent
Do not want any more children 147 82.2
Want more children 32 17.8

Total 179 100.0

 

The three tables together indicate that a significant majority of
acceptors of IUD knew how many children they wanted, they have been active
in using contraceptives to stay close to their goal, and finally they felt
that in spite of their desire and action they have exceeded their desired

family size by having unwanted children.

95

TABLE 26

Distribution of Acceptors According to Whether
Last Child Was Wanted or Not

 

 

 

Desire for Youngest Living Child NO. Percent
Last child not wanted by both 99 55.9
Last child wanted by both 46 25.9
Last child not wanted by one of the two 32 18.2

Total 177 100.0

 

DISCUSSION OF FINDINGS
For purposes of discussion and interpretation, and for relating our
findings to other relevant research findings, we have divided this section
into three major parts. The first part of findings deals with husband-
wife role relationship. The second covers the role of primary group mem-
bers and significant others--users. The last part deals with phases of

decision-making as revealed by their present family planning status.

Husband-Wife Role Relationship: The first two tables deal with husband-
wife role relationship. There is a wide range of relevant research find-
ings bearing on this topic in family sociology, agricultural diffusion
studies, and family planning. Here we would try to interpret and relate
our findings to this body of research knowledge.

Family Sociology: There are two types of orientation to this prob-
lem in this field. (1) The first and the abundant source of information

is the ethnographic data which emphasize the idealized sex-based role

96

relationship between wife and husband.94 According to these studies the
tasks of control management, decisions and appeals to God belong to the
husbands on the principle that generally in most societies any role which
is more honorific belongs to man.95 (2) There are relatively few studies
on actual role-relationship within the family as compared to idealized
generalizations. This lack becomes even more obvious when one is con-
cerned with the family in family planning. Rare exceptions to this trend
are the studies of Hill96 and Rainwater.97 Both of these authors find
the existence of cooperative role relationship as one of the important
variables to explain failure or success of individual couples in family
planning. Hill says, "The record on sociological facilitation is less
encouraging. Puerto Rican couples are poorly equipped organizationally
to undertake family planning. They lack the Skills of communication be-
tween spouses necessary to turn concordance on goals and means into con-
sensus so they cannot take effective action on their family Size goal."
Rainwater in his U.S. study came to a Similar conclusion: "In terms of
family planning goals, the number of children one has and the planning
involved in having them, achieve meaning from the ways married adults

conceive Of themselves as members of a family of procreation, and the ways

they regard their spouses as members. With respect to contraceptive

 

4William N. Stephens, The Family in Cross-Cultural Perspectives,
p. 288.

95
William J. Goode, The Family, p. 70.

 

6
Hill, Stycos and Back, The Family and Population Control: A Puerto
Rican Experiment in Social Change.

 

97Rainwater, And the Poor Get Children and Family Design: Marital
Sexuality, FamilygSisz_and Contracgption.

 

97

practices, the way in which contraception is executed from day to day will
depend to a considerable extent on how the husband and wife relate to
each other, on how they see themselves and their partners in marital re-
lationship.98

Agricultural Diffusion Studies: The dominant trend in this field
tends to treat man and farmer as synonymous. This may be because of the
practical obviousness of the fact. As a result, the family, as a unit
of decision-making for accepting agricultural innovation, has not been
Studied much. Male bias is predominant in this field. Exceptions to

99 100

this trend are studies of Wilkening and Straus. According to Burchinal,
Wilkening found that "husband-wife interaction in relation to decisions
about farm operations is not a simple function of the status of either
Spouse or the complexity of the farming enterprise. Rather the joint
decision-making patterns appear to be a function of the extent to which
farm family and farm firm decisions are viewed as having a joing conse-
quence... He [Wilkening] suggests that the roles played by husbands and
wives in decision-making are determined more by their preceptions of farm
and household needs than by culturally determined pattern of interac-

‘01
tion."L Evidence for the husband-wife sharing of the executive role

 

98Rainwater, And the Poor Get Children, p. 60.
99E. A. Wilkening, "Joint Decision-Making in Farm Families as a
Function of Status and Role," American Sociological Review, 23 (1958),
pp. 187-192.
100 . . -
M. A. Straus, "The Role Of Wife in the Settlement of the Columbia
Basin Project," Marriage and Family Living, 20 (1958), pp. 59-64.
101
Lee G. Burchinal, "The Rural Family of the Future," in Our Chang-
inngural Society, ed. James H. COpp, p. 171.

 

 

 

98

102 103
in farm families have also been reported by Beers and Fitzsimmons.

Family in Family Planning Studies: If farming and male go together,
bearing of children and female seem inseparable. The historical develOp-
ment of the field best illustrates the above statement. AS a result,
there has been a female bias in this field at the cost of male or husband.
The male-female controversy gets further compounded in relation to male
and female methods of family planning.105 In 1960 Bogue and Stycos made
a powerful attempt to rehabilitate males into family planning. While they
succeeded in drawing some attention to males, they to some extent revived
the controversy. The role of males has come to be questioned again be-
cause Of IUD being a female method.

Bogue has observed, "A high percentage of couples who successfully
plan their families are found to have discussed most of their problems
with each other with reSpect to family planning; they appear to have dis-
cussed the matter, agreed upon a course of action and jointly set out to
accomplish it."106 Stycos argued that, "There are several a priori rea-

sons for believing the husband to be less motivated for family planning

 

102H. W. Beers, "A Portrait of the Farm Family in Central New York

States," American Sociological Reviewg 2 (1937), pp. 591-600.

0

1 3C. Fitzsimmons and N. W. Perkins, "Patterns of Family Relation-
ships in Fifty Farm Families," Rural Sociology, 12 (1947), pp. 300-303.

104

J. Mayone Stycos, "A Critique Of the Traditional Planned Parent-

hood Approach in UnderdevelOped Areas," in Research in Family Planning,
ed. Clyde V. Kiser, pp. 481-482.

 

 

 

Ronald Freedman, "Family Planning Programs Today: Major Themes of
the Conference," in Fami1y_Planning and Population Programs, ed. Berelson,
et a1., pp. 818-819.

 

Donald J. Bogue, "Some Tentative Recommendations for a 'Sociologi-
cally Correct' Family Planning Communication and Motivation Program in
India," in Research in Family Planning, ed. Kiser, p. 536.

 

104

99

than the wife... But there are equally plausible reasons for believing
the male might be more motivated for family planning... At the very
least, the disadvantages of the large family would seem to be as great

for the males as for females."107 Freedman regards, "A prima facie case
for the interest of the father, too, in limiting fertility... If it is
true that preindustrial couples do not discuss fertility control or family
size, this may be because a long standing consensus on high fertility
leaves little to discuss."108

This was the trend before IUD came into the picture. With the ad-
vent of IUD the balance of power has again been tipped in favor of females.
In 1965, at the international conference Freedman Observed, "The Specta-
cular rise of a female method, the IUD, has eclipsed this line (at least
equal importance to man) at least temporarily."109 Once again the ques-
tion of only male, only female, or both together has been laid open.

When we examine Table 20 we get a clear indication that in the case
of this group of acceptors of IUD, it was definitely an involvement of
both the wife and husband. As high as 92.8 percent of the respondents
said that both were involved in reaching acceptance decision for IUD.

Our faith in this is further enhanced when we look at Table 22 which

gives the responses of further probes as to who made the final decision,

accepting the fact that both were involved. We find that in this group

 

107Stycos, Op. cit., pp. 490-491.

Ronald Freedman, "Norms for Family Size in UnderdevelOped Areas,"
in The Proceedings of the Royal Society, B. Vol. 159 (1963), pp. 225-226.

 

Ronald Freedman, "Family Planning Programs Today: Major Themes
of the Conference," in Family Planning and Population Programs, eds.
Berelson, et a1., p. 819.

 

100

of acceptors of IUD, both had almost equal chance of making a final deci-
sion. The fact that both the wife and husband are significant to an
almost equal degree in final acceptance decision validates the existence
Of cooperative role relationship for acceptance of IUD. As already dis-
cussed, this finding is widely supported by studies in family sociology,

agricultural diffusion, and family planning.

Role of Friends, Neighbors and Users: Tables 23 and 24 relate to this

 

aspect of decision-making. Subjective reference and objective empirical
evidence have been found to be two crucial factors in decision-making in

. 110 . . . 111 . .
-agricultural and family planning studies. Several studies in com-
munity action have found legitimization as a crucial factor in decision-

, 112
making.

A close study of Table 22 reveals that for the couple as a whOle
friends and neighbors provide Significant social Support--variously re-
ferred to as legitimization or subjective reference--at the time of
decision-making. We further note that between the two, wives have made
more use of these sources than husbands. Husbands have made very little
use of neighbors.

Table 23 deals with the problem of the need of Objective empirical

evidence at the time of decision-making. From the table, the significant

 

110
Bohlen, Op. cit., pp. 268-269.

111
Bogue and Heiskanen, Op. cit., pp. 8-9.

2Christopher Sower, et a1., Community Involvement, pp. 96-121.
Also see Paul A. Miller, "A Comparative Analysis of the Decision-Making
Process Within Community Organization Toward Major Health Goals," un-
published Ph.D. dissertation.

 

 

101

role of users in this regard is clear. Approximately two-thirds of the
couples consulted some user at the time of decision-making. We also noted
that on an average pur reSpondents, till the time Of interviewing, have
influenced 1.3 persons in deciding to take IUD. This is more concrete
and direct proof of the factor of Objective reference in decision-making.
The significance of their role is further enhanced and a new dimen-
sion to it is added when we compare the findings of this table with Tables
14, 15 and 17 of the communication chapter. This comparison brings out
clearly that while users are less frequently mentioned as communication
sources, they become very Significant and prominent at the time of decision-
making. This means that once the information is received and evaluated
as useful, the person searches out for what we have called objective em-
pirical reference to remove anticipated anxiety or fear resulting from

acceptance of IUD.

Stages of Decision-Making as Revealed by Family P1anning4$tatusz As al—
ready explained, we have divided the acceptance process into two Stages
of (1) diffusion and acceptance of the new idea including initial trial,
and (2) continued attempts to correlate ends-means in more and more effi-
cient ways.

Generally in agricultural diffusion studies any prOposed change which
involves both the stages is called "innovation'l and the one which involves
only the second Stage is called "improved practice." Further, it is also
suggested that change decisions are relatively very easy when only the
second stage is involved, as it does not interfere much with the basic

113
structure of ideas or values of the individual.

 

113Bohlen, Op. cit., p. 272.

102

In the field of family planning the need for effective and continued
use of contraceptives have led demographers to think of acceptance in two
stages of "initial acceptance" and "continued acceptance." Bogue refers
to the first stage as "implementation" and the second as "adoption and
continued use." In the first, one overcomes "wrong ideas" (wrong notions)
and accepts "new correct ones." In the second, the individual follows

. , , 114 '
the new idea as a part of his life. Stycos recognizes the need for

5 , 116
Minoru Noda and

"transitional stage" of contraceptive behavior."11
Freedman delineate two Stages of acceptance at the national level.
Mathen in the Singur study uses the initial and later stages of accep-
118
tance. Kantner regards conventional methods as a step to more sophis-
, 119 , , ,
ticated methods. In brief, we find a Wlde reference to two Stages of
family planning acceptance.
In our data, Tables 24, 25 and 26 relate to positions of our respon-

dents on acceptance continuum before accepting IUD. Table 25 Shows that

82 percent of the acceptors perceived their situation as having reached

 

114Bogue and Heiskanen, pp. cit., pp. 8-9
115 ,

Stycos, Op. c1t., p. 500.
116

Minoru Noda, "Contraception in Japan: Problems of Motivation and
Communication," in Research in Familnylanning, ed. Kiser, pp. 555-556.

 

Ronald Freedman, "Next Step in Research on Problems of Motivation
and Communication in Relation to Family Planning," in Research in Family
Planning, ed. Kiser, pp. 599-601.

118K. K. Mathen, "Preliminary Lessons Learned from the Rural Popula-
tion Control Study of Singur," in Research in Family Planning, ed. Kiser,

p. 42.

119John F. Kantner, "The Place of Conventional Methods in Family
Planning Programs," in Family Planning and POpulation.Brograms, eds.
Berelson, et a1. , p. 407.

 

 

103

the desired family size. They had definite family size goals and knew
that they had reached a point where the size of the family appeared as a
problem to them. As they put it, "We don't want any more children."

Table 24 goes a step further and relates that they not only defined
the problem as meaningful but took the further Step by trying some other
method. About eighty percent of the acceptors tried a different contra-
ceptive method before accepting IUD. However, in the case of a majority
of respondents, it was a failure. According to Table 26, about 55 percent
Of the respondents said that their last living child was not wanted to
either of them.

In brief, we conclude that in terms of our two stages of acceptance,
we find that a large majority was already past the first stage of accep-
ting a new idea and defining family planning as a meaningful goal. So
when IUD was promoted as a most effective way of planning a.family, ac-
ceptance Of it in their case was merely switching over from a.proven, less
efficient method to some expected, highly effective method to-bring about
a more efficient correlation between their desired goals and available
means. They had no problem of changing their basic idea structure. This
is best illustrated by Table 24. It shows very clearly that among our
respondents 80.7 percent had tried or were using some other method before
accepting IUD. A Similar high percentage of switching over from other

120
methods to IUD has been reported by Agarwala in India and by Takeshita

 

120See Family Planning News, Vol. 7, NO- 4 (April, 1966): P° 20'

121
John Y. Takeshita, "Lessons Learned from Family Planning Studies
in Taiwan and Korea," in Family_P1anning and Population Programs, eds.
Berelson, et a1., p. 706.

 

121

104

in Taiwan and Korea. While these authors have only noted this trend, we
have tried to provide a partial explanation with the help of the concept
of decision-making.

AS a caution it may be pointed out that the two stages, as concept-
ualized here, are not inevitable as is clear from Table 24. About 20 per-
cent of the respondents were those who perceived the two stages as one.

It seems that these peOple, either because of their superior ability or
because of the extraordinary efforts of change agents or because of the
heavy pressure of personal and social situation, were in a position to
compress the two stages into one. However, because one cannot expect

the first quality of ability to be universal and because it is dangerous

to wait for the third situation to arise till everybody reaches a break-
ing point, we may conclude that with the passage of time as users Of

other methods adopt IUD, more and more imaginative promotional attempts
will be required to get new converts to family planning through IUD. One
Suggestion on the basis of our analysis is that if a country gives im-
portance and fixes higher target of IUD, let it also fix equally a higher
target and importance for less sophisticated conventional methods. Kantner
and Freedman have very correctly Observed the need to view conventional
less SOphisticated practices as a step to more SOphisticated methods.
Another suggestion based on the 20 percent of new converts is that the
attempt should be made to compress the two stages into one by promotion
agencies. This can be done by combining both the "idea" and "technique"
together in educational efforts of the change agents, so that a good and
sure technique of IUD sells the idea of family planning and the advantages

of the idea of family planning promotes a good technique of IUD. In other

105

words, the fact of getting 20 percent new converts through IUD should not

be underestimated. On the other hand, this unique potential of IUD Should

be expanded and fully exploited by imagainative promotional efforts.

SUMMARY

This chapter brings into focus certain points in relation to decision-

making at the family level.

Main Findings:

(1)

(2)

(3)

(4)

(5)

(6)

The couples under study largely exhibited significant degrees
of cooperative role relationship in deciding about the accep-
tance of IUD.

Taking the couples as a whole, social influence of friends and
neighbors was in evidence and it was achieved more often through
the wife than the husband.

The influence of current IUD user was much prominent at the
decision-making Stage through providing objective empirical
evidence. Their role in taking the initiative in making people
aware of IUD was relatively insignificant.

Most of the couples clearly perceived their family Size as a
problem which needed their attention.

Most of these peOple tried or were trying to restrict family
Size through contraceptives. Therefore, for most of them IUD
acceptance involved only changing from a less efficient method
to a more efficient method.

In spite Of their efforts about 50 percent of them had exper-

ienced unwanted pregnancy.

106

In general, we would say the IUD acceptors in this Study
had a clear perception of their family Size goal, they were
serious about it, and had experienced frustration in achieving
their goal. This finding is fully supported by Freedman's find-
ing in Taiwan. According to Takeshita in Taiwan, "The program
has had a special appeal to couples who already feel they have
a problem of family limitation and who have made unsatisfactory
attempts to do something about it."122

(7) We found support for a "normal" acceptance process as consisting
of two Stages. However, the significance of 20 percent of our

respondents who could reduce this into a one act decision was

noted.

 

122Ibid., p. 700.

CHAPTER VI

MODERNITY IN CONSUMPTION AND COMMUNICATION BEHAVIOR
AND VALUE ORIENTATION

In the chapter on decision-making we had an overview of the behavioral
aspects of family planning and family limitation activities of IUD ac-
ceptors. We now turn to an examination Of some of the background factors
of their behavior. An attempt is made to understand the general value
orientation to life of IUD acceptors. What kind of people are these? How
do they live their lives? What is their world view--something predestined
or a place to make efforts and manipulate it? Are they progressive in
their ideology and outlook or adhere to tradition? What aspirations do
they have for their children? These and other Similar questions will con-
cern us in this chapter.

In doing SO we have tried to follow Blake and Davis' framework for
values and norms in human fertility research. According to them, "... the
normative aSpect of human society and human behavior is broad in coverage
but conceptually distinct. It embraces, for example, the notion of

' which are the goals or principles in terms of which Specific

'values,
. . 123
norms are claimed to be deSirable." In other words, for them values

are generalized goals in terms of which Specific norms of behavior are

 

123Judith Blake and Kingsley Davis, "Norms, Values, and Sanctions,"
in Handbook of Modern Sociology, ed. Robert E. L. Faris, p. 456.

 

107

108

claimed to be desirable. But they do not see the two to be causally re-

lated. In this connection they observe, "Presumably a norm 'exemplifies'

a value, but this does not mean that the norm is caused by the value it
124

exemplifies, or... A more satisfactory use of 'values' in sociological

analysis is to abandon them as causal agents and to recognize them frankly

as Sheer constructs by which we attempt to fill in subjective linkages in

the analysis of social causation."125 Thus an.analysis of both the norms

and values gives a more comprehensive understanding of the process and

the related action. In brief, then, according to this schema the last

chapter on decision-making relates to (behavioral) norms and what we

prOpose to do in this chapter is to consider values as explanatory aids

to the already considered (behavioral)norms of IUD acceptors.

Value orientation to life can be thought of in two ways--orientation
to present or the future way of life. Either of the two could result in
family planning action. For example, one can take to family planning to
protect his present life style, 2; alternatively, one may use it as a
means to achieve his future hopes and aspirations. Generally, in family
planning action, both value orientations are involved.

In this survey we have attempted to get to both the present and
future value orientations of IUD acceptors in a "limited" way. ‘We have
attempted to get to some ideas of their present way of life on three

crucial variables. One deals with the acceptor's position on the com-

munication network as determined by the use of four types of written

 

124Ibid., p. 460.

12
5Ibid., p. 461.

109

126
communications. This would give us some idea of their relatedness with
the outside world. The other deals with their personal aspect of life,
that is, their level of living as indicated by the use of eight consump-
127
tion articles. The third deals with their religious orientation as
revealed by their present commitment to this activity in terms of time
. 128
Spent on it.

So far as their orientation to the future is concerned we have tried
to ascertain if they have faith in the future and regard it as something
which can be manipulated, as against predestined by some power outside the
individual's control. This is revealed by responses indicating the re-

129
lative importance given to luck or effort in their lives. Secondly,

we have tried to measure their future aspirations in terms of education

 

126For seeking information on this, the following question was asked

of each respondent:
Do you read never sometimes regularly
a. daily newspaper
b. weekly magazine
c. monthly magazine
d other books

127
For seeking information on this, the following question was asked

of each reSpondent:
DO you own

(a) radio (e) name plate
(b) sewing machine (f) sofa and/or dining table
(c) tea and/or dinner set (g) carpet
(d) wrist watch (h) dressing table
128

For seeking information on this, each respondent was asked the
following question:

Do you Spend some time on any religious activity (Puja Path)
regularly?

129 . . . .

For seeking information on this, each reSpondent was asked the
following question:

In your life till now which has played a greater role--your efforts
or your luck?

110

130
of one of their children. Some studies have treated level of aspira-

tions for children as indicative of economic aspirations. Lastly, we
have attempted to know whether they have a modern progressive ideology
or are guided by tradition and custom in their lives.131
Thus, in brief, through a series of questions the respondents were
queried about their life Situation, their general outlook on life, their
educational aspirations for children and their willingness to manipulate
change, with a view to explore their present social milieu and their
future orientation to life. One of the main limitations of analysis in
this chapter is the fact that we do not have information about non-users
to highlight the differences. However, in Appendix 1 an attempt is made

to compare how the variables of this chapter and those discussed in pre-

vious chapters affect early or late use of IUD.

SURVEY DATA

All ’I' in .51.:

132
Several studies in diffusion of agricultural practices and family

133 . . . . .
planning have found communication behaVior to be indicative of

 

130
For seeking information on this, each reSpondent was asked the

following question:
How far in school do you want your daughter to go?

131
For seeking information on this,each reSpondent was asked the

following question:
If your daughter-in-law with the consent of your son takes up to
some part-time or full-time job would you approve or disapprove
her taking up the job?

132
James P. Bebermeyer and Everett M. Rogers, "Mass Media and Inter-

personal Communication in National DevelOpment: AID Diffusion Project,"
(unpublished), January, 1966, pp. 14-21.

133Donald J. Bogue and Veronica Stolte Heiskanen, How to Improve
Written Communication for Birth Control, pp. 1-20.

 

111

acceptance of change. The concept Of Opinion leader further emphasizes
its curcial role. In this survey each respondent was asked if he reads
daily newspapers, weekly or monthly magazines, or books. Table 27 gives
the communication scores ranging from 0-8 of the respondents. The aver-

age score for the group comes to 4.2.

TABLE 27

Communication Scores of IUD Acceptors*

 

Score NO. Percent

 

 

No. communications used - 0 4 2.3
l 4 2.3

2 25 13.8

3 13 7.2

4 36 20.0

5 35 19.5

6 22 12.2

7 14 7.7

High use of communication 8 _21. 15.0
Total 180 99.8

 

*The responses were recorded into three categories of "never," "some-

time," and "regularly." The three categories were coded 0, 1 and 2 re-

spectively. On this basis the communication scores ranged from 0 to 8.
Table 28 gives the distribution of respondents into three categories

Of very low, very high and medium in communication. This table shows ex-

ceptionally large difference between the first two categories of "almost

no communication" and "some communication." This suggests that so far

as this group is concerned "some communication" goes a long way, the dif-

ference between those with "no communication" and those with some commu-

nication being close to 67 percentage points. Hill found a similar trend

112

in the case of education and concluded that a little education goes a

. 134
long way in family planning.

TABLE 28

High, Medium and Low on Communication*

 

 

 

Categories No. Percent
Almost no communication 8 4.5
Some communication 131 72.7
Exceptionally high communication 41 22.8

Total 180 100.0

 

*Scores 0-1 = almost no communication; 2-6 = some communication; and
7-8 = exceptionally high communication.

Table 29 below divides the respondents into two categories of high
and low on communication. On the basis of scores in Table 27 we get an
average score of 4.2. Rounding this at score four we divide the group
into two. Those who scores less than four are termed "low" and those who
scored four or more than four are termed "high" on this variable.

Roughly about three-fourths of the acceptors are high in location on
the communication network. This may suggest a strong relationship trend
between existing level of communication and acceptance of family planning

(IUD) in the case of this group of early acceptors. This is strongly

135

supported by the studies in the fields of agricultural and family

 

134Reuben Hill, J. Mayone Stycos and Kurt W. Back, The Family and
Population Control, p. 124.

135M. C. Wilson and Gladys Gallup, Extension Teaching Methods and
Other Factors that Influence Adoption of Agricultural and Home Economics
Practices, p. 20.

 

 

 

:-

.i-

113

planning136 where one of the consistent findings is that exposure to a
variety of information sources and media is usually needed before an in-

novation is adopted.

TABLE 29

High and Low Around Group Average
on Communication Network

 

 

 

Categories No. Percent
High on written communication 134 74.4
Low on written communication 46 25.6

Total 180 100.0

 

CONSUMPTION PATTERN
Modern Consumer Items: Use of such items have been found to be generally
associated with acceptance of family planning practices. This factor has
been credited for providing a part of the motivation for developing the
137

13
small family size norm in the Western world, and in Japan. 8 Recently,

139
Freedman in his Taiwan study found this to be associated with family

 

136Bernard Berelson and Ronald Freedman, "A Study in Fertility Con-

trol," Scientific American (May, 1964), p. 10. Also see Bogue and Heiskanen,
op. cit., p. 6.

137Frederick Osborn, Three Essayp on Population: Thomas Malthus, Julian
Huxleynyrederick Osborn, p. 97.
138 . . . . .
Minoru Noda, "Contraception in Japan: Problems of Motivation and Com-
munication," in Research in Family Planning, ed. Clyde V. Kiser, p. 551.
139
Ronald Freedman, John Y. Takeshita, and T. H. Sun, "Fertility and
Family Planning in Taiwan: A Case Study of the Demographic Transition,"
American Journal of Sociology, 70 (July, 1964), pp. 16-23.

 

 

114

planning acceptance. The proverbial race between a baby or a car seems
to be universal. Thomlinson has observed, "A desire for more and better
material possessions and comfort enhancing conveniences is nearly uni-
versal."140 Family planning could be a very important factor in influ-
encing the outcome of this race.

This survey attempted to know something about this factor for our
IUD acceptors in Delhi. Each one of them was asked how many items he
owned out of a given list of eight articles of consumption. The respon-
dents were given a score corresponding to the total number of articles
owned. Table 30 below gives the distribution of acceptors according to

the number of articles owned.

TABLE 30

Use of Modern Consumer Articles*

 

 

 

Score NO. Percent
0 - (NO modern items owned) 9 5.1
1 17 9.4
2 22 12.4
3 23 12.7
4 39 21.6
5 25 13.9
6 28 15.5
7 14 7.7
8 - (All items owned) __3. 1.7

Total 180 100.0

 

*Articles considered were: radio, sewing machine, tea and/or dinner
set, wrist watch, name plate, sofa and/or dining table, carpet and dres-
sing table.

 

140Ralph Thomlinson, POpulation Dynamics, p. 330.

 

115

Table 31 below divides the group into "high" and "low" around the
rounded group average Score of four. All those who scored the group
average or more than that are classified as high and others are classi-

fied as low.

TABLE 31

High and Low on Modern Consumer Items
Around Group Average

 

 

 

Category No. Percent
High* on level of consumption 110 60.5
Low on level of consumption 70 39.5

Total 180 100.0

 

*Persons scoring equal to group average (4) or higher are classified

as high. Others have been treated as low.

Two broad trends become apparent in the above table:

1. Majority of IUD acceptors score either equal or higher than the
group average.

2. However, the Strength of the above relationship is sufficiently
weakened by the fact that about as high as 40 percent of the
acceptors scored less than the group average on this variable
indicating that at least in their case the low score on level
of living as indicated by certain items Of consumption was not
a very powerful barrier in the acceptance of family planning

(IUD).

116

B. Value Orientations

 

Religious Beliefs of Acceptors: Fertility is the result of biological
facts and complex social and cultural forces that may encourage child
bearing or discourage or limit it. The institution of religion in all
societies provides for both the encouragement and check of the fertility
phenomenon. However, it seldom affects fertility directly. "The major
influence on religion on reproductive behavior often lies outside the
strict theological field. It lies in the changes of ways of life which
the religions tend to impede--for example, the rising status of women,
aspirations for social mobility, the values attaching to secular evalua-
tion and the like."141 In other words, the effects of religion over
fertility are generally unconscious. People have other immediate ends
in mind and yet their resulting behavior affects fertility.

Therefore the variable of religion has been of particular interest
to studies in demography. Conflicting findings have been reported as to
the role of religion in family planning. According to some studies in
U.S.A., "religion has proved to be the social attribute of greatest single
importance... Religious preference is a factor not only in the choice of
methods but also in the effectiveness Of contraceptive practice as well.
Jews begin contraception earlier, use more effective methods, have the
largest birth intervals and report the fewest unplanned pregnancies.

Catholics are at the Opposite end Of this pattern and Protestants are

 

141Frank W. Notestein, Dudley Kirk, and Sheldon Segal, "The Problem
of Population Control," in The Population Dilemma, ed. Philip M. Hauser,
p. 132.

 

117

intermediate."142 On the other hand, Hill found Catholicism to be of
little significance in accounting for the high fertility pattern in Puerto
Rico, a Catholic state.143 In the West Indies the Roman Catholics were
found to take advantage of family planning services as much as any other

‘144
religious group. Religious differences are also found to be of little

145
significance for fertility differences in present day Europe.

In the case of India, a powerful indirect influence of religion

146
through various customs and beliefs has been noted in several studies.

The importance of having a son and early and universal marriage are some

147
often quoted factors. This has led some to believe that in the case

Of Hinduism the emphasis upon the religious duty of producing and rais-

1
ing children will not encourage pOpulation control except by continence. 48

While others on the basis of several recent KAP (knowledge, attitude, and

practice) surveys have come to the conclusion that caste and religion

are not directly related to knowledge and practice of family planning.149

 

142Charles F. Westoff, "The 'Family Growth in Metropolitan America':

A Progress Report," in Research in Family Planning, ed. Kiser, pp. 187-188.

143Reuben Hill, J. Mayone Stycos, and Kurt W. Back, The Family and

Population Control, p. 131.

144
George W1 Cadbury, "Outlook for Government Action in Family Plan-

ning in the West Indies," in Research in Familerlanning, ed. Kiser, p. 330.

 

1450sborn, Op. cit., p. 112.

146S. N. Agarwala, "Evaluating the Effectiveness of a Family Planning
Program," in Research in Family Planning, ed. Kiser, pp. 414-415. Also see,
K. K. Mathen, "Preliminary Lessons Learned from the Rural Population Con-
trol Study of Singur," in Research in Family Planning, ed. Kiser, pp. 38-39.

147

 

William J. Goode, World Revolution and Family Patterns, pp. 215-216.

148 ,
Osborn, Op. Cit., p. 108.

149B. L. Raina, Family Planning Program: Report for 1962-63, p. 12.

118

Dandekar Observes that as far as religion in family planning is concerned,
the "two major findings of this series of studies carried over a period

of five years and in number of urban and rural centers Spread over several
districts were as follows: Firstly, the pOpulation did not suffer from
any religious dogma Opposed to family planning..."150

In this survey an attempt was made to find the relationship of IUD

acceptance to the degree of religious commitment of the acceptors as re-
vealed by their regularity in performing daily prayers--Puja Path--some-
thing comparable to Rosary of Catholics. Each reSpondent was asked
whether he devotes some time every day to this ritual. Those who did SO
regularly as a part of daily life routine have been treated as "high" on
religiousness and others have been rated as "low" on this variable. In

Table 32 the first group is shown as having high orientation to religion,

and the other is treated as having low orientation to it.

TABLE 32

Religious Orientation of IUD Acceptors

 

 

 

Category of Religious Orientation No. Percent
High orientation to religion 97 53.3
Low orientation to religion 85 p 46.7

Total 182 100.0

 

This table shows that nearly as many high-religion-ritual oriented

people accepted IUD as those having low orientation, thus suggesting some

 

T

150Kumudini Dandekar, "Family Planning Studies Conducted by the
Gokhale Institute of Politics and Economics, Poona," in Research in Family

Planning, ed. Kiser, p. 8.

 

119

sort of equal role of religion so far as family planning (IUD) acceptance
or non acceptance is concerned.

This finding is interesting when considered with the finding of
several attitude surveys which repeatedly found lack of any significant
negative influence of religion in adoption Of family planning in India.
Bogue has observed, "in Hindu religion there seems to be few overpower-
ingly strong religious or moral taboos against the practice of family
planning--or at least few members of the pOpulation voice objections on
religious grounds when they discuss it."151 However, the trend Shown by
the table Should not be interpreted as religion providing a positive norm
for the small family. What seems to happen is that the peOple generally
do not face the problem of family planning with a vivid consciousness of
its relationship to religious teaching and values, except perhaps the in-
tellectually alert religious persons, or persons of very sound material
means. The laity seems to be guided by the immediate Situation that con-

152
fronts them.

Personal Control or Effort vs. Fate Orientation: Family planning implies
belief in future and confidence in one's ability to manipulate it. It
means that one looks ahead, orients himself toward future and commits him-

. 153 . . . .
self to some action. Fatalistic families were found to fare less well

 

151
Donald J. Bogue, "Some Tentative Recommendations for A 'Sociologi-

cally Correct' Family Planning Communication and Motivation Program in
India," in Research in Family Planning, ed. Kiser, p, 503,

152
Osborn, Op. cit., pp. 105-106.

153
Lee Rainwater, And the Poor Get Children, p. 50.

 

120

in dealing with the problem of family size in Puerto Rico.154 According
to Lorimer, where hOpe is weak, contraception will be absent or inef-
fective.155

The general attitude to life, in developing countries has been char-
acterized as that of fatalism, resignation or hopelessness. PeOple are
unaccustomed to the idea of manipulating the future to suit their ends.156
The Indian belief in "Nirvana"--the ideal of extinguishing the self--
and non-materialistic orientation to life have been cited as examples
illustrating this point. While these are very general observations very
few studies in this field have found this to be a crucial barrier to
family planning. Mathen has observed that, "One of the chief barriers
in a successful family planning campaign in a rural population is the
fatalistic attitude of the people towards the subject of family size.
There are people who believe that just as the time of death is predestined
the occurrence of birth or conception is also a matter beyond the control
Of man."157

But how powerful is the ideology of fate in the actual day-to-day
life of the Indian masses and to what extent are they today ascetic or

materialistic in their way of life needs to be further investigated.

More recent accounts of developing countries including India, point to

 

154Hi11, Stycos, and Back, Op. cit., p. 225.

155
Frank Lorimer, "Issues of Population Policy," in The POpulation

Dilemma, ed. Philip M. Hauser, p. 149.

156Hill, Stycos, and Back, Op. cit., pp. 144-145.

157Mathen, Op. cit., p. 38.

158Goode, 0p. cit., pp. 203-214.

121

the presence of a "revolution of rising expectations." Hauser159 mentions
this and Taeuber160 calls this develOping of rising aspirations as the
greatest social and political process of our time. This may partly ex-
plain the desire of 70 percent of the Indian adult population to be
highly concerned about the number of living children and their desire to
have limited number of children. 61 The Indian Institute of Public Opinion
found 74.5 percent in urban areas and 65.9 percent in rural areas reported
dissatisfaction with their present income.162

An attempt was made in this survey to identify the general orienta-
tion to life of the acceptors in terms of their evaluation of the role of
"fate" as against "efforts" in their lives. Each reSpondent was asked
which of the two has played a greater role in shaping his life. Those
who credited efforts more than fate have been ranked high on effort con-
tinuum and those who saw their position more as a work of fate and less
a result of efforts have been classified as low on this variable.

It appears that most of the respondents were effort-oriented to life
implying a belief in the future and the possibility of manipulating it
to meet their ends. Our findings are supported by Rainwater's studies in

the U.S.A. and Hill's study in Puerto Rico. Both of them found this to

 

159Philip M. Hauser, "Introduction and Overview," Op. cit., p. 3.

160Irene B. Taeuber, ”Population Growth in UnderdevelOped Areas," in

The Population Dilemma, ed. Hauser, p. 30.

161

 

Baljit Singh, "Family Planning Work in Ultar Pradesh," in (Proceed-
ings of) Second All India Conference on Family Planning, p. 60. Also see
Raina, p. 12.

162The Indian Institute of Public Opinion, ”Family Planning," Monthly
Public Opinion Surveys, IX (March, April, 1964), p. 36.

 

 

122

be a characteristic Of Successful family planners. Indian Institute of
Public Opinion reported that 52.8 percent of the people in urban areas

163
thought it a good idea to plan for the future.

TABLE 33

Effort vs. Fate Orientation of IUD

 

 

 

Category NO. Percent
Believes in effort 131 77.9
Believes in fate 37 22.1

Total 168 100.0

 

Aspirations for Education of Children: While the desire to have children

 

to continue the family name initiates fertility, parents' aspirations for

a better life Of their living children tends to inhibit unlimited number

164
of them. This desire for a better life for children is credited to be

one of the main reasons of the long decline in American fertility during
. . 165
the nineteenth century and the early part Of the twentieth century.
Therefore, "closely allied to an orientation toward life'as something one
can or cannot manipulate are the aSpirations held for self and children."166

However, the negative influence of living children on those yet to

be born depends on the changing concept of better life and differs from

 

163Ibid., p. 36.
164

165
Wilson H. Grabill, Clyde V. Kiser, and Pascal K. Whelpton, The

Fertilipy of American Women, p. 3.
166

Taeuber, Op. cit., p. 30.

Hill, Stycos, and Back, p. 55. Also see Minoru Noda, pp. 562-563.

123

culture to culture and between different groups within the same culture.
In societies such as India where change is relatively slow and difficult
self aspirations tend to be projected and realized through children.167
Also, because of the expected Old age dependency Of parents on children,
a part Of their self-interest gets tied to the better life chances of
children. Under the circumstances the children seem to have great econo-
mic value in addition to spiritual and emotional values for the parents.
NO wonder therefore that the parents Show so much concern about having
children, marrying and educating them, and extend their reSponsibility to
providing them a good start in life. Under conditions of serious com-
petition in society, opportunities in life tend to be determined by one's
educational achievements which thus becomes a crucial factor.

We in this survey attempted to ascertain parents' aspirations for
the education of children by asking each respondent how far in the school
he would like his daughter to go. The question is asked in terms of the
daughter rather than the son on the basis of pretest to get variation of
responses. The responses were recorded according to the six well recog-
nized stages in the education system--no education, primary, middle, high
school, B.A. and M.A. The first three Stages have been grouped as indi-
cating low educational aspirations, and the last three showing high edu-
cational aspirations for children.

Table 34 gives the distribution of reSponses in these two categories

along with the sub-categories. The table shows that the "family planners"

 

167
Bogue, “Some Tentative Recommendations for a 'Sociologically

Current'...," Op. cit., p. 526.

124

in our housing colonies have exceptionally high educational aspirations
for their children. One could hypothesize a strong and direct relation-

ship between aspirations for children and acceptance of family planning.

TABLE 34

Educational ASpirations

 

Category NO. Percent

 

Low Educational Aspirations 6 3.5
Illiterate (0)
Primary (0)
Middle (6)

High Educational Aspirations 169 96.5
High School (77)
B.A. (64)
M.A. (28)

 

Total 175 100.0

 

Bogue has very rightly observed that, "One of the most powerful
motives to which Indian couples will reSpond is the welfare of their
children. This should be dominant theme rather than hedonistic appeals
to greater personal comforts and a higher level of living."168 The argu-
ment is put forth that under the present Situation when there is a strong
tendency to put the child before the self, it would be easier to arouse
hOpe for one's children in the midst of deSpair and peOple would be willing
to hOpe for better things for their children as the second best longer-

run Objective. Similarly Westoff found the emphasis on children's education

 

168
Ibid., p. 526.

125

as a highly important factor in explaining Jewish greater success in

. . . . . 169
family planning as compared to Catholics and Protestants in America.
Osborn has gone a step further and referred to this trend as a general

170
rule holding good in most of the situations.

Ideological Orientation-~Modern vs. Traditional: Modern ideological orien-
tation means acceptance of new, rational and progressive ideas governing
the conduct of behavior. AS Opposed to this, traditional ideology implies
respect for tradition and the status-quo. A general finding which is
overwhelmingly supported in agricultural diffusion studies is that inno-
vativeness of individuals is related to modern rather than traditional
. . . . 171 . . . .
ideological orientation. In the case of family planning this assoc1a-
. , 172 ,
tion has been found to be true for western countries. This has also
been found to be true in the case of eastern countries. In Japan it was
found that the desire for more and more modern goods was a very important
. . . .173.. ..
factor in man s acceptance of family planning. Similarly in Taiwan
modern orientation to life was found to be associated with the small
174

family Size norm.

This has led some to suggest modernization and its accompanying ideo-

 

logy as a prerequisite to solving of the pOpulation problems of developing

 

 

170
Osborn, op. cit., p. 93.
1 l
7 Everett M. Rogers, Diffusion of Innovations, pp. 66-67.
172

Ronald Freedman, "Norms for Family Size in Underdeveloped Areas,"
in The Proceedings of the Royal Society, B, Vol. 159 (1963), pp. 220-234.

173Minoru Noda, Op. cit., pp. 551-562.

Freedman, Takeshita, and Sun, "Fertility and Family Planning in
Taiwan...," op. cit., pp. 16-27.

126

societies. But the recent experience in the spread of family planning
program of several developing countries indicate that to a fair extent
educational extension approach could perhaps make good for the lack of
missing modern ideological orientation to life of the peOple.175

With a view to find out the role of modern vs. traditional ideolo-
gical orientation the survey picked up the crucial institution of the
family and the role of women outside the home. It is socially crucial
in the sense that it brings face-to-face in a most forceful way, the
forces of the old and the new in ideology. It is also equally relevant
for the problem of fertility control because of its intimate relationship
with the status of women. The Specific question which concerned uS was
the housewife seeking a career outside the home. Each of the respondents
was asked the following question: ”If your daughter-in-law with the
consent of your son takes up to some part-time or full-time job, subject
to your final approval, would you approve or disapprove her taking up
the job." Those who replied yes have been rated high on modern-rational

ideology and those who disapproved have been rated low on this variable.

TABLE 35

Modern vs. Traditional Ideological Orientation

 

 

 

Categories No. Percent
Approve of daughter-in-law taking job 103 61.6
Disapprove of daughter-in-law taking job 64 38.4

Total 167 100.0

 

5
Bernard Berelson, "KAP Studies on Fertility," in Family Planning
and Population Programs, eds. Bernard Berelson, et a1., p. 664.

 

 

127

Table 35 above indicates a relationship in acceptance of family 77\

planning (IUD) and modern ideological orientation to life so far as this 3
1
group is concerned. However, the strength of this relationship is suffi:/.
ciently weakened by the fact that for 40 percent of our cases it was pos-
sible to accept IUD in spite of their being not so (modern) oriented.

The general trend as indicated by Table 35 is supported by studies
in Korea and Taiwan where they found a trend of getting more and more
less modernized IUD acceptor as a result of deliberate programmatic efforts
and the passing of time. As a matter of fact, some have argued that be-
cause of the advantages of IUD it tends to be acceptible by even those

176

who are more traditional in several ways.

SUMMARY

With a view to summarize the main trend findings of this chapter,
an attempt is made in Table 36 below to give the percent of respondents
scoring high in each of the variables considered in this chapter. The
following broad pattern emerges from Table 36.

The majority of acceptors score high on all the variables. This
suggests the general importance of the considered variables in the ac-
ceptance Of family planning (IUD) so far as this group is considered.

The strongest favorable influence is exerted by aSpirations for the
education of children, followed by faith in the capacity to manipulate
the future and the position of the acceptor on the communication network.
The national program should take note of this and manipulate them as

powerful motives for acceptance of family planning.

 

176John Y. Takeshita, "Lessons Learned from Family Planning Studies
in Taiwan and Korea," op. cit., pp. 691-710.

128

TABLE 36

Rank Order of Variables According to Percent Scoring High

 

 

Variables No. of Percent
Responses High
Aspirations for children education 175 96.5
Belief in efforts as against fate 168 77.9
Position on communication network 180 74.4
Modern vs. traditional ideological orientation 179 61.6
Level Of living 180 60.5
Religiousness 182 53.2

 

Religiousness seems to have a sort of uncertain influence. The
level of living and the need for modern ideological orientation to life,
although important, does not seem to be unsurmountable in acceptance to
family planning (IUD).

This conclusion is supported by findings in Korea and Taiwan, where
the poor and illiterate tend to accept IUD almost as frequently as the
modern and well-Off peOple. In Korea as high as 40 percent of acceptors
are illiterate. Takeshita has summarized the trend in Korea and Taiwan
as follows: "While practice of contraception before the program (IUD)
was definitely more frequently reported among the better educated, the
higher income and the more modern groups, acceptance in the program was
likely among the less educated, the lower income and the less modern group

as among the former."177 Our findings support the trend as observed above.

 

177Ibid., p. 702.

CHAPTER VII
SUMMARY AND CONCLUSIONS

Overview: Family planning programs have won wide intellectual acceptance
in India. As a result, several far-reaching policy decisions such as in-
itiating a national program of family planning, making funds available

on demand basis, and creating a nation-wide organization to provide free
and easy availability of many kinds of contraceptives and related services
8b every person in the country, have been taken within a relatively short
period of time.

While all these are essential first steps, equally crucial is the
acceptance of these measures at the behavioral level by the millions of
couples called the target group in this study. This leads into a variety
of important social science problems. The behavior of this target group
as a response to national policy was made the main focus Of this Study.

Of particular interest to this study was the positive response termed ac-
ceptance of one of the new contraceptive devices popularly known as IUD.

Acceptance was studied to unveil and better understand the dynamic
processes leading to changed behavior through acceptance of this innova-
tion. The main objective was the recognition of the fact that action pro-
grams would greatly benefit by such an analysis Of the process. If the
acceptance process is to be accelerated to ward Off future crisis, the

need for systematically studying, analyzing and understanding the innovation

129

130

acceptance behavior of the people in this most personal, sensitive and
vital area of their lives, becomes obvious.

This particular emphasis on the analysis of the acceptance process
makes this study different from usual demographic surveys which have
great use in providing information for policy decisions, but usually lack
in focusing on information necessary for improving action and accelerating
acceptance of family planning. Secondly, this emphasis implies a micro-
cosmic view Of the problem of population growth as opposed to macrocosmic
view with which demographic surveys are concerned. Hence, all through
this study the unit of concern has been the family, with the wife and the
husband as main actors exhibiting positive contraceptive behavior, both
between themselves and the immediate society. Lastly, this Study departs
from general demographic surveys in its methodological orientation. The
deficiencies of demographic approach in failing to explain the differ-
ential fertility behavior has been noted amongst others, by Hauser, Hill,
Rainwater, and Bogue. Each one of these authors indicate that the sub-
ject of family planning is more appropriately amenable to sociology and
recommend the need to explore it by family sociologists, social-psychologists
and diffusionists, for possible new understanding of fertility behavior
to complement the already available demographic information and under-
standing of the phenomenon of population growth.

According to Rainwater, the demographic orientation has tended to
encourage overly ambitious standards Of certainty in the family planning
studies and therefore he highlights the need for cracking the overly
quantitative mold into which such studies seem to have cast our conceptu-

alization of the process by which families regulate Size.

131

Keeping in view the above vieWpoint, this study used the Opportunity
provided by the research in understanding the process of family planning
acceptance within the diffusion framework used in studies of acceptance
of innovation in agricultural and health practices.

The diffusion approach emphasizes variables of communication, decision-
making, situational context Of change, and characteristics of innovations
and the men involved in the process of change. Some of these variables,
therefore, were of considerable interest to us in this study. In order
to better appreciate the significance of these variables, a conceptual
model of acceptance of family planning practice was deve10ped based upon
the two models of Hill's and Meier's. Based upon this conceptualization,
a semi-structured schedule was developed which was used as the main tool
for information collection on the variables of interest to this study
from the users Of IUD in three government colonies of New Delhi.

These three colonies were among the first ones where the program of
IUD was started in the country. As there were limited numbers of IUD
acceptors in the three colonies, the study involves all those who were
using IUD. There were 263 users. Out of these, eighty-one could not be
interviewed because Of various reasons. This study therefore limits to
182 cases of users.

Most of these families belonged to educated modern group of the
working and middle classes. All of them belonged to the service class
and were working in government offices. On the average they had lived
twelve years of married life, and they had an average of 3.2 living chil-
dren. The modal age groups for acceptance of the device were 25-29 and

30-34 years for women and men, respectively. In terms of some key

132

demographic variables our group was found to be comparable to a relatively
much larger study consisting of about 6,000 cases of family planners from
a Similar population of government colonies. However, when compared to

the general population, it is a highly atypical group.

Main Findings: Our data indicated several communication behavior trends

 

of this group of respondents. We found that division of roles on sex basis
showed an important bearing on the information receiving, gathering and
evaluating processes. As compared to husbands, more wives first became
aware of the innovation. Relative to their husbands, they took more
initiative in collecting additional information on the device.

We noticed a differential response in the case of wives and husbands
to the different communication media at the awareness stage. About three-
fourths of the wives were reported to have known about IUD through im-
personal maSS media. Thus the use of communication media tended to
Specialize on a sex basis.

The analysis of our data indicated that more wives (67%) collected
additional information on IUD, when compared to husband's (53%). In doing
so, wives largely depended upon personal cosmOpolite--c1inic staff--
sources, and husbands on personal localite--friends and relatives--
sources. It seems that at the “interest stage" the differential use of
communication media noticed at the "awareness stage" disappears. Personal
sources Of information become important to both of them. However, within
this broad category of personal sources, it was noticed that wives mostly
depended upon personal cosmopolite sources and husbands made the most use
of personal localite sources. Considering both the stages of "awareness

and interest" together, in relation to the use of different communication

133

media we found that personal sources were most intensively used by wives
and mass media was the least important to them. In the case of husbands,
mass media was reported to be important at the awareness stage and per-
sonal sources were more relied upon at the interest stage. At the evalu-
ation stage husbands tended to depend more on mass media while women
Showed an increased tendency to rely on personal cosmopolite sources.

At this stage we found the indication of a high degree of mutual exchange
of information between the wives and husbands.

In brief, then, we noticed that while husbands tend to use both the
mass media and personal sources of information with varying degrees of
emphasis at different stages, wives seem to maintain a consistent trend
of heavy dependence on personal sources, especially of cosmopolite nature.
However, this trend of isolation of wives from the mass media and of hus-
bands from personal cosmopolite sources (eXperts) seem to be largely cor-
rected by the evidence of a high degree of mutual intercommunication be-
tween the two inside the family. This was interpreted as the operation
of the two-step flow of communication where each member of the couple acts
as the Opinion leader for the other in relation to those communication
sources which, due to some reason, were not used by the other. This work-
ing of the two-step flow was seen as a possible explanation of effective-
ness of both the types of communication sources.

Lastly, in these days Of mass media our data highlighted the impor-
tance of personal communication sources. This was found to be crucial
for women all through the process.

The data of this study indicates that in the case of this group of

IUD users both the wive and husband were involved in decision-making.

134

Only in the case of seven percent of the cases the wife made the decision,
took the device and informed the husband about her using it after the
event. We also observed that in such cases where both were involved in
about 50% of the cases the wife made the final decision and in about 44%
of the cases the husband played this role. In the case of the remaining
cases, respondents claimed equal responsibility in making the final deci-
sion. A remarkable absence of concentration of final decision-making
authority in the male figure within the families of this group goes
counter to the general belief which regards the husband as the decision
maker within a family. At least this was not so in this group so far as
decision regarding acceptance of IUD was concerned.

We found that friends and neighbors of IUD users had a role in
decision-making. One significant finding was that while friends were
consulted by both the husbands (43%) and the wives (62%), consultation
with neighbors was much more in the case of wives (56%) as compared to
husbands (8%). "Outside-colony" orientation of husbands and "inside-
colony'orientation of wives might have caused this trend.

Consultation with IUD users as a factor in decision-making was studied.
In about 66% of the cases users were consulted either by the wife or the
husband, and at least in two-thirds of such cases this was done by the
wife. IUD being a female method might have produced this pattern of con-
sultation. On an average, each of the users studied claimed credit for
having influenced one more user of IUD, between the period they took the
device and the time of the interview.

In this group of peOple we found two groups of persons, on the basis

of their family planning status defined in terms of use of any other

135

family planning method prior to the use of IUD. About 80% of our reSpon-
dents were using or had used some other method before accepting IUD.
Another characteristic of this group was that most of them found the pre-
vious method inefficient, resulting in unwanted births in the family.
The other small group consisted of those for whom IUD was the first family
planning method ever used. This trend was explained as a possible result
of prior acceptance of the idea in the case of the first group SO that
they had to chose between efficient and more efficient methods, while in
the case of the other group acceptance of IUD involved both the acceptance
of family planning idea and the device. In other words, for the first
group it was easier to accept IUD as compared to the members of the second
group, and hence the difference between the sizes of the two groups.
Lastly, we examined some general characteristics of the life styles
of this group of IUD users. The selection of characteristics was based
upon the current interest as evident in the fertility literature. These
were: (1) aSpiration for children's education, (2) effort or luck orienta-
tion to life, (3) reading of printed mass media (newspapers, journals,
and books), (4) Statements reflecting ideological orientation, (5) ritua-
listic orientation to religion, and (6) consumption of certain modern
articles. Our data indicated that about 50% or more of our respondents
scored "high" on each of these considerations. A majority of respondents
had high aspirations for their children's education (96.5%), credited
effort orientation for their present position in life (77.9%), were read—
ing printed mass media (74.4%), had modern ideological orientation to
life (61.6%), were using more modern articles (60.5%), and were having a

non-ritual-religious orientation (46.8%). In brief, strongest favorable

136

influence amongst the characteristics considered was exerted by aspira-
tions for children's education and the lowest by non-ritual-religious

orientation to life.

Limitations of the Study: Like many studies, this investigation has

 

several limitations. A brief discussion of some of these would set
healthy limits to the findings of this study.

This is basically an exploratory study geared to the great need
pointed by Freedman for factual investigations focusing on "what" before
one proceeds too far with the "why." 78 The IUD being almost new, this
fact had to be kept in view. Its aim is not to yield generalizations
for wider application. In putting this limit the study recognizes what
Notestein emphasized that "... programs useful at one stage and in one
setting may be useless or even harmful in another context, depending on
the Stage of public acceptance and on a multitude of social,economic and
political factors."179 Findings from studies tied to a particular action
program, therefore, would have to be restricted in SO far as their general
application is concerned.

Another limiting condition on generalization is put by the fact that
the trends observed in the case of IUD--female method-~may not hold good
in the case of male methods for family planning even in the same popu-

lation.

 

178
Ronald Freedman, "Next Steps in Research on Problems of Motivation

and Communication in Relation to Family Planning," Research in Family
Planning, ed. Clyde V. Kiser, p. 597.

179

 

Frank W. Notestein, "General Significance of the Conference," in
Research in Family Planning, ed. Clyde V. Kiser, p. 608.

 

137

It has been pointed out in the study that the group with which we
were concerned is highly atypical. To add to this, it may also be em-
phasized that the physical environment of these well planned self-
sufficient colonies could be a significant factor in influencing the
trends we observed in this study.

The design of the study involved only IUD users. One would, there-
fore, do better not to infer that the non-users in these colonies would
Show Similar behavior when they are faced with the problem of adopting
IUD in the future. It would be better to keep an open mind and expect
that they may or may not Show Similar trends.

This study was done in the initial phase of the IUD program. As the
cases of acceptance were limited, we Studied the whole universe of users
to insure reasonable numbers of respondents. In other words, it was not
a sample survey. Of the two hundred and sixty-three users, we lost
eighty-one, or about 30% of the cases. We have no means to estimate how
the loss of these cases have influenced our findings.

Fertility data is regarded as the "hard core" of demographic studies.
If any study in this field has to have any comparability, it needs to
have enough basic fertility data. In this study, except for the number
of living children and sons, we do not have any information relating to
the ”hard core" and thus this lack becomes a limiting factor so far as

this study is concerned.

Suggestions for Further Research: Any logical extension of this explora-
tory study would be an improvement, to the extent it takes into considera-
tion the limitations pointed out in the previous section. It could use

the trend information revealed by this data and prOpose several hypotheses

138

relating to either of the two areas of communication and decision-making.
Use of a control group (non-users) would be a major improvement in the
design. Moving the locale of the study from an atypical group to addi-
tional more typical ones would generate possibilities of a wider appli-
cation. Inclusion of more fertility data would add to the comparative
value of the findings.

Improvements could also be made in the research tool, if one keeps
in view the limitations of several questions already indicated. Specific
suggestions in this area would be to attempt to deve10p a scale to mea-
sure variables related to the general background variables indicating
life orientation and life Style of the respondents. Some way Of incor-
porating users of other important methods would further sharpen the im-
plications of such future Studies to action programs. While all of the
above suggestions would have additional pay-off, it seems the main fac-
tors limiting the improvements would be the peculiar circumstances, such
as purpose, Sponsorship, finance, time and technical competence of re-

searchers, of each future study.

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APPENDIX - 1

SUB-ANALYSIS

Diffusion studies are concerned with the element of time in the pro-
cess of acceptance of innovations. Two distinct time periods--diffusion
period and acceptance period--have been identified in the corn study of
Ryan and Gross.180 According to Hoffer the Iowa Study Showed "that the
spread of knowledge and usage are separate considerations, but that the
degree of use depends upon adequate knowledge about the practice."181
This interdependence Of the two time periods is best exemplified by the
stages concept of the diffusion period, first steps of which are largely
knowledge or awareness oriented and the later steps Of which are mainly
concerned with usage decision-making processes.

Innovation studies have tended to study the problem of time in two
ways. One trend is to be mainly concerned with individual adOption pro-
cess from the time the individual knows Of it, till he actually adopts
it. Studies of Wilkening and Katz and Coleman focus on this aspect. They
recognize that individuals take different amounts of time in deciding
about the usage of innovations.

The other and more dominant trend is to Study the time element in
diffusion within a population where the new practice has been largely ac-
cepted within the framework of the Stages concept. The implicit assump-

tion here seems to be that the individuals more or less take the same

 

180Ryan, Bryce, and Neal Gross, Acceptance and Diffusion of Hybrid
Corn Seed in Two Iowa Communities, Iowa State College, Research Bulletin 372,
1950.
181 .
Charles R. Hoffer and Dale Stangland, Farmer's Reaction to New
Practices, Michigan State University, Technical Bulletin 264, 1958.

 

 

 

146

147

amount of decision-making time, or that individual differences balance

out each other. Given this consideration, they divide different members
of this group on the time dimension as innovators, early adOpters, late
adopters and laggards in accordance with the different phases of the total
time period the innovation took for Spreading throughout the population.
The next step of analysis in such studies is to examine the differences
between the communication behavior of the above categories both within

the system and outside the system.

If one were to highlight the differences between the above two ap-
proaches, one could State that the first approach studies time in rela-
tion to the individual unit of adoption; it is not concerned with aware-
ness which it takes for granted and treats it as the starting point of
analysis. On the other hand, the second approach treats time in relation
to the group as a whole, tends to assume individual differences--which
tend to even out--as of little consequence from the point of the group
and emphasizes the role of early or late awareness as important in making
some peOple adopt an innovation earlier than Others. Thus, according to
Rogers, "many change agents wish to speed up the process by which innova-
tions are adopted. One method is to more adequately communicate informa-
tion about new ideas SO awareness is created at an earlier data. Another
method is to shorten the amount of time required for adoption after an

. . . . . 182
indiVidual is once aware of a new idea." As already referred to, ac-

cording to Hoffer the hybrid seed corn study of Ryan and Gross Showed

 

182Everett M. Rogers, Diffusion of Innovation, p. 105.

 

148

"that period of knowledge and usage are separate considerations, but
that the degree of use depends upon adequate knowledge about the practice."
The above view is supported by Hassinger who has questioned the tendency
of most researchers who conceptualize the awareness stage as a random or
nonpurposive occurrence. Rogers has also observed that because of the
process of selective perception peOple become aware of an innovation at
different times, although all of them might be exposed to it Simultan-
eously.

In brief, then, on the basis of the above analysis there is enough
evidence to suggest the desirability of treating these two periods--em-
phasizing the speed of individual decision-making, and the speed of
awareness in a given population--as separate considerations in relation
to the element of time in the diffusion processes.

As already pointed out earlier, one of the concerns of this study
has been the problem of cutting Short the period of the spread of a
family planning innovation--the IUD. It is clear from the above discus-
sion of the two periods that such a saving of time could reasonably be the
combined result of both the periods and processes involved in them.

Keeping in View the above discussion, we would now engage in doing
our analysis of the time period in two ways. First we will study the
adoption period, emphasizing individual adoption time. Then we will be

concerned with time largely from the point of the group.

1-A. Speed of AdOption
Here our main concern is with the Speed of decision-making. In pro—

ceeding with this analysis we have divided the IUD users into two groups

 

 

\.-—

 
 

 

.4‘

.

..v

.s-

149

of quick decision makers and delayed decision makers. Quick decision

makers are those who made the decision and started using IUD within 14

days of their receiving their first information about the innovation.

Delayed decision makers are those who adOpted it two months or more after

their first information. Having divided the users into these two extreme

groups, we have tried to relate several selected variables, particularly

their presence or absence in an absolute or relative sense with early

or late adoption. In doing this analysis of time and variables through

a set of four-fold tables, we have assumed that the relationships obser-

ved in preceeding chapters would Still Show even at this next stage of

analysis. In other words, those variables which were found to be related

to acceptance would also be related to the speed of decision-making.

The statistical test of the relationships is the chi square test, and we

are considering the .05 level of significance to Show a solid relationship.

Percentage differences are considered for indicating general relationships.
The following fourteen variables subdivided into the categories indi-

cated,were considered because of their importance already noted in the

general analysis and also because of their being possibly related with

several others. For example we have considered the variable of "number

of living sons" as possibly related to "number of married years," "number

of living children," "past use of any other family planning method," and

"desire for more children."

. Age of husband--high and low

Education of husband--fair and high*

. Age of wife--high and low

Education of wife--fair and high*

Number of living sons--high and low

. Who was contacted first--wife or husband
Source of first information--personal or impersonal

\lO‘MvI-‘WNI—l

150

8. Who collected more additional information-—wife or husband

9. Consultation with user--yes or no

10. Modern article consumption score--fair or high*

11. Aspiration for children as indicated by daughter's education--

fair or high*

12. Age of marriage of daughter--low or high

13. Effort or luck orientation--effort or luck

14. Ritualistic religious orientation--high or low

On the basis of the analysis in the text we would expect: high age
of wife and husband, fair education of wife and husband, high number of
living sons, first contact with wife, her greater initiative in collect-
ing additional information, dependence on personal sources of first infor-
mation, consultation with users, fair amount of consumption of modern
articles, higher aSpirationS for children, higher proposed age of mar-
riage, effort orientation, and low ritualistic religious outlook to life,

to be related with quick decision-making. The tables below give the re-

sult of our analysis.

TABLE 37

Adoption Period Analysis:
Speed Of Decision-Making

 

(1) Age of Husband

 

 

up to 34 yrs. 34 + yrs.
low high x2 df P
quick decision 50 52 .041 l
delayed decision 50 47

 

*Variables 2, 4 and 11 have been subdivided into "fair" and "high"
because of the atypical characteristics of the respondents where almost
everybody must be fairly educated to hold a government job. On similar
reasons variables 10 and 11 have been divided into "fair" and "high."

151

 

(2) Education of Husband

 

up to high school high school +

 

fair high x2 df P
quick decision 64 38 5.472 1 **
delayed decision 35 61

 

(3) Age of Wife

 

 

 

 

 

 

 

 

 

 

 

up to 29 yrs. 29 + yrs.
low high x2 df P
quick decision 41 60 2.812 1
delayed decision 58 39
(4) Education of Wife
up to primary primary + 2
fair high x df P
quick decision 50 52 .037 1
delayed decision 50 47
(5) Number of Living Sons
1 son 1 + son 2
low high x df P
quick decision 52 48 0.127 1
delayed decision 47 51
(6) First Heard or Contacted
husband wife x2 df P
quick decision 30 71 13.495 1 ***

delayed decision

69 28

 

152

 

(7) Source Of First Information

 

 

personal impersonal

localite & press & 2

cosmopolite radio x df P
quick decision 66 25 12.368 1 ***
delayed decision 34 74

 

(8) Who Collected More Information

 

 

yes no xz df P
quick decision 30 53 3.924 1 **
delayed decision 70 46

 

(9) Talk to User?

 

 

yes no x27 df P
quick decision 36 56 2.388 1
delayed decision 63 44

 

(10) Modern Articles Consumption Score

 

 

from 0-3 from 4 + 2
fair high x df P
quick decision 59 44 1.623 1
delayed decision 40 55

 

(ll) Aspiration for Daughter's Education

 

up to high school high school +
fair high x2 df P

 

quick decision 61 37 4.266 1 **

delayed decision 38 62

 

153

 

(12) Age of Marriage of Daughter

 

up to 18 yrs. 18 + yrs.

 

normal age progressive age x2 df P
quick decision 46 52 .223 l
delayed decision 53 48

 

(13) Effort or Luck Orientation to Life

 

 

effort luck x2 df P
quick decision 48 53 .228 1
delayed decision 51 46

 

(l4) Ritual-Religious Orientation

 

 

yes no 2

high low x df P
quick decision 50 51 .016 l
delayed decision 50 48

 

The tables indicate the eXpected trend of relationships in the case
of all but two variables of "effort or luck orientation" and "higher num-
ber of living sons." Out of the remaining twelve variables, five are sig-
nificantly related with quick decision-making. These are:

. First contact or information to wife
. Personal sources of first information
. Higher aspiration for children

. Wife's taking more initiative in collecting additional information
. Fair education of husband

mwar—l

In the case of the remaining six although the tables show a moderate

trend in the expected direction, yet the relationship was not significant.

154

Our interpretation of the findings is that given fair education of
the husband, and higher aspirations for living children, contacting the
wife first through personal sources of information (cosmopolite and lo-
calite) to the point where she takes initiative in collecting more in-
formation, makes for a significant complex of factors for accelerating
the processes of decision-making within the family.

l-B. Diffusion Period:
The First and Second Groups of AdOpters

As already explained in the beginning of the first section of this
appendix, here we are concerned with diffusion period .as largely con-
cerned with awareness. Awareness we are treating in the sense of Hassinger
who argues that awareness must be initiated by the individual and is not
a passive act as conceptualized by most of the researchers. We also
noted that because of the processes of selective perception people be-
come aware Of innovation at different times, although all of them might
be exposed to it simultaneously.

Although all the cases studied in this project are early adopters,
in as much as we are dealing with the first several months of a new pro-
gram, we have divided them into two groups for closer analysis: earliest
first group and the second group. The same procedure as outlined for
adOption period analysis was followed in this stage. The variables used
are the same. The one difference between the two is that in this section
early and second groups have been defined in terms of the total time period
of the first nine months of the IUD program in these colonies. Here early
group represents those who accepted the device in the first four months

of the program and the second group includes those who accepted IUD in the

155

last four months of the program. In the tables they are referred to as .

first and second group. The expected relationships are also in the di-

rection as expected in the previous analysis. The tables below give the

results of this stage of analysis.

TABLE 38

Diffusion Table

 

(1) Age of Husband

 

up to 34 yrs. 34 + yrs.

 

 

 

 

 

 

 

 

 

 

low high x2 df P
first group 48 51 .180 1
second group 51 47
(2) Education of Husband
up to high school high school +
fair high x2 df P
first group 54 46 .864 1
second group 45 53
(3) Age of Wife
up to 29 yrs. 29 + yrs.
low high x2 df P
first group 46 55 1.050 1
second group 53 45
(4) Education of Wife
up to primary primary +
fair high x2 df P
first group 61 42 4.775 1 **
second group 38 57

 

156

 

(5) Number of Living Sons

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 son 1 + son
low high x2 df P
first group 39 57 4.239 1 **
second group 60 42
(6) First Heard or Contacted
husband wife x2 df P
first group 43 55 1.867 1
second group 56 45
(7) Source of First Information
personal impersonal
localite & press &
cosmOpolite radio x2 df P
first group 57 33 6.979 1 **
second group 42 66
(8) Who Collected More Information
husband wife xZ df P
first group 56 44 1.860 1
second group 43 . 45
(9) Talk to the Users?
yes no x27 df P
first group 50 46 0.141 1
second group 50 53

 

157

 

(10) Modern Articles Consumption Score

 

 

 

 

 

 

 

 

 

 

 

 

 

 

from 0-3 from 4 +
fair high x2 df
first group 56 45 1.450 1
second group 43 54
(ll) ASpiration for Daughter's Education
up to high school high school + 2
fair high x df
first group 59 44 2.806 1
second group 40 55
(12) Age of Marriage Of Daughter
up to 18 yrs. 18 + yrs.
normal age progressiVe age x df
first group 47 51 .183 1
second group 52 48
(13) Effort or Luck Orientation
effort luck x2 df
first group 50 50 .003 1
second group 49 50
(14) Ritual Religious Orientation
yes no 2
high low x df
first group 41 58 4.118 1
second group 58 41

 

158

The above tables indicate the expected trend of relationship in the
case Of all but one variable, "effort or luck orientation." Out Of the
remaining thirteen variables, four are significantly related with early
awareness leading to early adOption considered from the point of the
whole group. These are:

High number of living sons
Low ritual religious orientation

Fair education of wife
Personal sources Of first information

war—A

In the case of the remaining variables, although the tables Show a
moderate trend in the expected direction, yet the relationship was not
significant.

In brief, then, we can say that having more sons, a low ritualistic-
religious orientation, a favorable position in the personal (localite and
cosmOpolite) communication network and more educated wife, can be treated
as performing gate-keeping functions in relation to the couples in the
group. If they are in the required degree, they lower the barriers of
selective perception, and make such cases liable to be easily exposed to
innovation earlier than other members of the group.

Lastly, it may be noted that "effort or luck orientation" was found
to be unrelated in both the two approaches, and "high number of living
sons" which was not found to be related with Speed of decision-making
(first analysis) is found to be related with diffusion—awareness analysis
at .05 level. We may also note that in the case of the majority of vari-
ables, although we found mild relationship in the expected direction, it
was not significant at .05 level. Perhpas with enough number of cases
one could expect better results. We would therefore suggest further in-

vestigation in this direction.

10.

11.

12.

13.

14.

15.

16.

17.

18.

APPENDIX - 2

INTERVIEW SCHEDULE

Schedule No.

 

Name of the colony

 

Flat type

 

Block NO.

 

Flat No.

 

Name of the respondent

 

Age (in completed years)

 

Highest education degree or certificate

 

His present occupation

Income per month from the occupation

 

Wife's age (in completed years)

 

Wife's highest education degree or diploma

 

To what state do you belong?

 

How long have you been married (completed years)?

 

How many living children do you have? How many sons?

 

Have you heard of the new method of preventing pregnancy called the
IUD (loop/wire)? yes no

 

 

Do you know if the IUD is being used in this locality or by any of
your friends or neighbors? yes no

 

Do you think you and your wife might like to try it? yes no

(End interview and probe if by the end of the above questions he does not
mention his wife's use of IUD. Continue interview if he mentions use of

IUD.)

Since you use IUD, I wonder if you would be willing to answer a few ques-
tions about how you came to make that decision so that we can learn how
to help other peOple follow your example.

19.

Between you and your wife who was the first to hear of IUD?
husband wife . From where did you (she) first hear of it?

 

159

20.

21.

22.

23.

24.

25.

26.

27.

28.

29.

160

Roughly how many days or months before the insertion of IUD did you
(she) first hear of IUD?

 

When you first heard of IUD, what was your general reaction?
favorable unfavorable
(Probe for specific information)

 

 

Please recall all that happened from the time you first heard of IUD
till your wife actually had it inserted. Now would you tell me who
took more interest in this whole matter of your accepting IUD? Was
it your wife or yourself? husband wife

After you first heard of IUD did you yourself try to collect more
information about IUD? yes no

 

(If yes) How did you collect this additional information? (Probe for
full information by asking, did you do any other thing and so on.)

 

 

 

Did your wife also collect further information about IUD? yes__ no__
Would you tell us how she collected this additional information?

 

 

 

Now talking of this whole business of information collection, would
you tell us who collected more information, you or your wife?
husband wife

Usually in decisions on matters such as this both wife and husband
are involved. But generally one of them makes the final decision and
the other agrees. Now in this case of IUD, would you say you made
the final decision and she agreed OR she made the final decision
and you agreed

TO you what was the most attractive attribute or quality Of IUD that
made you accept it?

 

 

How did you learn about this particular aspect of IUD?

 

 

You have told me about the things you liked most about IUD. In ad-
dition to this, what other things did you like about IUD and how did
you learn Of them?

Other quality Liked How came to know of It
a.

 

 

 

 

 

 

b.
c.
d

 

 

30.

31.

32.

33.

34.

35.

36.

37.

38.

39.

40.

41.

42.

43.

161

You have told me things you liked about IUD. Now what about your
wife? In your view what did she seem to like most about IUD?

 

Could you tell me how she came to know about this.

 

 

Was there anything about IUD that made you fearful or doubtful about
it? yes no

 

(If yes) How did you overcome that fear or doubt?

 

 

In your view was there anything about IUD about which your wife was
fearful or doubtful? yes no

 

(If yes) How did She overcome that?

 

 

Did you consult with your friends about IUD at the time of making
your decision? yes no

 

(If yes) Generally speaking, were they favorable or unfavorable?
favorable unfavorable no Opinion

Did you consult with neighbors about IUD at the time of your making
the decision? yes no

 

(If yes) Generally speaking, were they favorable or unfavorable?
favorable unfavorable no opinion

Do you think at the time of your making the decision, your wife
(also) consulted her friends about IUD? yes no

 

Do you think at the time of your making the decision, your wife
(also) consulted with any neighbors? yes no

 

At the time of making your decision did you or your wife consult with
anybody who was using IUD? yes no
(Probe who talked, wife or husband or both. And who was the user:
friend/neighbor/relative/somebody in the locality/somebody in working
situation/others)

 

 

 

Since after you have had IUD have you talked to anybody about it?

yes no

(Probe for who talked: wife or husband or both, and to whom, friends/
neighbors/relatives/somebody in the locality/somebody in working
situation/others)

 

 

44.

45.

46.

47.

48.

49.

50.

51.

52.

53.

54.

55.

56.

162
Are you sure that any of the persons you and/or your wife has talked
to have been influenced to use IUD? yes no How many?

Did you use any other family planning method before taking up IUD?
yes no What method(s)?

 

 

 

(If yes) would you say you used the other method regularly?
yes no

 

 

Now please think of this other method you used before IUD. Would
you say you talked with others about that method? yes no

 

(If yes) Would you say you talked more, less, or about the same de-
gree about your old method as you do about IUD?
more less about same

(If the response is more or less, probe for why.)

 

 

When would you like to have your next child?

 

Do you read:

 

 

 

 

never sometimes regularly

daily newspapers ____ ____ ____
weekly magazines ____ ____ ___
monthly magazines ____ ___ ____
other books ____ .___ ___
Do you own:

radio yes no

sewing machine yes no

tea and/or dinner set yes no

wrist watch yes no

name plate yes no

sofa and/or dining table yes no

carpet yes no

dressing table yes no

 

How far in the school do you want your daughter to go?

 

What is the earliest age below which you would not like your daughter(s)
to be married?

 

In your life till now which has played a greater role, your efforts
or your luck? efforts luck

According to you which is more important in one's life.
one's efforts luck or chance

Who was more keen to have your last child, you or your wife?
husband wife

163

57. If your daughter-in-law with the consent of your son takes up to
some part-time or full-time job, would you approve her taking up
the job? approve disapprove

58. Do you spend sometime on religious activity (Puja Path) regularly?
yes no

 

 

59. On how many occasions have you helped your near relatives during
this year? no. of times

60. How many times have you visited your near relatives (outside Delhi)

during this year? no. of times
61. Are you insured? yes no
Remarks

 

 

 

 

 

 

 

 

INTRODUCTION STATEMENT

A brief statement used for introducing the investigator and the study
to the respondents is given below.

My name is Dinesh Chandra Dubey. I work as a social scientist in
the National Family Planning Institute of Health Ministry. We are making
a survey. This survey relates to family planning and especially to the
new method of family planning known as the "loop" or IUD. I would very
much appreciate if you can give me a few minutes to talk about your

ideas relating to this new device.

INFORMATION NOT USED IN THIS STUDY
Although information on all the questions was collected, some of it

is not used because of various reasons.

164

Questions 16, 17 and 18 were used as screening questions. We were
told by informed people that some women were using IUD without the knowl-
edge of their husbands. Taking this information at its face value, we
never wanted our study to become a cause of discord between wives and
husbands. These three questions were used to ascertain whether the hus-
band knows the fact of IUD use by his wife. The interviews were done for

only those cases where husbands knew about their wives using IUD.

Information on question 21 is not used because the respondents

hesitated to classify their reaction as for or against.

Question 22 is not used because the same information is more speci-
fically asked in question 23 and question 24.

Information on questions 37 and 39 is not used because the reSpon-
dents who talked to more than one friend or neighbor found it difficult
to answer these questions. The usual response was "some were favorable
and some were unfavorable." Similarly questions 47 and 48 were difficult
for the respondents to answer confidently.

Lastly, information on questions 59, 60 and 61 is not used as dif-
ferent respondents interpreted the questions differently because the key

terms in the questions were not precisely defined.

INFORMATION COLLECTED FROM CLINICS
As already pointed out, clinic information from case cards was used
for identification of the cases. The following information on each case

was available from the clinic cards.

165

. Card no.

Name of clinic unit

Name of woman

Name of husband

. Address

. Age of wife

NO. of living children (male female )
Date of L.M.P.

Interval since last confinement/mis-carriage/abortion
10. Remarks (menses)

11. Pelvic examination

12. Type of device inserted size

13. Date of insertion

14. Comments

15. Signature of medical Officer

©CDN©W<PWNH

Information from the first seven questions was used.for identifying

the reSpondents or IUD users.

   

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