For several years, the Bixby Center for Population, Health and Sustainability at UC Berkeley has taught a popular undergraduate course called Poverty and Population. The faculty, Prof. Ndola Prata, Dr. Martha Campbell and I, work in developing countries to make family planning readily available. The GSIs also often end up overseas as summer interns working on some aspect of family planning.
We often introduce a class by telling a human story based on a personal experience that has given us insight into family planning. I want to share these on my Berkeley blog as the course progresses.
In the 1960s, in what was then Bombay, the city medical officer Dr. Datta Pai was told by authorities in New Delhi to make voluntary male sterilization available. He found a few specialist urologists who could do the operation. A handful of professional men chose to have vasectomies.
Dr Pai decided to mount an exhibition on the various methods of family planning. There were posters illustrating condoms, intrauterine devices and male and female sterilization. He began by putting his exhibition in a museum. Predictably few saw it.
One day Dr Pai moved the exhibition to the Victoria Railway station in Bombay. This large, old, red brick building is perhaps one of the busiest places on the planet. Hundreds of thousands of commuters arrive every day, almost as many clinging to the outside of the carriages as are squeezed inside. Whether they wanted to on not, thousands saw the exhibition. A counselor stood beside the poster on vasectomy answering questions. Men wanting a vasectomy were told to come to a local hospital at 5.30 on Tuesday evening. Many men put their signature or thumb print to register their intention to get a vasectomy.
But practically none came to the hospital.
One day Dr Pai came and sat on a bench watching men talk to the counselor. He went up to one man who had just put his thumbprint on the list. “So you want to vasectomy?”
“Of course! I have no job. I sleep on the pavement. I have five children and I don’t want anymore. “
“So you’ll come to the hospital at 5.30 on Tuesday?”
“No!” Dr. Pia shook the man by the shoulders and said, “How can you be so stupid?”
The man fought back. “If the operation is as safe as you say, why do I have to go to a hospital to have it? In India people only go to the hospital to die.”
This was Datta Pia’s epiphany. He suddenly realized that it’s not facts but perceptions that determine people’s actions, particularly in something as important but private as human reproduction. He apologized to the man, and then said, “If I did the operation here on platform 9 would you have it?’
Impulsively, Pai told the man to come back the following morning. He invited the station master to share a glass of whisky – at that time Maharashtra was a dry state. By next the morning Dr Pai had erected a small tent. It had a wooden table inside for the patient to lie on and a kerosene, cooking stove to boil the instruments.
Within one month more vasectomies had been done on platform 9 than had been performed in all the hospitals of Bombay in the previous year.
I know this story is true because in 1970 I learned to do vasectomies on Platform 9 on Bombay Victoria Railway station in Bombay.
The take-away messages is that huge numbers of people want fewer children but choices are often presented in over-medicalized, culturally insensitive ways. The key to family planning is to listen to what people want, not try to tell them what to do.