Moving Targets: Routine IUD Insertion in Maternity wards in Tamil Nadu, India

Abstract

In l995, nurses and doctors in many of the public maternity ward in the state of Tamil Nadu in India were routinely inserting IUDs immediately following childbirth and abortions, as part of the target-orientated family, planning policy. This practice, sometimes carried out unbeknownst to women or against their will, has received little public attention. Tamil Nadu's success in reaching state targets for IUD acceptance far exceeded those of all other states and territories in India. This paper reports on an ethnographic study in 1995 of Tamil Nadu women's experience of routine IUD insertion and why health workers considered the policy necessary. Based on information from a follow-up visit in 1997, it describes how the change in national and state policy in 1996 to a target-free approach, with local determination of needs, is being implemented, but only in some hospitals and by some health workers. Reproductive health policy in India has been dominated by family planning and driven by numerical targets for a long time; it will take more time to assess the effects of the new policy.