The notion of quality in the public health system is becoming increasingly an issue for policymakers and planners in India. The Eighth Five-Year Plan identified the poor quality of family welfare services as one of the factors

Governmental efforts towards fertility reduction often face a dilemma: babies who are planners' worry are also a parent's hope and joy (Mandelbaum 1974:110). The beliefs of the people on this subject and what planners believe ought to be done may on occasion diverge substantially.

Fertility behaviour includes not only biological but also social reproduction, involving a complex network of institutions.