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

In 1991, an article on the Maternity Care Program in Matlab, Bangladesh, reported a substantial decline in direct obstetric deaths in the intervention area, but not in the control area. The decline was attributed primarily to the posting of midwives at the village level.

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.