833 



try to administer family planning programs based on contraceptive 

 technology. 



At this juncture there does not appear to be any real thrust in the 

 less developed countries, with the exception of India, for the legaliza- 

 tion of abortion. As long as a social stigma attaches to the practice, and 

 as long as it contravenes the moral feelings of many people, it seems 

 unlikely that political leaders in the LDCs will want to roil the waters 

 by championing abortion reform as the key to population control. 



The Problem of Medical Support 



There are also operational barriers, in the form of inadequacies in 

 the staffing and administration of family planning programs in the 

 LDCs. The Indian physician needs a present incentive to participate 

 in what are for him the boring and professionally unrewarding tasks 

 of inserting lUDs and lecturing at birth control clinics. The same argu- 

 ments woidd apply to the trained physician in other developing coun- 

 tries. Presumably the antipathy of most physicians to this type of work 

 might be overcome if the financial incentives were high enough. Yet 

 even with sufficient remuneration many physicians might participate 

 unenthusiastically. Furthermore, doctors could find themselves in a 

 conflict of values. On the one hand they may be trying to reduce infant 

 mortality, on the other to reduce fertility. Many find at least a surface 

 incompatibility between these two programs. Some doctors may be 

 able to work on both with equal dedication, viewing them as different 

 aspects of the broad concept of health care. Others however, more 

 deeply affected by the traditional outlook of the medical profession, 

 may feel more comfortable with programs to reduce infant mortality 

 than with those seeking to reduce parental fertility. 



The shortage of trained physicians, and the ambivalent attitude 

 with which a number of them approach the subject of birth control, 

 points up the need for large numbers of paramedical personnel fe 

 carry out programs of family limitation. Such personnel could be 

 given sufficient training to advise on contraception, insert lUDs, etc., 

 but need not receive the broader training of regular nurses. Para- 

 medical people trained in this fashion might not only be useful in the 

 execution of family planning programs, but in some instances might 

 spell the difference between success and failure. Before adequate num- 

 bers can be trained, however, the medical associations in a number of 

 countries would have to abandon the rather unsympathetic attitude 

 they have usually tended to hold toward paiamedical personnel. In 

 addition, there would have to be adequate incentives for the para- 

 medics, just as for regular medical workers, and for the men and 

 women at whom the birth control programs are aimed. 



One category of paramedical personnel already on the scene are the 

 village midwives who sometimes serve as abortionists as well. These 

 women have a certain amount of influence with the other women in the 

 villages and may feel threatened by the introduction of family plan- 

 ning programs. Hence it may be important for the success of such 

 programs to win these women over. The easiest way to do so would 

 probably be through some form of financial inducement. The most 

 effective way might be to combine such inducement with training in 

 the administration of the family planning programs, where feasible, 

 to preserve but redirect their influence in the community. 



