Dhanvanthi Rama Rau and the FPA of India

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The Margaret Sanger Papers
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May 6, 2011, 7:40 a.m. (view history)

Need context for these quotes.

MS wrote: “Lady Rama Rau hopes we can bring with us a person who can remain a while to set up an Experimental clinic--any suggestions?” (5/29/1952)

“Perhaps Lady Rama Rau has already sent you a copy of her letter to me.” and  “The suggestion of Lady Rama Rau to invite Dr. Boas to India is o.k. by me, but certainly I’ll not recommend any of our hard to get money to send him there.” and “As I recall events in London last year the reply to our cable from Lady Rama Rau had to be acted upon and the invitation accepted personally by the various members of the Committee who had left London, but who were written to or phoned to and their replies recorded.” (9/12/1952)

Helen Keller wrote: “I have also known of Nehru’s statesmanlike interest in birth control, and so I behold you and him and Lady Rama Rau working together--a triple Hercules--for the deliverance of a land cursed with excess of population.” (12/8/1952)

MS wrote: “ Lady Rama Rau has written me requesting that the scientists prolong their trip so that they can set up a scientific committee of conference in Bombay.” (2/8/1955)

MS wrote: “I must correct a mistake in your letter because I did not “launch Rama Rau on her career twenty years ago.”  She was merely a member of the All-India Women’s Group which sponsored my appearance in India then.  She did not become prominent in our movement until just before the Bombay Conference about six or seven years ago.  She belongs to many organizations and works for them as it suits her pleasure, by no means dedicating herself to IPPF matters, because actually she puts many things ahead of IPPF interests even now when only six months remain to prepare the Sixth Conference!” (8/14/1958)

“We have now organised experiments with foaming tablets in the field in village areas. In Badlapur village we are trying out the Volpar tablet, a consignment of which has been donated to us by the British Drug House. In Calcutta where a new branch of the FPAL has at last been definitively constituted, I have already fixed an experimental  centre for Fomos tablets, and in the Kalyan Refugee Camp we have started an experiment with Preceptin Jelly. Those experiments have been OKayed by the Government of India Committee on Family Planning. I am now planning to establish a fourth experiment with Durofoam in Travancore where a new branch of the FPAI has been established under the guidance of a well-known doctor. Dr. (Mrs.) Pennamma, M.D.  We are now planning an itinerary for Dr. Krishna Rao to travel through areas in India, from where we have had requests for help and training, on her way to Ceylon. On her way back she will visit Travancore and Cochin to guide groups in those areas.” Asks if she has to attend the Rome meeting, now that MS will be going. “My reason for trying to avoid this Conference in Rome is partly financial. The burdens I have had to bear recently have been rather heavy and if I am to do to Rome this year and Japan next year, I am afraid I will find my finances badly strained. My husband is due for retirement from his offices next year June, so that if I could avoid the Rome meeting I would not find it so much of a strain to attend the Meeting in Japan.” Let her know if MS has any strong objections."

"The Silver Jubilee Session of the A.I.W.C. was a great success. We were able to pass a strong resolution on Family Planning in which we also voiced our protest against the utilisation of public funds on experiments with the Rhythm Method, which the Government of India, Health Department has been sponsoring. There was unanimous agreement on the futility of the efforts being made to popularize so difficult and uncertain a method. I shall tell you more about this when I see you."

"You will be pleased to hear that the Family Planning Commission has just appointed a Committee known as the Family Planning Research and Programs Committee, 'to make recommendations to the Government of India regarding research schemes, and experimental and other programmes relating to Family Planning to be adopted, and the nature and assistance, if any, to be give to existing voluntary organisations in the field of Family Planning after a review of their present activities."

"The Director General of Health Services (Central Coord) has been appointed the Chairman and Dr. C. G. Pandit, secretary, Indian Council of Medical Research, the secretary. I am the only non-official who has been appointed to this Committee which is likely to meet within the next fortnight or so. I hope, therefore, that I will be able to help with this important work before leaving for Europe."

[44] FPAI established in July 1949 [45] under RR’s leadership.  She was a “well-known social worker and a former president of the All-India Women’s Conference.” Other founders were Mrs. Mitham J. Lam, Avabai B. Wadia, were also active in AIWC, they thought it important to broaden support for FP outside of women’s organziations.  AIWC instructed their branches to study FP question and establish clinic if possible.  RR and Wadia invited to join Planning Commission on Health and Social Welfare panels. July 1951 First Five-Year Plan announced that the government should provide advice for sterilization or contraception, regardless of whether they needed it for social or medical grounds.  Invited WHO rep Abraham Stone to India, some saw it as “Britsh” birth control for India, others who knew what was going on were not that happy either.  [46] Opposed gov’t selection of rhythm as only acceptable means. “There was also some doubt, resentment and anger in India.  India had plenty of experts of her own and many of them were striving to get somewhat more efficient methods accepted.  An American talking about a doubtful practice was entirely superfluous and liable to put the whole subject in a bad odour.”

Encloses a "stunning report" from K. P. Shah (letter from Shah to MS, 12/26/1952), which she is not sure that Rama Rau or the London office have seen.

Hopes that Gamble is keeping Rama Rau up to date on his "remarkable work throughout India. He went up to Pakistan and he and his son covered much territory and have set up several experimental clinics and of course, he never expects that these things are done unless he pays for them. I sincerely trust that he has given you all the addresses and what he has started in these experimental research projects. I am quite confident that there must be a reshuffling of our International planning so that we can bring in some of these ardent workers like Dr. Gamble. I feel also that India, like the United States, is too large an area to have only two representatives on the International."

Notes a lunch with the Rockefellers, their son is traveling around the world, and she hopes that Rama Rau has met him.

"I suggest that $50,000 should be coming for India's work, to pay doctor's salaries, expenses and secretarial reports for at least two years. This would give the greatest encouragement to all the rest of the Orient if we could prove that India is accepting the idea of birth control, is putting it in practice and is eventually reaping reward and results, by which I mean families to have only the number of children that can be supported, that have health, have future possibilities of advancement and progress and leave intact the health of the parents."

"This is all for the moment. There is much to be done everywhere but I am particularly interested in helping India, if it can be done through the International. As many people as want to give directly, we must not refuse them the privilege."

"I note in your letter that you have completed the first training course for 22 doctors, at your clinic. Naturally, I am delighted and I am sending this little note to several of our friends here, for their files....I note also that you are including in your clinic the 'well baby' and the 'well mother' which are very good titles, but I sincerely hope that your group will not be attracted by the easy road and stray away from the fundamentals of 'well baby' and 'well mother' work of birth control instruction, and take in sex education, marriage guidance, and all the other more or less respected, respectable, partially superficial efforts, rather than hold tight to the fundamentals, which include birth control and family limitation."

Asks her for a budget of the "costs and expenses of sending out doctors with their secretaries or assistants to all the provinces of India. That should be our aim and goal--to cover the country as we have covered it in this country, in forty-eight states, and England has done the same to Scotland and Wales. We need a large horizon to let the Foundations know that we have vision of the welfare of the country as a whole."

Says that the Badlapur experiment is "more or less firmly established," but they are having problems in Kalyan, where they can't find suitable quarters. They have hired a health visitor for 2 months to "do the house visiting and educate the women to the need of seeking our services. As in all such cases, disappointments have to be faced...but we have not lost heart and mean to go on steadily until our centre is established." They are also bearing the costs of equipment and supplies.

Mrs. Höjer set up a training course for doctors in Travancore, RR expects to go there in late May to try to set up another experimental centre. 

Rama Rau recently set up a FPA branch in Calcutta "with a strong committee of doctors and social workers."  She also reports a chance of a donation for a foam tablet experiment; expects they will have experimental centres in Badlapur, Kalyan, Calcutta and Malabar in the next few months.  "We consider expenditure undertaken on experiments with these easy methods, that do not require the aid of doctors, are very worthwhile, for ultimately we will have to deal with village areas where doctors are not available."

She discusses plans for the next All-India Conference on Family Planning in Amritsar in Oct-Nov. THey think it important to run a conference everyone or two years to give a "fillip to our work and bring about a co-ordination in our efforts which is so essential."

Rama Rau has spent last 2 weeks away from Bombay, in Calcutta where "the Family Planning work in that area needed a good deal of fillip and also I was anxious to establish one of my new experimental centres in the Bengal area. We are setting up three such experimental centres in crowded areas, with foam tablets instead of the diaphragm and jelly method. I have a free supply of foam tablets from the British Drug House (Volpar) Fomes Co. (New York) and from Japan, the Japanese Sampoons which doctors there claim are effective. For this purpose it will be necessary to set up a uniform clinic in each area with the same case cards and reliable people to keep all the records."

Says that the UN Population Studies Dept. has agreed to provide free statistical evaluation of their results, provided the Government backs these experiments. She has secured backing through the Government of India Committee on Family Planning Programmes and Research. Also reports on the work in Kalyan where Dr. Katherine Kuder of Ortho is prepared to give them a free experimental supply Preventin. Avabai Wadia has gone there to set up the experiment.

She plans to set up another centre in Travancore, under the supervision of Mrs. Hojar (Swedish) whose husband Dr. Hojar works at the Medical College of Travancore."In each of these centres that we establish, we are undertaking certain financial commitments which are going to be a great strain on our budget, but it seems necessary to to so, as it is the only incentive which throw responsibility on the workers of each area and produce results." Says when she was in New York she raised donations equiv. to $4K, and thanks Watumull for her suggestion that the Watumull Foundation might be interested in providing support.

Says that she is interested in Watumull's letter to Dr. S. C. Sen about the research in simple bc methods in India. Says that she met Sen recently and they both agree that the "prize" should be awarded to the Medical Council through the FPA India, "as it will help to link up whatever research work is undertaken directly with the F.P.A. and create a closer liaison between the two organisations." She prefers that they work this way than announcing the "prize" through "newspapers and their medium. It will be impossible to cope with the large number of unscientific claims that would be made by quacks throughout the country, unless the scientific group directs this work." [More on this that I did not summarize]

They have opened a "branch  service within the city of Bombay and appointed a new doctor to handle this new work. Dr. (Miss) Reubens goes four times a week to two branch areas for services to the women who cannot find time from their domestic responsibilities to come to our clinic. This service is proving of great value."

[243] Discusses how birth control had begun to take hold before World War 2, mentions Majaraja of Mysore State’s proposals for setting up clinics, MS’s 1936 trip, and clinics opened by individuals, like Professor R. D. Karve.  In 1949 India was drafting its first 5-year plan. [245] She made an effort to bring BC to the attention of the planning commission, worked to create a new organization.  Met A. P. Pillay (sexologist and male disease expert), V. N. Shirodkar (ob/gyn); her husband reluctantly let her use a ground floor office in the Bank House for a HQ.  [247] Drafted request to planning commission, also looked for a location for a clinic. [250] Organized the First All-India Family Planning Conference in 1951; Shirodkar was supportive, Pillay “had no faith in women social workers.”  [251] Admits they know little about modern family planning; [252] condoms not readily available in India, most were advised to use cotton soaked in oil, but says that most women found this distasteful and refused it.  [253] Conference was a success, DRR invited to join Advisory Health Panel of the National Planning Commission

[257] Agreed to plan the 1952 ICPP.  Before that happened Health Minister agreed to allow a WHO representative to research family planning on condition that only the rhythm method should be studied because it was the only ‘moral’ method.  Stone came to India and even “with his hands so tied...he traveled widely, assessed the situation, and of course, came to the same conclusions as all the demographers, national and international.  He was my guest for the three days he spent in Bombay, and my friends and I...had heated arguments with him.  We blamed him for accepting a limited assignment on such an important question.  He in fact agreed with us that the rhythm method, though scientifically sound under ideal conditions, could not succeed in our villages, where 80 percent of our population lived, where illiteracy was rife, where calendars and thermometers were unknown, where people reckoned time by phases of the moon, and menstrual charts could not be [258] kept to determine the ‘safe’ period for a woman.” Says Stone said that it was better to get something done than wait for better solution, and he hoped to return to India and speak more freely.

[259] Says that she approached Health Minister to inaugerate the ICPP, but as she objected to anything but continence, she refused.  [260] Did not want to ask Nehru because even if he was sympathetic, he would be put in a position of overruling his Health Minister. Radikrishnan was approached and accepted. Money was a problem in organizing the conference, but they were given $5K by Ellen Watumull [261] problems with hospitality and travel funds.  Says that they were able to get one entertainment for delegates through the Mayor of Bombay, “The rest of the conference was all our own amateurish, hastily put together work.”  They organized training programs for doctors in conjunction with the conference; were surprised by how many came from neighboring Asian countries, where FP was still a new subject. Many had recently become soveirgn and they all realized the dangers of overpopulation. 

[262] Mentions Radikrishnan’s speech and reaction; overflowing sessions; European delight that there was no religious opposition to BC in India; [263]  Indian doctors being trained by Stone, Levine, Helena Wright; by the end of the conference they had a “core of trained medical staff who could serve the Family Planning Association of India and who in their turn,  could train others in similar courses.”   Says that at the end of the Conference they decided to form an ICPP, and she and MS were put at head of it [only mention that MS was even there].

[266] She was nominated to the Family Planning and Research Committee of the Ministry of Health ca. 1953-54; says that they did the best they could to hire part and full-time social workers to reach out to people and convince them of the need to limit their families.  Sought to introduce family planning courses in medical and nursing schools and promote a new consciousness among health workers.   She traveled all over India promoting BC, [267] found most people interested; also found some wanting infertility help. Pillay opened a first infertility clinic, they had more infertilty patients seeking help than those wanting BC at first. 

Second 5-Year Plan was better for BC, it gave more money, and allowed use of more modern methods.  New program linking FP with maternity and child welfare programs at government health centers.  FPAI still did educational work, they also started some projects with outside funds.

She tells Sanger that she has written to William Vogt asking her to develop a project that he could try to raise funds for.He's looking for something that has "diminishing return over the period suggested."  Reports a recent 2K pound grant from Mr. Lokumal, a friend of Mr. Watumull, allowing them to go ahead with the Specialist service without financial worries.

Going to the Silver Jubilee All India Woman's Conference and will take FPA India workers with film and propaganda materials to show the 500 women delegates.

"Please do not feel anxious about Birth Control work taking second place, when we organise it with Child Welfare work. In India knowing the mentality of our people and the place of a child in the home, we are convinced that the more the subject is linked up with Child Welfare work the more interest we will be able to arouse in Planned Parenthood. People have a great desire for children and as the high mortality rates amongst the mothers and infants can only be cured by spacing children the approach to the whole subject from this angle produces a quick and direct response. This is not only my opinion but is also the opinion of Dr. Hannah Peters, who during these last eighteen months has been working amongst our people."

"About help from the Government for our Organisation, we have suggested to the Planning Commission that governmental agencies open clinics on the lines of the Family Welfare Centre, that we are running, and that work of this kind be organised in ten centres of India, but have asked for no direct help for our work. Like you, I feel that our Voluntary work will continue no matter what schemes the Government may sponsor so that we should be free from red tapism and the notions of the varying officials in power. In fact we hope to make our work a model for Government endeavour and, therefore, desire to keep ourselves free. I shall discuss this with you at greater length when we meet in Sweden.

Proposes opening "ten strong centres" immediately in: Bombay, Punjab, U.P., Madras, Bengal, Andhra, Hyderabad, Karnataka, and Malabar.

Each centre would have a central clinic which would cost about 1,000 rupees to staff and supply; and another 1,000 Rupees to have a specialist who traveled around setting up new clinics.  Estimates that it will cost 6,000 Rs. to start clinics up with furniture, etc. and about 24,000 rs a year for recurring expenses. The whole thing would cost 30K Rs. in the first year.

"I am enclosing a full scale plan that I submitted some time ago to the Planning Commission on the lines that you have suggested in your letter of the 4th March/ The plan will cover strategic areas in the whole of India with possibilities of expansion from the beginning of the scheme, through the services of specialists in each area.

According to my calculation we will require at least 3 lakhs of rupees and that is modest, if not niggardly scale, if we wish to see the work of an equal standard established throughout the country. I have also written Mrs. Durgabai asking for an interview early this month to discuss the details of the scheme, and have a promise from Colonel Khosla of the Punjab and one or two other important workers, that they will join me if such an interview is granted. So you realize that we are visualising the work on an All India basis and are pushing as hard as possible to get Government support.

Has been touring intensively during the last month in North India for the Committee on Social and Moral Hygiene, in Bombay briefly and then back out to North West of India.

Says that Helena Wright made a very good impression during her tour of India after the 3ICPP. "As you know she is a good worker and a persuasive talker. If it is at all possible to help her with the funds she requires, we would be glad to have her in India, though, I do not think that now she would be required to do the type of work she did for us in 1952."

Government program is "being fairly well formulated and Dr. Sushila Gore is undertaking the training programmes and setting up the Central Institute which we have visualised on the lines of the Margaret Sanger Research Bureau with all departments of family planning incorporated in the one Centre. Helena's dynamic personality and experience may produce quicker results in the development of the whole project if she came to India. Besides, our scientists are in need of deeper discussion on field work, in fact the whole idea of the [Scientific] Seminar arose out of the need for the exchange of views on the scientific approach to problems in cities, towns and villages. Certainly, from this point of view Helena will be helpful. It is on this account also that we will welcome both Dr. Abraham Stone and Dr. Lena Levine. Considering all these points, if it is possible to help her to come to Tokyo and then to India, I am quite sure we would welcome her."

They are finished with their FPA India conference, with a122 delegate meeting that was helpful for both doctors and social workers.

"The Conference was so successful that a general desire arose that next year, or late this year if possible, a smaller Group Conference should be called by FPAI only for the discussion of Research Projects. I am very anxious to take this on as it is only when practical workers meet and exchange views that we will be able to see our way more clearly. My suggestion to Dr. Wyon of the Luchiana Project, who has written to me welcoming such a proposal, is that if such a meeting is called in Bombay soon after the Tokyo Conference, we might persuade some of the foreign experts who will be attending the Tokyo Conference to break journey in India on their way home and to help us at such a Conference. I would like to know what you think of this suggestion."

Has not heard from Sanger or Watumull since Japan, hopes they are recovered from strenuous trip.

She plans to attend the meeting of the Family Planning Programmes and Research, Government of India Committee meeting on the 22nd in Delhi. "I am hoping at this meeting to secure a grant for our work from the funds reserved for Family Planning work.