How do you view the transformation of family planning?
One of the advantages for me was that I was the founding member of Nepal Family Planning Association. I had a strong inner faith and commitment towards family planning. Later on, I was the chief of family planning and maternal and children health divisions. When we established NFPA in 1959, the word family planning was not digested easily in the society. At that time, the maternal mortality and child mortality were very high in Nepal. With the success in family planning, we were able to drastically reduce the child mortality and maternal mortality. I realized that birth control could reduce both maternal mortality and child mortality.
How was it to avail contraceptives?
There were no pills. The condom was available but it was so expensive. Even we asked people to reuse condoms by following certain methods. It was very difficult to speak about the sexual issues in public as the society was not in a position to accept it. We were four doctors, three of them, Dr. Laxman Poudel, Dr. Narayan Keshari Shah and Dr. Jaya Narayan Giri, died. I was youngest among them. We took a decision. Sex was taboo but it should not be. We were four doctors who started talking about it and the society also tolerated us.
How difficult was it to encourage family planning?
When we started the introduction of family planning in Prithvi Narayan College, local people opposed our efforts saying that we were teaching immoral practices among the youth. We were chased by the local people and were forced to escape from the back door. People condemned us as encouraging their daughters and daughter-in-laws to be deviants. This was the case of 1958.
How was the overall situation?
In 1963, FPAN became an affiliate member of the International Planned Parenthood Federation (IPPF). There was a regional body consisting of Iran, India, Pakistan, Sri Lanka and Afghanistan. We held a regional conference in 1963 and King Mahendra had inaugurated it. After the inaugural by the King, it spread a good message about family planning. The society took notice of it. In 1968, the government launched the Family Planning and Maternal and Child Health Program. I joined Family Planning and Maternal and Child Health Program at the request of then chief Prayag Sharma. Eventually, I was made the chief after the retirement of Sharma. At that time, there were pills and condoms available. It was distributed freely through our offices in 40 districts.
When did the marketing of the contraceptives begin in Nepal?
Under the support of USAID, we had launched CRS Project under social marketing. After setting up of the project, we used local name for condom and pills. We called for a competition in 1978 and named Condom as Dhal (Shield) and Pill (kamal), as soft and delicate as women.
How do you look back at your role?
I consider myself as a lucky person. Since I was, I had been interested in family planning. I got an opportunity to work in the related sector. I managed to survive for a long period of time. I led the division for eight years. I led it single handedly. At that time, family planning was second highest foreign aid securing project after Malaria eradication in Nepal. Family planning had the budget.
In 1960 infant mortality was high and use of contraceptive was low, how do you see the present scenario when infant mortality and maternal mortality have gone down and contraceptive prevalence has gone high?
It is a gradual process and you cannot change it overnight. Abortion is also linked to contraceptives. The use of contraceptives by male and female members drastically reduced the maternal mortality.
As a pediatrician by profession, how did you start focusing on family planning?
My colleagues used to complain that I spent a lot of time for family planning rather than my area as a pediatrician. After launching CRS, we started Oral Rehydration Service (ORS), Jeevan Jal, for children. We also included immunization on our program. Only in 1977, the government started organized immunization programs in a few districts. I still believe that family planning and maternal and child health are two sides of the same coin. If we ignore family planning, it will have a setback in child and maternal health. You cannot separate them.
Do you think Nepal can sustain the achievement it has made in infant and maternal mortality?
Given the present state, Nepal has institution as well as manpower to sustain it. I have been visiting different parts of Nepal as the part of immunization campaign particularly Polio campaign; I see a lot of change even in the remote parts of Nepal.
How do you see the current rate of progress?
I am satisfied with the progress. What we see now is the work of past. Nepal has been giving priority to the population since 1970s with the formation of Population Commission headed by prime minister. I was involved in the area for a long time. Had not we controlled migration, what was the use of family planning? In 1974, we participated in the World Population Conference held in Romania. They redefined family planning.
Is family planning birth control?
Family planning is not birth control but family management. The attitude towards family planning and birth control was very negative. We also used health workers after giving some basic training to them. They are given training to teach the people how to use condoms, pills and Vitamin A. However, this turned ineffective.
How do you see the role of Female Community Health Volunteers?
They have been playing an important role. We introduced the concept of Panchayat Health Workers from Dolakha mobilizing the local community in 1980. The current Female Community Health Volunteers was a developed and extended version of Panchayat Health Volunteers. In 1982, New Era had evaluated Panchayat Health Volunteer Scheme and reported that this was a good practice. Despite all the problems, this is a good program.
How do you see your overall work?
Of course, I am professionally a pedestrian but I don’t have regrets over what I have done to promote the family planning, saving the lives of mothers and children. After heading family planning, maternal and child health divisions, I completely stopped my medical practice. I was the first pedestrian to change the blood in Prashuti Hospital. Family planning is more field and paper work. This is a non-practicing work. If you are committed to program, you need to focus on it. I am very happy.
How do you see the trend of family planning? How do you see the possibility to sustain it?
I do believe that Nepal has already built institutions to sustain the achievement. For this, we need to have patience. The other important component is leadership. There is the need to have committed persons. One has to apply the merit. There is the need to give stability. Frequent change in the leadership will disturb the process.
When did you leave the government?
I resigned from the government in 1990 and worked for a few years with WHO. I focused on health policy. I focused on polio eradication. I am the chairman of Polio Certification Committee. Nepal has been declared Polio Free since 2010. Since 2014, South Asia has been declared Polio Free.
What do you suggest for the future?
We need to spend more time for preventive methods. We achieved through low technology. We need to do hard work. We achieved the success using traditional method. We need to focus now on nutrition. We have 11 and 12 vaccines free. There is the need to go with the programs looking at the socio economic situation. Despite all difficulties and low socio economic growth, Nepal has made a record achieving the target set by MDGs.
When did Nepal start two-child policies?
Nepal introduced two-child families looking at Singapore in 1960s. National Population Commission even directed high government officials, politicians and others to strictly follow it. At that time it was predicted that the population problem was going to be acute. The commission recommended the government should regulate the policy. The commission proposed some benefits to parents who observed limits to two children, giving them free education, free health, etc. Those government employees with two children were given additional incentives including the promotion. Even the commission proposed to ban politicians who had many children.
Had Nepal lost some good chances in the past?
We missed some good chances in the past to equip our health system more effectively. Just after the end of the Vietnam War, USAID proposed we supply the telecommunication equipments to all health posts. They agreed to provide the equipment for family planning. They demanded installing the equipment at the main building which is currently occupied by the Ministry of Health. At that time family planning activities were in 40 districts. However, the government officials were not convince and they declined the offer. The Army also opposed the installation of the equipment on security grounds. Later, some of the equipments were brought by Nepal Telecommunication. Had we accepted the offer and brought all communication equipments, Nepal's health system would have made a much better progress.