A Matter of Choice

July 21, 2022by Rajeev Hora0

A Matter of Choice

“It’s been an exceptionally busy day, isn’t it Sister Sufia?”, remarked Dr Ramnathan, as he mopped the sweat off his brows and stretched himself on the crude recliner in his chamber His brief interval of rest was well-deserved indeed.  More fondly known to all his staff and patients in the hospital as Dr Ram, he had graduated from Vellore medical college as a gynaecologist some thirty years back.

A gold-medallist topper all along, he had spurned all offers to join from private hospitals and nursing homes. Instead, he had dedicated himself to work in a government hospital where he felt he could serve the needy with full devotion. Quite famous in the entire district for his professionalism,  most pregnant ladies who came to the hospital knew that he was one doctor they could trust when the crucial time was about to come. There certainly could not have been a better embodiment of the Hippocrates oath.

Absolutely Dr Ram; seven deliveries in a day is quite a record even by your standards”, said the veteran nurse, Sister Sufia in agreement as she passed him a steaming cup of coffee brought across from the vending machine, recently installed in the waiting room downstairs.

“Last case for the night will be Salma in an hour, Dr Ram”, Sufia informed him. “But she is in quite a bad shape. Thirty years old, fifth pregnancy and severely anaemic. In fact, she fell down on the stairs two days back. A head injury, but no haemorrhage. Mostly superficial”, she added.

Hmmm”, hummed Dr Ram in acknowledgement as he soaked in the pre-OT briefing with his eyes closed. His attempt to catch a quick shut-eye was however interrupted by the shrill voice of a news anchor leading a TV debate. The sensational subject for the night was the recent announcement by the United Nations that India would surpass China’s population by 2023. The news ticker at the bottom kept mentioning the same at a repeated interval.

“Ha, Ha!” burst out Dr Ram in an unexpected and rare outpouring of his thoughts. “For once the media cells have been stumped! They don’t know whether to celebrate this news or not. On one side we are beating China in something, on the other hand it would be a hard sell how to convince people that this is not something to be really proud of.

The minor media challenge was undoubtedly how to shift the blame by giving a polarising spin to this ‘not-to-be really proud of’ achievement. True to form, the vested news channels had started pumping out the narrative as to how a particular community had been the root cause of this productive issue.

Frankly Dr Ram, I feel very upset when these people start targeting a particular community for all the ills of this country. And then there is the fantastic conspiracy theory. As if having more babies and increasing the footprint on the ground is going to make the community win the clash of civilizations. Absolutely laughable and distressing at the same time”, said Sufia.

Statistics has not been my real forte but simple maths is indeed. At the time of partition, the total Indian population was 30 crore. Today it is probably 140 crore and increasing. The community being referred to is today close to 20 crores. Even if assuming that the population of the community under scrutiny had nil population at the time of partition, where has the additional 90 crores (140-30-20) come from?” she put forth her logic in askance.

“You are right Sister Sofia”, Dr Ram responded, “Incorrect theories emerge from flawed hypothesis. Blaming particular sects, communities and religions are never going to get us anywhere. Also, given our socio-economic-judicial state, even legislation is not going to work.”

 “The absolute core fact is that barring an aberration in the early seventies, population control has never been a priority for any government till date. For all the bluster, that we hear, there has never been a sincere acknowledgement that we have a serious problem at hand. Political perceptions and compulsions apparently lie behind this state of affairs. Or maybe the thought is more the population, greater the leverage as a bigger market.”

“In fact, cynically speaking, I feel it is actually the medical fraternity’s contributions which has led to this world-wide population explosion”, Dr Ram expounded.

“I don’t understand, Dr Ram”, said Sufia.

“Quite simple really Sufia” said Dr Ram smilingly, “The population increase has been a direct function of the overall increase in life expectancy. And it is the revolutionary improvements in the medical field in the last century which have led to that. Prior to that, the earth had a pretty sustainable model in this respect. Kind of survival of the fittest.”

You also know Dr Ram that there is no turning the clock back now”, nodded an amused Sufia. “More is certainly not the merrier. I interact with these ladies every Saturday in the counselling clinic. Most of them are poor and do not  have quite a clue regarding birth-control, hygiene and home-economics. And then of course is the national fetish to have at least one boy in the family. Frankly, I get quite puzzled and foxed thinking about it. You have been to so many forums and seminars. Where do you think lies the solution for our country?

 “Complex problems always have simple solutions”, said Dr Ram.

“The true solution really lies in widespread education of the girl child. Only thing is that such a national program has to be extremely relentless and focussed which goes beyond lip-service and affiliations. Every educated girl will thus grow up to be  aware of her physical requirements and limitations besides being financially self-reliant. Once confident on taking on this patriarchal dominated society, she will ensure that her pregnancy is a conscious choice and not something that is thrust upon her as a gender commitment or compulsion.”

“Besides uninhibited contraceptive availability, the effort has to be aided by top class pre-natal and post-natal care” he added. “That would make her confident that her progeny will survive. I guess that is the easier one though”.

“But complete and universal education for the female gender will take generations to achieve”, she remarked.

“Undoubtedly, but education need not come from higher literacy always. In today’s digital age, there is no dearth of constructive and useful information that can be transmitted through social media and these TV channels. How I wish the political media centres could concentrate on spreading this kind of awareness rather than concentrating on religious divides and spewing venom. I know it is wishful thinking. That’s why we need more politicians who behave like  visionary statesmen.”

Dr Ram suddenly realized that primetime news being over, it was time to proceed to the operation theatre. “Enough of sorting out the country’s larger issues Sufia. Let’s attend to Salma and be over for the day.”

“Yes, Dr Ram”, acknowledged Sufia following him a step behind.

Just as they entered the OT, they were taken aback to see Salma getting up from the bed. Frail, weak and ragged, she took a step towards Dr Ram and bent down in respect to touch his feet, “ Doctor Sahib, is bar bacha lo. Main jeena chahti hoon. Iske baad kabhi nahin.” translated as “Doctor, please save me this time. I want to live. I will not have any more children”

As Dr Ram reassuringly looked at Salma with paternal love, he could clearly see that:

Although looking like a kamikaze fighter with a bandaged head, Salma had no illusions or intent of contributing to a victory in the clash of civilizations.


 Worried that people who should be worried are not worried,

 Horax (Casper)


Postscript:  The folklore was that Dr Ram’s one look was sufficient to cure a patient. Salma and the newborn did survive, though barely.


First published at seekmediation.com on 21/07/22

Pl write to us at contact@seekmediation.com


Amit Comments

Dear Sir,
You have penned this article from the heart… And sometimes the mind is applied best where the heart is.
I can’t write any better. So here this time I am going to use brevity. Here are some points that I submit:
  • High fertility rates are in populations where there is lack of economic opportunity, or access to economic opportunities has barriers – mostly social.
  • However there is good news – real good news. The world, not just India will come to a population equilibrium as economic opportunities continue to abound. Here is a video by Dr. Hans Rosling. He was a physician from Sweden widely known for his population and other trend studies. He is also the founder of the Gapminder foundation. I was introduced to this video sometime in 2014 and I still can’t forget the impact it has had on me. It will make you laugh and it will make you feel good and fill you with hope. But you have to watch it in its entirety
Dr. Ram would have been very pleased… some complex problems do resolve over time.
For more such articles and videos – I suggest the website of the Gapminder Foundation

Regardless of a person’s socio-economic background, people want to love their children. It must surely be heartbreaking for a mother to send her less than 10 year olds to do back breaking work. I lived in Pune for 3 years between 2003 and 2006. The city once known for its relaxed and culture rich lifestyle was experiencing explosive economic growth. There was a seismic shift in demography happening right in front of me – and I was part of that demographic shift. This economic growth not only attracted the newly minted professional graduates from around the country but also people from rural areas upto 200 miles – from places where there was lack of water, frequent failure of crops and economic stagnation. I saw people living in shacks on the main streets of Pune with many children engaged in some economic activity including beggary. These families had no access to family planning and even no incentive. It used to break my heart seeing children as young as 5 years old with faces painted and performing tricks on the street. I used to think of the dire situation their parents were in to send these children to beg, pick and sort trash, often hazardous. Passing these slum dwellings on my way to work every day was an education and a reminder of what leads to unchecked familial growth.

With hopes of a bright future,


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