Of the four Bimaru states then (which account for maximum percentage of the country's population and are least developed in social as well as economic terms), Bihar is the worst since with a population of 98 million (as per the 1999 figures of the Registrar General of India) it has the highest total fertility ratio of 4.4 per cent.

In the absence of adequate government measures, the initiative to spread the message of population control and literacy, has been taken by non-governmental and social organisations. One such organisation working in Bihar is Janani-a non-profit organisation engaged in `social marketing of reproductive health-care, with special focus on family planning products and services'. It is an affiliate of DKT International, another non-profit body headquartered in Washington.

Janani president K Gopalakrishnan says in the organisation's progress report that Bihar was chosen as the first state for its development programmes, despite apprehensions in many quarters, because it was felt that the reproductive health aspirations of the people in this state, which is the poorest in India, were not being met adequately. Set up in 1996, the organisation's philosophy is to create a work environment that will attract `bright, confident and articulate young people who will look at development as a worthwhile career option.' Janani uses the concept of social marketing using modern marketing and communication techniques to make available products, services and concepts of welfare to the poorer and needier segments. The vast spread of the private market channels is used to ensure that non-clinical services are easily accessible and products are often subsidised to ensure affordability of prices.

In India, less than 25 per cent of the five lakh registered medical practitioners, including four lakh allopathic doctors, are ready to work in rural areas. Therefore, it becomes difficult to reach out to rural masses which rely on clinical services for family planning. According to government estimates, about 80 per cent of intrauterine devices (IUDs) and 70 per cent of sterilisations of its entire family planning programme are provided in rural areas. It then becomes imperative for any social organisation, working for population control, to make use of the private market channels for the distribution of clinical as well as non-clinical contraceptives. Janani uses this private market network in Bihar, which has over 65 per cent of health care services in the private sector. It has roped in private practitioners-both trained as well as untrained local `vaids' to provide family planning services.

The organisation has developed its own brand of male contraceptive (condoms), Mithun, and pills for females named Apsara. These are subsidised with the help of government support and hormone supplies from the United Nations Fund for Population Activities (UNFPA) and supplied to a vast network of rural shops. Extensive field distribution and aggressive promotion have made both these brands achieve a sizeable market share in the state. Besides, Janani also trains rural folk (essentially couples) who come from far-flung areas who are trained for three days at the organisation's headquarters in Patna for providing counselling to rural communities.

A third channel of the organisation's service delivery is the Surya Clinics where the services of qualified doctors are provided for clinical family planning measures are offered at between 20 per cent and 35 per cent of the lowest commercial rates.