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Saturday, April 17, 2021

What India needs for population stabilisation

The state needs to do three things: incentivise later marriages and child births, make contraception easy for women and promote women’s labour force participation.

Written by Shailaja Chandra |
Updated: March 16, 2021 8:50:37 am
Passengers waiting for local train in Mumbai

The National Population Policy 2000 affirmed a commitment to achieve replacement levels of fertility (total fertility rate of 2.1) by 2010. Ten states — Karnataka, Punjab, Gujarat, Assam, Telangana, Andhra Pradesh, West Bengal, Maharashtra, Tamil Nadu and Kerala — and Jammu and Kashmir, have achieved this goal, albeit much delayed. Kerala and Tamil Nadu had accomplished it decades earlier. This fertility decline over half of India has cut across all sections of society — the privileged and the poor, those educated or not, and the high and low caste. The National Family Health Survey-4 has shown how TFR has reduced even among illiterate women from all religions in the southern states — even in Kerala and Telangana which have a high proportion of Muslims.

The question that arises is how could the Southern states achieve population stabilisation so early and several others could follow suit, while Uttar Pradesh and Bihar continue to drift? When fertility reduction in the five southern states succeeded, irrespective of literacy and education levels and could permeate all sections, it overturns the conventional wisdom that literacy, education and development are prerequisites for populations to stabilise. The simple explanation is that fertility decline was achieved because southern governments proactively urged families to have only two children, followed by female sterilisation immediately thereafter. Almost the entire state apparatus was marshalled to achieve this objective.

The difference between the progressive South and the slowpoke Central- North is becoming disproportionately skewed. UP and Bihar are 23 per cent of India’s population and are projected to grow by over 12 per cent and 20 per cent in the next 15 years. Their high TFR pervades all religious groups despite the averment that high fertility prevails disproportionately only among Muslims. Action to prevent unwanted pregnancies particularly in these two Hindi belt states is urgently required.

For decades UP has had a dedicated agency — SIFPSA (State Innovations in Family Planning Services Agency). But its website gives dated information in contrast to its stellar COVID dashboard — demonstrating that communication and technical difficulties are overcome once a subject gains priority. Women in rural UP are still giving birth to four or more children. In some districts, the contraceptive prevalence rate is less than 10 per cent. In many districts neither Hindus nor Muslims use modern family planning methods. In such a scenario, demographics will eclipse economic growth and destroy the gains from a young populace. UP’s over-reliance on traditional methods of contraception needs to be swiftly replaced with reliable and easy alternatives .

Bihar has the highest fertility rate in the country and also the highest outmigration. Almost half the women in some districts have a migrant husband and empirical evidence shows women’s unwillingness to seek contraception in the absence of the husband, resulting in unprotected sex when he returns.

While national and state policies emphasise male vasectomy, politicians never champion its adoption. No other country in the world uses female sterilisation as excessively as India. After the 2014 Bilaspur outrage, when more than four-score sterilisations were conducted in less than six hours and several women died, one expected that states would go slow on compulsory female sterilisation. But surprisingly, even Kerala with all its progress still relies on female sterilisation (above 88 per cent) as the predominant modern method of contraception.

Indonesia and Bangladesh introduced injectables right from the late 1980s but India only did so in 2016. Executed properly, one jab renders protection from pregnancy for three months. This method needs greater impetus given the helplessness of women who carry the burden of unwanted pregnancies.

Three things are needed: Incentivise later marriages and child births; make contraception easy for women and promote women’s labour force participation. The population momentum, if managed properly in the Hindi belt, will remain India’s biggest asset until 2055. By 2040, India will be the undisputed king of human capital.

But alongside some other disturbing nationwide trends must also be counteracted without delay because stabilisation isn’t only about controlling population growth. A balanced sex ratio is essential to secure social cohesion. Son preference, falling sex ratios, and an abhorrence towards begetting a second or third female child are negative developments that have penetrated even into rural areas. The inheritance law favouring women’s rights to ancestral property is far from being implemented. Decades of policing doctors and sonography machines have failed to bear results. China is already facing a demographic catastrophe because its nearly four decade-long one child policy resulted in a strong son preference and a large bride shortage. India will need more than girl friendly schemes to change track.

And then there is ageing. Paradoxically, it is the Southern states that will face problems in future. Having largely redeemed their demographic dividend, the cohort of the elderly will start outstripping the working age population. The theoretical possibility that younger people from the Central-Northern states may fill the growing gap in services will need strong political support. With the “Marathi Manoos” syndrome rapidly spreading to many other states such prospects appear to be increasingly uncertain.

The freeze on the state-wise allocation of seats in Parliament until 2026 was extended through the Constitutional (84th Amendment) Act, 2002, to serve “as a motivational measure to pursue population stabilisation” — a goal which has not been achieved. In the absence of further extension, it will be politically destabilising.

India’s demography is like a three-dimensional jigsaw puzzle and whether one starts fitting the pieces at the centre of the puzzle or the corners, greater persistence is needed to complete the picture of a developed India.

This column first appeared in the print edition on March 16, 2021 under the title ‘The demographic distress’. The writer was executive director of the National Population Stabilisation Fund and former secretary, Health Ministry

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