Updated: July 4, 2021 8:15:26 am
There are many reasons to celebrate India’s achievements on the population front. Our Total Fertility Rate (TFR) is 2.2 — slightly higher than the replacement level of 2.1, the state when a couple is replaced by two children. Twenty-five out of 28 states and six out of eight UTs and most urban areas report a replacement TFR of 2.1 and less.
While we were the first country in the world to launch a National Family Planning Programme in 1952, its first 25 years were characterised by lacklustre implementation. Contraception choices other than female sterilisation were few. Then, the 21 months between 1975 and 1977 during the Emergency proved to be disastrous. Forced sterilisations of men were carried out in “family planning camps”, and incentives and penalties led to coercion to meet targets. This caused a public outrage that contributed to bringing down the Indira Gandhi led-Congress government.
The two decades between Emergency and International Conference on Population and Development in 1994 were a wasted period. As a signatory to the ICPD Programme, India formally recognised that reproductive rights and gender equality were fundamental to population stabilisation. The National Population Policy 2000 emphasised the importance of enabling women to determine their family size and did away with sterilisation targets.
While India has managed to slow down the growth of its population, yet our family planning programme leaves much to be desired. To begin with, women’s well-being has not been fully assured. In November 2014, 16 young women tragically died and many were left critically ill following tubectomies at a mass sterilisation camp in Bilaspur district, Chhattisgarh.
The burden of planning a family falls almost entirely on Indian women. According to the NFHS-4, in 2015-16, 36% of married women in the ages of 15-49 years underwent sterilisation as against less than 1% of married men aged 15-54 years. Less than 6% of men use condoms.
There is a large need for contraception among married women, and contraception choices for couples are limited. Besides sterilisation, there are only five other contraceptive methods available in the public health system. Injectables, which were approved for use in the private sector in India in 1994, were only added in the public health system in 2017, 23 years later.
But despite these gaps, India’s fertility rate is declining. Why then are some politicians and states such as Assam, UP and Lakshadweep calling for a two-child policy? It reveals a poor understanding of what is needed to stabilise population. Kerala and Tamil Nadu have shown what needs to be done: ensure the provision of basic services, promote girls’ schooling and improve development opportunities for women.
Nothing could be worse for India than to emulate China’s now reversed one-child policy. Given the country’s strong son preference, it has led to a skewed female-to-male ratio and an increase in sex-selective abortions. China is now facing a demographic disaster with an ageing population and shrinking workforce.
India does not have to worry about reducing population growth. The Institute for Health Metrics and Evaluation has projected that India’s TFR will drop to 1.3 by 2100. However, we need to make our family planning programme more effective, which needs three actions. One, get rid of misconceptions about vasectomies and links to virility. Two, prioritise women’s agency, giving them the ability to choose if, when, and how many children they want. Finally, promote choice and do away with any form of coercion. The Ministry of Health, in a response in Supreme Court in December 2020, stated that it was ‘unequivocally’ against setting limits on the number of children couples could have in a bid to ‘control’ population. This is why invoking a two-child norm makes littles sense.
This column first appeared in the print edition on July 4, 2021 under the title ‘The absurdity of two-child norm’. The writer is Executive Director, Population Foundation of India
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