Population: Turning a bane into boon
The 1975-76 Emergency period showed the unprecedented politically driven high pressure sterilisation drive in north and central India. In the next electi-on government lost power. He-nce politicians became extremely averse to FP. The FP programme got a major setback, which took several decades to recover.
The programme is fairly successful as the total fertility rate (number of children a couple over lifetime) – went down from above six in 1950s to 2.3 in 2013. But at the same time, the population has grown from about 30 crore at time of independence to about 130 crore now – and it will overtake China’s population by 2030 to become world’s most populous country.
We could have done better in family planning and rapidly reduced total fertility rate if the FP programme had focused on quality of service and choice of spacing methods of FP. Our FP programme is highly focused on single permanent methods - female sterilisation. The programme never seriously promoted temporary methods – condoms, pills and IUD – which would have attracted young couples who have high fertility rates.
Access to FP methods is limited in rural areas as all health facilities do not provide full range of FP methods. Given the opposition by some NGOs, the government did not introduce injectable contraceptives which are very popular in Muslim countries like Bangladesh and Indonesia. Thus, the program-me never took into account the religious diversity of India.
The FP programme, like other health programmes, has very slim national and state level tec-hnical top management capacity – with only 2-3 technical officers at national level and only one or half officer at state level to manage it. It has been driven by generalist administrators and supported by international agencies.
The programme became less important after the well-intentioned but mismanaged “Target Free Approach” which was introduced in 1994 to reduce the pressure of individual acceptor targets for each health worker. The targets were not replaced by any well-worked out method of monitoring the programme. Also, there was no major effort to improve quality of FP services or to expand the choice of contraceptives.
Hence, the programme lost its priority in government, international agencies and NGOs. As a result of low priority and limited managerial capacity, it produced only moderate results. Many southern states have achieved low birth rates but in the northern heart land, the birth rates are much above the replacement level. No major national FP programme review has been conducted so far.
Huge investment needed
Population has always been depicted as a bane on national economic growth. But with each mouth to feed, there are two hands to work and one brain to develop innovative ideas and products, which is forgotten in the usual population discourse. Two-thirds of India is poor and without regular income, depen-dent of vagaries of monsoon; rest is tied up in red tape of government begging for reforms.
To change this, we not only need economic growth of 8-10% but equity in income, health and education. This needs super massive investment and proper management of human resource development and basic services in rural areas. We have to invest heavily in quality education, primary and secondary health services, public health such as clean water, sanitation and disease control, full non-exploitative employment.
India needs a new model of development where human resource development (HRD), health and nutrition are at centre stage. HRD and health shou-ld be seen as the “new infrast-ructure” and new tools for “national defence.”
The country needs to make bigger investments in them to reap the benefit of 130 crore minds and bodies. Population growth links to many Sustainable Development Goals (SDG) – goals of poverty, hunger, health, education, gender equity, water sanitation, work, inequity and sustainable cities.
India cannot achieve SDG without investing adequately in human development and equity. Post-renaissance Western Euro-pe invested heavily in education, health and social security to re-ach today’s development levels. By investing heavily in human development, India can convert its large population from a bane to boon. China, Korea and Taiwan have done it. We can do too.
(The writer is Director, Indian Institute of Public Health, Gandhinagar)