A new demographic reality for India

The findings of the latest National Family Health Survey (NFHS-5), released on Wednesday, are important for two demographic milestones that the country has achieved. One is the decline of the Total Fertility Rate (TFR) below the replacement level and the other is women exceeding men in the population.

The survey has shown that the TFR, which is the number of children a woman might bear in her lifetime, which was 2.7 in 2005-06 and 2.2 in 2015-16, has come down to 2, below the replacement level of 2.1.

While differences at regional and state levels persist, the country’s population as a whole is set to peak and shrink in the coming years. This means population growth as a problem needs to be tackled only in some states like UP and Bihar where they are above the replacement level. While population explosion is no longer a worry, the opportunity to make use of the population dividend will pass very soon. Health and welfare policies that are targeted at an ageing population will also have to be adopted and implemented.

It is for the first time that the overall gender ratio has favoured women. There are 1,020 women for 1,000 men, calling for policies that are oriented to women’s needs and welfare. The demographic power of women is not reflected in any area of life now. At the same time, the gender ratio at birth in the last five years was still skewed against the girl child, showing the continuing preference for the male child.

There are improvements in maternal and child health, with a welcome rise in the number of institutional deliveries. Vaccination against common childhood diseases reaches most of those in the relevant age group. But the health and nutrition parameters are short of desired levels, and they even show a fall in certain areas. Anaemia is a serious issue for women and children and there are only minor gains in the case of wasting and stunting. Malnourishment remains a serious challenge. The pandemic might have had an impact but that only underlines the need to build public health and welfare systems that can withstand unexpected disruptions.

More women have bank accounts and mobile phones and have access to contraception and hygiene facilities now than in the past. But their share in the workforce is still low. Health insurance coverage has improved but is inadequate. The general state of health of the population as measured by diabetes and hypertension levels is a matter of concern. The data provided by the NHFS should be studied and well-utilised to frame policies at the national and state levels so that the positives can be strengthened and weaknesses addressed.

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