In his Independence Day speech, Prime Minister Narendra Modi spoke of ‘population explosion’ in the country and the need for planned families. It is encouraging to see family planning receive much-needed attention at the highest level after a long time. Given the recognition of the need to achieve a stable population from a rights-based perspective and considering the large young population in the country, the government must step up investment in family planning, which is considered the best development investment.
According to recently released UN population projections, India will overtake China in 2027 to become the world’s most populous country. To control the growing population, a few sections in the country have called for the introduction of a coercive population policy. There is no evidence on the effectiveness of such policies. In the past, similar policies in a few states have failed to bring down the fertility rates to the desired level. On the other hand, several Indian states, such as Kerala and Tamil Nadu, were able to bring down the fertility level without using coercive policies. China, which enforced a one-child policy in the past, had to abort it, having found itself in the midst of a population crisis in the form of declining sex ratio and an ageing population. These are challenges India could be faced with in the event of a similar policy being implemented.
Further, data does not support the notion of a ‘population explosion’ in the country. In fact, an analysis of Census data shows a declining trend in its growth rate over the decades. The decadal growth rate during 2001-2011 was recorded at 17.7% as against 21.5% during 1991-2001, 23.9% in 1981-91 and 24.7% in 1971-81.
There has also been a declining fertility trend in the country. According to the National Family Health Survey (NFHS), the Total Fertility Rate (TFR) has gone down from 3.4 in 1992-93 to 2.2 in 2015-16. The Sample Registration System Survey (SRS), 2017, also reported the TFR of 2.2 for the country. This figure is close to the replacement level fertility of 2.1 per woman, which implies that the country is on course to achieving population stabilization. NFHS 4 reports that 24 states and Union Territories have already achieved at par or below replacement level fertility. In fact, urban TFR (1.8) in the country is already below replacement level.
With increased access to education, economic and other development opportunities, fertility decline is a natural demographic phenomenon. Women’s education and labour force participation seem to have played a key role in reduction of TFR. Education, in particular, is one of the most important factors, which explains fertility differentials across the country. While there are compelling examples from within India, from states like Kerala, Tamil Nadu and Andhra Pradesh, global case studies from countries like Indonesia and Bangladesh also indicate the importance of investing in education and healthcare, women’s empowerment, employment opportunities for women and access to family planning services.
The decline in decadal growth rates and fertility has been witnessed among all religious groups. We should, instead, acknowledge the existing inter-state and inter-regional variations, depending on the level of education, health, nutrition, employment and empowerment of women across states. The religious fertility differentials seen right now in India are on account of the differences in the stages of transition that these communities are at, and not because there is an absence of transition in any particular community. There is no evidence to show that communities have larger families because of religious reasons or an approach to life. Instead, these seem to be determined by economic circumstances, poverty and marginalisation, among other factors.
An analysis of NFHS 4 data suggests that education has a negative impact on TFR: as the level of education increases, the TFR decreases. The highest TFR was observed in women who do not have schooling (3.06), while the lowest was reported in women having 12 or more years of education (1.71). Similarly, income also has a negative relation to TFR. A rise in income levels is accompanied by a decrease in TFR. The highest levels (3.17) were found among the poorest people and those belonging to the traditionally weaker social groups, the lowest TFR was observed in those who belonged to the richest wealth quintile (1.54).
Despite the fact that couples not only desire but also have fewer children than earlier, the overall growth in numbers still appears high because of the large base of young population in the country. India has a high proportion (about 30%) of young persons – adolescents (10-19 years) and youth (15-24 years), who are in the reproductive age group or soon will be. Even if this group produces fewer children per couple there will still be a quantum rise in numbers because the number of reproductive couples is high. Thus India, with its large proportion of young persons, will take some time to stabilize its population.
What is worrisome, though, is the high unmet need for family planning in the country. Although women do not want more than two children, 30 million currently married women in the age group of 15-49 years and 10 million young women in the age group 15-24 years wish to delay or avoid pregnancy but do not have agency or access to contraceptives, placing them at grave risk of death or disability during pregnancy and childbirth, especially where the quality of care is inadequate.
India’s modern contraceptive use is only about 48%, with female sterilisation accounting for 75%. The modern contraceptive prevalence rate (mCPR) for spacing methods is only 11.2%. Due to the lack of adequate knowledge of and access to contraception, women are increasingly resorting to unsafe abortions, as a proxy for contraception. According to a 2015 study, an estimated 15.6 million abortions occur annually in India. There is an urgent need to reach to the last mile and ensure access to quality family planning services for women across the country.
Greater attention needs to be paid for expanding the basket of contraceptive choices, especially spacing methods. Providing better access and quality of healthcare for young people will not only lead to improved health, but will also visibly improve educational outcomes, increase productivity and workforce participation, in turn resulting in increased household incomes and economic growth for the country. Global evidence has shown that investing in family planning is one of the most cost-effective public health measures and a development “best buy” which can help achieve directly and indirectly all 17 Sustainable Development Goals. In fact, as per a study conducted by the Population Foundation of India, titled “Cost of Inaction in Family Planning in India: An Analysis of Health and Economic Implications,” adequate investments in family planning can increase the country’s per capita GDP by 13% by 2031, prevent 1.2 million maternal deaths, avert 2.9 million infant deaths and 206 million unsafe abortions.
In order to meet the reproductive needs of India’s large young population, the government must significantly increase budgetary allocations for family planning. In 2016-17, 4% of the National Health Mission budget was allocated for family planning. Even the existing allocations are not fully utilized and overall spending was just 61% of the allocated budget during the year. The government should match budgetary provisions to the changing demographic profile of the country, and ensure that states fully utilize the allocated funds to improve quality of care.
Population stabilization has to be looked at in the context of wider socio-economic development. There exists a strong linkage between social development, health status and population stabilization. States and governments that have ensured higher access and efficiency in basic services have helped stabilise population and manage fertility issues. We hope the PM’s call will lead to higher investments, greater spending and increased focus on the needs of young people, so that every couple is able to exercise their right to plan their family as per their desire and needs.
(The writer is Executive Director, Population Foundation of India)
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