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Population of India: What the Government Should Do
Every year India adds more people than any other country in the world - about 18 million, much larger than about 7 million in China. Some of its populous states have more people than many large countries: For instance, the most populous state, Uttar Pradesh, with about 199 million people compares with Brazil and the next most populous Maharashtra (112 million) and Bihar (104 million) rub shoulders with Mexico (112 million) and Germany (82 million).
Everything is big when it comes to population in India: 26 million children are born every year (Australian population is about 22.6 million), of which 1.83 million die within their 5th birthday out of which one-sixth die within 24 hours of birth. After accounting for other deaths about 18 million people are added each year.
Of the current population of about 1.25 billion, 50% are below 25 and 65% below 35. According to a recent UN report, India's population will surpass China in 2028 when both countries will have 1.45 billion people each. It is quite conceivable that no other country will ever cross the 1 billion mark in the future.
In 1980s Indian planners aimed to achieve the replacement fertility rate of 2.1 by 2000 but failed. So. they came up with a new National Population Policy (NPP) in 2000 aiming to reach the target by 2010. But again failed and could only reach 2.8. Alongside, they also introduced the idea of "Two-Child Norm" to encourage parents to limit their families to two children. It created disadvantages for couples with more than two children, such as disqualification from Panchayat Institutions’ positions; denial of certain public services and government welfare programs, including maternal and child health programs. But there is no indication that the policy made any significant difference, except disqualifying some female Panchayat heads for ignoring this rule (which actually negates the efforts of women empowerment).
The net result of all these efforts is that today the total fertility rate is around 2.5, still away from the golden target of 2.1 which ultimately leads to population stabilization.
Steady Decrease in Birth & Death Rates
Family Planning in India
The family planning initiatives in India have traditionally revolved around only one thing – female sterilization. The policymakers sitting in New Delhi or in State capitals set targets of number of sterilizations and the bureaucrats galvanize the state machinery to set up sterilization camps to achieve the goals. All may be well on papers but ground reality of both the implementation and the ossified thinking that “population control only means female sterilization” betray the changed demographic realities of India.
Ground level health workers know “how these numbers are gathered” and targets achieved. Bureaucrats are, of course, unconcerned as long as they are given reports of targets met. They also don’t bother to stop and think “Why female sterilization and sterilization camps should be the only solutions to check population growth?”
Let us examine what the demographic indicators are saying loudly and why the over-hyped female sterilization is not the correct solution to manage Indian population.
Changed Demographic Realities of India
A. Young India
India is at an important stage of demographic transition. Look at the following figures:
Almost 40% of Indiansare younger than 15 years of age,
Over 50% of its population below the age of 25, and
Over 65% hover below the age of 35.
It is expected that, in 2020, the average age of an Indian will be 29 years, compared to 37 for China and 48 for Japan. By 2030, India's dependency ratio should be just over 0.4. Dependency ratio is nothing but total number of people who normally don’t work (below 15 and above 64) divided by those in the productive work force (age group of 15 – 64).
The large proportion of people in the reproductive age-group needs a range of contraception options; the permanent pregnancy termination through sterilization is not suitable for them.
B. Why is population still Increasing when the average family size is Decreasing?
In 1950s, the average number of children a woman had in her life time (called Total Fertility Rate (TFR)) was about six; now it is about 2.5 and in many Indian States it is less than 2. Yet, the population continues to grow.
India continues to add about 18 million people per year because over 50% population is in the reproductive age group. It is this large base of young reproductive people that imparts momentum to the population growth. So, the population growth is momentum driven.
Throughout the world, the importance of momentum driven population growth has increased as fertility levels have declined. In 1994, John Bongaarts estimated that population growth due to momentum could account for nearly half of world population increase during the twenty-first century. He pointed out that this momentum driven population growth could be reduced simply by raising the average age of childbearing. He further estimated that a 2.5 year increase in age at first birth would reduce population growth momentum by 21%.
Therefore, the correct ways to check population momentum are by delaying marriage, postponing child bearing, and spacing births. In brief: by delaying all pregnancies.
C. Where is the Real Problem?
Fertility Level (TFR)
TFR below 2.1 (10 States with 35% India’s Population)
Andhra Pradesh, Delhi, Goa, Himachal Pradesh, Karnataka, Kerala, Maharashtra, Punjab, Sikkim, Tamil Nadu
TFR between 2.1 and 2.4 (6 States with 20% India’s Population)
Assam, Gujrat, Jammu & Kashmir, Orissa, Tripura, West Bengal
TFR between 2.5 and 3.6 (9 States with 19% India’s Population)
Arunachal Pradesh, Chhattisgarh, Haryana, Jharkhand, Madhya Pradesh, Manipur, Mizoram, Rajasthan, Uttarakhand
TFR above 3.6 (4 States with 25% India’s Population)
Bihar, Meghalya, Nagaland, Uttar Pradesh
Five states - Bihar, MP, UP, Rajasthan and Orissa - with 44% of India's population will contribute 55% of population growth up to 2016. Performance of these states will be the decisive factor in the efforts of population stabilization. Family planning initiatives in these states need particular attention in order to bring down the national average TFR.
India should Focus on Five States with Higher Growth
Why focusing only on female sterilization and sterilization camps are bad?
Making only females responsible for family size is nothing but a gender bias. Males should also be made equally responsible for fertility and child care related activities. Gender bias apart, there are other compelling reasons why focus on permanent sterilization method is a wrong prescription to check population growth.
1. When sterilization is the only available method to prevent pregnancy, it leads to several distortions. For example, people tend to go for quick pregnancies before sterilization. This actually adds to population momentum which is the prime cause of population growth. Reducing population momentum demands delaying pregnancies.
2. Experts advice against female sterilization below the age of 27 because it leads to higher complication and failure rates. NFHS – 3 data clearly indicate that most of the sterilizations are done at younger age – sometimes as young as 20 year or even younger. Moreover, female sterilization also increases the risks of hysterectomy by four times. Therefore, heavy dependence on sterilization is not only putting young women to future health risks, but also depriving them of other contraceptive choices – better suited to their needs.
3. Encouraging sterilization camps is bad for two reasons: One, it encourages government bureaucrats to adopt coercive means to get people to the camp, neglecting proper screening for the sterilization operation. Second, camp conditions badly compromise quality of healthcare. Women also need pre- and post-operative care which is rarely provided. A lot of NGOs and other organizations familiar with the realities of camps even question the quality of operative conditions of the camp. They mention that most sterilization camps become active only during November to March, with the accompanying mania to meet the targeted numbers. Some activists even report death during or after such operations; fortunately such incidents rare but are fully preventable with proper care.
For Population Planners
Researcher Visaria applied Bongaart’s model of population growth and calculated the contribution of different factors in India's population growth up to 2101 – about 70% growth would come from momentum, about 24% from unwanted fertility, and only 6% from wanted fertility.
Indian population planners should understand and discuss these numbers thoroughly then decide where to put their resources and energy for best results. Their understanding is still based on the outdated Malthus overpopulation theory of 1798. As a result, their 100% attention is still focused on eliminating wanted fertility that contributes just 6% to population growth! Not a sane idea, in 21st century.
What do you Think?
Which is the Best form of long term Population Management?
What should the Indian Government do?
"You can solve the problem only if you understand it."
This is the age old wisdom that applies everywhere; but perhaps not known to the population planners in India
Family planning bureaucrats primarily need reeducation about the changed population dynamics of today’s India. Most officials are still obsessed by the sterilization focused model of population management, which they try achieving through predefined targets of sterilizations. They need to understand two things clearly: the concept of population momentum and the unmet need for contraceptives.
As pointed out earlier, the dominant cause of current population growth is population momentum as shown by demographer Bongaart in the nineties. By applying his model, Indian population experts suggest that in India 70 percent growth might be coming from population momentum, 24 percent from unwanted fertility, and only 6 percent from wanted fertility.
This analysis provides useful directions to Indian population planners in terms of where to focus resources and energy for best results. Their traditional obsession with sterilization as the primary tool for birth control puts them focusing all their energies in eliminating wanted fertility that contributes just 6% to population growth!
In fact, the current realities demand that the family planning battle is fought not in the sterilization clinics but on the social plain. The fight against population momentum which is the leading cause of current population growth, demands delaying all pregnancies. It provides three clear strategies:
1. Discourage and prevent child marriages.
2. Encourage postponing first pregnancy by two years after marriage
3. Increase availability of contraceptives for spacing births
The next dominant cause is unwanted and unplanned pregnancies, measured as “unmet need” for contraceptives. Almost a quarter births (450 million annually) take place simply because contraceptives are easily available particularly in rural areas. Condom awareness campaign should not be limited to HIV and STD prevention only. The young reproductive population needs range of contraceptive choices to prevent pregnancies more than the one time sterilization option.
Additionally, the following steps would also go a long way in rationalizing the family planning activities in the country:
- Strengthen the family planning healthcare system so that people get complete knowledge of possible contraceptive methods including IUCDs, pills, etc and turn sterilization into just one among other options.
- If at all incentives have to be given, they should go to the people availing services and never to the bureaucrats in any form.
- Allow sterilization camps only by NGOs and social civil organizations with complete freedom about pre- and post-operative care and camp duration.
- Monitor the quality of family planning healthcare through a set of quality parameters, as oppose to the current fashion of counting sterilization numbers.
- Female education and empowerment is the best contraceptive; counselling on these issues should be included into programs designed for rural areas.
Religion and Babies !!
This article is inspired by the one day roundtable held in New Delhi (Jan, 2011) on “Population and family Planning: Contemporary Challenges & Opportunities”, organized by the National Coalition on Population Stabilization, Family Planning & Reproductive Rights. I gratefully acknowledge the resource material from the Center for Health and Social Justice (CHSJ), New Delhi, India.
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