Two recent publications on India’s demographic profile and population policy weave interesting perspectives with a historical thread. One reflected on past attempts to restrain population growth and the other projected anticipated future trends. Both offer rich learnings on the transition from India’s past alarm over ‘population explosion’ to recent pondering on ‘falling fertility’ and its impact on our workforce, health and human development.
The first is a reflective piece by Mushtaque Chowdhury, a renowned public health leader of Bangladesh, titled ‘From population control to policy by numbers’. Chowdhary describes how Paul Ehrlich’s 1968 neo-Malthusian book The Population Bomb terrified economists and policymakers in affluent Western nations with apocalyptic descriptions of a population tsunami in ‘developing countries’. The ‘developed world’ then imposed an agenda of ‘population control’ on countries like India through aid programmes.
Sripati Chandrasekhar, a demographer and sociologist who served as India’s health minister in 1967, ardently embraced this agenda. He established a department of family planning, advocated a ‘cafeteria approach’ to fertility control, launched sterilisation drives and persuaded Parliament to raise the age of marriage. His passion for population control influenced the Indian elite, including Sanjay Gandhi, who proceeded to implement his own aggressive campaign of sterilisation during the infamous emergency of the 1970s. Gifts of cash and ‘transistor radio’ incentivised women to undergo tubectomy and men to undergo vasectomy.
Chowdhury narrates how this doomsday portrayal of the ‘population bomb’ was countered by the 1972 book The Myth of Population Control: Family, Class and Caste in an Indian Village. The author was Professor Mahmood Mamdani, academician father of New York Mayor Zohran Mamdani. The book questioned the claimed success of a Rockefeller Foundation-funded family planning study conducted by Harvard University in Khanna, Punjab. While researchers claimed high rates of ‘acceptance’ of contraceptive advice and drugs by the rural population, there was no discernible impact on fertility rates. Yet, this study became the poster child for global advocacy on family planning.
Mamdani, an anthropologist, pointed out that poor agricultural families may signal acceptance because of the perceived eminence of an American university which operated with support of the and state governments. However, they are disinclined to limit family size because of labour-intensive agriculture. Children also hold the promise of future economic security when parents age. As Chowdhury comments: “What surveys recorded as acceptance often reflected deference rather than conviction. In statistical terms, uptake had increased... In social terms, compliance masked constraints.”
The slogan ‘Development is the best contraceptive’ was coined in 1974 by the then Indian health minister Karan Singh at the World Population Conference in Bucharest, Romania. Subsequent Indian and global experience validated that axiom. South Indian states, which prioritised concomitant economic and social development policies, lowered fertility rates without resorting to coercive measures, while others who won national awards for high ‘couple protection’ rates continued to show high birth rates.
By the late 20th century, Western countries had already recorded low birth rates alongside economic growth. At present, late blooming Asian economies like Singapore and South Korea are trying to offset falling fertility rates by offering incentives to couples for producing more children. India’s economic growth, though late and uneven, is also impacting fertility rates.
Over time, India transitioned from family planning to family welfare, and from population control to population stabilisation. Recent national estimates reveal a total fertility rate (TFR) of 1.9, which is below the replacement rate of 2.1. Among the states, there is variation ranging from 1.1 in Sikkim to 3.0 in Bihar. Rural TFR is 2.1, while the urban rate is 1.6. As marriage and conception rates are falling among educated urban couples, the economic, social and political implications of this demographic shift are being debated.
The second publication is a report by the International Institute of Migration and Development and the Population Foundation that projected India’s demographic evolution between 2021 and 2051. In a recent article on the report, its lead researchers, S Irudaya Rajan and J Retnakumar, stated that India’s population would likely increase from 1,355.8 million in 2021 to 1,590.1 million in 2051. They report that the average annual increase of 0.5 percent suggests a prolonged period of slower expansion. It concludes, “India is poised to move beyond a youth-led, fast expanding population into an era of more urban, steadily ageing, balanced demographic structure.”
While debates rage on the impact of different rates of fertility decline among parliamentary representation in the future, it is also important to recognise that large populations have an ecological impact in terms of demands on land, water, food and energy. They can erase natural ecological barriers to microbial migration through efforts to expand urban housing and farming. We need to balance population size with sustainable human development, ecological sanctity and health security.
Policy and programmatic responses to this pendulum swing in demographic dynamics must include a shift of emphasis to promotion and protection of population health rather than population stabilisation; addressing malnutrition in all forms across the life course; increased health system capacity for addressing ailments of the elderly, especially non-communicable diseases, mental health disorders, disabilities at any age; and action on commercial and environmental determinants that imperil health.
These will rank as high priorities alongside health system responses to climate change and pandemic threats. Since the size of India’s working-age population is expected to start declining only after 2041, health workforce expansion can create employment for young persons. There is still time to reap the demographic and gender dividends.
Despite falling numbers in the 0-5 age group, six out of every 10 Indians will be vying for participation in the workforce by 2051. Since technology—including artificial intelligence—is scissoring jobs, India must invest in developing available human resources for technology-enabled, team-based training to meet growing healthcare needs of the foreseeable future.
K Srinath Reddy | Chancellor of the PHFI University of Public Health Sciences and Chair of the Centre for Universal Health Assurance at the Indian School of Public Policy
(Views are personal)
(ksrinath.reddy@phfi.org)