Recently released data from National Family Health Survey’s fifth round (NFHS-5) reveal that India’s Total Fertility Rate (TFR) has decreased to 2.0 from 2.2 in the previous round. TFR is the number of children born to a heterosexual couple during their reproductive life. Given that 2.1 is the figure at which the population is maintained at a stable level, taking into account the likelihood of some child deaths, the latest number suggests that the spectre of population explosion need no longer haunt India. However, five states still have a high TFR: Bihar (2.98); Meghalaya (2.91); Uttar Pradesh (2.35); Jharkhand (2.26) and Manipur (2.17). They too need to attain a TFR of 2.1 or lower.
The nomenclature of population-size limiting programmes has changed over the years, from population control to population stabilisation and from family planning to family welfare. These changes denote awareness that ‘development is the best contraceptive’. Population stabilisation signals a non-coercive approach than population control, while family welfare indicates that the goal is to increase health, wellbeing and social stability of well-planned small families.
Economic growth and equitable social development incentivise adoption of a small family norm. In particular, education of women and their employment in the workforce have a profound impact on couples choosing to have a small number of children. This has been borne out the world over and is now being validated in India too. The benefits of economic growth must not only be reflected in aggregate national indicators, but must also be well distributed across all sections of the population.
Along with economic growth, improvement in health and social services too reduce TFR. Poor families wish to have more children who will become working hands to shore up the family income, so that they can survive at a subsistence level. As the country’s economic growth increases opportunities for gainful employment, couples transitioning from poverty will limit the number of children to preserve the gains. When improved access to better healthcare and good nutrition improve child survival, there is no compulsion to produce many children to compensate for possible child deaths and seek security for support in old age.
Access to reproductive services is important. These include not only sterilisation procedures, which were aggressively implemented by earlier family planning drives, but also modern methods of contraception that can be used for spacing between child births. It is essential that women have easy access to such methods and autonomy of decision-making for their use. Female sterilisation still remains the most frequently used method of contraception, indicating that males are still placing the onus of surgical sterilisation on their female partners.
While 99% of married men and women aged between 15–49 years were aware of at least one method of birth control, use of modern contraceptive methods for family planning was reported by only 56.4%. There was a socioeconomic gradient in access to family planning methods. NFHS-5 shows that ‘unmet needs for family planning methods’ were reported by 11.4% in the lowest wealth quintile versus 8.6% in the highest wealth quintile.
Modern contraceptive methods were used by 58.7% of women in the highest wealth quintile and 50.7% in the lowest. Use of such methods was 66.3% among women who were employed, in contrast to 53.4% in women who were not. Women’s education levels matter, not only for gaining employment but also for awareness, autonomy and ability to negotiate choices with a partner.
While a young population provides a demographic dividend for economic growth, it is also essential that children be healthy and well-nourished. Loving parental attention and intellectually nurturing stimulation are essential for early child development. Birth spacing and a small family norm enable these. This makes awareness of, and access to, family planning methods essential. Even as the goal of population stabilisation is being achieved, it is imperative that we invest in fostering the health and wellbeing of all our people, throughout their life course. Decline in fertility frees up funds for investment in development of our human resources.
Population stabilisation is also needed for protecting the environment. A rapidly growing global population will quickly consume planetary resources, aggravating water and food insecurity. It will lead to greater energy utilisation, more extensive deforestation and even worse pollution than plagues the planet now. It will also deplete biodiversity and endanger other life forms with whom we share an interdependent existence. Even if science and technology have enabled humanity to escape the Malthusian trap, breaching planetary boundaries will be at our peril.
In his recent book The Journey Of Humanity, economist Oded Galor argues that climate policy should not be restricted to cutting carbon but should also involve “pushing hard for gender equality, access to education and the availability of contraceptives, to drive forward the decline in fertility”. India will do well to heed that advice.
Cardiologist, epidemiologist and President, Public Health Foundation of India (PHFI)