The Indian numbers game

Posted: 22 July 2003

Author: Nitin Jugran Bahuguna

In several Indian states, average family size has been reduced to between two and three children, and the 'total fertility rate'(measuring the number of children a women can expect to have in her lifetime) continues to decline across the country. Why then is India's current population growth rate still a ause for concern? Nitin Jugran Bahuguna reports.

Adolescent girls, India.© Kim Naylor/Christian Aid/Still PicturesFor one thing, a sizeable percentage of the population is in the reproductive age group. And the biggest challenge is to provide this group with an integrated package of reproductive health services. This includes the promotion of safe motherhood and child survival, nutritional services for vulnerable groups, services to prevent and manage reproductive tract infections and sexually transmitted diseases, the education of girls and empowerment of women.

Both demographers and health specialists now agree that good quality contraceptive services cannot be provided without addressing related reproductive health needs. Long years of experience have shown that contraceptive acceptance and their continued use hinge on ensuring safe and good quality services.

Take reproductive tract infections. In India, such infections are widely prevalent. If untreated, they can cause serious complications such as sterility, pelvic inflammatory disease, stillbirth and abortions, says Dr Saroj Pachauri of the US-based Population Council. "The fear of sterility and delayed childbearing have been major barriers to contraceptive acceptance and so the thrust must be on integrated services," says Pachauri.

Population policy

Official data concedes that the unmet need for contraception and the high infant mortality rate in some states, which encourages mothers to have more births, are other reasons for population growth. The goal of population stabilisation can be achieved only when child survival issues, maternal health issues and contraception issues are addressed simultaneously, states the government's latest Economic Survey for 2002-2003.Health worker explains how to take the pill to women unable to read or write.© Paul Harrison/Still PicturesThe Survey also says that success in containing the growth of population depends on publicly stated support by community leaders; the resources available for the Family Welfare programme; efficiency and accountability in the state health system; and women's education and status in the family. The Survey notes that none of these inputs have been sufficiently available to the Family Welfare programme.

According to the Census of India, the population of India as on March 1, 2001 was 1,027 million - with males at 531 million and females at 496 million. This followed the publication, in 2000, of the Indian National Population Policy (NPP 2000) and state population policy. These policies do attempt to incorporate the language of gender equity and women's empowerment in their objectives. But, say many researchers, they still reflect an overriding obsession with demographic goals.

Despite the fact that the preamble to the national plan speaks of the well-being of people, and of a comprehensive approach, the strategies proposed by the plan remain techno-centric, demographically oriented, and fragmentary. There are also clear contradictions: on the one hand, it calls for a target-free approach and on the other, it projects various targets for 2010 and a stable population by 2045.

Reduced investments

Given the fact that India has drastically reduced investments in sectors that critically affect health - such as food security, education and transport - how far can such policies be supported by concrete strategies for action? The public sector, instead of servicing the needy and the poorest of the poor, has abdicated its responsibility and literally handed over the health sector to private parties, claims Dr Nina Puri, President of the Delhi-based Family Planning Association of India (FPAI).

In her opinion, "the infrastructure for providing health services just does not exist...20 to 30 per cent of primary health centres are not in operation and in many others, doctors and other staff are not available."

Dr Puri is also concerned about the coercive and incentives-oriented element creeping back into some state population policies. She comes down heavily on states like Maharashtra and Madhya Pradesh that are reverting to the old "two-child" mantra.

Other measures which curtail women's empowerment are laws enacted by states like Rajasthan, Punjab and Haryana that disqualify elected members of panchayats if they have a third child. Women bear the brunt of such laws.

While the debate on 'population control' measures and their impact on the health of women rages on, linking the population programme with the democratisation of grassroots governance raises doubts about a state's seriousness in seeing women play an active role in local administration, adds Puri.

Human rights

The Tenth Five-Year Plan talks of a paradigm shift from demographic targets to a client-oriented approach, and the Ministry of Health and Family Wealth has set up an 'Empowered Action Group' to assist states with weak socio-demographic indicators to attain the goals listed in the NPP. But the reality is less promising.

The states of Bihar, Uttar Pradesh, Madhya Pradesh, Rajasthan, Orissa, Jharkhand, Uttaranchal and Chhattisgarh have been chosen for focused attention. However, the activities of the Action Group in these states remain unclear. Dr Puri, who is also a member of the National Commission on Population, is not aware of any recent meeting of the Group. "The last meeting I attended was in December 2001", she says.

The history of India's population policy clearly illustrates that prescriptive policies can be open to misuse by individuals in authority. The need today is to evolve a human rights framework incorporating reproductive rights as a part of a package of other rights that improve women's options and ensure their access to good quality, affordable and women-specific health care services.

  • The 2001 census showed that the population growth rate in southern regions of India is leveling off and approaching a rate similar to the rates in some European countries, but population growth is "soaring" in other parts of the country, raising the national average.

    According to Francois Farah, a representative of the United Nations Population Fund in India, the census showed that overall populationgrowth in India had dropped to 2.9 per cent, compared with 3.2 per cent in 1991.

    He said the eastern state of Bihar and the northern state of Uttar Pradesh still have high growth rates because state agencies have neither sufficiently distributed contraceptives nor provided medical facilities for family planning. He said the country could stabilise its population before 2045 - the government's estimate of when the leveling off will occur - if officials distributed family planning services equally to all regions.

    Fareh also said that officials would have to make a concerted effort to stop the spread of HIV in India, where four million people are HIV-positive, more than in any other country except South Africa. A 2002 US study predicted that the number of HIV-positive Indians would rise to between 20 million and 25 million by 2010.

    Source: Women's Feature Service, Delhi and Kaiser Daily Reproductive Health Report, 21st July 2003.